Women's Heart Advisor April 2016 Issue

Ask the Doctors: April 2016

Q: My best friend and I are having an argument we hope you can solve. I say that being pear-shaped is healthier than being apple-shaped. She says extra fat is bad, period. Who’s right?

A: This is not a simple question. Fat is not harmless. It causes inflammation, which can trigger cardiovascular disease (CVD) or aggravate it.

For years doctors focused on body-mass index (BMI), which is derived from a formula that considers weight and height. A BMI of 18.5 to 24.9 is considered ideal; 25 to 29.9 is considered overweight, and 30 and above is obese. Today we know that using waist circumference or waist-to-hip ratio provides a more accurate picture of cardiovascular risk. These measurements account for increased fat around the abdominal organs. This visceral fat elevates the risk of dying from CVD, even with a normal BMI.

Finding your waist-to-hip ratio is easier than calculating your BMI, too. First measure your waist at the top of your hip bone, and then measure your hips at their widest point. A woman with a ratio greater than 0.80 is considered obese.

Many women step on the scale with the goal of maintaining a certain weight. But it’s possible to attain a normal weight, yet have dangerous belly fat hidden inside. That’s why we advocate exercise along with a healthy diet.

Q: I’ve experienced a few random episodes of atrial fibrillation that awakened me at night. They’re not bad enough to scare me, but I’m wondering if I should tell my doctor.

A: Good that you asked. There is recent data suggesting that atrial fibrillation (AFib) carries a higher risk of fatal and nonfatal cardiovascular events in women than in men. An analysis of more than 30 clinical trials involving 4.4 million adults revealed that the risk of heart attack, stroke, heart failure, death from heart disease and death from any cause was significantly greater in women with AFib than in men with the disease.

You’d be wise to tell your doctor about these episodes. There are effective treatments to stop Afib and lower your risk.

Q: With two medications, my blood pressure has dropped from 180 mm Hg to 140 mm Hg. My doctor says it’s not low enough. Do you agree? I really don’t want to add another medication unless it’s absolutely necessary.

A: Blood pressure recommendations have changed. Formerly, a systolic reading of 140 mmHg was allowed up to age 80, after which 150 mmHg was considered acceptable. But the results of an important clinical trial presented at the 2015 meeting of the American Heart Association has doctors thinking differently.

The Systolic Blood Pressure Intervention Trial (SPRINT) involved more than 9,000 participants. Compared with patients whose blood pressure averaged 140 mmHg, those who were able to maintain a blood pressure of 120 mmHg and lower had a 43 percent lower risk of cardiovascular death, a 27 percent lower risk of death from any cause and a 25 percent lower risk of heart attack, stroke or heart failure. That’s impressive.

Doctors realize that it’s very difficult for many patients to achieve such a low blood pressure reading. Additionally, those who did in the SPRINT trial had more adverse events, which included kidney failure.

So I think the take-home lesson from SPRINT is not that 120 is an ideal figure, but that lower is better. If adding a medication brings your systolic pressure down safely, you should consider it.

Q: For years, I’ve enjoyed several cups of coffee every day. The caffeine doesn’t bother me. I feel fine and sleep well. But my husband is on my case to cut back. Do you think it would be wise?

A: If you are sleeping well and not experiencing arrhythmias, don’t worry about your coffee consumption. A study of almost 168,000 women and 40,000 men found that drinking more than five cups of caffeinated or decaffeinated coffee a day did not increase the risk of death. In fact, drinking one to five cups of coffee daily was associated with a lower risk of death. Additionally, coffee drinkers tended to have a lower risk of cardiovascular disease, type 2 diabetes, Parkinson’s disease and fatal prostate cancer. Enjoy your coffee.

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