Ask the Doctors September 2013 Issue

Ask The Doctors: September 2013

Are people who have naturally normal blood pressure and/or cholesterol levels considered much healthier than those whose numbers are controlled with the help of medications?

You ask an excellent question. Ever since the concept of the “cardiovascular risk factor” was pioneered in the classic Framingham Heart Study, doctors and scientists have investigated how much our treatments are able to prevent or reverse the potentially harmful effects of high blood pressure (hypertension) and high cholesterol (hyperlipidemia). These two conditions can work separately and together to increase the risk of stroke and heart attack, mainly via their deleterious effects on blood vessels. Hypertension causes damage to the inner lining of arteries, making them more susceptible to atherosclerosis—the process in which cholesterol plaques are formed, inflammation occurs, and calcium is deposited. Hypertension also makes the artery walls thicker and less able to deal with acute changes in pressure and bloodflow, so they are more prone to rupture. Hyperlipidemia accelerates atherosclerosis, both because more cholesterol is available enter the vessel wall, and because the lipid particles can cause direct injury to the blood vessels. When organs like the heart and the brain have their blood supply cut off by atherosclerosis, heart attacks (myocardial infarctions or MI’s) and strokes (cerebrovascular accidents or CVA’s) ensue.

When people with hypertension or hyperlipidemia are treated with medications, it doesn’t mean that their underlying blood vessels are suddenly going to be “healthy.” Medical and lifestyle therapy (diet, exercise, weight loss, and smoking cessation) can halt the process of atherosclerosis, but it does not wipe it away. Yes, a normal blood pressure is a normal blood pressure, but the risk of MI or CVA in a person treated for hypertension is not lowered to the level of an individual who never had hypertension. Many clinical trials have been conducted to assess the benefits of anti-hypertensive and lipid-lowering therapy. In people who have never had a stroke or heart attack, blood pressure control will generally drop risk of CVA over 5 years by a third to a half, and reduce heart attack risk by roughly a quarter to a third. For cholesterol reduction, the benefits are about a 25-30% reduction in heart attack or stroke. Of course, if a person has both hypertension and hyperlipidemia, then the predicted benefit of treating both conditions would be greater. So, although people are not immediately “healthy” with properly-treated blood pressure and cholesterol, their prospects for good health are considerably improved.

My husband has had one heart attack and has two stents. I worry about a second heart attack. I received CPR training several years ago, but I wonder if I need a refresher course. How do you know when someone needs CPR? Can CPR actually hurt someone’s heart or the stents in the heart?

In general, CPR certification lasts for two years after a training course. If an individual is unresponsive and you cannot feel a pulse, then they need CPR. However, calling 911 or having someone else call for you is the first thing that needs to be done, before you start chest compressions. If the cardiac arrest is in a public place, there will be many people around to help, and someone should be sent to obtain an Automated External Defibrillator (AED). The instructions on AED’s are easy to follow, and these devices can save someone’s life before help arrives. To your question, CPR does not injure the heart, and it will not cause stents to move or be damaged. Sometimes people undergoing CPR unavoidably experience chest wall trauma, such as fractured ribs, which rarely have any long-term complications. The more important concern is that CPR be performed correctly, and that is why your idea about going for a refresher course is a great one.

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