Author Archives: The HeartHealth Doctors

New Guidelines for High Blood Pressure

BW ARA labcoatJust released November 13, 2017, new guidelines for Hypertension, the term for High Blood Pressure, have implications for prevention of heart and vascular disease and stroke. The definition of “high” or elevated blood pressure is now lower, with emphasis on lifestyle changes to prevent progression to hypertension.

The guidelines are written by a group of scientists, researchers, and clinical experts from multiple societies – who review over 900 manuscripts and published research results to include what we know about blood pressure and the effects of uncontrolled blood pressure or hypertension. The guidelines emphasize lifestyle changes that anyone can make to help keep their blood pressure safe.  Lifestyle changes and at times medications can help keep blood pressure in a healthy range and prevent heart disease and stroke.

Why so much focus on high blood pressure? Hypertension is also called ‘the silent killer’ because it may not cause symptoms until heart damage has already happened. Consequences of uncontrolled high blood pressure include stroke, heart failure, erectile dysfunction, vision loss, heart attack, kidney disease/failure. The consequences add up if hypertension combines with other medical problems like diabetes or with lifestyle such as sedentary behavior.

What is blood pressure? It is a measurement of the force of the blood moving through your arteries (arteries are part of the circulation). Blood pressure is made up of two numbers, systolic and diastolic. Arteries exposed to elevated or high blood pressure over time can have changes such as increased size (aneurysm), increased plaque (atherosclerosis), and decreased function (eye blood vessel changes).

What are the new numbers??

The new blood pressure categories define normal as less than 120/80 mmHg, elevated systolic between 120-129 mmHg and diastolic less than 80 mmHg, stage I hypertension as systolic between 130-39 mmHg or diastolic between 80-89 mmHg, stage II hypertension systolic at least 40 or diastolic at least 90 mmHg, and hypertensive crisis is systolic over 180 and/or diastolic over 120 with patients needing prompt changes in medication if there are no other indications of problems or immediate hospitalization if there are signs of organ damage.

The new guidelines lower the level at which doctors will be paying attention to blood pressure. The category of pre-hypertension is eliminated.

How do I know my blood pressure??

How do you check a blood pressure? The new guidelines emphasized the importance of using proper technique to measure blood pressure. Patients can check blood pressure at home. The use of validated devices is recommended ~ a pharmacist can help with BP monitor selection. Be sure to sit with back support, feet on the floor, and arm at heart level (left chest), relax for 5 minutes before checking the blood pressure. Multiple readings are ok.

What affects blood pressure??

What is Lifestyle and how does it impact blood pressure?  Lifestyle refers to how we live, choices we can make on a daily basis, that add up considerably to our overall heart health. Patients often ask how they can reduce or avoid taking medications – it is possible  to use lifestyle ~ depending on the cause of the elevated blood pressure. Getting to goal weight, staying active, avoiding a high sodium diet (read labels, make your own food), liberal amounts of vegetables in the diet, not using tobacco products, managing stress, avoiding excess alcohol, are all great ways to use lifestyle to keep blood pressure < 120/80mmHg.

Really?

Over the counter medications can increase blood pressure. Nonnarcotic analgesics such as non-steroidal anti-inflammatory agents including aspirin, ibuprofen, and naprosyn can increase blood pressure and should be used with intent (not by habit). Pain can raise blood pressure so if the medicine helps reduce pain, that will help but don’t take these medicines ‘just because.’ Medicines such as decongestants, or stimulants for example sometimes found in diet pills, can increase blood pressure. Natural licorice can increase blood pressure levels. Prescription medications such as oral contraceptives, cyclosporin, erythropoietin, or meloxicam can increase blood pressure. Herbal compounds such as ephedra or ma huang can increase blood pressure. Awareness is important when working toward optimal blood pressure.

What does risk for atherosclerotic cardiovascular disease (ASCVD) have to do with blood pressure??

The new blood pressure guidelines focus on the patient’s risk for heart and vascular disease and take into consideration if the patient has already had heart attack or stroke or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk (using the same risk calculator used when evaluating whether or not to treat high cholesterol).

 

Reference: http://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017

 

Where can I get more information??

The Heart Health Docs have covered heart healthy diet and exercise extensively. Lifestyle habits play a powerful role in heart health and in blood pressure management. Simple habits like regular exercise, following the DASH diet, boosting potassium in your  diet, and limiting alcohol are great for getting to goal blood pressure. Keeping a healthy weight will help get to goal blood pressure.

We recommend checking out the American College of Cardiology site, CardioSmart for great information about hypertension.

 

https://hearthealthdocs.com/heart-healthy-diet/

 

https://hearthealthdocs.com/exercise/

 

Really all our site articles are helpful https://hearthealthdocs.com/articles/

 

 

Omega-3’s? Vitamin D? Vitamins? Which can prevent heart disease?

IMG_8348rt5x7bwWith heart disease continuing to be a leading cause of death throughout the world, researchers continue to look at how diet, supplements and other habits can impact the development of heart disease. Here is a rundown of some new studies that continue to shed light on how to prevent (or in some cases, not prevent) heart disease:

As most doctors have suspected for a while, vitamin D seems to have minimal effect on your heart and circulation system. This new study seems to confirm that fact.  Certainly, people with a severe deficiency should have replacement therapy, but routine use does not appear to have a significant preventive benefit.

The news with multivitamins is similar. We have suspected this for a while (see our prior article on the role of supplements) but now a large study on thousands of patients (in this case, limited to men) seems to confirm that routine multivitamin use really does not prevent future heart disease. This does not exclude other benefits, but reinforces our recommendation that multivitamins are probably not needed for those with a well-rounded diet.

How about fish oil? Here is a link to a nice updated article addressing which patients may benefit from omega-3 fatty acids. Despite high hopes, no studies have really shown a broad benefit to most healthy adults. But those with specific conditions may benefit.

These studies reinforce the Heart Health Doctors’ dietary advice – eat a balanced diet low in processed foods, unnecessary carbs (especially wheat-based) and saturated fats, and watch the total calories. As always, you should consult with your health provider about what specific diet is best for your health, and your medical conditions.

Here are our earlier articles on diet, supplements and heart disease:

Which Supplements Improve Wellness and Prevent Heart Disease?

Heart Healthy Diet – 10 eating tips

Do Healthy Adults benefit from Fish Oil?

 

Heart Health and Type 1 Diabetes

 

Diabetes plays such a role in heart disease that it is considered not only a risk factor but a coronary artery disease equivalent. Women who experience gestational diabetes have increased heart risk throughout their adult life. There a multiple presentations and forms of diabetes but broadly can be considered type 1 and type 2.

Fewer people have Type 1 Diabetes compared with Type 2 Diabetes, however in general Type 1 can present at much younger ages. I was diagnosed with type 1 diabetes at age 20 (also called “Juvenile diabetes” I was insulted to be diagnosed when I was no longer a juvenile – only to learn that the ‘juvenile’ terminology was no longer accurate, and yes, I did have T1D).

Recommendations for heart health and using lifestyle to reduce risk for heart disease applies if you have diabetes – and is even more important.

Heart Health and Type 1 Diabetes is a post for the organization Beyond Type 1 that outlines heart health and Type 1 Diabetes. Heart Health Docs followers will recognize a lot of the content and emphasis on heart healthy choices including the American Heart Association Life’s Simple 7

Take a few minutes this Labor Day weekend to check out The Beyond Type 1 website  ~ an excellent source of information covering nutrition, health, and stress management for anyone looking to improve their health, and is a great place to learn about type 1 diabetes specifically.

 

 

Diet and Heart Disease – What Does the Science Say About What to Eat?

IMG_8348rt5x7bwIt is so hard to keep up with research on diet and disease prevention, especially with so many conflicting reports in the media. To try to sort through this, some researchers looked comprehensively at all of the high quality research available about diet and prevention of heart disease. They put together this nice summary table showing which foods show evidence of harm, which show evidence of benefit, and which are inconclusive.
It is important to remember that this is addressing heart disease specifically, not general health or general disease prevention.  And they limited their conclusions to the most thorough studies of heart disease outcomes.  For example, I think a diet which is low in wheat-based carbohydrates can be very beneficial for maintaining weight and preventing long-term health complications.
If you, or a family member, suffers from chronic heart disease, this table is a good starting point for a discussion with your physician and other health providers about the optimal diet to prevent future heart issues.

 

ACC food guide

Here are more of our articles on Nutrition and Heart Prevention.

You Really Are (and might die from) What You Eat (. . .or Don’t Eat)!

IMG_8348rt5x7bwMost of us understand that there is a link between what we eat and our health – but how strong, and how important, is that connection? Heart and circulatory disease is the number one killer of American adults, and we know that certain dietary behaviors can either promote, or reduce, health consequences.

But a new study  just released, shows just how strong that association is between diet and heart disease. These researchers looked at all of the important studies of specific food types and disease associations, then compared this to national surveys of Americans’ eating habits. They then estimated what proportion was due these various dietary habits.

Overeating, or not eating enough, of the 10 foods and nutrients contributes to nearly half of U.S. deaths from heart and circulatory disease, the study suggests.bread

“Good” foods that were under-eaten include: nuts and seeds, seafood rich in omega-3 fats including salmon and sardines; fruits and vegetables; and whole grains.

“Bad” foods or nutrients that were over-eaten include salt and salty foods; processed meats including bacon, bologna and hot dogs; red meat including steaks and hamburgers; and sugary drinks.

Of course, this was a study of populations, and most of us are most concerned about our personal habits and risk of disease (remember, only your doctor or health care provider can give your specific advice about your health care). And most importantly, the fact that certain dietary habits are “associated” with bad health, doesn’t mean those foods “cause” bad health.   But this is an interesting study that helps quantify the most important targets for change in our diet.  (click here to read  the full study)

For more information on Heart Health and Diet, see our overview article here.

 

#GoRedCbus ~ When should you learn about Heart Failure?

BW ARA labcoatThe American Heart Association’s Go Red for Women event February 23, 2017 gave Columbus information about Heart Health for Women, and provided opportunity to support AHA in advocacy, research, and education.

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Left – right, JS, Dr. Albers, Dr. Basuray

Dr Anup Basuray (photo) presented a breakout session on a complex topic. The name Heart Failure does not in fact mean a heart has stopped working (my engineer/math husband is one of many who question the name Heart Failure – but this has been and remains our wording). The term is broad covering symptoms that occur when the heart is not fully functioning – leading to symptoms including shortness of breath, leg swelling, abdominal swelling, fatigue, and/or weight gain or loss. In his presentation, Prevent. Treat. Recover. : Transforming Heart Failure into a Success Story Dr. Basuray highlighted examples of young women patients he has treated. His case presentations illustrated the different ways people get heart failure; some specific to women, for example in the case of problems associated with pregnancy.

Heart Failure is diverse in cause, outcomes, and treatment. The slide here shows ~ 10 causes of Heart Failure, more recently identified is history of cancer treatment, and also included is ‘unknown‘ or doctor-speak, idiopathic. Heart valve disease, genetics (inherited causes), high blood pressure, drugs and alcohol, infection, coronary artery disease, pregnancy related, and irregular heart rate/rhythm can all be causes of Heart Failure.

Heart Failure results in fluid retention by the kidneys, a problem that is worse with high sodium diet. Western diets have high sodium – top sources are Breads and rolls, cold cuts and cured meats, pizza, poultry, soups, sandwiches, cheese, pasta dishes, meat dishes, SNACKS. Reading labels and being aware of sodium is key to heart health in general and to limiting fluid retention in Heart Failure in particular. Knowledge is power when considering what we eat – see here https://hearthealthdocs.com/heart-healthy-diet/  , and for surprising sources of salt https://hearthealthdocs.com/2016/06/08/surprise-sources-of-salt-in-your-diet/

Dr. Basuray addressed the power of prevention and how to stay healthy by knowing the following KEY modifiable risk factors for heart failure

  • High blood pressure
  • Diabetes
  • Obesity
  • High cholesterol

Know your numbers

  • Blood pressure, cholesterol, diabetes (blood glucose) screen
  • Every 4-6 years, as early as age 20

2013 AHA/ACC Heart Failure Guidelines 

So when should you learn about Heart Failure? Now is good. Same with choosing to live a heart healthier life.

Heart Health Docs recommended resources:

https://www.cardiosmart.org/Heart-Conditions/Heart-Failure

Who Benefits from Fish, or Fish Oil? Some New Info on the Link to Heart Disease

IMG_8348rt5x7bwWhile we have known for some time about the potential benefits of fish in the diet, the specific role of supplements containing the beneficial component, omega-3 fatty acids, has been less clear, due to inconsistent results from various studies.

Fortunately, a new study released this month has clarified the link between supplementation with omega-3 fatty acids and the development of heart disease. This was actually a meta-analysis, meaning it summarized the data from multiple previous studies, in a manner that yields more information than the individual studies themselves. This was a very thorough analysis, specifically looking at the best quality studies (called randomized trials), and specifically looking at the useful component of omega-3 fatty acids, EPA and DHA. Moreover, the researchers were focused specifically on heart and circulatory complications.

What did they find? The intake of omega-3 fatty acids, either from food or supplements,fish-oil reduced the risk of heart disease by 6%. This reduction is mild, and was actually insignificant, but there was a significant decrease specifically patients who started out with high triglyceride levels (> 150 mg/dL) or LDL cholesterol (> 130 mg/dL). When the researchers included additional nonrandomized studies, the reduction in heart disease was 18%. Another important conclusion was that there does not appear to be any harmful effect of supplementation.

So what can we conclude?
First, supplementation with 1 g of omega-3 fatty acids daily, either from food or supplements, appears to be mildly beneficial in preventing heart and circulatory disease.
Second, the majority of the benefit is in patients who start out with elevation of triglyceride or LDL cholesterol. Previous studies (such as this) have shown that otherwise healthy patients derive minimal or no benefit from fish oil supplementation.
Third, there does not appear to be evidence of harm at this level of supplementation.

Also of note, more detailed studies are ongoing to determine the optimal level of supplementation and specific patients. Finally, keep in mind that there are other potential benefits of fish oil supplementation unrelated to heart disease, so if supplementation makes you feel better or healthier, it may be reasonable.  As always you should discuss your specific health situation with your doctor before considering any supplement or other therapy.

 

For more information, here as a video I recorded last year for the video blogging site Vidoyen.com, who asked me, Do Fish Oil supplements prevent heart disease? Here is a link to my 3 minute reply.

Reference to original article:

Alexander D, Miller P, Van Elswyk M, et al. A meta-analysis of randomized trials and prospective cohort studies of eicosapentaenoic and docosahexaenoic long chain omega-3 fatty acids and coronary heart disease risk. Mayo Clin Proc 2017;92:15-29