Johns Hopkins Health Alerts - Heart Health

Genetic Testing for Heart Disease: Is It a Good Idea?

Fri, 12 Feb 2010 06:00:00 CST

Having a family history of premature heart disease (heart disease in a father or brother younger than age 55 or in a mother or sister younger than age 65) is considered a risk factor for heart attacks.

Today, many investigators are searching for genes that might be associated with premature heart disease. A few have been identified, such as that for familial hypercholesterolemia (see below), and some companies already market tests that purport to assess risk. However, genetic research is still in its early stages. In addition, many of the genes involved in heart disease have not yet been identified, and having a particular gene mutation does not mean that you are destined to have a heart attack.

So for now, we advise against genetic testing for the vast majority of people with a family history of premature heart disease, because the results are unlikely to change your doctor's treatment advice.

What is inherited high cholesterol? -- Familial hypercholesterolemia is an inherited form of high cholesterol that results from a mutation in the gene for the low-density lipoprotein (LDL) receptor. About 1 in 500 people inherits a single copy of the mutated gene from either their father or mother.

In people with familial hypercholesterolemia total cholesterol levels are usually above 300 mg/dL and LDL cholesterols are above 200 mg/dL. In addition, men with the condition often have heart attacks in their 40s and 50s; women, in their 60s.

Because people with familial hypercholesterolemia have a one in two chance of passing the mutation on to their children, family members can benefit from a blood cholesterol test at an early age. High total and LDL cholesterol levels indicate the need to start treatment.

Treatment involves the same measures used for other forms of high cholesterol. Dietary changes are especially important, and medication is always needed. However, even with treatment, very few people with familial hypercholesterolemia are able to lower their cholesterol to normal levels.

People who inherit high cholesterol levels and have a positive family history should make an appointment with a doctor who specializes in lipids if they are unable to lower their LDL cholesterol substantially after six months to one year of treatment. For a referral to a physician in your area, call MEDPED (Make Early Diagnosis to Prevent Early Death) at 888-244-2465 or visit www.medped.org.

15 Tasty Ways to Eat More Fruits and Vegetables

Fri, 11 Dec 2009 06:00:00 CST

Study after study reports that when your diet is high in fruits and vegetables -- which are the richest natural sources of vitamins, minerals, and fiber -- you are doing the best you can to protect your heart and help prevent many diseases, including cancer. Yet, approximately 90% of Americans fail to meet the government's recommendations for fruit and vegetable consumption.

In light of the mounting evidence that fruits and vegetables offer even more health benefits than previously understood, it makes good sense to increase your intake of these foods and explore a wider variety of the fruits and vegetables.

An apple a day may "keep the doctor away," but you'll be doing your body a favor if you sometimes snack on other kinds of produce -- kiwifruit, blueberries, carrots, pomegranate juice, or dried apricots, to name just a few. If you don't already eat at least two cups of fruit and three cups of vegetables every day, consider the following heart-healthy tips:

Heart Health Tip 1. Stock up on fresh fruits and keep them accessible on your countertop or visible in your refrigerator.

Heart Health Tip 2. Add fresh or dried fruit to your breakfast cereal.

Heart Health Tip 3. Thaw frozen berries and add them to plain or vanilla yogurt for a snack or dessert.

Heart Health Tip 4. Have a six-ounce glass of 100% fruit juice with your breakfast.

Heart Health Tip 5. As thirst-quencher or a mealtime beverage, make a "spritzer" by adding 100% fruit juice to sparking water or seltzer.

Heart Health Tip 6. Enjoy a fruit smoothie made by blending low-fat milk or yogurt with fresh or frozen fruits.

Heart Health Tip 7. Bring dried fruit (raisins, apricots, cranberries, apple slices) to work for mid-morning or mid-afternoon snacks.

Heart Health Tip 8. Add tomatoes, onions, peppers, and/or mushrooms to an egg-white omelet for a hearty breakfast or brunch.

Heart Health Tip 9. Chill small cans of vegetable juice to snack on at work.

Heart Health Tip 10. When dining out, start your meal with a salad.

Heart Health Tip 11. When making or ordering a wrap or sandwich, include lettuce, tomatoes, cucumber, and other raw vegetables.

Heart Health Tip 12. Add raisins, grapes, or apple slices to your salads.

Heart Health Tip 13. Make a big pot of vegetable soup on the weekend and freeze it in single-portion containers to reheat for a quick weekday lunch or supper.

Heart Health Tip 14. Make your own pizza (you can buy ready-to- use dough at a pizzeria or supermarket) and top it with mushrooms, onions, broccoli, spinach, or eggplant.

Heart Health Tip 15. Double the portion of vegetables you already eat at lunch and dinner.

Are You At Risk for an Aortic Aneurysm?

Fri, 01 Jan 2010 06:00:00 CST

The largest artery in your body, the aorta, is like the major highway for blood flow -- beginning after the blood leaves the left ventricle (your heart's main pumping chamber) and branching off into smaller vessels that supply every tissue and organ in your body. In other words, the aorta is one of your major lifelines.

With the constant traffic of blood flow, the walls of the aorta can become weakened in spots, causing portions to bulge outward like a balloon -- a condition known as an aneurysm. Often, aneurysms are too small to be life threatening, but some swell to the point where they are likely to rupture.

When an aneurysm ruptures, it causes internal bleeding that requires prompt surgical repair. Unfortunately, most individuals die before reaching the hospital.

An estimated 1.5 million Americans have an aneurysm in the aorta. Aneurysms can arise in the part of the aorta that runs through the chest, but most occur in the section that passes through the abdomen. About 4 to 9% of people older than age 60 have an abdominal aortic aneurysm. Ruptured abdominal aortic aneurysms kill 15,000 to 30,000 Americans each year, a figure that is low compared with the number of deaths from complications of coronary heart disease (CHD), such as heart attacks, which kill nearly 500,000 Americans annually.

But the odds of surviving an abdominal aortic aneurysm rupture are quite low. Approximately two thirds of victims die before reaching the hospital. Of those who do get to the emergency department, about half die nevertheless. This situation makes it vital to control any risk factors you have for developing an abdominal aortic aneurysm and, if possible, to identify the presence of an abdominal aortic aneurysm early.

Are you at risk? Older age is one of the main risk factors for aortic aneurysms -- about three quarters of abdominal aortic aneurysms arise after age 60. Gender and heredity also play a role. Men have a four to five times greater risk than women, and people with a family history of abdominal aortic aneurysms also are at heightened risk.

Although you cannot change these risk factors, you can control several others, including smoking. Smoking is not only a major risk factor for development of an abdominal aortic aneurysm but also raises the likelihood that an aneurysm will enlarge and rupture, possibly because smoking triggers inflammation in blood vessels. Other risk factors for abdominal aortic aneurysm -- CHD, uncontrolled high blood pressure, and high cholesterol levels -- all can damage the lining of the aorta and contribute to aortic aneurysm formation.

Flu shot a MUST for People with Heart Disease

Fri, 30 Oct 2009 06:00:00 CDT

Have you had your annual flu shot? Between 10% and 20% of people catch the flu each year, and a bad case can be deadly for individuals with coronary heart disease. Yet only one in three adults with cardiovascular disease get an annual flu shot. Read what the AHA advises.

People with heart disease are not only at higher risk for the flu than the general population but also more likely to have a severe case and to develop complications, such as viral or bacterial pneumonia. What's more, the flu can worsen coronary heart disease and trigger a heart attack.

No one knows for sure how the flu increases the risk of a heart attack. One possibility: Inflammation associated with the flu can trigger the rupture of unstable plaque, leading to the formation of a blood clot that could cause a heart attack.

Heart Benefits of the Flu Shot -- The strongest evidence for protection from a flu shot in people with heart disease comes from the Flu Vaccination in Acute Coronary Syndromes (FLUVACS) study. In that study, about 300 individuals who had been hospitalized for either a heart attack or a planned angioplasty were randomly assigned to receive a flu vaccine or remain unvaccinated. Over the next year, twice as many of the unvaccinated group (23%) died of heart disease, had a nonfatal heart attack, or developed severe ischemia (insufficient blood supply to the heart tissue), compared with those who were vaccinated (11%).

Bottom line advice: The American Heart Association (AHA) recommends a flu shot with the same enthusiasm as it does the control of cholesterol, blood pressure, and other modifiable risk factors for heart attacks. In a scientific advisory issued by the AHA and the American College of Cardiology heart doctors were asked to do something they may not normally do -- give their patients flu shots.

The Centers for Disease Control and Prevention also recommends an annual flu shot for individuals age 50 and older as well as anyone with a chronic health problem such as heart disease or diabetes. Besides getting a flu shot, two other simple measures -- frequent hand washing and, if possible, avoiding close contact with a flu sufferer -- can help reduce the risk of catching the flu.

What Is Non-HDL Cholesterol?

Fri, 22 Jan 2010 06:00:00 CST

Although levels of LDL ("bad") cholesterol are the primary focus of a cholesterol screening (which also measures total cholesterol, HDL ["good"] cholesterol, and triglycerides), about half of all heart attacks occur in people with normal LDL levels. So researchers have looked at other measurements that can help identify people at risk for cardiovascular disease.

Non-HDL cholesterol is obtained by subtracting the level of HDL cholesterol from total cholesterol. The resulting value measures not only LDL cholesterol, but also cholesterol contained in metabolic "remnants" of very low-density lipoproteins (VLDL), the main carriers of triglycerides. Like LDL cholesterol, these remnants promote the buildup of plaque in arteries. Studies have shown that non-HDL cholesterol is better than LDL cholesterol alone at predicting cardiovascular risk, especially in people with elevated triglycerides.

People with type 2 diabetes often have elevated triglyceride levels but relatively normal LDL cholesterol values, so measuring their non-HDL cholesterol can be useful in assessing their risk and guiding their treatment. One advantage of factoring in non-HDL cholesterol is that it requires no additional testing; it simply can be calculated after a standard cholesterol test.

According to guidelines from the National Cholesterol Education Program, desirable levels for non-HDL cholesterol are 30 mg/dL above target levels for LDL cholesterol. Thus, if you have type 2 diabetes, your level of non-HDL cholesterol should be no higher than 130 mg/dL (since the LDL cholesterol target is 100 mg/dL for anyone with diabetes). If your triglyceride level is above 200 mg/dL, ask your doctor about your non-HDL cholesterol.

Is White Wine Good For Your Heart?

Fri, 18 Sep 2009 06:00:00 CDT

In this House Calls column from a recent issue of our Health After 50 newsletter, a reader asks: Is white wine as "heart healthy" as red wine? Here’s what you should know about the heart health benefits of white wine.

The answer is probably -- though researchers continue to debate the question. Some studies have indicated that red wine is modestly better for the heart than white wine (or beer or spirits) because it contains resveratrol -- a polyphenol (plant chemical) associated with cardiovascular benefits, including reduced risk of heart attack.

Resveratrol is found in the seeds and skin of grapes, which are crushed together with the pulp to make red wine. White wines, on the other hand, are made with just pulp and therefore contain very little resveratrol. But recent studies have shown that the pulp does contain other polyphenols that may be heart healthy.

Moreover, although red and white wines differ in polyphenol composition, both contain similar amounts of alcohol -- which is known to increase level s of HDL ("good") cholesterol and prevent blood clots. And observational studies have found that drinking any type of alcoholic beverage in moderation has the potential to reduce the risk of a heart attack. ("Moderate" generally means no more than two drinks per day for a man and one drink for a woman. In most studies, "a drink" is the equivalent of about 5 oz of wine.)

Remember, too, that most experts don't advise nondrinkers to start consuming alcohol to improve their heart health. There are better ways to accomplish that -- starting with diet and exercise to control your blood pressure, cholesterol, and weight. Drinking should never be a substitute for these measures.

Key Heart Attack Prevention Strategies

Fri, 28 Aug 2009 06:00:00 CDT

Some people think that heart attacks are an inevitable part of growing older. But there's nothing inevitable about them. In fact, heart attacks are highly preventable. Yet too many men and women are not taking the steps that could help protect them. A recent article in the journal Circulation underscores this observation.

More than three quarters of U.S. adults could benefit from at least one strategy for preventing heart attacks and strokes, according to a recent analysis in the journal Circulation (Volume 118, page 576).

Using a mathematical model, researchers looked at the effects of 11 commonly recommended activities for reducing the risk of cardiovascular disease. According to the model, if all adults ages 20 to 80 followed through on all preventive activities for which they are candidates, more than 60% of heart attacks and 30% of strokes could be prevented over the next 30 years. The model also predicted that with more typical levels of follow through, heart attacks and strokes could be reduced by 36% and 20%, respectively.

The most beneficial strategies for preventing cardiovascular disease were providing aspirin to individuals at high risk for heart attacks, controlling prediabetes, losing weight for obese people, lowering blood pressure in those with diabetes, and lowering LDL cholesterol in individuals with coronary heart disease.

If you're obese or smoke; have diabetes, prediabetes, or coronary heart disease; or have high blood pressure or high cholesterol levels, ask your doctor whether you are taking advantage of all available measures to reduce your risk of heart attacks and strokes.

Can Anxiety Cause a Heart Attack?

Fri, 09 Oct 2009 06:00:00 CDT

A number of studies link depression with heart attacks, although doctors aren't sure how depression increases the risk. But what about anxiety? A reader asks: “I know that depression is a risk factor for a heart attack. But what about anxiety?”

Anxiety also appears to be a risk factor for heart attacks. According to a recent study of 735 older, healthy men, published in the Journal of the American College of Cardiology, those with the highest levels of anxiety were at greater risk for a heart attack over 12 years than men with less anxiety. In addition, the more severe the anxiety, the higher the risk of a heart attack.

The relationship between anxiety and heart attacks held even after controlling for other heart attack risk factors -- such as age, body weight, LDL cholesterol levels, and systolic blood pressure -- and after taking into account other negative emotions like depression and anger. In fact, anxiety was a better predictor of heart attacks than depression, anger, hostility, and type A behavior.

Anxious people experience chronic stress, which activates the autonomic nervous system and may increase inflammation and blood clotting, all of which can contribute to heart attacks. Anxiety may also impair regulation of heart rate. Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety, phobias, and generalized anxiety disorder.

All of these illnesses are treatable. If you think you may have an anxiety disorder, call your doctor. Treatment options include cognitive-behavioral therapy, relaxation techniques, and medication.

The Low-Carb/Low-Fat Diet Debate

Fri, 17 Jul 2009 06:00:00 CDT

If you have coronary heart disease and are overweight, you’ll want to try to drops those extra pounds through a regimen of regular physical exercise and a reduced-calorie diet. But which diet gives you the best chance of success: a low-carb or low-fat diet? Here’s advice from Johns Hopkins.

This is a good question -- and the best answer may be "something in between." Many studies have examined the low-carb/low-fat debate, typically showing that both approaches help people lose weight.

For example, a study in The New England Journal of Medicine found that of 322 obese adults, those on a low-carb diet lost 10 lbs over two years versus 6 lbs among those on a low-fat diet. While weight loss was greater with the low-carb diet, this eating plan can be high in saturated fat, which raises LDL cholesterol. This is particularly true if you take the bacon-and-eggs approach to low carb rather than choosing lower fat sources of protein, such as beans, nuts, and skinless poultry, as a substitute for carbohydrates.

So the most prudent diet may be one of moderation that is neither low fat nor low carb. In The New England Journal of Medicine study, a third group followed a Mediterranean diet -- low in red meat and saturated fat but fairly high in healthy fats from olive oil and fish and containing carbohydrates from fruits and vegetables. This group lost just as much weight as the low-carb-diet group.

In fact, the American Heart Association now recommends a Mediterranean-style diet for heart health instead of a strictly low-fat diet. A low-carb diet is not recommended, as its long-term effects on the heart are unknown.

Exercise Safety and Your Heart

Fri, 05 Jun 2009 06:00:00 CDT

In this Heart Health Alert, cardiologist Dr. Roger S. Blumenthal answers questions on heart health and exercise from two readers who exercise regularly, but still have concerns. These questions come from a recent issue of The Johns Hopkins Heart Bulletin.

Q. Is it a dangerous to exercise if I am having angina pains? I am a 55-year old longtime runner, and I recently "ran through" the pain during a 5K-road race. Is it unwise to continue a workout when I’m having chest pain? Shaker Heights, OH

Dr. Blumenthal: Angina -- chest pain or discomfort that occurs when an area of the heart muscle doesn't get enough oxygen-rich blood -- is a symptom of an underlying heart problem. That said, anginal pain itself is not a contraindication for exercise. In fact, a certain amount of regular exercise may help develop new blood vessels to the area of the heart where arteries are blocked. However, you should discuss with a physician your level of exertion and target heart rate. This is especially important if the degree of blockage is significant.

Like all muscle, the heart needs more oxygen during exercise, and strenuous exercise can cause an imbalance between oxygen demand and supply in the diseased portion of the heart; this can lead to serious consequences in some cases. If you are truly having anginal pains, you need to make sure that you are on an optimal medical regimen -- to repeat, you need to consult your doctor.

Q. I had a scare while lifting weights two days ago. I was bench-pressing 300 pounds, and my heart rate was close to maximum for me when I suddenly felt a sharp pain in my left side. I stopped my workout immediately but my heart rate remained elevated; I was wearing a heart-rate monitor and it showed that my pulse remained at 135 beats per minute for the next 15 minutes before dropping down to my usual resting heart rate of 60. I am a 49-year-old man and I have been weight lifting three times a week since my Marine Corps days, 25 years ago. My cholesterol level is under 200, I am a vegetarian, and I have no heart problems that I am aware of. However, I am now afraid to lift weights. Should I see a cardiologist? What tests should be performed? NYC, NY

Dr. Blumenthal: You certainly should see a doctor to try to determine the origin of your sudden pain, which may or may not be heart-related. Unfortunately, a middle-aged man, even with cholesterol relatively under control, may still be at risk of heart attacks and strokes.

Your optimal cholesterol level will depend on your overall cardiac risk, and your doctor will need to consider other factors, such as the details of your lipid profile (HDL, LDL, triglycerides), your blood pressure, and the possible presence of diabetes. The doctor should of course take a detailed family history, making note of any cardiac disease in your immediate and extended family. Based on your physician’s assessment, other tests may be warranted. These may include further blood tests for C-reactive protein and a noncontrast CT scan to look for calcium deposits in the blood vessels supplying your heart.

For your future cardiac health, I’d like to see you add some form of aerobic exercise to your workout schedule. This could include brisk walking, running, bicycling, swimming, or a workout on an aerobic machine such as an elliptical trainer, stair-climber, or rowing machine.

Beverages With an Unhealthy Boost

Fri, 26 Jun 2009 06:00:00 CDT

You've seen them in the grocery store refrigerated coolers, with fancy names, like Red Bull, Monster, Full Throttle, and Rockstar. They're the so-called "energy drinks" that come loaded with caffeine, sugar, vitamins, minerals, and other ingredients. But are they really good for you? Johns Hopkins reviews the data.

The popular high-caffeine, high-sugar beverages, typically sold in 8.3 oz aluminum cans (two-thirds the size of a standard size of Coca-Cola) contain about seven teaspoons of sugar and as much as two to four times the amount of caffeine (9 milligrams per fluid ounce) as Coke.

Caffeine is a drug and should be treated with caution. Some people are now suggesting that warning labels be placed on energy drink cans because of their high caffeine levels and their potential to raise blood pressure. Elevations in blood pressure were the point of small study presented at a recent American Heart Association meeting.

While the increases didn't reach dangerous levels in the healthy volunteers, the increases in blood pressure and heart rate could prove to be clinically significant in patients with heart disease or in those who consume energy drinks often, said James Kalus, Pharm.D., senior manager of Patient Care Services at Henry Ford Hospital in Detroit, Michigan, who led the study. "Individuals with high blood pressure and heart disease should be advised to avoid these drinks," he said.

Most energy drinks contain high levels of caffeine and taurine, an amino acid also found in protein-containing foods such as meats and fish. Both have been shown in some studies to effect heart function and blood pressure. In contrast, "sports drinks" like Gatorade and POWERade are simply mixtures of water, sugars, minerals, and salts, without chemicals aimed at increasing "energy" or alertness.

In Dr. Kalus' study, blood pressure and heart rate levels increased in healthy adults who drank two cans a day of a popular energy drink. According to Dr. Kalus, these changes occurred while the participants were sitting in chairs watching movies. "The increases in heart rate and blood pressure weren't enough for something to happen acutely," he said, "but a person on hypertension medication or who has cardiovascular disease may not respond as well. While energy drinks increase concentration and wakefulness, people with risk factors for heart disease could have a bad reaction. The subjects in this study were healthy, with low blood pressure."

Dr. Kalus feels that the increases in blood pressure and heart rate may be due to the caffeine and taurine in the drinks. The energy drink used in the study had as much caffeine as one to two cups of coffee, but some of the other energy drinks available contain much higher levels of caffeine.

Bottom line: "Energy drinks could affect some individuals if they didn't know they had a blood pressure problem in the first place," he said. "The study raises some concerns." Until further study, Dr. Kalus said people with high blood pressure or heart disease should steer clear of energy drinks because they could affect blood pressure and may even alter the effectiveness of hypertension medications.

Trans Fat-Free Tips

Fri, 15 May 2009 06:00:00 CDT

The American Heart Association recommends that you keep your trans-fat intake to less than 1% of your total calories. If you consume 2,000 calories a day, that's no more than 2 g of trans fat daily. On average, Americans get 2-3% of their total calories from trans fat.

Health officials have grown increasingly concerned about the potential dangers of trans fat, as research continues to show that a high trans-fat diet causes "bad" low-density lipoprotein (LDL) cholesterol levels to rise and "good" high-density lipoprotein (HDL) cholesterol levels to fall. There's also evidence that in a small percentage of adults trans fat may promote blood clot formation and inflammation and increase blood levels of triglycerides, lipoprotein(a), and small, dense LDL particles. All of these changes may increase your risk of a heart attack.

Getting rid of trans fat in your diet is not the only dietary route to a healthy heart. Don't forget that choosing a balanced diet that emphasizes fruits, vegetables, and whole grains and that is low not only in trans fat but also in saturated fat, cholesterol, and sodium is important, too.

In addition, remember that removing trans fat does not magically transform a trans fat-free food into a healthy food choice, especially if it is still high in both fat and calories. In fact, the trans fat-free version typically has the same amount of fat and calories as the trans fat-laden original.

Try some of these strategies for minimizing the amount of trans fat in your diet.

At Home:

Limit your intake of foods that commonly contain high amounts of trans fat, such as crackers, cookies, doughnuts, and frozen foods like pizza, french fries, chicken nuggets, and fish sticks.

Read nutrition labels and choose foods that are low in trans fat -- preferably less than 1 g per serving.

Don't forget to check the ingredient list. Even foods labeled 0 g trans fat can contain a small amount (up to 0.5 g per serving). Finding "partially hydrogenated" oil on the ingredient list is a tip-off to the presence of trans fat, regardless of what the label says.

Also be on the lookout for palm, palm kernel, cottonseed, and coconut oils as well as "fully hydrogenated" oils in the ingredient list. These unhealthy saturated fats are often used in place of trans fat.

When Eating Out:

Request nutrition information. A growing number of restaurants have this information but often don't advertise or prominently display it.

Check the Web first. Many chain and fast-food restaurants provide nutritional information on their websites.

Ask your server for information. What type of oil do you use for frying? What oil do you use in your salad dressing? Do you use vegetable shortening in your desserts and other baked goods?

Skip the fried foods, which are likely to be loaded with unhealthy trans and saturated fats. Baked, grilled, steamed, and broiled foods are smarter, lower-fat choices.

Eat only half your dish to reduce your trans fat intake. Portion sizes are so large at most restaurants that they can easily serve two.

More Reasons to Slim Your Tummy

Fri, 03 Apr 2009 06:00:00 CST

An estimated 65% of adults in the United States are either overweight or obese, and their excess weight translates to an increased risk of coronary heart disease. To determine if you are overweight, you can calculate your body mass index (BMI), a measurement of your weight in relation to your height. Or you can measure your waist circumference.

The adverse effects of obesity depend not only on the total amount of body fat you have but also on how that fat is distributed in your body. Excess weight concentrated in your abdomen is particularly dangerous because it leads to a condition called insulin resistance -- a reduced ability of the body to respond to insulin, a hormone secreted by the pancreas that helps the body use glucose, or sugar, as a source of energy. People with insulin resistance tend to also have high triglyceride levels, low levels of HDL cholesterol, high blood pressure, and thus an increased coronary heart disease risk. In addition, people with insulin resistance are more likely to develop diabetes, another risk factor for coronary heart disease.

Now new two new studies support the observation that people who carry their weight around their middle may face greater heart risks. The studies were reported in the Journal of the American College of Cardiology (Volume 50, page 752) and the Archives of Internal Medicine (Volume 167, page 1518).

The good news is that exercise may trim both your waistline and your odds of having a heart attack. In one study of more than 2,700 middle-aged adults, the larger that participants' waistlines were in relation to their hips, the greater their risk of plaque buildup in the arteries. In fact, waist-to-hip ratio was a better predictor of clogged arteries than was BMI.

The second study included 169 middle-aged men. In men of the same BMI, those with the lowest cardiovascular fitness had twice as much abdominal fat as their fit counterparts. And that excess belly fat was associated with higher triglyceride levels, increased ratios of total cholesterol to HDL cholesterol, and more insulin resistance (a diabetes risk factor).

Bottom line: Both studies support the notion that too much abdominal fat is harmful to the heart, even if your weight is normal. But the second study also points to a way to keep your waistline trim: regular exercise. As the fittest men had the least belly fat, exercise offers health benefits even when the scale indicates a healthy weight.

Heart Attack Prevention Checklist

Fri, 13 Mar 2009 06:00:00 CST

Are you doing all you can to stay heart healthy? Here are the ABC's of heart attack prevention -- an easy-to-remember checklist of the steps you can take to prevent a heart attack, from the cardiologists at Johns Hopkins.

Aspirin -- A daily low-dose aspirin (75–162 mg a day) is advised for people with an elevated risk of a heart attack. In some individuals, a dose of 325 mg is recommended. Aspirin is not appropriate for everyone, so be sure to consult with your doctor before starting aspirin therapy for your heart.

Blood Pressure -- Keep your blood pressure below 140/90 mm Hg (and ideally less than 120/80 mm Hg). If you have diabetes or kidney disease, make sure your blood pressure is less than 130/80 mm Hg. If you're unable to reach these goals after three to six months of lifestyle changes, your doctor may prescribe a blood pressure-lowering medication.

Cholesterol -- Your total cholesterol should be below 200 mg/dL. Keep your LDL ("bad") cholesterol well under 160 mg/dL if you are at low risk for a heart attack, below 130 mg/dL if you are at moderate risk for a heart attack, and less than 100 mg/dL if you are at high risk for a heart attack (and ideally lower than 70 mg/dL if you're at very high risk, for example, because of a recent heart attack or stroke). Your HDL ("good") cholesterol should be 40 mg/dL or greater if you are a man and 50 mg/dL or more if you are a woman (and preferably 60 mg/dL or higher). Your triglyceride level should be under 150 mg/dL.

If you are unable to reach your LDL goal after three to nine months of lifestyle changes, your doctor may prescribe medication. Exercise, dietary modifications, and possibly medication can help you meet your HDL goal. Losing excess weight, exercising regularly, and medication can help reduce your triglyceride level.

Diet and Weight Control -- Consume a variety of fruits, vegetables, whole grains, low-fat dairy products, fish, beans, poultry, and lean meats. Saturated fats should make up less than 7% of total calories; trans fats, less than 1%. If you're overweight, reduce your calorie intake and increase your physical activity to achieve and maintain a desirable body weight (a BMI below 25).

Exercise -- Perform at least 30 minutes of moderate-intensity physical activity, such as brisk walking, on five days each week. Exercising for longer periods (60-90 minutes a day) or more vigorously can provide additional benefits, including weight loss if that's one of your goals.

Additional Heart Attack Prevention Goals:

If you smoke, you should stop completely.

If you have diabetes, strive for the best possible control of your blood glucose level (HbA1c less than 7%). If diet and exercise do not adequately lower blood glucose, your doctor will recommend medication.

If you have prediabetes, keep your fasting blood glucose level below 100 mg/dL. You can do this by reaching a healthy weight and engaging in regular physical activity.

Taking Charge of Coronary Heart Disease

Fri, 20 Feb 2009 06:00:00 CST

Better treatment and lifestyle changes are improving the prognosis for the approximately 15.8 million Americans with coronary heart disease, according to a report in the New England Journal of Medicine.

Coronary heart disease is diagnosed when your coronary arteries -- the arteries that carry blood to the heart -- become narrowed by the buildup of deposits called plaques within the artery walls. This process, known as atherosclerosis, impairs the ability of the body to pump enough blood through the coronary arteries to provide adequate oxygen and nutrients to the heart. Even worse, formation of a blood clot on top of a plaque can cause a fatal heart attack.

But for those us with coronary heart disease, the news isn't all bad. A recent article in the New England Journal of Medicine (Volume 356, page 2388) reports that the number of Americans dying of coronary heart disease fell dramatically in just 20 years.

Between 1980 and 2000, the age-adjusted death rate from coronary heart disease in the United States dropped by about 50% in both men and women -- a total of about 342,000 fewer deaths. The decline was about half due to better treatments and half due to healthier lifestyles and improvements in the control of other heart risk factors.

The biggest treatment lifesavers included emergency treatments for heart attack -- such as clot-dissolving medication and artery-clearing procedures like angioplasty -- as well as therapies, such as aspirin, statins, and ACE inhibitors, to prevent further heart attacks and other complications.

Lower smoking rates and better control of blood pressure and cholesterol with lifestyle or medication were responsible for much of the benefit from improved control of risk factors.

Still, coronary heart disease remains the number one killer of Americans. What's more, this study found that increases in rates of obesity and diabetes undermined some of the gains made in other areas of coronary heart disease prevention.

Bottom line: What does this mean for you? Stick with your heart medications, but don't forget the importance of diet, exercise, and weight management in your overall health.

CPR to the Rescue

Fri, 30 Jan 2009 06:00:00 CST

If you have a friend or loved one with coronary heart disease, you'll want to know what to do in the event of sudden, cardiac arrest. A study reported in the journal The Lancet compares the benefits of mouth-to-mouth ventilation and chest compressions versus chest compressions alone and their findings may surprise you.

A heart attack typically occurs when a blood clot in a coronary artery completely blocks blood flow to a segment of the heart. When this blockage takes place, portions of the heart muscle are deprived of oxygen and become permanently damaged. Damage to the heart muscle can impair the ability of the heart to pump blood efficiently, which can lead to heart failure. The impaired blood flow can also damage the electrical system of the heart and lead to arrhythmias.

A study reported in The Lancet (Volume 369, page 920) found that victims of cardiac arrest (heart attack) stand a better chance of surviving if a bystander performs only chest compressions and forgoes mouth-to-mouth ventilation.

Japanese researchers found that of 4,068 adults who had a cardiac arrest outside the hospital, those who received chest compressions alone were twice as likely to survive with good brain function 30 days later as those who received standard CPR (22% vs. 10%).

The findings go against the long-held principles of CPR, which combine chest compressions and "rescue breaths." But they also support what a number of experts have said for years: Mouth-to-mouth resuscitation does little for cardiac arrest victims and may actually dim their already low odds of survival.

What's more, mouth-to-mouth ventilation is often a barrier to bystanders initiating CPR. Chest compressions are vital to keep blood flowing to and from the heart until medical help arrives; stopping to deliver rescue breaths may impede this blood flow.

Bottom line: Though these study results have spurred calls for revamped CPR recommendations, guidelines from the American Heart Association (AHA) still advise rescue breaths (two breaths after every 30 chest compressions) for all cardiac arrest victims. We advise that you follow the AHA recommendations.

Is It Stable or Unstable Angina?

Fri, 19 Dec 2008 06:00:00 CST

Chest pains can be frightening, no matter what causes them. But if stable angina is the cause, you can take steps to prevent the chest pain or relieve the pain if it occurs. In this Health Alert, Johns Hopkins doctors explain the important difference between stable and unstable angina and offer advice.

Angina is a warning sign that your heart needs more oxygen. In technical terms, the symptoms of angina are the result of myocardial ischemia (a shortage of blood and oxygen to the heart muscle due to the partial blockage of a coronary artery by the buildup of plaque). Stable angina occurs most often during physical activity, when the heart requires more oxygen than it does at rest but cannot get a sufficient supply because of the narrowing of one or more of the coronary arteries. Angina symptoms usually occur only when an artery is narrowed by 60–70%.

Recognizing the symptoms of angina

When people feel the discomfort of stable angina, they’re often worried that they’re having a heart attack. However, an episode of angina is not a heart attack; the chest pain subsides quickly with rest or nitroglycerin, and there is usually no lasting damage to the heart muscle. If you have stable angina, the most common symptom is a feeling of pressure beneath the breastbone. Some people experience other symptoms, such as sensations of tightness, squeezing, burning, aching, heaviness, or choking in the chest area. Angina can also produce pain in the left shoulder that radiates up to the neck and jaw, or pain in the inner part of the left arm that may travel down to the fingers. The intensity of the discomfort usually increases steadily, reaches a plateau, and gradually diminishes with rest—all within a few minutes. The pain, although uncomfortable, is rarely sharp.

Unstable angina, sometimes called crescendo angina, is a condition midway in severity between stable angina and a heart attack. If you have unstable angina, an inadequate supply of oxygen is reaching your heart, most likely because a blood clot or spasm of the coronary artery has narrowed—but not completely blocked—the artery. Like a heart attack, unstable angina is a medical emergency. In fact, it is a sign that a heart attack could occur soon. Unstable angina has three major features that distinguish it from stable angina:

The angina is unexpected and can occur at rest.

The angina is more severe and usually lasts for longer than 20 minutes.

The angina is not relieved by rest or medication.

Call 911 immediately if you think your chest pains are more than just stable angina. You’ll be taken to the hospital, where doctors can evaluate your chest pain. If unstable angina is diagnosed, you will likely need to stay in the hospital for about 2–5 days to receive treatment to prevent a heart attack.

Dr. Margolis Talks About Metabolic Syndrome

Fri, 28 Nov 2008 06:00:00 CST

In this discussion from an issue of the Johns Hopkins Heart Bulletin, Simeon Margolis, M.D., Ph.D. answers readers' questions about metabolic syndrome.

Q. Is metabolic syndrome a disease or medical condition?

Dr. Margolis answers: Metabolic syndrome is neither a disease or disorder but rather a term used to describe a cluster of specific disorders that, when they occur together, may significantly increase a person's risk of developing cardiovascular disease or type 2 diabetes. The value of the term is that it alerts both patient and physician that heart disease and diabetes, two seemingly disparate ailments, actually share common triggers.

You shouldn't look at metabolic syndrome as a disease per se, but as a group of important warning signs that something is medically wrong and needs to be fixed.

Q. What conditions constitute metabolic syndrome?

Dr. Margolis answers: Metabolic syndrome has no symptoms but the abnormalities involved can be detected by a physician. The actual definition of metabolic syndrome is under debate among medical groups and has pitted cardiac experts against endocrinologists in heated discussions over the validity of metabolic syndrome as a diagnosis.

By the definition determined by the National Cholesterol Education Program of the National Heart, Lung, and Blood Institute (this is only one of several definitions of metabolic syndrome), you have metabolic syndrome if you have at least three of the following five abnormalities:

Abdominal obesity (a waist circumference greater than 40 inches in men or 35 inches in women) indicates central obesity and an "apple shape," which is a major risk factor for metabolic syndrome.

A low HDL (good) cholesterol level (less than 40 mg/dL in men or less than 50 mg/dL in women).

A high fasting triglyceride level (150 mg/dL or higher) indicates hypertriglyceridemia, high blood levels of triglycerides, the most abundant fat in the body.

Higher-than-normal blood pressure (130/85 mm Hg or higher) or taking a blood pressure-lowering medication.

Elevated fasting blood glucose level (110 mg/dL or higher). Your glucose, or blood sugar, levels are elevated following a fast but are not high enough to constitute diabetes. Elevated glucose levels signify insulin resistance, the inability of the body to utilize glucose efficiently.

Why a Yearly Flu Shot Can Protect Your Heart

Fri, 07 Nov 2008 06:00:00 CST

The newest tool for preventing heart attacks is … a flu shot. Between 10% and 20% of people catch the flu each year, and a bad case can be deadly for individuals with coronary heart disease. Yet only one in three adults with cardiovascular disease gets an annual flu shot.

People with heart disease are not only at higher risk for the flu than the general population but also more likely to have a severe case and to develop complications, such as viral or bacterial pneumonia. What's more, the flu can worsen coronary heart disease and trigger a heart attack.

No one knows for sure how the flu increases the risk of a heart attack. One possibility: Inflammation associated with the flu can trigger the rupture of unstable plaque, leading to the formation of a blood clot that could cause a heart attack.

Heart Benefits of the Flu Shot -- The strongest evidence for protection from a flu shot in people with heart disease comes from the Flu Vaccination in Acute Coronary Syndromes (FLUVACS) study. In that study, about 300 individuals who had been hospitalized for either a heart attack or a planned angioplasty were randomly assigned to receive a flu vaccine or remain unvaccinated. Over the next year, twice as many of the unvaccinated group (23%) died of heart disease, had a nonfatal heart attack, or developed severe ischemia (insufficient blood supply to the heart tissue), compared with those who were vaccinated (11%).

The American Heart Association (AHA) recommends a flu shot with the same enthusiasm as it does the control of cholesterol, blood pressure, and other modifiable risk factors for heart attacks. In a scientific advisory issued by the AHA and the American College of Cardiology heart doctors were asked to do something they may not normally do -- give their patients flu shots. The Centers for Disease Control and Prevention also recommends an annual flu shot for individuals age 50 and older as well as anyone with a chronic health problem such as heart disease or diabetes.

Besides getting a flu shot, two other simple measures -- frequent hand washing and, if possible, avoiding close contact with a flu sufferer -- can help reduce the risk of catching the flu.

Healthy Teeth, Healthy Heart?

Fri, 17 Oct 2008 06:00:00 CDT

Recent research shows that treating gum disease – or avoiding it altogether with regular brushing and flossing – may improve the health of the coronary arteries. The findings add to evidence that taking care of your teeth may be one of the many ways to take care of your heart.

In most people with coronary heart disease, the underlying cause of the disease is atherosclerosis -- the buildup of deposits called plaques within the walls of the arteries. These plaques decrease the size of the artery's lumen, the channel or space through which blood flows. When atherosclerosis develops in the coronary arteries, it can decrease blood flow to the heart (causing chest pains called angina) or it can completely block blood flow (resulting in a heart attack).

Atherosclerosis doesn't develop overnight; it is a slow process that can take many years. It typically occurs after decades of lifestyle behaviors that lead to the accumulation of cells, fats, and cholesterol on the once-smooth inner lining of the arteries. This process typically starts when the endothelium (the thin layer of cells that lines the arteries) is injured, often because of exposure to toxins (such as cigarette smoke) or because of inflammation. The lining then expresses molecules that attract white blood cells and low-density lipoprotein (LDL) cholesterol. The damaged endothelium becomes permeable to these white blood cells and LDL cholesterol, which then enter the inner surface of the artery.

Now a study published in the New England Journal of Medicine (Volume 356, page 911) confirms that aggressively treating periodontitis, a chronic bacterial infection of the gums, may not only save your teeth but also improve the health of your coronary arteries.

The study involved 120 adults with severe periodontitis who were randomly assigned to undergo routine dental cleaning or intensive periodontal therapy. Participants in the latter group received local anesthesia so the dentist could aggressively remove plaque, extract any teeth that couldn't be saved, and inject antibiotics into the infected gums to kill bacteria. Two months later, endothelial function in the coronary arteries was better in the intensively treated patients than in the comparison group -- a difference that was still apparent at the six-month mark.

Decreased function of the endothelial cells that line the walls of the coronary arteries is an early sign of the development of coronary heart disease. Researchers still need to determine whether such intensive dental treatment helps prevent coronary heart disease or heart attacks in people with existing coronary heart disease. But the findings add to evidence that taking care of your teeth may be one of many ways to take care of your heart.

Another Reason to Enjoy Dark Chocolate

Fri, 05 Sep 2008 06:00:00 CDT

If you have a heart condition, it's important to keep your blood pressure under control to prevent a heart attack. Almost one in three adults has hypertension (high blood pressure), defined as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher.

While some risk factors for a heart attack cannot be changed – your age, gender, family history and so forth -- other risk factors can be controlled or even eliminated altogether. High blood pressure is one of these.

Now a small study published in the Journal of the American Medical Association (Volume 298, page 49) suggests that a little dark chocolate might help your blood vessels relax. In the study, 44 adults (ages 56–73) with mildly elevated blood pressure levels were randomly assigned to eat a 0.25-oz piece of either dark or white chocolate every day.

Over 18 weeks, those given the dark chocolate saw their systolic and diastolic blood pressures dip slightly -- by an average of two to three points -- while the white chocolate group experienced no change in their blood pressure levels. Eating these small amounts of chocolate did not cause weight gain or harmful increases in blood cholesterol or blood glucose.

Unlike white and milk chocolates, dark chocolate is rich in polyphenols, plant compounds that increase nitric oxide production. Nitric oxide helps blood vessels relax and dilate to facilitate blood flow. In fact, during the study, the formation of nitric oxide appeared to increase in the blood-vessel linings of the dark-chocolate eaters but remained constant in the white-chocolate group.

Take away message: These results are not a chocolate lover’s dream. The daily allotment amounted to 30 calories -- akin to a Hershey’s Kiss rather than a Hershey bar. Remember that overindulgence can lead to weight gain, which can send your blood pressure on the rise.

Choosing a "Heart Healthy" Hospital

Fri, 15 Aug 2008 06:00:00 CDT

Facing heart surgery? If you are, it is critically important to choose a hospital that has performed the surgery numerous times. But how do you know if your hospital is top-notch? Johns Hopkins provides practical advice.

Until recently, it has been easier to shop for a high-quality car than for high-quality healthcare. Fortunately, a number of organizations are making performance records of hospitals available to consumers.

One of these is the Department of Health and Human Services, whose site (www.hospitalcompare.hhs.gov) ranks hospitals based on their adherence to treatment guidelines for certain conditions, including heart attacks and heart failure. The site also gives each hospital’s death rates for these diseases.

The Joint Commission, which accredits hospitals, offers quality reports at www.qualitycheck.org that show how a hospital stacks up against others in its state and nationwide. Some websites focus on hospitals within a certain state: mhcc.maryland.gov/consumerinfo/ hospitalguide/index.htm details Maryland hospitals; data on New York hospitals can be found at www.myhealthfinder.com.

Companies such as Health Grades (www.healthgrades.com) also offer reports rating hospitals according to various criteria, such as the ratio of nurses to patients. But the data offered by all of these sites need to be taken with a grain of salt. A higher death rate may simply be a sign that a hospital treats sicker patients -- not that it offers subpar care.

So what should you focus on? One of the most important factors is procedure volume. You want to choose a hospital in your area that performs heart surgery most often. If you can’t find this information online, call local hospitals or ask your doctor.

Should You Have a Coronary Calcium Scan?

Fri, 25 Jul 2008 06:00:00 CDT

The American Heart Association (AHA) and the American College of Cardiology (ACC) has endorsed coronary calcium scans as a screening tool for coronary heart disease. A recent study shows that calcium scans can help predict survival.

While the AHA and ACC advise against these computed tomography (CT) scans in people at low or high risk for a heart attack, the associations concluded that the scans can be valuable for people without symptoms of coronary heart disease (CHD) who are at moderate risk according to their Framingham risk score. The associations also concluded that a coronary calcium scan can be considered in people with chest pain who have unclear results on an exercise stress test.

But as CT technology rapidly advances, CT scans of the heart are likely to have other important uses in the near future. Researchers are finding that these scans have the potential for quickly ruling out heart attacks in the emergency room and may one day offer sufficient detail to replace angiography for detecting blockages in the coronary arteries.

The expanded role of CT scans is supported by a study reported in the Journal of the American College of Cardiology (Volume 49, page 1860). The study indicates that CT scans that detect calcium in the coronary arteries, a sign of atherosclerosis, can help predict survival.

Researchers looked at more than 25,000 people without symptoms of coronary heart disease who had coronary calcium scans to assess their heart attack risk. Seven years later, 2% had died. After controlling for age, gender, and other heart risk factors, those with a calcium score of 11–100 (mild calcium buildup) had a twofold risk of dying of any cause, and those with a score greater than 1,000 (heavy calcium buildup) had a 13 times greater risk, compared with participants with a calcium score of 0. In addition, people with a score of 0 had a 10-year survival rate of 99%, compared with a survival rate of 88% for those with a score greater than 1,000.

Bottom line: Coronary calcium scans provide additional information about heart attack risk beyond such traditional risk factors as cholesterol, blood pressure, and smoking. This study suggests that calcium scans may do the same for predicting death. If you’re at moderate risk for a heart attack, your doctor may recommend a coronary calcium scan.

The Many Meanings of Heart Disease

Fri, 04 Jul 2008 06:00:00 CDT

When it comes to matters of the heart, clinical terms require careful consideration so that you know which recommendations apply to you. Here’s a list of common conditions that fall under the broad category of "heart disease."

Acute Coronary Syndrome: A term used to describe conditions, ranging from unstable angina to heart attack, that suddenly reduce blood flow to the heart.

Angina: Chest pain that results when atherosclerosis narrows coronary arteries enough to limit the supply of oxygen and blood to the heart.

Arrhythmia: An irregular or abnormal heartbeat.

Atherosclerosis: Atherosclerosis is the underlying cause of heart disease in most people. It occurs when fatty deposits (plaques) build up within walls of the coronary arteries. (Atherosclerosis and arteriosclerosis both refer to the same abnormality.)

Cardiac Arrest: An abrupt loss of the heart’s ability to pump blood, usually due to a heart rhythm abnormality. (Cardiac arrest is not the same as a heart attack.)

Cardiovascular Disease (CVD): CVD refers to any disease that reduces the blood supply from the arteries to the heart and other organs. The most common examples of CVD are coronary heart disease, peripheral artery disease, and cerebrovascular disease.

Congenital Heart Disease: "Congenital" means present at birth. This form of heart disease is an abnormality in the structure or function of the heart that develops before birth.

Coronary Heart Disease (CHD): CHD occurs when the arteries that supply blood to the heart are narrowed by the buildup of plaque (atherosclerosis). CHD is also referred to as coronary artery disease (CAD).

Heart Failure: Heart failure occurs when the heart is unable to pump enough blood to meet the body’s needs.

Hypertension: Chronic hypertension, or high blood pressure, can lead to heart failure, stroke, and kidney disease by increasing the demands on the heart.

Myocardial Infarction: Commonly known as a heart attack, a myocardial infarction occurs when a blood clot at the site of a plaque in a coronary artery blocks blood flow to a portion of the heart and results in death of heart muscle.

Myocarditis, endocarditis, or pericarditis: Acute inflammation of the myocardium (heart muscle), pericardium (the membrane surrounding the heart), or endocardium (the inner lining of the heart).

Mediterranean vs. Low-Fat Diet

Fri, 02 May 2008 06:00:00 CDT

Which is healthier for your heart: a Mediterranean-style diet or a low-fat diet? A study reported in the Annals of Internal Medicine looked into this question and the results may surprise you.

Lifestyle measures are essential to reduce your risk of a heart attack -- whether you are trying to prevent your first heart attack or have already had one and do not want to have another. The aim of lifestyle measures is to control the risk factors that can be changed.

Even when medication is required to lower your cholesterol or blood pressure, lifestyle measures can help make medication more effective and may allow you to take a smaller dose (which can reduce the risk of side effects). The most effective lifestyle measures for preventing a heart attack are quitting smoking, eating a healthy diet, and engaging in regular physical activity. Achieving a healthy body weight, drinking alcohol in moderation, and reducing stress are important as well.

When it comes to a heart-healthy diet, new research from the Annals of Internal Medicine (Volume 145, page 1) reinforces the benefits of a Mediterranean-style diet that is rich in fats from olive oil and nuts. Surprisingly, the study suggests that the Mediterranean-style diet may do your heart more good than a low-fat regimen. The findings, from a study of 772 older adults, highlight that not all dietary fats are alike and strictly limiting all fats may backfire when it comes to your heart health.

Mediterranean-style eating includes plenty of fruits, vegetables, whole grains, fish, and a relatively large amount of fat. But that fat comes mostly in the form of monounsaturated fats instead of the saturated fats found in meat and full-fat dairy products.

The study participants spent three months on one of three diets: a low-fat regimen that limited all types of dietary fat; a Mediterranean diet that emphasized virgin olive oil as the prime fat source; and another Mediterranean diet where nuts provided a large amount of the overall fat intake.

In the end, men and women on either Mediterranean diet showed greater improvements in blood pressure, the ratio of total cholesterol to HDL cholesterol, and blood glucose (sugar) levels than their peers on the low-fat diet. The olive-oil group also showed an improvement in C-reactive protein, a marker of chronic inflammation. The study wasn’t designed, however, to determine whether nuts or olive oil is the healthier fat source. So it’s probably best to include both in a healthy diet.

Zero Not Necessarily Zero When It Comes to Trans Fats

Fri, 23 May 2008 06:00:00 CDT

Though it may seem counterintuitive, foods labeled trans-fat free may contain a small amount, less than 0.5 gram, of trans fats -- which can add up, especially if you consume more than one serving.

Trans fats are probably the unhealthiest fats in the American diet. They not only raise low-density lipoprotein (LDL, or "bad") cholesterol but also lower the "good” high-density lipoprotein (HDL) cholesterol. In fact, trans fats are so harmful to your health that the Institute of Medicine says there is no safe level of intake and recommends consuming as little of this fat as possible.

The American Heart Association put a number on "as little as possible," advising Americans to keep their trans fat intake below 1% of total calories. To make it easier for you to reduce trans fat intake, the U.S. Food and Drug Administration now requires food manufacturers to list the amount of this fat on the Nutrition Facts panel. (The amount is listed beneath the entry for saturated fat.)

What’s more, many food manufacturers have developed trans fat–free versions of a variety of foods. But some of these trans fat-free products may not be as good for your health as you might think. Here’s why.

The government allows manufacturers to say their product has no trans fats if it has less than half a gram (0.5 g) per serving. That mean "if you’re eating more than one serving of a "no trans fat" product or several products that are labeled "not a significant source of trans fat," you could be eating more trans fat than you realize.

For instance, a product that claims it has no trans fat can legitimately have up to 0.49 g of trans fat per serving. So if you eat two or more servings of that food in one sitting, you could be consuming close to 1 g or more of trans fat.

So how can you reduce the possible trans and saturated fats you take in from products labeled trans fat free? It’s as simple as reading the ingredients list.

If the list of ingredients mentions partially hydrogenated oil, hydrogenated oil, or shortening, the product isn’t technically trans fat free. When eating these products, you should estimate that you are getting 1 g of trans fat for every two servings you eat. You can find the size of a serving at the top of the Nutrition Facts panel. Beware: It might be smaller than the amount you usually consume.

Also, be on the lookout for palm oil, palm kernel oil, and coconut oil in the ingredient list. These are the saturated fats commonly used in place of trans fat, because they are similar in taste and stability. When eating these products, check the Nutrition Facts panel for the grams of saturated fat per serving. You want to limit your daily intake of saturated fat to less than 7% of total calories.

Take Heart in Exercise

Fri, 11 Apr 2008 06:00:00 CDT

Your waistline may weigh more heavily in your risk of coronary heart disease, but exercise habits make a big difference as well, according to a recent study.

Research shows that regular physical activity helps prevent coronary heart disease. Regular exercise helps to control weight, lower blood pressure, and improve blood lipid levels. Yet, despite these beneficial effects, too many Americans are content with a sedentary lifestyle. According to the American Heart Association, only about 30% of adult Americans participate in any regular physical activity, and this level of participation tends to decline as people get older. Only 16% of people age 75 and older exercise on a regular basis.

Now research reported in the Journal of the American Medical Association (Volume 295, page 1412 ) underscores the importance of BOTH exercise and weight control in maintaining a healthy heart. Researchers found that among more than 27,000 middle-aged women, those who were overweight or sedentary were more likely to have various biomarkers of higher coronary heart disease risk -- including high LDL cholesterol, low HDL cholesterol, and elevated levels of blood proteins like C-reactive protein (CRP) and fibrinogen.

Weight was a more significant factor than exercise for predicting the presence of these biomarkers, but even overweight women improved their heart risks by getting regular exercise. Still, women who were both normal weight and regularly active had the best heart-health profile. Compared with them, normal weight, sedentary women were 26% more likely to have high CRP levels, while the odds were tripled among those who were both overweight and inactive. Obese women had still higher risks. Similar associations were observed for the other biomarkers.

Bottom line: The findings point to the importance of both exercise and maintaining a normal weight. Though a thin physique may be preferable to an apple shape when it comes to heart health, even slim women need regular exercise.

Stress and Heart Disease

Fri, 21 Mar 2008 06:00:00 CST

Though the evidence is not definitive, a lot of research suggests a possible link between stress and heart disease. Johns Hopkins cardiologists discuss this important topic.

We’ve all heard the remark: “If that person doesn’t slow down, he is going to have a heart attack.” So it’s not surprising that along with the usual advice about blood pressure, cholesterol, exercise, and diet your doctor may advise you to manage or reduce the stress in your life. Yet the presumed association between psychological or mental stress and heart disease remains just that -- a presumption.

After years of study, researchers have yet to prove that stress is a cause of heart disease or a trigger for a heart attack. But there is evidence to support a link between psychological stress and the health of your heart. For example, stress can cause you to overeat, smoke, drink too much alcohol, be physically inactive, and not take your medication -- all of which can have negative effects on your heart. It may also cause changes in your body that could make you more susceptible to heart disease and heart attacks.

Evidence: Interesting but Not Conclusive

When you are in a stressful situation, your body releases hormones to help you deal with the perceived threat. These hormones, such as epinephrine and cortisol, temporarily increase your heart rate and blood pressure. However, stress can cause other changes -- both temporary and more long lasting -- that can lead to problems for your heart.

What Should You Do? Though the evidence is not definitive, a lot of research suggests a possible link between stress and heart disease. Even if the relationship is indirect -- that is, stress causes you to engage in unhealthy behaviors or causes changes in your body that could put you at risk -- gaining control of your stress levels is important for both your physical and mental health. Here are three important steps for reining in the potential effects of stress:

Work with your doctor to keep track of and control any heart risk factors you may have -- from high blood pressure and high cholesterol to obesity and smoking.

Get regular exercise to lower your stress levels and its effects on your body. In a recent study of 134 people with coronary heart disease, those who walked or jogged for 35 minutes three times a week for four months reduced their stress levels and saw improvements in their heart rate variability and function of their blood vessels.

Learn some stress management techniques such as biofeedback, relaxation techniques (for example, meditation, progressive muscle relaxation, or guided imagery). These techniques can help manage your response to stress and in the process may improve some heart risk factors, too. A recent study found that meditation reduced blood pressure and blood glucose levels and improved insulin sensitivity and heart rate variability.

Research on Men, Women, and the Heart

Fri, 08 Feb 2008 06:00:00 CST

When it comes to the heart, men and women are more different than you might think. Here are insights on men, women, and cardiovascular health from the world of research.

Standard Tool May Misjudge Women's Heart Risks

The first step doctors take to judge heart attack risk may underestimate the odds for many women, according to an article in the American Heart Journal (Volume 150, page 1276).

In a study of 102 healthy women with a family history of early heart disease, many who had evidence of atherosclerosis in their coronary arteries were nonetheless judged to be at low risk for a heart attack according to their Framingham risk score (a standard measure that doctors use to gauge the odds of suffering a heart attack in the next 10 years). It is based on age, blood pressure, cholesterol levels, and smoking habits.

In the study, 98% of the women were deemed low risk based on their Framingham score. Yet when the researchers took computed tomography (CT) scans of the women’s coronary arteries, they found that one third had enough calcium buildup to signal significant atherosclerosis for their age. Calcium is a component of the plaques that can clog arteries.

One of the problems with the Framingham score is that it does not take into account family history of premature heart disease. Thus, healthy women with a sibling with early heart disease may a heart CT scan to better gauge their heart health. If the CT scan reveals signs of advanced atherosclerosis for their age, these women might consider taking aspirin or a statin to help lower their heart attack risk.

Fitness Protects Men From Cluster of Heart Risks

Middle-aged men who stay fit may lower their odds of developing a collection of risk factors for heart disease, according to a study from Archives of Medical Research (Volume 37, page 522).

The researchers studied 449 men and found that those with the highest fitness levels were unlikely to have the metabolic syndrome, a cluster of heart risk factors that includes abdominal obesity, high blood pressure, elevated blood glucose (sugar) and triglycerides, and low HDL levels. The syndrome is diagnosed when a person has three or more of these factors.

In the study, only 6% of the men with the highest fitness levels met the criteria for the metabolic syndrome -- vs. one third of the least fit men. Half of the fittest study participants had none of the components of the metabolic syndrome, compared with only 18% of their out-of-shape counterparts. The study included middle-aged men (average age 47) who were free of any heart disease symptoms. Participants walked on a treadmill to gauge their fitness levels and underwent an evaluation for their heart risk factors.

Overall, men with the lowest fitness levels were nearly 12 times more likely than their fit peers to have the metabolic syndrome. These findings point to the importance of even modest increases in regular, brisk physical activity, which could translate into a fitter body and lower heart risks.

Should You Have an Exercise Stress Test?

Fri, 18 Jan 2008 06:00:00 CST

Every year, thousands of Americans have an exercise stress test to find out how well their hearts can handle a workload. Should you be one of them? Johns Hopkins offers advice.

Most people who have an exercise stress test either have diagnosed coronary heart disease or symptoms that suggest heart disease, such as chest pain or shortness of breath. And if you are healthy, have no heart disease, symptoms, and have no risk factors for heart disease, you probably don’t need a stress test. But the answer to the question gets murkier if you’re symptom free but have risk factors such as older age, high blood pressure, elevated LDL cholesterol levels, or cigarette smoking.

The American Heart Association (AHA) offers some guidance. According to a scientific statement, the organization concluded there was insufficient evidence to recommend routine use of exercise stress testing in people with no symptoms of heart disease.

What’s more, they noted that the test could be detrimental for symptom-free individuals, because a false-positive result is common -- especially in symptom-free women.

But studies coming on the heels of the AHA statement are helping doctors better understand which symptom-free people may benefit most from an exercise stress test and how to perform the test to get the most meaningful results. One of these studies was led by Roger S. Blumenthal, M.D., coauthor of the Johns Hopkins Heart Attack Prevention White Paper. The study included more than 6,000 men and women without symptoms of heart disease, who were at low to moderate risk for a heart attack, according to their Framingham risk score.

At the beginning of the study, the participants underwent an exercise stress test -- but it was not the conventional test. Instead of just looking for changes in the electrical activity of the heart, the researchers also measured exercise capacity (how long the participant could exercise) and heart rate recovery (how quickly the participant’s heartbeat returned to normal after exercise).

Twenty years later, 246 of the participants had died of cardiovascular disease (a heart attack or stroke). What was striking was that 90% of these deaths occurred in people with below-average results on the exercise capacity and heart rate recovery components of the exercise stress test. Based on the results, the researchers estimated that about half of the men and women at moderate risk according to their Framingham risk score were really at high risk for a heart attack; the same was true for about half of the women deemed low risk by their Framingham score.

Bottom line advice -- Until more research comes in on the value of exercise testing for people without symptoms of CHD, the decision to have an exercise stress test remains very much an individual one.

Homocysteine and Heart Disease

Fri, 28 Dec 2007 06:00:00 CST

Each issue of the Johns Hopkins Heart Bulletin features a Grand Rounds section in which Hopkins specialists answer readers’ questions about heart health. Here’s a sample.

Q. I know that homocysteine was in the news several years ago, when it was identified as a marker for heart disease risk. I haven’t heard much about homocysteine since then. My wife says I should take folic acid, just to be sure that I keep my homocysteine levels low, but I don’t want to add another pill to the six I take already (for blood pressure, high cholesterol, and arthritis pain). I’m 59 years old and to the best of my knowledge, I’ve never even had my homocysteine levels checked. Should I ask the doctor to do that at my next visit, and should I be taking folic acid daily? Charleston, South Carolina

A. Homocysteine is substance that we all produce from an amino acid (a building block of protein) in food. In the normal course of events, the homocysteine that healthy people manufacture is converted into amino acids that do them no harm. If the conversion does not take place rapidly enough, due to a genetic defect or vitamin deficiency (notably the B vitamins B6, B12, and folic acid), elevated levels of homocysteine may damage arterial walls and promote the buildup of cholesterol, potentially leading to arterial blockage and a heart attack.

However, while elevated levels of homocysteine have been shown to be a risk factor for heart disease, it still has not been proven that lowering homocysteine reduces the risk of CHD or heart attacks. Some doctors check homocysteine levels in patients with a strong family history of heart disease. But the American Heart Association does not recommend taking folic acid or other B vitamins to lower CHD risk.

Let Them Drink Wine

Fri, 05 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Heart Health | Let Them Drink Wine

In recent studies, mice were less likely to die early if they received large doses of resveratrol – a substance found in red wine. But does this data translate to humans? Read what Johns Hopkins advises …

You’re sure to have heard reports that some alcoholic beverages, including red wine, offer cardiovascular protection. Now red wine is in the spotlight again, thanks to research suggesting that red wine has age-defying benefits that can counter the effects of an unhealthy diet. But before you reach for your wine glass, consider the science behind the headlines.

Despite a diet high in saturated fats, the French have low rates of heart disease. This phenomenon has been labeled "the French paradox." Some researchers theorize that the French enjoy pâté, cheese, and butter without harm because they regularly drink red wine, which contains chemicals like antioxidants that, when found in food, are believed to help prevent disease.

The substance that has received the most attention is resveratrol. It is most plentiful in red wine and found in lesser amounts in white wine, grape juice, and grapes themselves.

The latest red wine data come from researchers at Harvard Medical School and from a group of French scientists.

The Harvard study, published in the Journal of the American Medical Association, found that middle-aged mice fed a high-fat diet (described as the equivalent of “coconut cream pie for every meal”) were less likely to die early if they received large doses of resveratrol. The lucky mice grew fat, but they were less likely to develop diabetes and were otherwise as healthy as mice fed a standard diet.

The French study, published in Cell, found that a group of mice fed a high-fat diet and high doses of resveratrol had lower insulin levels, were able to run twice as far, and weighed almost the same as mice eating a regular, resveratrol-free diet.

These results sound promising, but it’s highly questionable whether they will translate to humans.

You could never get these benefits from drinking red wine; to get as much resveratrol as the mice in the Harvard experiment, a 150-lb. person would have to drink about 750 bottles of red wine daily.

And while publication of these scientific articles led to a huge increase in resveratrol supplement sales, there is no information on the benefits (or dangers) of resveratrol pills in people. In addition, supplements are pricey, and supplement manufacture is not regulated by the FDA; it’s impossible to know whether the supplements you purchase truly contain the amount of resveratrol advertised.

Pharmaceutical companies are experimenting with resveratrol-based therapies, but even if they’re successful, it will be years before these drugs become available. For now, drink red wine for pleasure and your heart.

Johns Hopkins Health Alerts | Heart Health | Let Them Drink Wine

Soy and Heart Attack Prevention

Fri, 26 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Heart Health | Soy and Heart Attack Prevention

Although research shows that eating foods high in soy protein does NOT significantly lower LDL cholesterol, soy still has a place in a heart-healthy diet.

Soy is another food component to consider in your efforts to prevent a heart attack. Even though research now shows that eating foods high in soy protein helps lower LDL cholesterol levels by a mere 3%, choosing soy-containing foods (such as soymilk and tofu) can still be beneficial for your heart. That’s because people who eat soy products tend to consume them instead of foods like meat and full-fat dairy products that are high in saturated fat and cholesterol.

Experts once thought that estrogen-like compounds known as isoflavones might be responsible for soy’s beneficial effects. But a recent review of research found that isoflavone supplements had no effect on LDL cholesterol levels.

Indeed, a large research review suggests that a soy burger or glass of soymilk may not be doing much for your cholesterol levels after all. Neither soy protein nor supplements containing soy compounds (isoflavones) are very effective at lowering levels of “bad” LDL cholesterol, according to the review, which was conducted by the nutrition committee of the American Heart Association and reported in the journal Circulation (Volume 113, page 1034).

Across the 22 trials the committee examined, adults who consumed even large amounts of soy protein saw their LDL levels dip by only 3%, on average. Isoflavone supplements did not reduce LDL cholesterol at all. In addition, soy products showed no benefits on blood pressure, HDL cholesterol, or triglycerides, another type of blood fat that contributes to coronary heart disease.

Still, it’s not time to take soy off your menu. In fact, the committee says that replacing hamburgers with soy burgers or whole milk with soymilk, for example, is likely to be a heart-healthy move, because soy products have no saturated fat but do have more healthy fats, fiber, and vitamins and minerals. So continue to eat soy as part of a healthy diet. However, there’s no need to spend your money on isoflavone supplements.

Johns Hopkins Health Alerts | Heart Health | Soy and Heart Attack Prevention

Heart Attack Symptoms? Be prepared.

Fri, 07 Dec 2007 06:00:00 CST

Johns Hopkins Health Alerts | Heart Health | Heart Attack Symptoms? Be prepared

The advice is basic – and it could save your life! Johns Hopkins emergency physicians offer practical advice to help you be prepared should you – or someone you love – has a heart attack.

For many people, heart attacks begin gradually and involve little pain or discomfort. In fact, the heart attack symptoms might be so mild or subtle that you aren’t even sure what’s wrong. This uncertainty can lead to lengthy and dangerous delays in making that all-important 911 call. According to the American Heart Association, the following symptoms can indicate a heart attack:

Heart attack symptom 1: Chest discomfort, particularly if it occurs in the center of the chest and lasts more than a few minutes or comes and goes. The discomfort may also feel like uncomfortable pressure or weight, squeezing, or fullness.

Heart attack symptom 2: Discomfort in other areas of the upper body, including pain or discomfort in one or both arms, the back, or stomach. Jaw pain is another possible symptom.

Heart attack symptom 3: Shortness of breath.

Other possible heart attack symptoms: Cold sweat, nausea, lightheadedness.

In the event of a heart attack a little preparation could help save the life of someone who’s having the heart attack. The American College of Emergency Physicians (ACEP) recommends that you compile two lists to aid the response to an emergency.

One list should include phone numbers of your family doctor, local hospital, ambulance service, police, and fire department. The list should be placed near each telephone in your home.

The second list should include the following information:

All your medications and their dosages

Any known allergies

Insurance information

Family contacts in case of an emergency

Any other information that emergency personnel might find useful (such as other illnesses that you might have).

Keep one copy of this list in a readily accessible place in your home and another copy with you (for example, in your purse or wallet), in the event you are unable to communicate with EMS personnel. The ACEP has developed a Personal Medical History form that you can use for this purpose. It is available on their website: www.acep.org/webportal/PatientsConsumers/MedicalForms.

Link correction: Dec 7, 2007 update We apologize for the outdated link. The ACEP just updated their website, and removed the suggested form. As an alternative, the American Red Cross offers "Tips for Creating an Emergency Health Information Card" at: http://www.redcross.org/services/disaster/beprepared/healthcard.html

Johns Hopkins Health Alerts | Heart Health | Heart Attack Symptoms? Be prepared

Chronic Chest Pain a Potential Red Flag for Women

Fri, 14 Sep 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Heart Health | Chronic Chest Pain in Women

Contrary to typical portrayals in movies and on TV, heart attacks don’t always have a sudden, intense onset. A recent study finds that for women, chronic chest pain may signal a future heart problem.

Although no one likes to think about having a heart attack, would you know what to do if you were? Even if you know what to do, would you follow through? More important, would you act quickly?

According to the National Heart, Lung, and Blood Institute close to one million people in the United States have heart attacks each year, and about one fifth of them die. Half of the deaths occur in the first hour after heart attack symptoms start and before the person reaches a hospital. These numbers underscore the importance of recognizing heart attack symptoms quickly and responding to these symptoms just as quickly.

Now a study in the European Heart Journal (Volume 27, page 1408) reports that for women, persistent chest pain may be a warning of future heart problems – even when a woman has no evidence of blockages in her coronary arteries.

The findings come from a study known as WISE, a government-funded project designed to evaluate chest pain in women -- a task that is less straightforward than in men. The central issue is that women are much more likely than men to suffer long-term chest pain in the absence of any large artery blockages. But that doesn’t mean their chest pain is innocuous.

Among women in the study with no signs of clogged arteries, those with persistent chest pain for at least a year were more than twice as likely to suffer a heart attack, stroke, or other cardiovascular complication over the next five years. The study included 673 women whose chest pain and other potential symptoms of coronary heart disease were evaluated by angiography (an x-ray examination of blood vessels that can detect blockages).

The take-home message: If you’re a woman, you should not simply live with chronic chest pain if angiography fails to detect artery blockages. Instead, you should ask your doctor about the ways you can reduce any heart risk factors you have. A healthy diet and regular physical activity are some of the most important ways.

Johns Hopkins Health Alerts | Heart Health | Chronic Chest Pain in Women

The Role of Inflammation in Atherosclerosis

Fri, 24 Aug 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Heart Health | Inflammation in Atherosclerosis

Researchers believe that chronic inflammation initiates and speeds along the process of atherosclerosis. How does inflammation damage your body and how can you detect it? Read on …

When you read or hear the word "inflammation,” what comes to mind? An infected cut or scrape? Swollen, congested sinuses? Painful, arthritic joints? What about coronary heart disease? It probably wasn’t on the list. Yet a large amount of research shows that inflammation plays a role -- possibly a major one -- in the development and progression of atherosclerosis, the buildup of fatty plaques that leads to coronary heart disease, heart attacks, and strokes.

The inflammation we are talking about is not the short-term kind that the immune system produces to help the body fight an acute infection or heal a wound. Instead, it is low grade and chronic inflammation -- present in the body at low levels day in and day out.

The inflammation - atherosclerosis story begins with risk factors: high blood pressure, high cholesterol, obesity, and smoking. These risk factors irritate and disturb the normal biology and activity of the arteries. This irritation in turn stimulates the production of cells and proteins that initiate and fuel inflammation.

Ongoing irritation and inflammation by these risk factors eventually injures the delicate tissues of the arteries. This injury stimulates the production of more inflammatory factors and attracts immune-system cells called monocytes that burrow into the arteries where they develop into other cells known as macrophages. Macrophages absorb cholesterol that enters the injured artery. As the cholesterol accumulates, the macrophages are transformed into foam cells, the earliest stage of plaques.

As plaque builds up inside an artery, inflammatory factors make the plaque unstable and prone to rupture or cracking. When a plaque becomes disrupted, its contents may spill into the bloodstream and come into contact with platelets and clotting factors that can produce a blood clot and ultimately a heart attack.

Detecting Inflammation -- Unfortunately, there are no outward signs that inflammation is damaging arteries. That’s why researchers have developed blood tests to measure substances in the blood that signal inflammation. The most widely known and commonly used is C-reactive protein (often abbreviated as CRP). CRP levels rise and fall with the intensity of inflammation in the body -- whether the inflammation involves the arteries or some other inflammatory disease such as rheumatoid arthritis.

Studies clearly show that elevated CRP levels are associated with an increased risk of heart attack or dying of heart disease. In fact, one study found that CRP was just as good a predictor of risk as LDL cholesterol. In addition, evidence is emerging that lowering high CRP levels can reduce future heart attacks in people who are at high risk. A high CRP level is 3 mg/L or above; the optimal level is less than 1 mg/L.

Johns Hopkins Health Alerts | Heart Health | Inflammation in Atherosclerosis

Research on Heart Disease and Periodontal Disease

Fri, 13 Jul 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Heart Health | Heart Disease and Periodontal Disease

Heart Data 1: The Early Onset of Atherosclerosis

If your children and grandchildren think that being under age 50 protects them against coronary heart disease, you should tell them to think again. A study reported in the American Journal of Cardiology (Vol. 95, page 469) found that risk factors such as high blood pressure and cigarette smoking can have adverse effects on the arteries of people in their 20s, and the more risk factors present in these younger people, the greater the likelihood that their arteries have already started to accumulate plaques putting them at risk of heart disease.

The investigators analyzed data on 1,080 men and women (age 24–43) in the Bogalusa Heart Study; none of them had known coronary heart disease. Their blood pressure, cholesterol levels, body mass index, and other characteristics were checked, along with the thickness of the wall of their femoral artery (the main artery in the thigh; it often shows signs of early atherosclerosis). The researchers found that the higher the number of risk factors in these young individuals, the greater the thickness of the arterial wall. The risk factors that best predicted thickening of the femoral artery included age, male gender, smoking, elevated systolic blood pressure, and an abnormal ratio of total cholesterol to HDL cholesterol. According to the investigators, when the femoral artery shows early stages of atherosclerosis, the coronary arteries are likely to be developing coronary heart disease as well.

Heart Data 2: Gum Disease and Your Risk of Coronary Heart Disease

If your dentist has diagnosed you with periodontal disease, it could mean problems for more than your gums. According to a study reported in the journal Circulation (Vol. 111, page 576), the bacteria that cause periodontal disease are associated with plaque buildup in the carotid arteries -- the blood vessels that transport blood to the brain. During dental exams of 657 patients (mean age 69), researchers collected samples of bacteria from below the gumline and analyzed them in the laboratory. They also measured the thickness of the carotid artery walls of the patients using ultrasound. Their findings? People with greater amounts of the oral bacteria that cause periodontal disease had slightly thicker carotid arteries.

A thickened carotid artery indicates a buildup of plaque, which is associated with an increased risk of coronary heart disease and stroke; people with plaque in their carotid arteries invariably also have plaque in the arteries that carry blood to the heart. However, no relationship was found between higher levels of oral bacteria and C-reactive protein, a marker of inflammation in the body, which some experts have hypothesized is the link between gum disease and coronary heart disease. This is the first study to show a direct link between cardiovascular disease and the bacteria responsible for periodontal disease. All the more reason to floss your teeth and see your dentist regularly.

For more Alerts and Special Reports, please visit the Heart Health Topic page.

Johns Hopkins Health Alerts | Heart Health | Heart Disease and Periodontal Disease

Eating Right for Your Heart's Sake

Fri, 22 Jun 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Heart Health | Heart Health and Nutrition

Dr. M. Dominique Ashen from Johns Hopkins’ Ciccarone Center for the Prevention of Heart Disease shares 15 easy ways to increase your consumption of fruits and vegetables.

Study after study reports that when your diet is high in fruits and vegetables -- which are the richest natural sources of vitamins, minerals, and fiber -- you are doing the best you can to protect your heart and help prevent many diseases, including cancer.

About 90% of Americans fail to meet the government’s recommendations for fruit and vegetable consumption. In light of the mounting evidence that fruits and vegetables offer even more health benefits than previously understood, try to increase your intake of these foods and explore a wider variety of the fruits and vegetables. An apple a day may “keep the doctor away,” but you’ll be doing your body a favor if you sometimes snack on other kinds of produce -- kiwifruit, blueberries, carrots, pomegranate juice, or dried apricots, to name just a few.

If you don’t already eat at least two cups of fruit and three cups of vegetables every day, consider the following tips:

Heart Health Tip 1. Stock up on fresh fruits and keep them accessible on your countertop or visible in your refrigerator.

Heart Health Tip 2. Add fresh or dried fruit to your breakfast cereal.

Heart Health Tip 3. Thaw frozen berries and add them to plain or vanilla yogurt for a snack or dessert.

Heart Health Tip 4. Have a six-ounce glass of 100% fruit juice with your breakfast.

Heart Health Tip 5. As thirst-quencher or a mealtime beverage, make a “spritzer” by adding 100% fruit juice to sparking water or seltzer.

Heart Health Tip 6. Enjoy a fruit smoothie made by blending low-fat milk or yogurt with fresh or frozen fruits.

Heart Health Tip 7. Bring dried fruit (raisins, apricots, cranberries, apple slices) to work for mid-morning or mid-afternoon snacks.

Heart Health Tip 8. Add tomatoes, onions, peppers, and/or mushrooms to an egg-white omelet for a hearty breakfast or brunch.

Heart Health Tip 9. Chill small cans of vegetable juice to snack on at work.

Heart Health Tip 10. When dining out, start your meal with a salad.

Heart Health Tip 11. When making or ordering a wrap or sandwich, include sprouts, lettuce, tomatoes, cucumber, and other raw vegetables.

Heart Health Tip 12. Add raisins, grapes, or apple slices to your salads

Heart Health Tip 13. Make a big pot of vegetable soup on the weekend and freeze it in single-portion containers to reheat for a quick weekday lunch or supper.

Heart Health Tip 14. Make your own pizza (you can buy ready-to- use dough at a pizzeria or supermarket) and top it with mushrooms, onions, broccoli, spinach, or eggplant.

Heart Health Tip 15. Double the portion of vegetables you already eat at lunch and dinner.

Johns Hopkins Health Alerts | Heart Health | Heart Health and Nutrition

Questions About Angina

Fri, 11 May 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Heart Health | Questions About Angina

Does having angina put you at risk for a heart attack? What’s the difference between stable and unstable angina? Johns Hopkins cardiologist Ravi Ranjan answers patients’ questions.

Q. I was recently diagnosed with angina. I am a 67-year-old woman, and other than being about 30 pounds overweight, I’ve been in good health my whole life. Is there a link between angina and heart attack, and, if so, what can I do to forestall a heart attack? From a Heart Bulletin subscriber in Olympia, Washington

A. The onset of angina is indicative of obstructive coronary artery disease, which can lead to a heart attack. To help prevent a heart attack, you can modify your risk factors by losing weight, starting an exercise regimen if you don’t already engage in regular physical activity, and eating more healthfully.

A heart healthy diet includes lots of fruits and vegetables, a moderate amount of whole grains, legumes, nuts, and oily fish, and small amounts of lean meat, poultry, and lowfat dairy foods.

In order to lose weight, you’ll also need to watch your portion sizes. I use this trick to help my patients: Visualize a normal-size dinner plate divided into four equal sections. Fill half the plate (two sections) with fruits and/or vegetables; fill a quarter of the plate with whole grains (rice, pasta, or bread); and fill the remaining quarter with lean meat, poultry, or fish. This trick will keep you mindful of portion sizes without becoming a slave to calorie counting.

Other heart attack risk factors are high cholesterol and high blood pressure. Your physician can determine if you have either of these, and if you do, whether you’ll need medication to lower them.

Q. My doctor just diagnosed me with unstable angina. I am 73 years old and had chest pains over the course of three months before I was finally diagnosed. My younger brother has stable angina and says he is less at risk for a heart attack than I am. What are the differences between stable and unstable angina, and is my brother really at lower risk? Is there anything can I do to lower my own risk? From a Heart Bulletin subscriber in Gibson Island, Maryland

A. Stable angina usually refers to chest discomfort associated with physical activity or emotional stress that is relieved by rest and/or nitroglycerin within 5 to 15 minutes. Unstable angina usually refers to chest pain that occurs at rest or with minimal activity, usually severe and of recent onset (within one month), or getting more severe and/or frequent.

Both you and your brother are at risk, but unstable angina can be an indication of progressive coronary disease. You can modify the risk factors by lowering your cholesterol, controlling hypertension, exercising regularly, eating a healthful diet, stopping smoking if you smoke, and controlling your weight. Also, if you don’t already take a daily aspirin, speak with your doctor about doing so.

Johns Hopkins Health Alerts | Heart Health | Questions About Angina

Heart Attack and Depression -- What's the Connection?

Fri, 01 Jun 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Heart Health | Heart Attack and Depression

Does a heart attack trigger depression? Does depression trigger a heart attack? No one is sure.

A heart attack is a catastrophic event, and a typical reaction includes periods of denial or despair, along with a mixture of symptoms of despondency, anxiety, insomnia, and irritability. For the majority of heart attack patients, these symptoms last a few days to several weeks after diagnosis, but then adjustment ensues as they learn -- with the help of family, friends, and doctors -- to cope with the recovery process.

But in many cases, depression is more persistent. These are the heart attack patients whose depression may eventually trigger a fatal cardiac arrest within one year. It’s too often the case that doctors, even many cardiac specialists, view depression in a patient recovering from a heart attack as "normal.” Granted, sadness and grief are normal reactions to loss, but a major depressive syndrome requires aggressive treatment. Clinical depression is not a normal consequence of a heart attack and it must be addressed and treated promptly -- just as the heart attack itself was treated.

Johns Hopkins cardiologist David E. Bush, M.D. has extensively studied depression in heart attack patients. Here he answers patients’ questions about this often-misunderstood condition.

Q. How prevalent is depression in people who have suffered a heart attack?

A. According to research reported in the Journal of Psychosomatic Medicine by researchers from the University Hospital Groningen in the Netherlands, about 18 percent of heart attack survivors have major depression following their heart attack. Depressed heart attack patients were found to be more than twice as likely to die from any cause and 2.5 times as likely to die of heart disease when compared with heart attack patients without depression.

Q. What is the risk of dying due to depression following a heart attack?

A. Depressed patients are 50 percent more likely than other heart attack patients to need hospital care. The mortality of those who are depressed while recovering from a heart attack compared to those who are not depressed in the same circumstances is two to four times higher. There seems to be a substantial increase in mortality that becomes apparent in the first four to six months of recovery from a heart attack.

Q. Are patients who are currently suffering from depression at risk for suffering a heart attack?

A. Heart disease and depression are intricately entwined and there is mounting evidence that an ill mind may be the cause of an ill heart. One Johns Hopkins study followed 1,200 male Johns Hopkins medical school graduates for 40 years, testing them every five years. Overall, there was a 12 percent incidence of depression. Among those who were depressed, there was twice as great a risk of developing coronary artery disease or having a heart attack compared to those subjects who were not depressed.

More evidence for this comes from the Women's Health Initiative, a major 15-year research program that addressed the most common causes of death, disability, and poor quality of life in postmenopausal women (cardiovascular disease, cancer, and osteoporosis). Researchers reported that among the 93,000 women studied, those who were depressed had a 50 percent greater risk of developing or dying from cardiovascular disease than women who didn’t show signs of depression.

Johns Hopkins Health Alerts | Heart Health | Heart Attack and Depression

A Pat Solution to Cholesterol Troubles

Fri, 01 Dec 2006 06:00:00 CST

Johns Hopkins Health Alerts | Heart Health | Cholesterol-Lowering Benefit of Sterols|Stanols

Do Take Control and Benecol have a place in your diet? Johns Hopkins cardiologist Christopher Sibley, M.D. looks at the data.

Can reducing your cholesterol be as easy and painless as spreading a pat or two of heart-healthy margarine on your toast or veggies every day? Well, there is fairly convincing evidence that food spreads containing plant additives called sterols or stanols, substances that inhibit the absorption of cholesterol in the intestine, can indeed lower your LDL (“bad”) cholesterol. Recent studies, however, have raised some potential concerns about the safety and efficacy of margarines based on plant sterols—but not stanols.

How Sterols and Stanols Work to Lower Cholesterol

In 2000, the U.S. Food and Drug Administration approved two cholesterol-lowering margarines: Take Control, which contains plant sterol esters extracted from soybeans, and Benecol, which incorporates plant stanol esters derived from pine tree wood pulp. Plant stanols and sterols, which are found naturally in many foods, have been included in several other products in addition to margarine.

Dietary plant sterols and stanols lower LDL cholesterol levels by about 6% to 20%, with considerable individual variation. They produce the greatest reduction of LDL cholesterol at a dosage of about 2 g/day; their effectiveness does not increase at higher dosages. The additives do not alter the levels of HDL (“good”) cholesterol or triglycerides.

Although dietary plant sterols and stanols produce comparable reductions in LDL cholesterol, several recent studies have found some significant differences between the two compounds. For example, research reported in the American Journal of Cardiology indicates that the cholesterol-lowering effects of plant sterols diminish after about two months. At this point, the LDL cholesterol levels of people consuming dietary plant sterols did not differ significantly from baseline. The level of plant sterols in the blood also rose after two months. In addition, the synthesis of bile acids declined significantly, which is believed to impair the cholesterol-lowering effect of the plant sterols. Other recent studies have shown that statins increase the blood levels of plant sterols several-fold and that the given in combination with statins also declines with time.

By contrast, plant stanols maintain their efficacy in reducing LDL cholesterol levels over the long term, whether given alone or in combination with a statin. In addition, stanols lower the blood levels of plant sterols and do not affect the synthesis of bile acids. In a study published in the Journal of the American College of Cardiology, researchers measured the levels of plant sterols and cholesterol in the blood and in fatty deposits removed from the carotid arteries during endarterectomy (an artery-clearing procedure that reduces the risk of stroke). They found that as the ratio of plant sterols to cholesterol in the blood increased, so did the proportion of plant sterols in the fatty deposits removed from the arteries. This discovery raises questions about the possible role of dietary plant sterols in plaque formation.

The Bottom Line on Sterols and Stanols

There are potential concerns about the efficacy and safety of plant sterols: With time, their LDL cholesterol-lowering effect diminishes, and their level in the blood increases. And plant sterols have now been found in atherosclerotic plaques.

These findings are rather worrisome, but according to Johns Hopkins cardiologist Christopher Sibley, M.D., “There is no need for people currently consuming plant sterol margarines to panic. Plant sterols may simply be innocent bystanders, and we don’t yet know whether their presence in plaques actively predisposes to heart attack and stroke. At this point, it remains an open question whether plant sterols wear a white hat or a black hat with regard to atherosclerosis.”

Plant stanols, by contrast, seem more likely to “wear white hats.” The LDL-lowering effect of the stanols does not decline with time, levels of stanols in the blood do not rise, and they have the added benefit of lowering plant sterol blood levels.

Johns Hopkins Health Alerts | Heart Health | Cholesterol-Lowering Benefit of Sterols|Stanols

Research Update on Coronary Heart Disease

Tue, 02 Jan 2007 06:00:00 CST

Johns Hopkins Health Alerts | Heart Health | Taking Combination Medications for Coronary Heart Disease

Is It Time For a Polypill?

Taking a combination of medications for your heart may be more beneficial than taking a single drug, according to a study in the British Medical Journal. The researchers followed 13,029 men and women diagnosed with coronary heart disease between 1996 and 2003, to look at how the medications they were taking affected their lifespan. They found that individuals who took a combination of aspirin, a statin, and a beta blocker had an 83% lower risk of dying, compared to those not taking any medications. That compared with a 47% reduced risk in those taking a statin alone, 41% with aspirin alone, and 19% with a beta-blocker alone.

Other drug combinations also fared better than a single drug. For example, a statin plus an ACE inhibitor plus aspirin cut the chances of dying by 71%; a four-drug combination—a statin, a beta-blocker, an ACE inhibitor, and aspirin—reduced the risk by 75%. Many doctors recommend more than one medication for their patients with coronary heart disease, and pharmaceutical companies are working on “polypills,” which combine commonly used medications into a single pill. These polypills would be more convenient and possibly cost less than taking the medications individually.

And speaking of polypills …

The Power of Psyllium Plus a Statin

If you’re taking a statin drug to lower your cholesterol level, try adding a soluble fiber supplement to the mix and you might get even more of a benefit. That was the conclusion reached by researchers at the Robert Wood Johnson Medical School in New Jersey, who studied 68 people with high cholesterol levels. In the study, reported in the Archives of Internal Medicine, these volunteers were given either 10 mg or 20 mg of the statin Zocor (simvastatin) daily plus a placebo, or 10 mg of Zocor daily plus a psyllium supplement (Metamucil, 5 grams 3 times a day).

After eight weeks of treatment, the participants taking 10 mg of Zocor plus psyllium experienced a 36% decrease in LDL cholesterol, which was equal to the LDL-lowering effect of 20 mg of Zocor alone. By comparison, LDL levels decreased by 31% in those who received 10 mg of Zocor plus a placebo. The addition of psyllium had no additive effect on lowering triglycerides or increasing HDL cholesterol levels. No serious side effects occurred when psyllium was added to the statin regimen.

This study suggests that you might be able to take a lower dose of your statin drug if you add a psyllium supplement. A lower statin dose could mean fewer and less severe side effects. However, never change the dose of your statin medication without first consulting your doctor.

Johns Hopkins Health Alerts | Heart Health | Taking Combination Medications for Coronary Heart Disease

Sex After A Heart Attack -- When Is It Safe?

Fri, 26 Jan 2007 06:00:00 CST

Johns Hopkins Health Alerts | Heart Health | Sex After A Heart Attack -- When Is It Safe?

Johns Hopkins cardiologists talk about a leading concern of heart attack patients.

It’s normal to be concerned about your safety following a heart attack, but unwarranted obsessions will interfere with lovemaking and rob the experience of its joy. Have you ever wondered:

Q. How long should I wait to resume sexual activity following a heart attack?

A. For most people, sex can be resumed within three to four weeks following your heart attack after having discussed it with your doctor. Whatever you do, however, don’t rush into sex with the feeling that you have to prove your sexual prowess following your heart attack. Take it slow, just as you would with any other type of activity.

Q. How dangerous is sexual activity after a heart attack?

A. For the most part, not very dangerous at all. Normal sexual activity is no more strenuous on the heart than a number of other routine physical activities, such as brisk walking, golf, or carrying 20 pounds of groceries from the car to the house.

After a heart attack, there are both physical and emotional hurdles the patient must clear in order to return to a full, active, and healthy life. The best-documented path to recovery after a heart attack begins with a supervised cardiac rehabilitation program (covered by most insurance plans and Medicare) at a hospital or medical center staffed with cardiac nurses and exercise physiologists, all working under the supervision of a cardiologist.

Q. How will a cardiac care program help?

A. Cardiac care programs have three major goals: maintain or improve one's functional capacity; improve quality of life; and prevent future heart attacks. Changes to diet, regular supervised exercise, and counseling on a variety of topics -- including sex -- are all vital components of this comprehensive approach to full recovery.

Cardiac rehabilitation programs are often referred to as medical boot camps for patients who have suffered a heart attack. In an 8- to 12-week period, patients who have suffered a heart attack are taken through a supervised exercise program (treadmill walking, stationary bicycling, strength training), provided with nutrition guidance, and taught stress management techniques. In addition, they are offered abundant encouragement to make positive lifestyle changes that will dramatically decrease the risk of a second heart attack, keeping them healthy and out of the hospital.

Therefore, when it comes to fear of death from sexual activity after a heart attack, there is little to fear. If you are able to live a physically active life, there is no reason to abstain from sexual activity. While you may be more aware of your heartbeat, breathing, and overall well-being, this is normal and will likely lessen over time.

Johns Hopkins Health Alerts | Heart Health | Sex After A Heart Attack -- When Is It Safe?

How Safe Is Crestor?

Fri, 16 Feb 2007 06:00:00 CST

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article How Safe Is Crestor? is no longer current, and has therefore been removed.

If you would like to read related articles about statin medications, please see the article Controlling Cholesterol -- Is There a 'Best' Drug?. Thank you.

Triglycerides: The Forgotten Lipid

Fri, 09 Mar 2007 06:00:00 CST

Johns Hopkins Health Alerts | Heart Health | Triglycerides

You probably know your total and LDL cholesterol, and perhaps even your HDL level. But do you know your triglyceride level?

Triglycerides don’t get nearly as much attention as cholesterol, but evidence is accumulating that your triglycerides may be almost as important as your cholesterol levels when it comes to the health of your heart, particularly if you have other risk factors for coronary heart disease (such as diabetes, high blood pressure, obesity, or a family history of coronary heart disease).

The triglyceride debate

Like cholesterol, triglycerides are a form of fat transported in the bloodstream. Triglycerides can come from food, but they are also manufactured in the body. For years, experts have debated how important triglyceride levels are in predicting the risk of coronary heart disease (CHD). Some experts argue that triglycerides are not an independent risk factor for CHD, but are merely an indicator of a higher likelihood of developing CHD, because people with high triglyceride levels are more likely to have other health characteristics (such as obesity, high blood pressure, diabetes, high LDL cholesterol levels, or low HDL cholesterol levels) that put them more at risk for CHD. More recent studies, however, provide convincing evidence that high triglycerides are a significant, independent risk factor for CHD as well as a sign that you have other CHD risk factors. The bottom line: You can’t afford to ignore your triglyceride level and what it may mean to your heart health.

Getting tested for triglycerides

When your physician orders a blood test called a lipid profile, it will include an analysis of your triglyceride level. To get an accurate reading, your doctor will ask you to fast overnight before the blood is drawn and sent to the laboratory. In a day or two, the lab will provide your physician with the results, which will also include your levels of total cholesterol, LDL cholesterol, and HDL cholesterol.

What should your triglyceride level be? Current guidelines from the National Cholesterol Education Program recommend a triglyceride value less than 150 mg/dL. If your triglycerides are in the 150–199 mg/dL range, they are considered “borderline high”; if they are 200 mg/dL or more, you have high levels. Talk with your doctor about the optimal triglyceride target for you.

Johns Hopkins Health Alerts | Heart Health | Triglycerides

What You Should Know About Angina

Tue, 03 Oct 2006 06:00:00 CDT

Johns Hopkins Health Alerts | Heart Health | The Difference Between Stable Angina and Unstable Angina

Your chest pain may be a symptom of stable angina – or something more serious. Johns Hopkins doctors explain the important difference.

Chest pains can be frightening, no matter what causes them. But if stable angina is the cause, you can take steps to prevent the chest pain or relieve the pain if it occurs. Angina is a warning sign that your heart needs more oxygen. In technical terms, the symptoms of angina are the result of myocardial ischemia (a shortage of blood and oxygen to the heart muscle due to the partial blockage of a coronary artery by the buildup of plaque). Stable angina occurs most often during physical activity, when the heart requires more oxygen than it does at rest but cannot get a sufficient supply because of the narrowing of one or more of the coronary arteries. Angina symptoms usually occur only when an artery is narrowed by 60–70%.

Recognizing the symptoms of angina

When people feel the discomfort of stable angina, they’re often worried that they’re having a heart attack. However, an episode of angina is not a heart attack; the chest pain subsides quickly with rest or nitroglycerin, and there is usually no lasting damage to the heart muscle. If you have stable angina, the most common symptom is a feeling of pressure beneath the breastbone. Some people experience other symptoms, such as sensations of tightness, squeezing, burning, aching, heaviness, or choking in the chest area. Angina can also produce pain in the left shoulder that radiates up to the neck and jaw, or pain in the inner part of the left arm that may travel down to the fingers. The intensity of the discomfort usually increases steadily, reaches a plateau, and gradually diminishes with rest—all within a few minutes. The pain, although uncomfortable, is rarely sharp.

Unstable angina, sometimes called crescendo angina, is a condition midway in severity between stable angina and a heart attack. If you have unstable angina, an inadequate supply of oxygen is reaching your heart, most likely because a blood clot or spasm of the coronary artery has narrowed—but not completely blocked—the artery. Like a heart attack, unstable angina is a medical emergency. In fact, it is a sign that a heart attack could occur soon. Unstable angina has three major features that distinguish it from stable angina:

The angina is unexpected and can occur at rest.

The angina is more severe and usually lasts for longer than 20 minutes.

The angina is not relieved by rest or medication.

Call 911 immediately if you think your chest pains are more than just stable angina. You’ll be taken to the hospital, where doctors can evaluate your chest pain. If unstable angina is diagnosed, you will likely need to stay in the hospital for about 2–5 days to receive treatment to prevent a heart attack.

Johns Hopkins Health Alerts | Heart Health | The Difference Between Stable Angina and Unstable Angina

Cholesterol-Busting Foods

Fri, 30 Mar 2007 06:00:00 CST

Johns Hopkins Health Alerts | Heart Health | Foods to Reduce Cholesterol

Here are some foods that can reduce cholesterol levels and will fit easily into your diet.

When people need to reduce cholesterol, they often think about eliminating some foods from their diet. But research increasingly shows that adding certain foods can also reduce cholesterol levels significantly. In fact, a study in the journal Metabolism found that people with high cholesterol who ate a diet not only low in saturated fat but high in plant sterols, soluble fibers, soy protein, and almonds effectively lowered their low-density lipoprotein (LDL or “bad”) cholesterol levels by 35%. Although this diet would be very difficult to follow for long periods, the study illustrated the feasibility of lowering LDL cholesterol through diet.

To avoid consuming excess calories, it’s important to substitute the cholesterol-busting foods described below for other foods (preferably those high in saturated fat and cholesterol) rather than simply add them to the diet.

Reduce cholesterol with plant sterols and stanols -- Plant sterols and stanols, plant compounds that are structurally similar to cholesterol, partially block the absorption of cholesterol from the small intestine. They lower levels of LDL cholesterol without adversely affecting high-density lipoprotein (HDL or "good") cholesterol levels.

Reduce cholesterol with soluble fiber -- The American Heart Association also recommends that people who are unsuccessful in their efforts to reduce cholesterol through lifestyle changes boost their intake of soluble fiber to 10 to 25 g each day. Good sources of soluble fiber include legumes such as peas and beans; cereal grains such as oats and barley, and vegetables and fruits such as carrots, apples, and dried plums (prunes). Fiber may help reduce cholesterol by interfering with the reabsorption of bile acids from the intestine, so the liver converts more cholesterol to bile acids.

Reduce cholesterol with nuts -- Although nuts are high in fat, the fats are predominantly monounsaturated and polyunsaturated, which are known to decrease LDL cholesterol levels. Although a number of types of nuts have been shown to help lower LDL cholesterol levels -- including walnuts, peanuts, pecans, macadamias, and pistachios -- the best evidence exists for almonds.

Johns Hopkins Health Alerts | Heart Health | Foods to Reduce Cholesterol

The ABCs of Heart Attack Prevention

Thu, 02 Nov 2006 06:00:00 CST

Johns Hopkins Health Alerts | Heart Health | Heart Attack Prevention

Dr. Roger Blumenthal and his cardiovascular team at Johns Hopkins offer guidelines to help you maintain a healthy heart.

You can modify or treat most of the risk factors associated with a heart attack or stroke. Here is an easy-to-remember checklist of primary prevention measures for people without symptoms of (a history of) coronary heart disease (CHD).

Heart Attack Prevention Tip #1: Take low-dose aspirin.
Goal: Low-dose aspirin (75 to 162 mg per day) for people at elevated risk for a heart attack. Not recommended for some people, so be sure to consult with a physician before starting aspirin therapy.

Heart Attack Prevention Tip #2: Keep your blood pressure under control.
Goal: <140/90 mm Hg (optimal is <120/80 mm Hg); <130/80 mm Hg for people with diabetes or kidney disease. If you cannot reach this goal after three to six months of lifestyle changes, you may benefit from medication to prevent a heart attack.

Heart Attack Prevention Tip #3: Lower your cholesterol. Goal: Total cholesterol <200 mg/dL; LDL cholesterol <160 for people with no more than one risk factor for a heart attack; LDL <130 for those with two or more risk factors; LDL <100 (with an optional goal of <70) for some people with two or more risk factors as well as for those with diabetes, history of stroke or aortic aneurysm, peripheral arterial disease, or coronary heart disease; HDL >40 for men and HDL> 50 for women (and preferably >60 for both men and women); triglycerides <150. If you cannot reach LDL goal after three to nine months of lifestyle changes, consider drug therapy to lower LDL. Exercise, improvements in diet, and quitting smoking can help meet HDL goals.

Heart Attack Prevention Tip #4: Watch your diet.
Goal: Consume a variety of fruits, vegetables, whole grains, low-fat or nonfat dairy products, fish, legumes, poultry, and lean meats. Saturated fats should make up <7% of total calories. If overweight, make changes in caloric intake to achieve and maintain a desirable body weight (body mass index of 18.5 to 24.9). For those who drink, limit alcohol intake (no more than two drinks a day for men, one drink a day for women).

Heart Attack Prevention Tip #5: Walk or do some form of exercise every day.
Goal: Perform at least 30 minutes of moderate-intensity physical activity (such as brisk walking) at least five days of the week. More vigorous activity can provide additional benefits, including weight loss if caloric expenditure exceeds caloric intake.

Additional Special Heart Attack Prevention Goals:
Individuals who smoke should stop completely.
Individuals with metabolic syndrome should reach normal fasting blood glucose levels (<100 mg/dL). People with diabetes should strive for the best possible control of blood glucose levels. If diet and exercise do not adequately lower blood glucose levels, medication is usually recommended; other risk factors for coronary heart disease must be treated aggressively.

Johns Hopkins Health Alerts | Heart Health | Heart Attack Prevention

Medications and Sexual Dysfunction: What's the Connection?

Fri, 01 Sep 2006 13:43:55 CDT

Johns Hopkins Health Alerts | Heart Health | Sexual Dysfunction and Heart Medications

Are your prescriptions medications causing sexual problems? Dr. Roger S. Blumenthal, medical editor of The Johns Hopkins Heart Bulletin, offers advice.

Every drug has its own profile of strengths and weaknesses. While a pill may be hailed as the miracle cure of the moment, the substance will, almost inevitably, have an undesirable downside. Because of this, physicians must weigh the risk-to-benefit ratio before they prescribe any medication.

Each year, doctors in this country write more than 1.5 billion prescriptions. This averages out to about six prescriptions for each person in the U.S. Many patients -- and their doctors, as well -- are simply not aware of the fact that scores of the most commonly prescribed drugs have been implicated, or at least strongly suspected, in either the development or worsening of sexual dysfunction.

A variety of common medications can cause sexual dysfunction. The most common offenders are prescription drugs for high blood pressure, heart ailments, and allergies. If a person is taking more than one medication, the adverse effects may be cumulative. In some circumstances, people may be faced with having to take medications (for their inherent benefits), despite a high likelihood that it is causing sexual dysfunction. It's an ironic and frustrating situation to be in. I have seen patients blame themselves, or their partners, when they weren't even aware that their problems had a physiologic cause.

Sometimes, patients will suspect that the medication mix is responsible for, or contributing to, their sexual sexual dysfunction. On their own, they may decide to try lowered dosages or stop taking the drugs altogether. This can be very dangerous and should certainly be avoided until one has spoken with their physician. In the case of high blood pressure medication, lack of the drug may cause blood pressure increases to dangerously high levels, which may predispose to a stroke or heart attack.

Although there are more than two hundred medications on the market known to compromise sexual performance, this often gets little attention. While this may be distressing, patients rarely voice their concerns about sexual dysfunction. Importantly, your physician may not even be aware of this problem if you do not bring it to their attention. When it comes to avoiding certain medications because of sexual dysfunction, there is no simple answer. Not every drug will cause problems for each patient who uses it. However, if you notice that you are now having sexual problems where none existed before, take a good look at all the medications you're taking.

Johns Hopkins Health Alerts | Heart Health | Sexual Dysfunction and Heart Medications

Is it a Panic (Anxiety) Attack or a Heart Attack?

Wed, 05 Jul 2006 12:35:52 CDT

Johns Hopkins Health Alerts | Heart Health | Differences Between a Panic or Anxiety Attack and a Heart Attack

Johns Hopkins cardiologist Roger S. Blumenthal, M.D. explains the importance difference between a panic attack and a heart attack.

Q. I had the shock of my life last week when I found my 58-year-old husband slumped over in his chair shortly after dinner. He had chest pain, a rapid heartbeat, shortness of breath, and he was sweating through his shirt. I called 911 and went with him to the hospital. The good news is that everything checked out OK. The strange news is that the doctor said he had suffered a panic attack, not a heart attack. What could be the problem? Our children are doing well in college, my husband owns his own business, and our lives are better than ever before. What kind of medical workup should he get so he can take steps to prevent another panic attack?

A. An acute anxiety attack, or panic attack, is a terrifying ordeal to experience. During a panic attack, a surge of fear overcomes the individual, often without any clear provocation. Many patients truly believe they are going to die, and some experience syncope, or fainting, as a reaction to this stressor.

The signs and symptoms of a panic attack are quite similar to those of a heart attack: palpitations, difficulty breathing, a sense of doom, lightheadedness, nausea, chest pain, and sudden chills. Unlike a heart attack, however, a panic attack is not medically dangerous.

Anyone diagnosed with panic attacks should be seen and evaluated by a psychiatrist who treats panic attack patients. Fortunately, panic or anxiety disorder is highly treatable. A type of therapy called "cognitive restructuring" helps people understand the nature of their symptoms, and many are greatly helped by understanding the diagnosis and learning to replace their maladaptive response with a clear recognition of what is happening to them. Cognitive therapy can help identify triggers, and can potentially lead to reduction in the frequency of panic attacks. Behavioral modification therapy and relaxation techniques are also used. In addition, anti-anxiety medications have been used with success.

Johns Hopkins Health Alerts | Heart Health | Differences Between a Panic or Anxiety Attack and a Heart Attack

A Revised Strategy for Controlling Atrial Fibrillation

Thu, 18 May 2006 11:09:02 CDT

Johns Hopkins Health Alerts | Heart Health | Controlling Atrial Fibrillation

It’s a type of abnormal heart rhythm that affects, or will affect, many of us. According to a report in Circulation, about one quarter of Americans—a figure far higher than earlier estimates—have a cumulative lifetime risk of developing atrial fibrillation.

In atrial fibrillation, the upper chambers of the heart (or atria) contract in a rapid, uncoordinated manner, quivering (fibrillating) instead of beating normally. Because the heart cannot keep up with the body’s demand for blood during an episode of atrial fibrillation, people may feel breathless and have mild palpitations, chest pain, or decreased endurance. Many patients, however, experience no symptoms during an episode of atrial fibrillation.

Atrial fibrillation usually poses no immediate danger. However, it is one of the greatest risk factors for stroke if left untreated. The American Heart Association estimates that atrial fibrillation is responsible for 15% to 20% of the 700,000 strokes that occur each year in the United States. Therefore, effective treatment for atrial fibrillation is crucial and can be lifesaving.

In the past, the goal in treating atrial fibrillation involved getting the heart back into normal rhythm with medication or an electric shock, followed by maintenance antiarrhythmic drug therapy. But an expert panel from the American Academy of Family Physicians and the American College of Physicians issued new guidelines in 2003 recommending that for most patients, treatment for atrial fibrillation should now focus on controlling the heart rate with drug therapy rather than attempting to restore normal heart rhythm (though rhythm control may still be appropriate in certain cases). For patients who have been restored to normal rhythm, recent studies suggest that certain drugs can help reduce the risk of recurrence of atrial fibrillation.

Any patient who experiences an episode of atrial fibrillation needs to be evaluated by a cardiologist, who can evaluate whether rate or rhythm control is the best course of therapy.

After a Heart Attack -- Should You Have a Home Defibrillator?

Sun, 21 May 2006 10:57:04 CDT

Johns Hopkins Health Alerts | Heart Health | Benefits of Home Defibrillator

People most likely to benefit from having a home defibrillator are those with known risk factors for cardiac arrest.

A defibrillator delivers a jolt of energy into the chest to jump-start the heart and reverse sudden cardiac arrest. Cardiac arrest is caused by an electrical malfunction of the heart that produces a fatally abnormal heart rhythm: The heart quivers and stops pumping blood, and the victim loses consciousness. Cardiac arrest differs from a heart attack, but it is triggered by a heart attack in about half the cases.

Some 80% of sudden cardiac arrests occur in the home. Normal ambulance delays are dangerous in such cases because survival chances drop about 10% every minute that passes without defibrillation. A home defibrillator can be lifesaving.

The home defibrillator tells a user with voice prompts where and how to apply two pads to shock the heart back to normal rhythm. If the problem is not cardiac arrest—and thus cannot be treated with an electrical shock—the defibrillator will not deliver one.

People most likely to benefit from having a home defibrillator are those with known risk factors for cardiac arrest. These include blocked coronary arteries, heart failure, and certain inherited heart abnormalities.

Johns Hopkins Health Alerts | Heart Health | Benefits of Home Defibrillator

Increasing The Odds Of Surviving A Heart Attack

Thu, 01 Jun 2006 06:00:00 CDT

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article Increasing The Odds Of Surviving A Heart Attack is no longer current, and has therefore been removed.

If you would like to read related articles about heart health, please go to the Heart Health topic page. Thank you.

Diagnosing Heart Disease -- Who Needs An Exercise Stress Test?

Thu, 03 Aug 2006 21:25:57 CDT

Johns Hopkins Health Alerts | Heart Health | Using an Exercise Stress Test to Diagnose Heart Disease

A standard exercise stress test uses an electrocardiogram (ECG) to record the electrical impulses from the heart during exercise. The electrical signal often changes when the heart is not receiving enough blood and oxygen during physical activity.

In people who have chest pain or are at risk for coronary heart disease, an exercise stress test can be used to detect the presence of heart disease. The test may also be performed to assess the safety and appropriate level of exercise for people beginning an exercise program after a heart attack or bypass surgery and to evaluate the effectiveness of certain treatments (such as those for arrhythmias).

The stress test to detect heart disease involves walking on a treadmill or pedaling a stationary bicycle. The speed and incline of the treadmill or the resistance of the bicycle are gradually increased until the person reaches his or her target heart rate (at least 85% of maximal heart rate). The stress test may be stopped early if the person becomes fatigued or experiences symptoms such as chest pain, shortness of breath, dizziness, or an irregular heartbeat.

An exercise stress test is not always accurate in detecting the presence of coronary heart disease. In young women and other people at low risk for coronary heart disease, the stress test may be abnormal even though there is no significant heart disease.

The stress test is also associated with a very small risk of a heart attack or a dangerous heart rhythm, but patients are carefully monitored during the stress test and treated immediately if any serious complications occur.

Johns Hopkins Health Alerts | Heart Health | Using an Exercise Stress Test to Diagnose Heart Disease