Women's Heart Advisor January 2013 Issue

Ask The Doctors: Womens Heart Advisor

Q. I was diagnosed with restless leg syndrome (RLS) several years ago. I recently heard that RLS increases my chance of heart disease. Is this true?

A. Yes, the Nurses Health Study shows restless leg syndrome (RLS) increases your risk of heart disease, but itís unclear what the mechanism or cause might be. There are some thoughts that poor sleep duration and quality can increase heart disease by increasing inflammation and there are some indications that many patients with RLS have similar risk factors for heart disease. Therefore, it is important to talk to your doctor about the symptoms and treat your risk factors. Of note, patients with heart failure should not take medication for restless legs since these can exacerbate fluid retention.

Q. There is so much information about the benefits of taking vitamin D, but now Iíve heard that daily D supplements are not helpful for lowering my cholesterol, blood pressure or blood sugar levels. Should I stop taking vitamin D, or just reduce my dosage?

A. Vitamin D has never been proven to lower cholesterol. Also, the data on how vitamin D may help improve blood pressure and diabetes is not that strong. It is important to wait for larger studies before making a decision to take vitamin D.

There are studies that show patients with extremely low vitamin D levels (less than 15 nanograms per milliliter [ng/mL]) may benefit from taking supplements. However, no one really knows because good quality, large randomized control studies have been lacking. For now, I only treat patients with extremely low vitamin D. For the rest, I recommend dietary supplementation only.

Q. Iíve been taking calcium supplements for years to help prevent osteoporosis. Is this still the right thing to do, or does extra calcium do more harm than good for my overall health?

A. There have now been multiple studies showing that supplemental calcium may increase your risk of heart attack and stroke. The data is compelling; the most recent study of 29,000 women in Europe found that calcium supplements increased the risk of heart attack and stroke. Therefore, we recommend that patients get calcium from dietary sources and if possible, to not take calcium supplement in a pill form. Foods high in calcium include dairy products, beans and dark leafy vegetables.

Q. Can eating eggs be a part of a healthy diet? If so, do you recommend eating just the whites, or can the yolks be good for you, too?

A. The American Heart Association recommends that we get 200 mg of cholesterol a day. Cholesterol comes from anything that originates from an animal, whether it is meat or dairy. Also, cholesterol is found in many processed foods.

Patients with heart disease should control their diet by eating a low cholesterol diet. The most important thing to keep in mind is not so much the type of food you eat, but to limit the overall dietary intake of cholesterol. Do I think it is ok to eat eggs? Yes, if it is part of heart-healthy diet where there is limitation on the overall cholesterol intake. Certainly egg whites are better than the yolk. Egg white contains no cholesterol and egg yolk contains 210 mg of cholesterol. By eating one egg yolk, you have exceeded your daily intake. Therefore, moderation is the key.

Q. I read that common over-the-counter pain medications increase the risk of heart attack and stroke. What can I take for my aching hands? I think I have arthritis, but itís not bad enough to see a rheumatologist yet.

A. You are thinking of non-steroidal anti-inflammatories (NSAIDS), such as Advil, Aleve and Motrin, which are commonly used to treat arthritis pain. They are great pain relievers, but they can dramatically increase blood pressure. Thatís why if you have heart disease or high blood pressure, we donít like to give NSAIDs. The American Heart Association does not recommend taking NSAIDs after a heart attack. Tylenol is the safest drug for heart patients. Low-dose (81 mg) aspirin would be a second choice. If these donít do a good job at relieving your pain, ask your family doctor for advice.