Category Archives: diet

Caffeine and Your Heart -Some New Advice

IMG_8348rt5x7bwYou may have seen this report in the media regarding the effect of caffeine intake on irregular heartbeats.  As many of you know, irregular heartbeats are common and can be quite bothersome.  The challenge to clinicians is sorting out which are due to a more serious underlying cause, and which are simply a nuisance. Because caffeine is a known stimulant, clinicians have often advised patients who suffer from palpitations and various types of irregular heart rhythms to avoid or minimize their caffeine intake.

This new study attempted to look at the link between caffeine intake and various types of Coffee Cupirregular heartbeats. Interestingly, the researchers found that there seemed to be minimal effect of caffeine intake on the extent of irregular heartbeats.

What can we can conclude? Although this study is limited in that it was a retrospective
review, it does show that caffeine may be just one of many triggers for heart related issues. It may play a role in certain patients but not in others. Some patients may want to experiment with their caffeine intake to see if it affects their symptoms, but it may not be necessary for all patients to eliminate it completely.  As always, you should discuss your specific cardiac symptoms and issues with your healthcare provider to determine the optimal treatment strategy for you.

 

Irregular Heartbeats? Coffee May Not Be So Bad for You

http://nyti.ms/23txNCq via @nytimeswell

 

People with irregular heartbeats are often advised to give up caffeine, but a new study suggests they may not have to forgo their coffee.

Researchers had 1,388 people record their intake of coffee, tea and chocolate over a one-year period, and used Holter monitors to get 24-hour electrocardiograms.

More than 60 percent of the participants reported consuming one or more caffeine-containing foods daily. But the electrocardiograms revealed no differences in premature beats or episodes of accelerated heart rate between caffeine users and abstainers. Thestudy is in the Journal of the American Heart Association.

“There’s no clear evidence that drinking more caffeine increases the risk for early beats,” said the senior author, Dr. Gregory M. Marcus, an associate professor of medicine at the University of California, San Francisco. In fact, evidence from other studies suggests caffeine may even be linked to decreased rates of cardiovascular problems.

“I tell patients that it is very likely that for some people, caffeine is an important trigger” of irregular heartbeats, Dr. Marcus said. “I generally tell them that it’s fine for them to experiment and weigh the pros and cons of caffeine to see how it influences their quality of life. The majority of arrhythmias are not life threatening.”

Can Fish Oil Really Prevent Heart Disease?

IMG_8348rt5x7bwWe are often asked about the role of fish oil, or omega-3 fatty acids in general, for the prevention of heart and circulatory disease.   I posted a video addressing this question on the video blogging site Vidoyen.com (clinic here to review). This video addresses the largest research study to date looking specifically at the role of fish oil and prevention. Unfortunately, it did show that the positive role of fish oil may be less than suggested in the past, but there could be a role for specific patients.  As always, yo should talk to your doctor about all of your supplements, to help learn which may play a role for your specific health conditions (and to ensure that there are no unwanted interactions with other medications or health conditions).

you can also find videos the dressing wine, saturated fats, and the new cholesterol medications on the side.  Thanks for your interest and heart disease prevention!

Heart Health News. . . You Can Use

IMG_8348rt5x7bwHere are some quick links to useful items in the news recently that reflect new findings on prevention and heart health:

Could drinking alcohol actually affect the way you exercise? Some new research described here suggests that could be the case – and in a positive way. 

The upshot? Because exercise and alcohol intake affect similar “pleasure” centers in our brain, you may actually be tempted to drink more in days you exercise – but people who drink moderate amounts of exercise also tend to exercise more regularly. . . and seem to be healthier. (see our earlier article about wine and heart health).

Is coffee good or bad for you? A new study described here looked at coffee intake and risk of death from various causes.

The upshot? Keep bringing on the java (and consider buying Starbucks stock!)

Can you be “too old” to exercise. . or get its benefits? Not according to new research. 

The upshot? Even in those over age 75, regular walking can reduce your risk of heart attack and stroke. So keep moving!

This article describes research into the link between weekend sleep and weekday sleep.

The upshot? Sleeping in late on weekends may feel good, but may have negative health consequences.

Remember. . only your doctor can give you specific health care advice. . so always check with your health provider if these articles (and the advice they contain) apply to you and your health situation. 

 

An Update on New Research – Straight from the Source!

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).

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 http://www.cardiosmart.com)

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.

Cardiac Rehab~Have you heard of it? #hearthealth @CardioSmart #CardiacRehab #exerciseworks

BW ARA labcoatHeart and Vascular Health result from a mix of a lot of different ingredients; we cover many of these ingredients here at the Heart Health Doctors (for example exercise, diet). Think of mixing or using the best ingredients possible (healthy weight, not smoking, healthy diet, staying active) as PRIMARY prevention (for someone who has never had a heart event).

Another important way to work on the ‘ingredients’ is by SECONDARY prevention – how to regain strength, heal after injury, and build back to great Heart & Vascular Health after an EVENT.

Cardiac Rehab is how. The event that will trigger going to Cardiac Rehab may be having a heart stent, a heart attack, open heart surgery for bypass of blocked heart arteries, valve replacement or repair, chest pain or angina, or most recently, a diagnosis of congestive heart failure; even a combination of these.

It would be great to have Cardiac PREhab programs; for now that is what we do at our blog – education for maintaining heart and vascular health.

Cardiac Rehab remains the program that can reduce mortality (death) by 25% if people who have had a heart event complete the program when compared with people who have had a heart event who did not complete a Cardiac Rehab program.

This CardioSmart video gives a great overview of Cardiac Rehab.

The benefits of Cardiac Rehab in our communities cannot be overstated. Often patients will tell me that they plan to “exercise on their own” or that (women here) they are busy making sure their families are organized and cared for, so “no time.” One program offers discount rate for a spouse to attend rehab sessions and exercise with the patient to help increase participation. I encourage and – to use doctor terminology – order my patients to enroll and participate in Cardiac Rehab despite excuses.

At Cardiac Rehab the exercise is monitored – so the patient’s physician learns of any heart arrhythmia, or of any blood pressure issue (under or over treatment). The patient learns about their heart disease, heart healthy habits, how to follow their personal exercise prescription, eat heart healthy, and how to identify and manage stress. It is time well spent. A challenge for patients of late unfortunately can be cost; many programs have financial aid to help patients attend and complete a rehab program, but I had no argument for my patient whose co-pays for cardiac rehab would have approached $2000 for his sessions. He simply could not participate. The hope is that that is an exception; insurers have the data that shows Cardiac Rehab programs result in patients having fewer followup procedures, come out with better quality of life, and are more prepared to succeed with SECONDARY prevention.

Often patients have up to a year to enroll in a Cardiac Rehab program after a qualifying heart EVENT.  Make it a priority to include this therapy and improve Heart & Vascular Health.

 

 

Wine: Is it really a toast to good health, and a healthy heart?

IMG_8348rt5x7bwYou may have seen recent articles in the media such as this that seem to contradict the notion that regular wine intake can be heart healthy. So this may be a good time to explore the link between wine intake and heart disease in more detail. For several decades, we have known that certain populations in the world, such as France, seems to have less heart disease despite a higher intake of saturated fats. One explanation for this finding (referred to as the “French paradox”) was the high intake of red wine in these populations, leading to speculation that red wine could somehow prevent heart disease. In fact, many studies have shown that so-called “moderate” alcoholic intake (one drink a day for women, or 2 or less for men) seems to lead to less chronic disease and a longer life span than those who drink heavily, or not at all.  Of course these are only observational (e.g. not randomized) studies, so there is always controversy about whether other factors could also play a role.

eca284793cc89e389f347e0f41da895aAlthough wine contains many heart-protective antioxidants, the agent which was postulated to be particularly protective is resveratrol, as animal studies have shown that high doses of this antioxidant can prevent chronic disease.  Although the studies were not really applicable to humans (due to extremely high doses of resveratrol), this led to the widespread notion that red wine is particularly “heart healthy”. Unfortunately, no other studies have been able to show that any particular agent in red wine makes it superior to other types of alcohol in the prevention of chronic disease. The new study released last week confirms this, as these researchers measured the amount of resveratrol in elderly Spaniards, to confirm their consumption of red wine.  They found no relationship between wine consumption and longevity, heart disease, or cancer.

So, what can we conclude about wine intake and heart disease?  First of all, you should ask your doctor about how alcohol could interact with your specific health conditions and overall risk profile.   Here are some other key points backed by the evidence:

1. Moderate alcohol use, as defined above, does seem to have a protective effect against chronic disease and increased longevity, compared to heavy drinkers or nondrinkers.

2. However, no specific type of alcohol, including wine, has clearly been shown to be superior in terms of its protective effect. Certainly, wine (red or white), with less alcohol and more antioxidants then other types of alcohol, would seem to be a reasonable choice for those who choose to drink alcohol.

3. Because the protective effect of alcohol has not been shown conclusively, there is not enough evidence to recommend that someone initiate regular alcohol use simply for the health benefits. Other lifestyle issues, such as a healthy diet, regular exercise, and weight maintenance are far more important.

4. In very detailed studies, there does not seem to be any specific elevated risk associated with mild or moderate alcohol use. Therefore those of us who incorporate alcohol into our lifestyle should focus on the quantity we drink, and making it part of a overall healthy lifestyle.

5. Increasing use beyond “moderate” can clearly increase the risk of complications and chronic illness.

So if you decide to incorporate alcohol into your lifestyle, do so for your enjoyment, not necessarily for your health – and always in moderation! And for more specific advice, check with your doctor.

New York Times summary of recent research.

Link to “Top Myths about Heart Disease” , interview with Dr. Steve Nissen from the Cleveland Clinic.

The role of diet in heart prevention

Saturated Fat: Old Foe, or New Friend?

IMG_8348rt5x7bwYou may have seen some of the recent media articles that address the debate over saturated fat. This is based on some newly published research that suggests that adults who reduce their intake of saturated fats don’t necessarily reduce the heart risk. Popular media has covered this widely, and even the New York Times declared that “Butter is Back”. So does that mean we now have the green light to load up on red meat, butter, and other sources of saturated fat?

The short answer is – probably not. I recently addressed this topic on the video blogging site Vidoyen.com, which you can view by clicking here. Many nutrition and public health experts, who certainly have more expertise than myself, have also weighed in (one of my favorites, Dr. David Katz, has this video and this excellent article which help rebut the “butter is back” theory). The consensus is that this recent research, which was a pooled analysis of prior research, not new data, has some serious flaws. Here is what the “experts” seem to conclude:

1. Saturated fattty acids (or SFA, such as red meat, cheese, and butter) have long been known to be linked to the development of heart disease.

2. While reducing SFA can reduce heart risk, what is important is how the “bad” fats are replaced – many diets (and people) tend to increase intake of carbohydrates – especially the processed kind, which are probably worse for long term heath. That is why many “low fat” foods really don’t improve your health- they replace the SFA with bad carbs instead.

3. The key seems to be to replace the SFA with “good” fats instead – that is, unsaturated fatty acids such as nuts, olive and other vegetable oils, and fish. When this has been studied, there appears to be a beneficial effect on heart risk and overall health. In fact, this is the exact goal of the Mediterranean Diet, which has been studied extensively and shown to reduce heart risk.

More importantly, think less about the “components” of your diet, and focus more on eating whole foods. For example, butter may actually be better than some of the processed spreads, but not as good as olive or vegetable oil. So the “old foe” is still a “new foe”!

Here are some more links to our articles on diet and nutrition:

Our overall guide to a heart healthy diet

Our top 10 eating tips

Nutrition Counts

The perils of carbohydrates

 

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.