Women's Heart Advisor January 2012 Issue

Ask The Doctors: January 2012 Women's Edition

Q. I am a ď60-somethingĒ woman with a personal and family history of cardiovascular disease. I have been diagnosed with osteopenia.† Should I worry about taking calcium and vitamin D?

A. The connection between calcium supplements and heart disease is unclear. Some studies have shown risk, while other studies have shown benefit. The most recent meta-analysis of clinical trials in† the British Medical Journal found a mildly increased risk of heart attack and other major adverse cardiac event in women taking calcium supplement. Therefore, the current recommendation is that you talk with your primary care physician, who will balance your risk of heart disease with your risk of osteoporosis.

Q. Is it safe for an 85-year-old woman to have mitral valve surgery? Iím in otherwise pretty good health.

A. The safety of the procedure really depends on your other medical conditions, as well as your age.† Factors such as reoperations, kidney disease (renal failure, renal insufficiency), chronic obstructive pulmonary disease (chronic bronchitis or emphysema) and bleeding disorders increase the risk of surgery.

Also, it is important to talk with your surgeon about how many cases he has done and what are the complication rates at the hospital where your surgery will be done, since these can affect safety.

Q. Doctors put a stent in my heart several years ago, and now I have carotid artery disease. What can I do to stop atherosclerosis from progressing? Conflicting diet advice is very confusing.

A. Atherosclerosis is a systemic disease, so the steps would you take to reduce your risk of stroke from carotid artery disease are the same as those for reducing the risk of heart attack from coronary artery disease. Your primary goals should be to lower your LDL cholesterol level below 70 mg/dL, keep your triglycerides below 150 mg/dL and lose weight, if you are heavy. A registered dietitian can help you determine the best way to accomplish this. If you have diabetes, you should make sure your blood sugar level remains in the acceptable range. Remember that if you lose weight, your diabetes is likely to resolve.

Because you are now at increased risk for stroke, your blood pressure should remain below 130/80 mm Hg, and you should take low-dose aspirin daily, providing your doctor says this is safe for you.

Q. I have a history of heart attack, two stents in my heart and one in my neck. What medications should I be taking to prevent another heart attack or a stroke?

A. Your doctor has probably recommended that you take a statin to lower cholesterol, low-dose aspirin to reduce the risk of stroke and second heart attack, a beta-blocker, and an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blocker. Also, it is crucial that you exercise, follow a good, healthy diet and monitor your weight so that you do not develop diabetes. Your fasting glucose should be less than 100 mg/dL. If it is higher than 100, you may have prediabetes or diabetes, and you will need further testing. If you do have diabetes or prediabetes, then you will need nutrition counseling and, possibly, medical therapy.

Q. Is it possible to have peripheral artery disease without coronary artery disease?

A. Yes. Peripheral artery disease (PAD) can exist alone, without atherosclerosis in other locations. However, these patients have increased risk of heart attack and stroke. For this reason, if you have PAD, your cardiac risk factors should should be treated aggressively, as if you have suffered a heart attack.

Q. Are there any beta-blockers that donít make you tired? Are ACE inhibitors easier to take?

A. All beta-blockers, even the newest generation, may make you tired to some extent. This response may be due to lowering your heart rate.

If you have essential hypertension alone, an angiotensin-converting enzyme (ACE) inhibitor would be better. They may not make you tired, but they can have side effects of their own, including dry cough and kidney problems. If these are problematic, you can switch to an angiotensin-receptor blocker (ARB).