Tag Archives: cholesterol

Not cancelled – Heart health tips for 2020

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

 

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

 

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

 

Here are 5 tips for Heart Health –

 

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

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

 

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

 

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

 

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

 

StayHome Ohio but don’t ignore an emergency.

An Update on New Research – Straight from the Source!

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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).

A New Option for Patients Who Can’t Tolerate Statins

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IMG_8348rt5x7bwFor over 20 years, statins (such as atorvastatin and simvastatin) have been one of our primary weapons to fight heart and vascular disease, because of their ability to reduce cholesterol, and subsequently prevent heart attacks and strokes. But in many patients, statins are poorly tolerated or ineffective at reducing cholesterol to  the desired target.

Recently, a new class of cholesterol-fighting drugs were discovered, and the first of these agents has been approved by the FDA. These medications, called PCS-K9 inhibitors, work differently than statins, and do not seem to have the common side effects of statins, such as muscle soreness. They appear to markedly lower cholesterol, and appear to be safe.  This article in the Wall Street Journal nicely summarizes the promise of these drugs, as well as the drawbacks (the drugs are very expensive, and must be given by injection).

In addition to those drawbacks, the new agents have yet to establish a long-term track record of safety and prevention of heart attacks and strokes. So initially, these agents will be reserved for patients who have genetic elevations of cholesterol, and those with known cardiovascular disease for whom statins are ineffective or not tolerated. In the near future, more agents will become available (lowering their price), and further studies will guide how to best use them.

In the meantime, statins remain our best weapon against high cholesterol – and are safe and well tolerated, even when given for many years. And as the above article documents, well-done studies have shown that most muscle soreness in patients on statins is either unrelated to the medication, or resolves when a different statin is used.

And of course, remember that diet and exercise, not just medications,  are effective weapons against high cholesterol.

More articles about cholesterol:

Overview of Prevention

The New Cholesterol Guidelines: What do they mean for you?

 

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

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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

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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.

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

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IMG_8348rt5x7bwWhat is the optimal diet for weight loss and reducing long-term risk? This question has been debated for some time. A new study funded by the National Institutes of Health (NIH), and described in detail here, sheds some light on the issue (but is probably not the final word). In this study, researchers divided about 150 participants into 2 groups – one consumed a “low carb” diet but could eat unlimited fats (even saturated fats, such as butter), while the second group consumed a low-fat diet, as touted by many health organizations for some time. This group had no limits on carb intake. Here is a summary of the results, from the New York Times:

By the end of the yearlong trial, people in the low-carbohydrate group had lost about eight pounds breadmore on average than those in the low-fat group. They had significantly greater reductions in body fat than the low-fat group, and improvements in lean muscle mass — even though neither group changed their levels of physical activity.

In the end, people in the low-carbohydrate group saw markers of inflammation and triglycerides — a type of fat that circulates in the blood — plunge. Their HDL, the so-called good cholesterol, rose more sharply than it did for people in the low-fat group.  Blood pressure, total cholesterol and LDL, the so-called bad cholesterol, stayed about the same for people in each group.

Nonetheless, those on the low-carbohydrate diet ultimately did so well that they managed to lower their Framingham risk scores, which calculate the likelihood of a heart attack within the next 10 years. The low-fat group on average had no improvement in their scores.

So the low-carb group, despite eating high levels of fat (mostly unsaturated – the good kind), lost more weight and improved the cardiovascular risk profile, in comparison to the low-fat group.

HeartHealth Docs take home message: This study was not large, but well done, and shows that reducing carbohydrate intake may be more important than reducing saturated fat. We advocate this type of diet, but still recommend moderation of saturated fats. So when you raise a toast of red (or white) wine this weekend, enjoy some cheese. . .but skip the crackers!

Here are several more articles on a heart healthy diet, as well as saturated fats, and nutrition counts.

 

Exercise – A Great Way to Multitask for Heart Health @CapCityHalf @OhioHealth

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BW ARA labcoatEight thousand two hundred fifty three runners completed Saturday’s 11th Cap City Half marathon, in addition to participants in the Patron Quarter Marathon and Commit to Be Fit 5K events.  It was a great event for Ohio.  The HeartHealth Doctors have posted information about heart function and exercise.  Exercise such as running can be the ultimate way to multitask for heart health by managing stress, getting to or keeping goal weight, improving cholesterol profile, and reducing high blood pressure. Exercise has been shown to impact diabetes risk and can assist diabetes management.  Research shows being more active is key to heart health; walking is an excellent way to exercise.  Walking 10 minutes twice daily gets you close to the recommended guidelines for physical activity (150 minutes per week of moderate (means heart rate increases, but you can have a conversation)).

The American College of Cardiology’s Cardiosmart resource has great information about how to Move More. Being active directly impacts numerous risk factors for heart disease.

Heart Health professionals are responding to the evidence of heart health benefits of exercise and athletics.  Sports Cardiology is a section of the American College of Cardiology and provides an area for Cardiovascular Specialists (doctors who treat heart and vascular disease) to help people be active.  Someone wanting to be active could be a professional athlete, a young person, someone who participated in sports at school and now wants to return to competition, or patients who have completed cardiac rehabilitation programs and want to continue to develop their exercise regimen with the goal of improving their heart health.  The membership in the Sports Cardiology section of the American College of Cardiology has grown from 150 in 2011 to > 4000 members.  Cardiologists are working to promote the benefits of exercise, balanced with modifying/reducing risks athletes may face.

The half marathon run May 3 had an Ohio feel to it; weather ranging from cool temperature, warmer temperature, intermittent grey skies, intermittent rain, some sunshine.  There were great crowds, creative signs for encouragement, good music from bands, DJ’s, and the help of many many volunteers.  It was a well run event (!) and sets the stage for the U.S.A. Men’s and Women’s National Half Marathon Championships coming to Cap City in 2016, 2017.  You don’t have to be a national champion runner to get benefit from exercise; use a tracker to check your steps (> 22,000 yesterday!), or commit to someone (or a group) who want/s to be more active.  Yesterday ~11,955 total event participants at the Cap City Half / Patron Quarter Marathon / Commit to Be Fit 5K – did great heart health multitasking.

 

2 months. . . .and 1700 “hits” . . . Thanks!

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IMG_8348rt5x7bwBW ARA labcoatLooking back at the first 2 months of our site, we have been so surprised and encouraged by the interest in heart prevention and wellness. We have had nearly 1,700 page views and over 170 followers. So thanks for your support, and for continuing to promote cardiovascular wellness!

Here are some posts from the past 2 months you may have missed:

Here are 10 tips for women to improve their heart health

Calculate your “Heart Age” . . . and learn what it means

An overview of exercise and it’s role in heart prevention. . and preventing dementia too.

10 tips for heart healthy eating. . . and disease prevention and Nutrition Counts!

Understand what the new cholesterol guidelines mean for you and your loved ones with high cholesterol

Is Fish Oil useful? Here is a link to our current views. . .  and an overview of other supplements as well.

Online resources about high blood pressure

As always, we appreciate your suggestions for topics. . Thanks again for your support!

 

Nutrition Counts

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BW ARA labcoatAnyone who is interested in heart and circulatory health, whether or not you have a direct diagnosis or medical reason to pay particular attention, will benefit from learning about nutrition.  March is National Nutrition Month, a great time to learn more – from an appointment with a registered dietician to review your own specific nutrition goals, or from browsing articles/ resources. Here are some options to check out –

A healthy diet and good nutrition play an integral role in heart and circulatory wellness.  The American College of Cardiology’s CardioSmart website Eat Better has a lot of information on eating habits, family eating, reading labels, goals for diet (see managing hypertension).  The American Heart Association Nutrition Center covers topics such as sodium’s impact on cardiovascular health and how we eat it (The Salty Six:  Bread & rolls, Cold Cuts/meats, Pizza, Poultry, Soup, Sandwiches).  Who thought Bread & Rolls and not Pizza were #1 for the most sodium we eat?

Being heart healthy includes maintaining a healthy weight; not always straightforward because of how work, life, & daily schedules interact with our available food which often comes high calorie, in large portions.  Counting calories plays a role in considering weight and fitness.  Dr. Sherry Pagato, a psychologist, writes about weight in her article, Do I Really Need to Count Calories to Lose Weight? She relates tracking calories to tracking spending (money) and gives a great example of the anxiety that can make both a challenge (here it is a conversation with a friend having financial difficulty).   Attention to detail pays off for both finances and nutrition.

Counting vegetables to be sure you are eating the recommended servings will payoff with heart and circulatory health.  Fruits and Vegetables, Are You Getting Enough? gives great examples for knowing portions, and ways to supplement the diet with more fruits/veggies.  Examples include building a meal around a vegetable as main focus (rather than meat), adding berries to salads, even adding leafy greens to smoothies.  Bottom line, counting servings of fruits & veg gives an objective assessment of your diet, much like tracking pedometer steps/activity.

Choose real food, try to eat local, keep it simple; track what you eat, and learn as much as you can about recommendations for healthy eating.  Take your own dietary inventory for Nutrition Month; do you eat ice cream? Butter? Sweets?  How many vegetables?  Are you eating out?  Are you at your goal weight?  What healthy additions can you make?

The impact of what we eat – from cholesterol and trans fats, to sugar – on heart health is significant. Cholesterol, trans fats, and sugar contribute to atherosclerosis/hardening of the arteries as well as lead to obesity which further compromises heart and circulatory wellness.

We can choose to eat for heart and circulatory health.  For those in central Ohio, check out the McConnell Heart Health Center’s Nutrition Month seminar 10 Ways to Improve Your Diet Now on March 18th.

Is your Heart older than You? Find out your “Heart Age”

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Grewal Kanny MD 2x3 webI decided to spend my birthday figuring out my age. Not my actual age, which is painfully obvious, but my “Heart Age”. This is a new online calculator (featured in the Wall Street Journal this week) created by researchers in the UK, which uses existing data regarding the prediction of future cardiovascular risk (from the Framingham database, which is the most comprehensive set of data available). It has been reformatted into an algorithm that compares your true age with your estimated cardiovascular age, as a general way to look at your overall cardiovascular health.   To use the calculator, you need to know:

– your true age, sex, height and weight

-a recent total cholesterol and HDL if available

-a recent blood pressure reading

-your family medical history

Of course, there are several limitations to a simple calculator like this – it doesn’t take into account any symptoms you may have, or the duration or severity of risk factors. And the database from which it is drawn was created predominantly from Caucasian Americans, so it may not directly predict risk for other ethnic groups (for example South Asians, whose risk may be higher, or based on different weighting of factors). But it is a nice snapshot of your CV health in a format that is easy to understand.

So how did I do? Well, fortunately my Heart Age came out less than my actual age – but not by much. (Luckily, I have 365 days to make some progress!) Give it a try yourself:

Here is a link to the Heart Age calculator.

If your heart age is older than your real age, don’t dismay (the average result is 6 years older than real age!), but do look back at the questions – and notice how dropping your blood pressure, cholesterol, or waist size has a positive impact. We can’t change our age or family history (and generally not our sex), but lifestyle changes can go a long way to reduce our risk. So click here to learn about the best medication for heart disease – a therapy that reduces blood pressure and cholesterol and shrinks our waist size as well!

For more information see our articles on heart healthly diet and heart prevention in women.

Here is an informative video interview with the creator, from the WSJ: http://live.wsj.com/video/how-old-is-your-heart/A280BEEC-4649-4472-8223-65856B0FB3A5.html