Lower Your Heart Risk
Risk comes from not knowing what you're doing - Warren Buffett
The cardiologist Sandeep Jauhar has become a Dante of modern medicine, with his earlier memoirs, “Intern” (2008) and “Doctored” (2014), casting the progress from training to career as a path studded with suffering, indignity and ethical hazard. His latest book, “Heart: A History,” is something of a “Paradiso,” pointing to the field’s brightest and noblest stars while recognizing just how much darkness is still left in the firmament.
Contemporary cardiology, Dr. Jauhar notes, is coming off a perhaps unrepeatable century of success. Since 1950, deaths from cardiovascular disease have declined by 60% in the U.S.—meaning that, every year, more than a million Americans who would have died under midcentury care survive. Today a host of advances—drugs that lower cholesterol and blood pressure, implantable defibrillators, catheterizations to unclog arteries, and even heart transplants—have turned many forms of heart disease into manageable illnesses rather than death sentences.
Now, however, Dr. Jauhar believes that the field “in its current form might have reached the limits of what it can do to prolong life.” For years, hospitals have raced to decrease “door-to-balloon time”—the delay from arrival to the deployment of a catheter for patients suffering heart attacks—on the dictum that “time is muscle,” with cardiac cells suffocating by the minute. Yet a 2013 study found that, beyond a certain point, additional rapidity may not increase survival. New and much-lauded (and pricey) drugs for heart failure improve mortality and hospitalization rates by only a few percentage points. And the number of cardiac transplants performed annually has stagnated. Where do we go from here?
Poignant and chattily erudite, “Heart” shuttles between scholarship and memoir to relate this continuing epic, the uneasy companionship between humans and our most metaphorized organ. Dr. Jauhar offers brief biographies of luminaries—such as John Gibbon, inventor of the heart-lung machine, and Werner Forssmann, pioneer of cardiac catheterization—that are sympathetic but not hagiographic.
Yet if medicine is to advance, it may be driven less by single superstar intellects than by methods of intensive and searching inclusivity. Dr. Jauhar discusses the famous Framingham Heart Study, in which researchers have followed residents of a Massachusetts town since 1948 to detect disease patterns, in one early example of learning from an entire population. Though flawed in its assumption that the results from its mostly white, middle-class subjects would be applicable world-wide, it provided the first evidence of smoking and cholesterol as risks for heart disease.
But we can do better. The Masala study of South Asians in the U.S. (mentioned in a footnote in Mr. Jauhar’s book) seeks to answer similar questions, this time for a group that other studies have excluded, underrepresented or buried under statistical noise. Many South Asians who die of heart attacks have no risk factors at all under the Framingham model. What such “mystery” cases need is less a super-sleuth than sustained epidemiologic attention.
Where “Heart” shines is in charting another crucial shift that sounds like a throwback but might well be cardiology’s next wave: attending to the mind-body problem. Interest in the connection between so-called affective traits and heart disease languished after the discrediting of the 1950s “type-A personality” hypothesis—essentially, a psychological profile invented by a pair of cardiologists in a rather improvisatory attempt to explain why so many executives had heart attacks.
While results of this early personality-typing research proved shaky, a more rigorous 1981 study found that a startling number of patients with life-threatening arrhythmias had suffered acute psychological stress the day of their attacks. This July, a small but provocative study demonstrated better outcomes for patients who had been prescribed an antidepressant after a heart attack.
Dr. Jauhar is careful to couch these findings in politically neutral terms, but they are ripe for more polemical interpretations. To a libertarian-minded reader, they are evidence that patients can increasingly be captains of their cardiologic fate, that self-knowledge and proactive management can mean survival. (Cardiac rehab centers that used to be long walls of treadmills are now just as likely to have yoga mats, meditation rooms and talk therapy.) To a progressive reader, such mind-body data shows that chronic stressors such as inequality and prejudice are not just unfair but literally poisonous to the heart.
What’s clear to all, though, is that, as Mr. Jauhar writes: “We will need to shift to a new paradigm, one focused on prevention—turning down the faucet rather than mopping up the floor.”
Source: Laura Kolbe, ‘Heart: A History’ Review: At the Bleeding Edge, The Wall Street Journal, September 14, 2018.
The My Heart Risk™ is a mobile app that helps to track physical activity and predict health status including risks of cardiovascular disease.
If you are a healthy woman without diabetes, the Reynolds Risk Score is designed to predict your risk of having a future heart attack, stroke, or other major heart disease in the next 10 years.
This interactive tool estimates your risk of coronary heart disease and provides personalized tips for prevention. Anyone can use it, but it’s most accurate for people who have never had any type of heart disease. If you have heart disease, be sure to talk to your doctor about your risk.
Despite the popularity of such diets, the research on how they impact heart health has been relatively scant. A new study, though, published this week by the American Heart Association, shows that eating a lot of protein—derived from both plants and animals—is linked to an elevated risk of cardiovascular failure.
Despite the muscle-building, flab-trimming and, according to recent research, mood-boosting benefits of lifting weights, such resistance exercise has generally been thought not to contribute much to heart health, as endurance workouts like jogging and cycling do. But a study published in October in the journal Medicine & Science in Sports & Exercise provides evidence for the first time that even a little weight training might reduce the risk of heart attack or stroke. People appear to gain this benefit whether or not they also engage in frequent aerobic exercise.
Preventing heart disease is a huge public health challenge. And right now doctors have good, but limited, options for finding out who is at greatest risk for it.
Doctors know that about half the risk for heart disease comes from lifestyle choices: how much, and what, a person is eating, how much alcohol they drink, if they smoke.
The other half is related to genetics, and it’s much harder to assess.
The just-released American Heart Association (AHA) Science Advisory doesn't justify my eating sushi for breakfast, lunch, and dinner every day during a recent visit to Japan. However, it does re-affirm that eating one to two servings of fish a week may help reduce the risk of heart disease and stroke.
Regular endurance exercise is thought to help protect folks who carry genes that put them at risk for heart trouble, but just how much can it help them?
Yes, cholesterol is important, but there's another fat—triglycerides—you need to keep tabs on. Here's how to get it under control.
Low-fat or low-carb? Butter or margarine? Avocado oil or coconut oil? Bombarded with contradictory media reports on the ever-changing landscape of nutrition research, it’s difficult for anyone to know which fats and other foods they should eat, and in what quantities.
Does heart disease run in your family? You could most likely slash your risk of developing or dying from heart disease if you are physically fit. Being strong helps too.
Those are the findings of the largest study to date of the associations between exercise, fitness and cardiac genetics.
Behind Public Health England's Heart Age Test is more than 70 years of data. And it all started in the small US city of Framingham, Massachusetts.
While doctors routinely test for other lipoproteins like HDL and LDL cholesterol, few test for lipoprotein(a), also known as lp(a), high levels of which triple the risk of having a heart attack or stroke at an early age.
Dr. Lloyd-Jones at Northwestern said that testing for lp(a) should be considered for people with early-onset cardiovascular disease — which means younger than age 50 for men and age 60 for women — or a strong family history of it. Since high lp(a) is hereditary, those who have it often have a parent, sibling or grandparent who suffered a premature heart attack or stroke. When one person has it, it’s important to test other family members too.
In the essay, Lundell describes his purportedly newfound understanding that a diet of natural, unprocessed food can prevent and reverse heart disease, high blood pressure, diabetes, and Alzheimer’s disease. He recalls two and a half misguided decades as a cardiac surgeon prescribing cholesterol-lowering medications and recommending a low-fat diet. He says that he recently realized the error of his ways, stopped practicing, and dedicated his career to heart disease prevention.
Studies of heart disease risk in various ethnic groups can also benefit people outside those groups, researchers say. “Differences across ethnicities tell us something important about biology that could be exploited in different ways,” says Dr. Herrington, of the Mesa study. “The subtleties and the differences between ethnicities can be very informative and can help us in ways that studying one ethnicity cannot.”
Proton pump inhibitor (PPI) therapy was associated with an increased risk of myocardial infarction in a data mining study.
The study revealed that the benefits of statins lasted more than a decade after the clinical trial closed. This new information gives credence to physicians’ use of blood pressure and cholesterol lowering drugs to improve survival in patients with hypertension.
A new look at an old study raises some questions and reignites a debate about saturated fat.
It remains to be seen whether the treatment, which was effective in a large clinical trial, will live up to its promise.
Doctors have long wondered what the magic blood pressure number is for people at risk for heart attacks and strokes.
The current strategy of reducing a person's heart-attack risk by lowering cholesterol to specific targets is being jettisoned under new clinical guidelines unveiled Tuesday that mark the biggest shift in cardiovascular-disease prevention in nearly three decades.
"A beer every day could keep the doctor away," chirped one headline that made the rounds this week. Another boldly proclaimed that a pint-a-day habit could flat-out prevent stroke and heart disease. Yet another promised to explain "Why drinking beer could be good for your heart," and then backpedaled. "Positive effects were negated by heavy drinking," added the subhead. That's better, but let's back up even more.
A cardiologist surveys his field and worries that we “might have reached the limits” of what we can do to prolong life.
If it feels hard to keep up with nutritional advice, don't worry—cardiologists are here to help.
Scientists now know a great deal about what you can do to reduce your risk of cardiovascular disease–the leading cause of death in the U.S. in both men and women. Follow these essential steps to protect your health. Although taking these measures doesn’t guarantee that you won’t ever have a heart attack, it should improve your odds.
The heart is a muscle that pumps blood and its essential cargo of oxygen and nutrients around the body. Like all muscles, it needs oxygen to work properly. Its supply comes in via the two powerful coronary arteries that network deep into the heart muscle. When something goes wrong with this supply, the condition is life threatening.
Learn more about risk factors for heart attack (myocardial infarction) – and learn how you can work with your doctor to make more informed decisions.
Boston Heart Diagnostics’ approach to cardiovascular disease risk assessment and treatment is different than any other laboratory.
First, we’ve developed two unique tests–the Boston Heart HDL Map™ and the Boston Heart Cholesterol Balance™ test to uncover specific and important information about your cholesterol that offers more insight than a standard lipid panel.
Why do you need to keep a healthy heart?
Heart disease is the #1 cause of death in men and women, greater than the next five causes of death combined!
Prevention falls into two main categories: preventing heart disorders in general and monitoring and treating any existing heart problems.
You can prevent heart disease by following a heart-healthy lifestyle.
Cardiovascular disease is responsible for half of all deaths in the United States and other developed countries, and it is a main cause of death in many developing countries as well. Overall, it is the leading cause of death in adults.
The University of California, Irvine Heart Disease Prevention Program at the UCI College of Medicine strives for excellence in scholarly research, community education, and clinical care aimed at the prevention, early detection, and reversal of coronary heart disease in children, adults, and the elderly. Our team of specialists and well-trained staff at the UCI Heart Disease Prevention Program strive to do what we do best: "Keeping Your Heart Healthy."