Ask the Doctors February 2014 Issue

Ask The Doctors: February 2014

Q. Are there any vitamins or other supplements that are proven to help the heart? Are there any that you recommend or any that we should avoid if we have hypertension or other heart conditions?

A. It is known that heart disease happens more frequently when certain nutritional deficiencies are present. For example, people with low levels of vitamin D are more likely to develop coronary artery disease (CAD) and experience a heart attack than those with normal levels. However, such information in itself does not prove that low vitamin D levels are causing these patientsí heart problems. In order to support a cause-and-effect relationship, one must treat with either vitamin D or placebo, and determine if raising vitamin D levels reduces risk of heart disease over time. Several clinical trials have studied this, finding no significant cardiovascular benefit or harm. However, the studies only lasted for five to seven years, and longer-term treatment may yield benefit.

If one takes vitamin, mineral, or other dietary supplements in hopes of preventing cancer or cardiovascular disease (CVD), the U.S. Preventive Services Task Force has a message for you: There is insufficient evidence to recommend for or against supplementation with beta-carotene, vitamins A, C, and E, antioxidant combinations, or multivitamins with folic acid. Also, the following supplements can cause or worsen pre-existing high blood pressure: ephedra, Siberian ginseng, bitter orange, and licorice. Deficiency in the mineral selenium has been linked closely to CAD and heart attack, but supplementation studies have have not shown cardiac benefit (one trial showed decreased risk of cancer). Finally, the standard multivitamin is the most commonly used dietary supplement. Does it prolong life, or help prevent CVD or cancer? Analyses of multiple studies have shown no evidence for harm. Depending on the type of study, a mild, nonsignificant trend towards decreased cancer risk and decreased CVD risk has also been seen, which could accrue further with time. Overall, the best goal would be to consume a balanced diet that is replete with essential vitamins and minerals. A standard multivitamin can be taken without fear of harm, and it may improve health, especially if oneís diet is not balanced.

Q. Any advice on getting a second opinion without insulting your doctor? I like my doctor, but I donít know if heís current with the latest in medications and treatments. Also, I have mitral valve prolapse, and I wonder when Iíll need a valve specialist.

A. Many people worry about asking for a second opinion, because they believe their doctor will be insulted. I would tell you two things. First, a physician who is insulted by the suggestion of a second opinion is acting in an immature fashion, and could be putting patients at risk. Second, despite the strong bonds which often develop between doctor and patient, it is always the patientís right to pursue a second opinion, because his or her health must take top priority.

Your concerns lie in the areas of drug therapy and management of your mitral valve prolapse. Perhaps a constructive, diplomatic way of bringing up this subject would be as follows: ďDoctor, I really appreciate the care youíve given me, and I definitely want to keep seeing you in the future. But I was wondering if I might benefit from a specialistís opinion, who could provide a fresh point of view on my medications and my heart valve. Do you think this might be a good idea?Ē If your doctor responds positively and in the affirmative, thereís no harm done, and you proceed with the referral. If he or she becomes upset, or just defers the referral and says you are doing fine, then you should obtain your own appointment with a specialist. In academic institutions such as Cleveland Clinic, patients can request their own appointments, and do not need a formal referral from their doctor.

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