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NerdWallet sifted through the fifty largest metro areas to find the ones with the best indicators of health, including health scores for the residents, health insurance coverage and a high prevalence of doctors and clean air.  NerdWallet assessed the health score according to the following factors:

How fit are the residents?  We assessed fitness of residents through the American Fitness Index, a composite index that includes the CDC’s Selected Metropolitan/Micropolitan Area Risk Trends Behavioral Risk Factor Surveillance System, environmental factors from the Trust for Public Lands, rates of disease and other government data.Is healthcare accessible?  We incorporated the percentage of residents who have health insurance as well as the number of physicians per 100,000 residents.Is the air quality good?  Research shows that cleaner air adds an average of 4 months to a resident’s life expectancy.  We included the number of high particle pollution days per year for each metro area.

Seth Bilazarian, MD’s insight:

Boston is number one in this survey.  The assessment mixes healthiest city parameters like fitness and pollution with most available and accessible medical care.  Different things, both important.  The survey is a little stacked toward cities with multiple medical schools and therefore multiple training programs and therefore multiple doctors.

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Background

The impact of diet on specific age-related diseases has been studied extensively, but few investigations have adopted a more holistic approach to determine the association of diet with overall health at older ages. We examined whether diet, assessed in midlife, using dietary patterns and adherence to the Alternative Healthy Eating Index (AHEI), is associated with aging phenotypes, identified after a mean 16-year follow-up.

Methods

Data were drawn from the Whitehall II cohort study of 5350 adults (age 51.3±5.3 years, 29.4% women). Diet was assessed at baseline (1991-1993). Mortality, chronic diseases, and functioning were ascertained from hospital data, register linkage, and screenings every 5 years and were used to create 5 outcomes at follow-up: ideal aging (free of chronic conditions and high performance in physical, mental, and cognitive functioning tests; 4%), nonfatal cardiovascular event (7.3%), cardiovascular death (2.8%), noncardiovascular death (12.7%), and normal aging (73.2%).

Results

Low adherence to the AHEI was associated with an increased risk of cardiovascular and noncardiovascular death. In addition, participants with a “Western-type” diet (characterized by high intakes of fried and sweet food, processed food and red meat, refined grains, and high-fat dairy products) had lower odds of ideal aging (odds ratio for top vs bottom tertile: 0.58; 95% confidence interval, 0.36-0.94; P=.02), independently of other health behaviors.

Conclusions

By considering healthy aging as a composite of cardiovascular, metabolic, musculoskeletal, respiratory, mental, and cognitive function, the present study offers a new perspective on the impact of diet on aging phenotypes.

Seth Bilazarian, MD’s insight:

“Western-type” diet (characterized by high intakes of fried and sweet food, processed food and red meat, refined grains, and high-fat dairy products) has been attributed to many disease of older age. This study characterizes ideal aging as avoidance of these disease. The additional life style strategies of exercise and smoking are strongly associated with favorable aging but diet is an independent predictor.  It makes common sense that the cumulative effect of daily diet over the middle third of life will have an impact on outcomes in the last third of life.

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Seth Bilazarian, MD’s insight:

Atrial fibrillation is the most common arrhythmia (irregular heart rhythm). It increases with each decade of life. About 15% of people in their 80’s have it. The rhythm causes the upper chamber to wiggle (Fibrillate) instead of contracting in synchrony with the lower chamber.

There are three main issues of Atrial Fibrillation:
1. a reduced cardiac output due to loss of atrial systole and transport
2. rapid heart rate and rhythm irregularity
3. risk of thromboembolism and Cerebrovascular accident in the range of 1.9% to 18.2% per year without anti-coagulation, based on a risk prediction score called CHADS2.

On the famous people list the only striking unanswered question is, why are the American politicians all Republicans?

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Sharing a rare moment of person-to-person time during the scientific sessions in San Francisco, Dr Seth Bilazarian asks Drs Samuel Goldhaber how he goes about bridging with dabigatran, rivaroxaban, and apixaban.

Seth Bilazarian, MD’s insight:

All of the new blood thinners or novel oral anticoagulants (NOAC)  have a warning in their label about the hazard of stopping them. These agents have a short half life so within 1 - 2 days they are out of the system and there is no blood thinner protection from the hazard of atrial fibrillation (AF).  Should patients going for procedures receive “bridging” with intravenous (IV) blood thinners to protect them during the interval off these new agents.  Perspective from Sam Goldhaber of the Clot Blog on theheart.org.

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People who own dogs or cats may have a reduced risk of cardiovascular disease,.

Top Ten Things To Know Pet Ownership and Cardiovascular Risk
1. This AHA Scientific Statement critically assesses studies regarding the influence of pet ownership on the presence and reduction of CVD risk factors as a novel strategy in reducing the risk of CVD.
2. Pet ownership, particularly of dogs, is probably associated with decreased CVD risk (LOE B), and may have a causal role in reducing CVD risk (LOE B). Further investigation is needed to establish a causal relationship.
3. While pet ownership may be reasonable for the reduction in CVD risk (Class IIb, LOE B), pet adoption, rescue, or purchase should not be done for the primary purpose of reducing CVD risk (Class III, LOE C).
4. An association between pet ownership and lower blood pressure has been found in some, but not all, studies.
5. Of all pets, dogs seem most likely to positively influence physical activity, especially with owners who regularly walk their dogs.
6. Pets also play an important role in providing social support, which is one of the most significant predictors of adherence to behavior change over time.
7. Companion animals may strengthen engagement in a weight loss program.
8. A positive relationship between pet ownership and autonomic function or cardiovascular reactivity to stress has been reported in most published studies. People with pets tend to have lower baseline heart rates, lower blood pressures, and significantly reduced increases in heart rate and blood pressure in response to stress. Recovery time from a stressful event is also markedly improved.
9. Further investigation is warranted regarding the influence of pet ownership on reducing CVD risk, including those on risk factor modification, primary prevention, and use of pet acquisition as a part of a strategy for secondary prevention of cardiovascular disease.
10. Minimal data are available to make an association between hyperlipidemia and pet ownership, as well as survival in people without established cardiovascular disease and pet ownership.

COMPLETE INFO at

Levine GN, et al; on behalf of the American Heart Association Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing. Pet ownership and cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2013:

http://circ.ahajournals.org/lookup/doi/10.1161/CIR.0b013e31829201e1

Seth Bilazarian, MD’s insight:

DISCLOSURE - I’m a dog lover.  I have given patient’s prescriptions to get a dog and walk the dog twice daily.  I’ve also told patients to walk the dog every day whether they have a dog or not.

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The news was less disappointing for aerobic exercise, with 51.6% of adults getting the recommended amount, than it was for muscle-strengthening activities, with only 29.3% getting the recommended amount.

The overall exercise rates also varied widely by state, ranging from 13% in Tennessee and West Virginia to 27% in Colorado.

The report was published in the May 3 issue of the Morbidity and Mortality Weekly Report, a CDC publication.

“Exercise not only helps with weight management, it helps reduce anxiety and depression; boosts energy, immunity and brain power; and significantly lowers the risk for chronic diseases such as cancer, diabetes and cardiovascular disease,” she said.

According to the Physical Activity Guidelines for Americans, adults should get at least:

=>  two and a half hours a week of moderate-intensity aerobic activity such as walkin

=>  or an hour and 15 minutes a week of vigorous-intensity aerobic activity, such as jogging.

In addition, adults should do muscle-strengthening activities, such as push-ups, sit-ups or activities using resistance bands or weights. These exercises should be done two or more days a week and work all major muscle groups, the guidelines suggested.

The highest proportion of adults meeting those guidelines were in the West (24 percent) and the Northeast (21 percent). Women, Hispanics and older and obese adults were less likely to meet the guidelines

“Simple steps to start moving include: enlisting a friend or family member to join you; taking a walk every evening after dinner; getting up and marching in place at every TV commercial; limiting TV and computer time; [and] scheduling your time to exercise in your daily calendar,

Seth Bilazarian, MD’s insight:

The authors put a positive spin on this report but half of Americans are not exercising even at these modest recommendation levels (75 minutes of vigorous exercise per week).  The muscle strengthening data is even worse: 80% of Americans are not doing it.

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Subclinical hyperthyroidism is associated with a 20% increased risk for cardiovascular mortality, primarily driven by heart-failure deaths, according to a large study in more than half a million individuals from general practice in Denmark, reported at the 2013 European Congress on Endocrinology.

“The main finding is a 20% increased risk of mortality in all levels of hyperthyroidism, including overt and subclinical but also high-normal, euthyroid patients, those lying in the lower range of the normal thyroid-stimulating hormone [TSH],”

“The take-home message is that if a person has a family history with any thyroid problem or has any signs of thyroid problems, they should go for a checkup. Their family doctors need to be aware that any sign of thyroid abnormality can affect cardiovascular health, and they should act accordingly.”

 The link between overt hyperthyroidism and cardiovascular mortality is quite well established, he said, but the finding of an association with subclinical hyperthyroid disease is much more novel.

Of 574,595 included individuals (mean age, 48.7 years; 39.1% male), 95.9% were euthyroid, 1603 (0.3%) had overt hypothyroidism, 11,834 (2.1%) had subclinical hypothyroidism, 3967 (0.7%) had overt hyperthyroidism, and 6264 (1.1%) had subclinical hyperthyroidism.

Seth Bilazarian, MD’s insight:

Symptoms of hyperthyroidism are not evident in patients who have sub-clinical hyperthyroidism.  The levels are abnormal but their are no symptoms.  In this very large study, the risk of death was 20% higher.  testing the thyroid level is very simple and is performed on a non fasting blood test.

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Seth Bilazarian, MD’s insight:

Just half of primary-care patients with hypercholesterolemia received recommended thyroid-function screening, a new retrospective study has found. 

Hypothyroidism is an important secondary cause of elevated total cholesterol and LDL cholesterol. In overt hypothyroidism cases, thyroid hormone replacement treatment often normalizes the cholesterol levels. For that reason, guidelines from the AACE, American Thyroid Association, and National Cholesterol Education Program (NCEP) recommend testing for hypothyroidism.

Dr. Willard’s study was designed to determine the rate of adherence to the guidelines by primary-care physicians. “The 50% rate of screening is a bit surprising. Although guidelines from the NCEP and [American College of Physicians] ACP state that thyroid dysfunction is [included in the] differential [diagnosis] for new-onset dyslipidemia, the practice of screening in standard clinical practice seems to often be overlooked.”

Of the total 4349 patients who had TSH levels screened, 151 had TSH levels greater than 5 mIU/L and 74 had TSH levels over 10 mIU/L. Of these 225 patients (with TSH levels >5), 50.7% received levothyroxine treatment, Of those 114 patients treated with levothyroxine, 75.4% did not receive a lipid-lowering agent within 1 year, possibly because correction of their hypothyroidism resulted in improvement of their lipid panel and correction of the dyslipidemia.

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 Eating fish, chicken, olive oil and other foods rich in omega-3 fatty acids while staying away from meats and dairy — the so-called Mediterranean diet — may help older adults keep their memory and thinking skills sharp, a large new U.S. study suggests.

Using data from participants enrolled in a nationwide study on stroke, the researchers gleaned diet information from more than 17,000 white and black men and women whose average age was 64.

The participants also took tests that measured their memory and thinking (cognitive) skills. During the four years of the study, 7 percent of the individuals developed problems with these skills, the researchers reported.

“Greater adherence to Mediterranean diet was associated with lower risk of incident cognitive impairment in this large population-based study,” said lead researcher Dr. Georgios Tsivgoulis, from the University of Alabama at Birmingham as well as the University of Athens, in Greece.

Seth Bilazarian, MD’s insight:

This makes reasonable biological sense since brain and cognitive health is so dependent on vascular health.  Strategies that improve vascular health and function of many years will reduce the likelihood of declining mental function.

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A stroke, sometimes called a “brain attack,” occurs when blood flow to the brain is interrupted. When a stroke occurs, brain cells in the immediate area begin to die because they stop getting the oxygen and nutrients they need to function.

What are the symptoms of a stroke?—

The symptoms of stroke are distinctive because they happen quickly—thus the origin of the name “stroke.”

Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)Sudden confusion, trouble speaking, or understanding speechSudden trouble seeing in one or both eyesSudden trouble walking, dizziness, loss of balance or coordinationSudden severe headache with no known cause

Seth Bilazarian, MD’s insight:

Good basic information from NIH MedlinePlus magazine everyone should know (called AHA “give me 5”).  Knowing these stroke symptoms and seeking early treatment can be life saving.  Faster treatment reduces the likelihood and severity of disability after stroke.

See on nlm.nih.gov