Many of us know that cholesterol, blood sugar, blood pressure, body-mass index and smoking are modifiable risk factors for heart disease. If you smoke or have high levels of the other risk factors, you will need to make lifestyle changes and/or take medications to prevent a heart attack. But these measures don't always stop a serious cardiac event fromoccurring.
Whether to continue taking clopidogrel with aspirin over the long term is a different issue. Aspirin alone can increase the risk of bleeding, and this risk increases with the combination of medications. Low-dose aspirin plus clopidogrel or other anti-platelet drug is recommended for up to one year after MI. Continuing the combination beyond that point is not common practice in all patients, since the increased bleeding risk may outweigh the benefits. However, the combination may be continued in certain patients, including those who received a left main artery stent, complex overlapping or branch-point stents, recurrent MI, in-stent clots or vascular events such as a transient ischemic attack while on aspirin alone. Even in these situations, an individuals bleeding risk needs to be considered to ensure safety.
If you are in charge of Thanksgiving dinner, cut down on the number of carbs you plan to serve. Do you really need mashed potatoes, sweet potatoes, rolls and stuffing, too? Swap one or two of these for healthier alternatives. Even the ubiquitous green-bean casserole would be a better choice, since it contains fiber from beans and a little fat from butter and mushroom soup, which will help you feel full.
"One of my patients, who was on dual anti-platelet therapy after stenting, decided to take large doses of garlic. He ended up in the emergency department with dangerous internal bleeding," Dr. Cho recalls. "Another patient took hawthorn, and it increased the potency of her digitalis. This caused her ejection fraction and kidney function to plummet."
Each year, about 1 million people in this country receive a pacemaker to regulate their slowing heart rate. These pacemakers are implanted in a pocket of tissue under the skin and send electrical pulses down a lead (wire) inserted into the heart muscle. Pockets can be a source of infection, which then spreads into the bloodstream via the lead and can infect the heart.
Immediate testing is done to determine whether or not a heart attack has occurred. These include an electrocardiogram (ECG) and a blood test for troponin, a protein that spills into the blood when heart muscle dies. If the troponin test is negative, a heart attack has likely not yet occurred. These patients are given several types of medication to prevent their condition from deteriorating.
Depression after a heart attack can have serious, even deadly, consequences. However, the effect of antidepressants on outcomes has been unknown. A 300-patient study published in the July 24/31 issue of JAMA suggests that treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram (Lexapro) significantly reduced the risk of a major cardiac event. Patients who had recently suffered a major or minor heart attack were randomized to the antidepressant or placebo for 24 weeks and then followed for a median of eight years. All-cause death, deaths from heart disease, heart attacks and revascularizations with angioplasty and stenting were tracked. At the end of the study, 40.9 percent of the patients on escitalopram had met one of these outcomes, compared with 53.6 percent of those who had received the placebo. When individual outcomes were examined, the SSRI beat placebo in all measures. However, only reduction in heart attack (8.7 percent vs 15.2 percent) was statistically significant.
Sixty percent of people in the world have fainted at least once in their life. In most cases, the underlying reason is a benign condition called vasovagal syncope (the medical word for fainting). It occurs when blood pressure suddenly plummets, causing a drop in blood flow to the brain.
The average life expectancy in the United States is estimated to be 79 for a woman and 75.5 for a man-lower than that of other developed nations. A prosperous life with too much food and too little exercise is to blame. Experts say the rapid rise in obesity and decline in physical activity are mainly responsible for high levels of cardiovascular disease in this country and many cancers. They say three-fourths of premature deaths from cardiovascular disease and half of premature deaths from cancer can be attributed to lack of a low-risk lifestyle.
Cleveland Clinic offers heart-failure education classes designed to teach patients and their families what they need to know about the condition, its progression, its impact on day-to-day life and its medications. Ask your cardiologist if theres a similar program in your area. If not, ask for information in writing.
Fasting: Intermittent fasting has been shown to be effective for both weight loss and diabetes resolution. With this approach, you eat a very low-calorie diet (500 calories if youre a woman, 600 if youre a man, split between two meals) two days a week, but not on successive days. Just make sure you talk with your physician first to ensure fasting will not interact with your medications, she advises.
In clinical trials, certain newer diabetes medications have been shown to reduce CVD events in addition to lowering blood sugar in diabetics at high risk for CVD. The GLP-1 receptor agonists liraglutide (Victoza, Saxenda) and semaglutide (Ozempic), and the SGLT2 inhibitors empagliflozin (Jardiance) and canagliflozin (Invokana) have been shown to be superior to placebo at preventing CVD death, heart attack, stroke and heart failure in patients with known CVD. Both drug classes are associated with lower risk of symptomatic low blood sugar levels (hypoglycemia) and weight loss.