High-Sodium, Low-Potassium Diet Linked to Heart Risk

Study Suggests Increased Risk of Death From Heart Disease From High-Sodium, Low-Potassium Intake

July 11, 2011 -- A diet high in sodium and low in potassium increases the risk of death from heart disease and other causes, according to a new study.

"Americans who eat a diet high in sodium and low in potassium have a 50% increased risk of death from any cause and about about twice the risk of death from heart disease," says researcher Elena V. Kuklina, MD, PhD. She is a nutritional epidemiologist with the CDC division for heart disease and stroke prevention.

Morton Satin, vice president of science and research for the Salt Institute, disagrees with the study. "It's highly flawed and reveals more of this dogmatic anti-salt agenda."

Research about sodium and heart disease has produced conflicting results. Studies have shown that high sodium intake or low potassium intake is linked with a higher risk for high blood pressure, the researchers write. The link is stronger for potassium.

However, the research about a link between intake of sodium and potassium and getting or dying from cardiovascular disease has been less consistent.

The researchers decided to focus on the sodium-potassium ratio. Recent research has suggested the ratio may be more important in explaining the risk for high blood pressure or cardiovascular disease than either alone.

The study is published in the Archives of Internal Medicine.

Kuklina and her colleagues followed 12,267 U.S. adults. They participated in the Third National Health and Nutrition Examination Survey from 1988 to 1994. They answered questions about their diet and had physical exams.

None of those studied was on a reduced salt diet at the start. Anyone with a history of heart problems or stroke was excluded.

The researchers followed them for nearly 15 years. "Using death certificate data, we looked to see if they died and from what causes," Kuklina says.

During the follow-up, 2,270 people died, including 1,268 from cardiovascular disease.

A higher sodium-potassium ratio was associated with an increased risk of death from heart disease as well as other causes.

A sodium intake of 1,500 milligrams a day maximum and potassium intake of 4,700 milligrams a day is considered adequate under the Dietary Guidelines.

Higher sodium intake was linked to an increased risk of death from any cause. Those in the highest sodium group ''had a 73% higher risk of death from all causes," compared to those in the lowest sodium group, Kuklina says. Those in the highest group took in more than 5,000 milligrams a day. Those in the lowest consumed 2,176 milligrams a day.

Those who consumed 4,069 milligrams of potassium a day had a 49% lower risk of death from all causes compared to those who took in 1,793 milligrams a day, she says. The higher the potassium intake, the lower the risk of death from heart disease.

The researchers did not find a significant link between sodium intake and cardiovascular disease death by itself, they say. However, they do not think this undermines the relationship between sodium and high blood pressure, which they say is ''well established." 

When they looked at the sodium-potassium ratio, they found those who had the worst ratio -- the highest sodium and lowest potassium -- had twice the risk of death from heart disease and a 50% increased risk of death from any cause during the follow-up.

Penis Size Linked to Length of Fingers

Researchers Find Association Between Penile Length and Ratio of Length of Men's Fingers

July 5, 2011 -- The ratio between the length of the index finger and the ring finger of men's hands is associated with penis length, a study shows.

Researchers found that men with a lower ratio, or a shorter length of the index finger compared to the ring finger, tended to have a longer penile length.

The study is published in the Asian Journal of Andrology.

In earlier research, the ratio, known as the digit ratio, has been linked to sexual behavior or hormonal activity. A recent study linked digit ratio to facial attractiveness or "hotness," and another found an association between digit ratio and prostate cancer risk.

Those findings have prompted some to suggest that digit ratio may serve as a marker for prenatal androgen or testosterone exposure.

"Based on this evidence we suggest that the digit ratio can predict adult penile size and that the effects of prenatal testosterone may in part explain the differences in penile length," write study researcher In Ho Choi of Gachon University Hospital in Incheon, South Korea, and colleagues.

In the study, researchers analyzed the relationship between digit ratio and penis size in 144 Korean men 20 or older who were hospitalized for urological surgery.

The length of the index and ring fingers of the right hand were measured prior to surgery, and flaccid and stretched penile lengths were measured while the participant was under anesthesia.

The results showed that after accounting for age, weight, height, digit ratio, individual finger length, and body mass index (BMI), only height and digit ratio were significantly associated with penis length.

However, height was associated with flaccid penile length only. Stretched penile length was not associated with height but was negatively associated with digit ratio. That is, those with a lower digit ratio tended to have longer stretched penile length.

Researchers say because digit ratio has been shown to vary among different ethnic groups, a strength of this study was that it was conducted in a single ethnic group of men.

Experts say these results may offer researchers insights beyond the obvious cocktail conversation.

"Over the past decade, the correlation of digit ratio with sexual behavior and other aspects of sexual biology has been well-documented and there is a growing list of traits with links to digit ratio, although the associations are less well established," writes Denise Brooks McQuade, of Skidmore College in Saratoga Springs, N.Y., in an editorial that accompanies the study.

"Thus 'hotness' aside, the value of digit ratio research for the biomedical scientist or clinician may come from the predictive abilities and risk-assessment qualities of the measurement," writes McQuade.

Study: Chantix May Be Linked to Heart Risk

Researchers Say Taking the Quit-Smoking Drug May Raise the Risk of Heart Attack

July 4, 2011 -- A new study shows an increase in the risk of heart attacks and other cardiovascular events among smokers who take the drug Chantix to help them quit.

The researchers, who reviewed 14 studies on Chantix, found a 72% increase in these events compared to smokers taking a placebo.

The study is published in the Canadian Medical Association Journal.

"Action needs to be taken by the company," says study researcher Sonal Singh, MD, MPH, referring to Pfizer, the maker of Chantix. "They need to put accurate safety information on the label."

In a statement, Pfizer points out that only 1.06% of the nearly 5,000 people in the analysis taking Chantix reported a problem compared to 0.82% of the people taking placebo.

"The actual difference in cardiovascular event rates seen in the Singh analysis was less than one quarter of one percent," the statement notes. "The analysis contains several limitations; most notably that it is based on a small number of events, which raises concerns about the reliability of the authors' conclusions."

Singh, an assistant professor of medicine at Johns Hopkins University, says safety concerns led him to stop prescribing Chantix a year ago.

This is not the first time that the safety profile of Chantix has been called into question. A black box warning, the FDA's most serious safety warning, was added to the Chantix label in 2009 due to concerns of a link with suicidal thoughts and behaviors, depression, hostility, and other behavioral changes.

Last month, the FDA issued a notice that Chantix may be associated with a small, increased risk of heart attacks and other cardiovascular problems among smokers with cardiovascular disease.

The new study finds that Chantix users with no previous history of cardiovascular disease are also at increased risk of serious problems.

In their analysis of data from 14 studies, the researchers found that 52 out of the 4,908 men and women taking Chantix experienced a serious cardiovascular event, such as heart attack, abnormal heart rhythm, stroke, heart failure, or related death, compared to 27 out of the 3,308 in the placebo group. That led the authors to conclude that Chantix raised the risk of serious cardiovascular problems by nearly 72% compared to placebo.

"Our findings have potential regulatory and clinical implications," the researchers conclude.

Tina Kaufman, PhD, an assistant professor of medicine and smoking cessation coordinator at Oregon Health and Science University, says that while the study does raise important safety concerns that doctors should discuss with their patients, the results are not likely to change prescribing practices among the cardiologists with whom she works.

"We're talking about a small risk compared to the huge benefits of quitting," says Kaufman, who was not involved in the study. "It's far more dangerous for them to continue smoking."

Painkillers Linked to Heart Rhythm Disorder

Study Suggests NSAIDs, Cox-2 Inhibitors May Raise Risk of Atrial Fibrillation

July 6, 2011 -- Widely used anti-inflammatory pain relievers may increase the risk of atrial fibrillation, a common heart rhythm disorder associated with stroke and heart failure.

In a newly published study from Denmark, use of non-selective, nonsteroidal anti-inflammatory drugs (NSAIDs) and Cox-2 inhibitors was associated with a significantly increased risk for atrial fibrillation.

Non-selective NSAIDs include the active ingredients in drugs such as Advil, Motrin and Aleve, and Naprosyn. The prescription drug Celebrex is a Cox-2 inhibitor. The researchers also included older Cox-2 inhibitor drugs such as diclofenac (Voltaren), etodolac (Lodine), and meloxicam (Mobic).

The risk was highest for new users of the drugs. New NSAID users had a 46% increase in risk, and new Cox-2 inhibitor users had a 71% increase in risk compared to people who did not take the pain relievers.

Atrial fibrillation risk increases with age, with close to one in 10 people over the age of 80 affected by the condition.

Recent studies have linked regular use of NSAIDs, including Cox-2 inhibitor pain relievers, to an increased risk for other heart conditions in both heart patients and older people without cardiovascular disease.

But the Danish study, published July 4 in the journal BMJ, is among the first to suggest an association with atrial fibrillation or flutter, which affects around 2 million Americans.

The study included just over 32,500 Danish patients diagnosed with atrial fibrillation or flutter between 1999 and 2008. Each case was compared with 10 patients who did not have the heart condition.

The participants were classified as current or recent non-selective NSAID or Cox-2 inhibitor users. Current users were further classified as new users or long-term users.

Researchers estimated that about four additional cases of atrial fibrillation per year could be expected among 1,000 new users of non-selective NSAIDs and seven extra cases of the heart condition could be expected among new Cox-2 inhibitor users.

But researcher Morten Schmidt, of Denmark's Aarhus University Hospital, says the observational design of the study limits the conclusions that can be drawn.

"Although our findings were robust, they do not prove that these pain relievers caused the atrial fibrillation," he tells WebMD. "It may be that differences between users and non-users of these drugs influenced the findings."

University of Massachusetts Medical School professor of medicine Jerry H. Gurwitz, MD, tells WebMD the study is "hypothesis generating."

"We don't have enough evidence at this time to indicate whether this is cause and effect," he says. "And if this association does exist, it is not really clear if it would make a clinical difference because we have a pretty clear idea when these drugs should be used cautiously or not at all."

Gurwitz explains that non-selective NSAIDs and Cox-2 inhibitors should not be used by patients with heart failure or kidney failure, and they should be used with extreme caution by older patients with other heart conditions.

Sitting for Long Time Linked to Pulmonary Embolism

Study Suggests Excessive Sitting May Increase the Risk for Blood Clots in the LungsBy Brenda Goodman
WebMD Health News

July 5, 2011 -- Maybe the couch should come with a warning label.

A flurry of recent research has shown that excessive sitting increases the odds of obesity, heart disease, diabetes, some kinds of cancer, and even premature death. Now a new study is adding another health risk to that list: pulmonary embolism (PE), or a blood clot in the lungs.

The study, of nearly 70,000 female nurses who were followed for 18 years, found that those who spent hours sitting and sedentary in their leisure time were much more likely to have blood clots in their lungs compared to those who were more active.

And the risk remained even after researchers adjusted their data to take into account other factors including body weight, heart disease, smoking, and the use of medications like blood thinners and nonsteroidal anti-inflammatory drugs (NSAIDs).

"Women who sat the most had more than twice the risk of PE compared to women who sat the least," says study researcher Christopher Kabrhel, MD, an attending physician and assistant professor of surgery in the department of emergency medicine at Massachusetts General Hospital, in Boston.

Most of the time, these blood clots, which can cause shortness of breath pain with breathing and increased heart rate, can be treated, but they can also be fatal. Researchers say that makes them a problem to take seriously.

"It's the third most common cause of cardiovascular death in the country. It's about as common as strokes," says Kabrhel.

Though this study wasn't able to definitively prove women in the study got blood clots because they sat so much, experts point out that sluggish blood flow, especially in the legs, is known to contribute to the problem. A piece of a clot in a deep vein, often in a leg, breaks off and travels to the lungs, causing a pulmonary embolism.

"Vein blood clots do occur in people who are not very mobile," says James D. Douketis, MD, an associate professor in the school of medicine at McMaster University in Hamilton, Ontario, Canada.

"The extreme example is someone who's had a stroke and is paralyzed. The risk of having a blood clot there is one in two," says Douketis, who co-authored an editorial that accompanied the study but was not involved in the research. 

In contrast, excessive sitting -- in this case, for nearly six hours each day on average -- increased the annual risk of having a pulmonary embolism from one or two out of every 1,000 adults to one or two in 500 adults.

Douketis points out that the risk from sitting appears to be slightly higher than the risk of blood clots associated with taking birth control pills and about half the risk of getting blood clots that a woman faces during pregnancy.

The study is published in BMJ.

"It's a nice study," says Jack E. Ansell, MD, chairman of medicine at Lenox Hill Hospital in New York City and an expert on thrombosis, or the formation of blood clots.

"There are always limitations to a retrospective review of this nature, but the findings look fairly definite," Ansell tells WebMD. "It provides further, additional evidence that inactivity can be harmful."

Sprouts Linked to Salmonella Outbreak in U.S.

Evergreen Produce Brand Alfalfa and Spicy Sprouts Behind Salmonella Outbreak

June 28, 2011 -- The FDA is warning people not to eat alfalfa sprouts or spicy sprouts produced by Evergreen Produce because of a danger of salmonella contamination.

The FDA says the sprouts have been linked to 20 reported cases, including one hospitalization, of Salmonella Enteritidis infection in Idaho, Montana, New Jersey, North Dakota, and Washington State.

Officials say this particular strain of salmonella is rarely seen in such frequency.

The tainted alfalfa and spicy sprouts are packaged in plastic bags labeled "Evergreen Produce" or "Evergreen Produce Inc."

The majority of people infected with salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. Most healthy people infected with salmonella recover without treatment in four to seven days, but some may require hospitalization from severe diarrhea.

The elderly, infants, and people with impaired immune systems are most at risk of developing severe illness from salmonella infection. In extreme cases, salmonella infection can spread from the intestines to the bloodstream and other body sites and eventually cause death if not treated with antibiotics.

The alfalfa sprouts associated with the outbreak are packaged in 4-ounce and 16-ounce plastic bags with pre-printed "Evergreen Produce" or Evergreen Produce Inc." labels. They are also packaged in 1-pound and 5-pound plastic bags with stick-on labels.

The spicy sprouts are packaged in 4-ounce plastic bags with pre-printed labels and 1-pound plastic bags with stick-on labels.

Consumers, retailers, and others who have alfalfa sprouts or spicy sprouts in such bags should discard them in a sealed container so that people and animals, including wild animals, cannot eat them.

People who think they may have become ill from eating contaminated sprouts should contact their health care provider.

The FDA says sprouts are a common source of food-borne illness. There have been at least 30 outbreaks of food-borne illness associated with raw and lightly cooked sprouts since 1996.

Officials say children, the elderly, pregnant women, and people with weakened immune systems should avoid eating raw sprouts of any kind, including alfalfa, clover, radish, and mung bean sprouts.

To reduce the risk of infection, the FDA advises cooking sprouts thoroughly and to request raw sprouts not be added to your food.

Study: Chantix May Be Linked to Heart Risk

Researchers Say Taking the Quit-Smoking Drug May Raise the Risk of Heart Attack

July 4, 2011 -- A new study shows an increase in the risk of heart attacks and other cardiovascular events among smokers who take the drug Chantix to help them quit.

The researchers, who reviewed 14 studies on Chantix, found a 72% increase in these events compared to smokers taking a placebo.

The study is published in the Canadian Medical Association Journal.

"Action needs to be taken by the company," says study researcher Sonal Singh, MD, MPH, referring to Pfizer, the maker of Chantix. "They need to put accurate safety information on the label."

In a statement, Pfizer points out that only 1.06% of the nearly 5,000 people in the analysis taking Chantix reported a problem compared to 0.82% of the people taking placebo.

"The actual difference in cardiovascular event rates seen in the Singh analysis was less than one quarter of one percent," the statement notes. "The analysis contains several limitations; most notably that it is based on a small number of events, which raises concerns about the reliability of the authors' conclusions."

Singh, an assistant professor of medicine at Johns Hopkins University, says safety concerns led him to stop prescribing Chantix a year ago.

This is not the first time that the safety profile of Chantix has been called into question. A black box warning, the FDA's most serious safety warning, was added to the Chantix label in 2009 due to concerns of a link with suicidal thoughts and behaviors, depression, hostility, and other behavioral changes.

Last month, the FDA issued a notice that Chantix may be associated with a small, increased risk of heart attacks and other cardiovascular problems among smokers with cardiovascular disease.

The new study finds that Chantix users with no previous history of cardiovascular disease are also at increased risk of serious problems.

In their analysis of data from 14 studies, the researchers found that 52 out of the 4,908 men and women taking Chantix experienced a serious cardiovascular event, such as heart attack, abnormal heart rhythm, stroke, heart failure, or related death, compared to 27 out of the 3,308 in the placebo group. That led the authors to conclude that Chantix raised the risk of serious cardiovascular problems by nearly 72% compared to placebo.

"Our findings have potential regulatory and clinical implications," the researchers conclude.

Tina Kaufman, PhD, an assistant professor of medicine and smoking cessation coordinator at Oregon Health and Science University, says that while the study does raise important safety concerns that doctors should discuss with their patients, the results are not likely to change prescribing practices among the cardiologists with whom she works.

"We're talking about a small risk compared to the huge benefits of quitting," says Kaufman, who was not involved in the study. "It's far more dangerous for them to continue smoking."