Blizzard of 2015

After the Blizzard of 2010, I wrote a blog about the dangers of shoveling snow. 

Please read. 

http://drportnay.blogspot.com/2010/12/snow-shoveling-and-heart-attacks-is.html?m=1 

Please be careful tomorrow. Here in the Fairfield County, Connecticut forecasters are predicting the Blizzard of 2015. 

Medications After a Heart Attack

From: www.secondscount.org

Your heart attack recovery will include medications. Taking these medications exactly as prescribed is one of the best tools at your disposal for avoiding death in the months following a heart attack. According to an article published in Circulation, the journal of the American Heart Association, heart attack patients who had not filled any of their prescriptions within 120 days of being discharged from the hospital had 80 percent greater odds of death than those who filled all of their prescriptions.

Medications you are likely to be prescribed after a heart attack fall into the following classes:

• Antiplatelet agents – to prevent blood clots and keep the stent open. Examples include aspirin, clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta). It is critical that these medicines not be stopped without checking with your cardiologist, for stopping them prematurely can result in another heart attack from the stent closing off abruptly.
• Statins – to lower cholesterol levels. Examples include atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor) and pravastatin (Pravachol).
• Beta blockers – to treat high blood pressure and decrease the incidence of abnormal heart rhythms. They can also help the heart remodel and improve heart function. They decrease the amount of work the heart has to do. Beta blockers after a heart attack have increased survival rates. Examples include metoprolol (Lopressor, Toprol XL), carvedilol (Coreg), nebivolol (Bystolic), atenolol (Tenormin) and bisoprolol (Zebeta).
• ACE-inhibitors/Angiotensin receptor blockers (ARBs) – to lower blood pressure. They can also help the heart remodel and improve heart function. ACE-inhibitors after large heart attacks have increased survival. Examples of ACE-inhibitors include lisinopril (Prinivil, Zestril), ramipril (Altace), captopril (Capoten), quinapril (Accupril) and enalapril (Vasotec). Examples of ARBs include losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), olmesartan (Benicar) and azilsartan (Edarbi).
• Calcium channel blockers – to reduce blood pressure and control the amount of calcium that enters the heart and arteries, allowing blood vessels to relax and reducing the workload of the heart. An example is verapamil (Isoptin SR, Calan SR).
• Nitrates – to expand the arteries leading to the heart and relieve chest pain. Examples include sublingual nitroglycerin, isosorbide (Imdur), isosorbide dinitrate (Isordil) and the nitroglycerin patch.
• Antianginal agents – to relieve chest pain. Besides nitrates (see above), ranolazine (Ranexa) may also be given to help decrease chest pain.
• Anticoagulants – to reduce the blood's ability to clot. If there is evidence of a blood clot in the heart after a heart attack, then warfarin (Coumadin) may be used to eventually dissolve the clot. If there is evidence for a certain type of abnormal heart rhythm, then depending on one's risk for stroke, warfarin (Coumadin), dabigatran (Pradaxa) or rivaroxaban (Xarelto) may be prescribed to thin the blood and decrease the risk for stroke
• Medications to protect the stomach – Because a heart attack is a stressful event, and subsequent medication regimens to keep the stent clear often include aspirin and other antiplatelet agents that can be tough on the stomach and increase the chance for bleeding from the stomach, your cardiologist may (or may not) recommend medications to protect the stomach. Examples include H2 blockers such as cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac), or proton pump inhibitors such as pantoprazole (Protonix).

More information about cardiovascular medications is available at Taking Your Medications and Medication Safety.

An Important Note About Aspirin and Other Antiplatelet Medications

After you suffer a heart attack, you should take aspirin every day for the rest of your life. If you receive a bare metal stent you should also take Plavix, Effient, or Brilinta for a minimum of a month after the procedure. If you receive drug-eluting (coated) stents you need to take Plavix, Effient, or Brilinta for at least a year after stent implantation. Taking these medications exactly as prescribed is critically important to prevent a blood clot from potentially forming in the stent. 

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From kevinmd.com: About to be discharged from the hospital? Here's 3 things you should know.

http://www.kevinmd.com/blog/2015/01/discharged-hospital-heres-3-things-know.html

About to be discharged from the hospital? Here's 3 things you should know.

The world of health care has made tremendous progress in the last several years in raising the quality and safety of clinical medicine. Despite this, the discharge process (when patients are discharged from hospital) is still fraught with potential pitfalls and opportunities for things to "slip through the net."

If you ask most patients who are discharged — particularly the elderly with multiple medical problems — they will tell you that the process often appears rushed and haphazard, with many things still unclear to them when they exit the hospital. A central problem rests with time itself. For a thorough discharge to occur, the physician needs to spend a lot of time methodically going over all aspects of the hospitalization, working out the appropriate discharge medications and then clarifying the necessary follow-up. This can sometimes take over an hour per patient and in reality this time simply doesn't exist in the busy world of hospital medicine (and doesn't in any health care system or country I'm aware of). Doctors and nurses, therefore, need to focus on the most pertinent points.

Having said that, there are also some things that patients can always do to greatly reduce their chances of post-discharge complications or an abrupt readmission. Here are 3 of them:

1. Don't leave the hospital without feeling comfortable about your medication list and clarifying every single one. During any hospitalization, many home medications can be stopped or changed. Common examples include blood pressure and diabetes medications that will be adjusted in response to fluctuations in these parameters during illness. In addition, there will be new medications prescribed upon discharge. Elderly patients, who form the bulk of hospital admissions, can be on a dozen or more medications, and it is imperative to go over the complete medication list and understand what needs to be taken and what doesn't. It may also be a good idea to have a family member present at this time as well. If this has not been explained thoroughly, be sure to ask the doctor or nurse to confirm before you leave the hospital.

2. Quick follow-up with your primary care doctor. It's always a great idea to quickly follow-up (within 5 to 7 days) with your primary care doctor. Medical studies may have shown mixed results regarding the efficacy of doing this, but it's basic common sense that this would be a useful thing to do after any complicated hospital admission. Let your doctor go over the details of your hospitalization, medication list, and whether you are still in good shape. Potential problems can be nipped in the bud, and any confusion with your medicines can be clarified. Nearly all primary care offices will reserve slots for their patients who've just been discharged from hospital.

3. Monitor yourself like a hawk. Remember that most people who leave the hospital are still in a somewhat fragile state of health. The hospital has done its job in getting you on the path to recovery, but there's still some way to go. If within the first few days, after leaving the hospital you start to go in the wrong direction, don't wait — seek help immediately. Never has the phrase a stitch in time saves nine been more appropriate. Examples include someone with congestive heart failure noticing increased leg swelling, or someone with chronic bronchitis noticing they are more short of breath again. You only have a small window from developing any of these symptoms to going past the point of no return and needing a hospital admission. Get help early on when you need it.

Although the whole discharge process is significantly better than it used to be a few years ago, we still have a lot of work to do. Many patients are still in 50/50 health when they leave the hospital, and there's no way to guarantee a successful outcome. But some basic and common sense rules should always be followed. Physicians often forget that nobody wants to get better and have a successful discharge more than the patient themselves. Education on points such as the above and putting patients in charge of their own care can work wonders in preventing complications and readmissions.

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being.  He blogs at his self-titled site, Suneel Dhand.

 

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Heart Disease & Stroke Statistics - 2015 Update

The American Heart Association has published its 2015 update - here are some take home points

• From 2001 to 2011, death rates attributable to cardiovascular disease (CVD) declined 30.8% and stroke rate declined by 35%
• CVD still accounted for 31.3% of all deaths and about 25% were <65 years of age. 
• About 1 million hospital discharges for heart failure occur yearly, which has not changed.
• There continues to be strong data that that we must continue to prioritize health behaviors (healthy diet pattern, appropriate energy intake, physical activity, and nonsmoking) and health factors (optimal blood lipids, blood pressure, glucose levels) throughout the lifespan
• About 75% of children and 50% of adults have ideal cholesterol levels; about one third of adults or about 80 million people have hypertension (blacks about 45%) and about 10% of adults have diabetes. 
• Current cigarette use declined from 24.1% in 1998 to 17.9% in 2013; but about one third of deaths are attributable to smoking and exposure to secondhand smoke.
• In 2013, 15.2% of adolescents reported being inactive during the prior week.
• Only half of American adults met the current aerobic physical activity (PA) guidelines (≥150 minutes of moderate PA or 75 minutes of vigorous PA or an equivalent combination each week), and women and minorities were less likely to meet the guidelines. 
• The leading risk factor for death and disability in the United States is suboptimal diet quality. Major contributors were insufficient intakes of fruits, nuts/seeds, whole grains, vegetables, and seafood, as well as excess intakes of sodium.

Food Rules

My all time favorite and most important

• #64 Break the rules once in a while

Food Rules

I'm a big fan of Michael Pollan's Food Rules

Here are just a few of my favorites from his 64 rules discussed in his book:

• Avoid food products that contain more than 5 ingredients
• Avoid food products with ingredients that a third grader cannot pronounce
• Don't eat anything your great-grandmother would't recognize as food
• Eat only food that will eventually rot
• Stop eating before you are full
• Eat mostly plants

Lifestyle Changes for Lower Blood Pressure

• Get moving - with regular exercise

• Focus on nutrition - Dash/Mediterranean Diet - mostly plant based and whole grains, make healthy choices and be mindful of portion sizes 

• Cut the salt - read food labels and aim for 1500mg sodium or less per day

• Take your medication - if you are superscribed medicine for high blood pressure, take it every day

• Check you blood pressure

• Lose weight - losing just 10 pounds can make a big difference

• Cut back on alcohol - men; not more than 2 drinks/day and women; no more than one. 

• Don't smoke - if you smoke, stop!

• De-stress and sleep well

Using weights to target belly fat | Harvard Gazette

I've been stressing this to my patients for a few years now. Great to see that there is a growing body of scientific evidence to support the positive effects of not just Cardio but also strength training (ST).

ST is vital not only for weight loss but to counteract the effects of aging on the body. As we age, we are consistently losing muscle mass. The only way to help counteract this is with ST.  

http://news.harvard.edu/gazette/story/2014/12/using-weights-to-target-belly-fat/?utm_source=twitter&utm_medium=social&utm_campaign=hu-twitter-general

Using weights to target belly fat

Healthy men who did 20 minutes of daily weight training had less increase in age-related abdominal fat than men who spent the same amount of time doing aerobic activities, according to a new study by Harvard T.H. Chan School of Public Health (HSPH) researchers and colleagues. Combining weight training and aerobic activity led to the most optimal results. Aerobic exercise by itself was associated with less weight gain compared with weight training.
The study appears online today in Obesity.
"Because aging is associated with sarcopenia, the loss of skeletal muscle mass, relying on body weight alone is insufficient for the study of healthy aging," said lead author Rania Mekary, a researcher in HSPH's Department of Nutrition. "Measuring waist circumference is a better indicator of healthy body composition among older adults. Engaging in resistance training or, ideally, combining it with aerobic exercise, could help older adults lessen abdominal fat while increasing or preserving muscle mass."
Prior studies had been focused on a specific population (e.g., overweight people or type 2 diabetics), were of short duration, and had mixed results. The new study was long-term with a large sample of healthy men with a wide range of body mass indexes (BMI).
Mekary and colleagues studied the physical activity, waist circumference (in centimeters), and body weight of 10,500 healthy U.S. men aged 40 and older participating in the Health Professionals Follow-Up Study between 1996 and 2008. Their analysis included a comparison of changes in participants' activity levels over the 12-year period to see which activities had the most effect on the men's waistlines. Those who increased the amount of time spent weight training by 20 minutes a day had less gain in their waistline (-0.67 cm) compared with men who similarly increased the amount of time they spent on moderate-to-vigorous aerobic exercise (-0.33 cm), and yard work or stair climbing (-0.16 cm). Those who increased their sedentary behaviors, such as TV watching, had a larger gain in their waistline.
"This study underscores the importance of weight training in reducing abdominal obesity, especially among the elderly," said Frank Hu, professor of nutrition and epidemiology at HSPH and senior author of the study. "To maintain a healthy weight and waistline, it is critical to incorporate weight training with aerobic exercise."
Other HSPH authors include Anders Grøntved, Walter Willett, Eric Rimm, and Edward Giovannucci.
The study was supported by National Institutes of Health grants.