April 2012
Ask The Doctors: April 2012 Women's Edition
There is no difference between the rates of stroke in women and men following bypass surgery. The overall risk depends on coexisting medical conditions that increase the risk of cerebrovascular disease. These risks are basically the same as those causing cardiovascular disease, with the addition of atrial fibrillation, patent foramen ovale (a hole between the upper chambers of the heart), sleep apnea, aneurysms and extensive aortic atherosclerosis.
Fish and Shellfish Provide Essential Fats for Heart Health
If there were a vote for the most valuable heart nutrient, omega-3 fatty acids would surely win. Omega-3s have been shown to significantly lower the risk of sudden cardiac death from arrhythmia, help prevent blood clot formation, inhibit the growth of artery-damaging plaque, reduce the amount of dangerous triglycerides made by the liver, increase levels of beneficial HDL cholesterol and lower blood pressure. Now, studies conducted in China suggest that omega-3s may also lower the risk of type 2 diabetes (American Journal of Clinical Nutrition, August 2011). However, the source of omega-3 that produced this result differed according to gender: Women benefited from a diet containing both fish and shellfish; men, from shellfish alone.
Women Face Higher Bleeding Risk After Receiving Coronary Stents
An analysis of the 2009 HORIZONS-AMI trial found that the female participants who were treated with emergency stenting for heart attack had significantly higher rates of bleeding events than the men. The study presented at the Transcatheter Therapeutics meeting in November 2011, found bleeding at the catheter insertion site; in the abdomen, eyes and skull; bruising, unexplained drop in blood pressure and need for transfusion. However, the rate of adverse events, such as death, subsequent heart attack or stroke, or need for bypass surgery was similar in women and men.
Beta-Blockers May Help With Breast Cancer Treatment
In the July 2011 Women’s Heart Advisor, we discussed research confirming that radiation therapy for breast cancer prior to 1984, as well as the presence of benign breast calcifications, both increase the risk of coronary artery disease. Now there’s more evidence supporting a breast-heart connection, but this time, the news is good. Two recent studies suggest that beta-blockers may reduce the cardiovascular side effects of chemotherapy and, possibly, prevent tumors from spreading. Beta-blockers are commonly prescribed to heart patients. They lower blood pressure and help the heart pump more easily by blocking adrenalin, thereby preventing the arteries from constricting. Common beta-blockers include metroprolol (Lopressor, Toprol XL), atenolol (Tenormin), carvedilol (Coreg), nadolol (Corgard) and propranolol (Inderal).
What You Should Know About Statin Use After Menopause
Cholesterol-lowering statins are powerful agents for preventing heart attack in men and women with heart disease. Statins also have unrelated benefits, such as lowering the risk for Alzheimer’s disease and age-related decline in lung function. But they can have adverse effects, too. A meta-analysis of five major trials (Archives of Internal Medicine, January 9, 2012) found that statins increased the risk of diabetes in postmenopausal women. The effect was consistent with all statins. So should you stop taking your statin if you are at high risk for heart disease, or have been already been diagnosed? Cleveland Clinic cardiologists say no.
Ask The Doctors: April 2012
Stents are tiny tubes of metal meshwork, which can hold open narrowed arteries. Although coronary stenting is a great idea, and has helped countless people with coronary artery disease (CAD), it has its limitations. First of all, stents are made of metal, and when blood comes in contact with metal it has a tendency to clot. This undesirable process is known as “in-stent thrombosis” or IST. The clot can enlarge, block the coronary artery, and cause a heart attack—the exact opposite of the result intended by the cardiologist! Medications like clopidogrel (Plavix) are very effective at preventing such clots from forming, and their consistent use is absolutely essential for stents to work successfully. Your doctor was concerned about the planned knee surgery because your clopidogrel would almost certainly be stopped at least a week before the procedure, putting you at potential risk.
Understand the Stroke Risks Linked to “Silent” Atrial Fibrillation
Atrial fibrillation (AFib) is usually characterized by episodes that are noticeable to the patient, who feels a flutter or racing in his heart. But not all arrhythmias are obvious, and a recent study suggests that “silent” AFib episodes are associated with a 2.5-fold increase in the risk for ischemic stroke. That’s because the chaotic rhythm of a heart in AFib allows blood to pool in the atria (the heart’s upper chambers), which can lead to the formation of a blood clot that can break free of the heart, travel to the brain, and block blood flow in an artery, causing an ischemic stroke.
Seek Your Cardiologist’s Approval Before Taking Daily Aspirin
If you have suffered a heart attack or stroke, or have had an invasive coronary procedure such as bypass surgery or stenting, your doctor may recommend you take a daily aspirin. Studies show that aspirin can be effective in preventing a second cardiovascular event (“secondary prevention”). However, if you don’t have advanced cardiovascular disease, evidence supporting the likelihood that aspirin will prevent a first heart attack (“primary prevention”) is inconclusive. For men of all ages, there appears to be a benefit in taking aspirin to prevent a first or second heart attack, and to generally reduce the risk of heart disease.
Research Shows Statins Still Under-Prescribed
Many heart experts agree that if you’ve been diagnosed with heart disease you should be on a statin, unless there’s a medical reason why you can’t take the cholesterol-lowering drug. But according to a study published in the November 29, 2011 issue of Circulation, despite robust clinical trial evidence, a substantial number of patients with obstructive coronary artery disease (CAD) remain untreated with statins. Out of 38,775 study participants, a small proportion were treated with non-statin therapy, and one in six patients were simply untreated.
Diastolic Dysfunction Can Be Serious, But is Often Overlooked
Of the two actions of the heart—pumping blood throughout the body (systole) and refilling with blood (diastole)—your systolic function is the one that tends to get the most attention. You can feel your heartbeat and know that the muscle is contracting and pushing blood to your brain, lungs, organs and your entire body. But the relaxation of your heart as it fills with blood and prepares for its next contraction is something that is often overlooked, though new research suggests that should not be the case.
Heart Beat: April 2012
If your physicians are pushing you to get more exercise, they’re not alone. In the past decade, the percentage of doctors advising their patients to become more physically active has grown considerably. Researchers determined that in 2000, about 22 percent of U.S. doctors advised their patients to exercise more. By 2010, that number rose to more than 34 percent. The percentages went up across the board, regardless of the patient’s condition, but in cardiovascular care, for example, the starting percentage was already higher than for other medical concerns. In 2000, about 34 percent of doctors advised patients with high blood pressure to exercise more, with that number climbing to more than 44 percent in 2010.
Device Shows it can Help Mitral Valve Patients Labeled High Surgical Risks
For many patients with serious mitral valve regurgitation, surgery to repair or replace the defective valve are two options that each have a proven history of positive outcomes. But what about patients who have severe mitral regurgitation, but are at a high risk for surgery? The technology to help these patients appears close at hand. Results of the EVEREST II trial were published in the Jan. 10 issue of the Journal of the American College of Cardiology, and the research shows that the percutaneous MitraClip (Abbott) device reduced mitral regurgitation and improved clinical symptoms in a group of high surgical-risk patients.