Happiness may be linked to reduced risk of heart disease

From the ACC Newsletter:

Bloomberg News (2/18, Cortez) reports that "people who are naturally happy appear to have a lower risk of developing heart disease or dying from heart attacks, according to" a study published in the European Heart Journal.

        The Washington Post (2/17, Huget) "The Checkup" blog reported that investigators "analyzed 10 years of data about 1,739 healthy adults who participated in the 1995 Nova Scotia Health Survey."

        The AP (2/18, Cheng) reports that the researchers "used a five-point scale to measure people's happiness." The investigators found that "for every point on the happiness scale, people were 22 percent less likely to have a heart problem." The research "was paid for by the US National Institutes of Health and others." The UK's Daily Mail (2/18, Hope), the UK's Press Association (2/18), Reuters (2/18, Kelland), MedPage Today (2/17, Neale), and HealthDay (2/17, Reinberg) also covered the story.
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Pediatricians Should Encourage Healthy Media Habits for Children and Adolescents

Here's a great article for parents of young children. We all need to
strive to encourage "healthy media" habits.

Pediatricians Should Encourage Healthy Media Habits for Children and
Adolescents

http://www.hcplive.com/pediatrics/articles/healthy_media_habits_in_kids

Program Helps Low-Income Smokers Kick Habit

http://www.npr.org/templates/story/story.php?storyId=123652184&sc=17&f=1128

Program Helps Low-Income Smokers Kick Habit
by Richard Knox

NPR - February 15, 2010

The overall U.S. smoking rate is half what it was in the 1960s. But this isn't true among low-income Americans: They're still smoking as much as everyone was a generation ago.

Massachusetts health officials say it doesn't have to be this way. They say they've found a way to get even the most hard-core smokers to quit.

The program is designed to help people like Sondra Pasquine. Pasquine, 24, works as a nursing home aide, and she wants to stop smoking. Through the Massachusetts program, she has a smoking cessation counselor, nurse Allison Diamond of the Dorchester House health center.

At a recent counseling session, Diamond pushed Pasquine to articulate what she doesn't like about smoking.

"What don't I like about it? The smell. It gets in your clothes, your hair," Pasquine replies. "And I just don't want cancer." Pasquine has seen family members suffer from smoking-related cancer.

Learning To Quit

During their 20-minute session, Diamond gives Pasquine some tips on how to be more conscious about what drives her to light up. She suggests jotting down the reason every time, and gives her a "pack wrap" diary that fits like a sleeve around her cigarette pack.

Diamond also writes a prescription for Chantix, a drug that blunts nicotine pleasure.

There's nothing revolutionary about the method. But preliminary data from the Massachusetts Department of Public Health indicate that getting low-income people like Pasquine to quit may just be a matter of giving them access to the same smoking cessation aids that richer and better-educated people have — nicotine patches, drugs and counseling.

That access — plus a big media campaign targeted at people enrolled in MassHealth, the Bay State's Medicaid program — appears to have brought impressive gains.

More than 75,000 MassHealth members have taken advantage of state-funded quit-smoking programs. Nearly half, the state says, have successfully quit.

Before the big push, about 40 percent of adults on Medicaid were smoking, a rate that hadn't declined in many years. But between 2006 and 2008, state figures show, their smoking prevalence dropped by 26 percent. By comparison, smoking among people without insurance coverage, a group largely on the lower end of the income scale, was unchanged.

Reaping The Benefits

And state officials say they're seeing major improvements in health — sooner than they expected. Within a year of entering smoking cessation programs, Medicaid recipients were hospitalized for heart attacks 38 percent less often than the previous year. Emergency room visits for asthma went down 17 percent. Pregnancy complications also went down, officials say.

"I think it's made a huge difference," says Dr. Nancy Rigotti, who heads tobacco research and treatment at Massachusetts General Hospital. She credits the generous Medicaid benefits with giving many low-income people the type of chance to quit they never had before.

Rigotti notes that federal regulations require that nicotine patches be sold in packages that contain a week's supply. That was intended to avoid dependence on the patches.

"So if you don't have a lot of money and you're hooked on nicotine, you may be able to scrabble together enough money to pay for a pack of cigarettes, but you probably can't buy a week's worth of nicotine patches," Rigotti says.

The Power Of Social Pressure

The Massachusetts program, launched as part of the state's landmark 2006 law that has gradually extended health insurance to almost all residents, has its skeptics.

Michael Siegel of the Boston University School of Public Health doesn't doubt that there's been a substantial drop in smoking prevalence among the Medicaid population. He's less convinced about the data on fewer asthma admissions and heart attacks, because there was no control population.

And Siegel, like others, doubts that providing low-cost smoking cessation pills and patches has made the difference. He thinks the media blitz should get most of the credit.

"My opinion is that what we're likely seeing here is that 80 percent of smokers want to quit anyway, and this publicity campaign got these smokers to pull the trigger," Siegel says. "I don't think it's necessarily [that] the medication itself had the effect, because quit rates are dismal from medication."

Others say it's possible that medication and counseling may give a needed extra boost to low-income smokers, who live in an environment where far more family members and friends smoke.

"It's especially hard when you have friends that smoke," says Pasquine. "You know, you see all your friends whip out cigarettes. It's like you're the only that don't do it."

'Ripple Effects'

There's no doubt that social factors exert a powerful force on pushing people to start smoking in the first place. And Nicholas Christakis of Harvard University says there's good evidence that social factors can work in the opposite direction — to encourage quitting.

"When you get one person to quit smoking, you get all these ripple effects," Christakis says. "When you get one person to quit, you get as many as three other people to quit throughout that person's network. So your intervention is four times as cost-effective as you thought it would be."

At some point, he says, the phenomenon can reach a tipping point. As the culture of smoking changes in a population, there are fewer smokers, and that makes it easier for the remaining ones to quit.

But of course, it's fundamentally a one-person-at-a-time deal. That's why, back at Dorchester House, Allison Diamond wants Sondra Pasquine to do one more thing before she leaves — blow into a carbon monoxide detector.

Diamond explains that carbon monoxide is in auto exhaust and cigarette smoke. "So the same thing that comes out of the exhaust pipe is in cigarettes, and you're breathing that in."

The detector shows Pasquine's carbon monoxide level is in the red "danger zone" from the cigarette she smoked that morning. She looks disgusted.

"I'm determined to quit now," she says.

Diamond guesses that Pasquine has a 50-50 chance of quitting in the next year. She'll probably need several more Medicaid-financed attempts.

But Diamond says the more times people try to quit, the better chance they have. Because each time, they gain more insight into why they're smoking. Copyright 2010 National Public Radio

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NYTimes: Hazards: Are Pipe and Cigar Users Blowing Smoke?

From The New York Times:

VITAL SIGNS: Hazards: Are Pipe and Cigar Users Blowing Smoke?

They may say they don't inhale, but such smokers were found to have
more than double the risk for abnormal lung function.

http://s.nyt.com/u/BhW

Good news for all Cardiologists

Sept 2009, I wrote a blog post describing the nationwide shortage of the nuclear isotope used in medical imaging.

Yesterday, the NY Times reported on the discovery of a new source of Technicium-99 from a nuclear reactor in Poland.

Read on for the good news -- New Source of an Isotope in Medicine Is Found

Herbal Products to Avoid in Patients With Cardiovascular Diseases

Herbal Products to Avoid in Patients With Cardiovascular Diseases^_*

Herb Purported Use Cardiac Adverse Effect of Interaction Alfalfa Arthritis, asthma, dyspepsia, hyperlipidemia, diabetes Increases bleeding risk with warfarin Aloe vera Wounds (topical), diabetes (oral) Hypokalemia causing digitalis toxicity and arrhythmia Angelica (dong quai) Appetite loss, dyspepsia, infection Increases bleeding risk with warfarin Bilberry Circulatory disorders, local inflammation, skin conditions, diarrhea, arthritis Increases bleeding risk with warfarin Butcher's broom Circulatory disorders, inflammation, leg cramps Decreases effects of alpha-blockers Capsicum Shingles, trigeminal and diabetic neuralgia Increases blood pressure (with MAOI) Fenugreek High cholesterol Increases bleeding risk with warfarin, hypoglycemia Fumitory Infection, edema, hypertension, constipation Increases effects of beta-blockers, calcium-channel blockers, cardiac glycosides Garlic High cholesterol, hypertension, heart disease Increases bleeding risk with warfarin Ginger High cholesterol, motion sickness, indigestion, antioxidant Increases bleeding risk with warfarin Ginkgo Poor circulation, cognitive disorder Increases bleeding risk with warfarin, aspirin, or COX-2 inhibitors Potential risk of seizures Ginseng Aging, diminished immunity, improves mental and physical capacity and stress tolerance Increases blood pressure Decreases effects of warfarin Hypoglycemia Gossypol Male contraceptive Increases effects of diuretics Hypokalemia Grapefruit juice Weight loss, to promote cardiovascular health Increases effects of statins, calcium-channel blockers, or cyclosporines Green tea Improve cognitive performance, mental alertness, weight loss, diuretic Decreases effects of warfarin (contains vitamin K) Hawthorn CHF, hypertension Potentiates action of cardiac glycosides and nitrates Irish moss Ulcers, gastritis Increases effects of antihypertensives Kelp Cancer, obesity Increases effects of antihypertensive and anticoagulant agents Khella Muscle spasms Increases effects of anticoagulant agents and calcium-channel blockers Licorice Ulcer, cirrhosis, cough, sore throat, infections Increases blood pressure Hypokalemia May potentiate digoxin toxicity Lily of the valley CHF Increases effects of beta-blockers, calcium-channel blockers, digitalis, quinidine, steroids Ma-huang (ephedra) Obesity, cough Increases heart rate and blood pressure Night-blooming cereus CHF Increases effects of angiotensin-converting enzyme inhibitors, antiarrhythmics, beta-blockers, calcium-channel blockers, cardiac glycosides Oleander Muscle cramps, asthma, cancer, CHF, hepatitis, psoriasis, arthritis Heart block Hyperkalemia Arrhythmia Death St. John's wort Depression Increases heart rate and blood pressure (with MAOI) Decreases digoxin concentration Storphanthus CHF Increases effects of cardiac glycosides Yohimbine Impotence Increases heart rate Increases or decreases blood pressure * Only major indications, adverse effects, and interactions are listed; thus, the list is not all inclusive.

CHF = congestive heart failure; COX = cyclooxygenase; MAOI = monoamine oxidase inhibitor.

JACC online

More Good News on the Safety on Statins

As reported on Medscape:

Muscle and liver adverse effects of simvastatin 40 mg daily were evaluated in a randomized placebo-controlled trial involving 20,536 UK patients with vascular disease or diabetes (in which a substantial reduction of cardiovascular mortality and morbidity has previously been demonstrated).

The excess incidence of myopathy in the simvastatin group was < 0.1% over the 5 years of the trial, and there were no significant differences between the treatment groups in the incidence of serious hepatobiliary disease.

This led the authors to conclude:

1. Among the many different types of high-risk patient studied (including women, older individuals and those with low cholesterol levels), there was a very low incidence (< 0.1%) of myopathy during 5 years treatment with simvastatin 40 mg daily. 
2. The risk of hepatitis, if any, was undetectable even in this very large long-term trial. 
3. Routine monitoring of liver function tests during treatment with simvastatin 40 mg is not useful.