Aspirin. Cholesterol-lowering drugs. Vitamins. New blood tests for predicting heart disease. The questions people have about the best ways to reduce their heart disease risk seem to multiply every time a new study is reported. But how do you know what to believe, and, more importantly, what will work best for you?
At the Maryland Heart Center, our experts answer questions on these and other heart-related topics every day based on their extensive clinical and research experience in terms patients can understand.
Some frequently asked questions are listed below. Click on any of the questions to read the answer, or scroll down to read them all.
To talk to or to schedule an appointment with a Maryland Heart Center expert,
please call 410-492-5538.
If you're overweight, losing weight is a good idea to keep your heart healthy. By taking off the extra pounds, your blood cholesterol levels may improve and your blood pressure may go down. There are so many diet options now. At the University of Maryland Heart Center, we still believe that a balanced diet combined with exercise is the best option for losing weight.
The Atkins Diet stresses a low amount of carbohydrates. People do have success with this type of low-carb diet. Two recent studies in the New England Journal of Medicine found that individuals who followed a high-protein, high-fat, low-carbohydrate diet lost twice as much weight over six months as those people who followed a low-fat diet. The question remains about the long-term success of this kind of diet. There are no long-term studies to determine what effect this diet has on cholesterol. Often, people who follow an Atkins Diet will see a lowering of triglycerides, but the triglyceride level quickly returns to a higher number once the diet isn't followed.
The South Beach Diet stresses the importance of consuming the right carbohydrates and the right fats. Developed by a cardiologist, the South Beach Diet has followers who have lost weight without cravings and without feeling deprived. Unlike Atkins, the South Beach Diet allows some carbohydrates. Simple carbohydrates such as those from white flour, sugar and processed foods are not allowed.
The Protein Power LifePlan is a diet that is often recommended by preventive cardiology. This diet has been developed by two physicians and has been tested for more than 10 years. It stresses proteins that are lean and determined by weight. It, too, restricts simple carbohydrates in the early phases of the plan. Promoting the use of "good" fats such as olive oil, canola oil and fish, the plan is similar to the Mediterranean diet. The Mediterranean diet is the only diet proven in clinical trials to reduce the risk of heart disease.
The tried and true method for losing weight is to have a healthy diet and to incorporate exercise into your daily routine. Here are some recommendations:
The decision whether to take an aspirin a day to help prevent a heart attack should not be made alone. You should discuss the possibility with your heath care provider. Oftentimes, long-term aspirin use is not necessary for people who are otherwise healthy. Also, people who have medical conditions such as high blood pressure, asthma, liver and kidney diseases may not benefit from aspirin.
We all know aspirin helps with headaches and muscle aches, but aspirin can help prevent a heart attack and stroke. It works by lowering the blood platelets clotting action. There are risks associated with this, including stomach bleeding and kidney failure.
Aspirin does not include directions on its label about how to use the product to reduce the risk of a heart attack. Remember to talk with a physician or nurse practitioner if this is the best option for you.
You have probably seen the television commercials talking about the benefits of taking a cholesterol-lowering drug. Also called statins, physicians often prescribe these types of drugs when despite dietary and exercise changes, a patient does not have a significant change in their LDL (referred to as "bad" cholesterol) cholesterol levels or when a patient doesn't have enough HDL ("good") cholesterol. People at an increased risk of cardiovascular disease may also be prescribed these medications.
You must talk to your health care professional about whether taking cholesterol-lowering drugs is right for you. If you have high cholesterol and have a family history of heart disease, it is a good topic to discuss with your physician.
Heart attack symptoms can vary. Some people may have one, many or no common symptoms at all.
In both men and women, the major symptom of a heart attack is chest pain just below the breastbone. People sometimes describe this pain as similar to indigestion or a feeling of squeezing, heavy pressure, an elephant sitting on their chest or a tight band around their chest. Pain is not always limited to this area. Other areas where pain may occur include the back, stomach, arms, shoulders, neck, teeth or jaw. Pain lasting longer than 20 minutes or pain that is similar to heartburn that doesn't go away may also be caused by a heart attack.
Other symptoms of a heart attack are shortness of breath, coughing, lightheadedness, dizziness, fainting, nausea, vomiting, sweating, dry mouth, anxiety and a feeling of impending doom.
Women often experience these symptoms differently than men. The symptoms can be less pronounced, like chest pain, or more common, like shortness of breath, nausea/vomiting, and back or jaw pain. Some women also report feeling extremely tired when they have a heart attack. Because chest pain is less common in women, they often ignore their symptoms and delay seeking immediate treatment.
If you or a loved one experience any of these symptoms, call 9-1-1 immediately. Don't wait to see if the symptoms disappear. Taking quick action can save your life
Blood pressure is simply a measurement of the pressure in your arteries. The systolic pressure is the force which the heart must exert to pump blood out of the heart. Diastolic blood pressure is the pressure of the arteries at rest. Blood pressure is recorded as systolic "over" diastolic. An ideal blood pressure is less than 120 over 80 (120/80). Blood pressure is measured by manually inflating a pressurized cuff around the arm and listening to the sounds of the artery as the cuff is deflated. Blood pressures vary by time of day, level of stress and level of activity. To accurately measure a blood pressure, one must be seated, at rest for 5 minutes, with the arm supported at the level of the heart. One blood pressure reading isn't sufficient to determine if hypertension, or high blood pressure, is present. Several readings must be done unless the blood pressure is recorded at a very high reading such as >190/>100.
Sometimes people think they have "white coat" high blood pressure because it seems their blood pressure is only high in the health care provider's office. While this may be true, often people who have high BP in the doctor's office also have higher blood pressures in stressful situations such as traffic, waiting in lines and during stressful personal encounters. One way to determine if someone has blood pressure problems away from the health care provider's office is to measure it with a 24 hour BP monitor.
Current research does not support the use of high-dose vitamins to prevent heart disease. It was once thought that higher doses of Vitamin E and Vitamin C could ward off heart disease. Large clinical trials found no benefit of using large doses of vitamins. There is no harm in using an all-purpose multivitamin. Be sure to ask your health care provider if the multi-purpose vitamin should or should not have iron. One study found that in patients on a combination of a certain statin, simvastatin (cholesterol lowering medication) in combination with niacin actually reduced the effectiveness of HDL (the good cholesterol). There are plenty of circumstances in which vitamin supplementation is medically necessary. Talk with a health care provider to find out which vitamins might be beneficial for you.
Congestive heart failure means that the heart is not pumping sufficiently to provide the blood supply the body needs. It can be caused by heart disease (heart attacks or blocked coronary arteries), hypertension (the most likely cause) or viruses. Symptoms of heart failure include shortness of breath and fatigue. Heart failure can be determined by measuring the pumping effectiveness of the heart through echocardiograms, nuclear imaging stress tests or by heart catheterization. If one is found to have heart failure there are many treatments needed. Often people with heart failure need diuretics (fluid pills and blood pressure medications. Multiple clinical trials have shown that certain medications are beneficial in reducing the death rate of heart failure.
Additionally, clinical trials have shown that in certain people with heart failure the use of an implantable defibrillator (ICD) can save many lives from sudden death. If you have heart failure, ask your health care provider if an ICD is right for you.
Until very recently, blood pressure and cholesterol levels were the only measurements taken to help determine someone's risk of heart disease. While these are still considered standard tests to predict a patient's heart attack or stroke risk, physicians have learned that many people with heart disease have normal cholesterol and blood pressure. Realizing this, other indicators of heart disease have been studied and new tests are being developed to better predict who may suffer from heart disease.
One of the newer tests measures levels of high-sensitivity C-reactive protein (hs-CRP). Studies have shown that hs-CRP is associated with inflammation in the bloodstream and high levels may indicate higher risk of heart disease. Statins may lower hs-CRP, but currently there are no studies to indicate that lowering hs-CRP changes the risk of developing heart disease. University of Maryland is participating in a large trial to help answer that question. hs-CRP is elevated by obesity, metabolic syndrome (a cluster of risk factors including low HDL cholesterol, high triglycerides, high blood pressure, central obesity [waist > 40 inches in men or > 35 inches in women], impaired glucose [> 100], or the presence of small, dense LDL).
Having any 3 of these factors indicates metabolic syndrome, also known as Syndrome X or pre-diabetes. Other factors that increase hs-CRP are inflammatory conditions such as arthritis, asthma or illnesses. A hs-CRP less than 1 is considered low risk. A hs-CRP > 3 and < 10 is considered high risk of developing heart disease. A hs-CRP > 10 is likely due to another inflammatory condition.
Another new blood test is the PLAC blood test. This test measures an enzyme in the blood called lipoprotein-associated phospholipase A2 (Lp-PLA2). The enzyme measured in the PLAC test is thought to be related to plaque in the arteries that can build up and cause heart problems. Like the test for CRP, the PLAC test can help determine who is at greater risk for heart disease. Someone with high levels of CRP or PLA2 may be at higher risk for heart disease, even if cholesterol levels are normal. As with hs-CRP, there are no randomized clinical trials to suggest that lowering PLAC will decrease the risk of heart disease.
There are several other tests that help determine risk of developing heart disease. These include measurements of lipoprotein particles. There are ample clinical trials with statistically significant evidence that changing LDL particle size from small, dense to large "fluffy" does reduce the risk of heart disease. The size of the LDL can be measured directly with one of three commercially available tests (VAP, NMR, or Berkeley HeartLabs) or indirectly through laboratory tests called Apo-B. Similarly, the size of the HDL cholesterol can be measured. Small HDL are not beneficial. One can have an adequate "total" HDL (> 40) but still not have the protection unless the HDL is large, called HDL2.
Lipoprotein (a) is another cholesterol abnormality that may suggest higher risk of heart and vascular disease. This is a chromosomal abnormality that is inherited by 50 percent of the offspring of a parent with the disorder. Generally, this is tested once to determine its presence. If one does not have it upon testing, they will never develop the disorder. If one does have elevations in lipoprotein (a), it can be treated with prescription medications. Lipoprotein (a) is more likely to cause plaquing in arteries than large LDL. This disorder can easily be determined through blood testing.
One more test that can be measured is homocysteine. This is a byproduct of protein metabolism. When elevated, homocysteine is very inflammatory to the artery lining. Elevations are associated with increased blood clotting and heart attacks. It is treated with vitamins and prescription strength folic acid. Talk with a physician to find out more about these tests and to learn more about your risk for heart disease.