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Tuesday, April 28, 2009

Preventable Death

A new study from PLoS Medicine has shown that smoking and high blood pressure top the list as the number 1 and 2 modifiable risk factors that cause death


That was my first response as I read the list. As a read more though I began to feel motivated and interested. There is so much disease that we can prevent. If I can just try and help my patients make better decisions on what they eat and be more active -- i might really be able to make a difference.

Here is the list of the estimated number of deaths related to the risk factors annually:

  • 467,000 for smoking
  • 395,000 for high blood pressure
  • 216,000 for overweight and obesity
  • 191,000 for inadequate physical activity and inactivity
  • 190,000 for high blood glucose
  • 113,000 for high LDL cholesterol
  • 102,000 for high dietary salt
  • 84,000 for low dietary omega-3 fatty acids from seafood
  • 82,000 for high dietary trans fat
  • 64,000 for alcohol use (26,000 averted from benefits for heart disease, stroke, and diabetes versus 90,000 alcohol-related deaths from injuries, violence, cancers, and other diseases)
  • 58,000 for low fruit and vegetable intake
  • 15,000 for low dietary polyunsaturated fatty acids (less than 1% of all deaths)
If you have been reading this blog, you will not be surprised with this list. So many of these modifiable risks are related to our sedentary life style and unhealthy eating habits (and of course smoking).

If we can just try and be more active, not smoke, and eat a steady diet of "heart healthy" foods, we might get to the point where we actually die from things other that cardiovascular disease. Remember that heard disease and stroke remain the #1 and #3 killers of all Americans.

Combination of Aspirin and Plavix Increase Risk of Infection After Bypass

A new study was just published in the Archives of Internal Medicine that found an increased risk of postoperative infection in patients undergoing bypass surgery who receive both aspirin and clopidogrel (Plavix).

We use both of these agents in combination to treat heart attacks and keep stents open. Both are "anti-platelet" agents which inhibits the function of the platelet and make it harder for blood to clot.

It has been known for some time now that patients on this combination therapy prior to surgery have increased risk of bleeding. Patients who bleed have a higher rate of infection. Therefore, the findings of this study are not surprising. In fact, the national recommendations are, if possible, to stop this combination therapy 5 days prior to surgery.

There is though some interesting and emerging date that the use of these agents
may interfere with some of the bodies natural response to sites of tissue injury and inflammation. Therefore, there may be more to this story than just just increased bleeding.

More studies will be needed to more better understand these findings.

For now, most patients should be off this combination therapy, as the guidelines recommend, prior to bypass surgery. However, there may be some instances where the therapy should be continued. I would discuss this with your physician if you are planning on having bypass surgery.

Monday, April 27, 2009

You're never to old for the "big one"

This past weekend I took care of a 47 year male in the early stages of a large heart attack. On the outside he appeared to be a healthy and fit guy. However, on the inside, he had a huge clot in his proximal left anterior descending artery -- a lesion we call the "widow maker." Think Tim Russert.

Heart attackes (myocardial infarctions/MI's) come in many different flavors. The ones that we all worry about are the acute ST elevation MI's (think Sanford and Son). This is when a cholesterol plaque ruptures and in the process of thrying to heal the crack in the innner lining of the wall of the artery -- a large clot froms. This clot can end up filling up the enite inside (lumen) of the artery and choke the heart muscle (myocardium). If not treated quickly, permanent damage will occur. Watch the animation below to see this process in action:

My job is to quickly and safely get in that artery and open it up with a balloon and a stent. Watch the animation below to view a stent being deployed.

How could this have been prevented?

My patient did have a family history of heart disease and high cholesterol.

In my patients, I help assess their risk of "cardiovascular events" with the following:

  • cholesterol levels
  • highly sensitive CRP (marker of inflammation)
  • stress test
  • carotid ultrasound
  • review of risk factors: smoking history, blood pressure, diabetes
  • family history
  • physical activity levels
  • eating habits

Please consult with your doctor to evaluate your risk of heart disease.

Sunday, April 26, 2009

Google AdSense

I have been thinking long and hard over whether or not I should allow advertizing on my blog. I set out to write this blog not for monetary gain. However, I now realize that I can use this towards a good cause. Any money that this blog earns (100%) will be donated to charity. I will keep a running update on just where and how much was donated.

Friday, April 24, 2009

Bigger and Bigger

We just keep getting bigger and bigger

  • 3/5 adults are overweight
  • 1/5 adults are obese
  • a child born in 2000, has a 1/3 chance of becoming diabetic
  • 1/3 children in America eats "fast food" every day
  • Diabetes has reached such an epidemic that it it no longer confined to adults, hence the name change from "Adult-onset Diabetes" to "Type-II Diabetes"

This really gets we thinking:

  • we eat to much or the wrong stuff
  • eating healthily costs too much
  • we are a sedentary society

I we do not make some drastic changes to ourselves and our kids, its terrifying to me to think of what the future will look like.

We are what we eat!!!!!

If the saying "We are what we eat" is true, then have become corn and fossil fuel.

I am in the middle of listening to a fascinating book called "The Omnivore's Dilemma" by Michael Pollan. As the desciption of the book from his website states, the author "follows each of the food chains that sustain us—industrial food, organic or alternative food, and food we forage ourselves—from the source to a final meal, and in the process develops a definitive account of the American way of eating."

It is truly an amazing account of who we are and what we eat. I had no idea just how "industrialized" are food and food habits have become and just how much corn has infiltrated into almost everything we eat.

I recommend this read.

I would love to hear your thoughts

Wednesday, April 22, 2009

Pre-Hospital care of the patient with an acute heart attack

Once a heart attack starts, the clock starts ticking on the viability of the heart muscle. If the blocked artery is not opened quickly, the heart muscle will be permanently damaged. Therefore, we try to have the artery opened in less than 90 minutes after the patient first arrives at the hospital. We call this the Door-to-Balloon time (D2B time).

One way to get the process rolling faster, is to have the emergency medical team alert the hospital that a patient is having a heart attack even before he/she arrives at the hospital. This gives the hospital time to mobilize the doctors/nurses/techs that will be taking of the patient, prior to hospital arrival.

A recent study in the April 2009 edition of the Journal of the American College of Cardiology: CardioVascular Interventions showed that in 10 regional communities that utilized the strategy of prehospital alert of a heart attack, 86% of patients were successfully treated in less than 90 minutes. This is well above the benchmark of 75% set by the American College of Cardiology.

At Stamford Hospital, we initiated this strategy over 2 years ago. We too have witnessed a dramatic decrease in our D2B times. With this, we are saving a lot of heart muscle and improving patient outcomes.

With the success of the program at Stamford Hospital, I have been helping develop similar programs for the Bridgeport and Norwalk communities at St Vincents Medical Center and at Norwalk Hospital's new program.


Sent from my Verizon Wireless Blackberry

Dr Portnay’s Guide to Healthy Living

I am frequently asked for diet recommendations from my patients. I routinely educate them that over and over again the most "heart healthy" diet has been shown to be the Mediterranean Diet. This consists of simply eating olive oil, red wine, fruits, veggies, nuts, and fish.

Our activity level, is just as important as what we eat -- I can not stress this enough.

To further assist my patients, I assembled and reworded recommendations from the American Heart Association for them in the form a a simple handout.

The following is my Guide to Healthy Living
  • Use up at least as many calories as you take in.
  • Be physically active.
  • Aim for at least 30 minutes of physical activity on most days of the week, if not all.
  • Eat a variety of nutrient-rich foods.
  • Eat a diet rich in vegetables and fruits.
  • Choose whole-grain, high-fiber foods.
  • Eat fish at least twice a week.
  • Eat less of the nutrient-poor foods.
  • Limit how much saturated fat, trans fat and cholesterol you eat.
  • Choose lean meats and poultry without skin and prepare them without added saturated and trans fat.
  • Select fat-free, 1 percent fat, and low-fat dairy products.
  • Cut back on foods containing partially hydrogenated vegetable oils to reduce trans fat in your diet.
  • Replace butter and cream were replaced with margarine high in alpha-linolenic acid or olive oil.
  • Cut back on foods high in dietary cholesterol.
  • Cut back on beverages and foods with added sugars.
  • Choose and prepare foods with little or no salt.
  • If you drink alcohol, drink in moderation.

*Adapted from the American Heart Association 2006 Diet and Lifestyle Recommendations
For more info visit: www.americanheart.org

Inaugural Post

I have been wanting to start a blog for some time now. My goal is to bring useful information and opinion to the everyday person. Everyday it seems that more and more information is published regarding what medications to take or not take, what food to eat or not eat, what exercise to do or not do, what procedures to have or not have to keep you alive longer, avoid a heart attack and keep promote overall well being.

My goal with this blog is to help the everyday person navigate all the information floating around out there and try and make sense of it all.

In addition, I will provide education on understanding the many aspects of heart disease and current and future treatment options.