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Examiner
  • Heart disease and the gut reaction

  • When it comes to predicting the risk of heart disease, researchers are now looking at a gut reaction for help. That’s not only a way of saying they have a new hunch about predicting the risk, but there is promising new data on how the digestive tract is involved in cardio vascular disease.

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  • When it comes to predicting the risk of heart disease, researchers are now looking at a gut reaction for help. That’s not only a way of saying they have a new hunch about predicting the risk, but there is promising new data on how the digestive tract is involved in cardio vascular disease.
    Researchers from The Cleveland Clinic report a blood test measuring and assessing levels of a compound generated by the bacteria in our stomachs predict a very strong indication of our future risk of heart attacks, strokes and death.
    The research showed that high levels of the compound, called trimethylamine-N-oxide (TMAO), are directly related to a higher risk for cardiovascular problems. The researchers believe TMAO could be a significant target that may help doctors prevent or reduce the risk of heart problems. In fact, measuring TMAO levels predicted heart risk better than other blood tests or usual risk factors, such as high blood pressure, cholesterol and smoking.
    And while saturated fats and cholesterol certainly play a role in heart disease and stroke, doctors have long known there is more to the puzzle that would explain why some people who have high cholesterol never go on to develop heart disease, while others with modest levels of cholesterol have early heart attacks.
    Researchers followed more than 4,000 patients with suspected heart disease for three years. Those with the highest TMAO levels were two-and-half times more likely to have a major cardiovascular event than those with the lowest levels.
    Where does it come from? The answer will not come as welcome news to those of us who enjoy meat and eggs on a regular basis or take certain nutritional supplements. The new research shows it’s not just what we eat but how we digest it that may lead to heart disease.
    Foods such as eggs and meat have high amounts of a fatty substance called lecithin. A waste product left behind by bacteria in our guts as they help us digest lecithin produces TMAO. The TMAO enters the blood stream where it can potentially make it more likely for arteries to clog.
    In a preclinical study, researchers found that dietary choline (found in egg yolks) becomes metabolized in your digestive tract into TMAO. Carnitine, found in red meat, is another source of the compound. TMAO changes how cholesterol is managed, helping cholesterol attach to blood vessels. It also makes it more difficult for your liver and intestines to get rid of cholesterol.
    People taking carnitine supplements or consuming energy drinks could also be influencing their long-term risk of heart disease, depending on what they consume with the supplements. The study also showed that even after consuming a large amount of carnitine, vegans and vegetarians did not produce significant levels of TMAO, as did those who consumed meat and dairy on a regular basis.
    Page 2 of 2 - On the bright side, research indicates that fried food may not be too bad for the heart if cooked in olive or sunflower oil. The new blood test may help identify people who are most in need of getting preventive cardiology help. And, although the study found an association between higher levels of TMAO in the blood and increased risk of cardiovascular problems, it did not prove a cause-and-effect relationship.
    More research is needed to determine whether TMAO is just an indicator of cardiovascular risk, or an actual culprit that should be targeted in the quest for cardiovascular prevention and treatment. Doctors say the research further illustrates the complicated relationship we have with the microbes living inside us, and could lead to new ways to prevent heart attacks and strokes.
    The take-away message from this new study is the reinforcement of the current recommendations that a heart-healthy diet should contain an abundance of fruits and vegetables with little to no red meat consumption.
    David Blick, MD, FACC, practices at the Carondelet Heart Institute at St. Mary’s Medical Center.
     
     
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