The statement was published Nov. 14 in the Association’s flagship peer-reviewed journal Circulation. An AHA scientific statement is an expert analysis of current research and may inform future treatment guidelines.

Telehealth enables remote delivery of health care through technologies such as structured telephone or video support and remote monitoring of wearable or implantable devices. This kind of technology-driven health care delivery grew tremendously during the COVID-19 pandemic, with up to 30% of all U.S. clinic visits conducted via telehealth in mid-2020—showing interest in and capability of telehealth as a substitute for face-to-face patient care. However, data has shown its use has slowly declined as COVID-19 restrictions eased in late 2021.

“Telehealth is transforming the way health care is delivered by improving convenience and availability,” said the statement’s lead author Edwin A. Takahashi, M.D., an assistant professor of radiology in the division of interventional radiology at the Mayo Clinic College of Medicine in Rochester, Minnesota. “However, we learned during the pandemic when we were forced to limit in-person care that there are limitations to using telehealth.”

This new scientific statement, “An Overview of Telehealth in the Management of Cardiovascular Disease,” highlights the impact of telehealth in heart disease, stroke and peripheral artery disease (PAD) management, reviews strategies and obstacles for telehealth adoption in cardiovascular disease (CVD) care and identifies knowledge gaps.

The writing group’s review found that telehealth may:

reduce health care costs;

improve access to care in rural and underserved areas; and

increase care quality and patient satisfaction.

These benefits are especially important for people with CVD, which disproportionately affects people from underrepresented racial and ethnic groups who often have additional barriers to health care and those with less access to medical care.

Telehealth portals and smart devices may be cost-effective options for remotely managing conditions that are cardiac risk factors, such as high blood pressure and diseases like heart failure and coronary artery disease. “Telestroke,” the most studied area of telehealth in CVD, which is highly specialized stroke care delivered by first responders receiving instructions and guidance from remote stroke experts, often leads to improved rehabilitation and recovery for people who have had a stroke or may otherwise lack access to specialized stroke care.

However, challenges that may prevent more widespread telehealth use in CVD include barriers for both health care professionals and their patients.

For health care professionals, the challenges identified are:

acceptance and uptake of telehealth technology, which may vary because of health care professionals’ age, technology expertise and perceptions;

inconsistent reimbursement and licensing matters (license requirements vary by state);

logistical challenges in scheduling and maintaining workflow; and

lack of infrastructure to analyze data from remotely monitored devices.

Privacy and security are also key factors for professionals to consider. “Even though most telehealth platforms are highly encrypted,” Takahashi said, “they are not fully secure and may be at risk for data breaches.”

For people with CVD, the challenges identified are:

limited resources to access technology and devices for older adults and under-resourced populations;

health literacy barriers, including cultural and language barriers that may prevent people from using digital platforms, consumer wearables and other devices to their full capacity; and

insufficient access to internet bandwidth for a high-quality video appointment.

The statement asserts that the infrastructure for broadband internet needs to be improved, especially in rural areas that lack direct access to medical care, thereby creating a “medical desert.”

Strategies to overcome obstacles

Infrastructure, technology and reimbursement are the key areas to address barriers to telehealth use. For the approximately 25% of U.S. adults without broadband access, the statement suggests public policy changes may be helpful to supplement efforts by the private sector to expand affordability and access to internet services. An appraisal of current policy and identifying potential targets for policy reform are necessary, according to the writing group.

And as the country shifts back to in-person care, the statement encourages research into the role of telehealth beyond the pandemic. “Telehealth has the potential to have a larger role in urgent diagnosis and remote monitoring,” Takahashi said.

But reimbursement challenges need to be addressed, and simplified, as well. Not all insurance payers reimburse equally for in-person vs. telephone vs. video appointments, which ultimately lowers reimbursement for professionals who care for patients without video capability. And, as telehealth expands, there is a need for standards in how to assess the quality of telehealth care provided.

“Telehealth will play an important role in the future of cardiovascular care because the evolution of technology will enable new remote care opportunities to improve medical accessibility,” Takahashi said. “Hopefully, this will have a strong benefit for patients from historically excluded and rural communities who often face health care disparities and are most at risk for cardiovascular diseases.”

As part of the AHA’s commitment to excellence in telehealth care, the Association acquired the American Board of Telehealth (ABT), a national entity that establishes best practices and standards for telemedicine education. The American Board of Telehealth, powered by the AHA, aims to weave telemedicine into the fabric of health care delivery across the country as a vital tool in promoting access to quality care no matter where the patient is located. This scientific statement was prepared by the volunteer writing group on behalf of the AHA Association Council on Cardiovascular Radiology and Intervention, the Council on Hypertension, the Council on the Kidney in Cardiovascular Disease, and the Stroke Council. AHA scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. AHA guidelines provide the Association’s official clinical practice recommendations.

In addition to reducing LDL (or “bad”) cholesterol by about 30 per cent when accompanied by a low-saturated fat diet — a level comparable to medications — the researchers found the portfolio diet limited other factors for an estimated 13 per cent reduction in the overall risk for coronary heart disease, which includes angina and heart attack.

The portfolio diet has four main components. Based on a 2,000-calorie diet, it includes 45 grams of nuts, or about a handful; 50 grams of plant protein such as soy, or pulses like beans and peas; 20 grams of viscous soluble fiber from oats, eggplant, apples, etc.; and 2 grams of plant sterols — natural compounds that inhibit absorption of cholesterol and are often included in enriched products like margarine.

“We’ve known the portfolio diet lowers LDL cholesterol, but we didn’t have a clear picture of what else it could do,” said John Sievenpiper, an associate professor in the Department of Nutritional Sciences at the University of Toronto and a staff physician and scientist at St. Michael’s Hospital. “This study allows for greater clarity and certainty about the effects of the diet and its health potential.”

The researchers conducted a meta-analysis that combined results from seven controlled trials involving more than 400 patients, and found that specific risk factors varied from about a 2 per cent reduction (for blood pressure) to a 32 per cent reduction (for inflammation).

The findings were published in the journal Progress in Cardiovascular Diseases.

“When you look at individual trials alone, data on these other risk factors can appear random,” said David Jenkins, a professor in the Departments of Nutritional Sciences and Medicine at U of T who holds a Canada Research Chair in Nutrition and Metabolism, and who developed the portfolio diet in the early 2000s. “But when you pool the results of several trials, the risk reductions become clear and together they provide a really strong case for the cardiovascular benefits of the dietary portfolio.”

Dietary and lifestyle modifications can enable patients to manage high cholesterol and cardiovascular risk, and the current study provides further rationale for that approach. “We’re starting to say to patients, ‘This diet will help you meet your cholesterol goals, but it will also improve your blood lipids and blood pressure, and lower inflammation,'” Sievenpiper said in a news release from U of T. “The same is not true for drugs, and they often produce other effects you don’t want.”

Adherence to the diet can be challenging for some patients, but many find that incorporating just a few more plant-based foods offers noticeable benefits. “One nice thing about the diet is that the effects are additive, so adopting one or more components is better than none. It’s not an all or nothing proposition, which is why we also call it a dietary portfolio,” Sievenpiper said.

The study’s findings on inflammation are particularly exciting, Jenkins says. Growing evidence suggests inflammation plays a role in cardiovascular disease, but recent studies have linked it to a host of other diseases, including cancer. “Especially with chronic lymphocytic leukemia, prostate cancer, and other watch-and-wait diseases, reducing inflammation may greatly extend a patient’s lifetime,” Jenkins said.

Some patients also choose the portfolio diet for ethical and environmental reasons — plant-based diets generally have a smaller eco-footprint than standard Western diets — or in the case of children, to head off future health problems. “Cardiovascular and other health risk factors can be elevated in children, and we’re learning that early intervention is really important for them,” said Sievenpiper, who is also a scientist in the Joannah & Brian Lawson Centre for Child Nutrition. “There are many reasons to consider this diet, from its planetary significance to health across the lifespan.”

“While exercise is known to reduce cardiovascular disease risk, pollution can increase the risk of cardiovascular disease, including heart attacks, asthma and chronic obstructive lung disease,” said Nadine Kubesch, Ph.D., lead author and researcher at the University of Copenhagen in Denmark. “Currently there is little data on whether poor air quality cancels out the protective benefits of physical activity in preventing heart attacks.”

Researchers in Denmark, Germany and Spain evaluated outdoor physical activity levels (sports, cycling, walking and gardening) and nitrogen dioxide (NO2 pollutant generated by traffic) exposure in 51,868 adults, age 50-65, comparing self-reported activities and lifestyle factors against heart attack. Over a 17.7-year period, there were 2,936 first heart attacks and 324 recurrent heart attacks.

To estimate average NO2 exposure, researchers used national traffic pollution monitoring data for each participants’ address and found:

• Higher levels were associated with more heart attacks; however, the risk was lower among those who were physically active.
• Moderate cycling for four or more hours per week cut risk for recurrent heart attack by 31 percent; and there was a 58 percent reduction when sports, cycling, walking and gardening (together totaling four hours per week or more) were combined, regardless of air quality
• Those who participated in sports had a 15 percent lower rate of initial heart attacks and there was a 9 percent risk reduction associated with cycling, regardless of air quality.
• Compared to participants with low residential NO2 exposure, those in higher risk areas had a 17 percent increased risk in first heart attack and 39 percent for recurrent heart attack.

In particiants who developed a heart attack (first or recurrent), the average NO2  exposure level was 18.9 microgramm per cubic meter air (μg/m3) with an overall average of 18.7 μg/m3, which is below the current NO2 European Union exposure guideline (50 μg/m3 over 24 hours).

“Our study shows that physical activity even during exposure to air pollution, in cities with levels similar to those in Copenhagen, can reduce the risk of heart attack,” Kubesch said. “Our research supports existing evidence that even moderate levels of regular physical activity, such as active commuting, are sufficiently intense to get these health benefits.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at www.heart.org/corporatefunding.

About the American Heart Association

The American Heart Association is devoted to saving people from heart disease and stroke – the two leading causes of death in the world. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit www.heart.org  or call any of our offices around the country.

But you can take action now to help prevent problems. Resources from the U.S. Food and Drug Administration (FDA) can help women of all ages learn how to use FDA-approved drugs and devices safely to prevent and treat heart disease.

The FDA offers fact sheets, videos, and other web-based tools to teach you not only about heart disease, but also conditions like diabetes and high blood pressure, which can increase a woman’s heart disease risk.

The FDA also created the “Heart Health for Women” site to connect women to FDA resources to support heart-healthy living. Click here to learn more.

“The risk of heart disease increases for everyone as they age,” explains FDA cardiologist Shari Targum, M.D., M.P.H. “For women, the risk goes up after menopause, but younger women can also develop heart disease.”

But remember you can fight back. “I encourage women of all ages to look to the FDA for resources to help them reduce their risk for heart disease and make informed decisions about their health,” says Marsha Henderson, director of the Office of Women’s Health at FDA.

Tips to Reduce Your Risk

Heart disease can lead to serious or fatal health issues such as a heart attack or stroke. But you can take steps to reduce your chances of a problem. Even small changes can help.

Manage current health conditions. Diabetes, high blood pressure, and high cholesterol can increase your risk for heart disease. Talk to your health care provider to confirm the best treatment plan.

Know that daily use of aspirin is not right for everyone. Talk with a health care professional before you use aspirin as a way to prevent heart attacks. If aspirin is right for you, find out: how much you should take, how often you should take it and how long you should take aspirin. Some products combine aspirin with other ingredients and are not meant for long-term use. You should also tell your healthcare provider about all of the medicines and supplements you take. Your risk of bleeding may be higher if you use aspirin with also taking certain medicines, vitamins, or herbs.

Recognize symptoms of a heart attack in women—and call 9-1-1 if needed. Symptoms in women can be different than those in men—and include shortness of breath, nausea, and an ache or feeling of tightness in the chest, arm, neck, jaw or abdomen. “If you have these symptoms and suspect you’re having a heart attack, call 9-1-1,” says Targum.

Do regular physical activity and maintain a healthy weight. You don’t need to complete all activity at one set time—and it’s okay if you’re not a fan of the gym. “Walking may be one easy way to start,” says Targum. “Talk to your health care provider about how much activity is right for you.”

Make heart-healthy food choices. “For example, you can eat fruits or vegetables with each meal—and limit saturated fat and sugary beverages like soda,” says Targum, who also emphasizes a focus on whole grains. And if you choose to eat meats, choose the leanest cuts available and prepare them in healthy ways. The Nutrition Facts label can tell you key information about the packaged foods you eat, and it includes details about serving sizes and nutrients like fat and sugar. You can check with your health care provider to confirm the food choices best for you.

If you smoke, try to quit. Check out the FDA’s resources to learn more about medicines to help you quit.

Talk to a health professional about whether you can participate in a clinical trial for a heart medication or procedure. A clinical trial is a research study that involves human volunteers. You can visit the FDA’s Women in Clinical Trials page to learn more.

Menopause and Heart Health

“Menopause does not cause heart disease,” says Targum. “But the decline in estrogen after menopause may be one of several factors in the increase in heart disease risk.”

Other risks, such as weight gain, may also increase around the time of menopause.

Hormone therapy can be used to treat some of the problems women have during menopause. “However, the American Heart Association recommends against using post-menopausal estrogen hormone replacement therapy to prevent heart disease,” says Targum.

Make a Plan, Take Action

Work with your health care team to make a plan for your heart health. No matter what routine you choose, make sure to keep a list of your medicines and supplements and bring it with you to all of your appointments. Also talk to your health care provider if you have any questions.

This article appears on FDA’s Consumer Updates page. Click here to see more updates.

At issue in the analysis published Monday in the Journal of the American College of Cardiology is the “risk calculator,” which aims to help identify people who may face a high risk for cardiovascular events within 10 years. The study authors found that the calculator overestimated risk in the specific population in which they chose to apply it.

However, some medical experts were quick to criticize the new study itself, saying the research methods used were flawed so that the findings about the calculator must be dismissed for the general population.

This isn’t the first time the risk calculator has been the focus of debate in scientific and medical circles. When it was first unveiled by the American Heart Association and American College of Cardiology in 2013, some critics questioned its accuracy, although subsequent studies have found it to be very useful in identifying high-risk patients.

The authors of the analysis published Monday said the calculator needs some reworking.

“Our study provides evidence to support recalibration,” they said. “Ongoing research and dialogue in this area remains crucial and should be encouraged to provide more rigorous, valid evidence in contemporary, diverse populations.”

However, Dr. Donald Lloyd-Jones, who served on the expert panel that helped create the risk calculator, took issue with the new study’s approach and findings. Lloyd-Jones, the senior associate dean for clinical and translational research and chair of the department of preventive medicine at the Northwestern Feinberg School of Medicine in Chicago, said the study authors erred by excluding hundreds of people who were at high risk.

The study examined the calculator’s results for about 312,000 people treated by Kaiser Permanente Northern California over five years addressing risk factors including cholesterol, blood pressure, weight, smoking status, physical activity, blood sugar and diet.

Researchers examined the health records of the participants, who were between the ages of 40 and 75 and did not have existing cardiovascular diseases at the beginning of the study.

The 312,000 study participants were chosen from 4 million people treated within Kaiser Permanente Northern California. Approximately 86,000 people who received cholesterol-lowering statins during five years of follow-up were excluded. Nearly 256,000 people were excluded because they hadn’t been in the healthcare system or had pharmacy benefits for more than a year.

This tended to skew the sample toward heavily engaged people who were already receiving intensive preventive care, Lloyd-Jones said.

“Every step they took moved the study towards finding the result they were looking for,” Lloyd-Jones said.

The strongest evidence that the analysis is skewed is that the study population had a 1.4 percent prevalence of diabetes, Lloyd-Jones said. That compares to about 10 percent for the general U.S. population, a disparity that Lloyd-Jones said indicates the people studied generally were far healthier and at lower risk than the usual primary-care population.

Lloyd-Jones said he has seen a pattern across published studies analyzing the risk calculator: It tends to overestimate the risk in people who are later found to exhibit more healthy behaviors and measurements; and it underestimates risk for people who are shown to have more health risks.

And that’s fine, Lloyd-Jones said, because the whole purpose of the calculator is to be an initial screening device that leads to the next step of an in-depth and more personal discussion with the patient.

“The cholesterol guidelines say use this tool as the starting point for a conversation, then bring your patient’s individual characteristics in to help you make a decision,” he said.

Other studies have found the calculator to be effective.

A December 2015 study  found it to be superior to two other methods in predicting the risks of atherosclerotic cardiovascular disease. The study used records from nearly 38,000 people participating in the Copenhagen General Population study, ages 40 -75 who did not have atherosclerotic cardiovascular disease, diabetes or take statins when they enrolled.

A 2014 analysis published in JAMA: Journal of the American Medical Association found that the calculator predicted risk very accurately in a broad, representative sample of the U.S. population and ranked people most likely to have cardiovascular events.

Researchers in that study, including Lloyd-Jones, applied the calculator to data from nearly 11,000 whites and African-Americans, ages 45-79 without existing atherosclerotic cardiovascular disease, and examined the overall group as well as those without diabetes or taking statins upon enrollment. This study population closely mirrored the U.S. population, Lloyd-Jones  said.

The paper describing the risk assessment equation used by the calculator was included as one of four new ACC/AHA prevention guidelines. The cholesterol guidelines recommend that the 10-year risk of heart attack and stroke should guide treatment, instead of a cholesterol number.

While Lloyd-Jones defends the calculator, he also pointed out that criticism is an expected part of scientific progress, and expects further improvements over the years.

“From a broad perspective, this is exactly what should happen,” he said. “Any time we use something new based on science, people should poke and prod at it, see what works and what may be a weakness. That’s how we keep improving ways to treat our patients. But any changes should be based on the best science.”

The finding was published in the European Heart Journal.

Takotsubo syndrome (TTS) is known as “broken heart syndrome” and is characterised by a sudden temporary weakening of the heart muscles that causes the left ventricle of the heart to balloon out at the bottom while the neck remains narrow, creating a shape resembling a Japanese octopus trap, from which it gets its name. Since this relatively rare condition was first described in 1990, evidence has suggested that it is typically triggered by episodes of severe emotional distress, such as grief, anger or fear, with patients developing chest pains and breathlessness. It can lead to heart attacks and death.

Now, for the first time, researchers have systematically analyzed data from the largest group of patients diagnosed with TTS worldwide, and found that some patients have developed the condition after a happy or joyful event; they have named it “happy heart syndrome.”

In 2011, Dr Christian Templin, principle investigator and consultant cardiologist, together with Dr Jelena Ghadri, resident cardiologist, established the first International Takotsubo Registry the University Hospital Zurich in Switzerland. For this study they have analysed data from the first 1750 patients registered from the 25 collaborating centres in nine different countries.

They found 485 patients where there was a definite emotional trigger. Of these, 20 (4%) had TTS that had been precipitated by happy and joyful events, such as a birthday party, wedding, surprise farewell celebration, a favourite rugby team winning a game, or the birth of a grandchild; 465 (96%) had occurred after sad and stressful events, such as death of a spouse, child or parent, attending a funeral, an accident, worry about illness, or relationship problems; one occurred after an obese patient got stuck in the bath.

Ninety-five percent of the patients were women in both the “broken hearts” and “happy hearts” groups, and the average age of patients was 65 among the “broken hearts” and 71 among the “happy hearts”, confirming that the majority of TTS cases occur in post-menopausal women.

“We have shown that the triggers for TTS can be more varied than previously thought,” Ghadri said. “A TTS patient is no longer the classic broken-hearted patient, and the disease can be preceded by positive emotions too. Clinicians should be aware of this and also consider that patients who arrive in the emergency department with signs of heart attacks, such as chest pain and breathlessness, but after a happy event or emotion, could be suffering from TTS just as much as a similar patient presenting after a negative emotional event. Our findings broaden the clinical spectrum of TTS. They also suggest that happy and sad life events may share similar emotional pathways that can ultimately cause TTS.”

The researchers found that “happy heart” patients were more likely to have hearts that had ballooned in the mid-ventricle than “broken heart” patients (35% versus 16%). Although this is a new and interesting finding, the small number of patients in this group means that more research needs to be conducted in order to discover whether or not it sheds any light on the mechanisms involved in TTS.

Templin said further research was needed to understand the exact mechanisms underlying both the “broken” and “happy” heart variants of TTS.

1. Take care of the basics

A healthy diet and exercise regimen are essential for a healthy heart. There’s no way around it. Most of the main predictors for heart disease, including hypertension, high blood cholesterol, diabetes, obesity, and physical inactivity can be modulated with diet and exercise. For some tips, the American Heart Association has an excellent guideline for a heart-healthy diet, and they recommend at least 150 minutes of moderate physical activity each week.

On top of preventing heart disease, research also shows that certain foods and regular exercise can make you happier. In a study of more than 12,000 subjects, people who consumed the most processed foods like fries, fried chicken, cookies, and cakes were 37% more likely to become depressed than people who avoided junk foods. On the other hand, Mediterranean diets slow the rate of neuropsychological decline compared to diets low in vegetables and high in animal fat. Exercise can make these mood and cognitive benefits even more pronounced. In the short-term, a good exercise session can improve your mood for about four hours, but regular exercise long-term has the potential to improve mood and self-esteem, and slow the progression of diseases like Alzheimer’s and Parkinson’s.

2. Invest in positive relationships

Emotionally supportive relationships, characterized by caring, sympathy, and understanding, keep your heart healthy. In fact, the degree to which you feel loved in your relationships affects your risk for atherosclerosis, or hardening of the arteries, and how quickly it advances. Research also shows that negative close relationships increase the risk for coronary heart disease even more than positive relationships can protect you from it. That’s because negative interactions carry heavy risks for depression, reduced self-esteem, and anger, all of which lead to inflammatory and immune stress responses that damage your organs.

Ultimately, it’s important for you to feel valued, so do your heart a favor by seeking supportive relationships and managing negative ones, whether that means repairing them, distancing yourself, or asking for outside help. Recognize, also, that relationships are a two-way street. In a study of individuals above 70 years old, something as trivial as helping others with small tasks and making them feel like help is available when they need it has been shown in research to prolong life for both parties.

3. Limit your work stress

Work can come with a lot of heart-damaging stress, especially since most of us spend the majority of our waking hours working. Maybe you have little control over your job prospects. Maybe you lack support from your colleagues. Maybe you experience an unfairly low pay rate. Or maybe you feel a lack of due recognition. These circumstances have all been found in research to be associated with risk factors for coronary heart disease like high LDL cholesterol levels and hypertension. In a study of more than 10,000 subjects, a chronic (5-year) effort-reward imbalance at work independently doubled the risk of new coronary heart disease.

Even if this speaks to your personal situation, there are certain things you can do to help your heart. Effective modifications include giving up an over-commitment to work. You may just be exhibiting too much need for control. Also, you can try stress-relieving techniques like regularly performing progressive muscular relaxation, listening to your favorite music, and monitoring emotions that might be counterproductive. Instead of bottling up stress, that energy can be used instead to remind yourself that you can always freshen your perspective, stimulate conversations with your colleagues about structural changes at your company, and even hone in on transferrable skills that can land you a more rewarding job. Coping with problem-solving tactics protects your heart from the damages of stress.

4. Tune in to your feelings

Research shows that tuning in to your emotions, being self-aware, and remaining optimistic are all keys to a healthy heart. You’ve likely felt your pulse racing at a time when you were very defensive, scared, or angry. That’s because hostility, anxiety, and anger are highly reactive emotions that increase your body’s stress response. As a result, your body can lose some control of your heart rate and initiate processes that promote blood clots and high blood pressure, both of which contribute to an increased risk for a heart attack. The hopeful news is that social support has been shown to decrease these disease risks, even for Type A (‘hostile’) and Type D (‘distressed’) people who tend to veer towards reactive responses. Another negative emotion, depression, also acts as a strong risk factor for heart disease and can benefit from social involvement.

Before stressful events come along, it’s critical that you have modes of support set up. Counseling and other uplifting relationships and activities can help you explore unhealthy emotional responses and encourage practical problem-solving, which will give your optimism a healthy boost. Quite interestingly, research studies have linked high levels of optimism with lower levels of blood pressure and higher levels of circulating immune cells that help the body defend against stress. A tendency towards forgiveness has also been proposed in research to affect physiological health.

5. Make meaningful life goals

As mentioned when discussing work stress, lowering one’s over-commitment to work can increase happiness and protect your heart’s health. More broadly though, extrinsic success goals in general, which include pursuing the ability to buy things, impressing or controlling others, and succeeding in a job, negatively relate to life satisfaction. In research, focusing on material goals predicts a whole slew of heart disease risk factors like depression, anxiety, low life contentment, disrupted sleep, and emotional disturbances. Health, in contrast, was found to be higher in people with more intrinsic goals like relational intimacy – deep interpersonal relationships built on trust and affection – and generatively – giving of oneself to others and being concerned for future generations. These pursuits, along with prayer, meditation, and reading spiritual texts have been shown in research to support health and happiness, especially when individuals were faced with making meaning of and adjusting to change and adversity.

When the cardiovascular system is studied specifically, research finds that people who practice self-reflection and live consistently with intrinsic life goals have lower levels of heart disease risk. The  potential inadvertent health benefits of a relationally-oriented and generous life are many. The list includes less cigarette smoking, lower cholesterol, lower blood pressure, more physical activity, less alcohol abuse, better diets, lower stress levels, greater social support, lower hostility and anxiety, greater optimism and hope, and greater well-being overall.

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Q. What are non-steroidal anti-inflammatory drugs (NSAIDs)?

A. NSAIDs are a group of drugs used to temporarily relieve pain and inflammation. They work by blocking the production of prostaglandins, or chemicals believed to be associated with pain and inflammation.

Q. What conditions do NSAIDs treat?

A. Prescription NSAIDs are important to help manage many debilitating conditions such as osteoarthritis and rheumatoid arthritis. Some prescription NSAIDs also are used to treat pain. Over-the-counter versions of some NSAIDs are used to treat pain associated with dental problems, tendonitis, strains, sprains and other injuries. NSAIDs are also commonly used to treat fever and to reduce pain associated with menstrual cramps.

Q. What are non-selective NSAIDs and COX-2 selective NSAIDs?

A. Non-selective NSAIDs work by inhibiting two enzymes that are involved with inflammation—cyclooxygenase-1 and cyclooxygenase-2 (COX-1 and COX-2).

There are several non-selective NSAIDs on the market, including diclofenac, ibuprofen, ketoprofen, meloxicam, naproxen, and oxaprozin. Ibuprofen and naproxen are available in both prescription and over-the-counter (OTC) versions. The doses in OTC NSAIDs are lower than the doses of prescription versions and should only be used for up to 10 days without seeing a doctor. So, if you take OTC ibuprofen (Advil and Motrin) or naproxen (Aleve), the doses are about half the doses of prescription versions.

COX-2 selective inhibitors are a newer type of medicine that block the COX-2 enzyme more than the COX-1 enzyme. The only COX-2 selective inhibitor currently on the market in the United States is the prescription drug Celebrex (celecoxib), which is marketed by Pfizer. It was believed that COX-2 inhibitors may be less likely to cause the stomach problems associated with the older NSAIDs, but all NSAIDs carry the risk of stomach problems.

Q. What are the risks of taking NSAIDs?

A. As with all drugs, there is the potential for an allergic reaction to NSAIDs. Symptoms might include hives, facial swelling, wheezing and skin rash.

There is the potential for gastrointestinal bleeding (bleeding in the stomach or elsewhere in the digestive tract) associated with all NSAIDs. The risk of bleeding is low for people who use NSAIDs intermittently. The risk of stomach problems goes up for people who take them every day or regularly, especially for people who are older than 65, people with a history of stomach ulcers, and people who take blood thinners or corticosteroids (prednisone). Alcohol use can also increase the risk of stomach problems.

In addition, using all NSAIDs, except for aspirin, increases the risk of heart attack or stroke. These serious side effects can occur as early as the first few weeks of using an NSAID, and the risk might rise the longer people take non-aspirin NSAIDs.

All NSAIDs also carry the risk of potential skin reactions. Patients should be alert for symptoms such as skin reddening, rash or blisters.

Aspirin is a non-selective NSAID and has been shown in clinical trials to reduce the risks of certain cardiovascular events in patients who have cardiovascular disease or who have already had a heart attack or ischemic stroke. Aspirin is sold in generic forms and under brand names such as Bayer and St. Joseph’s.

Q. Which people are at highest risk for cardiovascular adverse events associated with NSAIDs?

A. People who have cardiovascular disease—particularly those who recently had a heart attack, cardiac bypass surgery or stroke—are at the highest risk for adverse events. According to studies, people who have already had a heart attack are at an increased risk of having another heart attack or dying of heart attack-related causes if they’re treated with NSAIDs, other than aspirin.

Q. Which Cox-2 selective inhibitors have been taken off the market?

A. Merck voluntarily withdrew Vioxx (rofecoxib) in 2004 after finding out the results of a study that showed patients who took Vioxx had a higher risk for heart attacks than patients who took a placebo. FDA asked Pfizer to withdraw Bextra (valdecoxib) from the market in 2005 because the overall risk/benefit profile was unfavorable. The request was based on many factors. Along with the other risks associated with NSAIDs, there was a higher than expected number of reports of serious and potentially life-threatening skin reactions, including death.

An increased risk of cardiovascular adverse events has been shown for all COX-2 inhibitors, including Celebrex, which is still on the market in the United States. Based on available data, FDA determined that the benefits of Celebrex outweigh the potential risks in properly selected and informed patients. FDA asked Pfizer to include a boxed warning on the Celebrex label, and asked manufacturers of all prescription NSAIDs to revise their labeling with a boxed warning too. The boxed warning highlights the potential for increased risk of cardiovascular events as well as serious, potentially life-threatening gastrointestinal bleeding. It is important to know that FDA also determined that the risk for cardiovascular events was most likely present for the non-selective NSAIDs as well, and all of the manufacturers of these drugs were asked to add important warnings to their labels.

Q. What can consumers do to lower their risks with NSAIDs?

A. Tell your doctor about your complete medical history, including any history of cardiovascular disease or stomach ulcers. This will help you and your doctor weigh the risks and benefits. You can also ask your doctor what you can do to lessen the chance for stomach irritation such as taking medication with a meal. Also, ask what steps you can take to lower the risk of cardiovascular disease and report medication side effects to your doctor. Whether you’re taking a prescription NSAID or an OTC NSAID, following directions is important. Available scientific data don’t suggest an increased risk of serious cardiovascular events for short-term, low-dose use of OTC NSAIDs, but it is not known if that is because there is no risk or because there are many challenges when trying to study the use of OTC NSAIDs. Be aware that the OTC labeling states that if you take an NSAID for longer than 10 days, you should see your doctor. The lowest effective dose should be used for the shortest time.

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

“Aging affects everyone and causes changes throughout our bodies,” said Erika Boerman, PhD, a post-doctoral fellow in the Department of Medical Pharmacology and Physiology at the University of Missouri School of Medicine and lead author of the study. “The purpose of our study was to understand how blood vessels are affected by this process. We found that older arteries had a significantly lower number of sensory nerves in the tissues surrounding them and they were less sensitive to an important neurotransmitter responsible for dilation.”

Boerman’s study focused on mesenteric arteries ― a type of artery that supplies blood to the small intestines ― of mice that were 4 months and 24 months old. These ages correspond to humans in their early 20s and mid-60s, respectively. Without stimulation, the diameter of the blood vessels of both younger and older mice was approximately the same. However, when stimulated to induce dilation, differences between the age groups became apparent.

“The younger arteries dilated as expected,” Boerman said. “However, when we performed the same stimulation to the arteries of older mice, the vessels did not dilate. When we examined the presence of sensory nerves, we noted a 30 percent decrease in the amount surrounding the older arteries compared to the younger arteries.”

According to a news release from the medical school, the researchers found that even when purposefully exposing older mesenteric arteries to defined amounts of the neurotransmitter calcitonin gene-related peptide, or CGRP, the arteries’ ability to dilate was greatly reduced.

“Poor neurotransmitter function and a reduced presence of sensory nerves surrounding older vessels lead to age-related dysfunction of mesenteric arteries,” Boerman said. “The importance of this discovery is that if we can identify why this happens to mesenteric arteries, it may be possible to prevent the same thing from happening to other blood vessels throughout the body.”

More research is needed to understand why aging affects sensory nerve distribution and neurotransmitter performance. However, identifying this new mechanism of vascular dysfunction opens the door for future studies that could eventually lead to the treatment of health issues such as stroke and cardiovascular disease.

The findings were published in the Journal of Physiology.