Questions and Answers: 2010

1. What percentage of people has elevated cholesterol?
2. I recently had a stent placed. My doctor put me on aspirin and another blood thinner called plavix. Can I stop these before I have my tooth pulled?
3. Are people with migraine at increased risk for heart disease?
4. Is the level of intelligence related to the risk of heart disease?
5. How do women fare when it comes to prevention and treatment of heart attacks ?
6. Are nuts good for my heart?
7. I am diabetic but don’t have any heart problems. Should I take aspirin for protection?
8. Is there a relation between oral hygiene and heart disease?
9. I have read that owning a pet can help reduce your stress and improve your mood. Is there any cardiac benefit?
10. How will my cholesterol change after menopause?
11. I am a smoker who had a heart attack last month. Is it too late to quit now?
12. I have had a heart attack and often get stressed out at work. I am concerned this may affect my heart and set me back. What can I do?
13. Can lack of sleep affect my heart?
14. Can you please elaborate on the news regarding the use of a certain cholesterol medicine in healthy people with low cholesterol levels?

2009

15. What is syncope?
16. What is the relation between salt and cardiovascular disease?
17. Is there a link between the size of my neck and my risk of heart disease?
18. I have hypertension that is relatively well controlled. My doctor ordered an MRI that showed one of my kidney arteries is blocked. He recommended referral for possible stent placement. Is that necessary?
19. Will taking folic acid supplements help my heart?
20. What is your take on the recent news regarding Avandia?
21. My pregnant friend recently had a heart attack. How common is that?
22. I was recently diagnosed with heart failure , but was told that my heart was "strong". How can that be?
23. Is Cocoa good for my heart?
24. # I am a 56 year old woman with strong family history of heart disaease. I am always fearing the worst and can't shake my fears. I am doing what I can to reduce my risk. Is there anything else I can do?
25. Are energy drinks safe for the heart?
26. My doctor started me on a statin for cholesterol but it hurts my bones and I cannot take it. What should I do?
27. Is erectile dysfunction(ED) linked to heart disease in any way?
28. Is it true that olive oil reduces the risk of heart disease?
29. Is sea food and omega-3 Fatty acid beneficial for the heart?
30. Should healthy people with normal or low cholesterol take cholesterol medicine?
31. Is fish beneficial for the heart?
32. Is there a relation between psoriasis and heart disease?
33. Can second hand smoking really hurt your heart?
34. I am on a blood thinner called Coumadin for a heart condition. I am unable to travel to my doctor's office for the frequent blood checks needed. Is there an alternative?
35. What is a cardiac CT scan and who should get this test?
36. I am a 40 y.o. woman with strong family history of high blood pressure. What can I do to reduce my risk of having hypertension?
37. I recently had a cardiac catheterization. My doctor told me I had a blockage in one of the arteries in my heart, but it did not need "fixing". How can you tell if a blockage needs to be fixed?
38. I have atrial fibrillation and my doctor asked me to take a blood thinner. Is this necessary?
39. I recently had a heart attack. How can I reduce my risk of further problems down the road?
40. What is heart failure?
41. Is fish oil good for my heart?
42. Can stress in a teenager cause heart disease later in life?
43. Is there a relationship between blood pressure and outdoor temperature?
44. Can weightlifting cause high blood pressure or worsen existing high blood pressure?
45. My grandmother was diagnosed with Aortic Valve stenosis, but surgery was not felt to be an option. Are there any other alternatives?
46. As a woman, should I be as concerned about heart disease as my husband?
47. How is erectile dysfunction linked to heart disease?
48. I heard that some heartburn medications may interfere with my Plavix medicine. Is that true?
49. Are video games bad for my child's health?
50. I have mitral valve regurgitation and have been advised to have surgery. Are there any alternatives?
51. Does anxiety affect my heart?
52. Is getting stuck in traffic bad for my heart?
53. I keep hearing that we (baby boomers) are likely to face a shortage in cardiology specialists and access to cardiologists. Is that true?
54. Is it true that women may not get equal attention when it comes to heart disease?
55. My 82 year old dad recently had a heart attack . He was treated and released home but died few days later. I wonder if he received the right care!
56. I was told I needed to have my aortic valve replaced. What is the difference between a mechanical and a pig valve?
57. Can a defibrillator (ICD) protect me from a heart attack?
58. My father has atrial fibrillation and has learned that Hawthorn vitamins could help prevent the attacks. Could you please tell me what you know of Hawthorn, if anything?
59. I was recently diagnosed with a blocked artery in my leg. My doctor referred me to a cardiologist to have my heart checked. Why is that?
60. My son was diagnosed with Marfan's syndrome after finding a leaky valve in his heart. What is this syndrome and how does it affect the heart?
61. Can Tasers cause a heart attack?
62. How is anger linked to heart disease?
63. How can I tell if I am at risk for having a heart attack?
64. I was recently hospitalized for heart failure. My primary doctor was a hospitalist and the cardiologist was seeing me as a consultant. Did I receive the right care?
65. What is the cause of sudden death in some young athletes?

2008

66. Is there any correlation between sleep apnea and heart disease?
67. Sometimes I feel like my heart is skipping. Should I worry?
68. I am a middle aged woman with no heart problems. Should I take aspirin to lower my risk in the future?
69. Can patients who take nitroglycerine use Viagra?
70. How can I raise my HDL?
71. Are statins dangerous?
72. I was recently diagnosed with an irregular heart beat called atrial fibrillation. My doctor told me that this was likely related to my overweight and possible sleep apnea. I have always been heavy and never had these problems before. Please explain.
73. Does emotional stress cause heart problems?
74. My doctor told me that I have metabolic syndrome. What is it?
75. I recently had a heart attack and was treated with an emergency stent procedure. Since my problem has been fixed, should I expect a normal lifespan and should I worry about taking any medicines?
76. Have heard conflicting reports about the best way to perform CPR. Is it better to do chest compression alone or with mouth to mouth ventilation?

2007

77. I have type-2 diabetes. My blood pressure is not very high and I feel fine, yet my doctor insists on giving me pills to lower it further. Is it important to do so?
78. Does air pollution affect my heart?
79. How can I reduce my risk of a heart attack?
80. I am taking cholesterol medication, but I keep hearing about possible side effects. Should I be concerned?
81. I recently heard about a link between soft drinks and heart disease. Can you please explain?
82. My doctor started me on blood pressure medicine and my pressure now is better. Can I stop the medicine?
83. Can you please elaborate on the recent news that related some popular heartburn drugs to increased heart attacks?
84. I recently read about women possibly requiring different treatment for heart disease. Can you elaborate?
85. Is there a relationship between migraine and heart disease?
86. My Dad was recently diagnosed with pericarditis. What is this?

Answers

• What percentage of people has elevated cholesterol? About 20% of the adult population has elevated bad cholesterol or LDL. This number is down from about 32% back in 2000. The drop is due to a combination of better screening, better drugs and life style changes. The bad news is that a large percentage of adults are still not being screened or treated for high cholesterol. A recent study in The Journal of the American Medical Association showed that among those who tested high for LDL during the study: 35.5% had not been screened for LDL in the past, 24.9% who had been screened previously were unaware they had high LDL levels, and 39.6% were untreated or not treated adequately . (back to question list)

• I recently had a stent placed. My doctor put me on aspirin and another blood thinner called plavix. Can I stop these before I have my tooth pulled? You should talk to your cardiologist before interrupting the plavix and aspirin. Your surgeon or dentist must communicate and coordinate with your cardiologist before finalizing the plan to take you off these medicines. Depending on your type of stent and the time you had it done, you may be at risk for clotting the stent if you stop these medicines early. The consequences may be catastrophic. Simple procedures such as dental work should not require cessation of these medicines. Other elective and more invasive procedures or surgeries should be postponed until your cardiologist feels it is safe to come off the plavix. (back to question list)

• Are people with migraine at increased risk for heart disease? A study published in “Neurology” compared the risk of heart attack, stroke, and other risk factors for heart disease among 6,102 people with migraine headaches and those with no migraine. Those with migraines were twice as likely to have a heart attack and the risk was nearly three times greater for those who experienced migraine with aura . People with migraines with aura were also nearly three times more likely to have had a stroke. The risk of other underlying risk factors for heart disease, such as high cholesterol, diabetes, and high blood pressure, was also higher among those with migraine. Although the overall risk was small, people with migraine may need to be more aggressive in controlling their risk factors. (back to question list)

• Is the level of intelligence related to the risk of heart disease? : A Scottish study that tracked over a thousand patient for 20 years found that people with lower I.Q.’s had four times higher risk of heart disease. The exact reason behind this is not clear and the interaction may be complex. Factors that may contribute to low I.Q such as poor diet or chronic illness in early life may also lead to poorer heart health. In addition, people with lower intelligence also are known to adopt less healthful behaviors — they smoke and drink more and are more likely to have a poor diet. It may be that people with low I.Q. have a more difficult time understanding complex health messages and don’t fully understand the long-term health effects of an unhealthy lifestyle. (back to question list)

• How do women fare when it comes to prevention and treatment of heart attacks ? In general, women fare slightly worse that men in both. The “GO Red for Women” study uncovered some worrisome facts: nearly half of women would not call 911 if they thought they were having symptoms of a heart attack, half were not aware that heart disease is the number one killer in women, only 56% of women knew chest, neck, shoulder, and arm pain could be a heart attack symptom, and 29% of women knew shortness of breath was a symptom. These findings underscore the importance of heart disease education among women to improve the prevention and treatment of heart disease and heart attacks. (back to question list)

• Are nuts good for my heart? Yes. Some are better than others. Nuts can lower bad cholesterol, increase good cholesterol and induce early satiety, thus limiting the calorie intake. Almonds have the best reputation. Eating almonds has been shown to reduce the risk of heart attack and the likelihood of gaining weight. My advice is to eat small portions of unsalted almonds as a snack in between meals, especially when you are hungry or craving sweets. (back to question list)

• I am diabetic but don’t have any heart problems. Should I take aspirin for protection? The protective effect of aspirin (ASA) in healthy patients with no prior heart disease remains controversial. Diabetes is a well known risk factor for having a heart attack or stroke and patients with diabetes are at increased risk. Recently, the American Diabetes Association recommended aspirin at 75 mg to 162 mg per day for primary prevention in diabetics with a >10% 10-year risk of cardiovascular events. This includes most diabetic men >50 years of age or women >60 years of age who have at least one additional major risk factor (family history of cardiovascular disease, hypertension, smoking, elevated cholesterol, or albuminuria-protein in the urine-). (back to question list)

• Is there a relation between oral hygiene and heart disease? There appears to be an increased risk of coronary heart disease among adults with periodontal disease. The exact reason is not clear but it is felt that the chronic inflammation in the periodontal tissue may trigger an inflammation in the blood vessels that accelerates plaque buildup in the arteries and disrupts the health of the endothelium which is the inner lining of the arterial wall. Periodontitis- a very common chronic infection of the tissue surrounding the teeth-has been shown to be associated with elevated levels of C-reactive protein (CRP) and other inflammatory biomarkers, the same markers that have been linked to heart disease. In addition many of the risk factors for heart disease, such as smoking, diabetes, and obesity, also predispose to poor dental hygiene. In a small study, poor oral health was a stronger predictor of heart disease than some other traditional risk markers such as high triglycerides. Treating periodontal disease can result in long-term improvement in the health of the arteries and may reduce the risk of heart disease. (back to question list)

• I have read that owning a pet can help reduce your stress and improve your mood. Is there any cardiac benefit? There are many reports about the positive impact of owning a pet on general health. You are also right that some have reported improvement in psychological wellbeing in those who own a pet. From a cardiac standpoint, similar positive findings have been reported. In a study that followed patients with very stressful jobs who had hypertension, owning a pet was found to significantly reduce stress-related increases in blood pressure. The study was conducted by researchers at the State University of New York at Buffalo, who followed 48 stockbrokers already taking medication for hypertension, and found that those who obtained a pet reduced by half the increase in blood pressure that came with stress. Another study showed that dog owners had a significantly better survival rate one year after a heart attack. Overall, pet owners have a lower risk of dying from any cardiac disease. (back to question list)

• How will my cholesterol change after menopause? Blood levels of LDL cholesterol, the bad kind that blocks arteries, go up sharply in women at the time of menopause. This suggests that as women approach menopause, they need to have their lipid profiles checked even if their cholesterol levels have previously been "normal." It is well known that a woman's cardiovascular risk increases with age especially after menopause and it appears that a change in the bad cholesterol may be one of the contributing factors. These findings were recently reported in the Journal of the American College of Cardiology. (back to question list)

• I am a smoker who had a heart attack last month. Is it too late to quit now? Better late than never. A recent study in the Journal of the American College of Cardiology found that smokers who quit before an initial heart attack cut their risk of dying by 50%, while those who quit after a heart attack reduced their risk by 37%, compared with persistent smokers. Cutting back on the number of cigarettes smoked daily also reduced the risk of death after a heart attack. The message is : Not smoking is best, quitting after a heart attack is great, and if you can't quit, reducing the number of cigarettes smoked may still help. (back to question list)

• I have had a heart attack and often get stressed out at work. I am concerned this may affect my heart and set me back. What can I do? Let it out! A Swedish study in the Journal of Epidemiology and Community Health found that men who suppress their anger at work are two to five times more likely to suffer a heart attack or die from heart disease than those who quickly vent their frustration. Bottling up anger and frustration may harm the heart. The analysis found those who often relied on "covert coping," where they walked away or ignored unfair treatment, often paid the price in terms of their health. (back to question list)

• Can lack of sleep affect my heart? Poor sleep habits have been related to many illnesses and associated with increased risk of cardiovascular disease. Even more, taking a brief nap during the day may boost your heart. A recent publication in the Archives of Internal Medicine suggests that taking a 30min nap during the day three times a week may reduce your risk of dying from heart disease by 37%. (back to question list)

• Can you please elaborate on the news regarding the use of a certain cholesterol medicine in healthy people with low cholesterol levels? I believe you are referring to the drug Rosuvostatin (Crestor; by Astra Zeneca). Last year, a landmark trial -JUPITER- tested the use of Crestor in healthy people with low cholesterol (median LDL: 108mg/dl) who had an elevated C-reactive protein (CRP). CRP is a marker of inflammation that may predict increased risk of cardiac events. In this study, Crestor lowered the bad cholesterol-LDL- from 108 to 55mg/dl and reduced the rate of heart attack, stroke, need for cardiac surgery and death from a cardiac cause by 44%. Based on this, the FDA will likely recommend using Crestor to treat healthy people (males>50 and females>60) with low LDL levels (<130mg/dl) who have an elevated CRP (>2mg/l). This will expand the indication for treating cholesterol to millions of people who were not thought to need treatment based on current guidelines. (back to question list)

• What is syncope? Syncope is temporary loss of consciousness, described as "fainting" or "passing out." It's usually related to temporary insufficient blood flow to the brain. It's a common problem, accounting for 3 percent of emergency room visits and 6 percent of hospital admissions. Neurocardiogenic or vasovagal syncope is the most common type of fainting especially in children and young adults. It happens due to a complex reflex that causes blood pressure to drop, reducing circulation to the brain and causing loss of consciousness. Typical vasovagal syncope occurs while standing and is often preceded by a sensation of warmth, nausea, lightheadedness and visual "grayout”. It may be triggered by emotional stress, pain, pooling of blood in the legs due to sudden changes in body position, overheating, dehydration, heavy sweating or exhaustion. Syncope may also occur during violent coughing spells because of rapid changes in blood pressure. Some more serious heart and neurological problems can also result in syncope. (back to question list)

• What is the relation between salt and cardiovascular disease? Reducing the salt intake by just 1 gram per day for Americans will result in 250,000 fewer cases of new heart disease and 200,000 fewer deaths over 10 years in the US. A very modest decrease in the amount of salt -- hardly detectable in the taste of food -- can have dramatic health benefits for the U.S. This is particularly meaningful for African-Americans, who are more likely to have high blood pressure and whose blood pressure may be more sensitive to salt. These new statistics were recently announced at the American Heart Association's Annual Conference on Cardiovascular Disease Epidemiology and Prevention. (back to question list)

• Is there a link between the size of my neck and my risk of heart disease? Your collar size may tell if you are at risk for heart disease. Data presented at the recent American Heart Association meeting indicated that that the bigger a person's neck size, the greater that person's risk of high levels of LDL "bad" cholesterol, insulin resistance, and high blood sugar. All of these are markers for heart disease. This held true even after controlling for belly fat. (back to question list)

• I have hypertension that is relatively well controlled. My doctor ordered an MRI that showed one of my kidney arteries is blocked. He recommended referral for possible stent placement. Is that necessary? Your cardiologist will use information from the catheterization, your symptoms and stress test (if any) to decide if there is clinical benefit of doing surgery or putting a stent to relieve a blockage. Sometimes, when there is doubt and in case of borderline blockages, we can use a special device that measures pressure drop across a blockage. Several trials including the DEFER and FRAME studies have shown that when decision to stenting is guided by such an approach, patients tend to do better. (back to question list)

• Will taking folic acid supplements help my heart? Many people want to believe that taking a vitamin or supplement is good for the heart. Previous studies negated any cardiac benefits for Vit E and C. More recently, the SEARCH study was presented at the American Heart Association meeting and failed to show any reduction in vascular event rates in patients taking folic acid compared to placebo. SEARCH throws cold water on a once-promising hypothesis, based on a well-known association between higher blood levels of the amino acid homocystine and higher cardiovascular disease (CVD) risk, that using folic acid to reduce blood levels of homocystine would prevent CVD. (back to question list)

• What is your take on the recent news regarding Avandia? Rosiglitazone (Avandia, GlaxoSmithKline) is currently used by over 7 million diabetic patients worldwide. A recent article in the NEJM which raised some issues regarding the cardiovascular safety of Avandia has generated a media frenzy.The sensationalism surrounding this study created unnecessary chaos and confusion at the patient level. The report was a review of several old studies and was not an original work by itself. In this review, the incidence of heart attack in the Avandia group ranged from 0.4-1.8% compared to 0.36 – 1.4% in those not taking Avandia. So the fact is that the overall incidence was low and the excess events in the Avandia group were also low. There are also rumors that the timing of this publication and the way it was reported was perhaps politically motivated. The above data should at most send a signal of concern but not a wave of panic. The findings indicate the need to await the results of more reliable studies such as the RECORD trial which started in 2000 and has enrolled several thousand patients. Unfortunately, the sensational media coverage and the threat of litigation may abort this important study, although interim analysis of data has not shown a major problem with the drug; otherwise the study would have been halted earlier. (back to question list)

• My pregnant friend recently had a heart attack. How common is that? Since most childbearing women are usually young, it is relatively uncommon to encounter one with a heart attack. Pregnancy; however, does increase the risk of a heart attack by 3-4 folds. The cause for the heart attack is secondary to atherosclerosis and similar to the non-pregnant population in many patients. However; coronary dissection or tearing up of the coronary arteries is unique to pregnant women especially around the time of delivery and is another cause for heart attack. This may be related to excess progesterone weakening the artery, in addition to the increased blood volume and heart rate that has the potential to damage the arteries. The outcome is usually worse than in non-pregnant women of the same age. (back to question list)

• I was recently diagnosed with heart failure , but was told that my heart was "strong". How can that be? Heart failure occurs when the heart function cannot meet the demands of the body. Most people associate this with a weak heart muscle. In fact, up to 40 or 50% of heart failure occur in patients with normal contractility and strength of the heart muscle. These patients are said to have "diastolic" heart failure, a condition that is brought on by inability of the muscle to relax well in between heart beats. The prognosis for this kind of heart failure is slightly better; however , it may be harder to treat. (back to question list)

• Is Cocoa good for my heart? A recent study in the Journal of the American College of Cardiology showed that the consumption of cocoa can improve vascular function in diabetic patients. Flavanol-containing foods such as cocoa, red wine, certain fruits and vegetables have beneficial effects on bad cholesterol, platelet aggregation, insulin sensitivity, endothelial function and blood pressure. (back to question list)

• # I am a 56 year old woman with strong family history of heart disaease. I am always fearing the worst and can't shake my fears. I am doing what I can to reduce my risk. Is there anything else I can do? Yes: be optimistic! According to research reported in Circulation: Journal of the American Heart Association, optimistic women have a lower risk of developing heart disease and dying than pessimistic women. Pessimistic African-American women, in particular, had a higher risk of dying in the study. It is unclear if interventions to change attitudes can alter risk. (back to question list)

• Are energy drinks safe for the heart? The use of so called “energy drinks” has increased dramatically especially among teenagers and younger adults. These drinks have high levels of caffeine and taurine (an amino acid), both of which may adversely affect heart function and blood pressure especially if consumed in large quantities. In a recent study presented at the AHA meeting this year, blood pressure and heart rate levels increased in healthy adults who drank two cans a day of a popular energy drink which contained 80 mg of caffeine and 1000mg of taurine per can. The increases in heart rate and blood pressure weren’t enough to cause problems in the healthy subjects of this study, but a person with high blood pressure or who has cardiovascular disease may not respond as well. (back to question list)

• My doctor started me on a statin for cholesterol but it hurts my bones and I cannot take it. What should I do? Statins do not cause bones to hurt. While it is true that few patients may have real intolerance to this class of drugs, the majority of complaints may not be real and are out of proportion to what is reported in the literature. Many of these complaints are heightened by the news media and second hand information from other patients. A recent study in the Archives of Internal medicine showed that people with or without heart disease who were prescribed a statin and adhered to taking it had a 45% lower death rate than those who were less adherent. My advice to you is the following: In general, statins are very well tolerated and have a tremendous impact on longevity and well being. Before you decide to stop taking the medicine, discuss all options and concerns with your physician. (back to question list)

• Is erectile dysfunction(ED) linked to heart disease in any way? Yes. Two recent studies in the Journal of the American College of Cardiology showed that men with diabetes and ED have a higher risk of cardiovascular disease than those with diabetes only. Researchers also found that treatment with statins and phosphodiesterase 5 inhibitors, such as Sildenafil ( Viagra) may reduce the occurrence of major cardiovascular events in men with diabetes and ED. (back to question list)

• Is it true that olive oil reduces the risk of heart disease? The Food and Drug Administration (FDA) has approved a new qualified health claim for olive oil based on research that indicated consuming about 2 tablespoons (23 grams) of olive oil a day may reduce the risk of heart disease. A qualified health claim is one for which there is limited but inconclusive scientific evidence. Olive oil contains monounsaturated fat, which can lower total cholesterol and low-density lipoprotein (LDL or bad cholesterol) in your blood. According to the FDA, you get the most of these benefits by substituting olive oil for saturated fats, such as in butter, rather than just adding more olive oil to your diet. (back to question list)

• Is sea food and omega-3 Fatty acid beneficial for the heart? Controlled studies are lacking in this area. Most of the information is derived from observational studies. A recent publication in the Journal of the American College of Cardiology suggest that the low rate of heart disease in Japanese people is related to their high seafood intake and specifically to the high levels of marine-derived Omega-3 fatty acids. In this study, Japanese men had twofold higher level of Omega-3 FA than white and Japanese Americans. They also had the lowest incidence of atherosclerosis. (back to question list)

• Should healthy people with normal or low cholesterol take cholesterol medicine? Cholesterol medications that belong to the statin family have been proven to reduce heart attacks, strokes and death in patients with heart disease and in those without known vascular disease but with risk factors such as diabetes and kidney failure. Recenly, a very daring trial (JUPITER) investigated the benefit of a potent statin ( Crestor, Rosuvastatin) in people with no heart disease or risk factors and who have normal or even low cholesterol, but who have an elevated CRP( C-reactive protein). CRP is a marker of inflammation that has been linked to increased cardiovascular risk. The study showed that those who received Crestor had significantly lower cardiovascular event rate. It is estimated that this finding will extend the indication for cholesterol treatment to about 11 million Americans who do not qualify for treatment according to current guidelines. (back to question list)

• Is fish beneficial for the heart? Fish contains Omega-3 fatty acids that have a beneficial impact on the cholesterol levels especially the good cholesterol. They also possess anti-inflammatory properties. A recent study presented at the American Heart Association meeting indicated that baked or boiled fish is associated with more benefit than fried, salted or dried fish. Also, Caucasian, Japanese-American and Latino men were more likely to get the health benefits of fish than African-American or Hawaiian men, perhaps because of how their fish is prepared or genetic predisposition. (back to question list)

• Is there a relation between psoriasis and heart disease? It is becoming increasingly evident that inflammation plays a key role in heart disease. A recent publication in the American Journal of Cardiology highlighted the increased risk of coronary disease and heart attacks in patients with psoriasis, especially the severe form. This increased risk is independent of the traditional risk factors for heart disease. It is recommended that every patient who has psoriasis, and definitely every person who has severe psoriasis, ought to have their cardiovascular risk factors looked at and treated." (back to question list)

• Can second hand smoking really hurt your heart? A recent study in "Circulation" found that non-smokers who are exposed to any amount of smoke, even the equivalent of far less than one cigarette a day, had a 20-30 % higher risk of cardiovascular disease and heart attacks. Reducing exposure and second hand smoking does work! Early results of a study commissioned by the Department of Health revealed heart attack rates dropped by about 10% in England in the year after the ban on smoking in public places was introduced in July 2007. Separate research found an even sharper decrease - 14% - in Scotland, where the ban was imposed a year earlier. (back to question list)

• I am on a blood thinner called Coumadin for a heart condition. I am unable to travel to my doctor's office for the frequent blood checks needed. Is there an alternative? Many cardiac patients have to take Coumadin for one reason or another. Although the medicine is safe and effective, its monitoring may be cumbersome. Recently, home monitoring equipment for blood thinning have become available for patients. A large study called "THINRS", showed that weekly home monitoring was as effective and safe as the usual monthly clinic testing. Not all patients may be good candidates for this approach; however, home monitoring may be an alternative for patients whose disabilities or distance from a medical facility make clinic visits difficult. (back to question list)

• What is a cardiac CT scan and who should get this test? Cardiac CT is a test that is used to look inside the coronary arteries in a way that is somewhat similar to a cardiac catheterization. It has the advantage of being non-invasive and fast, but is less accurate than a catheterization and has several limitations. It is best used in symptomatic patients who are at intermediate risk for cardiovascular disease. Like most other cardiac procedures, there is no role for this test in asymptomatic patients who "just want to know" or who are concerned because of family history or other risk factors. The only valid approach for these patients is aggressive control of their modifiable risk factors. (back to question list)

• I am a 40 y.o. woman with strong family history of high blood pressure. What can I do to reduce my risk of having hypertension? A study in the The Journal of the American Medical Association followed more than 80,000 women, 27 to 44 years from 1991-2005. Researchers found the following six healthy lifestyle factors were associated with a lower risk of developing high blood pressure: Healthy weight: body mass index (BMI) of less than 25. Daily exercise: average of 30 minutes of vigorous exercise per day. Heart-healthy diet: following the Dietary Approaches to Stop Hypertension (DASH) diet based on high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains, and low intake of sodium, sweetened beverages, and red and processed meats. Moderate alcohol use. Use of non-narcotic pain relievers ( such as Iboprufen and related drugs) less than once per week and taking a folic acid supplement of 400 micrograms daily. Women with all six of these healthy lifestyle factors (unfortunately only 0.3% of the women in the study), had an 80% lower risk of developing high blood pressure, regardless of family history of hypertension. (back to question list)

• I recently had a cardiac catheterization. My doctor told me I had a blockage in one of the arteries in my heart, but it did not need "fixing". How can you tell if a blockage needs to be fixed? Your cardiologist will use information from the catheterization, your symptoms and stress test (if any) to decide if there is clinical benefit of doing surgery or putting a stent to relieve a blockage. Sometimes, when there is doubt and in case of borderline blockages, we can use a special device that measures pressure drop across a blockage. Several trials including the DEFER and FRAME studies have shown that when decision to stenting is guided by such an approach, patients tend to do better. (back to question list)

• I have atrial fibrillation and my doctor asked me to take a blood thinner. Is this necessary? Atrial fibrillation is a common arrhythmia that affects over 2.2 million Americans. Its incidence increases with age and 3-5% of people over 65yrs will have it. During atrial fibrillation, the heart's two small upper chambers (the atria) quiver instead of beating effectively. Blood isn't pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results. About 15 percent of strokes occur in people with atrial fibrillation. A blood thinner called Coumadin is required for many patients to lower the risk of stroke. Aspirin may be an alternative for some. (back to question list)

• I recently had a heart attack. How can I reduce my risk of further problems down the road? People with and without known heart disease can take certain measures to reduce their future risk. In general, controlling the modifiable risk factors such as smoking, cholesterol and high blood pressure is the key. Having a tight and aggressive control of all of these factors is much better than some control in only some of them. Cleveland Clinic researchers found that patients who were able to get their low-density lipoprotein (LDL) cholesterol below 70 mg/dL and their systolic blood pressure (the top number in a blood pressure reading) below 120 with medication had less plaque buildup over the course of the study than patients who reached just one or neither of these targets. The message is the following: Get your cholesterol as low as you can and get a solid control on your blood pressure. Having just "average" control of your risk factors is NOT enough. (back to question list)

• What is heart failure? Congestive heart failure is a term used to describe failure of the heart to meet the demands of the body. This can be due to weakness of the heart muscle with diminished ability to pump the blood or to increased stiffness of the heart making it harder for the heart to fill. The former is called systolic heart failure and the latter diastolic heart failure. Symptoms may include shortness of breath, diminished exercise tolerance, and/or swelling in the legs. Prior heart attack, poorly controlled hypertension and viral infections are some of the causes of heart failure. Regardless of the cause, there are now effective therapies to help with most types of heart failure. Aggressive blood pressure control, by itself, can reduce the risk of congestive heart failure by 50% in some patients. (back to question list)

• Is fish oil good for my heart? There are many supplements that people take to help their heart. Unfortunately, most of these do not work. Omega-3 Fatty acids (or fish oil) may be an exception. A recent publication in the Journal of the American College of Cardiology, reviewed the findings of four studies comparing the benefits of omega-3 fatty acids in heart disease prevention over the past 30 years. People with established heart disease, had a 30% reduction in the risk of cardiac death. There was also reduction of cardiac events in healthy people with no known cardiac disease when they took a daily dose of Omega-3 fatty acids. (back to question list)

• Can stress in a teenager cause heart disease later in life? There is no sure answer for this, but a small study from the University of California says that it may. In this study, the researchers found that teenagers who experience a lot of daily interpersonal stress have increased blood levels of a protein linked to chronic inflammation (CRP), which in turn might indicate a greater risk of heart disease later in life. (back to question list)

• Is there a relationship between blood pressure and outdoor temperature? A recent study published in the Archives of Internal Medicine showed a strong correlation between temperature and blood pressure readings. This was especially true in the elderly and most prominent in those 80 years or older. Increasing temperatures were associated with lower systolic blood pressure. The study authors suggested that periods of extreme temperatures should prompt careful monitoring of blood pressure and antihypertensive treatment in the elderly. (back to question list)

• Can weightlifting cause high blood pressure or worsen existing high blood pressure? Weightlifting doesn't cause persistent high blood pressure. But it can cause a temporary increase in blood pressure. This increase can be dramatic depending on how much weight you lift.
  
  Strength training exercises, such as weightlifting, had once been discouraged in people with high blood pressure. But this is no longer the case. Strength training can slow or reverse declines in strength, bone density and muscle mass as you age. If you have high blood pressure, here are some important tips for getting started on a weightlifting program: Check with your doctor before starting any new exercise program. Don't hold your breath. Holding your breath during exertion can cause your blood pressure to spike. Instead, breathe easily and continuously during each lift. Lift less weight with more repetitions. Heavier weights require more strain, which can increase blood pressure. Listen to your body. Stop your activity right away if you become severely out of breath or dizzy or if you experience chest pain or pressure. (back to question list)

• My grandmother was diagnosed with Aortic Valve stenosis, but surgery was not felt to be an option. Are there any other alternatives? Aortic valve stenosis is a relatively common condition especially in the elderly. The aortic valve controls the exit of blood from the left side of the heart. With wear and tear, the valve becomes thick, calcified and narrowed. This makes it harder for the heart to pump the blood through it leading to many problems including heart failure, angina, and death. Very old patients and those with other serious medical problems may not be surgical candidates. There is ongoing work being done in percutaneous aortic valve repair, where an artificial valve mounted on a stent is introduced from the leg artery without the need for surgery. This is not a standard procedure yet and much work remains to be done to establish its safety and efficacy. (back to question list)

• As a woman, should I be as concerned about heart disease as my husband? Absolutely! Heart disease has been the leading cause of death in women since 1908. Almost every minute, a woman in the United States dies from heart disease. Six times as many women will die from heart attacks alone this year than will die from breast cancer. Since 1984, more women than men have died of heart disease each year. Also, women are twice as likely as men to die after a heart attack. (back to question list)

• How is erectile dysfunction linked to heart disease? Erectile dysfunction(ED) is now considered a risk marker for coronary disease. Erection is attained through increased blood flow. If someone has blockages in the penile blood vessels that limit blood flow , ED results. These blockages are the result of plaque build-up in the blood vessels and are usually present throughout the circulation, including the coronay arteries that supply the heart. This is why in many people ED is a marker for the presence of vascular and coronary disease. (back to question list)

• I heard that some heartburn medications may interfere with my Plavix medicine. Is that true? Plavix is an anti-clotting medicine prescribed for patients after a heart attack and after having a stent procedure. Proton pump inhibitors (PPI) such as Prilosec , Nexium , Acifex and Pravacid are used to treat heartburn. There has been some suspicion that PPI's may blunt the effect of plavix and thus causer problems in some heart patients. No hard data exists to create a concern at this point and the American College of cardiology recommends that patients who are taking these medications should continue to do so. The ongoing COGENT-1 study should help clarify this matter in the future. (back to question list)

• Are video games bad for my child's health? The answer may depend on the type of video games. A recent study sponsored by Nintendo and presented at the American Heart Association meeting showed some surprisingly positive effect of some video games, at least in adults. In this study, playing active Wii sports video games and some Wii fit activities increased energy expenditure in adults as much as moderately intense exercise. The study concluded that the range of energy expenditure in these active games is sufficient to prevent or to improve obesity and lifestyle-related disease, including heart disease and diabetes! (back to question list)

• I have mitral valve regurgitation and have been advised to have surgery. Are there any alternatives? he mitral valve controls the flow of blood from the heart's upper left chamber (left atrium) into the lower left chamber (left ventricle). If the mitral valve leaks, a condition known as mitral regurgitation occurs where small to large quantities of blood flow back into the left atrium rather than to the aorta and subsequently on to the rest of the body. This condition, if severe, can lead to congestive heart failure or worsen existing heart failure. If the leakage is severe, surgical repair or replacement of the valve may be recommended. Several centers around the country are involved in clinical studies to explore less invasive approaches of fixing the valve without the need for surgery. These include putting a stitch across the valve or introducing hardware to tighten the valve opening and reduce the leakage. This is being done by introducing certain catheters from the arteries and veins in the legs or neck. Promising results have been reported; however, surgical treatment remains the gold standard for now. (back to question list)

• Does anxiety affect my heart? Anxiety and depression have both been felt to have a negative impact on cardiovascular health. In a recent publication in the Journal of the American College of Cardiology, researchers from Harvard found that patients with coronary artery disease and high level of anxiety had nearly double the rate of heart attack or death compared to patients with coronary disease and no anxiety. In this study, patients who started off with a high anxiety level but managed to control it later fared much better than those whose anxiety was unchanged or increased over the course of the study. (back to question list)

• Is getting stuck in traffic bad for my heart? It may! A German study shows that getting stuck in traffic may be unhealthy. They found that vulnerable patients were 3.2 times more likely to suffer a heart attack if they'd been in heavy traffic in the previous hour. One potential factor could be the exhaust and air pollution coming from other cars; however, the synergy between stress and air pollution may also exacerbate the problem. The risk was the same whether patients were driving or taking the bus and traffic appeared to be five times more dangerous to women than to men in this study. (back to question list)

• I keep hearing that we (baby boomers) are likely to face a shortage in cardiology specialists and access to cardiologists. Is that true? Unfortunately, what you are hearing is true and may be further compounded by the impending changes in health care and Medicare. The 2009 American College of Cardiology (ACC) Workforce Survey shows a significant and growing shortage in heart specialists in coming years. Currently, there is a shortage of more than 3,000 cardiologists in the U.S. workforce and this gap is expected to grow. The shortage is due to aging patient population (baby boomers), patients with heart disease living longer and an increase in the rates of obesity and type 2 diabetes in the general population as people live longer. Another important factor is that less and less students/physicians are choosing to train in cardiology and some are forced to early retirement due to the changing landscape in healthcare and decreasing Medicare funds to the field of cardiology. (back to question list)

• Is it true that women may not get equal attention when it comes to heart disease? You are partially right about this. While the gender gap is closing, there still remains some discrepancy in the treatment and diagnosis of heart disease in women. A recent publication in the Journal Circulation found that such discrepancy starts even after placing a 911 call, with women taking longer time to arrive to the hospital than men. In addition women are less likely to be diagnosed with a heart attack even if they have the same level of enzyme elevation in their blood as men and are less likely to receive certain cardiac procedures. When it comes to treatment, women tend to have slightly worse outcome after a heart attack and with certain procedures such as stenting and bypass surgery. (back to question list)

• My 82 year old dad recently had a heart attack . He was treated and released home but died few days later. I wonder if he received the right care! In all likelihood, your Dad did receive the best care. Heart attacks remain the leading cause of death in this country. Medicare data indicates that patients over 65 years old have a 16.5 % death rate within one month of their heart attack. This number may be much higher in very old patients like your Dad, or in those with complicating factors such as kidney disease, heart failure and other medical problems. (back to question list)

• I was told I needed to have my aortic valve replaced. What is the difference between a mechanical and a pig valve? Two types of valves may be used to replace the aortic valve: A mechanical, metallic valve or a biologic valve made of living material prepared in a certain way such as the pig valve. The choice between the two is usually decided after a thorough discussion between the patients and the cardiac surgeon. Mechanical valves require life-long anticoagulation with potent blood thinners . Tissue valves do not. Mechanical valves may be more durable. In general, mechanical valves are preferred for younger patients and biologic valves for those over 70. (back to question list)

• Can a defibrillator (ICD) protect me from a heart attack? An ICD is a device that is placed under the skin in the upper chest with a wire that leads into the heart. The ICD constantly senses the electrical activity of the heart, and if a dangerous heart rhythm should occur, called "ventricular tachycardia" or "ventricular fibrillation", the defibrillator is ready to deliver treatment in the form of either rapid pacing or a shock. This device is life-saving for people who are at risk for a cardiac arrest due to these dangerous heart rhythms. A heart attack is caused by sudden occlusion of a coronary artery. This is a mechanical problem that will not be prevented by the defibrillator. (back to question list)

• My father has atrial fibrillation and has learned that Hawthorn vitamins could help prevent the attacks. Could you please tell me what you know of Hawthorn, if anything? Hawthorn plants are shrubs and small trees characterized by their small pome fruit and thorny branches. The therapeutic benefits of hawthorn are felt to be secondary to its flavonoid and procyanidin properties. Hawthorn is felt to have many effects on the cardiovascular system, which include strengthening the heart muscle contraction, increasing coronary blood flow by dilating the heart's arteries and improving the conduction system of the heart. With regard to atrial fibrillation, one study has demonstrated a potential benefit in treating irregular heart rhythms by blocking potassium channels within the heart, not unlike the mechanism involved in more traditional medications that treat irregular heart rhythms. However, any studies have been too small to draw any firm conclusions and therefore it is premature to provide any validated recommendations. (back to question list)

• I was recently diagnosed with a blocked artery in my leg. My doctor referred me to a cardiologist to have my heart checked. Why is that? Peripheral arterial disease (PAD) is the name used to describe blockages in the arteries that supply the legs. Whatever causes disease in the leg arteries, can cause buildup and blockages in the coronary arteries. In fact, peripheral arteries are less likely to be involved by the process of atherosclerosis than coronary arteries, so when you have PAD, it is likely that you already have some form of coronary disease. Your cardiologist will be able to assess the level of coronary involvement, if any, and recommend appropriate treatment. (back to question list)

• My son was diagnosed with Marfan's syndrome after finding a leaky valve in his heart. What is this syndrome and how does it affect the heart? Marfan's syndrome is a disorder of the connective tissue in the body . It tends to run in families and can affect multiple organs . Diagnosis should be made by experts and genetic counseling should be provided. Cardiac involvement is due to defective elastin and connective tissue fibers that make up the valves and the aorta. Most concerning, is progressive enlargement of the aorta causing an aneurysm that may rupture. Another common involvement is disruption of the mitral valve resulting in leakage of blood from the left ventricle to the left atrium. When severe, surgical correction is indicated. (back to question list)

• Can Tasers cause a heart attack? Tasers are carried by over two-thirds of the US police agencies. Controversy and litigation has surrounded the use of these effective non-lethal weapons. Recent research from Wake Forest reviewed over 1200 case and found no link between tasers and fatal heart attacks. In addition , previous research has shown that injuries to police and suspects dropped down by 90% since tasers were introduced. (back to question list)

• How is anger linked to heart disease? Anger and hostility were associated with a 19% increase in coronary heart disease (CHD) events in healthy individuals and a 24% increase in risk among those with pre-existing heart disease. The study was recently published in the Journal of the American College of cardiology. The harmful effects of anger and hostility were greater in men than women. (back to question list)

• How can I tell if I am at risk for having a heart attack? There are many ways to assess someone’s risk. Measurement of C-reactive protein (CRP) and calcium scoring with CT scan have been used. However; the routine use of the first is still controvertial and the second is an expensive technology with radiation exposure and limited long term data. The Framingham risk scale is the best tested and easiest way to assess cardiovascular risk. Your 10 year Framinhgam risk score will vary depending on what risk factors you have. Patients at low risk will have a less than 10% chance of death or heart attack in the next 10 years. Those at high risk will have over 20% chance of death or heart attack in 10 years. You may calculate your “personalized” Framingham risk by going to our web site : www.coastalcarolinacardiology.com and clicking on the link “ Know if you are at risk for a heart attack” (back to question list)

• I was recently hospitalized for heart failure. My primary doctor was a hospitalist and the cardiologist was seeing me as a consultant. Did I receive the right care? Hospitalists are internists who specialize in care of sick patients in the hospital. Since many cardiac patients also have non-cardiac issues that a cardiologist may not be trained to handle, patients may actually do better if they are admitted to a hospitalist with their cardiologist acting as a consultant. A recent study in the Archives of Internal Medicine showed that hospitals where hospitalists are the primary care givers, performed better in almost every cardiac quality measure. It is possible that this is due to the fact that the cardiologist will have more time to focus on your cardiac care when someone else takes care of non-cardiac problems. In addition, there is a large body of evidence to suggest that hospitals that employ Intensivists to oversee-with the help of a cardiologist as needed- the care of all critically ill patients , have a 20% reduction in the death rate of these patients. The message here is that when each specialist focuses on what he does and knows best, patients do better. (back to question list)

• What is the cause of sudden death in some young athletes? It is always big news when a young healthy athlete collapses suddenly. Provided there are no other obvious causes, two conditions are peculiar to these young people. One is called hypertrophic cardiomyopathy where the heart muscle is very thick and exercise can trigger sudden arrhythmia. The other condition has to do with anomalous coronary anatomy where the coronary arteries have an abnormal takeoff from the aorta and exercise can constrict blood flow to the heart. Appropriate screening can sometimes identify people at risk. (back to question list)

• Is there any correlation between sleep apnea and heart disease? The relationship between sleep apnea and cardiovascular disease is being increasingly recognized. Obstructive sleep apnea is a relatively common condition that can increase cardiovascular morbidity. It is created by repetitive upper airway obstruction during sleep resulting in profound effects on the cardiovascular function, blood pressure, oxygen exchange, and continuity of sleep. It is estimated that 2-4% of adults have sleep apnea and about 70-80% of these have obesity as the main cause of their problem. Sleep apnea has also been related to increased risk of cardiac arrhythmia such as atrial fibrillation. Early diagnosis and treatment is likely to improve the overall cardiovascular performance with improvement in heart failure symptoms and blood pressure control. Weight reduction, avoidance of alcohol and sedatives, use of ventilatory assistance devices, and in a few cases surgical intervention are all helpful approaches to the treatment of sleep apnea. (back to question list)

• Sometimes I feel like my heart is skipping. Should I worry? It is always a good policy to check with your doctor if you have symptoms like these especially if this is a new problem. Having said that, and unless you have had prior heart disease, most skipping is usually benign and due to extra heart beats originating from the upper or lower heart chambers. Stress, coffee, tea, alcohol, oral decongestants, and some asthma medications can bring it on or make it worse. Many cases will improve by avoiding these triggers while some may require medication either short term or long term. (back to question list)

• I am a middle aged woman with no heart problems. Should I take aspirin to lower my risk in the future? Aspirin is proven to reduce cardiovascular events in both men and women who have coronary artery disease and in men without coronary disease. The use of aspirin for primary prevention in women like you , without coronary disease, has been controvertial. While the Women’s Health Study showed benefit only in women over 65 years, the Nurses’ Health Study confirmed the benefit of aspirin in all age groups and especially in those over 65. Overall, prophylactic use of aspirin in women appears to be helpful, especially for those over 65 years or who have risk factors for heart disease. (back to question list)

• Can patients who take nitroglycerine use Viagra? No. Viagra, Cialis, and Levitra all belong to a group of drugs that is called phosphodiesterase inhibitors. From a cardiac standpoint, these are generally very safe drugs to take. The only exception is in those patients who are either actively taking or are likely to take Nitroglycerine. The combination of these drugs and nitroglycerine can cause a severe and sudden drop in blood pressure. It is strongly recommended to refrain from using Nitroglycerine within at least 24 hours of taking Viagra. Cialis and Levitra have a longer half-life and may require a longer period of nitrate avoidance after taking them. (back to question list)

• How can I raise my HDL? HDL or high density lipoprotein is also known as the good cholesterol. A low level of HDL is a well known risk factor for cardiovascular disease. Levels below 40 mg/deciliter for men and 50 mg/deciliter for women have been associated with increased risk for heart attack and stroke. Levels over 60 mg for men and 70 mg for women are felt to be protective. Many patients who have low HDL levels also have high triglycerides. Unfortunately, we do not have very affective means of increasing the HDL as we do for lowering the bad cholesterol. Weight loss, exercise, and smoking cessation are helpful in increasing the HDL levels. The statins are much more effective in lowering the bad cholesterol but can also have a modest impact on increasing the good cholesterol too. The most effective drug therapy that we have for increasing the HDL is Niacin or Nicotinic acid. It is estimated that this can increase the HDL by about 20-40%. (back to question list)

• Are statins dangerous? Statins are a family of drugs commonly used to lower cholesterol. The benefits of statin therapy are well established in patients who have known coronary artery disease and also in some who do not have coronary artery disease. Many large scale trials have documented a 30-35% reduction in the rate of death, stroke, and heart attack, in these patients. Concerns about the safety of these drugs have been largely born out of information available from the news media and the Internet. The National Lipid Association convened a panel of experts recently to address the safety of statins. Overall, these drugs were found to be extremely safe. A small percentage of patients may have some muscle pains but serious muscle injury (rhabdomyolysis) is very rare. Liver experts also concluded that statins have a very low risk of liver injury and may even be safe to take in patients who already have certain types of liver disease. Overall the risk/benefit ratio of this class of drugs is very favorable. (back to question list)

• I was recently diagnosed with an irregular heart beat called atrial fibrillation. My doctor told me that this was likely related to my overweight and possible sleep apnea. I have always been heavy and never had these problems before. Please explain. Your doctor is probably right. Although atrial fibrillation has many other triggers, obesity and sleep apnea are also considered potential culprits in the etiology of this arrhythmia. Each 5kg/m2 increase in the body mass index(BMI) increases the risk of atrial fibrillation by 15%. In addition, the presence of obstructive sleep apnea is a strong predictor of atrial fibrillation too. This is likely related to the periods of hypoxemia or low oxygenation that accompany this condition. Also, remember that problems have to start at some point, so being “always” heavy and not having the problem before does not contradict what your doctor told you. (back to question list)

• Does emotional stress cause heart problems? Mental stress can predispose to increased risk of cardiac events. Stress is not as easy to quantify as other risk factors such as cholesterol, blood pressure, and diabetes. Because of that, some controversy still exists as to the exact role that it plays. Stress can augment oxygen use by the heart and aggravate myocardial ischemia in patients who already have coronary artery disease. Mental stress can also cause coronary constriction or spasm and may increase platelet aggregation and impair endothelial function, thus increasing the risk of coronary thrombosis. More recently, sudden weakening of the heart muscle, as a result of extreme mental stress has been described, mainly in post menopausal women. Several names have been given to this entity including Tako-Tsubo cardiomyopathy, stress cardiomyopathy, transient left ventricular apical ballooning and broken heart syndrome. Tako-Tsubo is the Japanese name for the octopus traps that fishermen still use to catch octopus. In this syndrome, the heart takes the shape of a octopus trap when it is suddenly weakened. This form of heart disease can sometimes mimic a heart attack. It, however, occurs in patients without any significant blockages in their coronary arteries. The good new is that if this syndrome is recognized early, over 95% of the patients will fully recover within a few weeks. (back to question list)

• My doctor told me that I have metabolic syndrome. What is it? Metabolic syndrome is being increasingly recognized as a major risk factor for coronary artery disease. According to the American Heart Association and National Heart, Lung, and Blood Institute, the presence of three or more of the following constitutes the diagnosis of metabolic syndrome: 1.) A waste circumference of more than or equal to 40 inches in men and 35 inches in women. 2.) Elevated triglycerides (more than or equal to 150 mg/deciliter). 3) Reduced HDL or good cholesterol (less than 40 mg/deciliter in men and less than 50 mg/deciliter in women).4) Elevated blood pressure (greater or equal to 130 mmHg systolic or 85 mmHg diastolic blood pressure or on drug treatment for history of hypertension) and 5) Elevated fasting glucose of greater or equal to 100 mg per deciliter or known history of diabetes.
  
  Findings from the Third National Health and Nutrition Examination published in 2002 estimated that about 47 million Americans have metabolic syndrome. A more aggressive approach to control risk factors is warranted in these patients to reduce the risk of heart attack and stroke. (back to question list)

• I recently had a heart attack and was treated with an emergency stent procedure. Since my problem has been fixed, should I expect a normal lifespan and should I worry about taking any medicines? Emergency stenting in the setting of a heart attack is the best treatment available to improve short and long term outcomes. Many variables including age, size of heart attack, kidney function, time to presentation..etc. can heavily influence the outcome and life span after a heart attack. Medicare database shows about a 16% mortality or death rate in the first month after a heart attack. This number may be higher or lower depending on the variables mentioned earlier. Please remember that although you received state of the art treatment, your problem is not “fixed”. Stenting and bypass surgery do not modify the disease process that led to your heart attack and serious work is needed on your part to aggressively modify your risk factors and take medicines that are proven to reduce cardiac events and cardiac death after a heart attack. (back to question list)

• Have heard conflicting reports about the best way to perform CPR. Is it better to do chest compression alone or with mouth to mouth ventilation? Cardiopulmonary resuscitation (CPR) is often performed by bystanders who witness a cardiac arrest. The standard has been to deliver chest compressions (about 5 every 5 seconds) interrupted by mouth to mouth ventilation at a rate of one to two breath for each five chest compressions. This can be done by the same operator or by another bystander. Recently, chest compression as a stand alone technique has been advocated. A study published in the Lancet this year looked at over 4000 patients who had CPR and found that chest compression alone is equivalent or superior to the conventional CPR which also includes mouth to mouth ventilation. This is likely due to the fact that ventilation usually requires interruption of compressions which in turn reduces the blood supply to vital organs. (back to question list)

• I have type-2 diabetes. My blood pressure is not very high and I feel fine, yet my doctor insists on giving me pills to lower it further. Is it important to do so? Diabetes is a very important risk factor for heart disease. A more aggressive approach to treating patients with diabetes is usually warranted. Current guidelines recommend targeting a blood pressure below 130/80 in diabetics. The ADVANCE study was recently presented at the European Society of Cardiology meeting in Vienna. In this study, even modest reduction (5.6/2.2 mmHg) in blood pressure using a combination of an ACE-I and a mild diuretic resulted in 18% reduction in cardiovascular deaths and 21% lower risk of developing new or worsening kidney disease. The benefit for treated patients was seen both in the group who began with blood pressures above 140/90 and those who began at levels below this cut-off. (back to question list)

• Does air pollution affect my heart? Urban air pollution may affect cardiovascular health in many ways. A recent publication in the American Journal of Respiratory and Critical Care Medicine addressed this issue. Inflammatory marker high-sensitivity C-reactive protein, oxidative stress markers, and various coagulation indices were all adversely affected by high levels of pollution. All these markers are associated with increased cardiac risk. Elevated nitrate, sulfate and ozone levels were found to be the main culprits. (back to question list)

• How can I reduce my risk of a heart attack? There are several conditions that may increase your risk of having a stroke or a heart attack. These include: smoking, diabetes, high cholesterol, high blood pressure, family history of heart disease in a first degree relative, sedentary life style, advanced age and obesity. Men may have a higher risk of a heart attack than women early on in life; however, women will "catch up" after menopause. Some of these risk factors such as gender, age, family history cannot be changed, but controlling the others will help reduce your risk.
  
  It is very important to lower your blood pressure if it is high. A blood pressure below 140/80 is desirable and in certain individuals, such as those with diabetes, a level below 130/80 is advisable. Many times this will require long term treatment with one or more blood pressure medicine. Although you may not feel "better" immediately after treating your pressure, it is well known that in the long run such treatment will lower your risk of heart attack by about 20-25%, stroke by 35-40% and heart failure by 50%.
  
  Even more important is lowering your cholesterol. Your doctor will advise you if your cholesterol needs treatment. Some patients such as those with diabetes or previous heart disease will benefit from having very low cholesterol. In general, lowering your bad cholesterol by about 30% is likely to reduce your risk of death from a stroke or heart attack by about 35%. Your doctor will advise you about the appropriate cholesterol level for your particular situation. Although diet and exercise are important in lowering cholesterol, many patients will have to take medicine to effectively control their levels.
  
  Good control of the diabetes is also very important and smoking cessation is essential as tobacco is well known to increase risk for heart disease and stroke. (back to question list)

• I am taking cholesterol medication, but I keep hearing about possible side effects. Should I be concerned? You should always discuss your concerns with your doctor. Every medicine has the potential for side effects and cholesterol lowering medications are no exception. The most commonly prescribed cholesterol medications belong to the "statin" family. These are highly effective drugs that have been clearly shown to save lives. In general, they are very safe and the risk of a serious side effect is very low. (back to question list)

• I recently heard about a link between soft drinks and heart disease. Can you please explain? I believe you are referring to a study that was recently published in the Circulation . Nine thousand middle-aged men and women in the Framingham study were followed for 4 years. Those who drank one or more soft drinks daily had a 48 % increased prevalence of the metabolic syndrome. Metabolic syndrome is a cluster of risk factors for heart disease including excess waist circumference, high blood pressure, elevated triglycerides, low levels of high-density lipoprotein (HDL "good" cholesterol) and high fasting glucose levels. What is striking about this study is that the risk was the same whether the drinks were diet or regular. The reason is unclear and the study demonstrates an association but does not prove causality. (back to question list)

• My doctor started me on blood pressure medicine and my pressure now is better. Can I stop the medicine? No. Remember that in most cases blood pressure, like high cholesterol, can be treated but not cured. This means that your pressure is better now because you are on the medicine and will likely go back up once you stop. High blood pressure often requires life long treatment with more than one drug. A reduction of the systolic blood pressure by 20 mmHg or the diastolic blood pressure by 10mmHg will decrease the risk of heart attack, stroke and heart failure by about 25%, 35%, and 50% respectively. (back to question list)

• Can you please elaborate on the recent news that related some popular heartburn drugs to increased heart attacks? Long term use of Proton pump Inhibitors such as Omeprazole(Prilosec), Esomeprazole (Nexium), and Lansoprazole (Prevacid) was recently linked to possible risk of heart attacks, heart failure and heart-related sudden death. The alarm was based on two small studies of Prilosec and Nexium. Like many other media scares recently, this one did not prove right either. After reviewing the pertinent information, the FDA concluded that these data did not suggest an increased risk of heart problems. The FDA added that health care providers should not change their prescribing practices and patients should not change their use of these products at this time. (back to question list)

• I recently read about women possibly requiring different treatment for heart disease. Can you elaborate? Women have been known to have a somewhat higher risk with invasive cardiac procedures and bypass surgery. The OASIS-5 sub-study was recently presented at the European Society of Cardiology meeting in Vienna. In this study, women presenting with acute coronary syndromes who were routinely referred to invasive treatment had a higher risk of death compared to those who were selectively referred for such treatment. The reasons for this difference are not clear although smaller body size, smaller arteries, and older age at presentation may all be contributing factors. (back to question list)

• Is there a relationship between migraine and heart disease? Data from the Women's Health Study showed that migraine with aura was associated with an increased risk for heart attack, stroke, and death due to heart disease, as well as with coronary revascularization and angina in women. Similar findings were found in men. A new analysis of data from the Physicians' Health Study was recently published in the Archives of Internal Medicine. Over 20,000 men were followed for about 15 years. There was 42% increased risk of heart attacks in those with migraine. This data indicates that patients with migraines should perhaps be more aggressive in treating their modifiable risk factors such as hypertension, high cholesterol, smoking cessation,etc. (back to question list)

• My Dad was recently diagnosed with pericarditis. What is this? Pericarditis refers to inflammation of the sac that surrounds the heart. The most common cause is a viral infection. Chest pain, especially with respiration and with changing positions, is a common symptom. The condition is usually self limited and treated with anti-inflammatory medication. Rarely, serious complications can result. Recurrences are possible, although uncommon. Refractory cases may require treatment with steroids. (back to question list)