Monthly Archives: October 2015

Heart Health Doctors go to Washington DC

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BW ARA labcoatThe American College of Cardiology (ACC) is home to nearly 50,000 cardiovascular care team members including your Heart Health Doctors. I spent 3 days last week in Washington DC with ~ 400 other ACC members who took time away from their patients and practices to visit Capitol Hill together on October 20 and educate our legislators about heart health.

  • HeartHealthDocs goal is education to gain knowledge and maximize heart disease PREVENTION. James Madison’s words can apply to knowledge used to defend against heart disease and optimize heart health:

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Photo above: Library of Congress, Madison building inscription.

Last week I learned more about how our government works; and had the opportunity to talk heart health and present the ACC message to 4 legislators from Ohio: Senator Sherrod Brown’s Legislative Fellow LaTasha Lee, PhD, MPH, Congresswoman Joyce Beatty’s Senior Legislative Assistant Donnica Hawes-Saunders, JD, Congressman Patrick J. Tiberi’s Legislative Correspondent Abigail Finn, and Congressman Steve Stivers’ Legislative Assistant Taryn Dorfman.

The ACC advocacy priorities are inspiring by necessity; despite a 50% decline in heart and vascular related deaths over the last 40 years, heart disease remains the #1 killer in the US (and the world), accounting for 1 in 4 deaths in America (ACC).

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ACC strives to create a value driven health care system, ensure patient access to care and cardiovascular practice stability, promote the use of clinical data to improve care, foster research and innovation in cardiovascular care, and improve population health and prevent cardiovascular disease.

The specific ask for our representatives is 4-fold:

  1. Support legislation to expand patient access to CARDIAC REHAB – by maximizing cardiovascular care team members’ work and programs.
  2. Promote the usability of electronic health records; to maximize your cardiovascular specialists’ time and energy focused on patients’ cardiac health, not on the computer.
  3. Support new funding for the National Institutes of Health and the Food and Drug Administration ~ where funding levels have remained flat for the past 12 years.
  4. Work with medical specialty societies to develop alternative payment models for effective and efficient patient care.

Read more about the importance of Cardiac Rehab here, only through research will we find ways to manage heart disease and promote heart health; without usable workflow, our cardiovascular care team members are limited both in access for patients and range of services offered.

The trip was full- great education and inspiration. October 20 was a remarkably successful legislative day for heart health not just for Americans in general, but also for those of us walking the hill. I logged > 18,000 steps on my pedometer on Tuesday.

Photo is at the 7 am start for the day on Capitol Hill – 

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An Update on New Research – Part 2

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IMG_8348rt5x7bwThere is always plenty of research being conducted on heart disease prevention, but this week I decided to go straight to the source. This week I will be blogging directly from the Cardiometabolic Health Congress in Boston – a collection of presentations on recent concepts and new research in the treatment of conditions like high blood pressure, high cholesterol and diabetes. The goal? To prevent heart disease and stroke.

For part 1 of my post, see here.

At this meeting, we have been hearing from experts in the fields of heart prevention, high blood pressure, high cholesterol, diabetes, and obesity. To point out some key findings, here are common questions from patients and the answers from some of the speakers at this meeting:

What type of exercise is best for prevention?  We all understand the importance of staying active, and many of us now count our steps to ensure we meet our activity goals. But one expert pointed out that to have maximal impact on weight loss, we need to go beyond light activity – he termed them “sweat episodes”. We should aim for 3-5 “sweat episodes” weekly – and no specific type of exercise to accomplish this is superior. For much more information on exercise, click here.

What diet is best to prevent heart disease? We are bombarded with diet advice – but very few diets have really been studied to see their effect on disease prevention. Dr. Frank Sachs, a Professor of Nutrition here is Boston, summarized the evidence for many of the commonly recommended diets. His conclusion – a Mediterranean Diet has the best evidence for prevention – not just for heart disease and stroke, but there is also evidence that it can improve mental function! Here are his slides summarizing the diet and its benefits:

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Slides reproduced from Dr. Frank Sacks “The Science Behind Heart Healthy Nutrition”, October 23, 2015

What is the ideal blood pressure target? For years, we have used 140/90 as a “target” blood pressure for patients on therapy for high blood pressure.   However, an important new study which was announced recently suggests that a more aggressive target (below 130) may be better at preventing heart complications. This study generated a lot of media attention – but the experts here warn that the full study has yet to be released and analyzed. However, it is promising evidence that “lower may be better” – stay tuned for further advice.

Why is high blood pressure so difficult to control? It is frustrating to patients with HBP (and their doctors!) when their BP cannot be fully controlled, even with multiple medications. Dr. George Bakris, an expert on hypertension, notes that the most common culprit (other than missing medication!) is excess sodium in the diet. Even patients who think they are “watching their salt” may be eating more than needed, especially from hidden sources. This can cancel out the effect of medication. The optimal diet for patients with HBP is the “DASH” diet – for more information, see here. 

An Update on New Research – Straight from the Source!

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IMG_8348rt5x7bwThere is always plenty of research being conducted on heart disease prevention, but this week I decided to go straight to the source. This week I will be blogging directly from the Cardiometabolic Health Congress in Boston – a collection of presentations on recent concepts and new research in the treatment of conditions like high blood pressure, high cholesterol and diabetes. The goal? To prevent heart disease and stroke.

Here are some highlights from the first day:

High Cholesterol: The big news in cholesterol treatment is the development of a new class of potent drugs, PCS-K9 inhibitors, (Which I previously reported on here) which are different from statins – they lower cholesterol potently, but must be given by injection. For now, they are reserved for patients with seriously elevated levels while taking statins – or those intolerant of statins.

While statins are very effective in patients with a history of heart disease, many patients who take them have never had cardiovascular disease – they were prescribed purely for prevention. Many people given statins are actually at low long term risk – and the statin may not impact their risk further. Recent research shows that we can refine which patients benefit by using a test to look for early evidence of plaque buildup in the arteries. This test, called a coronary calcium scan (or heart scan) is cheap and quick, and can clarify which patients really will benefit from a statin.  Here is a recent article from the New York TImes with more details.

Obesity: Anyone who has tried to lose weight know the frustration of seeing the weight return over time. We often attribute this to poor will power, but research now shows that certain hormones are activated that actually “stimulate” the body to gain weight – like a weight “thermostat” that tries to return to a prior setting. New research is trying to interrupt this cycle and allow weight to stay off.

Research also shows that there are different “types” of obesity – many people consider themselves overweight, but are otherwise very healthy – normal blood pressure, blood sugars, and cholesterol. In others, their weight leads to chronic issues and eventual complications. So always think of your weight in the context of your overall health.

Finally, when we decide to eat something, we assume we are doing so in response to feeling “hungry”. But research show that we often eat in response to other cues – sights and smells, emotional states, and availability of food. (A great example of “mindless” eating is chomping on popcorn while we are engrossed with a movie) So if you struggle with willpower, try to limit these non-hunger “cues” – remove unhealthy food from the house, and try to steer clear of temptations as you go about your day.

Tomorrow, we will hear about new research into high blood pressure and diabetes. (As always – these are general concepts – only your doctor can address your specific health issues).