Heart Attack Prevention for Women

December 13, 2011 by  
Filed under VIDEO

I just found this health related video on YouTube … and thought you might enjoy it!


Dr. Bob gives tips for women on the prevention of heart attacks. For more health tips and information visit www.DrBobShow.com.

Tell us what you think about this video in the comments below, or in the Battling For Health Community Forum!

Family Health History Part I: Why is it important?

December 20, 2010 by  

Many health problems have a genetic component to it. Yet, many of us never look back at our past for lessons for the future. Until health history repeats itself. Take me, for example. I was quite ill in 2001 and it took many different tests before I was diagnosed with Grave’s disease. My doctor then asked afterwards “Why didn’t you tell me you have a family history of thyroid problems?” I completely forgot that my mom had her thyroids taken when I was little girl. However, because of my diagnosis, it wasn’t a complete surprise when 5 years later, my niece and then 2 years later one of my nephews had similar problems.

Eight years ago, from out of the blue, without prior health problems, my father-in-law had to undergo an emergency triple heart bypass. That was when my husband learned that his grandmother and his uncle both died of heart attack.

Knowing our genealogy is important. But the family tree should also include data on health and medical. In other words, a family tree should also be a family health tree.

Last Thanksgiving, the US Surgeon General Dr. Regina Benjamin urged Americans to take the opportunity of family get-togethers to share the family health history with each family member

“While family health histories may seem old-fashioned, the truth is, the family health history is key to understanding your family’s unique genetic make-up and your individual disease risks.

Knowing your family health history can help you actually prevent disease, or detect diseases, such as many forms of cancer, for early treatment. The information your family health history contains can help you and your doctor determine your personal risk.  This means two things:  you can tailor your lifestyle to reduce your health risks; and you can be more carefully screened for diseases where your risk is high.

To make documentation of health history easier, the Surgeon General’s office has developed an online tool called My Family Health Portrait. The tool can help you record your health history electronically, making it easier to pass on the information to subsequent generations.

The Surgeon General believes that the older generations are an invaluable source of information when constructing a family health tree.

Says Dr. Benjamin:

“Older adults are more likely to know about the health conditions of previous generations. I like to think of the family health history as an heirloom that can help current and future generations live longer, healthier lives.”

Well, Christmas is another opportunity to start your family health tree or perhaps bring to completion what has been already started. The MD Anderson Cancer Center calls in creating a “health ances-tree”.

But why is a family health tree important?

Well, taking my family as example, my husband and I learned about some of our family’s health history when the same health problems occurred a generation later. His family history and my family history are now merged to become our children’s history. From what we have learned, we know what are the diseases our kids our genetically predisposed to. We cannot change our genes but we can change our lifestyle. By changing our lifestyle, we can reduce our risks and those of our children.

This holiday season, make a family health history your holiday project.

Coming next: how to build a family medical history.

Are your calcium supplements actually useless?

August 25, 2010 by  

Many of us swallow vitamin supplement pills each day, including calcium for bone health. Clinical guidelines on osteoporosis recommend supplementation with calcium especially for those who are at high risk for bone loss and fractures.

But the truth is, the benefits of calcium supplements are rather unclear, not to mention contradictory. Previous studies have shown that:

  • Calcium can protect against vascular disease.
  • Calcium can cause vascular disease by hastening vascular calcification.

So what now?

A group of researchers at the University of Auckland in New Zealand conducted a systematic search of electronic databases and conducted a meta-analysis of randomized clinical trials of calcium supplements compared to placebo. The results of the meta-analysis might have answered the calcium supplement question once and for all and can be summarized below:

  • Calcium supplements were associated with a significant increase (about 30%) in incidence of heart attacks.
  • Calcium supplements were also associated with trend of increased risk of stroke and mortality, although the increase is much smaller and not statistically significant.

These findings were consistent in all 5 trials included in the analysis and the increase of MI risk due to the supplements also increased with higher dietary calcium intake. Age, gender and type of supplement did not influence the results.

What is even more disappointing is the finding that calcium supplements have very little benefits when it comes to preventing fractures.

How reliable are the current results?

Some experts speculate that misdiagnosis of heart burns caused by the supplements as cardiac chest pains may have given erroneous results. This is based on the fact that many of the heart attack reported occurred within an average of 3.6 years after calcium supplementation was started. However, calcification of the blood vessels should take longer than that.

In addition, the studies analyzed were only those that did not include vitamin supplementation. It is common clinical practice, however, that calcium and vitamin D supplements are coadministered for osteoporosis. It is not clear whether vitamin D, which supposedly has cardiovascular protective properties, combined with calcium would give the same results.

However, the majority of experts agree is the fact that calcium supplements do not seem to prevent fracture indicates it is practically useless to take them even if the supplements as such are safe and do not cause heart problems.

According to senior author Dr Ian R Reid:

“Clinicians should tell their patients that, for most older people, the risks of calcium supplements outweigh the benefits. Changing to calcium-rich foods may be appropriate.”

According to independent expert Dr John Schindler (University of Pittsburgh Medical Center in Pennsylvania:

“I think the safest thing to tell your patients right now is if you can get your dietary calcium from good dietary sources, such as yogurt, sardines, and skim milk, that potentially might be all you need to ward off the risk of osteoporosis. Then we don’t have to deal with this increased cardiovascular risk.”

Still smoking after a heart attack?

June 21, 2010 by  

Smoking is a risk factor for heart disease. That we know. But the how cigarette smoking actually affects survival and longevity of those who already have heart disease hasn’t been fully explored. This recent study by researchers at Tel Aviv University tells us some encouraging news:

Smoking cessation after a heart attack is just as effective as medications in preventing a second one.

Taking a first heart attack as a serious warning, quitting smoking brings significant health benefits to heart attack patients, benefits which may be comparable to those of statins or even more invasive procedures. The researchers looked at 1500 heart attack patients with the following smoking habits:

  • More than 50% are smokers.
  • 20% are former smokers.
  • 27% are lifetime non-smokers.

After the heart attack, 35% of smokers were able to quit, with very strong benefits: People who quit after their heart attack lowered that rate by 37% compared with those who continued to smoke. People who quit before the first heart attack had a 50% lower mortality rate.

According to Dr. Yariv Gerber of TAU’s Sackler School of Medicine:

“It’s really the most broad and eye-opening study of its kind. Smoking really decreases your life expectancy after a heart attack. Those who have never smoked have a 43% lower risk of succumbing after a heart attack, compared to the persistent smoker…We found that people who quit smoking after their first heart attack had a 37% lower risk of dying from another, compared to those who continued to smoke.”

Smoking reduction after heart attack can have significant benefits.

OK, so quitting smoking is not an easy thing to do for some people. Ask US President Barack Obama. So if cessation is not possible, one can try reduction of the number of cigarettes smoked per day. The TAU study showed that even a reduction is better than going on as before. By reducing smoking after heart attack, the likelihood of dying from another heart attack within the next 13 years is also reduced by 18%.

Dr. Gerber continues

“The novel aspect in our study is that it is the first to show the benefit of a reduction in smoking. This is information that some smokers could live with ― literally. We would like people to consider cutting down as an initial step before complete cessation, especially those who find it impossible to quit right away.”

However, smoking, no matter how little, can cause other diseases such as cancer. Thus, though smoking reduction translates to reduction in mortality risk due to a cardiac event, it may still have an effect on overall mortality.

Breaking the taboo: docs should talk about sex to post heart attack patients

June 10, 2010 by  

Many people are lucky to survive a heart attack (myocardial infarction, MI for short) and undergo successful rehabilitation. However, the experience has a great impact on the quality of life of post-MI patients and this impact in turn is influenced by doctor-patient talk before discharge. Researchers at University of Chicago report that one aspect of life that is neglected by doctors before discharge is sexual activity. A survey of 1760 patients (1184 men and 576 women) revealed that this topic seldom comes up in predischarge instructions, leading to post discharge uncertainty and problems. The surveyed patients reported that

  • 46.3% of male and 34.5% female patients received discharge instructions on resuming sexual activity.
  • <40% of male and <20% of female patients discussed sex with their doctor in the year following their MI.
  • 67.7% of male but only 40.6% of female patients reported engaging in sexual activity 12 months after their attacks.

Sexual activity, however, is part of normal life and it is the aim of postMI rehabilitation programs to have patients lead a normal life as possible. Studies have shown that lack of sexual activity in postMI patients can lead to depression, strained relationships and poor overall quality of life. Unfortunately, sex is a topic that many people are not comfortable with. Many patients, especially women are reluctant to bring up the topic during predischarge discussion with their doctors and even during routine follow ups.

The researchers who conducted the survey believe that it is up to the doctors to introduce the topic into the discharge instructions in such a way that patients are not offended or embarrassed. However, some cardiologists may believe that this topic should better be discussed with a gynaecologist or urologist or even a sexologist. Others may be hesitant about bringing up the topic with patients who are older, unmarried, or of conservative background. However, breaking the taboo may do a lot of good for the patients who are most likely to take sexual advice better from their doctors than from close family members.

According to study author Dr Stacy Tessler Lindau of the University of Chicago, IL:

“Often physicians are focused on saving lives, and sexual health may not be valued as much as other treatments to prevent further progression of their coronary disease” But doctors need to be proactive and help patients recover their whole lives after an MI, “which includes an assessment of sexual history and ensuring that all parts of their physical and emotional well-being are addressed.”

For postMI patients facing this problem, check out the tips in a previous post.

Hospitals are speeding up heart attack care

January 6, 2010 by  

Many of us have seen the chaos in an emergency room, whether on TV or in real life. Overcrowding, too many patients, too few staff who are mostly overworked and lacking sleep. It is more than likely that patients do not immediately get the care that they need. In many cases, however, treatments are time critical and should be delivered within a time window or else it is too late.

This is why many hospitals are speeding up heart attack care. This good news is reported in the Journal of the American College of Cardiology. Receiving care in the shortest possible time, such as opening blocked arteries in the emergency room, is crucial to heart attack patients’ survival. When the arteries are blocked, blood supply to the heart muscle is cut off. The sooner the blood flow is restore, the better chances for heart recovery. Long periods of blood and oxy gen depletion can cause long-lasting and irreversible damage to the heart. Thus, hospitals and cardiologists worked to improve “door to balloon time”, with positive results.

“Door to balloon time” refers to the time when the patient arrives at the hospital until he or she gets an angioplasty or nay standard clinical procedure that clears the blocked coronary arteries.

Here’s how angioplasty works (Medline Plus):

“The doctor threads a thin tube through a blood vessel in the arm or groin up to the involved site in the artery. The tube has a tiny balloon on the end. When the tube is in place, the doctor inflates the balloon to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.”

The shorter the door to balloon time, the better are the chances for survival and full recovery.

Researchers at Yale University looked at 831 hospitals all the US to evaluate whether the ongoing campaign to accelerate care for heart attack patients is working. In 2005, only about 50% of patients get the necessary treatment within 90 minutes of arrival at the emergency room. The current figures estimated by the Yale survey were very encouraging.

Spring 2008: More than three-quarters (76%) of people suffering major heart attacks are getting their blocked arteries reopened within 90 minutes of arriving in the emergency room.

Summer 2009: Nearly 82% of eligible patients had a 90-minute or less door-to-balloon time in those hospitals.

These improvement in providing care however, were only observable in those hospitals participating in the care acceleration campaign. Some “slower” hospitals are now getting the message and are following suit.

So how did the hospitals manage to accelerate heart attack care?

The changes that helped most were simple steps that cut a few minutes here and few there. One such step was letting the emergency room activate the catheter lab upon the patient’s arrival, or even after a call from the ambulance on its way, instead of waiting for a cardiologist to confirm the diagnosis before getting ready for angioplasty. Some hospitals assigned cardiac catheter teams to be on duty 24 hours a day. Others required that on-call doctors arrive within minutes of a page from the ER.

Photo credit: Medline Plus

Transcendental meditation can help prevent heart attacks

December 15, 2009 by  

Transcendental meditation, which is the most widely form of meditation, has been associated with a lot of health benefits. It used to be dismissed by the medical world as a form of alternativemeditation medicine without any scientific merit. It has its roots in India, invented by named Maharishi Mahesh Yogi. It became popular in the 60s among the “flower people” and became very popular when rock group Beatles openly practiced it. However, it was only recently that the practice of transcendental meditation has become medically accepted as a form of relaxation technique. Studies have shown that any form of meditation can reduce stress, improve mental focus, boost creativity, and even lower blood pressure.

How does transcendental meditation work? According to the Maharishi University of Management

It is a simple, natural, effortless procedure practiced 20 minutes twice each day while sitting comfortably with the eyes closed. It’s not a religion, philosophy, or lifestyle. More than six million people worldwide have learned the TM technique — people of all ages, cultures, and religions.

It usually involves the use of a mantra or repeated sound and needs to be learned from a certified teacher.

Preventive medicine specialist Robert Schneider of the Maharishi University of Management in Fairfield, Iowa, collaborated with endocrinologist Theodore Kotchen of the Medical College of Wisconsin in Milwaukee to conduct the first study to evaluate the effect of transcendental mediation on the risk of myocardial infarction (heart attack). The 201 study participants were all high risk group for heart disease – African Americans with narrowed coronary arteries.

The participants were assigned to 2 groups. One group was instructed on practicing transcendental meditation for 15 to 20 minutes a day. The other group did not do medication. Both groups received standard treatment of prescription drugs for high blood pressure and atherosclerosis, and participated in an educational course in cardiovascular health. The patients were followed up for 5 to 9 years.  The study results showed that the meditation group experienced 47% fewer cardiac events such as heart attacks, strokes, and deaths compared with the non-meditation control group. This risk reduction is much higher compared to reductions by currently prescribed cardiovascular therapies, namely:

  • Anti-cholesterol statin drugs –  30% to 40% reduction.
  • Antihypertension drugs – 25% to 30% reduction.

The mechanism behind the it is not fully understood but the researchers believe it has something to with

  • Lowering blood pressure
  • Reducing stress hormones
  • Dampening  the sympathetic nervous system, which triggers the body’s stress response

We’ve shown that the brain has a direct positive influence on clinical outcomes”, according to the authors.

The study shows that transcendental meditation can be important technique in preventive medicine that can be incorporated in lifestyle change therapies.

The best and worst US states in heart attack care

October 26, 2009 by  

Somebody told me once that it all boils down to the right location, whether it’s real estate, business usa_mapsventure, or vacation. It seems it is the same when it comes to health care. In previous posts for example, I have tackled how geography can influence health, from based on the levels of air and noise pollution as well as UV radiation

A study published in the July issue the journal Circulation lists the best and worst states to be in, in order to survive a heart attack. This is based on the quality of care that hospitals in the states can deliver in terms of the treatment and management of heart attack and heart failure.

Of the best states, New Jersey tops the list, with “the least deaths and fewest hospital readmissions following a heart attack or heart failure.” The top 5 states are listed below:

  • New Jersey
  • Vermont
  • New Hampshire
  • Washington
  • Oregon

The US national average for heart attack mortality is 16.6% and 11.1% for heart failure. The best performing states have a maximum mortality rate of 10.9 and 6.6% for heart attack and heart failure, respectively.

Most of the states are sort of middle of the road when it comes to heart disease care but some states performed worse than the others. The 5 worst states to be in for patients of heart attack or heart failure are:

  • Oklahoma
  • Arkansas
  • Tennessee
  • Missouri
  • Louisiana

In these states, mortality rates from heart attack were about 24.9% and rates from heart failure were about 19.8%.

Aside from mortality rates, the rankings also took readmission rates into account. In the worst performing hospitals, 1 in 4 heart failure patients and 1 in 5 heart attack patients were readmitted within 30 days of their first admission due to many reasons including:

  • Medication problems
  • Infection
  • poor follow up care
  • Recurrence of the heart attack or failure.

Readmission and complications are preventable and in preventing these, deaths are also prevented.

According to study author Dr. Gregg Fonarow, professor of cardiovascular medicine at UCLA

“Being able to prevent preventable deaths is very important. Preventing early hospitalization again is also very important. The large difference highlights that more could be done.”

The researchers, however, were quick to emphasize that the ratings were general averages and do not necessarily reflect the performance of all hospitals in the said state. The state of Florida, for examples, has hospitals which were ranked among the bets but also has others which were ranked among the worst. A more detailed ranking of individual hospitals clinics according to different therapeutic areas is given by the US News and World Report. The top 4 hospitals are

  • Johns Hopkins Hospital
    Baltimore, MD
  • Mayo Clinic
    Rochester, MN
  • Ronald Reagan UCLA Medical Center
    Los Angeles, CA
  • Cleveland Clinic
    Cleveland, OH

None of these hospitals are located in the top ranking states.

Less secondhand smoke, fewer heart attacks

October 19, 2009 by  

smokeA few years after smoking bans were implemented in many parts of the world, more and more evidence is accumulating pointing to the short-term as well as long term benefits of such legislation. A few weeks ago, researchers from Iceland reported the first noticeable benefits in their country at the European Society of Cardiology 2009 Congress.

In the US, a recent report from the Institute of medicine (IOM) indicates that it is not only the smokers themselves who benefit from the smoking bans, but also the nonsmokers in their vicinity. It seems that less secondhand smoke exposure lead to lower risk for heart attacks.

According to the report, a large proportion of the nonsmoking population in the US is exposed to secondhand or environmental smoke and this includes 43% of children and 37% of adults. An estimate from 2000 revealed that about 126 million nonsmoking Americans are exposed to cigarette smoke.

Smoking cigarette is undeniably linked to very high lung cancer risk among smokers. For smokers, quitting is the only way to be healthy. Smoking bans, however, are more for the benefit of the nonsmoking segment of the population who may be unwillingly exposed to secondhand second smoke in public places. There are skeptics which question the claims that antismoking laws benefit nonsmokers especially in terms of cardiovascular health.

To clarify things, an IOM committee of experts conducted a comprehensive analysis of published and unpublished data on the link between secondhand smoke and short-term and long-term heart problems. Their analysis revealed that

  • Exposure to secondhand smoke increases risk for heart problems by 25 to 30%.
  • Smoking bands lead to reductions in the incidence of heart attacks range from 6 to 47%

According to Dr. Lynn Goldman, professor of environmental health sciences, Johns Hopkins Bloomberg School of Public Health in Baltimore, and chair of the committee:

“It’s clear that smoking bans work. Bans reduce the risks of heart attack in nonsmokers as well as smokers.  Further research could explain in greater detail how great the effect is for each of these groups and how secondhand smoke produces its toxic effects.  However, there is no question that smoking bans have a positive health effect.”

The message is clear: clean up the air, boost up health.

As of January 4, 2004, the state of antismoking legislation is the US is as follows (source: IOM report):

“…16,505 municipalities are covered by a 100% smoke-free provision in workplaces and/or restaurants and/or bars by state, commonwealth or local law; this represents 70.2% of the US population. 37 states and the District of Columbia have local laws in effect that require 100% smoke-free workplaces and/or restaurants and/or bars.

MI takes another victim: tribute to a friend

October 13, 2009 by  

heart_of_daisiesSadness and shock were the emotions I felt when I received this email:

„I bring you the sad news that my father passed away last Saturday. He was hospitalised 2 weeks ago after suffering from a heart attack and lost the battle on Saturday. The doctors did everything they could.“

The email was written by the 21-year old daughter of a good friend. Her husband JH was a picture of health the last time I saw him. He stopped smoking years ago and he jogs regularly. Annual check ups never indicated a heart problem. He was 49 years old.

According to the Medline Plus Medical Encyclopedia, heart attack or myocardial infarction

„… occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.“

The narrowing of the blood vessels that eventually lead to a heart attack is called coronary heart disease (CHD) or coronary artery disease.


Here are some US statistics on heart attack for 2009 (source: American Heart Association):

  • 610,000 new heart attacks.
  • 325,000 recurrent heart attack.
  • The average of a man having a first heart attack is 64.5 years ; for a woman it’s  70.3 years.
  • CHD is the largest killer of men and women in the US, causing about 1 out of every 5 deaths.
  • CHD estimated direct and indirect 2009 cost is $165.4 billion
  • The majority of heart attack cases occur in people above the age of 60 years.

Risk factors

Age, gender, genetics, and ethnicity are the non-modifiable risk factors for CHD.. Some of the modifiable risk factors are:

  • cigarette smoking (current)
  • abnormal blood lipid levels (cholesterol and triglycerides)
  • hypertension
  • diabetes
  • excess weight, especially abdominal obesity
  • a lack of physical activity
  • low daily fruit and vegetable consumption
  • alcohol overconsumption
  • psychosocial index.

I can’t really tell you what triggered JH’s heart attack. It was his first – and his last. He left behind three wonderful ladies – his lovely wife and two young lovely daughters. It is hard how heart disease affects people’s lives directly or indirectly. News such as this makes us more aware of how important – and fragile our heart is. It makes us more aware of our mortality…

Photo credit: stock.xchng

Michael Jackson’s death: Why it couldn’t have been a heart attack

October 5, 2009 by  

Michael_Jackson_1984When Michael Jackson suffered from cardiac arrest on June 25 this year, there were speculations that led to erroneous reports that Jackson suffered from a heart attack. It wasn’t clear whether the heart attack theories were based on medical evidence or the common mistake of equating cardiac arrest to heart attack. Once again, I have to put emphasis that heart attack (myocardial infarction in doctor speak) is not synonymous to (although it can cause) cardiac arrest, which is the sudden stopping of the heart.

Heart expert Dr. Melissa Walton-Shirley of Theheart.org wrote her blog heartfelt the many reasons why she is convinced that „Michael Jackson’s heart had nothing to do with his death [and] …was merely an innocent bystander.“ Dr. Walton-Shirley based her opinion on her analysis of Jackson’s risk factor profile which does not fit that of a young heart attack victim. These factors are listed and discussed below:

  • Family history. Heart disease seems to be not a part of the Jackson family medical history. Jackson’s parents are elderly (his mom is 79, his dad is 80) but are still fit. There has been no report of cardiovascular disease among his siblings.
  • Weight. Excess weight is a major risk factor for heart attack. Jackson was not overweight. On the contrary, he was underweight, looking „thin from the other side of the television screen but not emaciated.“ Excess weight is a strong indication of blocked arteries that lead to heart attack
  • Non-smoking. Smoking is another risk factor to consider and Jackson was a non-smoker.  
  • Diet. Jackson was rumored to be a vegetarian. Whether true or not, there is a strong indication due to his weight that he is not fond of animal fat.
  • Physical activity. The King of Pop can dance for extended periods, a feat that people with heart normally can do. Dr. Walton-Shirley, however, warns: Caution here on the exercise-tolerance issue, as 30% of all heart attacks may be asymptomatic.

In summary, Jackson did not have the most common risk factors that made him a likely victim of a heart attack.

Cardiac arrest, however, can be caused many things (including heart attack) and anybody can suffer from cardiac death that may or may not have to do with heart disease.

The latest autopsy reports reveal

Jackson was a fairly healthy 50-year-old before he died of an overdose. His 136 pounds were in the acceptable range for a 5-foot-9 man. His heart was strong with no sign of plaque build-up. And his kidneys and most other major organs were normal.

As to the real of cause of Jackson’s death, investigations are still ongoing. However, Dr. Walton-Shirley writes:

„His heart was merely an innocent bystander, a victim of the pop icon’s addiction and poor judgment, allegedly damned by a cardiologist’s stupidity, greed, and criminal negligence.“

Photo credit: wikicommons

Smokeless tobacco is deadly for the heart, too.

September 2, 2009 by  

heart-with-bandageThe use of smokeless tobacco products is on the rise. This has probably something to do with the widespread implementation of anti-smoking bans in many countries of the world. Thus, the age old practice of using products such as snuff and chew or spit tobacco, used to be thought as “unhip” and “gross” has recently been revived. Of course the very hip goes for e-cigarette, an electronic nicotine-containing smokeless cigarette.

It is a common misconception that it is the smoke that  makes cigarette smoking unhealthy. Without the smoke, chewing tobacco or using snuff are supposedly harmless. However, there is a growing body of evidence that indicates that smokeless tobacco products can be just as deadly. They have already been linked to several types of cancer, including pancreartic and esophageal cancer.

A recent meta-analysis by Swedish researchers shows that the use of chewing tobacco and snuff also significantly increase the risk for suffering and dying from a heart attack or a stroke.

In all in all, the researchers looked at eight studies from Sweden, where the use of snus (wet snuff)  is quite common and three studies from the US. Except for 2 studies, all participants of the other studies never smoked tobacco. Here some of the results of the study:

  • It is estimated that in 2000 alone, 0.5% of deaths from heart attack and 1.7% of deaths from stroke in American men were due to the use of smokeless-tobacco.
  • Among Swedish men, 5.6% of deaths from heart attack and 5.4% of deaths from stroke were due to smokeless-tobacco use.

According to author Dr Kurt Straif, researcher at International Agency for Research on Cancer

“Given the recent increase in use of smokeless tobacco, it is important to stress that all forms of tobacco are harmful and that the best prevention is not to start using any kind of tobacco, or-for users-to stop using all kinds of tobacco.”

The researchers think it is important that the public should be aware of the health risks of smokeless tobacco products. Several baseball players in the US are known to chew and spit tobacco during games, thus, setting a bad example to audience as well as TV viewers.

In addition, medical professionals tend to overlook smokeless tobacco products when taking medical history, assessing risks, and diagnosing symptoms.

American Heart Association spokesperson Dr Nieca Goldberg comments:

“Cardiologists [and other physicians] need to remember to ask patients not only about cigarettes but also about smokeless tobacco.”

Unfortunately, the meta-analysis did not elaborate on the substances responsible for the cardiovascular problems.  In view of the current controversy (and popularity) of e-cigs, it is of utmost importance whether the health risks in smokeless tobacco are also true for e-cigs.

Hospitals + hospitalists = better heart attack care

August 25, 2009 by  

heart-gift2Hospitals with hospitalists seem to deliver better quality care than those without, especially in cases of myocardial infarction. This is based on a study by Massachusetts General Hospital researchers reported in the recent issue of Archives of Internal Medicine. But wait a minute… what are hospitalists?

The term “hospitalist” is rather new, so new that one cannot find it in the Medline medical encyclopedia. According to the Society of Hospital Medicine,

hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital care.The majority of hospitalists (85%) are specialized in general internal medicine and some underwent extra training pulmonary/critical care.

The study looked at 3619 hospitals and medical centers in the US. It compared two groups of hospitals, one group which employed hospitalists (N=1461, 40%) and another group which did not (60%).

The two groups of hospitals were assessed based on health care provided in patients who suffered from heart attack, heart failure and pneumonia, which are the three most common clinical diagnoses in inpatients in the US. The researchers looked at the performance of the hospitals in treatment and diagnosis, and counseling and prevention of these 3 conditions for a one-year follow up period.

The results indicate that hospitals with hospitalists scored better in evaluations that reflect adherence to Hospital Quality Alliance (HQA) care measures for acute heart attack and pneumonia. Other differences also noted. In general, hospitals employing hospitalists

  • are more likely to be private, nonprofit teaching centers with at least 200 beds.
  • are more likely to have intensive care units.
  • have fewer Medicare patients and more Medicaid patients
  • had higher nurse-staffing ratios and more nurses per patient-hour

The hospitals with hospitalists scored much better in the care and treatment of patients of with heart attack and pneumonia but not those with heart failure.

Those who had the lowest scores were hospitals which were public and with fewer that 50 beds.

The results indicate that hospitalists and nurses do play an important role in delivering quality care to patients. However, the researchers warn from jumping into conclusions. According to co-author Dr Leroi S Hicks

“We’re not saying it was the hospitalists themselves who improved the quality of care in these conditions. We adhered very closely to saying that if having a hospitalist were itself a metric, there’s something about these hospitals that is associated with better care.”

Other factors, including bedside manners, as well as the difference between outcomes in heart attack and heart failure, need to be looked into.

Heart attack recovery: does fish oil supplement actually help?

June 9, 2009 by  

fish-oilFish oils are the so-called good fat. It contains lots of omega-3 fatty acid. Over the years, the use of fish oil or omega-3 fatty acid as a nutritional supplement has become popular. In fact, omega-3 ranks among the top favorites in terms of nutritional supplements. Omega-3 is especially known for being good for the heart. Currently, several supplements in the form of highly purified omega-3 fatty acids is available commercially, such as Omacor and Lovaza in the US and Zodin in Europe.

German researchers at the University of Heidelberg investigated the benefits of fish oil capsule supplement in heart attack patients. The study included 3,800 people who have had heart attacks. Half of the group was given fish oil capsules. The other half was given placebo. The study was blinded, e.g. none of the participants knew which capsule they got. The results of the study after a year of follow up shows:

The researchers explain that patients who have had a heart attack usually receive optimum medical care which includes medications, physiotherapy, and psychotherapy if necessary. Additional nutritional supplementation with omega-3 doesn’t seem to give additional benefits in terms of risk reduction.

Omega-3 fatty acids are found in natural food products such as fish (e.g. salmon, tuna, mackerel, sardines and herring). It is supposedly good for heart health because it lowers bad “LDL” cholesterol and increases good “HDL” cholesterol. The American Heart Association recommends eating fish 2 times a week at least. For supplement capsules, 1 g of omega-3 is recommended. However, supplementation is not recommended for infants, nursing mothers, and pregnant women. It also elevates the risk for bleeding and is therefore counterindicated before surgery.

However, this is not the first study to question the health benefits of omega-3 supplements.  A US FDA assessment cited the following as possible risks associated with omega-3 supplementations:

  • Increased bleeding especially if the patient is on blood thinners like warfarin or aspirin.
  • Impaired glycemic control among those with diabetes.

According to the authors

“we need to be a little more cautious about the prediction of individual benefit of any nutritional supplements.”

However, the researchers are quick to point out that the study results do not say anything whether omega-3 can do more harm than good. In other words, it is too soon to throw the baby out with the bath water.

Needless to say, we simply cannot undo what years of unhealthy lifestyle could to our health by just taking omega-3 supplements. It may be good for the heart, but it is far from the wonder drug that its marketers purport it to be.

Photo credit: stock.xchng

Heart attack emergency care: men have it better

May 27, 2009 by  

ambulance__ecnalubmaHere is another study on gender disparity in health care, and again, women are at the losing end. Researchers at Penn University looked at 683 cases of emergencies with symptoms of chest pains and the care given to the patients by emergency medical service (EMS).

Chest pains or angina pectoris is a major symptom of a heart attack and the standard emergency treatments are aspirin and nitroglycerin. However, the study showed that less female patients get these treatments compared to male patients.

Chest pain is a leading cause of emergency room visits in the US, accounting for more than 8 million cases a year.

The study reported the following figures in terms of pre-hospital interventions the study patients have received:

  • Aspirin:  24% of women vs. 32% of men
  • Nitroglycerin: 26% of women vs. 33% of men
  • IV line: 61% of women vs. 70% of men.

A heart attack occurs gradually, with the following symptoms and warning signs according to the American heart Association:

Early intervention in a heart attack is very important. Aspirin can reduce clotting around the ruptured plaques in the coronary artery that block blood flow to the heart. This minimizes the damage to the heart tissue. Many EMS organizations have cardiac monitoring equipment in their ambulances that can send information about a patient’s heart rhythm ahead to the hospital. This alerts the hospital to prepare equipment that might be necessary, e.g.  catheterization device to open blocked arteries. This way, the “door-to-balloon time” is significantly shortened.

But why this gender disparity? According to lead author Dr. Zachary Meisel, an emergency physician and Senior Fellow at the Leonard Davis Institute of Health Economics at Penn.

“Women with heart attacks have higher death rates than men, so these findings are very concerning, and it’s important for us to try to figure out why this is happening.”

The study results show that the disparity wasn’t linked to ethnicity, age, or gender of emergency personnel. Experts believe that this is due to several factors. One may be the fact that heart attack symptoms may present atypically in women. This can lead to differences in the way the symptoms – in this case chest pains – are interpreted by both paramedics and patients. A previous study has reported that women tended to downplay heart attack symptoms that lead to delayed medical help.

Photo credit: stock.xchng

Can your pulse rate predict your heart attack risk?

May 4, 2009 by  

heart2Researchers and scientists are continuously searching for ways to predict who is most likely to have a heart attack and who isn’t. French researchers report this could be as easy as measuring a person’s pulse rate three times.

The study looked at 7,746 French male civil servants. Their heart rates (measured by their pulse rates) were measured at rest (baseline), right before physical exercise (mild mental stress in anticipation of the exercise) and during exercise.

The results of the study show that “men whose heart rate increased the most during mild mental stress just before an exercise test had twice the risk of dying of a sudden heart attack in later life than men whose heart rate did not increase as much.”

The highest increase in heart rate during the mild mental stress was at least 12 beats a minute, the lowest, less than four beats per minute. The study participants who exhibited the highest increase in heart rate had twice the risk of sudden death due to a cardiac event compared to men who had the lowest increase.

However, those participants who had the highest increase in heart rate during the actual physical exercise had less 50% the risk of death compared with the men whose heart rate increased the least. The highest incidence of death due to a cardiac event occurred among the participants who increased their heart rate the most during mild mental stress and the least during exercise. There were none reported among those whose heart rate increased the least during mild mental stress and the most during the exercise test.

The authors think that the mechanism behind this effect lies with interaction between the autonomic (ANS) and sympathetic nervous systems (SNS). Vagus nerves are an important part of the ANS which controls the body’s autonomic functions including the heart beat. The SNS is responsible for increasing the heart rate and the dilation of blood vessels in the voluntary muscles and constriction of blood vessels in the skin and intestines during physical exercise.

According to lead researcher Professor Xavier Jouven

“There is a balance between the accelerator (sympathetic activation) and the brake (vagal activation). If vagal withdrawal occurs it is like releasing the brake. During an ischaemic episode, when blood flow to the heart is reduced, sympathetic activation occurs to counteract it. However, if there is no protection by the vagal tone (the brake), the activation can become uncontrolled and then it becomes dangerous. Our underlying assumption, which this study appears to have proved correct, is that the faster the vagal withdrawal in response to mental stress, the greater will be – during an ischaemic episode – the damaging effect of sympathetic activation unopposed by vagal activity.”

Heart attacks or myocardial infarctions are a major health problem in many developing countries. The US alone reports between 200,000 to 400,000 deaths due to heart attack each year. In 27 European countries, the mortality count is 486,000.

This method of predicting who is susceptible and who is not is easy, cheap, and non-invasive. However, it has only been tested for men. It still remains to be seen whether the same pulse rate readings can be a predictor of heart attack in women.

The power to predict a heart attack may be right at your fingertips

April 1, 2009 by  

handCould it be that predicting a cardiac event is as easy as raising a finger? Researchers at the Mayo Clinic have studied and seemed be quite satisfied with a test that is simple and noninvasive but is still “highly predictive” of a major cardiac event, such as a heart attack or stroke, for people who are considered at low or moderate risk.

The EndoPAT I a noninvasive finger sensor test device which measures the health status of endothelial cells that line the walls of the blood vessels and regulate blood flow. When endothelial cells are unhealthy, a condition called endothelial dysfunction occurs and can mark the start of atherosclerosis or hardening of the arteries, which in turn lead to cardiovascular disorders. The finger device measures blood flow which is indicative of endothelial function.

During the testing process

“…researchers at Mayo Clinic and Tufts-New England Medical Center in Boston used the device to test 270 patients between the ages of 42 and 66 and followed their progress from August 1999 to August 2007. These patients already knew that they had low-to-medium risk of experiencing a major heart event, based on their Framingham Risk Score. The score is the commonly used risk predictor and was developed from the Framingham Heart Study, a longitudinal study of heart disease.”

The study results showed that 49% of patients who had poor endothelial function as measured by EndoPAT had a major cardiovascular event (e.g. heart attack or stroke) during the 7-year follow up.

The EndoPAT is a product of Itamar Medical. I was approved by the US FDA for diagnostic use in 2003. It consists of a digital recording equipment plus two probes attached to the fingers like large thimbles. During the test, one probe is placed on each index finger and attached to a small blood-flow measuring machine. In parallel, a cuff, the kind that is used during blood pressure reading is placed around one arm. The cuff is inflated, then deflated “to occlude and then release blood flow to assess reactive hyperemia (RH), the normal blood flow response that occurs when occlusion is released.” Three timed readings are performed during the 15-minute test and the results are expressed in RH scores. A low RH score indicates low blood flow response, endothelial dysfunction and impaired vascular health.

This positive news about EndoPA is very welcome because cardiovascular health problems, most of which are preventable, have become a major global health concern. Millions of people suffer from heart attack and stroke each year, sometimes without any warning. Indeed, a predictive but still non-invasive instrument such as EndoPAT can help doctors and patients plan a preventive strategy to battle heart and stroke.

Is there sex life after a heart attack?

March 19, 2009 by  

Resource Post for March

Now, more than ever, patients with heart disease are much longer but heart-giftunfortunately their quality of life is not necessarily better. The latest medical advances save people’s lives but the care in the life after – after heart surgery, after discharge, rehabilitation, etc. – sometimes fall short.

Depression is a common aftermath of heart surgery and other cardiac events. A previous study showed that depression is commonly reported among young people aged 18 to 49 years old. They are tended to be female, of African American or Hispanic ethnicity.

I imagine that young people would be depressed since these years are the most active and productive years of their lives. Young women of reproductive age would be worried about their ability to raise their families or even able to start a family at all.

Depression has also been reported among the elderly but not to the extent observed in young people.

It is to be expected that one main cause of depression among young cardiac patients is sex, rather lack thereof. Sexual satisfaction is a part of life. And for the sexually active, the question of whether sex after a heart attack is still possible is another big factor that may contribute to depression and overall poor quality of life. Unfomarried-handsrtunately, Hollywood has erroneously portrayed in films the horrors of having a heart attack in the act of sexual intercourse, scenes which can dampen the spirits of both the heart patient and his/her partner. A report presented at the European Cardiology Society last year stated that heart patients

…may have concerns about resuming sexual activity, feelings of sexual inadequacy, changes in sexual interest or changes in patterns of sexual activity…[They] are worried about chest symptoms during intercourse or even an acute ischemic event during sex. Many lack information about returning to sexual activity.

Researchers looked at the sexual satisfaction of 35 female with either non-STEMI or unstable angina and reported the following results::

  • 49% resumed sexual activity within 12 weeks of hospital discharge.
  • 35% reported being “sexually unsatisfied
  • 41% were “mostly dissatisfied
  • 24% were “somewhat dissatisfied
  • 83% reported sexual desire to be lower compared to desire before the cardiac event.

But is there really room for sexual activity in a heart patient’s life?

Apparently, the answer is a resounding “Yes” but with some caveats.

According to this WedMD article “it is important to remember that sex is a workout. So doctors typically tell patients to abstain from sex after heart disease until they can withstand the cardiac workout.”

gametesThis means that people who are sedentary may have to abstain from postcardiac event sex until they are back on their feet and have passed their stress tests. What the doctors are saying is that if a patient can handle climbing the stairs or light jogging around the block, then he or she is ready to resume sexual activity.

But sometimes fear and the uncertainty can interfere even if the body is physically ready. Here are some tips that you may try to counteract this problem:

Do not blame yourself. It is not your fault and it is alright to feel frustrated. So stop blaming yourself. Erectile dysfunction is linked to heart disease. Some cardiac medications can interefere with sexual drive and performance. Nothing you can do or have done could change this.  However, you have to do something about it and the first step is talk about it.

Talk to your doctor. I know that this topic maybe embarrassing for some people, depending on personality as well as cultural and religious backgrounds. However, your doctor is the best person who can tell you whether you are ready or not and what it takes to get you back into shape. Your doctor can give you all the information you need and can even refer you another professional if necessary.

Avoid self-medication. Be careful about performance enhancing and erectile dysfunction drugs. You see them advertised on the Internet all theone_pill_a_day___ time and your email Inbox is probably flooded by sales pitches on cheap Viagra and penis enlargement pills. However, these drugs may not be what they seem. They may be disguised in the form of dietary supplements, tea, herbal remedy, or energy drinks. Some of these substances can increase heart rates while others can interact with the other drugs you may already be taking. So before you resort to self-medication, talk to your doctor first. He would know which drug would be most appropriate and safest for you.

Talk to your partner. Be open about your fears and worries. For all you know, he or she also has some doubts and worries about the situation. Take him or her when you go talk to your doctor.

Give yourself time. Sex doesn’t have to start at day one. It doesn’t have to be perfect the first time around after surgery. Take your time. Give your body and mind the time to heal and recover.

Go for counselling. Professional help may be necessary and your doctor can refer you to a psychologists or a sex counsellor. These health professionals may also prescribe drugs, devices, as well as therapies that can help.

fruits1Live a healthy lifestyle. You can’t live on sex alone. And your body should be fit to perform normal daily tasks, including sex. That is why you shouldn’t forget to maintain a healthy lifestyle which includes physical activity and the proper diet. Remember: a healthy and active sex life depends on an active and healthy lifestyle.





Photo credits: stock.xchng

Bleeding hearts

January 28, 2009 by  

Have you ever seen a bleeding heart? Literary, I mean? Up till now, many of us use the term “bleeding heart” figuratively to mean “a person who is excessively sympathetic towards other people.” A real softie, in other words. It could also refer to a plant (Dicentra sp. ) with heart-shaped white flowers with a red center

But hearts really do bleed and the amount of bleeding can indicate the extent of heart damage after a heart attack.

Heart attacks or myocardial infarction in doctor speak occurs when a blood vessel (an artery) transporting blood to the heart gets blocked, cutting off blood supply to the heart muscles. The clear the blockage, metal implants called stents are inserted into the artery. However, it has been observed that bleeding in the heart muscles can occur once the heart start pumping again.

Researchers at the Medical Research Council (MRC) Clinical Sciences Centre at Imperial College London have captured images of bleeding hearts. Using magnetic resonance imaging (MRI) technology, they took images of hearts of 15 patients who suffered from heart attacks of different severity.

“Analysis of the MRI scans revealed that the amount of bleeding correlated with how much damage the heart muscle had sustained. Patients who had suffered a large heart attack, where a lot of the heart muscle was damaged, had a lot of bleeding into the heart muscle compared with those whose heart attack was relatively small.”

The significance of heart bleeding has been poorly understood. These recent findings can help doctors and researchers in figuring out the bleeding, how it can be prevented and minimize the damage to the heart muscles.

According to Medline Plus

Magnetic resonance imaging (MRI) is a non-invasive method of taking pictures of the body and the internal organs. Unlike x-rays and computed tomographic (CT) scans, which use radiation, MRI scans use magnetic fields and radio waves. Each single MRI image is called a slice. One MRI test can produce many different slices. The researchers were able to view the area of bleeding in the heart because of the magnetic effects of iron, a metal which is present in the blood.

The researchers hope that this kind of imaging will be used alongside other tests to create a fuller picture of a patient’s condition and their chances of recovery. The research was funded by the Medical Research Council, the British Heart Foundation and the Department of Health, UK.

Photo credit: MRC Clinical Sciences Centre at Imperial College London

Resource post for November: time change, sleep and your heart

November 3, 2008 by  

Have you reset your clocks? Ready for the time transition? Depending on the season, we are moving back and forth in time. We “spring forward” in the spring and “fall backwards” in the autumn. The North Americans call it Daylight Saving Time or DST for short and Standard time, respectively. In Europe, we can it “summer time” and “winter time.”

How does time transition affect our health?

According to this latest study published in the New England Journal of Medicine, these transitions in time are linked to higher incidence of acute heart attacks. The Swedish study shows that the number of heart attacks increases significantly during the first 3 weekdays after the transition to daylight saving time (DST) in springtime. The effects of turning back the time in autumn is not so strong but still evident during the first weekday. Furthermore, there are some differences observed in the time transition effects which are dependent on gender and age.

The effect of the spring transition to daylight saving time on the incidence of acute myocardial infarction was somewhat more pronounced in women than in men, and the autumn effect was more pronounced in men than in women… The effects of transitions were consistently more pronounced for people under 65 years of age than for those 65 years of age or older.

Time change interferes with our biological rhythm and our daily routine especially our sleep. The most plausible explanation for the increase in heart attacks is sleep deprivation, which can badly affect cardiovascular health.

Because of its dependence of daylight hours, DST has also an effect on health conditions such as depression, vitamin D insufficiency, and night blindness.

 Who are most likely to be affected?

As the abovementioned study above suggests, those with heart problems and but also adults below 65 are more likely to feel the adverse effects of time change. Babies and little children will also feel it and get restless, adding to the woes of the poor parents.

Depending on each individual, the effects can last between 1 day and two weeks!

In addition, the severity and the duration of the effect vary from person to person. In general, however, “owl types” tend to suffer more at springtime.

Night owls” or “evening types” are people who have a natural tendency to stay up later at night. This puts them at risk for delayed sleep phase disorder, which occurs when their usual bedtime and wake time are much later than the social norms.

Since night owls have a hard time falling asleep when they go to bed early, they may be unable to compensate for the time change. As a result they may go to bed even later than normal, depriving themselves of needed sleep.

Those who are “morning types” among us however, will experience more problems this autumn (November 2) when we go back to Standard Time

How can we minimize the effect of time change?

The American Academy on Sleep Medicine (AASM) gives us the following tips to counteract the effects of time change:

 Why change time at all?

If it is bad for our health, then why do it?

Switching to DST is something we have to put up with because we are living in higher altitudes and have therefore varying day lengths depending on the season. People living close to the equator don’t need to bother with this.

Adjustment for DST in spring aims to optimally use the daylight hours, with the following results:

  • It makes us start work earlier in the morning when the sun rises early, and then leave us enough daylight hours in the evening for outdoor leisure activities.
  • It reduces energy consumption because we tend to use less indoor lighting.
  • Business benefits from DST because it encourages people to shop longer in the evenings.
  • It also aims to reduce traffic accidents and crime that usually tend to happen in the dark hours.

However, it does not benefit everybody, e.g. people who work in shifts (hospital staff, for example), those who frequently have to cross time zones (airline personnel, for example). The shift in time can create havoc with time-dependent machines and computer systems. International businesses get disrupted. For years, the time change on the two sides of the Atlantic happened on the same weekend – the last Sunday of March for DST and the last Sunday of October for going back to standard time. This has changed since 2007. In the US and Canada, it now happens on the second Sunday of March and the first Sunday of November. This asynchrony even complicates things and brings confusion to people working on intercontinental projects.

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.