Tag Archives: Lifestyle

More benefit to physical activity~ Prevents Heart Failure

BW ARA labcoat

Physicians talk about patients with heart failure (HF) when describing someone with shortness of breath, inability to exert physically without having shortness of breath, or also experiencing fluid retention (leg swelling, increased waist size).

 

Non-physicians (my husband for example) hear about ‘heart failure’ and imagine death, or heart stopping like in sudden cardiac death. The terms could be better, but for now are used as above for physicians and for HeartHealth Doctors followers: Heart Failure refers to symptoms of shortness of breath (dyspnea) or fluid retention either due to reduced (r) heart pumping function (also termed Ejection Fraction or EF) (HFrEF) or preserved (p) EF but ineffective heart pumping function (HFpEF).

 

Heart failure is one of the most common reasons for hospitalization and is more common as people get older.   In the US more than 6 million adults have HF.

 

HeartHealth Doctors blog has information regarding the benefits of exercise and heart healthy lifestyle as powerful ways to prevent symptoms from heart issues.

 

For the first time, the Women’s Health Initiative program (WHI) has reported benefit of physical activity specifically walking, for post menopausal women to prevent HF.

Physical Activity and Incidence of Heart Failure in Postmenopausal Women (J Am Coll Cardiol HF 2018;6:983–95) reports findings from WHI that support regular physical activity – reported as recreational physical activity by participants – as a powerful means of reducing Heart Failure risk (both HFrEF and HFpEF).

The findings again support exercise (physical activity) as medicine – without potential side effects, and with a good dose response (more activity time, less chance to develop Heart Failure).

The study looked prospectively at the women, and the following list are possible ways physical activity impacts risks for developing heart failure. As HeartHealth Doctors have outlined, physical activity improves risk factors for heart disease, and as pointed out in the Clinical Research Study, for Heart Failure-

 

Exercise or physical activity helps prevent or manage:

Obesity

Blood pressure

Glucose / blood sugar regulation

Inflammation and Oxidative stress

Left ventricular compliance (heart pumping/relaxing function)

Arterial function

Aerobic capacity

Skeletal muscle function

Coronary Heart Disease

Diabetes

Atrial fibrillation

 

The researchers removed participants who were unable to walk 1 block prior to enrollment.

They included post menopausal women age ~50-79 years at start of the study and followed the group for 15 years with surveys.

The study highlights new benefit to heart healthy habits of exercise and physical activity; still the best way to multi task for your heart health.

How much physical activity is enough?

The study suggests volume of activity is a good focus rather than intensity – just walk for example work toward the authors’ goal of ‘brisk walking (3.3 mph on level ground) with the target of achieving 30 min/day on 5 or more days of the week.’

Benefit was shown with regular walking pretty much in line with current guidelines of 150 minutes per week; which can be 10 minutes twice a day or 30 minutes 5 days per week ~ now a big study shows one more of so many reasons to be physically active.

 

Physical Activity and Incidence of Heart Failure in Postmenopausal Women (JACC: Heart Failure December 2018)

J Am Coll Cardiol HF 2018;6:983–95

New Guidelines for High Blood Pressure

BW ARA labcoatJust released November 13, 2017, new guidelines for Hypertension, the term for High Blood Pressure, have implications for prevention of heart and vascular disease and stroke. The definition of “high” or elevated blood pressure is now lower, with emphasis on lifestyle changes to prevent progression to hypertension.

The guidelines are written by a group of scientists, researchers, and clinical experts from multiple societies – who review over 900 manuscripts and published research results to include what we know about blood pressure and the effects of uncontrolled blood pressure or hypertension. The guidelines emphasize lifestyle changes that anyone can make to help keep their blood pressure safe.  Lifestyle changes and at times medications can help keep blood pressure in a healthy range and prevent heart disease and stroke.

Why so much focus on high blood pressure? Hypertension is also called ‘the silent killer’ because it may not cause symptoms until heart damage has already happened. Consequences of uncontrolled high blood pressure include stroke, heart failure, erectile dysfunction, vision loss, heart attack, kidney disease/failure. The consequences add up if hypertension combines with other medical problems like diabetes or with lifestyle such as sedentary behavior.

What is blood pressure? It is a measurement of the force of the blood moving through your arteries (arteries are part of the circulation). Blood pressure is made up of two numbers, systolic and diastolic. Arteries exposed to elevated or high blood pressure over time can have changes such as increased size (aneurysm), increased plaque (atherosclerosis), and decreased function (eye blood vessel changes).

What are the new numbers??

The new blood pressure categories define normal as less than 120/80 mmHg, elevated systolic between 120-129 mmHg and diastolic less than 80 mmHg, stage I hypertension as systolic between 130-39 mmHg or diastolic between 80-89 mmHg, stage II hypertension systolic at least 40 or diastolic at least 90 mmHg, and hypertensive crisis is systolic over 180 and/or diastolic over 120 with patients needing prompt changes in medication if there are no other indications of problems or immediate hospitalization if there are signs of organ damage.

The new guidelines lower the level at which doctors will be paying attention to blood pressure. The category of pre-hypertension is eliminated.

How do I know my blood pressure??

How do you check a blood pressure? The new guidelines emphasized the importance of using proper technique to measure blood pressure. Patients can check blood pressure at home. The use of validated devices is recommended ~ a pharmacist can help with BP monitor selection. Be sure to sit with back support, feet on the floor, and arm at heart level (left chest), relax for 5 minutes before checking the blood pressure. Multiple readings are ok.

What affects blood pressure??

What is Lifestyle and how does it impact blood pressure?  Lifestyle refers to how we live, choices we can make on a daily basis, that add up considerably to our overall heart health. Patients often ask how they can reduce or avoid taking medications – it is possible  to use lifestyle ~ depending on the cause of the elevated blood pressure. Getting to goal weight, staying active, avoiding a high sodium diet (read labels, make your own food), liberal amounts of vegetables in the diet, not using tobacco products, managing stress, avoiding excess alcohol, are all great ways to use lifestyle to keep blood pressure < 120/80mmHg.

Really?

Over the counter medications can increase blood pressure. Nonnarcotic analgesics such as non-steroidal anti-inflammatory agents including aspirin, ibuprofen, and naprosyn can increase blood pressure and should be used with intent (not by habit). Pain can raise blood pressure so if the medicine helps reduce pain, that will help but don’t take these medicines ‘just because.’ Medicines such as decongestants, or stimulants for example sometimes found in diet pills, can increase blood pressure. Natural licorice can increase blood pressure levels. Prescription medications such as oral contraceptives, cyclosporin, erythropoietin, or meloxicam can increase blood pressure. Herbal compounds such as ephedra or ma huang can increase blood pressure. Awareness is important when working toward optimal blood pressure.

What does risk for atherosclerotic cardiovascular disease (ASCVD) have to do with blood pressure??

The new blood pressure guidelines focus on the patient’s risk for heart and vascular disease and take into consideration if the patient has already had heart attack or stroke or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk (using the same risk calculator used when evaluating whether or not to treat high cholesterol).

 

Reference: http://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017

 

Where can I get more information??

The Heart Health Docs have covered heart healthy diet and exercise extensively. Lifestyle habits play a powerful role in heart health and in blood pressure management. Simple habits like regular exercise, following the DASH diet, boosting potassium in your  diet, and limiting alcohol are great for getting to goal blood pressure. Keeping a healthy weight will help get to goal blood pressure.

We recommend checking out the American College of Cardiology site, CardioSmart for great information about hypertension.

 

https://hearthealthdocs.com/heart-healthy-diet/

 

https://hearthealthdocs.com/exercise/

 

Really all our site articles are helpful https://hearthealthdocs.com/articles/

 

 

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. . . .

 

 

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.

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

Caffeine and Your Heart -Some New Advice

IMG_8348rt5x7bwYou may have seen this report in the media regarding the effect of caffeine intake on irregular heartbeats.  As many of you know, irregular heartbeats are common and can be quite bothersome.  The challenge to clinicians is sorting out which are due to a more serious underlying cause, and which are simply a nuisance. Because caffeine is a known stimulant, clinicians have often advised patients who suffer from palpitations and various types of irregular heart rhythms to avoid or minimize their caffeine intake.

This new study attempted to look at the link between caffeine intake and various types of Coffee Cupirregular heartbeats. Interestingly, the researchers found that there seemed to be minimal effect of caffeine intake on the extent of irregular heartbeats.

What can we can conclude? Although this study is limited in that it was a retrospective
review, it does show that caffeine may be just one of many triggers for heart related issues. It may play a role in certain patients but not in others. Some patients may want to experiment with their caffeine intake to see if it affects their symptoms, but it may not be necessary for all patients to eliminate it completely.  As always, you should discuss your specific cardiac symptoms and issues with your healthcare provider to determine the optimal treatment strategy for you.

 

Irregular Heartbeats? Coffee May Not Be So Bad for You

http://nyti.ms/23txNCq via @nytimeswell

 

People with irregular heartbeats are often advised to give up caffeine, but a new study suggests they may not have to forgo their coffee.

Researchers had 1,388 people record their intake of coffee, tea and chocolate over a one-year period, and used Holter monitors to get 24-hour electrocardiograms.

More than 60 percent of the participants reported consuming one or more caffeine-containing foods daily. But the electrocardiograms revealed no differences in premature beats or episodes of accelerated heart rate between caffeine users and abstainers. Thestudy is in the Journal of the American Heart Association.

“There’s no clear evidence that drinking more caffeine increases the risk for early beats,” said the senior author, Dr. Gregory M. Marcus, an associate professor of medicine at the University of California, San Francisco. In fact, evidence from other studies suggests caffeine may even be linked to decreased rates of cardiovascular problems.

“I tell patients that it is very likely that for some people, caffeine is an important trigger” of irregular heartbeats, Dr. Marcus said. “I generally tell them that it’s fine for them to experiment and weigh the pros and cons of caffeine to see how it influences their quality of life. The majority of arrhythmias are not life threatening.”

#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.