Women's Heart Advisor April 2011 Issue

Ask The Doctors: April 2011 Women's Edition

Q. What’s your opinion about eggs for people with heart disease?

Eggs are fine when eaten in moderation. If you have high LDL cholesterol or are taking a statin to lower your cholesterol, the American Heart Association recommends you eat less than 200 mg of cholesterol a day. One egg contains about 213 mg of cholesterol. If you have an egg for breakfast, you should eat vegetarian meals and nonfat dairy products that day. I tell patients it is okay to have one egg a week.

If you really love eggs, why not try liquid egg whites? They taste like whole eggs and are an excellent source of protein without cholesterol or saturated fat. You can have an unlimited amount of egg whites.

Q. I am taking warfarin (Coumadin) for atrial fibrillation, but I don’t know why.

Atrial fibrillation increases your risk of stroke. When your heart is beating too fast, it does not always contract well enough to completely empty the atrium of blood. This blood can pool and clot. Your heart can eject this clot into the bloodstream at any time, causing a stroke.

Warfarin helps prevent blood from clotting.

If you have no conventional risk factors for heart disease, you may take aspirin instead of warfarin. But if you have even one risk factor—hypertension or history of heart disease, for example—you should be taking warfarin.

An alternative to warfarin, the new drug dabigatran (Pradaxa), can be substituted, but the pros and cons should be weighed. (For more information on this drug, see the article on Pradaxa in this issue)

 

Q. I had a heart attack, and my husband had a stroke. Our granddaughter will be 25 this year. We think she should be tested for heart disease, but our daughter feels she is too young. Who is right?

Both of you are right. Even with a family history of cardiovascular disease, if your granddaughter is asymptomatic, she probably does not need a stress test.

The definition of premature cardiovascular disease (family history) is a fatal or nonfatal heart attack or stroke in a family member before the age of 55 for a man or 65 for a woman.

That being said, the American Heart Association and American College of Cardiology recommend that every person have a lipid panel by age 20 to determine their cholesterol and triglyercide levels. If they are at increased risk of cardiovascular disease, they should repeat the test yearly; if they are not at risk, every five years is sufficient.

Of course, your granddaughter should be living a healthy lifestyle from an early age. She should have normal blood pressure, fasting glucose and lipid levels. She should not smoke and should maintain a healthy body weight. These measures will help reduce the chance that she follows in her grandparents’ footsteps.

Q.

My mother was put on the beta-blocker metoprolol (Toprol) for high blood pressure. Now she thinks her diabetes is out of control because of it. Can this be possible?

Yes. Metoprolol can increase blood glucose levels and cause patients to gain weight. The risk is higher with metoprolol tartrate than metoprolol succinate, but neither drug is ideal for patients with diabetes.

I suggest you speak with your mother’s physician about switching her to carvedilol (Coreg), which does not raise glucose as much as metoprolol.

Q.

After having bypass surgery, I got involved in heart-healthy cooking and have lost 12 pounds. Before surgery, I used to have a glass of wine with dinner, but I have not had one since. What’s your opinion about an occasional drink?

Alcohol, particularly red wine, has been shown to offer some protection against death from heart disease when consumed in small amounts. The maximum daily recommended intake is 6 oz of wine, 1-2 oz of hard liquor or 12 oz of beer.

Alcohol is high in calories, so adding it to your diet may cause you to gain weight. It can also increase triglyceride levels. If you can stick with the recommended amount of 6 oz of wine with your dinner, I’d say go ahead.

But before you start, you may want to evaluate whether you want to add 90 calories a day to your diet.