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Studies show that modest wine consumption may reduce cardiovascular risks. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

By now, we have all likely heard that soda – with 39 grams of sugar per 12-ounce can – is associated with an increased risk of diabetes. Bur did you know that wine has a very low amount of sugar: about 1.2 grams of sugar in a five-ounce serving? Even more surprising, it may have benefits in reducing complications associated with diabetes.

Why is this important? The current rate of diabetes among the U.S. adult population is 12.2 percent, while another 84 million U.S. adults have prediabetes (HbA1C of 5.7-6.4 percent) (1).

For those with diabetes, cardiovascular risk and severity may not be equal between the sexes. In two trials, women with type 2 diabetes had greater cardiovascular risk than men. In one retrospective study, women with diabetes were hospitalized due to heart attacks at a more significant rate than men, though both had substantial increases in risk, 162 percent and 96 percent, respectively (2).

What may reduce risks of disease and/or complications? Fortunately, we are not without options. These include timing of blood pressure medications, lifestyle modifications (diet and exercise) and, yes, wine.

Diet vs. metformin for prevention

All too often in the medical community, we are guilty of reaching for drugs and either overlooking lifestyle modifications or expecting that patients will fail with them. This is not only disappointing, but it is a disservice; lifestyle changes may be more effective in preventing this disease. In a head-to-head comparison study (Diabetes Prevention Program), diet plus exercise bests metformin for diabetes prevention (3). This study was performed over 15 years of duration in 2,776 participants who were at high risk for diabetes because they were overweight or obese and had elevated sugars.

There were three groups in the study: those receiving a low-fat, low-calorie diet with 15 minutes of moderate cardiovascular exercise; those taking metformin 875 mg twice a day; and a placebo group. Diet and exercise reduced the risk of diabetes by 27 percent, while metformin reduced it by 18 percent over the placebo, both reaching statistical significance. Note that, while these are impressive results that speak to the use of lifestyle modification and to metformin, this is not an optimal diabetes diet.

I’ll drink to that!

Alcohol in general has mixed results. Wine is no exception. However, the CASCADE trial, a randomized controlled trial, considered the gold standard of studies, shows wine may have heart benefits in well-controlled patients with type 2 diabetes by altering the lipid (cholesterol) profile (4).

Patients were randomized into three groups, each receiving a drink with dinner nightly; one group received five ounces of red wine, another five ounces of white wine, and the control group drank five ounces of water. Those who drank the red wine saw a significant increase in their “good cholesterol” HDL levels, an increase in apolipoprotein A1 (the primary component in HDL) and a decrease in the ratio of total cholesterol-to-HDL levels compared to the water-drinking control arm. In other words, there were significant beneficial cardiometabolic changes.

White wine also had beneficial cardiometabolic effects, but not as great as red wine. However, white wine did improve glycemic (sugar) control significantly compared to water, whereas red wine did not. Also, slow metabolizers of alcohol in a combined red and white wine group analysis had better glycemic control than those who drank water. This study had a two-year duration and involved 224 patients. All participants were instructed to follow a Mediterranean-type diet.

Does this mean diabetes patients should start drinking wine? Not necessarily, because this is a small, though well-designed, study. Wine does have calories, and these were also well-controlled type 2 diabetes patients who generally were nondrinkers.

Blood pressure medications’ surprising results

Interestingly, taking blood pressure medications at night has an odd benefit, lowering the risk of diabetes (5). In a study, there was a 57 percent reduction in the risk of developing diabetes in those who took blood pressure medications at night rather than in the morning.

It seems that controlling sleep-time blood pressure is more predictive of risk for diabetes than morning or 48-hour ambulatory blood pressure monitoring. This study had a long duration of almost six years with about 2,000 participants.

The blood pressure medications used in the trial were ACE inhibitors, angiotensin receptor blockers (ARBs) and beta blockers. The first two medications have their effect on the renin-angiotensin-aldosterone system (RAAS) of the kidneys. According to the researchers, the drugs that blocked RAAS in the kidneys had the most powerful effect on preventing diabetes. Furthermore, when sleep systolic (top number) blood pressure was elevated one standard deviation above the mean, there was a 30 percent increased risk of type 2 diabetes. Interestingly, the RAAS-blocking drugs are the same drugs that protect kidney function when patients have diabetes.

We need to reverse the trend toward higher diabetes prevalence. Diet and exercise are the first line for prevention. Even a good, but nonideal, diet had better results, in comparison to medication. A modest amount of wine, especially red, may have effects that reduce cardiovascular risk. Blood pressure medications taken at night, especially those that block RAAS in the kidneys, may help significantly to prevent diabetes.

References:

(1) cdc.gov. (4) Journal of Diabetes and Its Complications 2015;29(5):713-717. (3) Lancet Diabetes Endocrinol. Online Sept. 11, 2015. (4) Ann Intern Med. 2015;163(8):569-579. (5) Diabetologia. Online Sept. 23, 2015.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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Suffolk County has a tough task in digging out of its enormous financial hole.

A group of independent and municipal financial experts completed their analysis of the impact of the COVID-19 lockdown on the economy and presented it to County Executive Steve Bellone (D) last night.

Over the next two and a half years, the county is facing a shortfall that is anywhere from $1.1 billion to $1.5 billion, which is three times the budget deficit the county faced coming out of the financial crisis of the last decade.

“This is a budget crisis that is greater than this county has ever seen before,” Bellone said on his daily conference call with reporters. “This report outlines it well. We have a long road ahead.”

Bellone is sending this report to the entire congressional delegation so they can understand the financial emergency created by the public health crisis.

“This is a crisis that’s beyond what a local government has the capacity to deal with on a local level,” Bellone said. “If ever there was a time that a local community needed their federal representatives to deliver for them, that moment is now.”

After residents did as the Centers for Disease Control and Prevention and the federal government instructed, by staying at home, not going to work and limiting their activities over the last few months, Suffolk County residents need the federal government to say, “Yes, we have your back,” Bellone said.

The range of estimates for the shortfall comes from the uncertainty about how the virus will affect the county for the remainder of this year. On the lower end, which is still an enormous financial challenge, the economy remains open. In a second scenario, where a second wave of the virus hits in the fall, potentially concomitant with the appearance of the flu, the county needs to enact some economic restrictions.

In the third scenario, the spread of the virus is so problematic that it forces another lockdown, which would cause the shortfall to balloon to $1.5 billion.

No matter how the virus affects the county later this year, however, this has a “cataclysmic financial impact,” Bellone said. “This is not something we can get through alone. We need that support.”

The county executive said he plans to meet with employee unions, including those that represent police, nurses and emergency workers, to have some tough conversations.

These people are out there “trying to keep the public safe and to prevent a second wave,” Bellone said. “These are tough conversations only because these are extraordinarily difficult challenges.” It’s not something they should have to think about.”

Ultimately, Bellone said he believes the federal government will step up to the challenge created by the public health crisis and the economic damage it wrought.

“I’m confident our federal government will deliver and will do what needs to be done,” Bellone said.

As for the ongoing protests, including a demonstration in Shirley yesterday, Bellone remained appreciative of the peaceful and constitutionally protected way demonstrators expressed themselves.

When the demonstrators marched along William Floyd Parkway, the police “worked to deescalate a situation that could have grown worse,” Bellone said.

Viral Numbers

In the last day, the number of people who died from the virus was three, bringing the total to 1,909.

Those deaths, horrific as they are for each person who died and for the families and friends who lost a loved one, are the lowest they’ve been since March.

“If there’s anything positive today in being able to talk about those numbers” it’s that the death toll is lower than it’s been since the beginning of the crisis, Bellone said.

In the 24 hours ending on May 31, the number of residents hospitalized with COVID-19 dropped by six to 247. The number of people in Intensive Care Unit beds remained unchanged at 67.

People with COVID-19 accounted for 68 percent of bed use, while residents with COVID-19 accounted for 54 percent of ICU bed use, which are each below the target 70 percent figure that was necessary for Phase 1 of reopening.

The number of positive tests increased by 275 to 39,980. That number, however, includes 200 people who had not been reported earlier, which puts the number of new infections closer to the county’s daily tally, which has been tracking below 100.

The number of people who have tested positive for the virus on an antibody test has increased to 14,222.

As for supplies, the county distributed 22,000 pieces of personal protective equipment over the last day, raising that total above 5.8 million.

Today, the county received 50,000 surgical masks from the Taiwanese government, which had shipped them to New York City last week and were delivered to Fire, Rescue and Emergency Services today.

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As a part of a drive-in movie series, Smith Point County Beach will show the movie “Jaws” on June 20, 45 years after the Steven Spielberg-directed film terrified theater goers throughout a country a year removed from a gas crisis that appears tame by comparison to the confluence of today’s challenges.

“Hopefully that will be an experience people will enjoy with their families,” County Executive Steve Bellone (D) said on his daily conference call with reporters. “Hopefully, they will enjoy it in a safe way.”

Suffolk County is approaching the end of its first full week in Phase One of an economic reopening, even as emotions run high in the county, the country and the world after the killing of George Floyd by a now-fired Minneapolis police officer who is now facing murder charges.

Group gatherings, even peaceful protests, themselves pose a health risk to attendees as researchers continue to try to develop a vaccine for a virus that threatens the health and lives of residents, particularly those with underlying medical conditions.

“We are always going to be concerned with people coming together in large gatherings, where they are not practicing social distancing,” Bellone said. “We want people to protest and express their First Amendment rights, but we want to do it safely.”

The county executive again thanked the community for peaceful expressions throughout the efforts to restart the economy and as protests in urban areas have, at times, led to violent confrontations with police and to rioting and looting.

Bellone said the Suffolk County Police Department is taking the approach that the officers are a part of the community and are not just in place to restrict or police others.

“When people are out there protesting because they have a message they want to get across, ‘We are there to make sure they are safe,’” Bellone said.

While officials remain concerned about the possibility of larger gatherings leading to resurgence of the virus after hard-won gains during the deadly month of April, they are also willing to change their guidance if such gatherings don’t lead to an increase in infections or put a strain on the recovering health care system.

The county can look at these gatherings and see how they affect public health, Bellone said. “We can take something away from that,” he said.

Still, the county executive said he urges residents not to become too cavalier about following rules that have led to an improvement in the overall health of the county, albeit at the cost of a slowed economy and an increase in unemployment.

“After being cooped up for so long” with all the devastation from the effort to flatten the curve and save people’s lives, residents need to think about “how to prevent sliding back in any way,” Bellone urged. “If people continue to be smart and exercise caution, we can reopen our economy safely. We need the public to continue to be smart.”

Viral Figures

The number of new positive tests for COVID-19 was 62, bringing the total to 39,705. That doesn’t include the 14,138 people who have tested positive for the antibody.

The number of people in the hospital with the virus, a figure no one in the health care system over the course of the year is likely to ever take for granted, declined by 16 to 253.

The number of people in the Intensive Care Unit also declined seven to 67.

The percentage of hospital beds and ICU beds with COVID-19 patients, meanwhile, was at 62 and 63, respectively, which are well below the original target of 70 percent or lower.

Another 25 people were discharged from the hospital over the last day.

The number of people who died from complications related to COVID-19 climbed by five to 1,906.

The county distributed another 24,000 pieces of personal protective equipment over the last day. That total has reached over 5.7 million since the pandemic reached the shores of Long Island.

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Photo from WMHO

Stony Brook Village restaurants, shops, community residents and others throughout Long Island are continuing in their efforts to support the hometown heroes at Stony Brook University Hospital during this ongoing pandemic.  

Three Village Inn/Lessing’s, Fratelli’s, Crazy Beans and Sweet Mama’s have delivered over 11,000 meals to these dedicated medical professionals, and some of the restaurants are donating extra meals with deliveries. 

Other participating shops in the village include The Crushed Olive, Village Coffee Market, Chocolate Works, Premiere Pastry, Brew Cheese and Penny’s Car Care who have delivered a variety of snacks, cheeses, pastries, cookies, drinks and much more. 

Donations have also been received from private citizens throughout towns in Nassau and Suffolk County as well as out of state.

If you would like to help show your support for healthcare professionals, you can donate to Stony Brook eateries or call the Ward Melville Heritage Organization at 631-751-2244. Your donation is fully tax deductible to the extent allowed by law and every dollar will go to this cause. 

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Local students from the Three Village area protest police misconduct in the wake of the death of George Floyd in Minneapolis. Photo by Myrna Gordon

Amid the confluence of social unrest caused by people eager to see the economy reopen faster and those distressed by the killing of Minneapolis resident George Floyd, County Executive Steve Bellone (D) said he appreciates the peaceful way people are demonstrating in Suffolk County.

“I want to thank everyone who has been out there, participating in these demonstrations, for doing this peacefully, and expressing their rights as American citizens,” Bellone said on his daily conference call. “Unfortunately, we have seen too many instance where that has not been the case across the country.”

Indeed, in several cities, the reaction to the death of Floyd after a former police officer knelt on his neck for over eight minutes, has led to violence and chaos.

“Looting is never acceptable,” said Bellone. “It undermines the point of the message. It has the effect of taking the attention away from the change people are fighting for, the change people want to see.”

Viral Numbers

The number of people who tested positive for COVID-19 in the last day was 111, bringing the total to 39,643. That doesn’t include the 13,953 who tested positive for the antibody.

As fo May 29, the number of residents in the hospital with COVID-19 declined by six to 269.

The number of people in Intensive Care Unit beds also declined by six to 74.

Over the last day, 24 people were discharged from the hospital.

The number of fatalities related to complications from the virus continues to climb, with nine people losing their lives to the pandemic, raising the total to 1,901.

The county distributed over 9,000 pieces of personal protective equipment in the last day, raising that total to over 5.7 million.

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County Executive Steve Bellone, center, SCPD Commissioner Geraldine Hart, left, and Chief of Department Stuart Cameron, right. File photo

With protests and violence rocking several cities, including New York City, after the videotaped killing of Minneapolis resident George Floyd, Suffolk County Executive Steve Bellone (D) called the officer’s actions a type of racism.

“Perhaps the most disturbing thing” about the way now-fired officer Derek Chauvin, who is now in jail on charges of third-degree murder, acted is the “lack of concern that this officer showed in knowing that he was being videotaped,” said Bellone on his daily conference call with reporters. “That suggests this officer felt that there was no accountability.”

In calling the actions of Chauvin structural racism, Bellone pointed to a Newsday investigation that revealed a similar type of racism and discrimination in the housing industry on Long Island.

While Suffolk County has made “an incredible amount of progress, we clearly have much more work to do,” Bellone said.

The county executive said he understood the protests that have taken place in response to videos that showed Chauvin kneeling on the neck of the handcuffed Floyd, whose pleas that he couldn’t breathe went unheeded.

Bellone, however, said overrunning a police station “can not happen” and expressed his support for the vast majority of police officers who are “hard working, dedicated professionals who are putting their own safety on the line to protect us.”

In a statement she read during the media call, Suffolk County Police Commissioner Geraldine Hart said Floyd’s death was “an outrage” and was “unacceptable.” She condemned the tragic killing, while adding that she holds the officers of the Suffolk County Police Department to the “highest standards.”

Suffolk County Police Chief Stuart Cameron, who has been on the force for over 35 years, described how he has been in situations where people resisted his efforts to arrest them.

Force is a “last resort,” Cameron said. Officers are trained to “use the bare minimum force necessary to get someone into custody.”

Cameron has never put a knee to another person’s neck and said he had never seen another police officer in the SCPD use a similar tactic during his career. Officers have not received training to pin a suspect to the ground with a knee to a handcuffed person’s neck.

Pinning someone to the ground could cause positional asphyxia, spinal damage, or can cause damage to the airway.

Cameron said he believes his officers will step in and intervene if another officer is using unnecessary or excessive force.

Gov. Andrew Cuomo (D) said the state would be getting the attorney general to review procedures following the demonstrations which turned violent on Friday, with multiple instances of recorder violence against protesters and violent actions against police.

Viral Numbers

As for the COVID-19 numbers, the county has had an additional 87 positive tests, bringing the total to 38,582. That doesn’t include 13,733 people who have tested positive for the antibody.

Hospitalizations have declined by 16 to 275 as of May 28. At the same time, the number of residents with COVID-19 in ICU beds has fallen by 5 to 80.

Hospital capacity was at 65 percent for overall beds and 62 percent for ICU beds.

The number of people who have been discharged from the hospital in the last day was 27.

An additional 13 people have died from complications related to the coronavirus. The total number of deaths has reached 1,892.

Separately, the county reopened its camping reservation system yesterday at 4 p.m. Residents made 4,739 reservations for 25,608 reservation days.

“That shows the demand we have and the desire for people to get out and enjoy summer,” Bellone said. “We are going to be able to have a summer here in Suffolk County.”

Beaches, meanwhile, remain open for residents only.

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After technical difficulties when Suffolk County tried to open up its camping reservation system, the county is starting the process again at 4 pm today.

Interested residents can make camping reservations for June 15 or later.

“We know that there will be many people trying to get online,” County Executive Steve Bellone (D) said on his daily COVID-19 conference call with reporters. “Hopefully, that’s going to work.”

As for the numbers related to the virus, an additional 86 people tested positive over the last day, bringing the total to 39,445. That doesn’t include the 13,406 people who tested positive for the antibody.

The number of people hospitalized with COVID-19 dropped 10, bringing the total to 291, which is a “milestone,” Bellone said. Suffolk County hasn’t had a number below 300 since the third week of March.

The number of people in the Intensive Care Unit also declined by seven to 85.

COVID-19 patients represented 68 percent of hospital capacity and 61 percent of ICU bed capacity, which are below the metrics the state had put out for a reopening that started on Wednesday.

The number of people who died from complications related to the virus increased by eight to 1,879.

After Governor Andrew Cuomo (D) indicated that frontline workers who died from the virus would received death benefits, Bellone said his office had indicated to the unions that anyone who died from COVID-19 would be considered a death in the line of duty.

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With phase one of an economic restart in its second day, leaders in Suffolk County are considering ways to enable restaurants that provide outdoor seating to open soon.

Outdoor dining is “an activity that we believe can be done safely,” County Executive Steve Bellone (D) said on his daily conference call with reporters. “We are hopeful that this is one of the areas we could see accelerated.”

Bellone said he would provide an order to grant automatic county approval to restaurants to expand their seating into creative outdoor spaces, which could include sidewalks, in the back of a restaurant, or in tents.

“There will be no delay in that process,” the county executive said.

While Bellone didn’t provide a specific time table, he added that “you could see certain activities that are moved up and outdoor dining is clearly one of those with the right protocols in place.”

As for the numbers related to COVID-19, an additional 101 residents tested positive for the virus, bringing the total to 39,359 people. That doesn’t include the 12,956 people who have tested positive for the antibody.

The number of people hospitalized with the coronavirus has declined by four to 301. The number of people in ICU beds declined by two to 92. These numbers are through May 26.

Over the last day, 12 people left the hospital.

In that same period, 10 people died from complications related to COVID-19. The virus has now played a role in the deaths of 1,871 Suffolk County residents.

The County Executive’s office distributed another 39,000 pieces of personal protective equipment over the last day.

On Friday, the courts on Long Island will reopen, with judges and their staff returning. The courts will have safety measures in place.

Bellone shared his shock at the video he has seen of the death in Minneapolis of George Floyd, who died after he told police officers he couldn’t breathe when he was on the ground and one of them put a knee to his neck during an arrest. Four police officers were fired in connection with Floyd’s death. Calling the video “horrific,” Bellone said he is “hopeful that we are going to see justice as quickly as possible.”

SBU Viral Research

Meanwhile, Stony Brook University announced researchers from all different schools on campus have started over 180 COVID-19 studies since the pandemic reached Long Island in March. Scientists are exploring the impacts of the virus from numerous perspectives and across the university.

Researchers are conducting 52 clinical trials on prevention, treatment and care of patients.

In the Renaissance School of Medicine, scientists have started 75 studies across 20 departments. These include exploring the benefit of convalescent plasma, using dry heat to disinfect N95 masks, using Artificial Intelligence to detect the virus and predict outcomes, determining physician health, and many others.

In the College of Arts and Sciences in the School of Medicine, one group of researchers are focusing on exchanging lipids in the viral coat, while another is examining COVID-19 proteins in plants for scaled-up production of antigens.

In the College of Arts and Sciences, over half of the 40 studies are in the Department of Psychology and are exploring the impact of isolation on well-being. Another study is looking at trainee experiences with online teaching and learning.

Scientists in the College of Engineering and Applied Sciences and the School of Medicine are conducting 10 studies. One investigates the use of Artificial Intelligence to help with drug discovery of antiviral candidates, the effects of the virus on clotting, and the development of informatics solutions for viral imaging.

Six studies are progressing in the College of Engineering and Applied Sciences on decision support for cancer treatment, tracking levels of community distress, vaccine designs for unknown targets and a diagnostic tool for rapid COVID-19 infection detection.

In the School of Social Welfare, scientists are determining the impact of social distancing on mental health and substance abuse, the impact of isolation on older adults during the COVID-19 crisis, the impact of the crisis on first-generation college students, and an examination of family violence.

The School of Marine and Atmospheric Sciences is tracking disease prevalence in New York State communities by monitoring novel coronavirus in sewage.

The College of Business is looking at the impact of the socioeconomic status in the context of virus-related decisions.

The School of Nursing is exploring the effect of the pandemic on student nurses, while the school of Health Technology and Management is studying the impact of the virus on occupational participation and life satisfaction.

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Suffolk County has created a new website to connect jobless residents with shops that need workers.

And so it begins.

The Suffolk County economy, stalled for over two months as Long Island tried to contain the spread of a deadly virus, has restarted, entering Phase One of a gradual reopening process today.

Calling the reopening a “new beginning,” County Executive Steve Bellone (D) said on his daily conference call with reporters that the county was “up to the test in every way imaginable.”

To bring employers and employees together, Bellone announced the start of a virtual career and talent portal that is part of the Department of Labor. The portal will link job seekers with Suffolk County businesses that need workers.

Bellone called the site a “one stop shop” that will do everything virtually, enabling employees to see job postings in real time. Veterans will get first priority for these jobs, as the county wants to honor those who have served the nation with a 24-hour hold on these postings. Residents can access the site through SCNYForward.info.

Amid the opening, the viral numbers continued to move in a positive direction for the county.

Hospitalizations declined by 30 to 305 as of May 25. The number of people in the Intensive Care Unit also declined by 12 to 94, which is the first time since March that the number of people in the ICU with COVID-19 was below 100.

Hospital capacity remained well below 70 percent, with 65 percent of beds available in hospitals and 60 percent available in the ICU.

In the last day, nine people have left the hospital to continue their rehabilitation and recovery at home.

The virus continues to claim the lives of residents. In the last day, 10 people died from complications related to the coronavirus as the number of people who died from COVID-19 in Suffolk has reached 1,861.

On the first day of reopening, the county executive said he hadn’t had any negative reports about people violating any ongoing restrictions on businesses or social distancing rules.

With contact tracers in place and the county monitoring public health, Bellone didn’t anticipate the county backsliding into another version of New York Pause.

The contact tracers should “give us the ability to target our response,” the county executive said, “rather than what we had to do at the beginning of the outbreak.”

Bellone said the county had learned important lessons on the other side of the viral peak, which should put it in a solid position to monitor any pockets of positive tests.

“I’m certain we are going to do this safely as we open up,” Bellone said.

Separately, Bellone urged the federal government to invest in infrastructure projects on Long Island, including a sewer project.

The county has one of the largest infrastructure projects for sewers in the region in decades, Bellone said.

“With federal investment in infrastructure, we would create jobs, boost our economy, improve water quality, a win-win for everybody,” Bellone said in a statement.

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Studies have shown 50 percent fewer cardiac events with CoQ10 supplementation. Stock photo
Supplementation may improve outcomes

By David Dunaief, M.D.

Dr. David Dunaief

Heart attacks and heart disease get a lot of attention, but chronic heart failure is often overlooked by the press. The reason may be that heart failure is not acute like a heart attack.

To clarify by using an analogy, a heart attack is like a tidal wave whereas heart failure is like a tsunami. You don’t know it’s coming until it may be too late. Heart failure is an insidious (slowly developing) disease and thus may take years before it becomes symptomatic. It also increases the risk of heart attack and death.

There are about 6.5 million Americans with heart failure (1), and heart failure contributed to one in eight deaths in 2017 (2).

Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands and may decompensate. There are two types — systolic and diastolic. The basic difference is that the ejection fraction, the output of blood with each contraction of the left ventricle of the heart, is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.

We have more evidence-based medicine, or medical research, on systolic heart failure. Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms may be similar, as well, and include shortness of breath on exertion or when lying down, edema or swelling, reduced exercise tolerance, weakness and fatigue. Major risk factors for heart failure include diabetes, coronary artery disease, high blood pressure, obesity, smoking, poor diet, being sedentary and drinking alcohol excessively.

Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. We are going to look at how diet, iron and the supplement CoQ10 impact heart failure.

Effect of diet

If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF. Oxidative stress is thought to potentially result in damage to the inner lining of the blood vessels, or endothelium, oxidation of cholesterol molecules and a decrease in nitric oxide, which helps vasodilate blood vessels.

In a population-based, prospective (forward-looking) study, called the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (3). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent reduction in the development of HF, compared to the group that consumed the least. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.

This nutrient-dense approach to diet increased oxygen radical absorption capacity. Oxygen radicals have been implicated in cellular damage and DNA damage, potentially as a result of increasing chronic inflammation. What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention.

This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, since it is an observational study, and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.

CoQ10 supplementation

Coenzyme Q10 is a substance produced by the body that helps the mitochondria (the powerhouse of the cell) produce energy. It is thought of as an antioxidant. 

Results of the Q-SYMBIO study, a randomized controlled trial, showed an almost 50 percent reduction in the risk of all-cause mortality and 50 percent fewer cardiac events with CoQ10 supplementation (4). This one randomized controlled trial followed 420 patients for two years who had severe heart failure. This involved using 100 mg of CoQ10 three times a day compared to placebo.

The lead author goes as far as to suggest that CoQ10 should be part of the paradigm of treatment. This the first new “drug” in over a decade to show survival benefits in heart failure.

A meta-analysis involving 13 studies of CoQ10 supplementation with HF confirmed that CoQ10 resulted in ejection fraction improvements among patients with less severe stages of HF, although the authors suggest that studies with more diverse demographics and that refine and compare dose responses are warranted (5).

Thus, if you have heart failure, you may want to discuss CoQ10 with your doctor.

Iron deficiency

Anemia and iron deficiency are not synonymous, since iron deficiency can occur without anemia. A recent observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (6).

In this study, iron deficiency was defined as a ferritin level less than 100 μg/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100–299 μg/L.

The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF and is common in these patients. Thus, it behooves us to try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin and iron levels checked, for these are correctable. 

I am not typically a supplement advocate; however, based on the latest results, CoQ10 seems like a compelling therapy to reduce risk of further complications and potentially death. Consult with your doctor before taking CoQ10 or any other supplements, especially if you have heart failure.

References:

(1) Circulation. 2019;139(10):e56–528. (2) cdc.gov. (3) Am J Med. 2013 Jun:126(6):494-500. (4) JACC Heart Fail. 2014 Dec;2(6):641-649. (5) Am J Clin Nutr. 2013 Feb; 97(2): 268–275. (6) Am Heart J. 2013;165(4):575-582.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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