Tag Archives: Heart Disease

WHAT I’VE LEARNED…….ABOUT EXERCISE

heartstethatscopeThe other day my patient Mr. T, was having his physical and I asked him about his health habits.  I asked about his exercise, and he explained to me that he did aerobic exercise three days a week for 30 minutes, doing treadmill and cross-training and bicycling, and he said something to me that was very accurate and worth sharing:  “I know I could do more, but I am exercising to make sure my heart can ‘take it’ if something were to happen.  Perhaps it won’t prevent me from having a heart attack, but it’s enough to help me get extra flow to my heart so that my heart will make it through.”

You know…. I 100% agree with Mr. T, and this is something I have found over the past 25 years of practice; that exercise keeps you in shape, helps prevent heart issues ‘to a degree’, but more importantly, makes your heart more capable of withstanding the stresses to your body under extreme health issues or in the event of a heart attack.

This is exemplified by the results I see on treadmill testing in the office.  I still do the standard Bruce Protocol treadmill testing as I find it very predictive of a person’s heart-health.  The old-fashioned treadmill test have been around since the late 60’s, and is often considered too ‘old-fashioned’ or not ‘sexy’ as a medical test, and thus it is overlooked.  But, the treadmill is an excellent test for prognosing….predicting the future.  A person’s performance on the treadmill has two facets:  Diagnosis & Prognosis.

Diagnosis:    The diagnostic side of the treadmill is good, but imperfect.  Based on the changes in the blood pressure, heart rate, and EKG (electrical tracing) we can see that the heart is healthy or that there are issues with blood flow in one of the coronary arteries (one of the three major arteries to the heart muscle).  Sometimes the tracing changes are very specific and very diagnostic, but this type of test is not as accurate as say a Nuclear Stress Test done by the cardiologist, which uses  both the treadmill portion to look exercise capacity and at the heart function and imaging based on blood flow of radioactive tracer dye in the heart.  That said, it is much simpler and much less expensive.

Prognosis:  The prognostic side of the treadmill is it’s strong suit.  Based on comparing data of the patient’s specific performance with millions of others who did the same test protocol, one can generally predict their longevity based on the heart’s capacity, heart rate response to exercise and  to recovery.  I’ve performed thousands of treadmill tests and have seen that exercise capacity has a direct correlation with patient survival through stressful events, even survival in the setting of the rare heart attack occurring despite reassuring diagnostic features of a treadmill test.

So, although exercise is not a perfect preventive approach to one’s health, it ranks as #1 on my list of the 8 Keys to health (See the entire list in my book:   THE KEYS  )

Do:  Exercise at least 3 days per week

Do:  Exercise for at least 30 minutes.

Do:  Perform aerobic exercise (bike, run/treadmill, fast walk, swim, cross-train)

Do:  Get you heart-rate up during exercise and get a ‘sweat’ going.

 

SO WHAT HAPPENED TO GEORGE BUSH AND HIS HEART

george bushThe news reported that former President George Bush had a cardiac stent placed to prevent a heart attack and to help improve his heart blood flow.  Why did he have this?

NYTIMES ARTICLE

Well, George Bush is 67 years old, a common age for men in the US (and across the world) to develop heart disease.  By heart disease I mean narrowing of the coronary arteries.  The stent,  a metal scaffolding, is inserted into one of these small arteries that provide blood flow to the heart muscle itself, to enhance the blood supply to the muscle and to reduce the narrowing from 70% or greater, to less than 10%.  In the process of establishing improved blood supply, it is felt that this protects the artery from further injury or the potential of heart attack.

Over a half-a-million stents are placed in the US yearly, so this is not unusual, but what is unusual is that he had this stent placed after having had a physical exam that disclosed the reduced blood supply and that it was done without him having any symptoms (so we are told…perhaps this is not true).

Narrowing of the coronary arteries can happen even in men and women who have good cholesterol, minimal risk factors for heart disease, and who follow good diets and exercise habits, as these developments are part of the aging process.  These risk factors enhance the potential for issues, but at least a third of people with heart disease do not have clear-cut risk factors that make them candidates fora heart attack.  The only way to find these patients is through screening tests like treadmill exercise testing.

When found, most people do not require treatment other than medications because many studies have shown that this approach is the safest and most effective in preventing future issues.  Although narrowed arteries that are not causing issue would seem best treated by ‘opening’ them, multiple studies have shown this NOT TO BE THE CASE.  Asymptomatic coronary artery disease is best left managed with medicines.

So why did George Bush have a stent?  Either he is having symptoms that the press did not tell us about or his doctors felt he was at an increased risk for a bad outcome if this was left untreated.  There are situations in which this could be the case, but the data is sketchy on these situations and the benefits of intervening.  It may be that as a ‘special person’ he is getting worse treatment that would generally be the case.  The medical care of the President of the US has been far from perfect in the past, as detailed by many historians.

PRESIDENT GARFIELD’S MEDICAL CARE…WHAT THE HECK?

 

NEW ‘SUPER CHOLESTEROL REDUCING’ MEDICATION IS COMING…AND IT WILL REQUIRE A SHOT

curtainStatin medications have had a profound effect on heart disease across the world, but there are a variety of limitations with these medications including lack of effect, side effects, and inadequate results in patients at highest risk (inability to achieve ‘goal’ levels of cholesterol.)

Enter a new treatment, a medication that is a ‘biological agent’, an antibody that is directed against the production of cholesterol and appears to cause a profound reduction in cholesterol, up to 50% greater effect than the strongest statins.  The medication appears generaly safe and is undergoing broad testing by a variety pharmaceutical firms that see billions of dollars in sales from this category of medication, particularly for patients with heart attacks and known heart disease.

The medication will require an injection, much like insulin, and will be given once or twice a week.  All of this will depend on the outcome of ongoing research, but keep your eyes out for this information and we’ll keep you updated.

The Research

NY Times Article

 

WHAT HAPPENED TO JAMES GALDOFINI?

james-gandolfiniI was shocked to hear about the unexpected death of James Gladofini, the well-know star of the SOPRANOS HBO SERIES.

Although the details are not available, I already know that this will get some 50 year-old guys wondering whether they are at risk for sudden death due to coronary artery disease.  It will raise awareness.

Of course, the particulars in his case, are hard to know.   From appearances he was a barrel-chested overweight fellow who ‘huffed and puffed’ often during his acting, and ate a lot of steaks (if you can believe his characters actions…..perhaps not true).  That said, how does a 51 year-old man die suddenly of a massive heart attack.

Certainly, sudden and unexpected death is possible for any of use (sorry to say).  We can all  kid….but yes….that truck really could run us off the sidewalk!! (I’m hoping not….but…hey…let’s be real!)

Beyond these issues, the real question is preventing this from happening to you….how do you do it?

1.  Exercise regularly.  This is the best method to prevent a heart attack or to survive it …..it’s not just about ‘not getting’ your heart attack…it’s living through it, and people who are in better shape….survive such stresses better and more often.  Read THE KEYS , my simple book on suggestions for living longer and healthier,  for some direction here and what your minimum exercise requirement is.)

2.  Know your cholesterol and blood pressure.  These two items have the greatest impact on your risk, independent of any actions you may or may not take.  Come on in to check on these and see if you need attention to these.

3.  Lose some weight…if you are significantly overweight.   Now….James Gladofini was probably obese as defined by a BMI (body mass index) of over 30.  Being overweight is not a concern….being obese is!   Again….figure our your BMI by looking at THE KEYS and the BMI chart in the back

4.  Take a baby aspirin daily.  This is a very simple method for preventing heart disease and is particularly a consideration for men (less so for women as they have much lower risk…age-for-age…as men.)

5.  Come in and get a heart check up.  A simple treadmill test is very diagnostic in this regard and very reassuring, or we can do a CT scan of the heart to check for Calcium deposition in the coronary arteries.

Of course….we don’t know Mr. Gladofini’s heart history…it may have been substantial, he may have had many heart stents in the past and a long history of heart disease….. but you can do a lot to prevent this from happening to you and to give yourself peace of mind!

 

I TOO AM EXCITED ABOUT THE MEDITERANEAN DIET

NEWS78More Olive Oil Please!

A new report in the NEJM (New England Journal of Medicine), out of Spain, demonstrates great heart advantage to the Mediteranean diet.  A 30% reduction in risk for heart attack was noted, for patients eating 1 liter of olive oil per week, along with additions of good oils from nuts (1 oz. per day).

We will be exploring this topic in April, with Debbie Landau West, when we look at the practical implementation of a Mediteranean diet in your life.

http://www.nejm.org/doi/full/10.1056/NEJMoa1200303

A PATIENT WONDERS: WHAT ABOUT THE DANGERS OF CALCIUM? ….. HERE’S MY ANSWER

citrical


 Dear Dr. Lakin,
In this morning’s NY Times (Science section), there was an article reporting  the results of “… a Swedish study that followed 61,433 women born between 1914 and 1948 for an average of 19 years.  After controlling for physical activity, education, smoking, alcohol and other dietary factors, they found that women who consumed 1,400 mgs. or more of calcium a day had more than double the risk of death from heart disease, compared with those with intakes between 600 and 1,000 mgs.  These women also had a 49 percent higher rate of death from cardiovascular disease, and a 40 percent higher risk of death from any cause. ”   The authors noted that calcium can increase blood levels of a protein associated with higher risk for cardiovascu  lar disease.I now take 1760 mgs. of calcium a day.  (Citracal – 1260 mg + Multi-vitamin – 500 mg.)  My last bone scan (April 2012) showed a 13% lower reading than the previous scan 3 years earlier.  Should I be concerned about the findings in the Swedish study?  Should I make any changes to mydaily calcium intake?Thank you in advance for your advice.

Mary Anne

Mary Anne;
 
Such epidemiological studies are always interesting and often curious, but they are difficult for any decision-making in a particular patients situation.
 
The risk of death is 100% of course…..eventually!  For all of us (but I’m working on this one!)
 
Seriously.  If your risk is 1% in your 60’s.  Perhaps 2% in your 70’s….from heart disease…..and 4 % in your 80’s……then you will increase to 1.5, 3 and 6% respectively.  I don’t think that is much in ‘absolute’ terms……so I would not let such indendiary comments lead to too much teeth gnashing.
 
I think this entire issue is uncertain as there is data, quite as compelling, just as contradictory and touting the benefits of calcium.
So…..I would:
1.  Do the most you can with natural forms of calcium.
2.  Continue to supplement…although you might diminish that a bit (I suppose) in deference to these findings.
 
 
DR LAKIN
 
 
PS…..I drove to work today…….1000% more dangerous than taking calcium!

 

 

 

MORE ON ASPIRIN…….

Aspirin may be among the topics most discussed in these pages and today there is another study on aspirin, this time looking at coated aspirin and perhaps it’s reduced effectiveness compared to plain aspirin.

I think most people use coated aspirin now as it is the type most advertised, and it does provide some benefit in reducing the potential for stomach irritation.  That said, it is possible that this ‘coating’ will alter the pharmicodynamics of the aspirin.

In this recent study in the journal Circulation, plain aspirin was found more effective that coated aspirin, in which people initially showed some resistance to the aspirin effect.  Retesting however, showed that those people initially not gaining the blood thinning effects of aspirin, eventually showed a response.

So…what are we to make of this information?  Not much.  Perhaps there is a benefit to ‘plain’ aspirin, but if you are taking coated aspirin regularly it appears to be just as effective.

Also, another comment, on aspirin resistance.   There are a lot of articles written on this topic, suggesting that patients get checked for aspirin resistance, but in my practice I have never seen one documented case of aspirin resistance, and I have checked people for this in the past.  In addition, in this journal article, they too found really no evidence of widespread aspirin resistance.  So, another practical point:  Don’t worry about aspirin resistance.  If you are an aspirin-taker….feel confident in it’s effectiveness.

http://circ.ahajournals.org/content/early/2012/12/04/CIRCULATIONAHA.112.117283.abstract

http://www.nytimes.com/2012/12/05/business/coating-on-buffered-aspirin-may-hide-its-heart-protective-effects.html

LIPITOR RECALL…GENERICS FROM INDIA

More and more medications are being manufactured in India and these are produced safely and without concern.

This week, the LA TIMES reported that there is a recall of bottles of Lipitor 20 and 40mg tablets manufactured by Ranbaxy.  The reason for recall is small particles of glass in the medications (which is a reason for recall, but unlikely to cause any harm).

http://www.latimes.com/business/money/la-fi-mo-generic-drug-recall-20121123,0,2306475.story

If you have questions, ask your pharmacist the particulars about your prescription.

 

I NEVER META STUDY I DIDN’T LIKE

Meta Analysis is a term that refers to a study that develops conclusions by combining the data and results from several studies. By employing statistical methods that are valid, the researchers essentially create new conclusions from a variety of data from different studies.
The recent study of Omega-3 Fatty Acids is one such study. This concluded that Omega-3’s are not effective in preventing heart disease.
Omega-3 fatty acids are the good fats found in fish and vitamin purveyors like to isolate those fats and provide them in a supplement that they claim will provide all the benefits of a cold-water fish diet. This study debunks that myth and suggests that a diet high in fish is good for the heart, but the straight supplement is not.
You will be seeing more and more reports of Meta Analysis….a powerful method of finding hidden data in multiple small studies.

More information at:

http://jama.jamanetwork.com/article.aspx?articleid=1357266

DEFIBRILLATOR WIRES CALLED DANGEROUS–MAY FAIL

A recent study of implanted defibrillator heart devices, also known as an AICD,  calls into question the safety of the wires (leads) on St. Jude Medical’s Durata and Riata implanted devices.  This a device meant to ‘shock’ the heart out of dangerous or life-threatening arrhythmia.  (It is not a pacemaker…a much more commonly used device.)

The leads are prone to failure (either causing loss of function of the device of unexpected ‘firing’ of the device.

Dr. Robert Hauser has published an article on this topic and it is the source of much controversy.

If you have an implanted defibrillator, contact your cardiologist (electrophysiology doctor) to review information about the safety and performance of your unit.

More information on this topic is available here:

http://www.nytimes.com/2012/08/22/business/cardiologist-warns-about-safety-of-st-jude-heart-device-component.html?hp

To monitor your medical device, look to this FDA website and keep in contact with your physician who implanted the device.

http://www.fda.gov/medicaldevices/safety/default.htm