Testosterone and the Heart

If you are a man, at some point in your life you are likely to be a candidate for hormone replacement therapy. As we age, our testosterone levels decline, and with them often a number of physical and psychological characteristics. It has long been understood that low testosterone levels can be linked to reduced libido, sexual dysfunction, diminished energy, and a reduced overall sense of well-being. For these reasons, replacement therapy with testosterone drugs is a strong and steadily growing area of medicine for aging men.

Beyond these basic facts, testosterone remains a controversial drug. Its abuse is linked to changes in the body that may increase the likelihood of cardiovascular disease, and partly because of this, the potential benefits and risks of testosterone replacement therapy have long been the subject of much debate. Is this therapy actually safe?

In recent years, evidence has been surfacing that testosterone replacement may actually reduce cardiovascular disease risk. Usually isolated in scope, these papers concern many favorable changes in cardiovascular health markers, such as the management of triglycerides and cholesterol.

One of the first potential benefits of testosterone replacement therapy (TRT) -  is the management of triglyceride and cholesterol levels. As detailed in a growing number of studies, testosterone replacement therapy consistently improves the lipid profile in men with hormone deficiency. The most consistent endpoints of improvement appear to be a reduction in total cholesterol, a reduction in LDL (‘bad’) cholesterol, and a lowering of serum triglycerides. The improvements in lipid profile appear to be more pronounced in older men, although both young and old populations tend to show improvements in serum lipids when testosterone is given to correct a deficient state.

The effect of TRT on HDL (‘good’) cholesterol levels is less consistent. Studies giving testosterone gels, patches, or the longest-acting ester (testosterone undecanoate) tend to show improvement or no consistent effect on HDL. Studies with the more common esters such as cypionate and enanthate tend to show minor decreases in HDL during therapy, likely owing to the brief supraphysiological peaks for several days after administration. Note that HDL is often improved when TRT is combined with exercise and other lifestyle modifications.

Androgen deficiency is associated with an increase in certain inflammatory markers that can support the progression of atherosclerosis. Testosterone replacement therapy has been shown to reduce some of the same inflammatory mediators, specifically TNF-alpha (tumor necrosis factor-alpha) and IL-1B (interleukin-1beta). Inflammation in the vascular system is an especially important concern with heart disease. For one, vascular inflammation is associated with the deposition of arterial plaque, a key component of this disease. Inflammation of the blood vessels may also damage the arteries, making them both thicker and weaker. Scarring may be noticed, and blood flow may be reduced. All of this can restrict blood flow and reduce the heart’s blood pumping capacity. By helping to reduce the production of TNF-alpha and IL-1B, hormone replacement therapy may reduce inflammation, vascular damage, and the chance for atherosclerosis. Again, instead of seeing a neutral or ‘negative’ effect, we find a specific improvement in the cardiovascular disease risk profile with the administration of this drug.

A growing number of studies have linked androgen deficiency to insulin resistance, as well as increased abdominal obesity. These two factors are also common with men suffering from cardiovascular disease, and may directly contribute to (among other things) endothelial cell dysfunction and vascular damage. Androgen substitution has been shown in several studies to reduce midsection fat deposits, increase glucose tolerance, and improve the overall metabolic state. It has additionally been postulated that due to the important role of testosterone in managing insulin sensitivity, androgen deficiency may be a contributing factor to adult-onset (type 2) diabetes. Likewise, the substitution of testosterone in aging men with hypogonadism might reduce the likelihood of developing diabetes.

The endothelium is a layer of cells that lines the blood vessels throughout the entire circulatory system. These cells are responsible for managing the passage of some materials in and out of the blood vessels, and supporting the flow of blood through the system. Endothelial cells play a role in vasoconstriction and vasodilation, they regulate certain inflammatory processes, and they’re involved in blood clotting and in supporting the formation of new blood vessels. Endothelial dysfunction is linked to androgen deficiency in men, and may result in elevated blood pressure (hypertension), vascular ‘stiffness,’ and significantly increased risk of cardiovascular disease. Likewise, replacement of testosterone in men with a deficiency has been shown to improve endothelial function, blood vessel dilation, arterial vasoreactivity, and blood flow.

One additional important ‘endpoint’ of improvement to this therapy appears to be an increase in endothelial progenitor cell activity, which helps repair damage to the vascular system.

 Traditionally, most physicians are extremely cautious with testosterone drugs. Many family doctors are very willing to prescribe estrogens to their female menopausal patients complaining of symptoms such as sexual dysfunction, but when it comes to their male patients with similar complaints, the response is often different. Many of these same physicians are much more willing to prescribe a drug like Viagra than the basic male androgen testosterone. Some mistakenly consider testosterone to be ‘too dangerous’ to give most of their patients, and reserve its use for extreme cases. And when testosterone is considered, it is given only for a very narrow and specific set of psychological or physical symptoms.

It seems clear that we can no longer paint testosterone as simply a ‘bad’ hormone for the cardiovascular system. While excessive high-level elevations of this hormone may indeed damage an individual’s cardiovascular health, we have strong evidence that within a certain physiological range, it may also protect the cardiovascular system from some of the same health issues. As such, its replacement may indeed turn out to be very important medical intervention for millions of men across the country, helping us to not only live better— but also live longer.

After all this time, it appears that this very controversial hormone, the same steroid demonized in the media, might actually help reduce the risk of cardiovascular disease in aging male patients. The study we reviewed this month is, likewise, something all men should take to heart— literally.

Drink Water, Lose Weight

One of the most familiar pieces of weight-loss advice is also among the simplest: Drink lots of water. It makes you feel fuller, for one, so you don't eat as much junk later on (and maybe you won't drink sodas or other sugar-filled drinks).

Now, a new study adds some scientific heft to that advice. People who drank more water, researchers found, stayed slimmer than those who drank less. The study followed more than 120,000 people for about two decades, checking in on their lifestyle habits and weight every four years.

Overall, people in the study gained a small amount weight during each four-year span. But each cup of water a person drank per day meant they gained, on average, nearly three-tenths of a pound less during that time. The more water they drank, the less weight they put on – a noteworthy finding for a study that, for most participants, spanned a large chunk of middle age.

Fruit juice and sugar-sweetened beverages like soda, on the other hand, made participants gain more weight; each cup per day led to half a pound and four-fifths of a pound more weight gain in four years, respectively. Subbing water for a sugary drink, then, would likely have an even bigger impact, says An Pan, a public health researcher at the National University of Singapore who helped lead the study. Swapping a 12-ounce soda for a large glass of water every day would lead to a 1.25-pound smaller weight gain over four years.
If you tire of constantly sipping plain water, the researchers found that coffee had a similar slimming effect, too – though unlike water, it's easier to drink too much joe, which can have some downsides.

High Smog Levels Tied to Serious Heart Problems

High levels of particulate air pollution - commonly known as smog - raise the risk of heart attack and other serious heart problems, according to a new study.

Particulate air pollution refers to tiny particles in the air known as PM10. The European Union's PM10 safety threshold is 50 micrograms per cubic meter (mcg/m3), but this study suggests that the harmful effects of PM10 may occur below that level.

The researchers compared data on average daily concentrations of PM10 in Brescia, Italy, between 2004 and 2007 and daily hospitalizations for cardiac events during that period. They found a significant association between PM10 levels and the number of admissions for heart attack and other acute coronary syndromes (an umbrella term for conditions where blood supply to the heart muscle is suddenly blocked), heart failure, worsening heart failure and heart rhythm disorders. For every 10-microgram increase in PM10 levels, there was a 3 percent increase in hospital admissions for serious heart problems, according to the study.

The researchers also found that men and people older than 65 were especially vulnerable to having acute coronary syndromes or heart rhythm disorders with increasing PM10 levels. In addition, people who had previously been hospitalized for heart problems were more likely to be admitted to the hospital with heart problems when PM10 levels were higher. "We need to pay particular attention to protecting patients who are older and who have had a previous heart attack or other heart problem, as they are more vulnerable to having another cardiac event," study author Dr. Savina Nodari said.

"Previous studies support the hypothesis that air pollution may increase cardiovascular-event rates because PM10 can induce processes that are bad for the heart, including inflammation and coagulation," she added.

Nodari said the current PM10 threshold is too high, and the cutoff should be reduced to 20 to 30 mcg/m3 or less, "because, like cholesterol, the risk is continuous -- the higher the levels the greater the risk. If we can obtain a lower level of PM10 probably we will lower the risk of heart disease."

Low arsenic levels linked with heart disease

Exposure to even low levels of arsenic in drinking water and food may increase the risk of developing, and dying from, heart disease, a new study suggests.

In the study, researchers analyzed urine samples from 3,575 American Indians in Arizona, Oklahoma and North and South Dakota, living in regions where arsenic levels in drinking water were "low to moderate," meaning they were above the limit set by the U.S. Environmental Protection Agency, which is 10 micrograms per liter, but below 100 micrograms per liter.

Urine samples were collected between 1989 and 1991, and the participants were divided into four groups based on the concentration of inorganic arsenic in their urine. (There are two types of arsenic, organic and inorganic, inorganic arsenic is thought to be more toxic).

The participants were followed until 2008, and those in the group with the highest urine arsenic concentrations were 32 percent more likely to develop cardiovascular disease, and 65 percent more likely to die from the condition over the nearly 20-year period, compared to the people in the group with the lowest arsenic urine concentrations.  The findings held after the researchers took into account certain risk factors for heart disease, such as smoking and high body mass index. However, the strength of the link declined slightly after the researchers took into account other risk factors: high blood pressure, diabetes and liver disease, suggesting that these factors may explain part of the link between arsenic exposure and cardiovascular disease risk, the researchers said.

While previous studies have linked high levels of arsenic exposure to increased risk of cancer and heart disease, few studies have looked at the effects of low to moderate exposure.

In 2001, the EPA estimated that the drinking water of 13 million Americans had arsenic levels above the limit of 10 micrograms per liter. People can also consume the element through their food, although no limit has been set for food.

Recently, the Food and Drug Administration set a limit for the amount of arsenic in apple juice, but has not done so for food. Concerns have been raised over levels in rice, but after testing, the agency said that levels of arsenic in rice were too low to pose health risks over the short term, although it said more research on the long-term health effects is needed.

"Given the large population exposed, even a modest increased risk of cardiovascular disease due to arsenic could have important public health implications,", "These findings support the importance of low to moderate arsenic exposure as a cardiovascular risk factor with no apparent threshold," they said.

Because the study involved American Indian populations, who are at an increased risk for diabetes, the findings would be particularly applicable to other groups that also have a high diabetes risk, said study researcher Dr. Ana Navas-Acien, an associate professor of environmental health sciences and epidemiology at Johns Hopkins Bloomberg School of Public Health.

The results are based on a single measurement of urine arsenic levels, which took place at the study's start, so it's not clear if the study participants' levels would have remained the same over time. However, a separate analysis done by the researchers showed that the measurement taken at the study's start was generally consistent with measurements taken at two other points.

It's not clear how arsenic exposure might increase the risk of heart disease, and the study cannot prove that arsenic exposure causes heart disease. Diabetes, high blood pressure and liver disease which were more common among those with the highest urine arsenic concentrations could play a role.

It could also be that some other factor, related to both arsenic exposure and cardiovascular disease risk, could explain the link, Navas-Acien said. Studies in animals suggest that arsenic exposure increases the risk of developing plaques in the arteries, or arteriosclerosis, which can cause heart disease.

Heart attack damage repaired using gene therapy

Heart attacks cause cells in the affected area to stop beating and become encased in scar tissue, but researchers believe the damage may not be permanent.
Using a combination of genes they were able to coax the scar-forming cells into a state which closely resembles healthy, beating heart cells, suggesting the condition is reversible.
The scientists, from the Gladstone Institutes in America, had already demonstrated their technique on mice but have taken a step further by doing the same to human heart cells in a laboratory.
The study is a "proof of concept" that the scar-forming cells, known as fibroblasts, "can be reprogrammed successfully into beating heart cells," and mend the heart from within, they said.
Dr Deepak Srivastava, who led the study, explained: "Fibroblasts make up about 50 per cent of all cells in the heart and therefore make up a vast pool of cells that could one day be harnessed and reprogrammed to create new muscle.
"We've now laid a solid foundation for developing a way to reverse the damage – something previously thought impossible – and changing the way that doctors may treat heart attacks in the future."
The researchers reported last year that by injecting three genes, known as GMT, into the hearts of live mice, they could turn the scar-forming fibroblasts into beating heart cells.
The new heart muscle cells beat in time with neighbouring cells and improved the heart's ability to pump blood around the animals' bodies.
Attempts to replicate the findings in human heart tissue initially failed, but by adding a further two genes to the mix the team was able to achieve similar results.
Dr Ji-dong Fu, one of the authors of the study, which was published in the Stem Cell Reports journal, said: "While almost all the cells in our study exhibited at least a partial transformation, about 20 per cent of them were capable of transmitting electrical signals — a key feature of beating heart cells.
"Success rates might be improved by transforming the fibroblasts within living hearts rather than in a dish – something we also observed during our initial experiments in mice."
The researchers intend to test the five-gene mixture in larger live mammals, such as pigs, and eventually to develop a combination of drug-like chemicals which could achieve the same effect but would be safer and easier to administer.
Figures released by the British Heart Foundation last year revealed that the number of patients who are surviving heart attacks has increased dramatically over the past decade.
Some 70 per cent of women and 68 per cent of men in England now live through the ordeal, compared with just a third of all cases in the 1970s.
However, about 750,000 people in the UK are now living with heart failure, a condition where the heart muscle is so damaged by a severe heart attack that it cannot function properly, which kills three quarters of patients within five years.
Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: “This research represents a small but significant step forward. Last year these scientists had a real breakthrough when they turned fibroblasts - the cells that form scarred heart tissue - in the hearts of mice into beating heart cells, by injecting them with a ‘cocktail’ of different genes.
“Now, using a different combination of genes, they have managed to turn human fibroblasts into beating heart cells in a culture dish. This process is still a long way from the clinic, but advances like this bring us closer to the likelihood that we could one day use these techniques to mend human hearts.”

Turmeric compounds improve heart health

Turmeric compounds improve heart health as much as exercise.

A chemical that naturally occurs in turmeric root appears to improve heart health as much as moderate aerobic exercise.

Turmeric root has been an important component of traditional Asian medicinal systems for hundreds of years. In recent decades, scientific studies have confirmed the potent anti-inflammatory and anti-oxidant properties of the trio of turmeric chemicals known as "curcuminoids," which give the root its distinctive yellow-orange color. Although only one of these chemicals is properly known as "curcumin," the name is commonly used to refer to all of them collectively.

The three new studies all compared the effects of exercise and curcumin on heart health and postmenopausal women over an eight-week period. All the studies were randomized, double-blind and placebo-controlled. Curcumin was delivered by means of colloidal nanoparticles.

Can turmeric prevent heart disease?

In the first study, researchers assigned 32 women to either take a curcumin supplement, engage in moderate aerobic exercise training, or undergo no intervention at all. The researchers measured participants' vascular endothelial function - the responsiveness of the layer of cells that line the blood vessels, a key indicator of overall cardiovascular health - both at the beginning and end of the study. They found that while there was no improvement in the control group, endothelial function significantly increased in both the exercise and curcumin groups. Most surprisingly, the improvement in the two experimental groups was identical.

The second study examined curcumin's effects on the responsiveness of arteries to changes in blood pressure ("arterial compliance"), another key measure of cardiovascular health. In this study, 32 women were randomly assigned to receive either a curcumin supplement or a placebo pill, or to undergo an exercise routine plus either a curcumin or placebo pill. The researchers found no significant improvement in the control group, significant (and equivalent) improvements in both the exercise-only and curcumin-only groups, and the greatest improvement among participants who exercised and also took the supplements.

In the final study, researchers examined the effects of exercise and curcumin on the rate of age-related degeneration of the heart's left ventricle. 45 participants were randomly assigned into one of the same four groups used in the second study.

The researchers once again found that both exercise and curcumin produced significant increases in heart health. In this study, however, curcumin alone did not appear to provide any benefit. Specifically, brachial systolic blood pressure (SBP) decreased among participants who exercised, whether or not they took curcumin. In addition, heart-rate-corrected aortic augmentation index (AIx) and aortic SBP both decreased significantly only among participants who both exercised and took curcumin.

"Regular ingestion of curcumin could be a preventive measure against cardiovascular disease in postmenopausal women," the authors of the first study wrote. "Furthermore, our results suggest that curcumin may be a potential alternative ... for patients who are unable to exercise."

Curcumin is best absorbed from turmeric root, rather than from supplements.

Heart Murmur

A heart murmur is an extra sound that the blood makes as it flows through the heart. Your doctor uses a stethoscope to listen to your heartbeat. When you have a heart murmur, your doctor can hear an extra whooshing or swishing noise along with your heartbeat.

It can be scary to learn that you or your child has a heart murmur. But heart murmurs are very common, especially in children, and are usually harmless. These normal murmurs are called "innocent" heart murmurs. There is nothing wrong with your heart when you have an innocent murmur. Up to half of all children have innocent murmurs.1 They usually go away as children grow.

Adults can have innocent murmurs too. They can happen when your blood flows harder and faster than usual-during pregnancy, for example, or a temporary illness, such as a fever. They usually go away on their own. Innocent murmurs are often found in adults over 50 years of age.1

Sometimes, though, a heart murmur is a sign of a serious heart problem. This is called an abnormal heart murmur.
Abnormal murmurs are signs of a heart problem. In children, abnormal heart murmurs are usually caused by problems they are born with, such as a heart valve that doesn't work right or a hole in the wall between two heart chambers.

In adults, abnormal murmurs are most often caused by damaged heart valves. Heart valves operate like one-way gates, helping blood flow in one direction between heart chambers as well as into and out of the heart. See a picture of blood flow through a normal heart .

When disease or an infection damages a heart valve, it can cause scarring and can affect how well the valve works. The valve may not be able to close properly, so blood can leak through. Or the valve may become too narrow or stiff to let enough blood through. When a damaged heart valve cannot close properly, the problem is called regurgitation. When the valve can't let enough blood through, the problem is called stenosis.

Heart valves can be damaged by heart disease or by infections like rheumatic fever or endocarditis. The normal wear and tear that comes with aging can also cause some damage.

Some heart murmurs are caused by a thicker than normal heart. When the heart muscle grows too large, it can get in the way of normal blood flow and cause a murmur. Most heart murmurs are found during regular doctor visits. During exams, doctors listen to each part of the heartbeat, including any extra sounds, or murmurs, that may be there.

If a doctor hears a murmur, he or she can often tell whether it is innocent by how loud the noise is, what part of the heart it is coming from, and what kind of sound it is. He or she will also look for signs of a heart problem-for example, shortness of breath when the person is active, lightheadedness, a fast or irregular heartbeat, or a buildup of fluid in the legs or lungs. If your doctor thinks your murmur may be a sign of a problem, you will have tests to check your heart. You may also be sent to a heart specialist, called a cardiologist, for more tests.

• An echocardiogram is a type of ultrasound test. It turns sound waves into pictures that show how well your heart is working.
• An electrocardiogram, also called an EKG or ECG, checks the electrical activity of your heart. It translates your heart's electrical activity into line tracings on paper. The spikes and dips in the line tracings are called waves.
• A chest X-ray shows the size and shape of your heart and the position and shape of your large arteries.
• Cardiac catheterization can check for defects in the heart. A thin tube is inserted into an artery in your leg or arm. The tube, called a catheter, is slowly pushed up to your heart. A small amount of dye is injected, and the pictures show the heart chambers and valves as the dye moves through them.

If you have an innocent murmur, you do not need treatment, because your heart is normal. If you have an abnormal murmur, treatment depends on the heart problem that is causing the murmur and may include medicines or surgery. Not all abnormal murmurs need to be treated. If you have an abnormal murmur and have no other symptoms, your doctor may only monitor your condition with an echocardiogram.

If you have symptoms, you may need to take medicine to lower your blood pressure and reduce your heart's workload. You may need surgery to replace a valve or repair a heart defect. Most heart murmurs are normal, and there is nothing you can do to prevent them or cause them. They just happen. Most abnormal murmurs cannot be prevented, either. They are often caused by infections or by problems that run in families.

What you can do is take good care of your heart by eating healthy food and getting regular exercise. Work with your doctor to control your blood pressure and your cholesterol. And if you smoke, quit. Your doctor can help you quit your smoking habit.

Positive Effects Of Steroids And The Heart

Cardiologists at the Royal Prince Alfred Hospital in Australia recruited both juicing and non-juicing bodybuilders for a study. Each bodybuilder had various aspects of the heart measured (carotid intima-media thickness, arterial reactivity, left ventricular dimensions, etc.). These measurements indicate whether bodybuilding, steroid usage or both affect the function, size, shape and activity of the heart.

The doctors found some obvious and not so obvious results. Predictably, those bodybuilders who used steroids were physically stronger than those who didn’t. What was surprising was that the use of steroids was not found to cause any significant changes or abnormalities of arterial structure or function.

In essence, when the bodybuilders (both groups) were compared with sedentary controls, any changes in heart function were common to bodybuilders. The take home message from this study is that bodybuilding itself can alter (not impair) arterial structure/function and that steroids do not appear to impair cardiac function.
It’s been long established that men have a higher risk of heart disease. One of the risk factors implicated is Testosterone. Reportedly, the recreational use of Testosterone can alter lipoprotein levels and, in fact, case reports exist describing bodybuilders who’ve abused steroids and have experienced heart disease or even sudden death. But the question remains, is the causal association one of truth or just an association?

To answer this, researchers at the University of North Texas recruited twelve competitive bodybuilders for a comprehensive evaluation of the cardiovascular effects of steroids. Six heavyweight steroid-using bodybuilders were compared with six heavyweight drug-free bodybuilders.

As expected, the heavy steroid users had lower total cholesterol and HDL levels as compared to the drug-free athletes. What was unexpected was that the steroid users also had significantly lower LDL (the bad cholesterol) and triglyceride levels as compared to the non-steroid users. In addition, the juicers also had lower apolipoprotein B levels (a marker for heart disease risk). Thus, the authors concluded that androgens do not appear to raise the risk of cardiovascular disease. (4) The take home message from this study is that the negative cardiac side effects of steroids are most likely overstated.

In a little more progressive study, researchers at the Albert Einstein College of Medicine in the Boogie Down Bronx (the BDB to those in the know) examined Testosterone as a possible therapy for cardiovascular disease. (5) The researchers note that T can be given in oral, injectable, pellet and transdermal delivery forms. It’s noted that injections of Testosterone (100 to 200 mg every two weeks) in men with low levels of T will decrease total cholesterol and LDL while raising the HDL.

In fact, Testosterone therapy has been found to have antianginal effects (reduces chest pain). Low levels of Testosterone are also correlated with high blood pressure, specifically high systolic pressure. The researchers determined that returning T levels back to normal and even high-normal levels have positive cardiovascular effects and should be considered as an adjunctive treatment for maintaining muscle mass when someone has congestive heart failure.
Strong research demonstrates that the risks of negative cardiovascular effects of steroids are overstated. In fact, a recent paper published in the Canadian Journal of Applied Physiology questioned the whole risk of using steroids. (6) Joey Antonio, Ph.D. and Chris Street MS, CSCS published strong data showing that the risks of steroid use are largely exaggerated, much like scare tactics used by your parents while you were a kid. Of course, it goes unsaid that abuse of anything will lead to unwanted consequences.

We know that as we age, circulating Testosterone levels naturally decrease. For most people the Testosterone decrease goes from high-normal to mid to low normal. Data shows that there’s an inverse relationship between T levels and blood pressure as well as abdominal obesity (that paunch we see on so many middle age males).

Testosterone replacement lowers abdominal obesity and restores Testosterone back to normal levels. Restored Testosterone is correlated with better mood, better muscle tone, stronger sex drive, lower cardiovascular disease risks, stronger bones and better memory. It’s important to note that while conservative use gives a pronounced positive health benefit, higher doses may not necessarily lead to further health benefits.

12 Possible Heart Symptoms Never to Ignore

Heart Disease
Heart disease is the No. 1 killer of U.S. men and women, accounting for 40% of all U.S. deaths. That's more than all forms of cancer combined.
Why is heart disease so deadly? One reason is that many people are slow to seek help when symptoms arise. Yes, someone gripped by sudden chest pain probably knows to call 911. But symptoms of heart problems aren't always intense or obvious, and they vary from person to person and according to gender.

Heart Disease Warning Signs
Because it can be hard to make sense of possible heart symptoms, doctors warn against ignoring any warning signs, toughing them out, waiting to see if they go away, or being quick to blame them on heartburn, muscle soreness, or other less serious, noncardiac causes. That's especially true for men and people over 65, as well as for people with other cardiac risk factors, such as high cholesterol or blood pressure, obesity, smoking, diabetes, or a family history of heart disease.

Heart Disease Risk Factors
'The more risk factors you have, the higher the likelihood that a symptom means something is going on with your heart,' says David Frid, MD, a cardiologist at the Cleveland Clinic. 'People often don't want to admit that they're old enough or sick enough to have heart trouble. Putting off treatment for other medical problems might not be so bad, but a serious heart problem can mean sudden death. It's better to go in and get it evaluated than to be dead

Anxiety - Heart attack can cause intense anxiety or a fear of death. Heart attack survivors often talk about having experienced a sense of 'impending doom.

Chest Discomfort - Pain in the chest is the classic symptom of heart attack, and 'the No. 1 symptom that we typically look for,' says Jean C. McSweeney, PhD, RN, associate dean for research at the University of Arkansas for Medical Sciences College of Nursing in Little Rock and a pioneer in research on heart symptoms in women. But not all heart attacks cause chest pain, and chest pain can stem from ailments that have nothing to do with the heart. Heart-related chest pain is often centered under the breastbone, perhaps a little to the left of center. The pain has been likened to 'an elephant sitting on the chest,' but it can also be an uncomfortable sensation of pressure, squeezing, or fullness. 'It's not unusual for women to describe the pain as a minor ache,' McSweeney says. 'Some women say the pain wasn't bad enough even to take a Tylenol.' Women, more so than men, can also experience a burning sensation in their chest, rather than a pressure or pain. 'Sometimes people make the mistake that the pain comes from a stomach problem,' says Nieca Goldberg, MD, clinical associate professor of medicine at the NYU Langone Medical Center in New York City and another expert on women's heart symptoms.

Cough - Persistent coughing or wheezing can be a symptom of heart failure -- a result of fluid accumulation in the lungs. In some cases, people with heart failure cough up bloody phlegm.

Dizziness - Heart attacks can cause lightheadedness and loss of consciousness. So can potentially dangerous heart rhythm abnormalities known as arrhythmias.

Fatigue - Especially among women, unusual fatigue can occur during a heart attack as well as in the days and weeks leading up to one. And feeling tired all the time may be a symptom of heart failure. Of course, you can also feel tired or fatigued for other reasons. How can you tell heart-related fatigue from other types of fatigue? 'If you don't feel well and all the wind is knocked out of your sails, don't try to figure it out on the Internet or from a book,' says Goldberg. 'Wasting time is dangerous.

Nausea or Lack of Appetite - It's not uncommon for people to feel sick to their stomach or throw up during a heart attack. And abdominal swelling associated with heart failure can interfere with appetite.

Pain In Other Parts of the Body - In many heart attacks, pain begins in the chest and spreads to the shoulders, arms, elbows, back, neck, jaw, or abdomen. But sometimes there is no chest pain -- just pain in these other body areas. The pain might come and go.
Men having a heart attack often feel pain in the left arm. In women, the pain is more likely to be felt in both arms, or between the shoulder blades.

Shortness of Breath - People who feel winded at rest or with minimal exertion might have a pulmonary condition like asthma or chronic obstructive pulmonary disease (COPD). But breathlessness could also indicate a heart attack or heart failure.
"Sometimes people having a heart attack don't have chest pressure or pain but feel extremely short of breath," Goldberg says. "It's like they've just run a marathon when they haven't even moved." During a heart attack, shortness of breath often accompanies chest discomfort, but it can also occur before or without chest discomfort.

Sweating - Breaking out in a cold sweat is a common symptom of heart attack. 'You might just be sitting in a chair when all of a sudden you are really sweating like you had just worked out,' Dr. Frid of the Cleveland Clinic says.

Weakness - In the days leading up to a heart attack, as well as during one, some people experience severe, unexplained weakness. 'One woman told me it felt like she couldn't hold a piece of paper between her fingers,' Dr. McSweeney says."

Equipose 200

Boldenone Undecylenate has become a very popular steroid with athletes and bodybuilders due to the fact that it has very low side effects and has anabolic properties which promote a steady gain in quality muscle mass over time. GP Bold 200 (Boldenone Undecylenate) was tagged with the name Equipose® when it first became available as a veterinary steroid and was widely used in racehorses. Equipose 200 (Boldenone Undecylenate), as it is often called, can be effectively incorporated in both "cutting" and "bulking" cycles due to the well balanced effects of this anabolic substance. GP Bold 200 (Equipoise) aromatizes very little, and therefore produces almost no estrogenic side effects such as water retention or "gyno" (the development of female tissue under the nipples in males resulting in unattractive and often painful lumps in this area), and therefore is a favorite among bodybuilders who are looking to make solid gains without the extra bloat, or are nearing contest. Equipose 200 (Boldenone Undecylenate) also dramatically increases protein synthesis and red blood cell count meaning that nutrients are transported throughout the body much more effectively. Because of this, Equipose® is able to make much more use of less food, enhancing its capabilities as an effective hormone to use when "cutting" and a bodybuilder is trying to reduce calories to get into contest shape. Also, the increased red blood cell count caused by Boldenone Undecylenate also increases oxygen transportation throughout the body, thus giving athletes and bodybuilders much more endurance and the capability to endure cardio sessions for much longer periods of time, which obviously makes Equipose 200 (Boldenone Undecylenate) even more popular among those looking to shed bodyfat. Users of  Equipose 200 (Boldenone Undecylenate) also report a dramatic increase in vascularity, which can also be attributed to the oxidizing benefits of Equipoise. Bodybuilders using Equipose 200 (Boldenone Undecylenate)  in a cutting cycle often look to stack it with an oral steroid such as Stanozolole or Oxandrolone to further increase anabolic activity while keeping estrogenic side effects out of the picture. Equipose 200 (Boldenone Undecylenate) also has properties which make it very favorable amongst Bodybuilders looking to incorporate it into their bulking cycles. Users of Equipose 200 (Boldenone Undecylenate) often report an increase in appetite and the ability to eat more food easily when trying to gain weight in the offseason. The mild nature and steady gains produced by Equipose 200 (Boldenone Undecylenate) also make it very effective for those looking to do longer cycles (12-20 weeks ), where as most users note a continuous gain in muscle mass and strength over this time and credit the steroid with helping the muscles maintain a more defined, vascular tone throughout bulking . Bodybuilders looking for size often stack Equipoise with other anabolic drugs such as a testosterone preparation (GP Test Enanth 250, GP Test Cyp 250, GP Test Prop 100 etc.) and/or Deca-Durabolin . Bodybuilders looking to bulk might also incorporate an oral compound into this stack such as GP Oxan or GP Methan. Women bodybuilders are also fond of Equipoise due to its mild nature and low androgenic properties. The most often side effect of the drug being an increase in libido, women find that the drug rarely causes any masculizing side effects when kept in a reasonable dosage range. Male bodybuilders generally buy Equipose 200 (Boldenone Undecylenate) in doses of 300-800mg's a week for 8-20wks, depending on goals, while women bodybuilders often find a dosage of 50-100mg's a week to be very effective for making quality gains while keeping side effects to a minimum. Equipose 200 (Boldenone Undecylenate) has a long half life (7-10) days and is most commonly injected twice per week to keep blood concentrations as steady as possible.

Do Men's and Women's Hearts Burn Fuel Differently?

Researchers at the University of Illinois at Chicago College of Medicine will study gender differences in how the heart uses and stores fat  -  its main energy source - and how changes in fat metabolism play a role in heart disease.

When stressed, the heart changes how it uses fuel for energy. These changes may play a major role in the development of heart disease and are different in men and women, says E. Douglas Lewandowski, director of the UIC Center for Cardiovascular Research. The changes occur long before any symptoms, he said, and may be key to early diagnosis and treatment.

Lewandowski uses imaging techniques he developed to see fat molecules and the rate at which they are being burned in beating hearts. In healthy hearts, the balance between using fat for energy and storing it in tiny droplets within the cells is in a dynamic equilibrium. 

When a female heart is stressed, such as through chronic disease like hypertension, it becomes much less efficient at metabolizing fat, Lewandowski says. When a male heart is stressed, it starts using more sugar as fuel. These changes in the heart can also affect how fat is stored and used in other parts of the body.

"Because the heart is the body's number-one consumer of fat, when it starts using fat differently, there are consequences throughout the entire body," Lewandowski said. He thinks that changes in fat metabolism in the heart may send out signals to fat cells in other parts of the body to store more fat, and to insulin-producing cells in the pancreas that may trigger the onset of diabetes, which is often present along with heart disease.

Lewandowski will further investigate how gender differences in fat metabolism are related to the development of heart disease in men and women. He will also look at how higher levels of fat accumulation in heart cells may cause stiffness and lower the efficiency of heart muscle contraction. Understanding these changes may help identify targets for therapies, or lead to better diagnostic tests for heart disease.

Coffee and green tea may help lower stroke risk

Green tea and coffee may help lower your risk of having a stroke, especially when both are a regular part of your diet.

• People who drank at least one cup of coffee daily had about a 20 percent lower risk of stroke compared to those who rarely drank it.
• People who drank two to three cups of green tea daily had a 14 percent lower risk of stroke and those who had at least four cups had a 20 percent lower risk, compared to those who rarely drank it.
• People who drank at least one cup of coffee or two cups of green tea daily had a 32 percent lower risk of intracerebral hemorrhage, compared to those who rarely drank either beverage. (Intracerebral hemorrhage happens when a blood vessel bursts and bleeds inside the brain. About 13 percent of strokes are hemorrhagic.)

Gene Regulates Heart's Ability to Regenerate After Injuries

 Researchers at UT Southwestern Medical Center have identified a specific gene that regulates the heart's ability to regenerate after injuries.

The function of the gene, called Meis1, in the heart was not known previously. The findings of the UTSW investigation are available online inNature.

"We found that the activity of the Meis1 gene increases significantly in heart cells soon after birth, right around the time heart muscle cells stop dividing. Based on this observation we asked a simple question: If the Meis1 gene is deleted from the heart, will heart cells continue to divide through adulthood? The answer is 'yes'," said Dr. Hesham Sadek, assistant professor of internal medicine in the division of cardiology, and senior author of the study.

In 2011, Dr. Sadek's laboratory showed that the newborn mammalian heart is capable of a vigorous, regenerative response to injury through division of its own cells. As the newborn develops, the heart rapidly loses the ability to regenerate and to repair injuries such as heart attacks.

The research team demonstrated that deletion of Meis1 extended the proliferation period in the hearts of newborn mice, and also re-activated the regenerative process in the adult mouse heart without harmful effect on cardiac functions. This new finding demonstrates that Meis1 is a key factor in the regeneration process, and the understanding of the gene's function may lead to new therapeutic options for adult heart regeneration. The findings also provide a possible alternative to current adult heart regeneration research, which focuses on the use of stem cells to replace damaged heart cells.

"Meis1 is a transcription factor, which acts like a software program that has the ability to control the function of other genes. In this case, we found that Meis1 controls several genes that normally act as brakes on cell division," Dr. Sadek said. "As such, Meis1 could possibly be used as an on/off switch for making adult heart cells divide. If done successfully, this ability could introduce a new era in treatment for heart failure."