Author Archives: The HeartHealth Doctors

Not cancelled – Heart health tips for 2020

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BW ARA labcoatIn a short time Ohioans have learned about social distancing to flatten the curve-from schedule changes, event cancellation/reschedule, and even changes with regular medical care. The CapCity Half – a favorite event supported by OhioHealth has been canceled for April, rescheduled to August. Fortunately, these efforts appear to be limiting spread/reducing high numbers of people becoming severely ill with Covid19.

 

The goal of flattening the curve is to avoid overwhelming the health care system-so that if an emergency happens, patients can get treatment. Unfortunately in a pandemic, despite many cancellations, heart and vascular disease are not canceled. Heart attack and stroke still happen.

 

What are signs/symptoms of a heart or vascular emergency?

 

A person’s appearance – pale, sweaty, difficulty breathing, visibly uncomfortable, fainting- can be signs of heart attack. Pay attention to family members and neighbors and call 911 if concerning signs.

 

Don’t ignore symptoms especially chest pain, back, jaw, or shoulder pain, shortness of breath, dizzy/lightheaded, heart racing or palpitations, severe leg swelling, fatigue, even nausea and vomiting some or all of which can be symptoms of a heart attack.

 

For stroke remember FAST – Face drooping, Arm weakness, Speech change, Time to call 911.

 

What if someone has new symptoms but not so severe? What about non-emergency care? It is not cancelled ~ elective surgeries and procedures and tests are closely reviewed and timing determined in balance with the pandemic but non-emergency healthcare is important.

 

Routine healthcare via tele visit or video visit or even a phone call to a nurse are not cancelled. Keep a log if you are aware of a change or new symptom, write down questions if you wonder about a medication.

 

Tele ~ Greek for distant ~ medicine offers a way to connect and consult with health care professionals via telephone and video visits.

To respond to our patients, in a short time the clinicians and teams at OhioHealth have launched even more widespread tele health and video appointments for patients to touch base, evaluate symptoms, and allow for evaluation of and follow up for heart and vascular conditions. Elective or routine testing and heart checks will be rescheduled – we are all working to keep patients heart healthy by keeping the timing of routine checks flexible.

 

Bottom line: focusing on heart health is not cancelled even in a time of social distancing and working to flatten the curve ~

 

How can you Social Distance and stay heart healthy? What’s important from a heart and vascular standpoint?

 

Here are 5 tips for Heart Health –

 

1) Take medications as prescribed; be sure to keep adequate supply – pharmacies are deemed essential and will be open. Keep a regular schedule while social distancing – especially with medications but also with food, rest, physical activity a schedule helps structure your time.

2) Stay physically active – the ultimate way to multitask for your heart and circulation, physical activity such as taking a walk in the home or socially distant outside, standing up and sitting back down in a chair, light stretching, running, lifting weights – helps manage stress, keeps immunity strong, lowers BP and cholesterol ; it’s an amazing way to help your heart. Physical activity doesn’t have to be perfect – remember that 10-15 minutes twice a day most days of the week meets current recommended guidelines for physical activity. Learn about and give meditation a try. Meditation can help with biofeedback and stress management, lowers blood pressure, and has been shown to help heart health.

 

3) What are you eating? Are you experimenting with whatever remains in the pantry? Heart healthy eating hasn’t been cancelled – choose fresh foods as able, vegetables, whole grains, nuts, and avoid processed foods. Keep portions in check.

 

4) Are you sleeping? Good sleep habits help heart health from preventing arrhythmia to helping blood pressure stay at goal.

 

5) Collect data to discuss with your team. Track home blood pressure, heart rate, weight depending if managing heart conditions such as hypertension, arrhythmia (for example atrial fibrillation) or heart failure.

 

StayHome Ohio but don’t ignore an emergency.

More benefit to physical activity~ Prevents Heart Failure

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Physicians talk about patients with heart failure (HF) when describing someone with shortness of breath, inability to exert physically without having shortness of breath, or also experiencing fluid retention (leg swelling, increased waist size).

 

Non-physicians (my husband for example) hear about ‘heart failure’ and imagine death, or heart stopping like in sudden cardiac death. The terms could be better, but for now are used as above for physicians and for HeartHealth Doctors followers: Heart Failure refers to symptoms of shortness of breath (dyspnea) or fluid retention either due to reduced (r) heart pumping function (also termed Ejection Fraction or EF) (HFrEF) or preserved (p) EF but ineffective heart pumping function (HFpEF).

 

Heart failure is one of the most common reasons for hospitalization and is more common as people get older.   In the US more than 6 million adults have HF.

 

HeartHealth Doctors blog has information regarding the benefits of exercise and heart healthy lifestyle as powerful ways to prevent symptoms from heart issues.

 

For the first time, the Women’s Health Initiative program (WHI) has reported benefit of physical activity specifically walking, for post menopausal women to prevent HF.

Physical Activity and Incidence of Heart Failure in Postmenopausal Women (J Am Coll Cardiol HF 2018;6:983–95) reports findings from WHI that support regular physical activity – reported as recreational physical activity by participants – as a powerful means of reducing Heart Failure risk (both HFrEF and HFpEF).

The findings again support exercise (physical activity) as medicine – without potential side effects, and with a good dose response (more activity time, less chance to develop Heart Failure).

The study looked prospectively at the women, and the following list are possible ways physical activity impacts risks for developing heart failure. As HeartHealth Doctors have outlined, physical activity improves risk factors for heart disease, and as pointed out in the Clinical Research Study, for Heart Failure-

 

Exercise or physical activity helps prevent or manage:

Obesity

Blood pressure

Glucose / blood sugar regulation

Inflammation and Oxidative stress

Left ventricular compliance (heart pumping/relaxing function)

Arterial function

Aerobic capacity

Skeletal muscle function

Coronary Heart Disease

Diabetes

Atrial fibrillation

 

The researchers removed participants who were unable to walk 1 block prior to enrollment.

They included post menopausal women age ~50-79 years at start of the study and followed the group for 15 years with surveys.

The study highlights new benefit to heart healthy habits of exercise and physical activity; still the best way to multi task for your heart health.

How much physical activity is enough?

The study suggests volume of activity is a good focus rather than intensity – just walk for example work toward the authors’ goal of ‘brisk walking (3.3 mph on level ground) with the target of achieving 30 min/day on 5 or more days of the week.’

Benefit was shown with regular walking pretty much in line with current guidelines of 150 minutes per week; which can be 10 minutes twice a day or 30 minutes 5 days per week ~ now a big study shows one more of so many reasons to be physically active.

 

Physical Activity and Incidence of Heart Failure in Postmenopausal Women (JACC: Heart Failure December 2018)

J Am Coll Cardiol HF 2018;6:983–95

Quality, not Quantity: the New Goal for Weight Loss

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IMG_8348rt5x7bwFor years, we have heard over and over that our weight is tied to the amount of calories we eat.  The prevailing wisdom was that if we could just reduce the calories taken in, then we could lose weight.  More recently, we are starting to understand that the type of food we eat, not just a total calories, may be more important to our health.  Now a major study confirms the concept.

These researchers, in a very careful and rigorous fashion, studied not just the total calories take it in, but also the quality and type of food eaten in a large group of test subjects whose weight, and overall health status, was tracked over a year. You can read the details of this extensive study here, but here are some of the key conclusions:

  1. Dieters who cut back on added sugar, refined grains and other processed foods, while also increasing their intake of vegetables and whole foods successfully lost weight, regardless of total caloric intake.
  2. This strategy applied equally to reducing fats or carbs, as neither strategy was clearly better.
  3. The key point is that these dieters were not told to count calories, just focus on better quality selection of food, and they had successful weight loss and still actually reduced the total amount of calories a day. So this seems to confirm that quality, not quantity, is the key to a healthy diet.

For more articles on a heart-healthy diet, see our Diet page.

Exercise can make your body feel younger. . . and (maybe) actually make it younger?

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IMG_8348rt5x7bwAs we prepare for Thanksgiving (and in my case, the Thanksgiving Day Turkey Trot!) there is some good news on exercise and aging.  We know that lifelong regular exercise can reverse many of the effects of aging – at least in “elite” or professional lifelong athletes. But what about “regular people” who commit to a lifestyle of regular activity? Can their bodies become “younger” too?

A recent study (link to full study here) tried to answer this question – by studying the Running Turkeybodies (specifically, muscle tissue) of older individuals who had remained active though regular leisurely activities. The main findings, according to this article in the New York Times summarizing the study:

“The muscles of the older exercisers resembled those of the young people, with as many capillaries and enzymes as theirs, and far more than in the muscles of the sedentary elderly.

The active elderly group did have lower aerobic capacities than the young people, but their capacities were about 40 percent higher than those of their inactive peers.

In fact, when the researchers compared the active older people’s aerobic capacities to those of established data about “normal” capacities at different ages, they calculated that the aged, active group had the cardiovascular health of people 30 years younger than themselves.”

What does this mean?

  1. Committing to an active lifestyle can slow, or even eliminate” many of the changes in our muscles that we consider “normal aging”
  2. Even though our overall exercise capacity does diminish over age, these changes are slowed significantly in those who remain active, compared to less active older individuals.
  3. In the words of one of the researchers, “exercise could help us to build a reserve of good health now that might enable us to slow or evade physical frailty later”

So this is more evidence for all of us to stay active – here is our overview of physical activity and its benefits on heart health, and here are more articles on exercise:

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

Is Running Risky? Lets check the science. . . .

Can 1 Minute of Exercise Possibly be Useful?

What is the “right dose” of exercise for a long and healthy life?

 

 

Does diet advice drive you nuts? Maybe it should drive you TO nuts. . . .

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IMG_8348rt5x7bwWe have known for a while that nuts are a natural source of good fats, vitamins, and healthy minerals.  Doctors and other health experts (including the HeartHealth Docs) have recommended nuts as part of a balanced diet for some time, and they are an important part of the Mediterranean diet, which seems to have a lot of heart healthy benefits.

But a new study, which you may have seen reported in the media, is the most comprehensive to date to look specifically at the link between nuts and heart prevention. The researchers analyzed data from 3 very large population health studies, including over 200,000 healthy adults, who were followed for up to 30 years to look at incidence of heart disease and stroke. What did they find?

1. Participants who consumed at least 5 servings of nuts weekly had about a 14% lower risk of heart disease than those who never ate nuts.
2. The link was similar for those who ate peanuts, tree nuts, or walnuts.
3. Surprisingly, there was a preventive benefit for heart disease but less so for stroke (with exception of peanuts and walnuts, which did have a slight positive effect).
4. Other not products, such as peanut butter, did not seem to have a protective effect.

Like a lot of population studies, this one was retrospective, so it did not prove that there is a direct link between nut intake and reduced disease. And the groups studied were not ethnically diverse. But it was carefully performed and in a very large population, so it is the best evidence so far that nuts are part of a healthy prevention diet.

Take away messages:
1. 1-5 servings of nuts weekly can be an important component of a preventive diet, especially for those who have, or are at risk for, heart and vascular disease.
2. All type of notes seem to be beneficial, even peanuts which are technically a legume.

3. Because nuts have a lot of calories, portion sizes important.  A serving of nuts is 1 ounce, which is about 28 peanuts, or 23 almonds.

4. Processed products such as peanut butter do not seem to have the same beneficial effect.

So find ways to incorporate whole nuts into your diet, but watch the portions!

Here is a link to more information about the study.

Here is more information from our site regarding diet and prevention.

Here are examples of a single serving of almonds:

Nut portions

 

 

 

 

New Guidelines for High Blood Pressure

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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?

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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

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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?

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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)!

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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.