Monthly Archives: February 2014

Is your Heart older than You? Find out your “Heart Age”

Grewal Kanny MD 2x3 webI decided to spend my birthday figuring out my age. Not my actual age, which is painfully obvious, but my “Heart Age”. This is a new online calculator (featured in the Wall Street Journal this week) created by researchers in the UK, which uses existing data regarding the prediction of future cardiovascular risk (from the Framingham database, which is the most comprehensive set of data available). It has been reformatted into an algorithm that compares your true age with your estimated cardiovascular age, as a general way to look at your overall cardiovascular health.   To use the calculator, you need to know:

– your true age, sex, height and weight

-a recent total cholesterol and HDL if available

-a recent blood pressure reading

-your family medical history

Of course, there are several limitations to a simple calculator like this – it doesn’t take into account any symptoms you may have, or the duration or severity of risk factors. And the database from which it is drawn was created predominantly from Caucasian Americans, so it may not directly predict risk for other ethnic groups (for example South Asians, whose risk may be higher, or based on different weighting of factors). But it is a nice snapshot of your CV health in a format that is easy to understand.

So how did I do? Well, fortunately my Heart Age came out less than my actual age – but not by much. (Luckily, I have 365 days to make some progress!) Give it a try yourself:

Here is a link to the Heart Age calculator.

If your heart age is older than your real age, don’t dismay (the average result is 6 years older than real age!), but do look back at the questions – and notice how dropping your blood pressure, cholesterol, or waist size has a positive impact. We can’t change our age or family history (and generally not our sex), but lifestyle changes can go a long way to reduce our risk. So click here to learn about the best medication for heart disease – a therapy that reduces blood pressure and cholesterol and shrinks our waist size as well!

For more information see our articles on heart healthly diet and heart prevention in women.

Here is an informative video interview with the creator, from the WSJ:

Wrapping Up #HeartMonth

IMG_9814rtEvery month is Heart Month here at Heart Health Doctors.  That said, February 2014 is the 50th anniversary of American Heart Month.  The Columbus Dispatch 2/23/14 supplement Your Health focuses on Heart Health with tips to use through the coming year & beyond.  In this post I  summarize a few of the articles and have added heart specific information.

Your Health covers the heart health benefits of activity, consideration of medication – from aspirin therapy to high blood pressure medicine, and diet.  There is a great photo of a treadmill desk; these are desks where users can actually walk while using a computer or reading.  As well as standing desks, the treadmill desks offer great alternatives to sitting.  Breaking up sedentary behavior – or encouraging people to just “move more”  will improve heart health. “Sitting is the new smoking” is now a common comment from physicians interested in prevention.

Understanding why you are taking any pill or food is important; we don’t always consider closely what we eat – be it food or medicine – and may lapse in consistency.  The importance of taking medication for high blood pressure is reviewed.

Here is a good video about high blood pressure:

Your Health also writes about, the ‘miracle’ heart drug aspirin.  Aspirin has risks and benefits – with evidence for benefit for healthy men older than 50 years to prevent heart attack and stroke (and colon cancer), but for healthy women that benefit doesn’t outweigh risk of bleeding until age 65 years old.  Any medicine choice is a time to talk to your health care provider; because many different factors are involved.

As outlined here at Heart Health Doctors, your diet is a key part of overall heart health.  But what if you are not at goal weight?  Using different ways to get to goal weight are reviewed with Jennifer Burton RD at the McConnell Heart Health Center who was interviewed for the Your Health Dispatch supplement.

Finally, as winter in central Ohio has shown us, weather and how to prepare for it, can challenge anyone’s best intentions to stay active.  Sports Medicine Physician and athlete Dr. Darrin Bright is interviewed for the article on Exercise Smart.  Cardiologists in particular appreciate the risk of cold weather activity.  The stress of cold temperatures combined with strenuous activity such as, specifically, snow shoveling can be dangerous and a set up for heart attack.

Any consideration of cold weather activity should include asking “have I been active?” and “am I ready for this?”  Don’t ignore symptoms (chest pain, shortness of breath, back pain, shoulder jaw or neck pain, dizziness/lightheadedness among others); proceed gradually.

Dr. Bright’s recommendations to dress according to the temperature help guide anyone wanting to be active during winter.  The recommendations in the article to dress in layers and be prepared for changes in footing apply; I like the message that weather should not stop us from being active year round.

We know the benefits of exercise, but the goal is to be safe – and ready.  Exercise Smart has great information for winter activity; but what Central Ohioans (this one at least!) are definitely ready for this year, is spring.

Exercise News: Delay Dementia, and Never Too Late to Start!

Grewal Kanny MD 2x3 webIf you are looking for more reasons to exercise, just turn to some recent news:

A recent study, which was a well-done randomized trial, showed the following: (quoted from this article) Regular brisk walks can slow down the shrinking of the brain and the faltering mental skills that old age often brings, scientists say.  Studies on men and women aged 60 to 80 found that taking a short walk three times a week increased the size of brain regions linked to planning and memory over the course of a year.  The prefrontal cortex and hippocampus increased in size by only 2% or 3%, but that was enough to offset the steady shrinkage doctors expected to see over the same period.  “It may sound like a modest amount but that’s actually like reversing the age clock by about one to two years,” said Professor Kirk Erickson, a neuroscientist at the University of Pittsburgh.

Meanwhile, while the benefits of exercise are well known, a couple of recent studies show that even for those who have been sedentary until middle age, an increase in physical activity starting later in life improves long term health, and allows you to live longer. Here is a summary in the New York Times.

Now if you, like most of this blog’s heart health-educated readers, already exercise regularly, here’s a challenge which can amplify the benefit: add interval training. In other words, rather than settling for a steady walk, light jog, or session on the exercise machine, use intervals to push the training benefit further, by training your muscles, heart, and lungs to work more efficiently (an added benefit – burn more calories and improve your aerobic fitness). Some ways to add interval training:

– for walkers, replace a steady, moderate-intensity walk with alternating 3 or 4 minute “power walks” (at a hard pace which makes it difficult to talk) with 1 or 2 minutes of a slow, recovery pace.

on a treadmill or exercise machine, try a similar ratio of “higher intensity” and recovery periods.

– for joggers, my favorite interval routines are 4 minutes hard running with 1 minute of walking recovery (great for a treadmill, repeated 6 or 8 or for max impact, 12 times), or a mile at hard pace followed by recovery, repeated 3 times. Yesterday, I did 3 cycles of 1 mile hard running and a 10-exercise weight circuit – a great workout in 60 minutes.

Regardless of the specific type of intervals, this type of workout can add variety, maximize your aerobic training, and increase calorie burn and metabolism – all great benefits!

Here is our overview of exercise

Which Supplements Improve Wellness and Prevent Heart Disease?

Grewal Kanny MD 2x3 web

Those of us who treat heart disease deal with controversies on a daily basis; but I am not sure that any topic provokes more passion and controversy than a discussion about the use of supplements for the treatment and prevention of cardiovascular (and other) disease.   As medical doctors, we are trained to promote therapies grounded in ‘evidence” – that is, clinical trials and investigation. Unfortunately, most supplements and minerals have never been studied as thoroughly as drugs, so the “evidence” either for or against their use is lacking. Confusing this picture is that the proponents of supplement use may have an economic bias for their use, or their preference is based on their personal experience with a limited number of patients.

I am not a pharmacologist or nutritionist, but I do have an immense interest in any and all therapies that can improve my patients’ long-term health. Unfortunately, there is just not the evidence to recommend any specific supplement for the long-term prevention of cardiovascular disease, or any disease or complication for that matter. The preponderance of evidence suggests that eating a healthy and balanced diet, and of course improving lifestyle through weight control and exercise, is far more important than the potential effect of any specific supplement. This is even the case for a general multivitamin. This editorial article, which was just published in the last few months, summarizes the largest analysis to date of all the major research involving supplements in healthy patients. It summarizes a new analysis in over 100,000 subjects, and reaches the conclusion that none of the studied supplements can clearly prevent chronic disease. Fortunately very few of them are harmful as well (the exceptions are B-carotene and possibly Vitamin E, which may cause cancer).  Here is a quote from the authors (including the Johns Hopkins School of Public Health):

In conclusion, β-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful. Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases. Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, we believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.

For this reason, I do not recommend the routine use of supplements by any of my patients, including a daily multivitamin; but I don’t discourage their use, unless a specific interaction is seen that could be harmful. Certainly, for patients with a specific chronic condition, it is worth looking for nutritional deficiency that can contribute but that can only be done by your physician or care provider. Here is some information about specific supplements:

Folate, Vitamin B6, and B12:  A well done study recently showed that these agents did not prevent vascular disease or cancer.

Fish Oil (omega-3 fatty acids): Here is our video which addresses the potential role of Fish Oil in prevention of heart disease.

Vitamin D: Vitamin D deficiency, diagnosed by a low blood level, is a potentially serious condition that benefits from replacement therapy. For those without a true deficiency, there does not seem to be a benefit to taking supplemental doses. Here is a recent article from USA Today which references a recent large study which pooled the results from 40 earlier studies. The conclusion is that Vitamin D supplementation does not seem to prevent chronic disease, except in those with a true deficiency documented by a blood test.

Selenium: The conclusion form the lead researcher of a recent study: “At this time, we cannot support using selenium supplements as a means of preventing cardiovascular disease in healthy people”.

We will address other specific supplements in future posts. In the meantime, consider skipping some (or all) of those supplements,  and instead focus on daily activity (see article here)  and a heart healthy diet (see article here). As always, we appreciate your comments and are happy to provide references.

Need a great book for Heart Month?

IMG_9814rtDr. Suzanne Steinbaum’s Heart Book – Every Woman’s Guide to a Heart-Healthy Life published in 2013 is a good one.
Full disclosure: I am a cardiologist. Dr. Steinbaum is a cardiologist. The book is for Women; I bring my own perspective as a physician/provider – I can’t *not* be a cardiologist. Good news that Dr. Steinbaum writes in an approachable style, bringing practical information (lots of it) to Women of all backgrounds/interests (cardiologist or not). The book walks you through an inventory of your life: stress, passion, family, work, habits. You will learn why your heart matters and how you hold your heart health in your hands. Chapter 6 is a good one from my perspective: Inside the Office-The Art and Challenge of Communicating with Doctors. Dr. Steinbaum includes patient examples of what to do to get the most out of your appointment, but also teaches the reader what the doctor may be dealing with on a given office day- What Your Doctor Needs to Know <–> What You Want From Your Doctor.

Dr. Steinbaum’s chapter “Let’s Do Some Tests” is a concise description of heart diagnostics — what your heart specialist may check and why. Beyond doing Translational Medicine so well (meaning, how to write or communicate so our patients understand and are inspired), the book drills down on the advice I try to cover into my 15-minute patient appointments in much more detail: how you can use diet, exercise, stress & weight management, to lower your risk for heart disease. Dr. Steinbaum challenges the reader to a Dietary Action Plan, elaborating well on the many issues we have with food beyond whether or not it is heart healthy. Once you appreciate behavior as outlined here, you can identify opportunity for change. Exercise, also, is given excellent coverage as “The Ultimate Prescription.” Similar to the chapters on diet, The Ultimate Prescription chapters help clarify the behaviors that relate to why or why not people are drawn to exercise. Yes, it benefits your heart health to exercise, but do we all understand why or how to get it done? The book helps.

Dr. Steinbaum asserts, accurately, that Health Care is Self-Care, but goes on to be real and consider “Hormone Hell” and “When Bad Things Happen.” The Heart Book is worth a look. I give a lot of talks teaching women that they can reduce their risk of heart disease by > 80% with lifestyle … not smoking, maintaining a healthy weight, getting regular exercise, and following a heart healthy diet. Using personal and patient stories, Dr. Steinbaum writes for any audience – the book has great information for men and women who want tools for heart health. We all benefit from her effort.

Today’s News: More Reasons to Avoid Refined Sugar

Kanny S Grewal MD 5x7 (4)I don’t think it is a surprise to anyone that extra sugar in our diet is bad – bad for maintaining our weight, and bad for our long term health. But today’s news confirms that fact, thanks to a thorough study published this week that looks at sugar intake and long term risk of heart problems.

The key finding is that those folks who eat a high percent of refined sugar in their daily diet (defined as a % of total calories), have higher long term risk of heart problems. This may not seem like news to all, but this is one of the largest and most thorough studies to make the link.

Here is a quote from the CNN article below:

“Sugar has adverse health effects above any purported role as ‘empty calories’ promoting obesity,” writes Laura Schmidt, a professor of health policy in the School of Medicine at the University of California at San Francisco, in an accompanying editorial. “Too much sugar doesn’t just make us fat; it can also make us sick.”

But how much is too much? Turns out not nearly as much as you may think.  As a few doctors and scientists have been screaming for a while now, a little bit of sugar goes a long way.

Added sugars, according to most experts, are far more harmful to our bodies than naturally-occurring sugars.  We’re talking about the sugars used in processed or prepared foods like sugar-sweetened beverages, grain-based desserts, fruit drinks, dairy desserts, candy, ready-to-eat cereal and yeast breads. Your fruits and (natural) fruit juices are safe.

What does this mean for us? Well, it confirms we need to restrict added sugars in our diet, by avoiding the foods mentioned above (and I would add, fruit juice is not ideal – focusing on small portions of whole fruits is probably better). Based on this study, the goal would be to reduce calories from refined sugar to less that 10% of our total (that is not easy to calculate, so better to just minimize foods known to be high in sugar). And since most processed foods have added sugar (even bread), the message is to minimize (or better, eliminate) all processed foods.

Here is the link to a good summary of the findings from

And here is our main article on a heart healthy diet.

Please comment with any advice you’d like to share about how you (or your patients) have been successful at reducing sugar.

Reference Link: