Poor quality relationships may lead to a broken heart

This summer I wrote about a study that showed women who keep their feelings to themselves during an argument with their partner were more likely to have depression and irritable bowel syndrome, and also more likely to die.

A study published this week in the Archives of Internal Medicine provides further support that having a poor marital relationship contributes to bad health - specifically bad heart health. Researchers in Britain studied over 9,000 men and women. They asked the participants questions about their close relationships (including their marriages), such as how much support they receive and how much stress and worry the relationship causes. After adjusting their calculations for other factors that can affect heart disease, such as age, obesity, high cholesterol, depression, and work stress, they found that people who reported negative close personal relationships were more likely to have heart disease and heart attacks.

Now this is not to say you should run out and divorce your partner if your relationship isn't quite up to snuff. However, it does suggest that relationship maintenance might be in order - especially if you have children or jobs that limit couple time. Schedule a "date night." Make time for sex. Remind yourself why you got together in the first place - and tell each other about those great qualities. Also make time for yourself - even if it's only 10 minutes in a hot bath. If these steps don't lead to improvement, couples therapy is always a great option.

Panic attacks possibly linked to heart disease and death

If you've ever had a panic attack, this headline may not surprise you. Many of the symptoms of panic attacks can mimic a heart attack: racing heart, chest pain, sweating, nausea, dizziness, and shortness of breath. These symptoms usually peak within 10 minutes, and they can be accompanied by fear of leaving home. Approximately 1 in 75 people experience panic disorder, and it is more common in women than men.

Researchers investigated the relationship between panic attacks and heart disease in a study of nearly 3,400 postmenopausal women. They found that women who had experienced a panic attack in the previous 6 months were four times as likely to have heart disease, and three times as likely to have a stroke. These women also were 75% more likely to die from heart attacks and stroke.

If you are in this population of women (i.e., a postmenopausal women who has been diagnosed with panic disorder or who has experienced panic attacks), these findings may seem worrisome. However, it is important to note (as the investigators do) that the number of women who actually had an event (i.e., heart attack, heart-related disease, or stroke) was extremely small - only 81 women, or 2.5% of the those studied. Still, it is something to discuss with your doctor, who may recommend additional tests to evaluate your heart and vascular health.

Meantime, also know there is treatment for panic disorder. Anti-anxiety medications and cognitive behavioral therapy can help to alleviate the symptoms and improve your quality of life.

Men better than women at assessing heart attack risk

Most people know that your family's medical history is an important part of your own medical history. It helps you to understand what kinds of health problems you may be more likely to acquire, based on your genetic make-up.

A new study, however, suggests that young women with a family history of heart attack are less likely to understand their risk for heart disease and more likely to make poor lifestyle choices that increase their risk. Researchers analyzed data from nearly 2,500 men and women ages 30-50 who participated in the Dallas Heart Study and who had a family history of premature heart attacks. They defined family as a first degree relative (i.e., mother, father) and "premature" as a male family member who had a heart attack before age 50 and a female family member who had a heart attack before age 55.

They found that compared to women with no family history of heart attack, having such a family history was linked to having 2 or more traditional risk factors for heart disease (i.e., high cholesterol, high blood pressure, diabetes, and smoking). The investigators did not find this association for men. They also found that women with a family history of heart attack were more likely to have coronary artery calcification, or buildup in the walls of the arteries in the heart. This build-up matched that for men without a family history of heart attack. Women with a family history of heart attack also were less likely to make healthy lifestyle choices. They smoked more and exercised less than men with the same family risk. Finally, fewer women with a family history of heart attack perceived their risk of heart attack to be as high as men with the same family history.

These findings are not surprising, but they are concerning. Men typically have been the focus of research and education on heart disease. Consequently, women may underestimate their actual risk, despite their family histories. Yet this is a dangerous precedent, as heart disease is the number one cause of death for women just as it is for men.

If you are among the women with a family history of heart disease, know the risk factors, including which ones you can control. Then make those healthy lifestyle choices - stop smoking, eat less fat, move your body, and limit stress. This is not just a men's disease, and you can be affected.

Avandia - the next Vioxx?

In two studies published in JAMA today, it appears that a popular class of drug for diabetes, known as thiazolidinedione (popular brand names = Avandia [rosiglitazone] and Actos [pioglitazone]) is causing some heart problems. Avandia was found to increase risk for heart attack by 42% and double the risk of heart failure. Actos also was found to increase the risk of heart failure, although it reduced risk of heart attack, stroke and death.

Actos and Avandia are used most often in the treatment of type 2 diabetes. The drugs act on similar mechanisms to lower glucose (blood sugar) levels in the body. They can be prescribed alone, or in conjunction with other therapies, such as insulin.

This is not the first time research has suggested these drugs may cause serious cardiac events. This past May, the New England Journal of Medicine published two studies that also revealed Avandia caused some heart problems. In response, a federal advisory panel met to discuss the drug and voted to keep it on the market. The FDA also placed stricter warnings on both Avandia and Actos in June.

Does this sound familiar? Drs. Solomon and Winkelmayer seem to think so. They wrote a great piece on common threads between the Vioxx case and the current findings on Avandia. It seems the jury is still out, because at present GlaxoSmithKline is keeping Avandia on the market. However, if this does become another Vioxx, let's hope GSK doesn't wait too long to do the right thing.

Meantime, if you're taking Avandia or Actos, you may want to discuss this new research with your health care provider. You also want to remember that good nutrition, exercise, and maintaining a healthy weight are also important for managing your type 2 diabetes.

Red, red wine - go to my heart?

I was reading the newest issue of Food & Wine magazine this weekend when I came across an article touting all the health benefits of wine (yeah! for my love of red wine). I was pleased to see they were citing premier medical journals as the sources of their information. However, as I read the fine print, I was dismayed they were making broad claims about wine promoting longevity and reducing heart attack risk "for all" based on studies conducted on men.

So, I did what any good researcher of women's health would do - I went to Pubmed and searched both for the articles they cited and to see whether there were similar findings about women available. I found a couple of things.

The blanket statement that drinking wine "promotes longevity" may be misleading. While the authors of the study cited in F&W indeed found that men who preferred to drink wine had a 34% reduction in mortality because fewer died cardiovascular-related deaths, it is important to note some key limitations of this research, acknowledged by the investigators themselves. For one, this study is of a fairly homogeneous sample of older men. Second, the wine drinkers were healthier to start, including fewer smokers, lower triglycerides, and lower BMIs (all of which are associated with cardiovascular disease). Thirdly, the authors explicitly state that caution must be used when trying to extend these findings to the general population and especially to women. Finally, the authors note the relationship between wine and lower mortality rate may reflect other research that has shown wine drinkers tend to make healthier food choices than drinkers of other alcoholic beverages, rather than reflect the benefits of wine itself. Future research is most definitely needed before making claims about longevity.

Although F&W's claim that wine reduces heart attack risk referred to (yet another) study of men, there is research out there on women, heart attacks, and alcohol. Investigators studied 1,885 women's drinking patterns and history of non-fatal heart attacks. They found that women who drank alcohol were consistently less likely to have had a heart attack than women who abstained, and this trend was related to how much women drank. Women who drank less than 1 drink per day cut their risk by 4%, whereas women who drank 3 drinks per day cut their risk nearly in half. This is not a license to down a bottle of wine a day, however. The researchers also found that women who drank enough to become drunk at least once a month were three times as likely to have a heart attack as those who did not drink and six times as likely to have a heart attack as those who did drink without becoming intoxicated. Finally, they found that women who drank wine were less likely to have a heart attack than women who drank liquor.

Now I won't argue with F&W about their finding that red wine has tannins, and tannins do protect against heart disease. I also won't argue too much with them about evidence that suggests wine MAY protect against type 2 diabetes, stroke, cataracts, colon cancer, and brain decline, except to say that many of these benefits probably reflect healthier lifestyles rather than properties of wine. What I will say is that you should consume your research as you would a fine wine - pay attention to its complexity and character, gauge its potential, be clear about its possible faults, and know know how to compare it to recognized standards.