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The American Heart Association (AHA) Dietary Guidelines for Healthy American Adults have been revised to recommend using soy protein-containing foods to help reduce saturated fat and cholesterol in the diet. The association released "A Statement for Healthcare Professionals From the Nutrition Committee of the AHA" which officially recommends the addition of soy to the diet to benefit individuals with high cholesterol levels.

Individuals in the who receive the greatest benefit are those with total cholesterol levels greater than 240 mg/dL. Most studies that have shown a reduction in total and LDL cholesterol fed subjects at least 30-50 grams of soy per day, but the current FDA guidelines for making a soy health claim stipulate that individuals are advised to consume 25 grams of soy protein daily. To attain the benefits shown in the studies, individuals would have to consume 20 to 100 percent more than that. Consumers with high cholesterol may want to look for products that provide 10 grams of soy protein per serving, and try to eat three or more servings per day in order to lower their total and LDL cholesterol levels.

Soy foods have been consumed in Asian countries for hundreds of years but are fairly new to Western diets. The traditional Asian soybean curd, tofu, is becoming popular because it can be used in many dishes. It has a relatively bland flavor and can easily take the place of eggs or dairy products in many recipes. TVP is commonly used as a meat extender or replacement. Soy flour and ISP can be added to baked products to improve their nutritional quality without affecting their taste. New soy products are appearing that are replacements for common foods, such as soymilk and soy cheeses.

Men and women who stayed active after a first heart attack were significantly less likely to die early or to have a second heart attack, according to research in the journal Circulation. Patients who kept physically active after a first heart attack had a 60% lower risk of fatal heart attack or a second nonfatal heart attack than those who did not.

Lyn Steffen-Batey, an assistant professor of epidemiology at the University of Texas led the study. Steffen-Batey said that unlike other studies that have focused on a specific group, her results applied no matter how severe someone's heart attack was and held for men, women, Hispanics and whites, smokers and people with high or low cholesterol.

Researchers studied 406 Mexican-American and non-Hispanic white survivors of a first heart attack admitted to hospitals in the Corpus Christi, Texas, area. Only four of the people in the study were classified as vigorous exercisers, which was not surprising since regular, vigorous exercise significantly reduces the risk of ever having a heart attack in the first place.

Researchers noted that smoking and eating habits had less effect on outcomes -- physical activity was the most noticeable similarity among those who avoided a second attack.

Laughter and an active sense of humor may help influence heart and artery disease, according to a study released at the American Heart Association's Scientific Sessions 2000 meeting. Researchers compared the humor responses of 150 patients, who had either suffered heart attacks or had undergone revascularization procedures such as angioplasty, to those of 150 healthy age-matched controls. Results showed that heart patients were 40% less likely than their healthy counterparts to laugh in a variety of common situations. Individuals with heart disease were less likely to recognize humor or use it as an adaptive mechanism, and they generally showed less ability to laugh, even in positive situations.

Michael Miller, M.D., director of the center for preventive cardiology at the University of Maryland Medical Center, Baltimore reported the results of the study. "Because we know of many more factors that contribute to heart disease than factors that protect against it," Miller says, "the ability to laugh - either naturally or as learned behavior - may have important implications in certain societies such as the United States, where heart disease remains the number one killer."

Miller says that the theory that laughter may release some "endothelial protectants" is an attractive hypothesis that will require further study. Theoretically, if laughter releases protective chemicals in the body, laughing during anger may counteract potential adverse effects to the endothelium. While stress may be associated with a sense of urgency, anger and hostility, and a "hearty" laugh often coincides with a feeling of well being and euphoria.

Older people who suffer from depression are more likely to develop heart disease, according to recent research reported in the October 10 issue of Circulation Journal. Dr. Curt D. Furberg from Wake Forest University, Winston-Salem, North Carolina, and colleagues collected data on nearly 6,000 patients aged 65 years or older, including about 4,500 patients who had no cardiovascular disease at the start of the study, and found that people with the highest levels of depression had a 40% higher risk of coronary heart disease, and 60% higher risk of death than those who had the lowest depression scores. Every 5-unit increase in the average depression score was associated with a 15% increased risk of developing coronary heart disease and a 16% increase in death, after adjustment for other risk factors.

Depressive symptoms, like feelings of fear or loneliness, irritability, lack of concentration, and sleeplessness, occur in 19-30% of people age 65 years or older (about 5 million Americans), but only 1% of those affected receive treatment. Those with higher scores reported that they felt 'down,' didn't sleep well, were unhappy or had little hope about the future," notes Furberg. The researchers found that women reported more depressive symptoms than men. Married participants or those who lived with others had lower depression scores. Smokers and those who had problems performing daily activities due to physical impairment had higher scores. Participants who were inactive and overweight also had higher scores.

Furberg suggests several explanations for why depression might predispose some individuals to increased heart risk:

* Depression is associated with poor physical activity, less exercise, more smoking and an increase in other behaviors that increase heart disease risk.
* A depressed state increases mental stress, which may increase plaque formation and vessel blockages.
* Depression is thought to increase production of free radicals and fatty acids, which can damage the lining of blood vessels placing the person at higher risk for sudden death.

Because the study excluded people with prior heart attack or cardiovascular disease and those who were in a medical or retirement facility, Furberg says it is unlikely that the depressive symptoms occurred as a result of disease. It remains to be seen whether treating depression in the elderly will reduce the rate of heart disease and death. Two clinical studies involving the treatment of depression in elderly Americans are being undertaken.

New research comparing U.S. and Canadian healthcare systems found that Canadian patients with unstable angina were 44% more likely to have had a heart attack or died six months after coming to the hospital complaining of chest pain, but after one year the overall mortality rate for patients with small heart attacks and unstable angina was nearly the same for Canadians and Americans. Researchers found that more U.S. than Canadian hospitals were equipped to provide high-tech treatment to patients with unstable angina. More had on-site treatment facilities, and even when they did not have such facilities, U.S. patients were more likely to be transferred in a timely manner to a hospital that did. The study was done by researchers at the University of Alberta, and was reported in the September 19 issue of Circulation Magazine.

Clot-dissolving drugs given to heart attack victims don't help patients over age 75, and may actually increase the risk of death, according to a study published in the current issue of Circulation, the Journal of the American Heart Association. The researchers found that patients over 75 who were given the clot-busters were nearly 40% more likely to die within 30 days of treatment than patients who did not get the drugs. In an editorial, Harvard Medical School's Dr. John Ayanian said the findings support the use of angioplasty over thrombolytic therapy in the elderly.

Cardiovascular disease is the leading cause of death for older Americans, but physicians are often reluctant to perform coronary artery bypass surgery and other potentially life-saving operations on octogenarians, citing their age as an overwhelming risk factor. A new study published in the March issue of the Journal of the American College of Cardiology reveals that cardiac surgery can be a safe option for many elderly patients. Dr. Karen P. Alexander of Duke University Medical Center in Durham, NC examined data on 67,764 patients, 4,743 of them octogenarians, who underwent cardiac surgery at 22 centers participating in the National Cardiovascular Network (NCN). She found that octogenarians without other risk factors, such as a recent heart attack, did almost as well as their younger counterparts.

The American Heart Association has created a special web site for victims of heart disease, called "Living With Heart Failure." The site includes information about exercise and diet, treatments, a caregiver's guide, and other help for both the patient and family members.

The National Institutes of Health announced results of a study that found that the combination of following the DASH (Dietary Approaches to Stop Hypertension) diet with reduced sodium levels reduced blood pressure more than either the DASH diet or lower sodium intake alone. National Heart Lung and Blood Institute Director Dr. Claude Lenfant said that "These results challenge Americans to eat the DASH diet and to reduce sodium consumption and the food industry to reduce sodium levels in foods. Meeting this challenge, along with other lifestyle changes, could prevent the rise of blood pressure with age and allow patients to control their hypertension with fewer or even no drugs."

"The combination of eating the DASH diet at a lower sodium level is a significant effect ? equal to or greater than the result you would expect from treatment with a single hypertension medication," says Dr. Frank Sacks, chair of the DASH-Sodium Steering Committee and Associate Professor of Medicine at Brigham and Women's Hospital and Harvard Medical School. "However, the long-term health benefits of the low sodium DASH diet will depend on whether the American public is willing to make long-lasting dietary changes, including choosing lower sodium foods, and whether the food industry makes available a greater number of lower sodium food products," adds Dr. Sacks.

The findings were published in the January 4 issue of the New England Journal of Medicine.