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Sunday, February 28, 2010

Coffee Drinkers Have Lower Stroke Risk

SAN ANTONIO (MedPage Today) -- Drinking just one cup of coffee a day was associated with a lower chance of suffering a stroke, a large, prospective study showed.


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Friday, February 26, 2010

Walnuts may improve lipids, endothelial function in diabetics

Add walnuts to your list of probable "heart-healthy foods"

A small randomized crossover trial showed that flow-mediated dilation improved in people with type 2 diabetes who added walnuts to their meals over an eight-week period.

For complete story visit theheart.org.


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Stanford Review Finds Painfully Few Surefire Treatments For Muscle Cramps

For many years, I have advised patients to try and use quinine to control muscle cramps. After reading the following article, I will not be doing this anymore.

Most cases of muscle cramps never get reported to public health authorities, so it's difficult to say how common they are. But you probably know someone who's had them. You've probably had them, too. And the older you get, the more likely you're having one right now...


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Thursday, February 25, 2010

Single Men Have Higher Risk of Stroke

From WebMD:

Single and unhappily married men are at increased risk of dying from stroke, suggests a study of more than 10,000 men.


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Wednesday, February 24, 2010

Stand Up While You Read This!

Interesting piece in the NYTimes:

Too much sitting still, recent studies in rats and humans suggest, can offset the benefits of even regular exercise.


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Medicine, 'luck' help multi-heart attack survivors

Nice article from CNN on how modern medicine continues to improve the outcomes for heart attack victimes


A fifth heart attack, such as the one suffered this week by former Vice President Dick Cheney, is not rare because of advances in modern medicine, cardiologists say.


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Tuesday, February 23, 2010

My Life Check

My Life Check

This is a great website from the AHA.

My Life Check was designed by the American Heart Association with the goal of improved health by educating the public on how best to live. These measures have one unique thing in common: any person can make these changes, the steps are not expensive to take and even modest improvements to your health will make a big difference. Start with one or two. This simple, seven step list has been developed to deliver on the hope we all have--to live a long, productive healthy life.

Life's Simple 7:
  1. Get Active
  2. Eat Better
  3. Lose Weight
  4. Stop Smoking
  5. Control Cholesterol
  6. Manage Blood Pressure
  7. Reduce Blood Suger

Monday, February 22, 2010

NYTimes: The Claim: To Cut Calories, Eat Slowly

From The New York Times:

REALLY?: The Claim: To Cut Calories, Eat Slowly

Can stopping to savor every bite help you lose weight?


Why We Gain Weight As We Age

I found the following story on the NPR iPhone App:

Why We Gain Weight As We Age
by Patti Neighmond

NPR - February 22, 2010

It's a pretty common lament, the idea that you just can't eat what you used to. But why is that so? And is it avoidable? There are a number of reasons why we put on the pounds as years go by, but take heart: There are ways to fight back — and win!

There are some particular biological changes that happen as we age. For one, aging muscles actually contribute to the increase in the amount of fat we store in our bodies, says Cheryl Phillips, president of the American Geriatrics Society.

"So, if you look at a woman who is 70 years old and compare her to what her body was like at 25 years of age, even though her weight may be exactly the same, she had more percentage of muscle in her body when she was 25 than she does when she's 70."

Our Aging Muscles

In large part, that's because we lose muscle cells as we age. When younger muscle cells get damaged, they're quickly repaired. That's not the case with older muscles, according to UCLA researcher and geriatrician Jonathan Wanagat. He says we don't know why muscles literally shrink as we age. But there are a number of theories.

"I think one of the ones that have become increasingly interesting and popular is the idea that the stem cells in the muscle are not able to respond to damage or to aging the way they did when we were younger," says Wanagat. And if damaged muscle cells aren't repaired, they sort of whittle away and die, he says. Decreases in growth hormone, testosterone and estrogen levels may also account for the loss of muscle fiber and the inability of tissue to replenish itself.

In addition, the muscle cells we're left with are sort of worn out, according to Phillips. "If you think of muscles as being the energy powerhouse of our body, that's where most of our calories are burned. And when we talk about metabolism, what we're really talking about is how efficiently those powerhouse cells — the muscle cells of our body — burn the energy we bring in."

Energy is delivered to the body in the form of calories. And if you keep your caloric intake exactly the same as you get older, says Phillips, those unburned calories end up as fat.

Its sort of a one-two punch, says Wanagat. The energy powerhouse cells in muscles get damaged with age. That damage accumulates over time and, on top of that, the body's ability to repair that damage also dwindles with aging.

Building Strength At Any Age

And that's where exercise comes in. Wanagat says countless studies have shown that exercise — even among individuals in their 80s — works. It actually helps the muscle cells get bigger. And beyond size, it makes the muscles stronger.

"We aren't sure exactly how exercise makes muscles stronger, but we know that when we measure the grip strength of the hands or feet, grip is strongest just after exercise, even among people in their 80s and 90s. So weightlifting at any age offers low risk and great benefit, says Wanagat.

At UCLA, geriatrician and researcher Gail Greendale has just begun a second yoga study with seniors to try to figure out what poses work best for the older body. Greendale wants to understand how each yoga pose stresses muscles and joints. Then, she hopes to figure out how to modify the poses for the older body in order to maximize strength-building and minimize injury.

In addition, Greendale says that as we age the immune system can get out of whack, turning on an inflammatory response when there are no bacteria or viruses to kill, and keeping it on long after the body's invaders have left. Such an inappropriate inflammatory response can actually damage one's own cells in whatever part of the body the inflammation occurs, whether it's in muscles, joints or organs.

Ensuring such muscle and joint strength can also help fight this and other unfortunate aspects of aging, arthritis and inflammation. People over 75 are likely to have chronic joint problems, says Greendale. The joints are less able to tolerate the strain and stress of movement; they can be painful and swollen. Building joint and muscle strength can defend against that. Copyright 2010 National Public Radio

Friday, February 19, 2010

New MRI protocol for patients with implantable devices may eliminate defibrillation-threshold testing

This is very important good news for all patients with pacemakers and defibrillators.

From theheart.org:
Researchers have developed a new protocol for the safe MRI of patients with cardiovascular implantable devices.

For complete story visit theheart.org.


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Thursday, February 18, 2010

Diabetes Risk of Statins Outweighed by Heart Benefit

From MedPageToday:

Statin drugs raise the risk of diabetes significantly, but the danger appeared PUNY compared with their cardiovascular benefits, researchers found in a meta-analysis.


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JAMA: studies find little evidence to support genetic testing to improve CV risk assessment

From CardioBrief:

Two separate studies appearing in JAMA cast doubt on the practical value of genetic testing to improve cardiovascular risk assessment. In the first study, Nina Paynter and colleagues, led by Paul Ridker, calculated genetic risk scores based on 101 SNPs (single nucleotide polymorphisms) from 19,313 women enrolled in the Women's Genome Health Study. They found that [...]


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Mediterranean Diet: Ingredients For A Heart-Healthy Eating Approach

In countries bordering the Mediterranean Sea, heart disease is less common than in the United States. Researchers believe that foods common to Greece and southern Italy are a major reason for this difference. The February issue of Mayo Clinic Women's HealthSource covers key components of the Mediterranean diet as well as reasons why this approach is beneficial to heart health...


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Preliminary Data Show Possible Health Benefits Of Eating Chocolate

Giving chocolates to your loved ones may help lower their risk of stroke based on a preliminary study from researchers at St. Michael's Hospital. The study, which is being presented at the American Academy of Neurology in April, also found that eating chocolate may lower the risk of death after suffering a stroke...


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High Levels Of Vitamin D In Older People Can Reduce Heart Disease And Diabetes

Middle aged and elderly people with high levels of vitamin D could reduce their chances of developing heart disease or diabetes by 43%, according to researchers at the University of Warwick. A team of researchers at Warwick Medical School carried out a systematic literature review of studies examining vitamin D and cardiometabolic disorders...


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Happiness may be linked to reduced risk of heart disease

From the ACC Newsletter:

Bloomberg News (2/18, Cortez) reports that "people who are naturally happy appear to have a lower risk of developing heart disease or dying from heart attacks, according to" a study published in the European Heart Journal.

        The Washington Post (2/17, Huget) "The Checkup" blog reported that investigators "analyzed 10 years of data about 1,739 healthy adults who participated in the 1995 Nova Scotia Health Survey."

        The AP (2/18, Cheng) reports that the researchers "used a five-point scale to measure people's happiness." The investigators found that "for every point on the happiness scale, people were 22 percent less likely to have a heart problem." The research "was paid for by the US National Institutes of Health and others." The UK's Daily Mail (2/18, Hope), the UK's Press Association (2/18), Reuters (2/18, Kelland), MedPage Today (2/17, Neale), and HealthDay (2/17, Reinberg) also covered the story.
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Wednesday, February 17, 2010

Pediatricians Should Encourage Healthy Media Habits for Children and Adolescents

Here's a great article for parents of young children. We all need to
strive to encourage "healthy media" habits.

Pediatricians Should Encourage Healthy Media Habits for Children and


Program Helps Low-Income Smokers Kick Habit


Program Helps Low-Income Smokers Kick Habit
by Richard Knox

NPR - February 15, 2010

The overall U.S. smoking rate is half what it was in the 1960s. But this isn't true among low-income Americans: They're still smoking as much as everyone was a generation ago.

Massachusetts health officials say it doesn't have to be this way. They say they've found a way to get even the most hard-core smokers to quit.

The program is designed to help people like Sondra Pasquine. Pasquine, 24, works as a nursing home aide, and she wants to stop smoking. Through the Massachusetts program, she has a smoking cessation counselor, nurse Allison Diamond of the Dorchester House health center.

At a recent counseling session, Diamond pushed Pasquine to articulate what she doesn't like about smoking.

"What don't I like about it? The smell. It gets in your clothes, your hair," Pasquine replies. "And I just don't want cancer." Pasquine has seen family members suffer from smoking-related cancer.

Learning To Quit

During their 20-minute session, Diamond gives Pasquine some tips on how to be more conscious about what drives her to light up. She suggests jotting down the reason every time, and gives her a "pack wrap" diary that fits like a sleeve around her cigarette pack.

Diamond also writes a prescription for Chantix, a drug that blunts nicotine pleasure.

There's nothing revolutionary about the method. But preliminary data from the Massachusetts Department of Public Health indicate that getting low-income people like Pasquine to quit may just be a matter of giving them access to the same smoking cessation aids that richer and better-educated people have — nicotine patches, drugs and counseling.

That access — plus a big media campaign targeted at people enrolled in MassHealth, the Bay State's Medicaid program — appears to have brought impressive gains.

More than 75,000 MassHealth members have taken advantage of state-funded quit-smoking programs. Nearly half, the state says, have successfully quit.

Before the big push, about 40 percent of adults on Medicaid were smoking, a rate that hadn't declined in many years. But between 2006 and 2008, state figures show, their smoking prevalence dropped by 26 percent. By comparison, smoking among people without insurance coverage, a group largely on the lower end of the income scale, was unchanged.

Reaping The Benefits

And state officials say they're seeing major improvements in health — sooner than they expected. Within a year of entering smoking cessation programs, Medicaid recipients were hospitalized for heart attacks 38 percent less often than the previous year. Emergency room visits for asthma went down 17 percent. Pregnancy complications also went down, officials say.

"I think it's made a huge difference," says Dr. Nancy Rigotti, who heads tobacco research and treatment at Massachusetts General Hospital. She credits the generous Medicaid benefits with giving many low-income people the type of chance to quit they never had before.

Rigotti notes that federal regulations require that nicotine patches be sold in packages that contain a week's supply. That was intended to avoid dependence on the patches.

"So if you don't have a lot of money and you're hooked on nicotine, you may be able to scrabble together enough money to pay for a pack of cigarettes, but you probably can't buy a week's worth of nicotine patches," Rigotti says.

The Power Of Social Pressure

The Massachusetts program, launched as part of the state's landmark 2006 law that has gradually extended health insurance to almost all residents, has its skeptics.

Michael Siegel of the Boston University School of Public Health doesn't doubt that there's been a substantial drop in smoking prevalence among the Medicaid population. He's less convinced about the data on fewer asthma admissions and heart attacks, because there was no control population.

And Siegel, like others, doubts that providing low-cost smoking cessation pills and patches has made the difference. He thinks the media blitz should get most of the credit.

"My opinion is that what we're likely seeing here is that 80 percent of smokers want to quit anyway, and this publicity campaign got these smokers to pull the trigger," Siegel says. "I don't think it's necessarily [that] the medication itself had the effect, because quit rates are dismal from medication."

Others say it's possible that medication and counseling may give a needed extra boost to low-income smokers, who live in an environment where far more family members and friends smoke.

"It's especially hard when you have friends that smoke," says Pasquine. "You know, you see all your friends whip out cigarettes. It's like you're the only that don't do it."

'Ripple Effects'

There's no doubt that social factors exert a powerful force on pushing people to start smoking in the first place. And Nicholas Christakis of Harvard University says there's good evidence that social factors can work in the opposite direction — to encourage quitting.

"When you get one person to quit smoking, you get all these ripple effects," Christakis says. "When you get one person to quit, you get as many as three other people to quit throughout that person's network. So your intervention is four times as cost-effective as you thought it would be."

At some point, he says, the phenomenon can reach a tipping point. As the culture of smoking changes in a population, there are fewer smokers, and that makes it easier for the remaining ones to quit.

But of course, it's fundamentally a one-person-at-a-time deal. That's why, back at Dorchester House, Allison Diamond wants Sondra Pasquine to do one more thing before she leaves — blow into a carbon monoxide detector.

Diamond explains that carbon monoxide is in auto exhaust and cigarette smoke. "So the same thing that comes out of the exhaust pipe is in cigarettes, and you're breathing that in."

The detector shows Pasquine's carbon monoxide level is in the red "danger zone" from the cigarette she smoked that morning. She looks disgusted.

"I'm determined to quit now," she says.

Diamond guesses that Pasquine has a 50-50 chance of quitting in the next year. She'll probably need several more Medicaid-financed attempts.

But Diamond says the more times people try to quit, the better chance they have. Because each time, they gain more insight into why they're smoking. Copyright 2010 National Public Radio

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NYTimes: Hazards: Are Pipe and Cigar Users Blowing Smoke?

From The New York Times:

VITAL SIGNS: Hazards: Are Pipe and Cigar Users Blowing Smoke?

They may say they don't inhale, but such smokers were found to have
more than double the risk for abnormal lung function.


Good news for all Cardiologists

Sept 2009, I wrote a blog post describing the nationwide shortage of the nuclear isotope used in medical imaging.

Yesterday, the NY Times reported on the discovery of a new source of Technicium-99 from a nuclear reactor in Poland.

Read on for the good news -- New Source of an Isotope in Medicine Is Found

Thursday, February 4, 2010

Herbal Products to Avoid in Patients With Cardiovascular Diseases

Herbal Products to Avoid in Patients With Cardiovascular Diseases*
HerbPurported UseCardiac Adverse Effect of Interaction

AlfalfaArthritis, asthma, dyspepsia, hyperlipidemia, diabetesIncreases bleeding risk with warfarin
Aloe veraWounds (topical), diabetes (oral)Hypokalemia causing digitalis toxicity and arrhythmia
Angelica (dong quai)Appetite loss, dyspepsia, infectionIncreases bleeding risk with warfarin
BilberryCirculatory disorders, local inflammation, skin conditions, diarrhea, arthritisIncreases bleeding risk with warfarin
Butcher's broomCirculatory disorders, inflammation, leg crampsDecreases effects of alpha-blockers
CapsicumShingles, trigeminal and diabetic neuralgiaIncreases blood pressure (with MAOI)
FenugreekHigh cholesterolIncreases bleeding risk with warfarin, hypoglycemia
FumitoryInfection, edema, hypertension, constipationIncreases effects of beta-blockers, calcium-channel blockers, cardiac glycosides
GarlicHigh cholesterol, hypertension, heart diseaseIncreases bleeding risk with warfarin
GingerHigh cholesterol, motion sickness, indigestion, antioxidantIncreases bleeding risk with warfarin
GinkgoPoor circulation, cognitive disorderIncreases bleeding risk with warfarin, aspirin, or COX-2 inhibitors
Potential risk of seizures
GinsengAging, diminished immunity, improves mental and physical capacity and stress toleranceIncreases blood pressure
Decreases effects of warfarin
GossypolMale contraceptiveIncreases effects of diuretics
Grapefruit juiceWeight loss, to promote cardiovascular healthIncreases effects of statins, calcium-channel blockers, or cyclosporines
Green teaImprove cognitive performance, mental alertness, weight loss, diureticDecreases effects of warfarin (contains vitamin K)
HawthornCHF, hypertensionPotentiates action of cardiac glycosides and nitrates
Irish mossUlcers, gastritisIncreases effects of antihypertensives
KelpCancer, obesityIncreases effects of antihypertensive and anticoagulant agents
KhellaMuscle spasmsIncreases effects of anticoagulant agents and calcium-channel blockers
LicoriceUlcer, cirrhosis, cough, sore throat, infectionsIncreases blood pressure
May potentiate digoxin toxicity
Lily of the valleyCHFIncreases effects of beta-blockers, calcium-channel blockers, digitalis, quinidine, steroids
Ma-huang (ephedra)Obesity, coughIncreases heart rate and blood pressure
Night-blooming cereusCHFIncreases effects of angiotensin-converting enzyme inhibitors, antiarrhythmics, beta-blockers, calcium-channel blockers, cardiac glycosides
OleanderMuscle cramps, asthma, cancer, CHF, hepatitis, psoriasis, arthritis
Heart block
St. John's wortDepression
Increases heart rate and blood pressure (with MAOI)
Decreases digoxin concentration
StorphanthusCHFIncreases effects of cardiac glycosides
Increases heart rate
Increases or decreases blood pressure

* Only major indications, adverse effects, and interactions are listed; thus, the list is not all inclusive.

CHF = congestive heart failure; COX = cyclooxygenase; MAOI = monoamine oxidase inhibitor.

JACC online

More Good News on the Safety on Statins

As reported on Medscape:

Muscle and liver adverse effects of simvastatin 40 mg daily were evaluated in a randomized placebo-controlled trial involving 20,536 UK patients with vascular disease or diabetes (in which a substantial reduction of cardiovascular mortality and morbidity has previously been demonstrated).

The excess incidence of myopathy in the simvastatin group was < 0.1% over the 5 years of the trial, and there were no significant differences between the treatment groups in the incidence of serious hepatobiliary disease.

This led the authors to conclude:
  1. Among the many different types of high-risk patient studied (including women, older individuals and those with low cholesterol levels), there was a very low incidence (< 0.1%) of myopathy during 5 years treatment with simvastatin 40 mg daily. 
  2. The risk of hepatitis, if any, was undetectable even in this very large long-term trial. 
  3. Routine monitoring of liver function tests during treatment with simvastatin 40 mg is not useful.