Heart Beat September 2013 Issue

Heart Beat: September 2013

Among the highlights in the new American College of Cardiology and American Heart Association guidelines for the treatment of heart failure are recommendations for earlier uses of certain devices and drug therapies. For example, the guidelines call for extension of cardiac resynchronization therapy (CRT) device use to patients with mild-to-moderate heart failure. CRT devices have traditionally been recommended for more serious cases of heart failure. The guidelines, published in the Journal of the American College of Cardiology, also recommend the earlier use of aldosterone antagonists. They are blood pressure medications that help reduce fluid levels in the body, which in turn reduce the workload of the heart for people with hypertension or heart failure. The new guidelines also emphasize more shared decision making between patient and physician, and new thoughts on genetic testing.

Starting your day with a nice hot cup of coffee or tea may do more than provide a little pick-me-up. A large French study found, among other things, an association between coffee and/or tea consumption and reductions in systolic and diastolic blood pressure levels. Regular consumption of those beverages was also associated with lower pulse pressure and heart rates. The reduction in heart rate was more strongly associated with tea than coffee. Researchers divided study subjects up into three categories: those who drank no tea or coffee, those who drank between one and four cups daily and those who drank more than four cups. The most significant reductions in blood pressure, pulse pressure and heart rate were seen among those who drank the most coffee and/or tea. Researchers also noted, however, that coffee consumption was more often associated with smoking, higher scores on stress and depression indexes, and higher cholesterol levels, while tea drinkers tended to be non-smokers with lower cholesterol levels. The study was presented at the European Society of Hypertension 2013 Scientific Sessions in Italy.

Nitrous oxide, also known as “laughing gas,” remains a widely used anesthetic, but there have been concerns for many years about possible impacts on heart health, particularly among individuals at higher risk for heart attack. But a recent study published in the journal Anesthesiology found that nitrous oxide does not raise the risk of heart attack during surgery or soon afterward. The issue was related to the fact that nitrous oxide renders vitamin B12 inactive, and by doing so, increases the levels of the amino acid homocysteine in the blood. High levels of homocysteine are associated with damage to blood vessels. In the study, researchers gave some surgical patients vitamin B12 and folic acid intravenously to help balance homocysteine levels and did not give other patients the B vitamins. There was no difference in heart attack risk among the two sets of patients.

The importance of physical activity in preventing a heart attack is well established. But a recent study, published in the journal Stroke, found that exercising at least four days a week lowers your stroke risk by 20 percent, compared with individuals who are sedentary. And working out four days a week also lowers your risk of stroke by 16 percent when compared to people who work out one to three days per week. Researchers added, however, that to achieve the protective benefits of exercise, you need to work up a little sweat. A leisurely walk, though valuable in many ways, won’t afford the same risk-lowering advantages as a very brisk walk or jog or set of tennis. What wasn’t clear in the study was just how long you should exercise to achieve maximum benefits. The American Heart Association has recommended 150 minutes of moderate-intensity exercise per week, and many he

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