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Thursday, December 31, 2009

Empowered Patient: Top tips for 2010

Here's an excellent article to get you started towards empowering yourself for the new year:

The top ways to empower yourself and take your health care into your hands this year

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Wednesday, December 30, 2009

Mortality Impact of Obesity Said To Be Underestimated

Obesity may have an even greater impact on mortality than anticipated, according to a new method of adjusting for confounding.


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Saturday, December 26, 2009

5 tips for getting what you need from your doctor

This is a great article. Doctors definitely need to learn how to be better communicators.

I tell all my patients to bring with them a list of all the medicines they take. I tell them to please write down questions prior to our visit. I give them paper to takes notes during our visit. I try and provide them with a list of websites I have visited that I think provides good quality info (see my blog for a list of these sites).

Here's the article:

"Doctors are often rushed, so patients must come to appointments prepared. Learn five steps to having a successful doctor appointment."


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Thursday, December 24, 2009

Strongest evidence yet that Lp(a) causes heart disease

Please do not forget that there is a overwhelming amount of data supporting lowering LDL as the most important marker for primary and secondary prevention of cardiac disease.

Research on sub-lipid particles, like LP(a), will be useful to measure to help reduce patients "residual risk", once LDL is < 70mg/dL.

"A novel genetic study provides the strongest evidence to date that Lp(a) is a causative factor for coronary disease; the results suggest that medications targeting Lp(a) could lower the risk of..."

For complete story visit theheart.org.

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Tuesday, December 22, 2009

How medication mistakes happen in the hospital

What a great idea -- give patients a list of their medications not only at discharge but everyday while in the hospital!

Originally published in MedPage Today

by Katrina Woznicki, MedPage Today Contributing Writer

Hospitalized patients were often clueless when asked about their medications, with almost all of them unable to name all their medications and many leaving out as many as a half-dozen drugs they have been prescribed, according to a small survey of patients in a Colorado hospital.

Ninety-six percent of the 50 patients surveyed left out at least one drug when they were asked to list their medications, and, on average, patients omitted 6.8 medications, Ethan Cumbler, MD, of the University of Denver, and colleagues reported in the Dec. 10 issue of Journal of Hospital Medicine.

Moreover, 44% of the patients thought they were taking a medication that had not been prescribed.

The researchers conducted the patient survey as part of a larger project examining a potential role for patients in reducing medication errors and improving patient safety.

"This study is a first for raising the questions How involved should patients be in their hospital medication safety?' and How do you involve them?'" Cumbler told MedPage Today.

"We don't live in a perfect healthcare system and errors do occur. If you have a patient who wants to be involved in their medication safety, you have to let him or her know what they're taking and to let them be an active participant."

Among scheduled medications, patients commonly omitted several important therapeutics, including antibiotics, cardiovascular drugs, and antithrombotics.

When asked about PRN medications, patients were most likely to omit analgesics and gastrointestinal medications.

"The patient, as the last link in the medication administration chain, represents the final individual capable of preventing an incorrect medication administration," Cumbler et al wrote in the journal article.

But if the survey reflects the average hospital patient, this is a weak link.

The majority of the participants, 81%, said seeing a hospital medication list would improve their satisfaction with the care they received; however, only 28% reported that they saw such a list.

A total of 50 participants answered questions about their outpatient and inpatient medications and described their attitudes about hospital medications and level of interest in patient involvement in hospital safety.

The findings, Cumbler added, only provide a snapshot of one small group of inpatients at one hospital.

The average age of participants was 54, 46% were men, and 74% were non-Hispanic white.

Patients were on an average of 5.3 outpatient prescription medications, 2.2 over-the-counter medications, and 0.2 herbal remedies.

Age did prove to be a factor in patients' ability to accurately identify their hospital medications. Patients age 65 and younger omitted 60% of their PRN medications, whereas patients 65 and older failed to report 88% (P=0.01).

Hospital organizational culture and the complexity of medicine itself pose challenges for inpatients to keep track of their medications, said Ruth S. Day, PhD, Director of the Medical Cognition Laboratory and Associate Professor of Psychology and Neuroscience at Duke University, who was not involved in the study.

"People have trouble perceiving, pronouncing, and remembering medication names even under the best of circumstances," Day said in an interview.

Protocols for outpatient medication monitoring have garnered a lot of attention, added Derung Mimi Tarn, MD, PhD, Assistant Professor of Family Medicine at the University of California at Los Angeles Medical Center, who was not a part of the study.

However, there has been very little focus on the inpatient setting, and it is not routine to give patients medication lists in the hospital. The issue, Tarn said in an interview, warrants further investigation.

Moreover, whether patients could even be effective at reducing hospital medication errors is uncertain.

Patients with dementia or delirium or those in the ICU may not prove helpful in ensuring hospital medication safety, said Tang. "However, there are definitely patients in the hospital who could serve as a valuable stopgap for example, obstetrics patients and parents of pediatric patients," she said. "The level of patient participation would need to be individually based."

Cumbler agreed that "one solution will not work for all," and that approaches to inform inpatients may have to be customized depending on factors such as condition and age.

The study, he added, was only designed to assess whether patients were informed about their hospital medications and whether they were interested and prepared to be more active participants in their care.

Visit MedPageToday.com for more hospital news.

Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.
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Letter to me From Senator Dodd

Dear Friend, Thank you for contacting my office. My staff and I are reviewing your e-mail and will get back to you shortly. In the meantime, please sign up for the Dodd Digest, my e-newsletter. I'll be e-mailing these updates to let you know about the work I'm doing on behalf of our state and our nation. Please go to my website, Dodd.Senate.Gov, to sign up. You'll be hearing from me soon. Chris- Please note, due to the high volume of mail I receive, I am only able to respond to residents of Connecticut.

Monday, December 21, 2009

Letter to me from Senator Lieberman

Dear Dr. Portnay:

Thank you for contacting me regarding your concerns about decreased Medicare payments to physicians and other providers of Medicare services. I, too, am very concerned about a viable long-term solution to the payment formula and have taken numerous actions in the Senate to achieve this. Fair payments to physicians and other health care providers are critical to preserving access for more than 44 million American senior citizens who depend on the Medicare program for their essential health services.

I understand and share your views that the rising costs attributable to physicians' services must be taken into consideration when determining Medicare reimbursement. As you know, Medicare law specifies a formula for calculating the annual update in payments for physicians' services. Many Members of Congress, myself included, continue to be concerned about the potential impact of payment reductions on patients' access to services. During my time in the Senate, I supported a number of efforts to examine Medicare updates for payments under the physician fee schedule, as well as legislation designed to undo any impending Medicare cuts to physicians, hospitals, nursing homes, home health care agencies, and other health care providers; and I will continue to do so.

While legislative interventions have prevented payment reductions from occurring in the past, Congress has not addressed the underlying issue of the payment formula accurately reflecting practice costs. Because of my continued concerns about ensuring sufficient payments to physicians, last Congress I sent letters to the Administrator of the Centers for Medicare and Medicaid Services in support of a viable solution to the Medicare physician reimbursement formula and asked congressional leadership to bring legislation to the floor to stop impending cuts and find a long-term solution to the issue. I understand these cuts in physician payments for Medicare services are unsustainable, especially given the rising costs of health care services; and I made my concerns known to those who serve on the Senate Finance Committee as they worked to craft physician payment legislation. In addition, I was supportive of legislative efforts to pass a two-year payment fix so that Congress would not have to repeat this process every year and physicians would have stability in payments beyond one calendar year.

Medicare payment policies and potential changes to these policies are of continuing interest to Congress. The Medicare program has been a major focus of deficit reduction legislation since 1980. With certain exceptions, reductions in program spending have been achieved largely through regulating payments to providers, primarily hospitals and physicians.

Although the task confronting Congress in rectifying the Medicare physician payment formula is formidable, it is one to which I remain committed to finding a more lasting solution. Any actions the Administration can take to more accurately account for the realities of spending on practitioner services under this formula, both as to actual spending and target spending, will help facilitate Congress' efforts and enhance access to the high-quality care that Medicare patients need and deserve.

Please be assured that I remain firmly committed to restoring adequate funding to Medicare physician and patient services during this 111th Congress and beyond. As we debate comprehensive health care reform policy, this issue is critical toward ensuring the ability of providers to deliver high-quality care and services and for Medicare beneficiaries to continue to access essential health care services.

Thank you again for sharing your views and concerns with me. I hope you will continue to visit my website at http://lieberman.senate.gov <http://lieberman.senate.gov/> for updated news about my work on behalf of Connecticut and the nation. Please contact me if you have any additional questions or comments about our work in Congress.


Joseph I. Lieberman
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The Lewin Report | Our Bill Was Introduced

This us huge. This bill will stop the proposed Medicare cuts to the
field of Cardiology and will insure patients continue to have the
access they deserve.

Please contact you Congressmen to ask them to support this very
important bill.


Friday, December 18, 2009

AHA: Focus on cardiovascular health, not disease

This is terrific news. As many of you know, I'm a huge believer that the key to our health is prevention of disease by promotion of healthy living, not the treatment of disease.

" AHA is, this year, trying to focus minds on cardiovascular health, rather than cardiovascular disease, as it unveils its latest statistics. Understanding the numbers that underlie cardiovascular...

For complete story visit theheart.org."


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Heart Disease and Stroke Statistics--2010 Update. A Report From the American Heart Association

I look forward to this report every year. I contastantly refer to itas I talk to colleagues and patients.

Here's some interesting data from this 2010 report:

- An estimated 81 100 000 American adults (more than 1 in 3) have 1 or more types of CVD.
- Of these, 38 100 000 are estimated to be > 60 years of age.

- The average annual rates of first cardiovascular (CVD) events rise from 3 per 1000 men at 35 to 44 years of age
to 74 per 1000 men at 85 to 94 years of age.
- For women, comparable rates occur 10 years later in life.

- Mortality data show that CVD as the underlying cause of death (including congenital cardiovascular defects) accounted for 34.3% (831 272) of all 2 426 264 deaths in 2006, or 1 of every 2.9 deaths in the United States.
- Nearly 2300 Americans die of CVD each day, an average of 1 death every 38 seconds. CVD claims more lives each year than cancer, CLRD, and accidents combined.
- A recent study of the decrease in US deaths due to CHD from 1980 to 2000 suggests that approximately 47% of the decrease was attributable to evidence-based medical therapies and 44% to changes in risk factors in the population due to lifestyle and environmental changes.

Out of Hospital Cardiac Arrest:
- The median survival rate to hospital discharge after EMS-treated out-of-hospital cardiac arrest with any first recorded rhythm is 7.9%



Wednesday, December 16, 2009

FDA advisory panel votes in favor of broadened rosuvastatin indication

The Food and Drug Administration (FDA) Endocrinologic and Metabolic Drugs Advisory Committee voted 12 to 4 today, with one abstention, in favor of broadening the indication for rosuvastatin (Crestor, AstraZeneca) to include patients with normal LDL-cholesterol levels but who are at low to moderate risk for cardiovascular disease based on other risk factors, most notably elevated levels of high-sensitivity C-reactive protein (hs-CRP).

Specifically, the advisory panel felt there was sufficient evidence of benefit to justify the risks of prescribing rosuvastatin in men >50 years old and women >60 years old who had fasting LDL-cholesterol levels <130 mg/dL, hs-CRP >2.0 mg/dL, triglycerides <500 mg/dL, and no prior


Stay slim, active, smoke-free: Live long and free of CVD

Everyone agrees: smoking, physical inactivity, and abdominal obesity increase the risks of coronary heart disease (CHD), but just how much are risks reduced in those who can claim "none of the above"?

Men with all three "low-risk factors" had a 59% lower risk of CHD events and a 77% lower risk of dying of cardiovascular disease than did men who smoked, were inactive, and had larger waist circumferences.


Monday, December 14, 2009

The Mediterranean Diet: Alcohol


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Stop Smoking, Or At Least Try

A new study reveals that quitting smoking after a heart attack significantly reduces the risk of death.  But even reducing the number of cigarettes smoked yields some benefit.


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Friday, December 11, 2009

The Best New Exercises

There's a popular saying among fitness experts: "The best exercise is the one you're not doing." The take-home message? To achieve the best results, you need to regularly challenge your body in new ways. So while classic movements like the pushup, lunge, and squat are the staples of any good workout plan, varying the way you perform these exercises every 4 weeks can help you avoid plateaus, beat boredom, and speed fat loss.


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LDL Rises Around Time of Menopause

Blood levels of LDL "bad" cholesterol increase dramatically in women around the time of menopause, and the rise is not related to aging, new research confirms.


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Extending Intensive LDL-Lowering Boosts Benefits

NEW YORK (MedPage Today) -- For those who might have lingering doubts, post-hoc analyses of two landmark statin trials -- PROVE-IT and IDEAL -- affirm the value of an intensive versus moderate approach to lipid-lowering, researchers here reported.


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Menopause Itself Appears to Increase CVD Risk Factors (CME/CE)

NEW YORK (MedPage Today) -- Women's cardiovascular risk increases through the menopausal transition, with contributions from both menopause itself and chronological aging, researchers found.


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Why You May Soon Hear a Lot More About CRP Testing

AstraZeneca wants to sell its cholesterol drug Crestor to certain people with normal cholesterol levels. A panel of FDA advisers is meeting next week to consider the proposition, and the agency just put out a hefty pre-meeting memo that summarizes the risks and benefits. (If you don't want to read the whole memo, Dow Jones Newswires story hits the high points.)

AstraZeneca's request is based on a big study called Jupiter, which found the drug reduced the risk of serious heart problems in patients with normal cholesterol but high levels of something called C-reactive protein, or CRP. The company wants FDA approval to use the drug to treat patients like those in the study.

But CRP has yet to join stalwarts like cholesterol and blood pressure as a common measure of cardiovascular risk. "I don't feel we currently evidence for the routine use of [CRP and other new biomarkers] in screening people for risk of heart disease," Thomas Wang, a Mass. General doc, told the Health Blog this summer.

Still, the CRP test might be useful in cases where docs are on the fence about a patient's risk. Indeed, some doctors may already be prescribing Crestor to borderline patients with high CRP levels. And if AstraZeneca gets the new indication it's seeking, don't be surprised if you see a big marketing push aimed at driving up the number of patients who get a CRP test.

Photo by CarbonNYC via Flickr


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Thursday, December 10, 2009

Patients Often Lack Knowledge of Their Own Medications

"Patients routinely under-report, or even over-report, their outpatient and inpatient medications, and
should be included in hospital medication management to improve safety, according to a study published online Dec. 10 in the Journal of Hospital Medicine."


I've been very frustrated with how we educate patients and document what medicine they were taking prior to admission to the hospital and what medications they should be taking on hospital discharge. To do this, many hospitals use a "Medicine Reconciliation Form." I have yet to see this "tool" implemented well at any hospital. One problem is, as mentioned above, patients often so not know what medicines they are taking. Another problem is that many different individuals can fill out this form, on admission or discharge. I can't begin to tell you how often I see a patient 1-2 weeks after discharge and they have NO idea what Rx they are taking (let alone why!).

All patients on my Post-PCI service have their "Med Rec Form" meticulously filled out by my physician extenders. I also have all my patients care around a "Medication Card" in their wallet or purse. On this card, we list all the patients Rx including name of drug, dose of pill, how many pills taken at one time, how many times a day the pill is taken. Unfortunately, as a "consultant", I have no control over medications prescribed by the patient's other MD's.

Until the medical profesion finds a way to solve this problem, there will still be thousands of patients injured every year from improper medication use.
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Wednesday, December 9, 2009

Can a typo be blamed?

I just finished reading a great piece on theheart.org regarding the " Mounting debate over aspirin use in primary prevention."

In this piece, there is an interview with ATT investigator Dr Colin Baigent (Oxford University, UK) who was a coauthor on both manuscripts regarding the use of aspirin for primary prevention.

Here's the most amazing part of that interview:

"Can a typo be blamed?

Baigent offers one possible explanation for why aspirin for primary prevention was so heartily embraced when the 2002 BMJ paper came out: a critical typo in the original paper. While the online HTML and PDF versions are now correct, in the original print edition of the BMJ paper, the final sentence reads: "For most healthy individuals, however, for whom the risk of a vascular event is likely to be substantially less than 1% a year, daily aspirin may well be appropriate." A correction swiftly issued by the BMJ noted that final word should, in fact, be inappropriate.

Baigent says he received "a profuse apology from the BMJ editor at the time." Still, it's possible the misprint helped disseminate a flawed message about aspirin in primary prevention. It was never the ATT investigators intention to emphasize that daily aspirin in low-risk patients was a good idea, he says."

NPR.org » Surgeon: Health Care Debate Can Learn From Farmers

I think Atul Gawande is amazingly bright and thought provoking.

Last week I finished listening to his book "Complications"

His writings on the health care debate have been seminal (and he has the ear of Obama)


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Tuesday, December 8, 2009

Well: Firm Body, No Workout Required?

Muscle-activating shoes claim to tone legs and buttocks while you walk. But do they bring results you can see?


Report: Cancer Deaths Declining Since 1990s

December 8, 2009

A report by the American Cancer Society says cancer deaths overall in the United States have been dropping since the 1990s. Researchers say that the decades-long effort to improve diets and reduce bad habits, like smoking, have begun to pay off.

Copyright © 2009 National Public Radio®. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.


New cancer cases and the death rate from the disease have both dropped significantly over the last five years. Researchers say one reason is that decades of pushing to improve diets and reduce bad habits has begun to pay off. NPR's Patti Neighmond reports on the findings published in the journal Cancer.

PATTI NEIGHMOND: In order to understand what the slow but steady decline in cancer death means, look at it this way, says oncologist Otis Brawley, chief medical officer for the American Cancer Society. Compare the risk in 2006 to 15 years earlier, in 1991.

Dr. OTIS BRAWLEY (American Cancer Society): All told, the population as a whole has a 16 percent lower risk of dying from cancer in 2006 versus 1991.

NEIGHMOND: Men are still more likely to get cancer, but they did see the greatest reduction in risk. 2006 is the most recent year data's available. These findings confirm earlier evidence that cancer rates are down. One huge reason: People are quitting smoking and fewer are starting.

Dr. BRAWLEY: The population went from about 50 percent of people smoking, or men smoking especially, in the 1960s, to now about 25 percent smoking. And that's driven down lung cancer.

NEIGHMOND: The biggest cancer killer. Lung cancer cases are down. So are cases of the second biggest cancer killer - colon cancer. Brawley says people are changing their diets to include more colon-friendly food like fruits, fiber and vegetables. People are exercising more, which also helps. But overwhelmingly, he says, the biggest change is in screening for the disease. Epidemiologist and study researcher Elizabeth Ward with the American Cancer Society says the most effective screening method is colonoscopy.

Dr. ELIZABETH WARD (American Cancer Society): Colonoscopies is in many ways the gold standard of colorectal screening tests, because it allows for examination of the entire colon. The physician can actually visualize polyps or early cancers and in some cases remove them during the exam itself.

NEIGHMOND: Ward says the cancer declines are remarkable but adds quickly it could be better. For example, with colon cancer only about half the people who should be screened are. Many of those who aren't screened are African-American and Hispanic.

Dr. WARD: Both African-American and Hispanic populations still have lower rates of private health insurance and either lack health insurance or are covered by some public programs that don't have access to the full range of colorectal cancer screening tests and may not even be able to readily see a physician when they note signs and symptoms of colorectal cancers such as blood in the stool.

NEIGHMOND: In the meantime, health experts like Brawley worry that the obesity epidemic could undo many of these recent cancer gains.

Dr. BRAWLEY: The increasing obesity epidemic in the United States could very well cause a tsunami of cancer in the next 20 to 30 years. Already we have increases in esophageal cancer, increases in pancreas cancer, that are all related to obesity.

NEIGHMOND: Obesity is also linked to breast, prostrate, uterine, colon, liver and kidney cancer.

Patti Neighmond, NPR News.

Major push under way across US to cut rehospitalizations

From ACC Newsletter:

The AP (12/8, Neergaard) reports that "a major push is under way around the country to cut rehospitalizations, in part by arming patients with simple steps to keep their recovery on track -- like getting past harried receptionists for quicker follow-up doctor visits, and reducing medication confusion." Dr. Harlan Krumholz, of Yale University, "helped the American College of Cardiology begin a 'Hospital to Home' program this fall, signing up hundreds of hospitals to share solutions with the goal of cutting heart patients' readmissions by 20 percent within three years." Dr. Krumholz said, "Somehow this idea of one in four people landing back in the hospital in a month is treated as business as usual, that it's part of being sick in America. It doesn't have to be that way."
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Monday, December 7, 2009

Knowing What’s Worth Paying for in Vitamins

From The New York Times:

Vitamin sales in the United States are expected to grow 8 percent this year to $9.2 billion, according to Nutrition Business Journal.


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Saturday, December 5, 2009

Unstable Angina

Unstable angina - angina that occurs at rest and apparently for no reason - is a strong warning that one of the coronary arteries has become critically unstable, and that without rapid treatment a full-blown heart attack may ensue. Read about what causes unstable angina, how to recognize it, and how to make sure you are getting the appropriate care, here.

Unstable Angina originally appeared on About.com Heart Disease on Friday, December 4th, 2009 at 07:16:51.


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From fat to gym rat, woman loses 200 pounds


These days, Becky Griggs starts her morning well before the sun comes up, in time to meet her clients at the gym at 5:30. It's a big change from six years ago, when she was 352 pounds and, as she calls it, engaged in a "slow form of suicide."


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Thursday, December 3, 2009

Chances Of Surviving A Cardiac Arrest At Home Or Work Unchanged In 30 Years

This is fascinating yet not surprising. Bystander CPR and automated defibrillators in homes and public places are the key to improving these stats.

Article to follow:

The chance of surviving an out-of-hospital cardiac arrest has not improved since the 1950s, according to a report by the University of Michigan Health System. The analysis shows only 7.6 percent of victims survive an out-of-hospital cardiac arrest, a number that has not changed significantly in almost 30 years...


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Hospitals providing faster care for heart attack patients

We are making great strides to treat heart attack patients as quickly as possible
In 2005, only about 50% of patients arriving at the hospital with an acute heart attack had their artery opened by angioplasty in less than 90 minutes.
In 2006, the ACC founded the Door-2-Balloon Alliance. This natioanl D2B alliance specific aim was to help improve hospitals performance. I'm proud to have been a part of this seminal work, under the leadership of Dr Harlan Krumholz at Yale. The alliance provided hospitals with tools and suggestions to improve its performance.
In a recent article in JACC, researchers found that "by spring of 2008, 76 percent of patients" received treatment within the recommended time.
Meanwhile, "more recent data shows continued improvement. Nearly 82 percent of eligible patients had a 90-minute or less door-to-balloon time in those hospitals by last summer."
This is amazing and should begin to lower MI mortality even lower.

Wednesday, December 2, 2009

Fwd: 10 surprising facts about cholesterol

Great article I found on cnn.com:

Elevated blood cholesterol is bad news. Thirty-four million Americans
have levels that can increase their risk of all sorts of health
problems. But if you think you've heard everything you need to know
about this waxy fat, there may be a few surprises in store.


LDL cholesterol

Here is some information about LDL cholesterol:

• If too much is circulating in the blood, it can begin to build up on
the walls of blood vessels

• Buildup of cholesterol contributes to the development of plaque in
the blood vessels

• Plaque makes blood vessels narrower and less flexible and increase
the risk for heart attack and stroke

Foods high in omega-3's

Foods found with Omega-3's (other than fish) include olive oil, canola
oil, fish oils, flaxseeds, avocados, and walnuts. Depending on your
eating habits, you may or may not need a Omega-3 supplement.