Category Archives: Heart Health

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

#GoRedWearRed ~ Women’s Heart and Vascular Health

BW ARA labcoatThe OhioHealth Women’s Heart & Vascular Conference January 30, 2016 was a great opportunity for healthcare professionals to focus on current research and practice for Women’s Heart Health.

It takes dedicated research and study to understand how best to identify heart risk and heart disease in women and dedicated clinicians who will put the research findings into practice. The American Heart Association Wear Red Day, Go Red for Women campaigns work to educate women about heart and vascular disease ~ 

For Wear Red Day 2016, here are a few conference takeaways:

Dr Alton

Dr Alton

  1. Ischemic heart disease is not a “Man’s” disease ~ in fact heart disease is the leading killer of mothers, wives, aunts, daughters, sisters. Cardiac tests may include radiation exposure; ask about the tests your doctor is recommending – are there alternatives that don’t involve radiation.

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Dr. Barac discussing CardioOncology

Dr. Barac discussing CardioOncology

2. Cardio Oncology focuses on heart health in the setting of cancer treatment; either history of cancer treatment or current – the goal is to be sure women can receive the most effective cancer treatments while protecting their heart function ~ As with all heart health, making sure you control risk factors for heart disease (hypertension or high blood pressure for example) also helps the heart stay strong during chemotherapy.

 

Dr Amburgey

Dr Amburgey

3. Consider pregnancy a stress test for your heart  It is important to follow up if you have hypertension in pregnancy, pre-eclampsia, or eclampsia or diabetes in pregnancy because these conditions may improve after delivery but are now included as risk factors for heart disease and stroke for women over the next 30 years.

 

 

Dr. Neff-Massullo

Dr. Neff-Massullo

4. Vascular disease is under-diagnosed in women ~ the role of hormone therapy and venous thrombo-embolism (VTE) or blood clots in veins is significant. While it is not recommended to test everyone who starts hormone therapy, it is important to speak up if you have a family history of blood clots or any signs/symptoms of blood clot (leg swelling, pain) – especially in the first 12 months of hormone therapy.

 

Test of venous disease ~ Doppler showing venous reflux

Test of venous disease ~spectral  Doppler ultrasound showing venous reflux

5. Venous disease can cause leg pain and swelling, over time can be disabling due to skin changes such as ulcers; compression socks and vascular procedures can help.

 

 

 

 

Dr. Rock-Willoughby

Dr. Rock-Willoughby

6. Women suffer from delay seeking treatment AND delay of diagnosis of acute MI (heart attack).    For Women: Don’t wait for symptoms to go away; it might not be chest pain; women can experience fatigue, sweats, shortness of breath, dizziness, nausea or abdominal pain – call 911. For Healthcare Providers : Think Nose to Navel ~ a program designed to reduce the time to EKG evaluation for women.

7. What’s a treatment that reduces risk of death, heart attack, and more heart procedures?  Cardiac Rehab. Why are referrals and enrollment not 100%? Why are both even lower for women? Make time for Cardiac Rehab and for Heart Health; it’s worth the effort.

Dr Albers introducing Dr Amin to discuss Atrial Fibrillation

Dr Albers introducing Dr Amin to discuss Atrial Fibrillation

8. Women are underrepresented in Heart Rhythm Disorders research; we know that being a woman increases stroke risk in atrial fibrillation. Be sure to ask your doctor if you have atrial fibrillation, if you need to be checked for atrial fibrillation, and if you should be taking a medicine to reduce your risk of stroke. Get involved and participate in clinical research.

 

McConnell Heart Health Center

McConnell Heart Health Center

Thanks to conference attendees  ~ the room was at capacity ~ more healthcare professionals learning about the diagnosis and treatment of heart and vascular disease in women.

Hello #HeartMonth

BW ARA labcoatThe OhioHealth Women’s Heart & Vascular Program CME event on Saturday 1/30 was a fabulous kick off to February ~ Heart Month ~ which includes #WearRedGoRed for Women Friday February 5 and the Go Red for Women Luncheon here in Columbus on Thursday February 25 to benefit the American Heart Association.

We appreciate the American Heart Association support for the conference (see registration table photo below) with Red Dress pins, wristbands, and great Know & Go cards for participants.

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The morning event at the McConnell Heart Health Center brought together health care professionals interested in learning about Women’s Heart & Vascular Health; from Heart & Vascular physicians with keynote presentation from Dr. Ana Barac discussing CardioOncology.

Dr. Mary Alton gave a great opening lecture on Women & Heart Disease, including Yentl syndrome.  She covered cardiac testing for women ~ or how can we choose the best way to learn about a woman’s heart function.

Dr. Barac presented current research in how to protect women’s hearts during chemotherapy for cancer; as well as the risk of high blood pressure (hypertension) and other risk factors that weaken a woman’s heart function when going through cancer treatments.

IMG_6674The OhioHealth Women’s Heart & Vascular Pregnancy Predicts Risk Program ~ why was this started & what’s a risk from pregnancy? was introduced by Dr. Laurie Amburgey, Maternal Fetal Medicine, and discussed by Dr. Ashley Chambers, Internal Medicine. Both providers discussed the fact that a woman’s heart risk with pregnancy issues like pre-eclampsia doesn’t stop with delivery of the baby. Dr. Chambers told us about the OhioHealth program to be sure women have appropriate risk factor management in the years after having a pregnancy that predicts Heart Risk.

Dr. Joddi Neff with Riverside Radiology and Interventional Associates gave a great “Ask the Expert” session on Vascular Medicine – (a big topic that could have its own conference) and focused on risk of blood clots with hormone therapy, and management of venous diseases for women.

Faculty & Course Director Clockwise from bottom left: Dr. Alton, Dr. Nicholson, Dr. Amin, Dr. Rock-Willoughby, Dr. Chambers, Dr. Amburgey, Dr. Neff-Massullo, Dr. Barac, Dr. Albers

Women’s Heart & Vascular CME Faculty 
Clockwise from bottom left: Dr. Alton, Dr. Nicholson, Dr. Amin, Dr. Rock-Willoughby, Dr. Chambers, Dr. Amburgey, Dr. Neff-Massullo, Dr. Barac, Dr. Albers (Course Director)

Dr. David Nicholson and Dr. Jayme Rock-Willoughby with OhioHealth presented the session “From ER to CR” highlighting the “Nose to Navel” goal for early EKG for women with symptoms occurring in that anatomical range, and the Women’s Cardiac Rehab programming launched at the McConnell Heart Health Center in 2015 ~ an effort to get more women through Cardiac Rehab.

Dr. Anish Amin, a Heart Rhythm Specialist closed with an excellent talk on Women’s risk for stroke with atrial fibrillation (a heart arrhythmia).

More to come with take home points for patients from the morning sessions.

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Lexie Sines, with OhioHealth CME

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. 

 

Heart Health Doctors go to Washington DC

BW ARA labcoatThe American College of Cardiology (ACC) is home to nearly 50,000 cardiovascular care team members including your Heart Health Doctors. I spent 3 days last week in Washington DC with ~ 400 other ACC members who took time away from their patients and practices to visit Capitol Hill together on October 20 and educate our legislators about heart health.

  • HeartHealthDocs goal is education to gain knowledge and maximize heart disease PREVENTION. James Madison’s words can apply to knowledge used to defend against heart disease and optimize heart health:

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Photo above: Library of Congress, Madison building inscription.

Last week I learned more about how our government works; and had the opportunity to talk heart health and present the ACC message to 4 legislators from Ohio: Senator Sherrod Brown’s Legislative Fellow LaTasha Lee, PhD, MPH, Congresswoman Joyce Beatty’s Senior Legislative Assistant Donnica Hawes-Saunders, JD, Congressman Patrick J. Tiberi’s Legislative Correspondent Abigail Finn, and Congressman Steve Stivers’ Legislative Assistant Taryn Dorfman.

The ACC advocacy priorities are inspiring by necessity; despite a 50% decline in heart and vascular related deaths over the last 40 years, heart disease remains the #1 killer in the US (and the world), accounting for 1 in 4 deaths in America (ACC).

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ACC strives to create a value driven health care system, ensure patient access to care and cardiovascular practice stability, promote the use of clinical data to improve care, foster research and innovation in cardiovascular care, and improve population health and prevent cardiovascular disease.

The specific ask for our representatives is 4-fold:

  1. Support legislation to expand patient access to CARDIAC REHAB – by maximizing cardiovascular care team members’ work and programs.
  2. Promote the usability of electronic health records; to maximize your cardiovascular specialists’ time and energy focused on patients’ cardiac health, not on the computer.
  3. Support new funding for the National Institutes of Health and the Food and Drug Administration ~ where funding levels have remained flat for the past 12 years.
  4. Work with medical specialty societies to develop alternative payment models for effective and efficient patient care.

Read more about the importance of Cardiac Rehab here, only through research will we find ways to manage heart disease and promote heart health; without usable workflow, our cardiovascular care team members are limited both in access for patients and range of services offered.

The trip was full- great education and inspiration. October 20 was a remarkably successful legislative day for heart health not just for Americans in general, but also for those of us walking the hill. I logged > 18,000 steps on my pedometer on Tuesday.

Photo is at the 7 am start for the day on Capitol Hill – 

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