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Friday, November 29, 2013

The Power of a Daily Bout of Exercise


A new study suggests a moderate daily exercise session can blunt the harmful effects of overeating and being inactive, which too many of us will be doing as the holidays approach.

Wednesday, November 27, 2013

Heart Attack Pain Similar for Men and Women

A new study found that too much has been made of gender differences in chest pain, the hallmark symptom of heart disease.


Great quick update from the American Heart Association

Scientific Sessions is the American Heart Association's largest annual gathering of scientists and healthcare professionals devoted to the science of cardiovascular diseases and stroke, and the care of patients suffering from these diseases. Many ground breaking discoveries are presented by the top leaders in their field and we, as promoters of public health education , would like to share a few of these discoveries with you.

Coffee may help perk up your blood vessels.The caffeine in a cup of coffee might help your small blood vessels work better, according to research presented at the American Heart Association's Scientific Sessions 2013. The study takes us one step closer to understanding how coffee might benefit cardiovascular health.

How long should you perform CPR? Researchers found more than half of the men studied had symptoms up to a month before cardiac arrest. The good news is that thirty-eight minutes or longer of CPR can improve the chance of a person surviving cardiac arrest and having normal brain function.

As if they'd never smoked! Certain smokers who quit can reduce their risk of heart disease to the level of never-smokers sooner than previously thought, according to a new study. Smoking is the most preventable cause of death in America. Quitters win!

Wednesday, November 20, 2013

New treatment guidelines for lipid treatment for cardiovascular disease

Here are the four major primary and secondary prevention patient groups which the guidelines advocate who should be treated with statins to reduce the risk of atherosclerotic cardiovascular disease (ASCVD)
  • Individuals with clinical ASCVD
  • Individuals with LDL-cholesterol of levels > 190mg/dL, such as those with familial hypercholesterolemia
  • Individuals with diabetes aged 40-75 years old with LDL-cholesterol levels between 70-189 mg/dL and without evidence of ASCVD
  • Individuals without evidence of ASCVD or DM but who have a LDL-cholesterol levels between 70-189 mg/dL and a 10-year risk of ASCVD > 7.5%
The evidence supporting the first three groups of patients is significant and noncontroversial. 

There is significant controversy regarding the fourth group. Some are writing that this recommendation is too narrow. Others are writing that this recommendation is too broad. Many have issues with the risk calculator which is used to calculate the 10-year risk. The guidelines do advocate using novel strategies for further helping to define risk (hsCRP, calcium score by CT scan, carotid intimal thickness by ultrasound) - which I have been using for a few now. I also believe that in treating younger patients, its vital not to just look at their 10-year risk but their lifetime risk of ASCVD.

Always remember, that these are just recommendations and not law and that it is always imperative to discuss the risk assessment and medical therapy with your physician.

Thursday, November 14, 2013

New guidelines published

This past week, The American Heart Association and the American Cardiology Association Task Force on Guidelines published 4 very important reports. These included new guidelines for lipid treatment, new guidelines for CV risk assessment, new guidelines for lifestyle recommendations to reduce CV risk and new guidelines on obesity management. I will be writing much more in separate blog posting regarding lipid treatment and CV risk assessment.

I wanted to comment here on continued the emphasis placed on adherence to a Mediterranean style diet in the new guidelines. Those of you who know me and/or have read my blog know that I am a very strong believer in the benefits of the Mediterranean diet on heart health.

Apr 30, 2013
More good news about the Mediterranean Diet -- Researchers from Greece have reported in the journal Neurology that adherence to a Mediterranean Diet can significantly improve memory functioning. You will recall that the ...
Feb 25, 2013
A very important study was published this week in the New England Journal of Medicine. In one of the largest trials to date, the Mediterranean-Style Diet (either supplemented with extra-virgin olive oil/EVOO or handfuls of ...
Feb 25, 2013
Mediterranean Style Diet. Want to read more about the landmark trial showing the benefits of the Mediterranean-Style Diet, check out these articles: http://nej.md/VypTpf · http://onforb.es/15JjoEa · http://nyti.ms/ZDLAIj.
Dec 14, 2009
... Mediterranean Diet: Alcohol. http://blog.drgourmet.com/the-mediterranean-diet-alcohol/. Sent from my Verizon Wireless BlackBerry. Posted by Dr Portnay at 12:19 PM · Email ThisBlogThis!Share to TwitterShare to Facebook ...
Aug 02, 2009
I continue to be amazed with twitter and its ability to connect peopel of like interests. Recently, I have met Ray Darken and his http://the-mediterranean-diet.com/ website. I love this site and his frequent tweets (@HealthyDietz).
Feb 18, 2010
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 ...
Jun 01, 2011
Beyond just nutritional health, the Mediterranean Diet promotes a way of living that includes the following components, which could explain the positive health benefits. Intense physical activity that includes work and all its ...
Although there is a huge upside to the Mediterranean diet, it does not specifically address issues of caloric restriction and weight loss. For this, I tell my patients to focus on whole foods and avoid processed starches. "Eat more like a caveman" I often tell my patients. I also advise patients that need weight loss to simply cut in half what they currently eat in bread, sweets, potatoes, pasta, and rice. I remind patients that patients who are more than 30lbs overweight that they are 300x more likely die from cardiac disease.
I hope this helps

Monday, November 11, 2013

Testosterone and CV Disease

A study published in the Journal of American Medical Association last week raises initial red flags for the use of testosterone and the risk of increased cardiovascular events.

In this study, investigators were studying patient with "Low-T Syndrome" or low testosterone levels as measured in the blood. These patients studied were at increased risk for cardiac events with 20% having a prior history of MI, 50% having diabetes, and more than 80% having coronary artery disease.

The investigators found that patients taking testosterone had a 30% higher risk of heart attack, stroke and death compared with the Low-T patients not taking testosterone.

This report does not show a "causal" relationship but this "association" does raise red flags. At the very least, patients currently taking or considering starting testosterone therapy should be discussing this report with their physician.

Hunt is on for the last surviving trans fats

Last week, the FDA announced that it will be moving to ban trans fats from our foods permanently. Consumption of these partially hydrogenated oils have been specifically linked to increasing the risk of cardiovascular disease. "The FDA says cutting trans fats could prevent as many as 20,000 heart attacks a year".

Follow this link for a great article from Marketplace that discusses the announcement

Monday, November 4, 2013

A letter from a patient

Here's a terrific note I just received from a patient. Helping people like this feel better is why became a Cardiologist. 

Doctor Portnay,
I just thought I'd drop you an email.  I just want to let you know that
I am feeling great, and I mean great. Somehow that little tweeking
and you telling me to increase my dosage of lasix seemed to do the
trick. The my tireness, and feeling sluggish went away.
I am in Boston and realized that I am back to being myself. I am
walking everywhere with a spring in my step.
So, I want to thank you for saving my life.  I didn't realize how sick
I was. I just plugged along going to work and my slowing down was
hardly noticeable to me.  I thought it was just some thing that happen
in the aging process. I was going down hill fast.  My decline was like some-thing one of my science teachers mentioned to me a million years ago.
Put a frog in cold water and while the heat is turned on, he will sit in the
water it he boils to death.
I was like that frog, I didn't know how sick I was or that my heart was
failing. My sister Chris, working for Cardiology saw something was
wrong with me, and I should be check you by, you specificially.

With your testing and quick action, the pacemaker was installed,
beautifully by Doctor Pittaro.  I was quickly able to get back to
work. It took a while before I noticed that my health generally was
improving. With your positive attitude, and wise counsel I was feeling
better and better.  I'm not sure but I think about a year later, you suggested getting into the Weight Mate program. I lost 40 pounds, changed my whole attitude about food and feel 20 years younger.
Another lucky break for me occurred when I turned 66 and retired.
I suddenly found myself free from the stress of work. I could now focus
on my health issues.  I feel now my future is looking brighter and brighter.
Thanks again,   see you in the spring for the next appointment.