Tag Archives: heart attack

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. . . .

 

 

#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.

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

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

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

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

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

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

This CardioSmart video gives a great overview of Cardiac Rehab.

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

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

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

 

 

Heart Healthy at Home/Work #HealthiestEmployers

BW ARA labcoatAre employers interested in their employees heart health?  You bet, based on the response to my workshop With all Your Heart, Heart Healthy Habits at Work & Home at the Makoy Center in Hilliard.  The workshop was part of the events at Columbus Business First’s inaugural Healthiest Employers program.  The inaugural gathering for employers today included an awards presentation, mini-workshops and a wellness expo.

With my workshop presentation I wanted to show attendees the benefit of heart healthy behaviors, as well as how to impact cardiac arrest and stroke.

Keeping physically active can be social or integrated throughout the day – bottom line is avoid prolonged sitting.  The talk covered heart healthy eating behaviors and energy balance.  I discussed risk factors for heart disease and the American Heart Association’s Simple 7  for further information about heart health.  The audience questions showed our shared interest in heart health and what interventions have been shown to improve it.  One question in particular concerned transcendental meditation.  Transcendental Meditation has been shown to be beneficial; the talk today did not allow time to discuss further – if interested, watch Dr. Steinbaum’s short video for an overview of TM.

Heart healthy interventions through lifestyle play a role in long term life quality.  I also introduced / reviewed life saving Hands Only CPR to help someone suffering a cardiac arrest, and how to stop a Stroke FAST.

Work-life and staying healthy are inseparable.  Better performance and delivery are the result of a heart healthy work force; it was great to share heart healthy information this morning.

ucm_111393spot a stroke FAST.

 

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What do Women need to know about Heart Disease?

Women’s Heart & Vascular* Health will be an ongoing topic at HeartHealth Doctors.  Why?  Ladies first applies for women and heart disease; but not in a polite, etiquette way- Since 1984 more women than men have died from heart disease.  *Vascular health is part of circulation, meaning the arteries and veins, the heart is the main active pump in our circulation.

Dr. Albers’ post for Women’s Health talks about the recent Heart of Women’s Health meeting at the American College of Cardiology’s Heart House in Washington DC.  Check out the article, or if you are pressed for time-  Here are 10 great tips for improving your heart health; presented at a breakout session of the Go Red for Women luncheon and seminar February 2013.

These 10 tips apply to anyone wanting to improve their heart health:

Women's Health

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

Kanny S Grewal MD 5x7 (4)As you may of heard, some experts created new guidelines for clinicians to treat high cholesterol, and they have generated quite a bit of controversy, since they are a big departure from prior guidelines. The big new difference is that they no longer emphasize having “target” levels of cholesterol, LDL, etc and rather focus on just using statins at low, moderate, or high doses based on the patients level of “risk”, which is calculated from a formula based on age, sex, and various risk factors. This could be a sound approach, since some experts feel that simply being on a statin will reduce heart risk, regardless of how much a patients “numbers” actually change. They also conclude that most other types of cholesterol medications, besides statins, don’t have much impact on heart disease and are not generally recommended. The controversy is that the recommended formula to calculate an individual’s long-tern risk has not been thoroughly tested, and it seems to overestimate risk in many groups of patients.

What messages can we “take home” from these new guidelines? Here are a few:

1. The best treatment for high cholesterol remains lifestyle – diet and exercise.

2. The decision to start medication therapy should be individualized and come from the patient, after a thorough discussion with their clinician about risk.

3. Patients with established heart disease clearly benefit from statin therapy, which clearly reduces future risk of heart attack and stroke.

4. For patients without a history of heart disease or stroke,the benefit may be very negligible, unless they fall in a “high risk” group based on other risk factors such as diabetes. These patients should discuss the pros and cons of medication therapy with their doctor.

4. One way to think of statin therapy: it reduces future risk of heart attack and stroke by one-third in everyone. That means a 300 lbs diabetic who just had a heart attack, and a 30 year old fitness fanatic in perfect shape. The difference is the baseline risk. If you start with a risk of 1 in 100 of a heart attack the next 5 years, is that 1/3 reduction really worth taking a potentially toxic pill every day? Probably not. But 1 in 10, or 1 in 5? Probably yes.

So if you have been recommended therapy, or already on therapy, for high cholesterol, ask your doctor about your cardiovascular risk both with and without medication. And more importantly, stay active, maintain your weight, and focus on your diet!

Here is an some excellent summaries of the debate about the new cholesterol guidelines:

Dr. Krumholtz discussion in New York Times

Experts Reshape Treatment Guide for Cholesterol