Monthly Archives: January 2015

Is Butter really “Back”? Not exactly. . . .

IMG_8348rt5x7bwIf you are perplexed by some the recent media stories claiming that butter (and other saturated fats) may not be so bad (such as this article from the New York Times last year) – here is an excellent article from a trusted, knowledgeable resource – the Harvard School of Public Health – that clarifies the issue (click here for article).

Here is the conclusion of the article:

In the case of dietary fat, most scientists do agree on a number of points. First, eating foods rich in polyunsaturated fat will reduce the risk of heart disease and prevent insulin resistance. Second, replacing saturated fat with refined carbohydrates will not reduce heart disease risk. Third, olive oil, canola oil, and soybean oil are good for you—as are nuts (especially walnuts), which, while they include some saturated fat, are also high in unsaturated fat, tipping the balance in their favor. Finally, omega-3 and omega-6 fatty acids are essential for many biological processes—from building healthy cells to maintaining brain and nerve function—and we should eat a variety of healthy foods, such as fish, nuts, seeds, and vegetable oils, to obtain adequate amounts of both fatty acids.

Other, finer points are still unclear. For instance, monounsaturated fat is believed to lower risk for heart disease. But it’s difficult to study in Western populations, because most people get their monounsaturated fat from meat and dairy, which are also full of saturated fat. Still, people can choose from a variety of monounsaturated-fat-rich foods, such as peanuts and most tree nuts, avocados, and, of course, olive oil. And though scientists agree that omega-3 and omega-6 fatty acids are essential, they debate how much of each we actually need.

As you can see, the point is not that butter is good – it’s that replacing it with other processed foods such as refined carbohydrates won’t improve your health.

Here is my earlier post on saturated fats, along with links to a useful video and other resources.

Here is more information about a heart healthy diet.


Asian Americans Face Greater Risk for Stroke and Hypertension

Asian Americans are at higher risk for stroke and hypertension compared to whites, according to a study examining U.S. death records from 2003–2010.

IMG_8348rt5x7bwAlthough heart disease is the No. 1 killer of all Americans, certain races and ethnic groups face higher cardiovascular risk than others. Asian Americans are the fastest growing racial/ethnic group in the United States, yet little is known about heart risks in distinct subgroups of the Asian American population.

Published in the Journal of the American College of Cardiology, a recent study analyzed death records for the six largest Asian-American subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean and Vietnamese. Together, these subgroups make up 84% of the Asians in the United States.

After comparing U.S. death rates from 2003–2010, researchers found that stroke and high blood pressure was more common among every Asian American subgroup compared to non-Hispanic whites. Compared to whites, Asian Indians and Filipino men also had greater mortality from coronary artery disease—a condition that occurs when the heart’s arteries narrow, often due to the plaque build-up on the arterial walls. (text taken from

Until further studies clarify the specific reasons for elevated risk in Asian Americans, the goals for prevention in this population are similar to all adults, with a few areas of emphasis:

1. Blood Pressure Control – monitoring blood pressure – .and prompt treatment of elevated readings – it is important for all adults, but in Asian American’s we may need to emphasize more thorough monitoring, and consider intervention ( either lifestyle changes or medications) at an earlier age or with lower blood pressure targets. Here is more information.

2. Manage Your Cholesterol – in recent years we have certainly learned more about specific changes of cholesterol in the Asian population. For example, here is an article I co-authored which looked at specific cholesterol findings in Indian Americans.  Even though the spectrum of specific cholesterol abnormalities vary among the various agents are groups, the lifestyle advice to minimize the impact is universal: Reduce intake of saturated fats, processed grains, and minimize wheat based carbohydrates. Here is more information.

3. Stop smoking and minimize tobacco exposure. Hopefully the impact here is self-explanatory. Here is additional information.

4. Monitor Blood Sugar – Type 2 (or “adult onset”) diabetes is far more common in certain Asian populations (such as Indians), especially those that have moved to Western countries that eat highly processed diets. In many Asians, diabetes can develop even in the absence of the usual weight gain (e.g. abdominal fat) typical in other populations. Ask your physician about screening recommendations for those at risk of diabetes.

4. Stay Active! Regular readers of our blog should be well versed in the many benefits of the ultimate medical therapy: Regular exercise. Here is an overview of the benefits of exercise, and here is even more information.

For now, the screening recommendations for prevention of heart disease and stroke in Asian Americans are no different from the population at large. However, there is some evidence that certain screening tools may benefit certain populations. These include advanced blood testing and imaging to screen for early coronary plaque. If you are concerned about your risk, you should ask your physician whether additional screening may be useful. or even consider calculating your very own “Heart Age”.  In the meantime, clinical studies are providing more and more information about cardiovascular risk in this growing segment of Americans.

A Great Patient Story

BW ARA labcoatNice to start 2015 with a patient story to teach the importance of your circulation. Circulation includes structures that direct blood and fluids as they move or circulate through the body. Arteries (tubes that take the blood from the heart to the body), veins (tubes that return blood to the heart from the body), and a third part, named lymphatics, are structures that keep our bodies working.

In 2008 the Surgeon General of the United States published a call to action for Venous Thromboembolism, a problem that affects veins and can affect the heart, and is a leading cause of death. Venous thromboembolism refers to blood clots (also called thrombi (plural of thrombus)) that form in a vein in the setting of slow flow, inflammation, injury, or other factors.

The journal Vascular Medicine publishes patient information about vascular diseases – here is the paper on Venous Thromboembolism and Pulmonary Embolus. 

The patient story starts with me before I became a cardiologist or even a high school graduate. I ran on the track team in high school. My coach taught us not just track, but would also tell us he was teaching us how to stay fit and strong so that we would always know the discipline that training required — how to pace, how to stay active, how to prepare for a goal. At the time I had no idea what a gift his coaching was, but went on to apply it to 10 marathons, triathlon, biathlon, rowing, my practice, and my patients because staying active plays a key role in heart health. 

The patient is that coach. He called me in 2013 when my focus was on training for the Philadelphia marathon. I was ready to talk about the 20 miler, how the taper might go, etc. It took a minute to realize he actually had a symptom. He has remained active and exercises at a high level with swimming, calisthenics, weight lifting, and bicycling in addition to travel abroad for work. The symptom was shortness of breath, happening when exercising or at the end of a set of pushups (yes, a set of pushups as in one of multiple reps in multiple sets). He had been getting back to his home exercise regimen after travel to Europe when the symptom started. We talked about his travel for work, how his knees were faring (he had a career as a paratrooper which had inflicted degenerative change to the knees to say the least). While in Europe he had received an injection to the left knee and was evaluated in Germany when he had subsequent significant swelling. 

It was when he mentioned the last bit – the leg swelling – when it clicked: chance of Pulmonary Embolus (PE). In addition to the oddity of him actually experiencing/complaining of a symptom like shortness of breath, the possibility of PE expedited his evaluation. 

Screen Shot 2015-01-04 at 8.38.49 PMA computed tomography (CT) scan of the chest showed bilateral PE. Followup evaluation for deep venous thrombosis (DVT) was positive for a blood clot in the leg where he had had the swelling.  I have his permission to post the blood clot on the Internet so will show a still frame as well as a movie of the vein with grey DVT in the vein.

The blue arrows in the table (Table 1) point to the key symptoms he experienced, and to the shadowy grey clot as it appears on a lower extremity venous duplex (below) (the Vascular Medicine Journal patient information article by Dr.s Evans and Ratchford also has an example of a vascular ultrasound study in Figure 1, with a cross section view).

Screen Shot 2015-01-04 at 8.41.23 PM

Another blog post can be how to keep active people safe when an issue (like PE) happens.  My partner actually showed my coach the video (below) of the blood clot floating in the vein when he broke the news that the trans-Atlantic trip scheduled for later that week as well as leg squats were on hold until treatment progressed.

Another blog post can celebrate the heart healthy benefit of lifelong exercise; the patient’s echocardiogram showed normal function and heart findings of someone younger than chronological age. The leg ultrasound totally normalized after treatment. He did not develop post thrombotic symptoms or syndrome, which can prove challenging – as well described by Dr.s Evans and Ratchford in this Patient Information Page in Vascular Medicine Journal.

For now, I am thankful for my high school track coach calling with the symptom and agreeing to share a great story & add information about blood clots, DVT, and PE for HeartHealthDocs followers interested in education about Circulation & Heart Health.