Heart Disease is Preventable

IF CORONARY DISEASE IS PREVENTABLE WHY IS IT THE LEADING CAUSE OF DEATH IN BOTH MEN AND WOMEN?

The simple answer: Coronary artery narrowing is a silent disease that develops over many years from untreated risk factors that are unknown or not addressed.

People don’t realize they have heart disease until something bad happens, such as a heart attack or sudden death. They don’t realize subtle symptoms such as mild shortness of breath, upset stomach and fatigue are signs of heart disease. Women tend to complain less and are more often not diagnosed when they do see a physician.

Narrowed coronary arteries restrict blood flow to the heart muscle and begin causing symptoms that resolve with rest. When arteries become blocked, the pain persists. A part of theArtery heart dies because the muscle is starved of blood and oxygen. Sweating, weakness, discomfort in the chest, jaw, neck, arm and sometimes the back are common with a heart attack. This is a medical emergency and 911 should be called for immediate medical care. If the artery can be opened with angioplasty and stents soon enough, heart damage is decreased. Fifty percent of people who have heart attacks die before reaching a hospital.

Coronary artery disease is preventable, but unhealthy lifestyles and food choices are difficult to change. We live in a fast food environment. The number of people smoking has decreased and some people are making healthier food choices through education, but heart disease is still the leading cause of death. Obesity has increased to epidemic proportions, even in the young, so we have a long way to go to become a healthier nation.

50% of US citizens have either high blood pressure, high cholesterol or smoke
2/3 of adults are overweight or obese
1/3 of children are overweight or obese
Overweight 5-year-olds show evidence of early heart disease

Take control of your health and reduce heart disease risks with healthy actions. See a physician to monitor health and measure glucose, thyroid, cholesterol, vitamin D, blood count and inflammatory markers such as C-reactive protein.
♥ Stop tobacco use
♥ Control high blood pressure
♥ Treat abnormal cholesterol levels with dietary modification and medication
♥ Obesity and Diabetes: normalize weight and glucose
♥ Exercise daily with your doctor’s recommendation
♥ Limit alcohol consumption
♥ Consider heredity factors and obtain early testing/treatment

You can counteract good genes by making bad life choices. You can offset bad genes by making healthy choices. The choice is yours to make.

MENOPAUSE IMPACT ON HEART DISEASE

Heart disease, osteoporosis and dementia increase with age.
New information supports prescribing estrogen to reduce these risks.

Few doctors will prescribe a hormone replacement following menopause because the Women’s Health Initiative (WHI) showed the risks of use far outweighed its benefits. According to the study, prescribing hormone replacements to block hot flashes put women at risk of breast cancer, uterine cancer, strokes and blood clots.

Hormone supplementation is complex. There are many pros and cons, but the WHI conclusion made it easy for doctors to just say no.

However, new research may reverse that practice. It might be time to once reconsider the use of hormone replacement for some woman.

Loss of ovarian hormone effects after menopause (or surgical ovarian removal) results in reduced bone density, leading to osteoporosis and broken bones. Many other symptoms such as skin wrinkling, hair changes and reduced libido are non-life threatening, but are irritating. In addition, serious health problems evolve over years and impact long term health.

Heart shapped brain♥ Heart diseasebrain skeleton
Osteoporosis
Dementia

 

 

Heart disease is the #1 cause of death in women.
There was a time when we were told estrogen had no effect on cholesterol, but a recent study showed reduced estrogen resulted in decreased function and effectiveness of HDL. HDL is High Density Lipoprotein, the good cholesterol. We want this number to be high.

♥ In a Danish study, women who took estrogen after menopause had a significant reduction in heart attack, heart failure and mortality (with no increase in cancer, clots or stroke).
♥ A Japanese study on menopausal women reported similar favorable heart findings and, in addition, showed improved bone density.

Osteoporosis results in more than 1.5 million fractures each year.
Fifty percent of all women over the age of 50 will suffer an osteoporosis-related fracture. Estrogen aids in calcium metabolism and is a key component of bone mass. Loss of estrogen with menopause contributes to weak bones and fractures in aging women. Poor diet and lack of exercise during adolescence reduce bone strength in later years. Proper exercise, vitamin D and adequate calcium intake are beneficial for bone health.

Dementia
Alzheimer’s disease is the 6th leading cause of death in the US – 2/3rds of these are women. At this time, Alzheimer’s is the only cause of death in the top ten that cannot be prevented or cured. The good news is, a recent preliminary study of the brain showed positive estrogen effects on the hippocampus (memory area) in women taking estrogen. Hormone replacement may reduce dementia in women. (See: Estrogen is back in the news. www.lipsticklogic.com)

As the population ages, dementia, osteoporosis and heart disease are becoming more prevalent. It is important to re-examine what can be done to reduce these debilitating illnesses. Estrogen replacement may once again be appropriate in some women.

Note: Why some women cannot take estrogen supplements.
There are 230,000 new cases of Breast Cancer each year and, annually, 40,000 women die from the disease.

There are many types of breast cancer. Some breast cancers result from genetic mutations, but 85% of breast cancers occur in women with no family history.

In some types of breast cancer, hormone replacement supports abnormal cell growth, helping the cancer cells grow and spread. These cancer cells have surface markers for estrogen and/or progesterone. This means hormone supplements should not be prescribed. A personal history of breast cancer or uterine/ovarian cancer also precludes the use of replacement therapy.

In the Women’s Health Initiative, the highest risk for breast cancer was associated with hormone replacement when both estrogen and progestin were prescribed. Women who have had a hysterectomy do not require progestin.

For additional information on similar topic see our other women’s health blog:www.lipsticklogic.com

CT Scan Your Heart

Did you know heart CT scans can identify narrowed coronary arteries better than a stress test?

Stress Tests
Treadmill testFor many years, the standard medical evaluation to look for heart disease has been a stress test. Walking on a treadmill, with continuous heart monitoring and periodic blood pressure checks, is still considered useful, and provides a functional heart evaluation.

The determination is based on stressing the heart with exercise and evaluating the cardiac response by electrical changes on the ECG. With patients suspected of having microvascular disease – when large coronary arteries mayEcho_heart be normal but tiny arterioles are stiff and narrowed – the stress test is done with usual monitoring, followed by an immediate heart echocardiogram to further evaluate heart function under physical stress.

Nuclear Stress Tests
nuclear stress testIn addition to the treadmill evaluation, a nuclear dye may be injected into a vein and the heart is scanned to evaluate blood flow, comparing the heart at rest with blood flow through the heart muscle with exercise. These comparisons evaluate differences in blood flow and identify possible coronary artery narrowing.

Invasive Coronary Arteriogram – Coronary Angiogram
The gold standard for evaluating narrowed coronary arteries is the invasive coronary Coronary angioangiogram. In that procedure, a catheter is placed in an artery, threaded to the heart and dye visible under fluoroscopy X-rays is used to outline the inside of the arteries supplying the heart muscle with blood and oxygen. If an artery is dangerously narrowed, the blockage can be dilated and stented to keep it open and prevent a heart attack. So, this test can be both diagnostic and therapeutic.

CT Coronary Angiogram (CT = Computed Tomographic Angiogram of the coronary arteries of the heart)

ct-heartJohns Hopkins researchers recently published their research comparing the noninvasive cardiac CT scan with stress tests and coronary angiograms. The CT angiograms showed a 91% accuracy in detecting or ruling out an artery blockage. Stress tests measured out at 69% accuracy.

Both heart CT scans and invasive angiograms are more expensive than stress tests. Stress tests provide information, but the CT scan is better. If the CT looks good, further medical follow-up will still be required, but you avoid complications, higher radiation exposure, and higher cost of the invasive procedure.

No evaluation carries 100% accuracy. The American Heart Association and the American College of Cardiology recommend stress tests as a first line screening tool. These guidelines may change because of this study showing the increased accuracy of the CT angiogram.

For more information on heart CT scans and the calcium score check out: https://www.nlm.nih.gov/medlineplus/ency/article/007344.htm

Betty Kuffel, MD

HEART ATTACK RISKS

Understand your risk factors and take action … before you have a heart attack.

Your Heart Book Cover- Final FINALThe American College of Cardiology reported young women with heart attacks are more likely to die than men. Part of this scenario is because many women do not experience the classic symptoms of chest pressure, arm, or jaw pain. Women are also more likely to report stomach symptoms, fatigue or shortness of breath instead of chest pressure when a coronary artery is closing. Without the proper diagnosis, life-saving interventions including stents to open a closing artery are delayed or not performed.

In a study evaluating women under age 55, Yale researchers found half the women believed they were healthy prior to a heart attack. Fewer women than men in the study had not received education from their care providers regarding risks for heart disease. Many of the women had modifiable risks and only 22% of them received information about heart disease and how to reduce their risks.

Nearly half of women in a 2012 survey did not report heart disease as a leading cause of death, yet they considered themselves well-informed on female health issues. Read a quick take on statistics and how you can identify and reduce your risks.

Excerpt from Your Heart book:

Women and Heart Disease

Many women do not realize they are at high risk for heart disease and early death. Under age 50, heart attacks in women are twice as likely to be fatal as in men. Each year more than 250,000 women die of heart attacks. Six times the number of women die from heart disease than from breast cancer. Many factors weigh into these statistics including hormones.

♥ Research reported in the National Institutes of Health bulletin, The Heart Truth for Women, states that by leading a healthy lifestyle, women can lower risks by 82%. You are in charge. This means: regular exercise, healthy weight and not smoking. Also take medications to control other risk factors such as high blood pressure and high cholesterol. What you choose to do and what you eat can improve health and prolong life.

♥♥♥♥♥

Five risk factors both men and women can modify and reduce their risk for dying from a heart attack:
• High cholesterol
• Smoking, tobacco use
• Diabetes
• Obesity
• High blood pressure

What to do about these risks: See your physician for an evaluation

  • Check your cholesterol and blood pressure.
  • Treat cholesterol and blood pressure abnormalities with diet modification and medication.
  • Stop all tobacco use.
  • Keep blood glucose normal with diet and medication.
  • Eat a Mediterranean diet and control your calorie intake. Consider the 5/2 diet for weight reduction (discussed in previous blogs on this website)
  • Exercise at least 30 minutes each day.

Betty Kuffel, MD

Sleep Apnea Affects Memory and Heart Health

Are you sleepy during the daytime? Is snoring a problem? Both are symptoms of a serious health problem. Apnea means without breath. Sleep apnea occurs when air movement in and out of the lungs is reduced during sleep, making blood oxygen plummet. Brain sensors identify the low oxygenSunset level and high carbon dioxide shift. This, in turn, triggers partial awakening to correct the problem. Deeper breathing is stimulated, often accompanied by loud snoring as increased effort overcomes the obstruction.

Once the airway is opened again, oxygen rises and carbon dioxide drops. The extra breathing stimulus isn’t needed…and sleep resumes. This cycle repeats many times each night. During most episodes, full awakening doesn’t occur. Other times, the person suddenly awakens gasping and choking. Individuals with sleep apnea may not experience overt symptoms, may be unaware of snoring episodes, and don’t realize their memory lapses and frequent naps are related to a problem that also increases their risk for serious heart problems.

Obesity contributes to this problem, but many thin people are affected, too. Alcohol, narcotics and sedatives relax throat muscles resulting in breathing problems. A narrow airway or large tonsils, even in children, can cause sleep apnea.

There are two primary types of sleep apnea. Obstructive sleep apnea occurs when the airway is blocked by oral tissue when throat muscles relax during sleep. Central sleep apnea is related to reduction of the respiration mechanism in the brain. Both types negatively affect health.

To diagnose the problem, a sleep study to continuously monitor oxygen, heart rate rhythm, and wakening is needed. The primary treatment for sleep apnea is “continuous positive airway pressure,” known as CPAP. This means wearing a carefully fitted mask attached to a small machine. The pressure and fit are individualized for each person to produce enough air pressure to keep their airway open during the normal relaxation of muscle tone during sleep. The adjustment to wearing such an apparatus may be inconvenient and a bit awkward at first, but can be life-saving.

After a good night’s sleep most people with sleep apnea experience a significant improvement in health and wellbeing. Small travel units are available.

What are the symptoms of sleep apnea?
• Restless sleep and fatigue
• Frequent awakening
• Daytime sleepiness, irritability
• Reduced memory
• Morning headaches and confusion
• Chest discomfort
• Children and teens may be poor students
• Behavioral problems in children

Health and heart risks associated with sleep apnea:
• Car accidents due to daytime sleepiness
• Atrial fibrillation, irregular heart beat
• Heart attacks and strokes
• High blood pressure
• Sudden death
• Dementia

Consult a physician and inquire about a sleep study if you are concerned about this health problem.

www.mayoclinic.org/diseases-conditions/sleepapnea
Betty & Bev

NEW BLOOD PRESSURE GUIDELINES

September 11, 2015

High blood pressure increases risk for:
heart attacks, heart failure, strokes, and kidney failure.

Blood pressure.2Until today, physicians did not have an optimal goal for patients with high blood pressure. New information released from the Sprint study was reported by officials from the National Heart, Lung and Blood Institute. A paper with all the data will be published in a few months.

The Sprint study examined nearly 10,000 men and women, ages 50 and older, who were at risk for heart and kidney disease. Twenty-eight percent of the participants were over the age of 75.

Officials from the National Heart, Lung and Blood Institute announced they ended the study a year before the planned conclusion because of the potentially lifesaving results. This is extremely important information because high blood pressure is so prevalent. One in three people (79 million adults in the US), have high blood pressure and half of those being treated have systolic pressures over 140.

About two years ago, a panel of experts at the National Heart, Lung and Blood Institute panel recommended a systolic goal of 140 because there was no convincing data to show lower was better, now we have that data.

There have been improvements over the past few years with healthier lifestyles, more exercise and lowering abnormal lipid levels, but cardiovascular disease remains the leading cause of death. Uncontrolled high blood pressure contributes to heart disease in addition to the other disorders noted above. It is important to monitor your blood pressure and take control of your health. If your blood pressure is consistently above 120 systolic (the upper reading), see your healthcare provider for assistance in lowering your blood pressure to 120 or below.

Betty Kuffel, MD

FAT FACTS FOR A HEALTHIER HEART AND BRAIN

UNDERSTANDING FATS

Heart disease is the number one cause of death for both men and women.
Childhood obesity contributes to early high blood pressure, Type 2 diabetes and heart disease.
Food choices and exercise beginning in childhood are important throughout life.
Changing behaviors over recent years has reduced heart disease but it remains the #1 killer.

The Mediterranean Diet is an excellent life diet that includes fruits, vegetables, fatty fish such as salmon, whole grains, foods rich in monounsaturated fatty acids such as avocados, olive oil and nuts.

Recent research published in the Journal of the American Heart Association reported testing a population of people ages 21-70 on each of three different diets. They found a reduction in bad (LDL) cholesterol levels when consuming one avocado/day.

Avocado heartFive million Americans have Alzheimer’s disease.
A study at Brigham & Women’s Hospital examined the relationship between healthy fat intake and memory retention. Over 4 years, women on higher amounts of monounsaturated fats had better memory.

Intake of healthy fats contributes to both heart and brain health.

Excerpt from:

Your Heart: Prevent and Reverse Heart Disease in Women, Men and Children

The Science of Fats

Dietary fat is a primary component of atherosclerosis and coronary heart disease. When fat consumption is high, the tendency to develop the disease early in life is increased and progresses with age. This section will provide information on types of fat, why some are more harmful than others, and which dietary choices are beneficial.

Fat Structure
Monounsaturated, Polyunsaturated and Trans Fat
First of all, monounsaturated fatty acids and polyunsaturated fatty acids (PUFA) are healthier than trans fats. They begin as oil, liquid at room temperature. The process of hydrogenation raises the melting point making oil become solid at room temperature, and turns oil into stick margarine. The hydrogenation process makes them unhealthy.

If oil is “partially hydrogenated,” the reaction process is stopped at the point where the product is soft like some brands of margarine marketed in plastic containers. Adding hydrogen makes the oil more resistant to spoilage, prolonging shelf life.

Many commercial baked goods contain trans fats. You may already understand what trans fats are because they are frequently in the news. Trans fats are bad fats because when consumed, they raise cholesterol. Found naturally in the fat of meat and dairy products, trans fats also form during the hydrogenation of healthful plant-based oil.

(Molecular discussion follows. Please skip the next 2 paragraphs if you are not interested in the chemistry of fats.)

By definition, monounsaturated fats contain only one molecular double bond in the fatty acid chain; polyunsaturated fats have more than one double bond. Fats are called trans or cis depending on the position of the double bonds. In the hydrogenation process both cis and trans fats are formed. The trans fat configuration is a unique partially hydrogenated fat in which the molecular configuration is in the trans position producing a straighter molecule. This results in a higher melting point. Basically, the hydrogenation process turns healthy plant-based oils into unhealthy fats that will raise blood lipid levels when consumed.

Saturated fats (example: lard) are fully saturated with hydrogen; no more hydrogen can bond. However, they are not called trans fats because their bonds can rotate (not locked in the cis or trans molecular configuration). Saturated fats are solid at room temperature.

♥ Olive oil is a primary monounsaturated oil source. Olive oil contains oleic acid which has a single cis double bond. Therefore it is a mono–single unsaturated fatty acid. Olives, avocados, sunflower seeds, peanuts, almonds, whole grains, popcorn and cashews are high oleic acid. Research shows an improvement in diabetic insulin levels and blood sugar control when olive oil is used. Remember oil is caloric. Even though it is healthier than butter, one tablespoonful of any fat equals 100 calories.

Polyunsaturated fat is divided into two types: omega-3 fatty acids and omega-6 fatty acids. Primary sources of omega-6s are soy, corn and safflower oil. Omega-3s are found in canola oil, flaxseed, walnuts and cold water fish. Soybean oil contains both omega-3 and omega-6.
When you eat trans fats your LDL goes up. That results in more “lard” in your arteries. In addition, trans fats may also lower your good cholesterol. You need to keep your consumption of trans fats as low as possible. The American Heart Associations recommends limiting intake to less than 1% of your total daily calories.

Be sure to read labels. Many processed foods contain trans fats. If a serving has less than 0.5 grams of trans fat, the label may state zero. Some restaurants now advertise they are no longer using trans fats in deep frying. That is excellent news; however, any fried food contains significant amounts of oils and calories. Avoid all fried foods if you are on a calorie-restricted diet or have lipid abnormalities.

Some of the common commercial foods containing trans fats are: microwave popcorn, cake, cookies, pie, margarine, frosting and coffee creamers. If you buy commercial items, choose those containing zero trans fat. Specifically avoid partially hydrogenated oils and shortening.

Denmark was the first country to ban tans fats from foods. In 2008, California became the first state to ban restaurant chains from using trans fats for cooking; New York City and Chicago followed suit. More recently, five additional states have joined in, as have cruise ship lines and hotel chains. As a country, along with banning smoking in public places and the many Quit Smoking campaigns, we are now taking steps to change food choices to help overcome our heart disease crisis.

Cutting both trans fats and saturated fat from your diet is very important. Combine this modification with eating only lean meat and adding omega-3 fatty acids found in fish. Making these choices places you on the right track toward heart health.

♥ If you need to cook with oil, use mono-unsaturated products such as olive oil, peanut and canola oils or polyunsaturated oils. If your LDL and total cholesterol levels are high and you are overweight, avoid fatty meat, eat few egg yolks, avoid cheese and whole milk products. Consider eating veggie egg white only omelets.

* * *

For Heart Health and Weight Control Avoid Saturated Fat:
Animal fat contributes to heart disease and obesity. Eating fried foods and fatty meat including hamburger, steaks, prime rib, rib-eye and T-bone cuts all contain significant calories and fat. Even when grilled, these are not good choices if you are trying to reduce your fat and calorie intake.

Choose lean cuts such as sirloin, and remove all visible fat from all cuts of meat. Pork loin without fat and bone can be a healthy choice. Remove all skin and fat from poultry.

Broil, bake and boil meats. Frying and deep frying any food is not recommended for health reasons.

For Brain Health and General Health Choose to Eat Monounsaturated and Polyunsaturated Fat:
Avocados are nutritious and contain monounsaturated healthy fat. A whole small avocado contains about 250 calories, less than most meat servings. Healthy monounsaturated fats are also found in olive oil, peanut oil, hazelnuts and pumpkin seeds.

Healthy fats, the omega 3 and omega 6 (polyunsaturated fats) are found in:  walnuts, flax seedAvocado tree oil, chia seeds and marine algae oil.

Best wishes for healthy living.

Betty and Bev

See our women’s health blog lipsticklogic.com for addition health information.