Category Archives: Heart Health

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.

#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

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

IMG_8348rt5x7bwThe 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

Heart Health Doctors Road Trip -> Ohio to Washington DC

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US Capitol building ~ Scaffolding (almost) off

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The American College of Cardiology (ACC) National Legislative Conference offers an opportunity for heart team members to connect with lawmakers regarding issues key to patients’ heart health. Providers including pharmacists, nurses, nurse practitioners, physician assistants, practice administrators, and physicians spend one day learning about the issues and a second day taking our ACC messages to Capitol Hill. ACC also included a focused workshop on leadership for Women in Cardiology this year, held one day before the Legislative Conference. All sessions comprised a busy and high yield 3 days in Washington DC. Key takeaways are:

The Women in Cardiology (WIC) leadership workshop was held at the American College of Cardiology Heart House, now celebrating the 10th year at the DC location. The workshop brought information to attendees – from communication skills to financial ‘well being’ to an overview of current state for women physicians in both academic and community medicine / private practice. The cardiovascular workforce is aging; recruiting a diverse workforce for future cardiovascular team members, in particular women in cardiology, is key to our nation’s heart & vascular health. Presentations from Dr Reshma Jagsi, Dr Robert Harrington, & panel assembled by Dr. Toniya Singh gave attendees perspective on careers in cardiology. ACC Women in Cardiology Section Chair Claire Duvernoy and the WIC leadership council organized a high yield workshop.

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Women in Cardiology Leadership workshop attendees at Heart House

The legislative conference covered key topics for providers including the new payment legislation for Medicare.

Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)

MACRA is not the Affordable Care Act. Sessions including a panel discussion  “MACRA 101” as well as a talk from Jean Moody-Williams, RN, MPP – Deputy Director, Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services (CMS) representative helped bring the cardiovascular team up to speed on prep for the new law.

Over 400 cardiovascular professionals gathered in Washington DC for the Legislative Conference ~ Ohio was well represented at the meeting.

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Legislative Conference participants from Ohio after first day of the conference ~ prepped for Capitol Hill

This year the conference also included an introduction to Social Media and how to communicate cardiovascular topics to a wide audience ~ Twitter for CV professionals. State based advocacy was also a focus; with key examples for how the cardiology team can work with state legislators to improve cardiovascular health & care delivery. A great example from Ohio includes legislation to bring students education about CPR.

Tuesday visits to Capitol Hill are summarized well by the ACC blog. From a personal standpoint the day was spent in a totally different environment from office practice or the inpatient cardiology service & echo lab.

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Ohio ACC Chapter Governor Dr. Laxmi Mehta & group at the Capitol September 13

Ohio participants divided into groups to visit the Hill; our group included a nurse practitioner, two cardiovascular fellows in training, our ACC Ohio chapter Governor, and myself.  We found our way around the Hill to the offices of Representatives Joyce Beatty, Pat Tiberi, and Warren Davidson, also to Senators Brown and Portman’s offices. Our group took turns talking to legislative aides about legislation to expand patient access to the key secondary prevention program of cardiac rehab, asking for increased funding for heart programs from NIH, FDA , and ensuring congressional oversight for the MACRA roll out & implementation.

We provided first hand education about cardiac rehab – what it offers patients, what’s involved, why the proposed legislation will increase availability for participation, and talked about the impact of medical research on Americans. Having a representative personally thank us for the care a family member received for a potentially devastating heart condition brought home the importance of what we as the cardiology team do everyday in addition to stepping into the advocacy role to ensure providers can continue their practice.

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Ohio Chapter ACC Advocacy ~ Cardiovascular team members meeting with Congressman Warren Davidson, 8th District, Ohio

The 2 days of conferences were made up of more sitting than moving, but Tuesday on Capitol Hill was again a ‘good step’ day with > 15,000 steps by 7pm (is there more credit for walking in the DC sunshine = hot?). Getting to the Mall for a run before Monday’s sessions was not only beautiful at sunrise but also gave an opportunity to exercise.

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Washington Monument & reflection pool Monday September 12 6:30am

 

 

 

Are “Bad” Fats Still Bad? Some New Information

 

We often receive conflicting information on the role of dietary fats and heart risk. A new breadstudy released this month is attempting to clarify this link, since it is one of the largest studies ever conducted on dietary fats and overall long-term health risk. It was performed by the well-respected Harvard School of Public Health, and used a database of over 126,000 men and women followed for 32 years. These were healthcare workers who are in good health, and the dietary habits were followed closely with detailed questionnaires. Their rates of death over 32 years were then tracked carefully.

Here are some of the key findings:
1. Eating more saturated fat and trans-fats (“Bad” fats) was indeed associated with an increase in overall mortality (death rates).
2. Eating more polyunsaturated and mono unsaturated fats (“good” fats) did reduce the overall risk of death. For example, replacing just 5% of your total calories of bad fats with good (polyunsaturated) fats, would reduce the risk of death by 27%.
3. Simply replacing the bad fats with carbohydrates did not show any protective effect. (I call this the “Snackwell Cookie” effect)
4. In addition to lower heart and vascular disease, subjects  who ate more healthy fats also had a lower risk of dying from neurodegenerative and respiratory disease. So, a healthy diet may protect against a variety of chronic diseases.

Polyunsaturated fats contain essential fats your body can’t produce by itself, such as omega-6 and omega-3 fatty acids. Some of the best sources are nuts, seeds, fatty fish, and leafy greens. They are also found and vegetable oils such as canola, soybean, and safflower oil.  In this particular study, monounsaturated fats were also protective but less so than polyunsaturated fats. The most common example of a monounsaturated fat is olive oil.

Of course, this was a retrospective review, so the findings are not as powerful as a randomized study.  Nevertheless, the study appears to support the recommendation that we should reduce saturated fats in our diet, and emphasize polyunsaturated fats instead. We should also be careful not to increase our carbohydrate intake to compensate, emphasizing the role of total calories.  We still have a lot to learn regarding the optimal diet for disease prevention, but studies like this continue to shed light on the subject.

MORE INFORMATION:

This article from CNN Online has a very nice summary of the findings, along with an excellent summary of the various types of good and bad fat, and examples of each in the diet:   Good fats can cut risk of death by 27% @CNN

Here is a link to the scientific summary of the study:

Is Butter really “Back”? Not exactly. . . .

Low Fat or Low Carb? A new study sheds some light. . . .

 

 

Another Reason to “Stand Up” to Heart Disease!

IMG_8348rt5x7bwIn case you need another excuse to get off the couch (and think about a treadmill desk). . . it appears “too much sitting” may in itself contribute to the progression of heart plaque. . .

Too Much Sitting May Up Risk of Coronary Artery Calcification

Marlene Busko

SAN DIEGO, CA — Each added hour spent sitting was associated with a 14% increase in coronary artery calcium (CAC) score, independent of traditional risk factors, including physical activity, in a study of middle-aged subjects without cardiovascular disease[1].

“Our study contributes to the growing body of evidence whereby health consequences of ‘sitting too much’ appear to be distinct from those of ‘too little exercise,’ and [it] suggests that increased subclinical atherosclerosis may be one of the mechanisms through which sedentary behavior increases CV risk,” Dr Jacquelyn Kulinski (Medical College of Wisconsin, Milwaukee) told heartwire from Medscape.

The researchers examined data from 2031 participants in theDallas Heart Study who were aged 20 to 76, with a mean age of 50. Just over half (62%) were women, and about 50% were black.

Participants had a CT scan to measure CAC; a CAC score above 10 was deemed positive and a score below 10 was deemed negative. In addition, the participants wore a watch accelerometer for at least 4 days to measure body movements, which were classed as sedentary, light activity (nonexercise), or moderate to vigorous physical activity.

On average, participants were sedentary for 5.1 hours a day, but this ranged from 1.1 to 11.6 hours a day. Older people, those with a higher body-mass index (BMI), and those with diabetes or hypertension were more likely to spend more time sitting.

After adjustment for BMI, systolic blood pressure, total cholesterol, HDL cholesterol, statin use, type 2 diabetes, smoking, household income, education, marital status, employment, and moderate to vigorous physical activity, each hour of sedentary time was associated with a 10% higher odds of having CAC (adjusted odds ratio 1.10, 95% CI, 1.01–1.21; P=0.035).

Moderate to vigorous physical activity was modestly associated with CAC in models adjusted only for age, gender, and ethnicity, but the association disappeared after adjustment for traditional cardiovascular risk factors, including smoking, diabetes, BMI, cholesterol, and blood pressure, Kulinski added. Even though study participants exercised only an average of 6 minutes a day, other studies in marathon runners have also reported that exercise was not associated with CAC, she noted.

LINK TO FULL ARTICLE:

Too Much’ Sitting May Worsen Coronary Calcification, Regardless of Exercise
Heartwire from Medscape, 2015-03-11