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CardioSmart (@CardioSmart) 3/25/13, 11:01 AM Did you know that appropriate anticoagulation can reduce risk of stroke by over 66%? ht.ly/jgp0L

To reduce the risk of a stroke & improve health, limit alcohol to 2 drinks a day for men & 1 drink a day for women http://t.co/MG1dg6VBel

More and more reasons to live healthy

Over the past week, numerous studies and reports have been published touting the benefits of healthy living. Much of this is directly related to how and what we eat but also our size and our level of physical activity also play a role.

Here are brief descriptions of the recent news:

Study links 180,000 global deaths to sugary drinks

• This includes almost 25,000 adult Americans
• 1/100 deaths of obese people can be blamed on sweetened beverages
• 3/4 of these deaths are due to diabetes
• United States was third in death attributable to sugary drinks among the 35 "large" countries
• Cuba was highest amongst all countries

Excess salt blamed for 2.3 million deaths from Cardiovascular Disease worldwide

• 187 countries consumed, on average, 3950mg sodium/day - ~ 2x the recommended daily intake
• 1/10 death in the US can be linked to high salt intake
• 1/3 deaths occurred in people < 69 years-of-age

Patients with chronic kidney disease live longer with healthy living

• Healthy Living = "not smoking", regular exercise, avoiding low body weight
• Patients with the highest "healthy living score" were 53% less likely to die than patients with the lowest "healthy living score"
• Patients who never smoked were 46% less likely to die
• Patients who exercised regularly were 20% less likely to die

Start eating for your heart

Three easy ways to start incorporating the Mediterranean style diet into your daily routine:

- substitute olive oil for butter for cooking or dipping whole wheat bread
- use low fat or nonfat milk products
- start to eat a handful or two of almonds or walnuts every day

Rebates motivate shoppers to buy produce, whole grains

Very interesting study.

For some time I have been troubled by the fact that eating healthy costs more than eating poorly. For some, this is a major barrier to improving family eating patterns.

A study out of South Africa now has shown that if healthy food is made more affordable, people tend to eat more of the good stuff and less of the bad stuff.

Read more at the link below:

Rebates motivate shoppers to buy produce, whole grains, study says http://t.co/WeMvo9WEoZ

Heart-Healthy Living Cuts Cancer Risk

http://www.medpagetoday.com/Cardiology/Prevention/37957

Here's another good article about "Life's Simple 7" and it's health benefits

Heart healthy living also reduces risk of cancer

The American Heart Association (AHA) is reporting that not only are 7 simple lifestyle modifications strongly linked to reducing the risk of heart disease but also strongly linked to reducing the risk of cancer.

Life's Simple 7 is a seven-point plan devised by the AHA as part of its My Life Check campaign to help Americans adopt a heart-healthy lifestyle.

"The 7 simple steps are:

Get Active: raise physical activity level to minimum of 150 minutes exercise a week (eg half hour brisk walking five days a week).

Keep to a Healthy Weight: aim to have your body mass index (BMI) no higher than 25.

Eat a Healthy Diet: low in saturated and trans fats, cholesterol, sodium and added sugars; high in whole grain fiber, lean protein, and a variety of colorful fruits and vegetables.

Control Cholesterol: aim to have a total cholesterol level of under 200 mg/dL (but also check balance of HDL or "good" cholesterol and LDL, or "bad" cholesterol, eg too little HDL, less than 40 mg/dL for men or less than 50 mg/dL for women, can be bad for heart).

Manage Blood Pressure: normal is less than 120 mm Hg systolic AND less than 80 mm Hg diastolic. Prehypertension is 120 - 139 systolic OR 80 - 89 diastolic.

Reduce Blood Sugar: fasting blood sugar level above 100, could indicate diabetes or prediabetes.

Do Not Smoke: smoking is the most important preventable cause of premature death in the US: apart from increasing risk of lung cancer, by itself it increases the risk of coronary heart disease and is also a major risk factor for stroke."

The researchers are reporting that following 6 or 7 of the steps reduced the risk of cancer by 51%.

Meeting just 4 of the factors was linked to a 33% reduction in cancer risk.

Meeting just 1 or 2 was associated with a 21% lower risk.

These are very encouraging results. It is becoming clear that following a "simple" 7 recommendations are important towards leading a healthy life one that will not just reduce your risk of heard disease but also reduce your risk of cancer too. My suspicion is that as we learn more, we will discover that following these lifestyle recommendations will prove to reduce the risk of other illnesses as well.

Sent from my iPhone

Quality of Life Improves After Coronary Intervention In Octogenarians

A recent reveals that the Quality of Life (QoL) proves after percutaneous intervention (PCI -- angioplasty and stent) in octogenerains.

The study was a meta-analysis. This mean it combined the results from 11 previously published articles to study this patient population. In total, there were 700 octogenarian patients identified within the 11 studies with a mean age of 82.9 years. Studies were heterogeneity in the populations, methodology and QoL tools utilised.

Overall, older patients improved at least as much as younger patients. The benefits are greatest in the first 6 months and may continue until at least 3 years.

While mortality remains one of the most important factors post PCI, improving symptoms remains a very important factor to me and my patients. My experience is that patients of any age can gain significant improvements in QoL with successful PCI.

How I use my iPhone to keep me motivated

I love mobile technology and specifically smartphones. I was an early adopter. I started with a Treo 600. Then I transitioned to Blackberry and now to the iPhone.

I love this device for many reasons but the app environment is what makes it so special.

What I want to do today is share with you some of the apps I use on my iPhone to help keep me motivated while I exercise. They fall into different categories and I will share with you some of the apps that I find helpful. After reading my short blurbs about each app, follow the links -- each developer does a much better job than I do describing their apps in pictures and words.

Apps that track what I do:

Runkeeper 

This is a terrific app. It uses the iPhones GPS to track every run I go on. It tracks my distance, time and speed. It even gives me updates as to my pace during my run. There are also built in coaching tips. I can see my progress on the phone or on the web. I use this app all the time. 

Moves

This is my new favorite app. Just turn the app on and carry your iPhone in your pocket. It will magically track your steps for the day. It also does integrate in with the GPS and can give me a storyline of where I have been throughout the day. It can tell the difference when I am walking, biking or running. Its an amazing little app and I check it routinely throughout the day to keep tabs on how I'm doing. When it is clear that I am falling behind on my quest to reach 10,000 steps/day - I force myself to get up and get moving. 

Apps that keep my mind occupied while exercising:

Audible

I love listening to books. I listen to them constantly during my commute up and down the Merritt Parkway between Fairfield and Stamford. But I also listen to books during my workouts. This will not work for everyone -- some need music to keep them moving. Yet, I find that if I get lost in a good book, I totally can ignore the pain and misery my workout may be causing me. Audible is a amazon.com product. It is a subscription service that lets you download books and listen to them on your iPhone. It is simple to use and I just love it.

Pandora

Of all the streaming music radio services, I always come back to Pandora. I hate buying music, making playlists and syncing them to my phone. Who has time for that? With Pandora, you just select a type of music or specific artist that you like to listen to and viola! it will create a terrific playlist for you. This works great for workout when I don't want to listen to a book and just want to listen to music to keep me motivated and pumped. 

MOG

A friend recently turned me on to this amazing service. Its very similar to Spotify but its better. While its a paid subscription service ($9.99/month), it lets you download an unlimited amount of albums, artists, or songs that you like to your phone or you can opt to just stream them. This works great for discovering new music or for those times when I just want to listen to a specific artist/album and not a mix.

I 

You're killing your loved ones

A new study has recently shown that secondhand smoke increases the risk of atherosclerosis more than other well-known risk factors.

Overall, the prevalence of atherosclerotic plaque in those exposed to secondhand smoke was 24%. Those exposed to the highest amount of smoke were 90% more likely to have plaque than the general public.

This increased risk was greater than other traditional well-known risk factors like diabetes, high cholesterol, hypertension and kidney disease. 

Please, please -- if you smoke - STOP!!! But if you cannot, at least do it in private so you do not kill you loved ones.

Exercise - Just do it

Many times throughout the day, I spend time talking with patients about the importance of exercise.

There are many ways to include exercise into your daily or weekly routines. Exercise can take the form of going for a walk, run or a bike outside. Alternatively, going to the gym and getting on the treadmill, elliptical or stationery bike work too. I also encourage patients to try doing classes like spinning, Zumba or  water aerobics.

I also tell my patients not to lose sight of things that were fun when they were kids. So if they liked to bike ride, try to start biking again. If they liked to play frisbee, find an ultimate Frisbee team. If they like to play basketball or softball or tennis try to get involved in those activities. Take up ice-skating again. Take up dance again. All these opportunities exist for adding exercise into your life.

There are also easy ways to add more exercise into your daily life. Take the stairs - go out of your way avoid elevators and escalators will be very beneficial. Try parking at the back of the parking lot. Take a walk around the block after dinner.

Time and again, research continues to add more and more compelling data on the benefits of frequent exercise.

Not watching CPR more traumatic than watching it

French researchers have announced the finding of a very interesting study.

For years, the medical community ushered patient's loved ones away from the patient so they did not have to experience the trauma of watching their loved one undergo CPR and attempt of resuscitation. The medical community felt that this was protecting the loved one. However, anecdotal accounts have shown that loved ones experience less trauma and achieve closure with the exeprience of watching the resuscitative attempt.

Now, French researchers have tested this theory. Working with out-of-hospital cardiac arrest victims, some loved ones were offered the opportunity to watch CPR. After a few months time, the researchers went back and questioned the loved ones. The researchers found a lower level of post-traumatic stress symptoms in those loved ones that watched CPR vs those that did not.

We still do not know if loved ones would find the same comfort in watching in-hospital cardiac arrest CPR.

This is a thought provoking study. I hope more research will be done on this topic.

I know the next time I will think twice about asking a family to leave the room when attempting to revive their loved one.

Even Mummies Have Heart Disease

Fascinating new findings have been recent announced at the ACC and published in the Lancet.

For many years, coronary artery disease (CAD) was felt to be a disease of the industrialized, modernized world. Our lack of exercise, diet filled with processed foods and saturated fats and our inhalation of cigarette smoke and pollution has led to CAD becoming the number one killer of men and women in the modern world.

Now, researchers have announced that this is NOT true. Examining 137 mummies from four different ancient cultures (Egyptian, Peruvian, Ancestral Peubloan and Unangan), researchers have revealed the presence of heart and vascular calcifications.

This may lead to a significant change in our thinking and understanding as to the route cause of atherosclerosis. Might CAD be a part of human history? Could it be that all humans have an underlying inherent predisposition for coronary/vascular plaque build up?

Z-pack and cardiac disease may be a deadly combination

The FDA announced a public warning for the popular antibiotic azithromycin (Zithromax and the antibiotic in the widely prescribed Z-pack).  

The FDA is warning that this medication increases the risk of a potentially fatal irregular heart rhythm. 

Patients at risk for this azithromycin-induced arrhythmia include those who already have a prolonged QT interval, low blood levels of potassium or magnesium, and an abnormally slow heart rate, or who take drugs to treat arrhythmias. Elderly patients and patients with cardiac disease also may be more susceptible to the arrhythmogenic effects of the antibiotic.

Patients take a five day course of azithromycin (Z-pack) has been shown to have a small increase in the suffering sudden death. These finding were brought to light in a recent article published in the New England Journal of Medicine. This should not be a huge surprise to clinicians. Azithromycin is a macrolide-class antibiotics. This class of medications have been well known to increase the QT interval and potentiate arrhythmias.  

Please consult your physician for more information. 

Niacin

The results the HPS2-THRIVE trial were presented at the ACC the other day. In this large trial, niacin was shown NOT to prevent major adverse Cardiovascular events any more than placebo. This is despite causing average reductions in LDL of 10 mg/dL and triglycerides of 33 mg/dL, in addition to a 6 mg/dL increase in HDL.

When interpreting a trial like this, it is important to understand the patient population studied. These were patients at high risk that already had LDL < 70mg/dL. This is important to understand. In patients like this, it is clear that niacin does not work. But what about patients who are on statin with an LDL > 70mg/dL? Many of these patients are on niacin for its LDL lowering properties and not for it HDL raising properties, as was studied in this trial. The jury is still out?

If you currently take niacin therapy, I suggest you discuss whether or not you should continue using it prior to discontinuing it on your own.

Veggie Heart

I love this photo I found on the web.

Niacin

theheart.org is reporting today that The European Medicines Agency (EMA) will be launching a review of all niacin (nicotinic acid) agents. This is due to new data from a soon to be reported trial at the ACC in San Francisco, HPS2-THRIVE. It is being reported that a combination of niacin and another agent (which was supposed to reduce the flushing of niacin)  "failed to show that the combination reduces the risk of major vascular events (such as heart attack and stroke), and a higher frequency of non-fatal but serious side effects was seen in patients taking the combination."

The EMA is launching the review to insure that the findings do not apply to all niacin medicationd but hopefully only to the above combination compound.

As of now, if you are currently on niacin, there is no specific warning that you must stop using it. Recent studies over the past year have shown that although niacin raises the HDL and lowers LDL - no definitive reduction in clinical outcomes have been proven.

If you are concerned, I recommend you discuss it further with you physician. 

Danger: Processed Meat

Bacon, sausage, ham, etc has once again to be are strongly associated with  all-cause mortality and cardiovascular death.  

In a large trial recently reported, processed meat by middle-aged adults was associated with a near doubling of the risk of all-cause mortality, compared with low consumption, over a mean of 12 years. The risk CV death was increased by more than 70% among people eating high quantities va those eating small quantities per day. 

The researchers also found a more than 43% increase in cancer. 

As the authors pointed out, processed meats contain more saturated fats, cholesterol and salt.

Rohrmann S, Overvad K, Bueno-de-Mesquita HB, et al. Meat consumption and mortality. Results from the European Prospective Investigation into Cancer and Nutrition. BMC Med 2013.

Usual care was no match for a home blood pressure monitoring

An interesting new study was just published. It compared patients doing home monitoring of their BP and uploading the data to Heart360 vs usual care.  American Heart Association's web-based Heart360, a free, online tool for tracking heart health where users can upload blood pressure data and send it to their health providers.

After 6 months, blood pressure was significantly better controlled in home monitoring group than in those with usual care.

This is important finding. We are gaining more and more evidence that using technology to interact with patients when they are away from the doctors office (Heart360, reminder texts to teens to take their medications, ...) improves compliance. We also know that even small reductions in BP have long lasting real benefits.

For those patients with consistent BP's > 140/90 - consider talking about using the Heart360 program with you heart care provider.

Ramipril improves symptoms of intermittent claudication

Ramipril improves symptoms of intermittent claudication

http://rdd.me/5pdkv9aq

Interesting study which showed that treatment of intermittent claudication  with the drug ramipril (an ACE inhibitor known to lower BP and be beneficial in diabetics to help prevent kidney damage) has been shown to significantly improve symptoms. 

While the drug in this small study did seem to help patients, it was by no means a miracle drug. At the end of the study, patients could walk 4.25 seconds farther. 

Other known therapies that can help IC include Pletal and a walking program. 

Maybe the combination of all three would be most beneficial. Hopefully this approach will be formally tested. 

Here is another terrific resource put out by the AHA -- Life's Simple 7

All of these 7 steps have been steps that I have been educating my patients on since I started practicing Cardiology over ten years ago

The core principles:

1. Get active
2. Control cholesterol
3. Eat better
4. Manage blood pressure
5. Lose weight
6. Reduce blood sugar
7. Top smoking

Just a Little Heart Attack

This is a terrific short video. I was introduced to it yesterday at @HVHeartAssoc (Hudson Valley/Fairfield County American Heart Association) #Go Red for Women luncheon yesterday. I was proud to participate in this annual luncheon to raise awareness for heart disease in women. Heart disease is still the #1 killer of women in this county (1/3 women will die of heart disease).

I hope you enjoy this as much as I did.