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Belly fat linked with repeat heart attacks

The authors recommend using waist circumference in clinical settings to identify first-time heart attack patients at increased risk of recurrent events.

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Photo by Tammy Gann from Unsplash.com

Heart attack survivors who carry excess fat around their waist are at increased risk of another heart attack, according to research published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).

Prior studies have shown that abdominal obesity is an important risk factor for having a first heart attack. But until now, the association between abdominal obesity and the risk of a subsequent heart attack or stroke was unknown.

“Patients are typically put on a stringent medical treatment regimen after their first attack to prevent second events (called secondary prevention),” said study author Dr. Hanieh Mohammadi of the Karolinska Institute, Stockholm, Sweden. “Secondary prevention works through reducing risk factors associated with heart attack and stroke such as high blood sugar, lipids and blood pressure. It was previously unknown whether abdominal obesity is a risk factor for recurrent events among patients on secondary prevention treatments.”

The study, the largest and most definitive ever conducted on this topic, followed more than 22,000 patients after their first heart attack and investigated the relation between abdominal obesity (measured by waist circumference) and the risk for recurrent cardiovascular disease events. The researchers specifically looked at events caused by clogged arteries, such as fatal and non-fatal heart attack and stroke. Patients were recruited from the nationwide SWEDEHEART registry and followed for a median of 3.8 years.

Most patients – 78% of men and 90% of women – had abdominal obesity (waist circumference 94 cm or above for men and 80 cm or above for women).

Increasing abdominal obesity was independently associated with fatal and non-fatal heart attacks and strokes, regardless of other risk factors (such as smoking, diabetes, hypertension, blood pressure, blood lipids and body mass index [BMI]) and secondary prevention treatments. Waist circumference was a more important marker of recurrent events than overall obesity.

Dr. Mohammadi said: “The reason abdominal obesity is very common in patients with a first heart attack is that it is closely linked with conditions that accelerate the clogging of arteries through atherosclerosis. These conditions include increased blood pressure, high blood sugar and insulin resistance (diabetes) as well as raised blood lipid levels.”

“Our results, however, suggest that there may be other negative mechanisms associated with abdominal obesity that are independent of these risk factors and remain unrecognised,” she added. “In our study, patients with increasing levels of abdominal obesity still had a raised risk for recurrent events despite being on therapies that lower traditional risk factors connected with abdominal obesity – such as anti-hypertensives, diabetes medication and lipid lowering drugs.”

This was the first study of its kind to analyse men and women together and separately. The relationship between waist circumference and recurrent events was stronger and more linear in men. In women the relationship was U-shaped, meaning that the mid-range waist circumference (rather than the lowest) was the least risky. It must be noted that the mid-range waist circumference for women included in the study was above the cut-off traditionally recognised for abdominal obesity (80 cm).

Dr. Mohammadi noted: “There were three times as many men in the study compared to women, contributing to less statistical power in the female group. Therefore, more studies are needed before definite conclusions can be drawn according to gender, but this is a start.”

Regarding possible reasons for the different results between sexes, she said: “Some studies have suggested that abdominal obesity may be more directly associated with the evil visceral fat (fat that sits around your organs) in men compared to women. In women it is thought that a greater portion of the abdominal fat is constituted by subcutaneous fat which is relatively harmless.”

Dr. Mohammadi concluded: “Abdominal obesity not only increases your risk for a first heart attack or stroke, but also the risk for recurrent events after the first misfortune. Maintaining a healthy waist circumference is important for preventing future heart attacks and strokes regardless of how many drugs you may be taking or how healthy your blood tests are. Abdominal obesity can be tackled by eating a healthy and balanced diet and regular physical activity.”

The authors recommend using waist circumference in clinical settings to identify first-time heart attack patients at increased risk of recurrent events.

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Cannabidiol therapy could reduce symptoms in autistic children and teenagers

The use of cannabidiol (CBD) cannabis extract can lead to meaningful benefits and improve the behaviour of children and adolescents with autism spectrum disorder.

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New research presented at the 2025 European Congress of Psychiatry reveals that the use of cannabidiol (CBD) cannabis extract can lead to meaningful benefits and improve the behaviour of children and adolescents with autism spectrum disorder (ASD). ASD affects approximately 1 in 100 children around the world and symptoms can include difficulty interpreting language, difficulty expressing emotions, and repetitive behaviour and routines.1,2 

The meta-analysis included randomised, placebo-controlled trials on the efficacy or safety of CBD cannabis extracts in children and adolescents with ASD. Three studies were used in total with 276 participants with a mean age of 10.5, ranging in age from 5 to 21. The dosage of CBD cannabis extract started at 1 mg/kg per day and was titrated up to 10 mg/kg.  

Key findings from the study include: 

  • CBD cannabis extract use shows moderate improvements in social responsiveness and small yet notable reductions in disruptive behaviours.
  • CBD cannabis extract significantly enhanced social responsiveness and reduced disruptive behaviour.
  • The use of CBD cannabis extract has a favourable safety profile as it did not increase adverse events compared to placebo  
  • There were no significant differences between adverse events in CBD cannabis extract versus placebo  

Lara Cappelletti Beneti Branco, Lead Investigator, São Camilo University Center, University of São Paulo, said: “The global population prevalence of ASD diagnosis amongst children and adolescents is growing, but many treatment pathways are not effective. It is promising to see the effect of CBD cannabis extract on the study participants. However, there still needs to be considerable focus on further research with larger trials to clarify its efficacy and safety in managing ASD.” 

Professor Geert Dom, EPA President, said: “ASD can be extremely frustrating for all involved; parents of children and adolescents with the disorder, the treating clinicians and of course the children and adolescents themselves. A large part of this frustration is down to finding a viable treatment option that works to reduce symptoms. It is with delight that we see the results of this meta-analysis and we hope to see further research into this so we can move towards a solution to the unmet need within this community”.  

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Relaxation techniques may help lower high blood pressure — at least in the short term

Most relaxation techniques seemed to lower both systolic and diastolic blood pressure for people with high blood pressure after 3 or fewer months. The most commonly included interventions were breath control (13 studies), yoga/tai chi (11), biofeedback (8), progressive muscle relaxation (7), and music (7).

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Relaxation techniques may help lower high blood pressure—at least in the short term—but the longer term effects are unclear, finds a pooled data analysis of the existing research published in the open access journal BMJ Medicine.

And the risk of bias in the existing body of research means that further, more rigorously designed and longer studies are needed to confirm whether these techniques have a constructive role in the treatment of high blood pressure, conclude the researchers.

High blood pressure affects around a third of 30-79 year olds and is one of the leading attributable causes of deaths in both men and women, note the researchers. While drugs are available to treat the condition, adherence to them is poor, generating interest in alternative approaches, such as relaxation techniques, to reduce one of the major risk factors for high blood pressure—high stress levels. But it’s far from clear which of these methods, which can include breath control, mindfulness, yoga, Tai Chi, and biofeedback, among others, might be most effective.

To build on the evidence base, the researchers scoured research databases for studies, published in English up to February 2024 that looked at the potential impact of relaxation techniques on high blood pressure (140/90 mm Hg and above) and elevated blood pressure (120/80 mm Hg and above). They included 182 studies, 166 of which looked at high blood pressure, and 16 of which looked at elevated blood pressure (pre-hypertension).

Where possible, the researchers deployed network meta analysis, a statistical technique used to simultaneously compare the effects of several different ‘treatments’.

The pooled results of 54 studies showed that most relaxation techniques seemed to lower both systolic and diastolic blood pressure for people with high blood pressure after 3 or fewer months. The most commonly included interventions were breath control (13 studies), yoga/tai chi (11), biofeedback (8), progressive muscle relaxation (7), and music (7).

Compared with no intervention, breath control achieved a reduction of 6.65 mm Hg in systolic blood pressure (the first and higher number in a blood pressure reading), meditation a drop of 7.71 mm Hg, meditative movement, such as tai chi and yoga, a drop of 9.58 mm Hg, and mindfulness a drop of 9.90 mm Hg.

Music was also associated with a fall of 6.61 mm Hg, progressive muscle relaxation with a fall of 7.46 mm Hg, and psychotherapy with a reduction of 9.83 mm Hg. Combined techniques were associated with a drop of 6.78 mm Hg in blood pressure. 

There was no statistical evidence of effectiveness for any technique after 3 to 12 months and the certainty of the evidence was very low. The most commonly included techniques at this timepoint were biofeedback (7 studies), yoga/tai chi (4), and progressive muscle relaxation (4).

Very few studies included long term follow up of 12 months or more, and of the 3 included in the network analysis, the results showed that compared with no treatment autogenic (self directed) training might lower both systolic and diastolic blood pressure, but the certainty of the evidence was low. 

There was no statistical evidence of effectiveness for other treatments assessed at this time point, including biofeedback, progressive muscle relaxation, and techniques involving a combined approach.

Limited data were available for elevated blood pressure: only two studies compared relaxation techniques with no treatment/usual care and the effects on systolic blood pressure were small. 

The researchers note that the descriptions of relaxation interventions were sometimes incomplete or sparse, there were few data on costs and cost effectiveness, and most of the included studies didn’t report information on the risk of cardiovascular disease/events/deaths. 

But they suggest: “The results of our systematic review and network meta-analysis indicate that relaxation or stress management techniques might result in meaningful reductions in blood pressure at up to three months of follow-up.” 

But they caution: “Uncertainty exists about this effect, however, because of the risk of bias in the primary studies, the potential for publication bias in this area, and imprecision in the effect estimates, meaning that the observed changes in blood pressure might be too small to affect cardiovascular or cerebrovascular outcomes.” 

And they add: “Hypertension is a chronic condition, likely to require long term drug treatments or behavioural changes. As such, interventions that are used for a brief period, or provide only short term benefits, are unlikely to be clinically useful. 

“Too few studies exist, however, to assess whether the beneficial effects of relaxation are maintained when the techniques are practised for longer than three months. Future studies must clearly report whether participants were still using relaxation methods at the time of the outcome assessment, with details on adherence to the relaxation schedule. These factors might strongly influence the effectiveness of the different relaxation and stress management techniques.” 

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Poor oral health linked with body pain and migraines in women

Findings highlight the importance of good oral health to potentially mitigate pain and improve overall wellbeing, prompting further exploration into the role of oral microbiota in chronic unexplained pain conditions. This includes fibromyalgia, a condition experienced by 67 percent of the study participants.

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New research from the University of Sydney has revealed poor oral health is significantly associated with higher instances of migraines, abdominal and body pain in women. 

Published in Frontiers in Pain Research, the world-first study identified specific oral microbes correlated with certain pain conditions, suggesting a potential relationship between the oral microbiome and the nervous system.   

The findings highlight the importance of good oral health to potentially mitigate pain and improve overall wellbeing, prompting further exploration into the role of oral microbiota in chronic unexplained pain conditions. This includes fibromyalgia, a condition experienced by 67 percent of the study participants. 

“This is the first study to investigate oral health, oral microbiota and pain commonly experienced in women with fibromyalgia, with our study showing a clear and significant association between poor oral health and pain,” said lead investigator Associate Professor Joanna Harnett from the Faculty of Medicine and Health. 

“Our findings are particularly important to fibromyalgia which, despite being a common rheumatological condition, is often underrecognised,” said first author and PhD candidate in the Faculty of Medicine and HealthSharon Erdrich.  

“Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain, and headaches including headaches, as well as fatigue, sleep disturbances, and cognitive problems.” 

The research examined associations between self-reported oral health, the oral microbiome, and various pain presentations in a group of New Zealand women with and without fibromyalgia.   

Oral health was assessed using the WHO oral health questionnaire and evaluated against body pain, headaches, migraines, and abdominal pain using validated instruments, including the Short-form 36 (which measures quality of life), the International Headache Society headache survey and the functional bowel disorder severity index. Strong associations were evident between oral health scores and pain and each of these were associated with specific microbes found in the mouth, which were assessed using advanced genomic technology.   

Participants with the poorest oral health were more likely to suffer from higher pain scores: 60 percent were more likely to experience moderate to severe body pain, and 49 percent were more likely to experience migraine headaches. Lower oral health was a statistically significant predictor of frequent and chronic migraine. 

Four oral microbial species from the Dialister, Fusobacterium, Parvimonas and Solobacterium genera were significantly associated with pain after age, BMI and added dietary sugars were considered.   

A weak but significant inverse correlation with diet quality and oral health was also found, though the researchers note this has yet to be investigated in detail. 

The Australian Dental Association recommends regular oral hygiene appointments and dental health checks, in addition to twice daily teeth brushing and flossing. 

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