Tuesday, February 28, 2006

Cocoa cuts heart disease mortality

Eating or drinking cocoa products such as dark chocolate may help lower blood pressure and reduce the risk of death from any causes including heart disease in older men, according to a new Dutch study.

The study found that older men who ate the highest amount of cocoa were half as likely to die of cardiovascular disease as those who ate less or no cocoa.

Scientists believe the health benefits are largely attributed to flavanols, which have been linked to lower blood pressure and protect the endothelial cells lining the blood vessels from being damaged.

Consuming cocoa in a range of forms - in dark or milk chocolate, biscuits, spreads, mousses, and drinks appeared to cut the risk of death overall and could even help guard against some cancers. The researchers said the elderly men got two-thirds of their cocoa from chocolate confectionery.

In a study at the Agriculture Research Service, here in Beltsville, researchers evaluated the total amounts of flavanols and antioxidant capacity in cocoa and chocolate.

How about cocoa instead of a chocolate bar? A cup of hot cocoa may sound like a healthy drink filled with antioxidants, but almost all cocoa drink mixes contain cocoa treated with alkali (also called Dutch cocoa) to produce a darker, richer taste. This process significantly reduces flavonoid content.

Unless you find a chocolate mix made with untreated cocoa, start with plain cocoa (not Dutch) and add your own sweetener and milk to make a flavonoid-rich cup. The result is a low fat, healthy drink. You can try Hershey's. (Notice the Hershey's Special Dark is dutch processed, so avoid this one.)

If you like those chocolate bars, don't worry. Surprisingly, the fat content of chocolate is not a reason to avoid it. Chocolate contains cocoa butter, which is high in saturated fat, yet one-third of chocolate's fat comes from stearic acid. Although it's a saturated fat, stearic acid does not raise LDL cholesterol (the bad cholesterol) as do most other saturated fats. Stearic acid is converted in the liver to oleic acid, a heart-healthy, monounsaturated fat.

Another one-third of chocolate's total fat comes from oleic acid itself. In a recent study, volunteers followed a diet with the majority of their fat calories coming from either chocolate or from butter. The volunteers who consumed chocolate fat did not show an increase in their cholesterol levels, but those who ate butterfat developed elevated LDL cholesterol levels.

I'm hungry. Gotta go.

Monday, February 27, 2006

Genes, salt, and hypertension

Researchers have demonstrated that looking for several variations of genes that control blood pressure can predict the risk for high blood pressure caused by high levels of salt. Once it is fully developed, this effective diagnostic test will be the first of its kind.

When a subject had three or more variations in these genes, the new genetic test correctly predicted risk for salt-induced high blood pressure in 94 percent of cases. (Health is adversely affected by high salt intake in up to half of Americans.) The more gene variants, the bigger the health problems.

"A genetic test for high blood pressure and/or salt sensitivity will be instrumental in motivating Americans to adopt heart healthy lifestyles and help to improve their overall health and quality of life," researchers said.

Studies now show that salt-sensitivity is harmful in the presence of a high-salt dietary regimen.

Serum markers of inflammation and endothelium-dependent vasodilation are altered in salt-sensitive hypertension. These alterations could help to explain the greater target organ damage and cardiovascular risk observed in salt-sensitive subjects.

What to do about salt-sensitivity, besides taking effective antihypertensive medication?

Follow the DASH plan. By following the DASH regimen you will be lowering your dietary sodium content. The first D.A.S.H. (Dietary Approach to Stopping Hypertension) study had even shown that you could lower blood pressure without altering sodium intake. It showed that by boosting other minerals, you will excrete more sodium in your urine. This is also evident in a recent study.

Of course, it's most effective to lower salt and eat the DASH way as shown in the second DASH study. In fact, it's the way our ancestors ate. Their sodium/potassium ratio was a healthy 1:4, the result of eating plenty of fresh fruits and vegetables. Our current ratio is reversed to an unhealthy 4:1, the result of too much salt (especially in processed foods) and too few fresh fruits and vegetables.

To be salt sensitive is to have your blood pressure increase more than 10 percent following a high-salt meal, though this is not a foolproof test.

Your doctor can help you ascertain your sensitivity level, but the wise call is for all of us salt users to take steps to shake the habit.

Sunday, February 26, 2006

Do your genes increase your risk for CAD?

The risk of coronary artery disease is increased by 15% to 31% by genetic variants in a pair of genes that regulate the formation of blood clots, according to researchers in the most comprehensive assessment to date of the role of hemostasis genes in risk of coronary artery disease.

A meta-analysis of 191 studies, which tracked seven genes that regulate hemostasis, determined that a mutation of the factor V gene increased the relative risk by 17%while a variant of prothrombin was associated with a 31% increase in relative risk.

The genetic variants aren't common, with about 3 percent of whites carrying the protein V version and 1 percent carrying the prothrombin version.

"They are not common enough or associated with enough risk to warrant screening for them. In the future, if a number of weakly acting gene variants are identified, that might warrant screening. At the moment, the question is hypothetical."

Yet, the findings have important implications for "designing new therapies that target blood clotting pathways to help prevent heart disease. More generally, they suggest that bigger and deeper studies than have been customary will be needed to identify the genetic causes of heart attacks."

A must-read on blood clotting disorders. I've known many who have heart disease without common risk factors. This information could be very valuable for them and their blood relatives.

Saturday, February 25, 2006

Prehypertension danger reaffirmed

People who have "prehypertension," blood pressure levels just below the cut-off for a diagnosis of high blood pressure (in the range of 120/80 to 139/89 mm Hg), have an increased risk of cardiovascular disease, according to a report in The American Journal of Medicine.

Researchers investigated the relationship between prehypertension and the risk of new cardiovascular disease in nearly 9,000 men and women. The rate of cardiovascular disease over the 11.6 years of follow-up increased significantly as blood pressure levels increased. Compared with patients with optimal blood pressure, those with high-normal blood pressure had a 2.5-fold risk of developing cardiovascular disease, after consideration of other cardiovascular risk factors.
Cardiovascular disease risk was especially high among blacks, diabetics, obese patients and those with LDL levels, the "bad" type of cholesterol, between 100 mg/dL and129 mg/dL, the investigators observed.

Prehypertension is clearly associated with a significant increase in cardiovascular disease," the researchers conclude.

  • High blood pressure affects 65 million Americans.
  • The American Heart Association estimates that 59 million Americans have prehypertension
  • High blood pressure is a factor in 77 percent of strokes – the #3 cause of death in the United States.
  • High blood pressure causes more visits to doctors than any other condition, accounting for 48 million visits per year.

Follow the guidelines to lower blood pressure.

Friday, February 24, 2006

Statins and impotence: Going beyond Viagra

Researchers at the University of Pennsylvania School of Medicine say preliminary results of a small study show promise in improving erectile dysfunction (ED) in men who had shown minimal reaction to Viagra.

"It's already known that there is a connection between erectile dysfunction and coronary disease. The risk factors are the same for both, and thus, ED can be a marker for coronary disease," explains the lead author.

"Normal erections are caused when nitric oxide is made, but with endothelial dysfunction, the body doesn't make enough of it, causing the erectile dysfunction. Normally, Viagra prevents the breakdown of the little nitric oxide that is there, so that there is enough of it for an erection to occur." However, about 10-30 % of men are classified as "Viagra non-responders" - in these men, Viagra did not significantly help their erectile dysfunction.

Patients with ED took Lipitor or a placebo. They were rechallenged with Viagra and asked if the ED had improved. "There did seem to be some improvement for those who received Lipitor versus the placebo. We theorized that if you could make the edothelium healthier through the use of statins -- so that there is more nitric oxide available -- you would improve the endothelial dysfunction and Viagra would work better for the patient."

"These preliminary results show promise. They support the hypothesis that erectile dysfunction may be one sign of a generalized vascular disorder characterized by endothelial dysfunction and that statin drugs may improve the endothelial dysfunction, even before altering the lipid profile

Past studies have shown that statins improve endothelial dysfunction in other arteries, including the aorta, an important location for the development of plaque that can break away and cause a stroke.

Maybe statins should be in the water supply. At least partners of the 10-30% probably think so.

Thursday, February 23, 2006

Research reinforces gum disease-atherosclerosis link

New research is reinforcing the longstanding belief that a connection exists between periodontal disease, or severe gum inflammation, and cardiovascular disease. The researchers hypothesize that the atherosclerosis may be a result of bacteria from gum infection entering the bloodstream, creating inflammation in other parts of the body.

It is too early to know if treating gum disease lowers the risk of heart disease, but gum disease may be a risk factor for heart disease -- one that can be prevented.

In other words, brush, floss and see your dentist regularly.

"If you have a healthy mouth, chances are you have a healthy body," the study author said.

The study is in its fifth year and includes more than 1,000 participants. Researchers are looking forward to more conclusive results in about five years.

Try this alcohol-free product to lower bacteria levels.

Wednesday, February 22, 2006

Cholesterol drug combination: Good news.

Ezetimibe plus simvastatin, a combination of two anti-cholesterol drugs marketed by Merck/Schering-Plough Pharmaceuticals as Vytorin, is no more damaging to muscles than simvastatin alone, a team at Rush University Medical Center in Chicago reports in the American Journal of Cardiology.

Ezetimibe reduces cholesterol levels by blocking dietary absorption, while simvastatin works by reducing cholesterol produced by the body.

Previous reports have linked "statin" drugs, like simvastatin, with muscle side effects, but it was unclear if adding ezetimibe would lead to even greater risks.

The authors found that the likelihood of muscle problems did not increase when ezetimibe was used in combination with simvastatin. Moreover, none of the patients developed rhabdomyolysis, a potentially fatal condition involving muscle breakdown.

This drug combination is especially effective in lowering cholesterol.

VYTORIN 10/40 mg decreased LDL cholesterol by 59 percent compared to 48 percent for Lipitor 40 mg in a 2004 study.

Significant differences in LDL cholesterol reductions, at all doses compared, resulted in more high risk patients achieving LDL cholesterol levels less than 70 mg/dL with VYTORIN as compared to Lipitor. In particular, 57 percent of high risk patients taking VYTORIN 10/40 mg achieved a LDL cholesterol goal of less than 70 mg/dL as compared with 23 percent of the patients (n=115) taking Lipitor 40 mg.

VYTORIN has continued to gain share in the U.S. market.

Tuesday, February 21, 2006

A smooth landing into a diagnosis of heart disease

Taking prescription beta blocker or statin drugs may boost the chances of having only mild chest pain instead of a heart attack as the first symptom of heart disease, U.S. researchers reported on Monday.

Previous studies had shown those types of drugs cut heart disease risk overall, but the new research is the first to demonstrate they may reduce the chances of someone having a sudden heart attack without earlier symptoms.

"If there are warning symptoms like angina with exercise, there is enough time to see a doctor and get started on effective treatments that reduce risk," said Mark Hlatky, one of the study's authors.

"Having a heart attack causes permanent damage, even if it doesn't kill you," he added.

Among 916 patients whose first heart disease symptom was a heart attack, 20 percent were taking statins. In a group of 468 patients with chest pain, 40 percent took statins.

Nineteen percent of heart attack patients were on beta blockers, compared with 48 percent of those with chest pain.

Because the study was not prospective, it lacked information on confounding factors such as the use of aspirin therapy to prevent coronary heart disease," Dr. Smith added. "If aspirin therapy was strongly associated with the use of statins and beta-blockers, it could explain some of the effect of these two drugs."

"Although our findings must be confirmed by randomized studies, they suggest that use of statins and beta-blockers for primary prevention may not only reduce the incidence of coronary artery disease but may also increase the likelihood of more stable, lower-risk clinical presentation of coronary atherosclerosis," the authors concluded.

This is a terrific study. I applaud the study authors for looking over patient records and drawing the potential lifesaving conclusions that came from this analysis. We all fear that out-of-the-blue heart attack and wonder if we should be paying attention to every little chest discomfort, arm or neck pain, shortness-of-breath issue. This can create such anxiety. Perhaps these two classes of drugs will allow symptoms of heart disease to be more readily apparent through a classic clinical presentation of increasing symptomatic warnings with activity which allows a thorough workup without the danger of a sudden change in clinical status.

Monday, February 20, 2006

Aspirin cuts severity of stroke

Aspirin, the wonder drug, is in the news again.

It is well known that the use of aspirin and other anti-platelet therapies reduces the risk of recurrent stroke and ischemic events. Now, a study presented here recently at the International Stroke Conference (ISC) has reported that people who use anti-platelet therapies prior to having a stroke also have significantly better outcomes compared with those who do not use them. And, the findings seem to apply to all anti-platelet medications, not just aspirin.

After a mean of 16 months of follow-up, patients who had been using antiplatelet therapy had a significantly lower stroke score (4.8 for users vs. 8.0 among non-users) if they had no history of prior ischemic event. Conversely, there was no meaningful score difference among patients who had had a prior event depending on whether they had been using an antiplatelet drug or not (4.91 vs. 4.86, respectively).

On the basis of these data, Dr. Sanossian said it appears that antiplatelet therapies are underutilized. Even if the stroke risk scores did not reflect a benefit to taking antiplatelet among patients who had a history of prior ischemic events, past research has shown that these agents greatly reduce the risk of a subsequent events.

These data demonstrate that antiplatelet use can contribute to a less severe stroke in those with no history of prior event.

Heart Health Quiz

True of False?
  • An aspirin a day keeps the heart attack away.
  • Lack of sleep can harm your heart.
  • Chocolate is good for your heart.
  • Crushing chest pain is the telltale sign you're having a heart attack.
  • Drinking alcohol can lower your risk for heart disease.

See the video for the answers. Scroll to the February 18th entry, Heart Health Quiz.

Sunday, February 19, 2006

Link between stress and heart disease

More and more evidence suggests a relationship between the risk of cardiovascular disease and environmental and psychosocial factors. These factors include job strain, social isolation and personality traits.

Studies using psychosocial therapies to prevent second heart attacks are promising.

As part of the CBS "Early Show" HeartScore 2006 series, Dr. Emily Senay speaks about the dangers of stress, which can have a detrimental effect on your heart.

See the video. Scroll to the February 15th, 2006 entry, Stress and Heart Disease.

Want to maintain weight loss? Be vigilant.

Losing that extra weight is one thing. Keeping it off requires a lifetime of counting calories. That's the message from a more than two-decade study of monkeys.

The latest study with rhesus monkeys has shown that lifetime calorie restraint to prevent obesity is the most powerful way to reduce age-related health problems such as high blood pressure and high triglycerides and to prevent or delay the progression of insulin resistance toward diabetes. Monkeys whose food intake was maintained in amounts to assure a constant healthy body weight were not only healthier; on the average they lived longer than their counterparts who ate as much as they wanted. Monkeys fed 30 percent less over the long term extended their lifetimes to 30 years from an average of 23 years.

Genetic differences allow some primates to remain thin and others to grow fat when fed an identical diet over the years, the study found.

Other monkeys, when forced to slim down by as much as 25 percent, regained the weight they'd lost once caloric restrictions were lifted — regardless of whether they'd been on a diet for two months or two years.

Studies have shown that each person has an age-related “set point" for weight somehow regulated by physiology and genetics. This may help explain why more than 95 percent of dieters who shed 35 extra pounds or more eventually regain the weight. “Basically, while your weight may fluctuate throughout life, your body’s natural tendency is to return to its individually programmed body composition.”

What's the message?

“I highly recommend the bathroom scale model of weight loss. If you see your weight creeping up, then cut back on your portions,” study author Barbara Hansen, PhD, said.

I'm a big fan of Barbara Rolls' research at Penn State University. Out of the research, she developed the Volumetrics Plan.

Here is a sample menu of the low-energy-density plan.

Saturday, February 18, 2006

Uncontrolled high blood pressure and your brain

Uncontrolled high blood pressure can increase your risk of short-term memory problems and decreased verbal ability as you age.

A study on a group of otherwise healthy, older males found that men with hypertension (high blood pressure) who are unable to control it with medication performed poorly on short-term recall and verbal tests in comparison to other men.

Having high blood pressure that was adequately controlled by medication did not appear to affect the men's cognitive abilities. Nor did having untreated high blood pressure - a surprising finding. The researchers speculate this could be because the men in this group may only be at the early stages of hypertension, and able to control their blood pressure through lifestyle changes rather than medication.

The researchers also note that the fact that there was no difference in performance between men with blood pressure that was successfully controlled by medication and men with normal blood pressure suggests that blood pressure medications do not negatively affect men's cognitive abilities.

After analyzing the data, the researchers found a significant interaction between age and hypertension, with older men who had uncontrolled high blood pressure performing significantly worse on tests measuring verbal fluency (the ability to generate words in a specific category) and short-term memory (the ability to immediately recall words on a list).

"Do age effects on cognition vary as a function of hypertensive status?" wrote the authors. "The answer is, yes."

Therefore, if you are having memory troubles, you may not be able to blame your antihypertensive medication side effects. It could be aging, but it could also be uncontrolled hypertension.

(According to a national survey, 70 percent of Americans are aware of their high blood pressure, 59 percent are being treated for it, and 34 percent of those with hypertension have it under control.)

Unraveling heart disease myths

  • Myth: Heart disease only affects older people
  • Myth: Since I am thin and I exercise, I am not at risk for a heart attack
  • Myth: Symptoms will warn me that a heart attack is coming
  • Myth: Heart disease doesn't really affect women
  • Myth: A low-fat diet is all I need to work on for heart health

Why are they myths? The reasons.

See the video. Scroll down to the February 18th entry: "Heart disease misconceptions."

When will you die?

Researchers at the San Francisco VA Medical Center have created an index that is 81 percent accurate in predicting the likelihood of death within four years for people 50 and older.

The index, which weighs different mortality risk factors according to a simple point system, is potentially useful to health care providers, policymakers, and researchers, say the study authors.

The information can be obtained using a 12-question form that "could be completed in a few minutes by a patient or medical office receptionist.

  • A patient who scores 0-5 has a less than four per cent risk of dying within four years.
  • A score of 6 to 9 points predicts a 15-per-cent risk of death.
  • 10 to 13 a 42-per-cent risk,
  • and 14 or more points a 64-per-cent risk of dying within four years.

The test could help doctors identify high-risk patients so that specific interventions could be targeted to them. (It's probably not useful for younger people, however, because four-year mortality is already low in people younger than 50.)

Here's the test:


1. Age 60-64: one point
65-69: two points
70-74: three points
75-79: four points
80-84: five points
85: seven points

2. Sex (Male/Female) Male: two points

3. a. Weight:
b. Height:
703 X (weight in pounds divided by height in inches) squared
BMI** less than 25: one point

4. Has a doctor ever told you that you have diabetes or high blood sugar? (Y/N)
Diabetes: two points

5. Has a doctor told you that you have cancer or a malignant tumour, excluding minor skin cancers? (Y/N)
Cancer: two points

6. Do you have a chronic lung disease that limits your usual activities or makes you need oxygen at home? (Y/N)
Lung Disease: two points

7. Has a doctor told you that you have congestive heart failure? (Y/N)
Heart Failure: two points

8. Have you smoked cigarettes in the past week? (Y/N) Smoke: two points

9. Because of a health or memory problem do you have any difficulty with bathing or showering? (Y/N)
Bathing: two points

10. Because of a health or memory problem, do you have any difficulty with managing your money -- such as paying your bills and keeping track of expenses? (Y/N)
Finances: two points

11. Because of a health problem do you have any difficulty with walking several blocks? (Y/N)
Walking: two points

12. Because of a health problem do you have any difficulty with pulling or pushing large objects such as a living room chair? (Y/N)
Push or Pull: one point

Total Points:


Surprisingly, and controversially, having a body mass index (BMI) of 25 -- the "overweight" category -- seemed to be protective, as long as the person doesn't have diabetes. On the other hand, a BMI less than 25 was associated with a shorter life expectancy.

** Simple BMI calculators are readily available on the Internet. Calculator

Friday, February 17, 2006

New CVD treatment approaches

Several new approaches to treatment and diagnosis of cardiovascular disease (CVD) hold out the promise of immediate response in emergency situations.

In part three of the CBS "Heartscore" series, The Early Show medical correspondent Dr. Emily Senay discusses the newest tools in the field.

See the video. (Scroll to the January 16th entry, "Heart disease breakthroughs.")

Iron and heart disease

It has been suggested that iron plays a role in the development of cardiovascular disease (CVD) through its pro-oxidant properties. However, epidemiological studies on iron status and the risk of CVD have yielded conflicting results. A prospective study to evaluate the relationship between iron status and CVD in a middle-aged French population was performed.

Serum ferritin was positively associated with total cholesterol, serum triglycerides, systolic and diastolic blood pressure, body mass index and hemoglobin. However, no linear association was found between serum ferritin and heart disease risk in men or in women. The researchers concluded that the data do not support a major role of iron status in the development of heart disease in a healthy general population.

This was an intriguing look at ferritin, a measure of the iron stores in the body, and the association with cardiovascular disease. Many believe that the pro-oxidant, iron, damages arteries, increasing the risk of heart disease. Perhaps the elevated levels of ferritin in diseased tissue arteries are a consequence of the heart disease process, not a cause. In fact, in one study, low iron concentration was associated with with inflammation and infection, boosting the risk of heart disease.

So, eating lean foods higher in iron, may be OK. Just keep the saturated fat content low and monitor other risk factors, as mentioned above.

Thursday, February 16, 2006

When stroke hits, call 911.

Two new studies show that getting an ambulance is the best way to receive quick, lifesaving treatment for patients suffering a stroke.

One study found that patients who dialed 911 to get an ambulance were seen by doctors within 30 minutes. Those who walked in were evaluated within 34 minutes and those who came by public transportation were not seen for 55 minutes.

Dr. Yousef M. Mohammed, director of the stroke fellowship program at Ohio State University, says the four-minute difference may seem insignificant. But he adds that "a stroke is an emergency, and 'time is brain.' If you walk in or come by car or taxi, we are losing valuable time here."

Seventy-three percent of those arriving by ambulance received brain imaging by computed tomography or magnetic resonance imaging. Only 63 percent of the walk-ins and 60 percent of those arriving by other mean received these services.Moreover, 97 percent of ambulance arrivals were evaluated by a staff doctor, rather than a nurse, physician assistant or doctor-in training, compared to 89 percent of walk-ins and 82 percent of those arriving by other means.

People need to learn the warning signs of stroke and call 911 immediately if they think someone might be having a stroke.

When lights and sirens are blaring, "the floodgates open up and everyone pays attention," as opposed to a woman quietly pushing her husband in a wheelchair, said Dr. Joseph Broderick, a stroke expert from the University of Cincinnati.

The top warning signs of stroke include:

  • Sudden numbness or weakness of the face, limbs, or one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Blurred vision in one or both eyes
  • Dizziness, loss of balance, or difficulty walking
  • Sudden severe headache

Defibrillators cut from budget

President Bush has requested billions more to prepare for potential disasters such as a biological attack or an influenza epidemic, but his proposed budget for next year would zero out popular health projects that supporters say target more mundane, but more certain, killers.

If enacted, the 2007 budget would eliminate federal programs that support inner-city Indian health clinics, defibrillators in rural areas, an educational campaign about Alzheimer's disease, traumatic brain-injury centers, and a nationwide registry for Lou Gehrig's disease. It would cut close to $1 billion in health care grants to states and would kill the entire budget of the Christopher and Dana Reeve Paralysis Resource Center.

The spokesman for the American Heart Association said he cannot fathom why the administration has recommended eliminating a $1.5 million program that provides defibrillators to rural communities and trains local personnel on how to use the machines to restart hearts that go into cardiac arrest.

"Coronary heart disease is the number one killer in the United States. This is actually something we can arm ourselves with."

Do defibrillators work?

The American Heart Association estimates that at least 100,000 of the 335,000 U.S. cardiac arrest deaths each year could be prevented if defibrillators were in common use, and that includes having them for first-responders such as police.

As an example:

Pete Candelaria and his family are pleased that at least some Bernalillo County sheriff's deputies carry heart defibrillators in their patrol cars.

The family plans to help lobby for more of the devices.

Bernalillo County, N.M., Deputy David Brown saved Candelaria's life with one of the computerized machines last week after Candelaria suffered a heart attack while riding in his truck on I-40.

Candelaria's wife was racing toward the nearest emergency room in Albuquerque when Brown caught up to the truck. He is one of 40 deputies trained to use defibrillators. When he didn't find a pulse on Candelaria, he hooked up the machine to the man's chest, followed the commands to perfection— including performing CPR— and shocked him twice with the device. Emergency medical crews arrived and Candelaria was taken to a hospital, where he remains in stable condition.

Oh, yes. They work.

See an Automatic External Defibrillator demonstration. Know this BEFORE you need to use one.

Also, consider taking an instructional course in the use of the device given by your local American Heart Association or Red Cross affiliates.

Wednesday, February 15, 2006

Hidden heart dissease in women

For years, researchers have suspected that women develop heart disease differently than men.

Now, according to CBS's Early Show medical correspondent Dr. Emily Senay, the latest results from ongoing studies of heart disease in women offer new evidence that those suspicions are correct, when it comes to diseased heart arteries.

See the video. Scroll to the February, 14, 2006 video: "Heart disease in women."

Atrial fibrillation and the Mini-Maze

Harry Whittington, the 78-year old lawyer who was accidentally shot by the Vice President over the weekend, suffered "atrial fibrillation" (a particular type of irregular heart rhythm) and a "minor heart attack."

Atrial fibrillation can be controlled. Dr. Calvin Weisberger, a regional chief of cardiology for Kaiser Permanente, about 8% to 10% of people over age 80 have a history of atrial fibrillation. Mr. Whittington's atrial fibrillation could be due to his age, the stress of the accident, or the biochemical response of the heart to the pellet.

There's a new procedure to treat atrial fibrillation, a rhythm that, though benign, can increase one's risk of stroke and may cause fatigue and a loss of well-being.

The maze procedure can cure atrial fibrillation by creating barriers to the electrical pathways, in the form of scar tissue, in the atria (the heart's upper chambers).

In the procedure, the surgeon creates multiple cuts into the atria muscle in an intricate pattern, or maze, and then stitches the incisions together to produce scars. Because the scars do not carry electrical signals, they interfere with stray electrical impulses that cause atrial fibrillation and, as a result, allow the heart to restore a regular, coordinated heartbeat.

What was once an open-heart procedure may be no longer. For here comes the mini-maze, the new minimially invasive maze procedure.

  • Read an interview with the inventor of the mini-maze.
  • Television segment on the mini-maze.
  • Webcast of the mini-maze procedure.

Tuesday, February 14, 2006

Angioplasty: threading the catheter through the wrist

..."Basically," he explains, "the same catheter we introduce into the groin artery, we are going to introduce into the radial artery (in the wrist). … It gives us the opportunity to have easy control of the bleeding, and for that reason, the patients don't necessarily have to stay overnight."

"The patients love it. It's much more comfortable. They don't have to lay flat. … They can get up. They can walk around. They can hang out with their families. They can go down the hall immediately."

See the video: Day one of the CBS Heathwatch series, Heartscore 2006. (Click play on the right side of the page.)

Estrogen: reassuring news

Post-menopausal estrogen therapy does not appear to protect women in their 60s and older from heart disease, but researchers say it may have some protective effect for women in their 50s.

The Women's Health Initiative, which conducted the research, stopped the analysis in March 2004 because of a higher risk of stroke among women taking estrogen. But further examination of the data shows that, at least for women between 50 and 59, the hormone may provide a boost to heart health. Researchers did not examine stroke risk.

Given the new findings, some experts said Food and Drug Administration warnings in package inserts of estrogen pills might be too stringent, though some experts say the study still does not offer a ringing endorsement for prescribing estrogen.

Researchers found that 201 estrogen takers required bypass surgery or angioplasty; had heart attacks, episodes of angina or died from a cardiac problem, compared with 217 on a placebo who had related heart events. Of the more than 10,000 in the study, 1,396 women between 50 and 59, had heart problems so dramatically less frequent that researchers attributed it to the daily dose of estrogen. Thus, there is intriguing evidence that the risks associated with estrogen and estrogen-plus-progestin may be limited to women who start taking the hormones later in life.

The estrogen findings should be seen as reassuring to women considering hormone therapy to relieve hot flashes and other symptoms of menopause.

Another study, recently performed, on estrogen benefits and timing, echoes these current findings. This is good news all around for women who feared estrogen supplementation. However, stroke risk needs further clarification.

Monday, February 13, 2006

Good blood sugar....now bad?

Blood sugar levels should be kept as low as possible in men with heart disease, suggests a new study scheduled to appear in the Feb 15 issue of the American Journal Epidemiology.

The study by a team of scientists at UCLA and Cedars-Sinai Medical Center in Los Angeles found that even in the normal range, a lower blood sugar level was linked with a lower risk of death from cardiovascular disease. "Our findings suggest that for men with cardiovascular disease, there is apparently no 'normal' blood sugar level."

"For these men, across the normal range, the lower their blood sugar, the better. Their death rate over a two-year period soars from slightly more than 4 percent at a glucose level of 70 (mg/dl) to more than 12 percent at 100 (mg/dl) -- an enormous increase."

Interestingly, a blood sugar level higher than 100 mg/dl is no different from 100 mg/dl in the death risk. Men with a blood sugar at 100 and men with 150 mg/dl had the same risk of death from heart disease and stroke.

Women, however, had a different pattern of death risk. "For women, we found no evidence of any change in risk across the normal range, from 70 to 100, but then their risk seems to rise quickly through the impaired range and continues to increase with higher glucose in the diabetic range; therefore a blood sugar level of 100 seems to be a sensible cut point for women with cardiovascular disease," the authors said.

This is a fascinating study with extremely important implications. I remember meeting Willaim Castelli, third director of the Framingham Heart Study, in 1997, and I asked him how he treats a non-diabetic's (less than 126) blood glucose. He stated that he treats anyone with a glucose at or above 100 with diabetes medications along with lifestyle changes. Nine years later, we have good evidence that pre-diabetes should be treated agressively.

Sunday, February 12, 2006

Systolic BP trumps diastolic BP in the elderly

A study was conducted to clarify the relationship between mortality due to cardiovascular diseases (CVD) and systolic blood pressure (SBP) and diastolic blood pressure (DBP) in young and elderly Japanese men in the absence of antihypertensive treatments.

  • Both SBP and DBP levels were significantly and linearly related to CVD mortality in the age groups 30-64 years.
  • In those at least 75 years old, however, no significant increase in the relative risk of CVD was observed with increasing DBP levels, whereas the relative risk of CVD increased significantly with increasing SBP levels.
  • Adjusting for major risk factors confirmed these relationships.

These data show that elevated SBP is an independent risk factor for CVD mortality for Japanese men of all ages, whereas elevated DBP is not an independent risk factor for CVD mortality for elderly men.

The old adage that your systolic BP (top number) can go up 10 mmHg per decade of life without ramifications is proven wrong again.

Drugs that treat the angiotensin system and calcium channels are excellent choices for managing systolic hypertension. Salt reduction can also reduce systolic hypertension.

Whole grains good for the diabetic heart

Women with type 2 diabetes who incorporate more whole grains, bran, and cereal fiber into their diets may reduce their risk of heart disease, according to a new study.

"To adapt a diet high in whole grains and low in glycemic load will help diabetic patients to reduce the risk of cardiovascular disease," the study author stated.

Women who reported eating more whole grains, bran, and cereal fiber tended to have lower levels of two markers of blood vessel inflammation that have been linked to heart disease - CRP and TNF-R2.

In fact, whole grain cereal, which contains the bran and germ layer, "may confer stronger effects than fibers from other food sources such as fruit and vegetables."

Whole grains are also a rich source of minerals, vitamins and antioxidants."These compounds may have important biological functions, which as a whole could make an important contribution to reductions in diabetes and ischemic heart disease," the study's authors wrote, speculating that slower digestion is likely a key factor as well.

Here are some easy directions for cooking whole grains.


Saturday, February 11, 2006

20 ways to lower your blood pressure

Like bananas, apricots are a particularly good source of potassium, the blood pressure-lowering mineral. Eating a handful of aprciots, a particularly healthy snack, is just one of 20 ways to lower your blood pressure according to a good article in Reader's Digest. (Yes, I know it's not a medical journal, but it still offers some very good tips.)

Adopt a few of them and see if you notice a change. Of course, you will need to purchase a home blood pressure device to see if there's improvement. Research indicates that home monitoring helps control blood pressure.

Friday, February 10, 2006

Red grapefruit could lower heart disease risk

Eating a red grapefruit a day could reduce cholesterol by 15 per cent and triglycerides by 17 per cent and protect against heart disease, according to research from Israel.

Fifty-seven post-operative bypass patients with high triglyceride levels in the blood (hypertriglyceridemia) were divided into three groups. The standard anti-atherosclerosis (9% fat) diet of two groups was supplemented by one Israeli Jaffa red or white grapefruit for 30 days. The third group ate the standard diet and was considered the control group.

“The results of the investigation in humans have shown that a generally accepted antiatherosclerosis diet supplemented with fresh red or blond grapefruits positively influences the serum levels of total cholesterol and [bad LDL cholesterol]. However, only a diet supplemented with red grapefruit was effective in significantly lowering the level of serum triglycerides."

Many experts now recommend that you should not mix grapefruit juice and certain medications.

Chemicals in grapefruit interfere with enzymes that break down certain drugs in your digestive system. This can result in abnormally high blood levels of these drugs and an increased risk of serious side effects.

If you are currently not taking your medications with grapefruit juice, don’t start. If you already eat grapefruit regularly and take any of these medications, talk with your doctor before making a decision to increase your grapefruit intake or stop it.

Thursday, February 09, 2006

Minimally invasive aorta surgery

A minimally-invasive procedure can repair a wide range of problems in the upper part of the aorta, the giant blood vessel leading out of the heart. In this region, called the thoracic aorta, the intense force of blood pulsing out of the heart can rip the aorta's walls apart or cause them to balloon outward, eventually leading to a rupture that brings almost certain death.

For decades, patients have had a choice between open-chest surgery and waiting for the "time bomb" to explode. Some haven't had a choice, because their age or health makes them too high-risk for surgery. More than 15,000 Americans die each year from ruptured thoracic aortic aneurysms, dissections and other problems.

An experimental procedure called endovascular thoracic aortic repair, or ETAR, has now been shown to shore up the aorta without surgery. Devices called stent-grafts are inserted by snaking a long tube up into the aorta from a small incision in the leg or belly. Only in the last year has the U.S. Food and Drug Administration approved the first device designed for this purpose, paving the way for more hospitals to offer it.

Earlier this week, in a presentation at the Society of Thoracic Surgeons meeting, a multi-specialty University of Michigan Cardiovascular Center team gave data from 73 patients who had ETAR at U-M over the last 12 years. Three-quarters of them were considered too high-risk to have surgery. The average survival was nearly four years, and almost half of the patients are still alive today and have not needed additional procedures, though the researchers say close monitoring is needed after a patient has ETAR.

"The minimally invasive approach to major aortic problems promises to revolutionize the way a broad spectrum of patients are treated," says Himanshu Patel, M.D., the lead author of the STS scientific poster. "Even in high-risk patients who would not otherwise be treatable, we see acceptable, encouraging results.

Thoracic aneurysms occur in the ascending aorta (25% of the time), the aortic arch (25% of the time), or the descending thoracic aorta (50% of the time).

An aneurysm is an abnormal widening or ballooning of a portion of a blood vessel. The blood vessel wall becomes weaker in this location. The most common cause of aneurysm? Atherosclerosis.

See a picture of a thoracic aorta aneurysm.

Wednesday, February 08, 2006

Will you get heart disease?

The number of cardiovascular risk factors people have at age 50 can have a dramatic impact on their life expectancy, researchers are reporting.

The findings, based on a large, long-running U.S. study, suggest that 50-year-olds who are free of major risk factors are unlikely to suffer coronary heart disease or stroke in their lifetime.

Moreover, 50-year-olds without cardiovascular risk factors could expect to live about a decade longer than their peers with multiple risk factors.

Among men who were free of risk factors at age 50, only 5 percent developed atherosclerosis-related heart disease or stroke by the age of 95. That compared with 69 percent of men who had two or more risk factors at age 50.

The difference was substantial among women as well - 8 percent, versus 50 percent.

These low-risk 50-year-olds tended to live into their 90s. That meant that they were not overweight, did not smoke, and did not have diabetes, high cholesterol, and high blood pressure.

Few people in the current study had "optimal risk factor levels" at the age of 50 -- just 3 percent of men and 4.5 percent of women.

“It sounds trite, but physical activity, eating a healthy diet, and maintaining a healthy weight could make all the difference."

Your prescription:

  • 30-60 minutes of physical activity on most days
  • don't smoke
  • lose weight, especially abdominal fat. An unhealthy waist circumference is above 35 inches (women), or above 40 inches (men).
  • control high blood pressure. (less than 140/90, preferably less than 120/80)
  • lower cholesterol (preferably LDL less than 100)
  • become non-diabetic

Tuesday, February 07, 2006

Low fat diet disappointment

Low-fat diets failed to reduce the risk of breast and colon cancer and also fell short for cardiovascular disease, according to a large controlled intervention trial.

One group of women followed a low-fat diet, while another did not reduce the amount of fat they ate. The low-fat group showed slightly lower rates of breast cancer, colorectal cancer and heart disease -- but the differences were so small that they could be due to chance.

Researchers suggested that the women in the long-running study — with an average age of 62 — may have started their healthy eating too late. They also didn’t reduce fats as much as the diet demanded, and most remained overweight, a major risk factor for cancer and heart problems.

However, there were trends toward greater reductions in coronary heart disease risk in those with lower intakes of saturated fats or trans fats and higher intake of vegetables and fruits.

To Stanford University researcher Dr. Marcia Stefanick, chair of the Women's Health Initiative steering committee, "just adopting a low-fat diet is not enough. We really need to home in on getting nutritious foods into our diets.''

The researchers said they were not overly disheartened by the results. They said that the importance of different types of fat was not recognised when the investigation started, so the women were merely asked to reduce total fat consumption. In an editorial commenting on the study, Cheryl A.M. Anderson, Ph.D., M.D., and Lawrence J. Appel, M.D., M.P.H,. both of the Johns Hopkins School of Public Health, stressed that dietary policy has changed since the start of this study with more emphasis on types of fat.

With more data to come from this study in the future, the current research should allow those, who prefer the higher fat Mediterranean plan, where focus is put on the type of fat consumed, to rest more comfortably. The Mediterranean diet focuses specifically on the type of fat ingested. I think it's a winner.

(Dr. Dean Ornish responds to the study.)

Monday, February 06, 2006

Latest roadway hazard - heart attacks

Seven per cent of men having a heart attack drove themselves to hospital and only 60 per cent went by ambulance, according to research published in the latest Journal of Advanced Nursing.

The study, which looked at 890 heart attack patients admitted to six major teaching hospitals in Dublin, Southern Ireland, also found that it took women five times as long as men to go to casualty departments after their symptoms first started. But only one per cent got behind the wheel and drove to the hospital.

“People who drove themselves to the hospital said they did it because it was the quickest way to get to the hospital, they felt well enough to make the journey and they would have pulled over if necessary.

“However, many also reported that they felt they were going to collapse when they arrived in the casualty department.The average time it took women to get to hospital after the onset of initial symptoms was 14 hours, compared with 2.8 hours for men.

Only 63 per cent of women and 60 per cent of men travelled by ambulance. Many said they were too embarrassed to go in an ambulance or that they should be used for more urgent cases.

Seven per cent of men and one per cent of women drove themselves to the hospital and a further four per cent of men and three per cent of women used public transport. 33 per cent of women and 29 per cent of men were driven to the hospital.

“Women need to be much more aware of the risks they face from heart attacks and the importance of seeking prompt treatment.”

As mentioned in a previous post, the ACT IN TIME campaign, a National Heart, Lung, and Blood Institute education campaign has now begun. Check it out. It's short, concise, and very important. Remember:

The longer an artery is blocked and the blood supply is cut off, the more heart muscle will die and be replaced by scar tissue. Depending on the extent of heart muscle damage, a heart attack can be deadly or disabling.

Sunday, February 05, 2006

Best gluteal exercises

How are you doing with your weight training program? Research tells us that weight training is good for the muscles, including your heart muscle.

The American Council on Exercise (ACE) recently announced research that determines the most effective gluteal exercises. “The results of this research showed that several of the exercises were as effective as the traditional squat at targeting the gluteal muscles. This study confirmed the relative value of alternative exercises such as lunges, step-ups, quadruped hip extensions, and four-way hip extensions, providing viable options for individuals who may have difficulty properly performing traditional squats.”

Some of these exercises can be safer, yet effective, for those with joint problems.

Here is a detailed look at the exercises.

Statins vs. arrhythmias after bypass

Atrial fibrillation (AF) is a common arrhythmia following open heart surgery. Patients who develop postoperative atrial fibrillation are more likely to have other complications during or after surgery, including, heart attack, congestive heart failure and respiratory failure. Postoperative atrial fibrillation is associated with longer Intensive Care Unit and hospital stays.

Age has been identified as the major independent predictor of post-operative AF. Increasing age of patients accounts for the higher incidence of postoperative AF in recent years. Incidence of AF after CABG far exceeds the reported prevalence in the general population and in patients with coronary artery disease(CAD). Similarly, it is significantly higher than the reported incidence of AF after major noncardiac surgery regardless of CAD status.

The mechanisms responsible for the high incidence of AF after CABG surgery is unclear. Some of the mechanisms suggested are:

  • ß-blocker withdrawal,
  • the use of cardiopulmonary bypass,
  • inadequate atrial protection,
  • and overmanipulation of the right atrium.

According to a new report, treatment with a cholesterol-lowering statin drug appears to reduce the risk of atrial fibrillation following coronary artery bypass grafting (CABG) by about 50%.

Overall, 28% of subjects developed atrial fibrillation. A history of atrial fibrillation raised the risk of postoperative atrial fibrillation by nearly 12-fold, whereas statin use cut the risk by 48%.

The study findings "may have important clinical implications because atrial fibrillation is a frequent complication after cardiac surgery that increases in-hospital morbidity and mortality and prolongs hospital stay," the authors conclude.

Saturday, February 04, 2006

Hypertension risk factors and relation to CVD

Data from the Strong Heart Study estimating hypertension incidence and hypertension risk factors and their association with cardiovascular disease (CVD) was recently reported.

Risk of developing hypertension:

  • prehypertension: 3.2 times the risk
  • microalbuminuria: 1.7 times the risk
  • diabetes: 1.5 times the risk
  • overweight: 1.3 times the risk
  • obese: 1.5 times the risk
  • consuming alcohol 1.2 times the risk

(microalbuminuria: leakage of small amounts of protein (albumin) into the urine. An early warning of kidney damage)

Risk of developing cardiovascular disease:

  • controlled hypertensives: 2.2 times the risk of those with normal blood pressure
  • uncontrolled hypertensives: 2.8 times the risk of those with normal blood pressure
  • prehypertensives: 1.7 times the risk of those with normal blood pressure

(Prehypertension: A systolic pressure of 120 to 139 mm Hg or a diastolic pressure of between 80 and 89 mm Hg.)

So, there are a number of risk factors that lead to the development of high blood pressure and once you develop hypertension or prehypertension, you boost your risk for CVD.

Friday, February 03, 2006

You know your Framingham heart risk. Should you get a stress test?

The value of exercise testing (ET) in individuals without symptoms remains controversial. You might think you need an exercise stress test, yet your doctor doesn't, and vice versa.

The results from a new study indicate that ET improves the prediction of a first coronary event only in those individuals who are already at an elevated risk based on the Framingham risk assessment.

Positive exercise testing was associated with coronary event (CE) occurrence (including cardiac deaths, acute myocardial infarction and stable or unstable angina) only in subjects with higher test risk, defined by a 10-year Framingham score of greater than 10.4%.

In other words, if your test result was less than 10.4%, a stress test provided no more information on risk. If greater than 10.4%, then additional information was provided on your risk for a subsequent CE. As a matter of fact, subjects with a result between 10-15% and positive ET had a probability of CE largely equivalent to the probability in subjects with known coronary heart disease.

What is YOUR risk? Use the Framingham risk assessment tool to find out. (If you already have heart disease, stroke, peripheral arterial disease, abdominal aortic aneurysm, diabetes mellitus, or chronic kidney disease, you’re automatically considered to be at high risk.)

Today is National Wear Red Day

February 3, 2006, is National Wear Red Day!

National Wear Red Day is a day when Americans nationwide will wear red to show their support for women's heart disease awareness.

One in three women dies from heart disease. It’s the #1 killer of women, regardless of race or ethnicity. It also strikes at younger ages than most people think, and the risk rises in middle age. And, two-thirds of women who have heart attacks never fully recover.

New guidelines for the prevention and treatment of women with heart disease have been published. (If you already have heart disease, stroke, peripheral arterial disease, abdominal aortic aneurysm, diabetes mellitus, or chronic kidney disease, you’re automatically considered to be at high risk. Also, some women with genetic cholesterol problems may also be at high risk.)

  1. Determine your risk for getting heart disease in the next 10 years.
  2. Once you determine your risk, read the heart disease prevention strategies based on your risk category.

A national study conducted by the American Heart Association showed that just over 50% of American women know that heart disease is their leading killer. Spread the "Love Your Heart" message to your friends by wearing red today!

Thursday, February 02, 2006

Depression and cardiac arrest

There appears to be an association between depression and an increased risk of sudden cardiac death, independent of established coronary heart disease risk factors, the findings of a multicenter study suggest.

The analysis showed that depressed subjects were 43 percent more likely to experience cardiac arrest than non-depressed subjects. Moreover, the link between depression and cardiac arrest was noted regardless of gender, age, or whether the patient had heart disease or not. The association remained significant, suggesting that atherosclerosis may in part be implicated.

Patients with milder depression had a 30 percent increased risk of cardiac arrest, whereas those with severe depression had a 77 percent increased risk.

Poor adherence to treatment and unhealthy lifestyle habits may explain the association. Also, a decrease in heart rate variability may be a factor.

As mentioned in a previous post, a single bout of exercise can help lift depression. Another recent study indicates that attainment of personal goals (in this case, exercise goals) appears to be of particular importance for lowering depressive symptoms.

Healthcare givers should help patients set goals and develop self-management strategies to achieve those goals.

Will you have a stroke?

The estimates for lifetime risk (LTR) of stroke has been reported for the United States population based on data from the Framingham study.

Lifetime risk was the same at ages 55, 65, and 75 years for study participants:

1 in 5 for women,
1 in 6 for men.

Participants with a normal BP, less than 120/80, had approximately half the LTR of stroke compared with those with high BP,140/90 mm Hg.

The LTR of Alzheimer's disease at age 65 approximated 1 in 5 for women and 1 in 10 for men.

The LTR of developing either stroke or dementia approximated 1 in 3 in both sexes.

  1. The LTR of stroke in middle-aged adults is 1 in 6 or more, which is equal to or greater than the LTR of Alzheimer's disease.
  2. Women had a higher risk because of longer life expectancy.
  3. BP is a significant determinant of the LTR of stroke, and promotion of normal BP levels in the community might be expected to substantially reduce this risk.

As hypertension is the BIG risk factor for stroke, Americans should closely monitor their numbers. Sure, it's nice that life expectancy has increased, but it's the quality that counts. Here are the latest blood pressure guidelines: follow them to make sure your later years are healthy ones.

Wednesday, February 01, 2006

February is American Heart Month

I, GEORGE W. BUSH, President of the United States of America, do hereby proclaim February 2006 as American Heart Month, and I invite all Americans to participate in National Wear Red Day on February 3, 2006. I also invite the Governors of the States, the Commonwealth of Puerto Rico, officials of other areas subject to the jurisdiction of the United States, and the American people to join me in recognizing and reaffirming our commitment to combating heart disease.

If you're in the Washington D.C. area in 2006, consider visiting the "Healthy Heart" exhibit at the National Museum of Health and Medicine in the Walter Reed Army Medical Center.

To see the Invision Guide to a Healthy Heart, the basis for the exhibit, visit this interactive site.

Word from the WISE on women and heart disease

The word from the WISE investigators is that doctors are missing the diagnosis in up to three million women with coronary heart disease because their clinical and diagnostic signs differ from a male presentation.

Gender differences in cardiovascular risk factors and in the clinical presentation of coronary artery disease may explain why some women with coronary arteries that appear to be clear on angiography are actually at high risk for ischemic heart disease, reported investigators who analyzed data from the Women's Ischemia Syndrome Evaluation, or WISE study.

The lack of angiographic evidence of frank stenosis in women may cause them to be overlooked as candidates for more aggressive interventions, the researchers said.

"When there are no blockages, everybody slacks off, including the patient, and we don't want to do that," said Dr. George Sopko of the National Heart, Lung and Blood Institute. Such patients almost certainly need treatment, he said.

Women may complain of chest discomfort, dizziness, shortness of breath, or fatigue, have a negative stress test, and then a negative angiogram which only spots large blockages. Doctors offer no treatment and may even give a patient the impression that she is neurotic or needs to be treated for depression.

In the government-sponsored study, only a third of a group of women had obvious blockages in their coronary arteries. In a similar group of men, three-quarters or more would have a severe blockage, said Dr. Carl J. Pepine, the chief of cardiovascular medicine at the University of Florida in Gainesville.

In the remaining two-thirds of the women, those without blockages, more than half had abnormalities in their arteries, like an inability to dilate when needed, that could cause ischemia, Dr. Pepine said. The abnormalities occurred in both the coronary arteries and smaller ones that feed the heart, a network of tiny vessels called the microvasculature. Tests showed that the artery walls were full of plaque but had grown outward to accommodate it, so that the opening appeared normal. But eventually, the condition may progress enough to start pinching the artery shut, Dr. Pepine said.

After four years, the rate of deaths or heart attacks in the group without blockages was 10 percent.

"That's much too high for somebody with a normal coronary angiogram," Dr. Pepine said.

It is not clear why women seem more prone to the hidden vascular disease, the researchers said, though it may be linked to hormonal imbalances and a greater tendency to suffer from inflammation, which plays a role in artery disease.

What to do?

  • Identify candidates for exercise stress testing vs. medication stress testing: Using the evaluative tool Duke Activity Status Index (DASI) in women with heart disease symptoms prior to stress testing can help determine who would be eligible for an exercise stress test versus a stress test using intravenous medications to increase the heart load instead of exercise. Current guidelines offer physicians little guidance on how to identify women who would not be able to sufficiently complete the exercise test.
  • Determine Role of Pre-menopausal Hypertension in Disease Risk: Women who have high blood pressure before menopause, especially high systolic blood pressure, should be considered at a higher risk and treated accordingly.
  • Recommend stress echocardiography and single positron-emission computed tomography studies. They appear to be much better at estimating near-term prognosis (event-free survival) in women with chest pain symptoms.

Finally, patients with microvascular disease, who have gone through an entire battery of tests, with positive or negative results, are often treated with medications. All tests may be negative, but if the medication helps you with your symptoms, then physicians will want you to stick with the medications.

It's often a tough nut to crack. Don't ignore symptoms. Gain knowledge of the condition, be assertive, and work closely with your healthcare givers. The result should be in your favor.

Friday is National Wear Red day.

Future predictors of high blood pressure

Will certain metabolic factors and their change over time influence the development of high blood pressure in adults with initially optimal blood pressure (BP) ?

Researchers analyzed associations of BP in the optimal range, less than 120/80, metabolic risk factors, and their changes over 4-year follow-up, with 8-year incident hypertension, in a cohort of American Indians with a high prevalence of obesity.


1. Baseline normal glucose
Next exam(4 years later): baseline level of BP and decrease in beneficial HDL were the most potent predictors of hypertension 8 years later. Contributing factors: waist circumference, increase in BP, and presence of diabetes at the second examination.

2. Baseline abnormal glucose or diabetes
Next exam(4 years later): presence of diabetes was the most potent predictor of hypertension 8 years later. Contributing factors: an increase in BP and LDL cholesterol over the first 4 years.

Thus, hypertension can be predicted by initial metabolic profile (glucose and cholesterol) and unfavorable metabolic variations over time, in addition to initial BP.

So, if you have an optimal initial BP, increasing abdominal obesity, abnormal lipid profile, and presence of diabetes are major predictors of the development of high blood pressure.

Reason to get off of the couch:

A new study indicates that the addition of exercise to a low calorie diet is crucial to reducing abdominal fat cell size in obese individuals. The exercise could be of a low- or high-intensity nature. Diet alone, diet plus low-intensity exercise, and diet plus high-intensity exercise reduced body weight, fat mass, percent fat, and waist and hip girths to a similar degree. However, only exercise added to the dietary regimen, reduced fat cell size at the waist as determined by tissue biopsy.