Tag Archives: heart attack prevention

Some NSAIDs potentially dangerous for heart attack survivors

When heart attack survivors or those with heart disease take certain pain relievers it puts them at higher risk for heart attack or death according to a new study in Circulation, a journal of the American Heart Association. Continue reading

Cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs)

I’m surprised how many of my patients are NOT aware of the potential cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) or naproxen (Aleve). If you’re in their camp, don’t miss this report: Continue reading

The Formula for Good Health = 0, 5, 10, 30, 150

An easy-to-remember formula for good health (0, 5, 10, 30, 150) is proposed in a wonderful editorial in American Family Physician titled “Preventive Health: Time for Change.” The author suggests this formula to physicians to “help patients achieve healthy lifestyle goals”:

  • 0 = no cigarettes or tobacco products
  • 5 = five servings of fruits and vegetables per day
  • 10 = ten minutes of silence, relaxation, prayer, or meditation per day
  • 30 = keep your BMI (body mass index) below 30
  • 150 = number of minutes of exercise per week (e.g., brisk walking or equivalent)

The editorial is penned y Colin Kopes-Kerr, MD, from the Santa Rosa Family Medicine Residency in Santa Rosa, California:

It is time to make a decision. Which will be our health promotion strategy—primary prevention or secondary prevention?

Traditionally, the only one available to us was secondary prevention. Medicine consisted of a one-on-one physician-patient relationship, and taking care of patients meant minimizing the impact of any diseases the patient had. We did not have the time or tools to do anything else. More recently, we have been able to reduce a patient’s mortality by 20 to 30 percent by treating heart disease with a statin or beta blocker. These two medications have had the most dramatic effects in secondary prevention.

But now, the way we practice medicine has changed. We have a real choice to make. According to recent literature, primary prevention appears to work better than any other strategy in medicine. So why do some physicians not implement primary prevention? Despite the literature, maybe physicians are not getting the news. We need to keep repeating the message to physicians and patients that primary prevention is simple and effective. Next, we need to take a look at our own behavior as physicians and determine if it makes sense in the context of primary prevention.

There are 10 major studies on the effects of primary prevention.(1–15) These studies demonstrate very large correlations between specific healthy lifestyle behaviors and decreases in major chronic diseases (e.g., diabetes mellitus, heart disease, stroke, cancer) and all-cause mortality.

Although these studies offer a complex array of data to sift through, the elements of a healthy lifestyle are clear: not smoking, regular exercise, healthy diet, healthy body weight, and reduced stress.

Although exercise guidelines vary, I ascribe to the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans, which recommends at least 150 minutes of brisk walking or the equivalent per week.(16) For the diet criterion, the Atherosclerosis Risk in Communities study illustrates that merely consuming five servings of fruits and vegetables per day is associated with the same benefits as consumption of a Mediterranean-style diet.(11) A standard of five servings of fruits and vegetables is much easier to remember and adhere to.

There is strong support for at least one weight-related variable in a healthy lifestyle. This may include body weight, body mass index (BMI), waist circumference, or waist:hip ratio. The INTERHEART study showed waist:hip ratio to be the most predictive of cardiovascular disease.(6) However, unlike BMI calculation, measurement of weight:hip ratio has not yet become standard in U.S. practices. I use BMI as the metric, and a value less than 30 kg per m2 as the cutoff between a healthy and unhealthy lifestyle. The goal is to move away from this outer limit toward a more ideal parameter, such as less than 25 kg per m2.

The final variable of a healthy lifestyle, which has strong support from the INTERHEART study, is stress reduction.(7) The INTERHEART study offers useful suggestions for measuring stress—perception of severe stress at home or at work, financial stress, or major life events.(7)

The minimal lifestyle intervention that would be beneficial is not defined. However, 15 to 20 minutes of silence, relaxation, or meditation appears to be a common interval.(17) To be more inclusive of patients, I set the criterion to an even less restrictive amount, about 10 minutes per day.(17) This is enough time to produce a change in biorhythms and is achievable for most patients.

Information alone does not lead to behavior change, however. Motivational interviewing or brief negotiation is a new framework that can close the gap between knowledge of available lifestyle interventions and changing behaviors. The framework has already been proven markedly effective for tobacco, drug, and alcohol addiction.(18) Few physicians have received the training necessary to implement motivational interviewing or brief negotiation. Resources for learning about these skills include the Kaiser Permanente Medical Group Web site and the book Motivational Interviewing in Health Care: Helping Patients Change Behavior.(18)

In terms of health, we can have it all. We have the requisite tools to convert knowledge into healthy behaviors. This newfound power to reduce diabetes, heart disease, stroke, cancer, and all-cause mortality with primary prevention strategies should impel us to change how we counsel patients. Research is needed to explore why some physicians are not making this change.

Address correspondence to Colin Kopes-Kerr, MD, at cpkerr@nni.com. Reprints are not available from the author.

Author disclosure: Nothing to disclose.

REFERENCES

  1. Stampfer  MJ, Hu  FB, Manson  JE, et al.  Primary prevention of coronary heart disease in women through diet and lifestyle.  N Engl J Med.  2000;343(1):16–22. View here
  2. Hu  FB, Manson  JE, Stampfer  MJ, et al.  Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.  N Engl J Med.  2001;345(11):790–797. View here
  3. Forman  JP, Stampfer  MJ, Curhan  GC.  Diet and lifestyle risk factors associated with incident hypertension in women.  JAMA.  2009;302(4):401–411. View here
  4. Knowler  WC, Barrett-Connor  E, Fowler  SE, et al.; Diabetes Prevention Program Research Group.  Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.  N Engl J Med.  2002;346(6):393–403. View here
  5. Knoops  KT, de Groot  LC, Kromhout  D, et al.  Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project.  JAMA.  2004;292(12):1433–1439. View here
  6. Yusuf  S, Hawken  S, Ounpuu  S, et al.; INTERHEART Study Investigators.  Effect of potentially modifiable risk factors associated with myocardial infraction in 52 countries (the INTERHEART study): case-control study.  Lancet.  2004;364(9438):937–952. View here
  7. Rosengren  A, Hawken  S, Ounpuu  S, et al.; INTERHEART Investigators.  Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study.  Lancet.  2004;364(9438):953–962. View here
  8. Chiuve  SE, McCullough  ML, Sacks  FM, et al.  Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications.  Circulation.  2006;114(2):160–167. View here
  9. Chiuve  SE, Rexrode  KM, Spiegelman  D, et al.  Primary prevention of stroke by healthy lifestyle.  Circulation.  2008;118(9):947–954. View here
  10. Kurth  T, Moore  SC, Gaziano  JM, et al.  Healthy lifestyle and the risk of stroke in women.  Arch Intern Med.  2006;166(13):1403–1409. View here
  11. King  DE, Mainous  AG  III, Geesey  ME.  Turning back the clock: adopting a healthy lifestyle in middle age.  Am J Med.  2007;120(7):598–603. View here
  12. Khaw  KT, Wareham  N, Bingham  S, et al.  Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study [published correction appears in PLoS Med. 2008;5(3):e70].  PLoS Med.  2008;5(1):e12. View here
  13. Ford  ES, Bergmann  MM, Kröger  J, et al.  Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and nutrition–Potsdam study.  Arch Intern Med.  2009;169(15):1355–1362. View here
  14. Lee  CD, Sui  X, Blair  SN.  Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men.  Arch Intern Med.  2009;169(22):2096–2101. View here
  15. Djoussé  L, Driver  JA, Gaziano  JM.  Relation between modifiable lifestyle factors and lifetime risk of heart failure.  JAMA.  2009;302(4):394–400. View here
  16. U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. View here.
  17. Dialogue Partner. View here
  18. Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: Guilford Press; 2008. View here

Can Calcium Supplements Cause Heart Attacks?

Calcium supplements are coming under scrutiny due to concerns that they might increase heart attacks. A new study shows that patients over 40 who take 500 mg/day or more of calcium have an increased risk of heart attack.

And, the theory is plausible as too much calcium might lead to vascular calcification and atherosclerosis.

But it is WAY, WAY, WAY  too soon to jump to any conclusions for at least a couple of reasons:

  • The analysis only looked at people taking calcium supplements alone.
  • It doesn’t address the role of dietary calcium or taking vitamin D along with calcium. Especially since some research suggests that taking calcium plus vitamin D does not significantly affect coronary artery calcification.

The Doctors of Pharmacology at the Natural Medicines Comprehensive Database tell prescribers this:

Continue to advise people to use calcium supplements if needed, but not to exceed recommended amounts.

Advise patients to consider their TOTAL calcium intake from supplements PLUS foods. Recommend aiming for calcium 1000 mg/day for adults under 50 and 1200 mg/day for adults over 50. Many people get about half this amount in their diet.

To this I add, if you’re going to take a calcium supplement (and, I do), then be sure to take it with vitamin D (and consider having your doctor test your vitamin D level).

To figure out dietary calcium intake, I have my patients count 300 mg/day from NON-dairy foods plus 300 mg/cup of milk, fortified orange juice, etc.

I also recommend vitamin D (based upon the new guidelines from Osteoporosis Canada) 1000 IU/day for adults under age of 50 and up to 2000 IU/day for adults over 50, to maintain adequate levels and help prevent fractures. I recommend using vitamin D3 (cholecalciferol) because it’s more active, but vitamin D2 (ergocalciferol) is also fine for increasing vitamin D levels. And, I do not recommend sunlight exposure for increasing vitamin D levels. You can read my reasons here.

Keep in mind, as I’ve told you before, the Institute of Medicine will come out with new calcium and vitamin D recommendations later this fall.

Is milk from grass-fed cows more heart-healthy?

Reuters Health has a report I thought you might find interesting. It’s based upon a new study answering the question, “If milk does the heart good, does it do the heart better if it comes from dairy cows grazed on grass instead of on feedlots?” The bottom line? Cow’s milk from cows grazed on grass may actually be heart healthy.

Earlier experiments have shown that cows on a diet of fresh grass produce milk with five times as much of an unsaturated fat called conjugated linoleic acid (CLA) than do cows fed processed grains. Studies in animals have suggested that CLAs can protect the heart, and help in weight loss.

Hannia Campos of the Harvard School of Public Health in Boston and her colleagues found, in a study of 4,000 people, that people with the highest concentrations of CLAs — the top fifth among all participants — had a 36 percent lower risk of heart attack compared to those with the lowest concentrations.

Those findings held true even once the researchers took into account heart disease risk factors such as high blood pressure and smoking.

The new findings suggest that CLA offers heart-healthy benefits that could more than offset the harms of saturated fat in milk, Campos said.

“Because pasture grazing leads to higher CLA in milk, and it is the natural feed for cattle, it seems like more emphasis should be given to this type of feeding,” she told Reuters Health by email.

Dairy products in the U.S. come almost exclusively from feedlots, she added. And cow’s milk is the primary source of CLA. (Beef contains a small amount.)

Campos and her colleagues looked to Costa Rica for their study, where pasture grazing of dairy cows is still the norm. They identified nearly 2,000 Costa Ricans who had suffered a non-fatal heart attack, and another 2,000 who had not. Then they measured the amount of CLA in fat tissues to estimate each person’s intake.

Since CLA typically travels with a host of other fats, the researchers went a step further to tease apart its effects from those of its predominantly unhealthful companions, they report in the American Journal of Clinical Nutrition. The difference in risk attributed to CLA subsequently rose to 49 percent.

“Whole-fat milk and dairy products have gotten such a bad reputation in recent years due to their saturated fat and cholesterol contents, and now we find that CLA may be incredibly health-promoting,” Michelle McGuire, spokesperson for the journal’s publisher, the American Society for Nutrition, and associate professor at Washington State University, told Reuters Health in an email. “Whole milk is not the villain!”

Each year, approximately 1.5 million Americans will suffer a heart attack. A third will not survive.

The evidence may now be piling up: another paper out of Sweden in the same issue of the journal as the Costa Rican study also hints at heart attack protection through milk fat.

Further, the benefits of CLA may extend beyond the heart to the prevention of cancer and diabetes, suggests McGuire, pointing to results of other animal studies.

“Milk is actually the only food ever ‘designed by nature’ to be fed to mammals,” she added. “We need to look to milk as the perfect food and learn everything we can from it.”

TV Viewing Linked To Increased Heart Risk Factors In Young Adults

TV watching in early adulthood is linked to increase in risk factors for heart disease, researchers have just announced. They studied more than 5,600 men and women who were asked about their viewing habits at age 23 and then again at age 44.

Their findings were that that people who watched more television were more likely to have metabolic problems such as higher blood pressure and a higher body mass index, as well as more inflammation in their systems.

The study was presented at the Nutrition, Physical Activity and Metabolism & Cardiovascular Disease Epidemiology and Prevention joint conference in San Francisco. If these findings find their way into the peer-reviewed medical literature, they will be another wake up call on the dangers of a sedentary life.

Could increasing your happiness reduce your risk of heart disease?

In a large, population-based study out of Europe, researchers found that an increased positive affect (happiness) was protective against a 10-year incidence of coronary heart disease. The researchers are suggesting that preventive strategies may be enhanced not only by reducing sadness and depressive symptoms, but also by increasing positive affect and happiness.

Bloomberg News reports that “people who are naturally happy appear to have a lower risk of developing heart disease or dying from heart attacks, according to” the study published in the European Heart Journal.

The Washington Post “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 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.”

You can also learn more about the health dangers of sadness and depression, and get tons of tips on eliminating them in my book 10 Essentials of Happy, Healthy People: Becoming and staying highly healthy. You can see the Table of Contents here, and read the first chapter here.

if you’d like to have a free measure of your health, including your physical, emotional, relational, and spiritual health, I’ve designed some assessment tools you can utilize at no cost:

Acai Berry Supplements. Super fruit or super rip off?

A reader wrote, “I would like to see Dr. Walt do a blog topic on the claimed health benefits, to include weight loss, from taking Acai Berry supplements. There seems to be a lot of controversy and confusion about the Acai berry and it would be helpful to get Dr. Walt’s unbiased opinion.” Here it is: Continue reading

Daily Glass of Orange Juice Is Heart Smart

An apple a day is said to keep the doctor away, but orange juice may be good at the job, too. An antioxidant in orange juice called hesperidin improves blood vessel function and helps lower a person’s risk of heart disease, researchers have just reported.

More Information: Continue reading

More reasons to consider having your vitamin D level checked – you may think better and have less arthritis

Low vitamin D levels may impair thinking and adequate vitamin D levels may help prevent knee osteoarthritis, according to two studies released this last week. Both of these studies, added to the others I’ve discussed in this blog in the past, may lead you to get your doctor to check your vitamin D level at your next physical exam.

More Information: Continue reading

New research questions low-dose aspirin prevent heart attacks and strokes

BBC News reports that “low-dose aspirin should NOT routinely be used to prevent heart attacks and strokes,” according to research published in the Lancet.  So, if you are on a daily aspirin for primary prevention of a heart attack or stroke, should you stop taking it?

More Information: Continue reading

FDA Approves Triple-Drug Antihypertensive Polypill – Should you consider a polypill?

Hidden behind all of the Swine flu news stories is this one – which I feel is significantly more important when it comes to public health. The FDA just gave its official thumbs-up to an antihypertensive polypill. Could this pave the way for a preventive medicine polypill? And, should you consider taking a polypill?

More Information: Continue reading

Are multivitamins helpful or harmful when it comes to preventing chronic diseases?

According to the LA Times, “a spate of high-profile studies published in the last few years shows that a variety of popular supplements — including calcium, selenium, and vitamins A, C and E — don’t do anything to reduce the risk of developing heart disease, stroke, or a variety of cancers.” And, the New York Times is reporting, “In the past few years, several high-quality studies have failed to show that extra vitamins, at least in pill form, help prevent chronic disease or prolong life.” But what about multivitamins? Are they helpful or harmful

More Information: Continue reading

How You Can Eat Heart-Healthy Food While Eating Out – What to enjoy, what to avoid

Eating out doesn’t have to mean consuming foods that contribute to heart disease. Recently Men’s Health magazine Editor Peter Moore discussed healthy options in three different types of cuisines, Italian, Mexican, and Chinese, and talked about menu “warning” words that can hint at unhealthy choices, and menu “friends” that could point to the opposite on a CBS Program. I though you’d benefit from his advice.

More Information: Continue reading

What a woman’s heart needs, at every age

Heart disease is the number-one killer of women in the US. While 8 million women have it,  you can take specific steps to protect your heart starting at an early age. What’s more, a new study shows that in recent years the overall heart disease risk for Americans – especially women – h=asn’t continued the healthy downward trend it showed in previous decades. Here are some tips for women of all ages.

More Information: Continue reading

Doctor Urges Caution in Interpreting New Findings on Cholesterol Drug

On March 31, 2008, pharmaceutical giant AstraZeneca trumpeted the early closing of its so-called JUIPITER trial of a cholesterol-lowering drug (statin), Crestor. The results after only two years yielded “unequivocal evidence” of the drug’s effectiveness, the trial concluded, and the company argued that it could not be withheld from anyone who was well and had normal cholesterol levels but had an elevation in another normal blood constituent, the C-reactive protein (CRP). But, what’s the “other side” of this story?

More Information: Continue reading

Inexpensive blood test identifies people with a normal cholesterol at risk for heart attack, stroke – and a statin medicine may save lives and change preventive medicine

Whew! This is long title describing the remarkable results of a study, just announced at the American Heart Association’s meeting in New Orleans, which showed that AstraZeneca’s cholesterol fighting Crestor (rosuvastatin) slashed deaths, heart attacks, strokes, and artery-clearing procedures in apparently healthy patients who had normal cholesterol levels. The study has made a dramatic impression on some doctors who now expect an adjustment to preventive care guidelines.

More Information: Continue reading