Arrythmia

Low-dose dietary supplements of omega-3 fatty acids have little effect on lowering cardiovascular risk (see article on page 6). However, high doses of omega-3, either eicosapentaenoic acid (EPA) alone or EPA plus docosahexaenoic acid (DHA), can significantly lower cardiovascular risk in patients with high triglyceride levels. The U.S. Food & Drug Administration (FDA) has approved several products-Lovaza, Omtryg, Vascepa and Epanova-that are now available by prescription. Results of the REDUCE-IT trial, presented at the American Heart Association (AHA) 2018 Scientific Sessions, showed that in patients with elevated triglyceride levels and cardiovascular disease or diabetes plus one additional risk factor, 4 grams per day of purified EPA reduced the risk of a major cardiovascular event by 25%. In a science advisory issued Aug. 19 online in Circulation, the AHA summarized the findings of 17 clinical trials in which high-dose EPA or EPA plus DHA reduced triglyceride levels by 30 to 36%. The AHA concluded they are a safe and effective option for reducing triglycerides whether used alone or in combination with other lipid-lowering drugs.

Blood pressure (BP) is measured when the heart is contracting (systolic BP, the first number) and when the heart is resting (diastolic BP, the second number). Ever since the Framingham Heart Study identified that high systolic BP was a stronger predictor of cardiovascular outcomes than high diastolic BP, physicians have focused on lowering high systolic pressures. After the definition of hypertension was lowered from 140/90 millimeters of mercury (mmHg) to 130/80 mmHg in 2017-a controversial move-guidelines continued to emphasize treating the higher number. But a study involving more than 1.3 million outpatients published in the New England Journal of Medicine on July 18, 2019, may change this practice. In this study, researchers showed that having either high systolic or high diastolic high BP, or both, increased the risk of heart attack and stroke. Additionally, the negative influence of blood pressure on cardiovascular outcomes was seen at 130/80 mmHg, validating the lower threshold for hypertension.

Many people take glucosamine supplements to relieve joint pain from osteoarthritis. The good news is that this practice may offer some protection against heart attack and stroke, as well. British researchers surveyed more than 466,000 patients, none of whom had been diagnosed with cardiovascular disease at the time. As reported in BMJ May 14, 2019, during the next seven years there were 5,745 heart attacks, 3,263 strokes and 3,060 cardiovascular deaths in the group. After adjusting for other risk factors, habitual glucosamine use was associated with a significantly lower risk of all types of fatal and nonfatal cardiovascular events.

What's your systolic blood pressure? The answer may depend on whether the reading is taken in your upper arm or wrist. Researchers have found the variation to be as large as 20 mmHg in 14 percent of the people tested. On average, a reading taken in the radial artery at the wrist was 5.5 mmHg higher than that taken in the brachial artery on the bicep. This could have implications for who is given anti-hypertension drugs, the authors said online March 25, 2019, in Hypertension.

If you use sleeping pills and have hypertension, you may find it increasingly difficult to control your blood pressure. A study of older adults found an association between regular use of sleeping pills and the need for more antihypertension medication. Researchers enrolled 752 participants between 2008 and 2010 and followed them through 2012 and 2013. At the start of the study, 37 percent of the participants said they slept poorly, and 16.5 percent used sleeping pills on a regular basis. The mean number of antihypertension drugs used was 1.8. During the study, almost 20.7 percent of the participants increased the number of blood pressure medications they took. As reported online March 25, 2019, in Geriatrics & Gerontology International, the researchers found no connection between difficulty falling asleep or staying asleep and change in the use of blood pressure medication. However, they did find consistent use of sleeping pills was connected to higher risk of needing to add additional antihypertension medications to control blood pressure.

There's news that many people would like to hear. A small observational study of Greek patients presented at the annual meeting of the American College of Cardiology in March 2019 found that taking a daily nap can lower blood pressure.

French researchers analyzed the results of food questionnaires completed every six months by 44,551 adults ages 45 and older participating in an ongoing study on food habits. On average, more than 29 percent of their total calories came from ultra processed foods. During the seven-year study, 602 participants died. After carefully adjusting for other factors, the researchers concluded that every 10 percent increase in the amount of ultra processed foods consumed increased the risk of all-cause death by 14 percent. Ultra processed foods tend to be high in calories, carbohydrates, salt and fat and low in fiber and vitamins. In addition, they may contain harmful food additives and contaminants.

Our biological clock (circadian system) governs many physiological processes, including blood pressure. Blood pressure normally dips at night. People who do not experience this temporary drop (called "non-dippers") are at increased risk for developing heart disease. Researchers discovered that one of four main genes comprising the circadian system act differently in men and women. They found that male mice missing this gene (PER1) become non-dippers and have a higher risk of heart and kidney disease. In contrast, female mice missing the PER1 gene continue to show normal dips in blood pressure at night (American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, January 2019 ahead of print). This phenomenon may explain in part why premenopausal women, who are less likely to be non-dippers than men of the same age, have a lower risk of heart disease. After menopause, their risk climbs due to other factors and quickly erases this biological benefit.

Cigarette smoking is a major risk factor for cardiovascular disease (CVD) and death from CVD. In fact, nearly one-third of U.S. deaths attributed to cigarette smoking are due to CVD. Although most smokers attempt to quit multiple times before they are able to call it quits, many do not stop smoking until they have developed smoking-related complications. Quitting smoking reduces subsequent CV events and mortality, regardless of duration or intensity of smoking, comorbidities or age. Patients benefit even when they quit smoking after they have developed CVD. This provides a strong rationale for quitting-if only the best way to accomplish this were known. Physicians have had little guidance to use in counseling patients on the most effective strategies to stop smoking. The American College of Cardiology addressed this need with an Expert Consensus Decision Pathway on TobaccoCessation Treatment (Journal of the American College of Cardiology, Dec. 25, 2018). It summarizes recommendations for a comprehensive approach to treating tobacco dependence with a chronic disease management strategy, monitoring tobacco use over time and making repeated efforts to encourage and assist smokers to quit using tobacco. The document gives physicians the information they need to answer smokers' questions about therapies for overcoming nicotine withdrawal, while bolstering self-control over smoking. It also discusses barriers to implementing and sustaining smoking cessation treatment that should be recognized and addressed to help smokers overcome their addiction to tobacco.

Obese individuals tend to have other risk factors for heart attack and stroke, such as diabetes, high blood pressure and high cholesterol levels. That has caused the role of obesity as a cardiovascular risk factor to be questioned. A study spearheaded at Cleveland Clinic suggests that it is. The authors conducted a meta-analysis of five studies with a total of 900,000 participants in which a genetic polymorphism associated with obesity was used to determine its potential link to cardiovascular outcomes. They found that as body-mass index rose above the mean, risk of type 2 diabetes and coronary artery disease (CAD) rose with it. No connection between obesity and stroke was seen. Although these results do not prove that obesity causes diabetes and CAD, they strongly suggest that obesity increases the risk these issues will develop (JAMA Network Open, November 2018).

Small calcium deposits in breast arteries are not associated with breast cancer, but they may be a marker of coronary artery disease (CAD) long before other symptoms appear. Researchers evaluated 2,100 asymptomatic women ages 40 and older using mammography and computed tomography angiography imaging of the coronary arteries, among other tests.

If there are specific concerns that you would like to have addressed, please write them down before you leave home and raise them early in the appointment. Please don't wait until the end of the visit to speak up. Knowing what's on your mind helps us plan our time with you, and you will be more likely to leave the office satisfied, if your questions have been answered.