Tag Archives: heart risk

Can 1 Minute of Exercise Possibly be Useful?

IMG_8348rt5x7bwYou may have noticed (or perhaps soon will) this article from the NY Times earlier today with an enticing headline: Only a single minute of high intensity exercise  can replace 45 minutes of moderate exercise. This seems like good news for those of us who are always pressed for time to find time for exercise. But we need to delve into the details of this study before drawing broad conclusions about the optimal duration of exercise.

The study in question showed that an exercise routine using high intensity exercise for one minute of total duration (in a routine that took 10 minutes total including warmup and rest periods) had similar benefits to a longer routine of moderate exercise in this study group of 25 subjects. It suggests that incorporating intervals of high intensity exercise can shorten the amount of time needed to obtain long-lasting health benefits.

I do think this is an enticing concept and it is a very good reminder that adding interval trainingrunning shoes can be quite beneficial to our health and our fitness goals. But we need to remember why we advocate for physical activity for wellness and disease prevention. Exercise should not be a “bitter medicine” taken as quickly as possible, but should be considered a desired component of our day-to-day lifestyle. Therefore I think that moderate exercise, such as brisk or sustained walking, as well as light jogging, can have much broader benefits, such as improving our mental state, helping concentration and sleep, and of course improving our long-term health and disease prevention.

This article is certainly a useful reminder that adding intervals to exercise, for those of us who are physically able, can help us reach our fitness goals quicker and more successfully.  However, these type of programs can also increase the risk of injury or worsen underlying medical conditions.  Therefore, high intensity exercise regimens should only be undertaken with the guidance of a fitness professional, and for those with chronic heart or other medical conditions, with the approval of our personal physician or health care provider.

Here is the link to full article.

#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.

IMG_6621

 

 

 

 

 

 

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.

A New Option for Patients Who Can’t Tolerate Statins

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?

 

#Heart Health for Women; Start here this Valentine’s Day #LoveYourHeart

IMG_2641 ara echoWhat better day to talk about the Heart than Valentine’s Day?

More science is showing the benefit of starting early with habits that promote heart health.  Treatments already available & scientifically proven are UNDERUTILIZED: would you think 20% was a good score?! No. But 80% of people eligible for cardiac rehab DON’T take part in this essential treatment / program.

This post covers TWO topics for Women’s Heart Health:

  • A recent study showing the impact of 20 years of healthy choices for young women 
  • A NEW program to promote the established, effective heart treatment Cardiac Rehab.

Heart month is a great time to bring attention to what we know about preventing heart disease as well as what opportunities are available for managing heart risk.

  • A recent study showing the impact of 20 years of healthy choices for young women 

In 2015 we have learned about healthy habits or behaviors that impact RISK for developing heart disease with PRIMARY prevention. A paper published in the Journal of the American College of Cardiology (JACC) in January reports the impact of 6 habits on the risk of heart disease for women. This study,

Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women

looked at a group of young women ages 27-44 years old and followed them over 20 years. Can you think of what the 6 healthy behaviors might be? We have covered them here on HeartHealthDoctors – like a lot of heart healthy changes they are available to us NOW. So pick one and START living a healthy lifestyle:

A healthy lifestyle was defined as not smoking, a normal body mass index, physical activity ≥ 2.5 h/week, television viewing ≤ 7 h/week, diet in the top 40% of the Alternative Healthy Eating Index–2010, and 0.1 to 14.9 g/day of alcohol.

1) Not smoking

2) Get to GOAL weight which is a normal Body Mass Index (BMI)

3) Move your body through space; physical activity at least 2 1/2 hours per week

4) TV viewing < or equal to 7 hours per week

5) Follow a heart healthy diet 

6) If a woman chooses to drink alcohol, amount of 1 drink per day or 12 oz beer, 4 oz wine, or 1.5 oz liquor correlates to ~14gm

Marlene Busko writes for Medscape about the JACC paper that ” Adoption of six healthy lifestyle behaviors could avert about 73% of coronary heart disease (CHD) cases among women over 20 years, as well as 46% of diabetes, hypertension, and hyperlipidemia, conclude researchers, based on their analysis of about 69 000 participants …”

Key to know with the Nurse’s Health Study findings is that Coronary Heart Disease (CHD) risk was lower for women without AND with heart disease risk factors BOTH groups showed decreased events with more healthy lifestyle habits/behaviors.

  • A NEW program to promote the established, effective heart treatment Cardiac Rehab.

At OhioHealth we have launched a cardiac rehab program for women to help give every opportunity to succeed at SECONDARY prevention and prevent or slow disease progression. To improve the ‘ low test score of 20%’ participation in Cardiac Rehab the OhioHealth Women’s Heart and Vascular Program launched a program for cardiac rehab designed for women. Education and exercise in the company of other women with heart disease offers a new way to help women who have had a heart event (Chest Pain, Heart Attack, Coronary artery Stent, Heart Valve surgery, Coronary artery bypass surgery) and are starting on their SECONDARY prevention journey.

Read more about Cardiac Rehab here; 10TV News did a great story / coverage of the Women’s Cardiac Rehab program (click text to view story and video).

 

 

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

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

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. . . .

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.