Category Archives: Heart Health

Not cancelled – Heart health tips for 2020

BW ARA labcoat In 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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For 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:

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.
This strategy applied equally to reducing fats or carbs, as neither strategy was clearly better.
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.

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

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We 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:

New Guidelines for High Blood Pressure

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BW ARA labcoat Just 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/

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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It 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.

#GoRedCbus ~ When should you learn about Heart Failure?

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The 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.

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

Can a “Good” or “Bad” Lifestyle Overcome “Good” or “Bad” Genes for Heart Disease?

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The genes we inherit from our parents are important -not just for our looks or height, but also for our risk of chronic disease. In particular, we know a portion of heart disease can be determined by our genetic risk. At the same time, there is a lot of evidence that our lifestyle can either promote or reduce our risk of illness and/or overall longevity. Heart specialists have long wondered about the relative importance of healthy lifestyle and our predetermined genetic risk. A new study has shed some light on this important topic and given us some guidance on prevention of heart disease (Click here for a link to the full article).

In a nutshell, the researchers found that “bad” genes can double our lifetime risk of heart disease, but a “good” lifestyle can cut the risk in half. Meanwhile, a “bad” lifestyle can erase close to half of the benefits of “good” genes.

Remember, simply having a history of heart problems in her family does not mean you are doomed to develop heart problems yourself. Heart disease is extremely common and is actually the #1 killer of adult men and women in the US. Certainly, if multiple family members have succumbed to heart disease, especially at a relatively young age, then suspicion would be raised about a genetic predisposition. To get specific advice regarding your personal heart risk, you should discuss your specific situation with your doctor or health care provider.

So, while we cannot do much about the looks and height we inherit from our parents, a “heart healthy” lifestyle can certainly undue a lot of the heart risk!

Please follow these links to our other articles for information on heart healthy diet, overview of heart prevention, and the role of exercise.

Interested in heart health information?

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The Heart Health Doctors site is here to help people improve their heart and circulation health through education.

There is a lot of health information on the internet – a great resource to check for up to date discussions on research is the Topic Archive for the ongoing blog from Women’s Health Research at Yale called ‘Help with the Headlines,’ http://medicine.yale.edu/whr/news/heart/archive/

Topics include diet, exercise, caffeine, stress, and depression and effects on heart health. The format is question & answer, for non-cardiologist readers to learn about their heart health. Check back to the Help with the Headlines site for my comments on an August 2016 study that showed new findings about heart disease risk factors for women.

Each issue can be downloaded – the most recent post looks at whether loneliness and social isolation can lead to heart disease.

http://medicine.yale.edu/whr/news/heart/hearthealth.aspx