Health ShortsCardiology
ACE Inhibitors Helpful for CHF Over time, high blood pressure can damage the pumping ability of the heart and lead to congestive heart failure, a disorder that results in a buildup of fluids that can congest the lungs and cause swelling of the feet and ankles. For persons with hypertension, diuretics have been found effective in preventing heart failure. Once heart failure has developed, however, many doctors prescribe ACE inhibitors to reduce blood pressure and improve kidney function. Heart patients with diabetes may also benefit from ACE inhibitors because of their beneficial effect on the kidneys. [SOURCE: “ACE inhibitors: who needs them?” Cleveland Clinic Women’s Heart Advisor Supplement, April, 2007] ACE Inhibitors--Not Equally Effective Studies have found that ACE inhibitors, when taken by persons who have survived a heart attack, reduce the risk of a second attack. One recent study, however, found that not all of these medications had the same level of effectiveness when prescribed for this purpose.
Among 7,512 patients 65 years and older, those taking ramipril, lisnopril and perindopril were less likely to die during the first year than subjects taking enalapril, fosinopril, captopril or quinapril.
[SOURCE: L. Pilote, et al, “Mortality Rates in Elderly Patients Who Take Different Angiotensin-Converting Enzyme Inhibitors after Acute Myocardial Infarction: A Class Effect?” Annals of Internal Medicine,” July 20, 2004] After Dinner Mint: Bad for Heartburn An after dinner mint is a cultural tradition, and many Americans assume that the purpose is to aid digestion. In fact, while the mint may freshen your breath and leave you with a good taste in your mouth, it is not recommended if you’re prone to heartburn. Both the mint and the chocolate tend to relax the sphincter at the bottom of the esophagus, making it easier for stomach acids to wash up, causing heartburn.
Smoking and high-salt intake have also been linked with an increased risk of heartburn. Regular exercise and a high-fiber diet reduce the risk.
[SOURCE: Richard Honaker, “Peppermint May Freshen Breath But Worsen GERD,” Consultant, July, 2005; Jeff Evans, “Lifestyle Risk Factors for GERD,” Internal Medicine News, December 15, 2004] Alcohol–Good and Bad for the Heart One or two alcoholic drinks a day may help protect against heart disease, but heavy consumption of alcohol can weaken the heart and affect its structure, contributing to congestive heart failure. In some individuals, this change in the structure and size of the heart brought on by heavy drinking can also promote irregular heart rhythms. In one Danish study, men consuming 35 or more drinks a week had a 45 to 63 percent increased risk of atrial fibrillation compared to moderate drinkers. [SOURCE: “The Risks of Heavy Drinking,” Johns Hopkins White Papers, Coronary Heart Disease, 2006; Circuluation, September 20, 2005] Ambulatory BP Monitoring: Good but Not Always Necessary Most medical experts agree that 24-hour ambulatory blood pressure monitoring is the most effective way to measure blood pressure and diagnose hypertension. The patient wears the device all day and during sleep to measure how his or her blood pressure responds to various situations. Over a six-month period, according to one study, ambulatory monitoring led to less intensive medication therapy and better control of blood pressure.
Ambulatory monitoring is relatively expensive, however, and the THOP study (Treatment of Hypertension Based on Home or Office Blood Pressure) found that home monitoring also resulted in less intensive drug therapy and lower medical costs. Home monitoring is endorsed as a better alternative to ambulatory monitoring by the U.S. Joint National Committee and the European Society of Hypertension.
[SOURCE: Louis Kuritzky, “Self-Measured Home Blood Pressure in Predicting Ambulatory Hypertension,” Clinical Cardiology Alert, February, 2005; Caroline Wellbery, “Blood Pressure Monitoring: Home vs. Physician’s Office,” American Family Physician, October 1, 2004; George Stergiou, et al, “Self-Monitoring of Blood Pressure at Home Is an Important Adjunct to Clinic Measurements,” British Medical Journal, October 16, 2004] Angina: Don’t Deny or Ignore It More than 6.8 million Americans are diagnosed with angina–brief episodes of heart-related chest pain brought on by several minutes of exercise, walking up stairs or emotional stress. Because the pain goes away quickly with rest, many individuals never report the problem to their doctors, joining what researchers call “the submerged clinical iceberg” of angina. A British study of 10,000 government workers found that persons with undiagnosed angina were twice as likely to die or suffer physical limitations as other subjects. They had a risk higher even than that of heart attack survivors.
[SOURCE: “Heart Beat–Hidden Angina,” Harvard Heart Letter, January, 2004; Harry Hemingway, et al, “Prognosis of Angina with and without a Diagnosis: 11-Year Follow Up in the Whitehall II Prospective Cohort Study, British Medical Journal, October 18, 2003] Angina Hurts Women More Women with angina were more likely than men to suffer progressively increasing physical limitations over a period of 10 years or longer, according to a study of 128 heart patients. The authors theorized that women “may be avoiding physical activities and situations that trigger anginal episodes,” leading to onset of chest pain at progressively lower levels of activity.
[SOURCE: “Women’s Physical Function Suffers More than Men’s from Cardiac-Related Chest Pain,” Women’s Health Weekly, March 13, 2003] Anxiety May Make Heart Flutter For heart disease patients, anxiety and other forms of psychological distress are powerful independent risk factors for the development of atrial fibrillation, an abnormal heart rhythm that develops in the upper chambers of the heart. The higher the patient’s level of anxiety, depression or hostility, the greater the long-term risk of atrial fibrillation, according to a study conducted by Charles M. Blatt, M.D. of Harvard Medical School.
[SOURCE: Bruce Jancin, “Psychological Distress Lifts Atrial Fib Risk,” Clinical Psychiatry News, March, 2005] Appetite Suppressants Pose Danger Appetite suppressants such as fenfluramine and dexfenfluramine have been implicated in many cases of pulmonary hypertension and heart valve problems. According to one European study, subjects reporting use of any appetite suppressant within the previous year had a 10-fold increased risk of pulmonary hypertension. Use of an appetite suppressant for longer than three months resulted in a risk more than 20 times that of other subjects.
In another study, persons diagnosed with pulmonary hypertension associated with fenfluramine or dexfenfluramine had a median survival of 2.5 years.
[SOURCE: Leung Ying Ying, et al, “Pulmonary Hypertension, Hyperthyroidism, and Fenfluramine: A Case Report and Review,” Medscape General Medicine, November 8, 2006] Artery Disease in Legs Increases Risk of Heart Attack and Stroke If the arteries in your legs are diseased, you are also likely to have coronary artery disease and a high risk of having a heart attack or stroke.
The classic sign of diseased arteries in the legs (known as peripheral artery disease or PAD) is leg pain that comes on when you’re walking or climbing stairs and goes away when you rest. Many persons, however, have no symptoms.
About 60 percent of persons with PAD also have blockages in one or more coronary arteries. Individuals with PAD are six times more likely than others to die of a heart-related cause.
[SOURCE: “Leg blockages increase heart attack and stroke risk,” Cleveland Clinic Women’s Heart Advisor, April, 2007] As Weight Goes, So Goes BP Weight loss may be better than any pill for the treatment of high blood pressure. Analyzing data from 25 studies including 4,874 subjects, Dutch researchers concluded that blood pressure falls about one point for every kilogram (2.2 pounds) of body weight lost. Subjects taking hypertensive medication registered even greater blood pressure reductions for each pound of weight loss.
[SOURCE: "Weight Loss Key for Treating High Blood Pressure," Reuters Health, November 21, 2003; Hypertension, November, 2003] Blood Test Predicts Heart Risk A test measuring blood levels of the protein NT-proBNP was highly effective in predicting heart attack risk in a study of about a thousand heart disease patients. Subjects with the highest levels of this protein were eight times as likely as those with the lowest levels to suffer a heart attack, stroke or heart failure, according the study published in the Journal of the American Medical Association [January 10, 2007].
The test has been used for some time by emergency physicians to help identify heart failure in patients with shortness of breath and other symptoms.
The blood test is believed to have more value at this time for patients with established heart disease rather than for the general public.
[SOURCE: Salynn Boyles, “Blood Test Predicts Heart Attack Risk,” WebMD Health News 2007 from K. Bibbins-Domingo, JAMA, January 10, 2007] BP Control Essential for Diabetics From 55 to 65 percent of Americans with diabetes also have high blood pressure, and it increases their risk for cardiovascular disease. According to the HOT (Hypertension Optimal Treatment) study, subjects following intensive control of blood pressure had 51 percent fewer heart attacks, strokes and other cardiac-related events.
The American Diabetes Association recommends a blood pressure goal of 130/80 or lower for diabetics.
[SOURCE: John R. White, Jr. and Jason Schick, “Home Blood Pressure Monitoring and Diabetes,” Clinical Diabetes, Winter, 2004] BP: Even 'Normal' Not Low Enough If your blood pressure is 129/78, your doctor probably says you're doing fine. Both the systolic and diastolic are within the normal range, even though the 129 is just below what is considered "high normal." However, when nearly 2,000 heart disease patients with blood pressure averaging 129/78 were given hypertension medication, they showed a rather dramatic benefit - a 15 to 31 percent reduction in major cardiovascular events such as heart attack, stroke, death, hospitalization for chest pain and the need for angioplasty or heart surgery. "Previously, only cholesterol-lowering drugs have been shown to slow disease progression. The current study demonstrates that blood pressure lowering drugs have similar benefits," the authors wrote.
[SOURCE: Steven Nissen, JAMA; "Is 'Normal B.P. Low Enough?" Tufts University Health & Nutrition Letter, February, 2005.] BP Linked to Sex Problems in Women A major cause of erectile dysfunction in men, high blood pressure has also been linked to sexual problems in women. A self-administered questionnaire given to 224 premenopausal women found that those diagnosed with hypertension had lower scores on questions related to vaginal lubrication, ease of achieving orgasm and pain during intercourse. The study found no evidence that hypertension medications (ACE inhibitors, beta blockers, calcium channel blockers and diuretics) had any negative effect on sexual function.
[SOURCE: Louis Kuritzky, "HBP and Sexual Function in Women," Neurology Alert, November, 2000] Buying a Home BP Monitor When you’re buying a home blood pressure monitor, look for the seal of the Association for the Advancement of Medical Instrumentation (AAMI), the group responsible for testing and setting standards.
There are many high-quality monitors on the market, ranging in price from $10 to $125, depending on features they offer. Manufacturers include Omron, A&D Medical LifeSource, Lumiscope, Mark of Fitness, Panasonic and Samsung. After testing 16 of the best-selling monitors, Consumer Reports selected the Omron Intellisense HEM-711AC as its number one choice. A Wall Street Journal article gave top honors to A&D Medical LifeSource monitor #UA-787.
[SOURCE: John R. White, Jr. and Jason Schick, “Home Blood Pressure Monitoring and Diabetes,” Clinical Diabetes, Winter, 2004] Cereal and Milk Good for Teens Adolescents with a high intake of whole grains, refined grains and dairy products were less likely than other youth to have high blood concentrations of homocysteine, according to data from the Child and Adolescent Trial for Cardiovascular Health. A high homocysteine level during childhood and adolescence is believed to be a risk factor for cardiovascular disease in later life. No association was found between homocysteine concentrations and intake of fruits, vegetables or red or processed meats. A high intake of poultry was associated with higher homocysteine levels. [SOURCE: Pamela L. Lutsey, et al, “Serum Homocysteine Is Related to Food Intake in Adolescents: The Child and Adolescent Trial for Cardiovascular Health,” American Journal of Clinical Nutrition, June, 2006] Chronic chest pain is often the reason a person is referred for coronary angiography, a scan used to help diagnose coronary artery disease. One study found that 45 percent of women referred for angiography still had chest pain a year later-regardless of whether they were diagnosed with coronary artery disease or whether they underwent angioplasty or surgery.
[SOURCE: Kerri Wachter, "Persistent Chest Pain Common in Women after Angiography," Family Practice News, March 1, 2003] Compression Key To Successful CPR “Push hard, push fast,” is the key advice in the new American Heart Association guidelines for delivering CPR (cardiopulmonary resuscitation) to a person having cardiac arrest.
Compression on the patient’s chest is more important than mouth-to-mouth resuscitation, according to the AHA. Guidelines call for 30 chest compressions (instead of 15 as previously recommended) for every two rescue breaths. There’s no need to stop and check to see how the patient is responding; just keep on pushing. According to research, circulation increases with each compression but slows with even a momentary interruption.
Cardiac arrest–when the heart ceases to beat–can occur as a result of a heart attack, an abnormal heart rhythm, electrocution or near drowning.
[SOURCE: Jamie Stengle, “Heart Association Offers New CPR Guidelines,” Yahoo News, November 29, 2005] Consecutive Workouts Better for Heart Regular exercise is one of the most effective ways to increase HDL, the "good" cholesterol, and the author of a recent study believes that working out three or four days in a row increases the benefit. In the study conducted at Auburn University, men who worked out 30 to 45 minutes a session for four consecutive days increased their HDL four to six points while lowering harmful triglycerides, and effects were detected up to three days later. According to Peter Grandjean, Ph.D., author of the study, the benefits of exercise are cumulative and wear off more quickly after a single session.
[SOURCE: Mark Anders, "The Save-Your-Heart Workout: Triple Your Cholesterol-Busting Benefits," Prevention, February, 2002] Cooling May Save Heart Muscle The goal of heart attack treatment is to save heart muscle by restoring blood flow as quickly as possible. Among other ways explored by scientists to preserve and protect heart muscle after a heart attack is mild cooling-down to about 91.4 degrees Fahrenheit. Early data from the COOL MI (Cooling as an Adjunctive Therapy to Percutaneous Intervention in Patients with Acute Myocardial Infarction) trial were presented at the 2001 meeting of the American Heart Association. Results demonstrated the safety and yielded some promising results regarding the effectiveness of an investigative method of therapeutic cooling.
[SOURCE: "Endovascular Cooling System Safely Used in Patients," Health & Medicine Week, December 10, 2001] Coronary Calcium Scans Found Effective A painless, non-invasive scan that can be performed in less than 10 minutes has been found to be an effective way of evaluating the health of coronary arteries. A coronary calcium scan (also known as electron beam CT or multidetector CT scanning) measures the amount of calcium in coronary arteries. Calcium is a component of plaques but is not present in healthy arteries.
A study of 4,613 men and women in their 50s and 60s found that those with higher calcium scores were more likely to have a heart attack, stroke, surgery or angioplasty in the next four years. The predictive value of the test was found to be better than that of the commonly used Framingham risk score.
[SOURCE: “Coronary Calcium Scans Predict Heart Attacks,” Johns Hopkins White Papers: Coronary Heart Disease, 2006; from Journal of the American College of Cardiology, July 5, 2005] CRP Blunts Effect of Low-Fat Diet Persons with high levels of c-reactive protein (CRP), a marker for inflammation within the cardiovascular system, have an elevated risk of heart disease, even if their cholesterol numbers are normal. A recent study at Johns Hopkins found that individuals with high CRP levels obtained less benefit from following a low-fat, low-cholesterol diet than did other subjects. They showed reductions in total cholesterol and LDL, but less pronounced than the reductions in subjects with normal CRP levels.
[SOURCE: "Longevity Facts," Johns Hopkins Medical Letter, October, 2003] CRP May Indicate Hidden Disease A Mayo Clinic study published in the Archives of Internal Medicine [September , 2004] confirmed that inflammation, as measured by c-reactive protein (CRP), may be one of the earliest signs of heart disease. Using echocardiography to produce high-quality images of the aorta, the main artery through which blood is pumped from the heart, researchers found that CRP was the single factor most closely linked to the presence of plaques. "Among our study volunteers with no heart disease symptoms who were found...to have aortic plaques, a doubling of the CRP nearly doubled the chances that the plaque would be a thicker, more dangerous one," wrote the authors. Treatment of CRP involves daily aspirin and efforts to lower cholesterol through diet, weight loss, exercise and control of blood pressure.
[SOURCE: Bijoy Khandheria, M.D., et al, "C-Reactive Protein and Atherosclerosis of the Aorta," Archives of Internal Medicine, September, 2004] CRP Test Adds Little, Study Says Inflammation is a major factor in the development of plaque in blood vessels, and some authorities have recommended a blood test for CRP (C-reactive protein) as a way of detecting inflammation and identifying individuals at risk for heart disease. A recent study, published in
Archives of Internal Medicine [July 10, 2006] concluded, however, that widespread use of CRP screening is not advised.
Based on data from about 16,000 Americans from 1987 to 1989, the study found that traditional risk factors such as age, cholesterol, blood pressure, smoking and diabetes were good indicators of heart disease. Adding CRP to any or all of these risk factors did not improve the ability to predict a heart attack, stroke or heart failure.
[SOURCE: Daniel DeNoon, “CRP Test: Identify Heart Risk?” WebMD Health News, 2006 from A.J. Folsom, Archives of Internal Medicine, July 10, 2006] Depression, Inflammation Bad Combo Men with depression and high levels of c-reactive protein (CRP) had a significantly higher risk of suffering a heart attack or stroke over a seven-year period, according to a recent German study. Recently linked to an increased risk of heart disease, CRP is a protein produced in response to inflammation anywhere in the body. Men with high CRP (3.0 mg/L or greater) but no symptoms of depression also had a higher risk of heart attack or stroke, but not great enough to reach statistical significance. The authors of the MONICA study stressed the importance of having "full knowledge of an individual patient's status when judging the effect of CRP."
[SOURCE: Miriam E. Tucker, "Depression, CRP Interact To Up Cardiovascular Risk: Large Database," Family Practice News, April 15, 2004] Diet Creates BP Risk in ‘Stroke Belt’ Dietary fiber has proven health benefits, regardless of the food source. A recent study indicated, however, that fruit fiber and cereal fiber are most beneficial for reducing the risk of coronary heart disease (CHD). In a study analyzing data from 91,058 men and 245,186 women, researchers found a 30 percent reduced risk of heart disease for each 10-gram increase in fruit fiber and a 25 percent reduced risk for each 10-gram increase in cereal fiber. "In contrast, vegetable fiber was not associated with CHD incidence or mortality," the authors wrote. Vegetable fiber has other demonstrated health benefits. And aside from the fiber, vegetables have nutrients that protect against heart disease, hypertension and other illnesses.
[SOURCE: Archives of Internal Medicine, February 23, 2004; "Fiber from Fruits and Cereals Reduces CHD," Pharma Marketletter, March 8, 2004; "Fiber from Fruits, Cereals Prove Heart-Healthy," IDEA Personal Trainer, May, 2004] Diuretics Improve Exercise Capacity Diuretics have always been a standard part of treatment for congestive heart failure, and a recent study found that these drugs improved exercise capacity of heart failure patients by as much as 30 percent. The study concluded that patients may be at increased risk of hospitalization or even death if diuretics are withdrawn. Don't Nurse a Grudge Nursing a grudge might leave you in need of nursing care. Research shows that negative emotions create stress, raise blood pressure and set you up for heart disease and other stress-related health problems. In a study conducted at Hope College in Holland, Michigan, students who were told to brood over old grudges registered dramatic increases in blood pressure and heart rate. When they contemplated forgiveness, blood pressure and heart rate fell. Forgiving a grudge means acknowledging and expressing your hurt but allowing yourself to move beyond the negative emotions which ultimately harm you and not the person who wronged you.
[SOURCE: Erin O'Donnell, "How To Forgive Your Enemies," Natural Health, December, 2002] Don’t Take Prehypertension Lightly Normal blood pressure is anything below 120/80 mm/Hg and readings even slightly above that are pre-hypertension (120-140/80-90 mmHg). At lower levels of pre-hypertension, patients might be advised to exercise more, reduce sodium intake, lose weight and eat more fruits and vegetables. When blood pressure remains elevated, doctors may prescribe medication. According to one study, pre-hypertension triples a person’s risk of a heart attack.
[SOURCE: Richard S. Lang, Cleveland Clinic Men’s Health Advisor, June, 2006] Door to Balloon–90 Minutes Is Best Door to balloon time is the term used by doctors and hospitals for the time it takes to get a heart attack patient from the door of the emergency center to treatment with balloon angioplasty. Angioplasty is the preferred method of restoring blood flow to the heart for most heart attack patients with ST-segment elevation.
American Heart Association and American College of Cardiology guidelines suggest a goal of 90 minutes or less, but fewer than half of hospitals meet that standard.
One way of reducing door to balloon time is having emergency medical technicians perform an electrocardiogram on the way to the hospital. Time is also saved when an attending cardiologist is on site 24 hours a day or when emergency physicians (rather than a cardiologist) determine whether ST elevation is present and activate the heart catheterization team.
[SOURCE: Elizabeth H. Bradley, et al, “Strategies for reducing the door-to-balloon time in acute myocardial infarction,” NEJM, November 30, 2006] A heart attack is life threatening. In a person who also has chronic obstructive pulmonary disease, it is doubly dangerous.
A study published in the American Journal of Cardiology [March, 2007] found that heart attack patients with COPD were twice as likely to die as those without COPD. According to the researchers, patients with COPD were less likely to be treated with angioplasty, beta blockers or cardiac rehabilitation.
[SOURCE: John A. Spertus, American Journal of Cardiology, March, 2007; “MI Mortality Higher in COPD Patients,’ Reuters Health Information] A study conducted at the University of Southern California found a 33 percent increase in heart attacks from Thanksgiving to New Year's Day. This spike in heart attacks over the holidays may be partly a result of overindulgence in high fat, salty foods and alcohol. Holiday stress may also play a role as many individuals suffer depression and disappointment when reality falls short of idealized media images of celebrations and family life.
[SOURCE: "Winter the Most Dangerous Season," USA Today Magazine, October, 2000] At least 40 percent of diabetics die of heart disease. Even with no previous history of heart disease, a diabetes patient is as likely to suffer a heart attack or stroke as someone who has already had an attack. To head off cardiovascular problems, doctors recommend tight control of both blood sugar and blood pressure.
[SOURCE: Richard Pasternak and Vincenza Snow; "Reducing the Cardiovascular Risk in Patients with Diabetes," JAAPA-Journal of the American Academy of Physicians Assistants, November, 2003] | ArchiveAIDS & HIV |
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