We are fortunate to live in an age in which most pregnancies go well, and most mothers and babies leave the hospital healthy and happy. However, pregnancy related deaths still occur, and many are due to cardiovascular disease. Sadly, it appears that in as many as 8 out of 10 cases, death could have been prevented had the woman, her doctor, or both, paid greater attention to her health.
Cardiomyopathy, a weakening of the heart muscle, occurs in a small percentage of pregnancies, but researchers from the University of California Irvine found that the condition is more common in women with high blood pressure, obesity, or a history of substance abuse. Black women are also more likely to develop pregnancy related cardiomyopathy. As many as one in three women in the study who died of the condition ignored their symptoms or waited too long to see a doctor.
Symptoms can include shortness of breath, fluid retention, and generalized weakness. Cardiomyopathy can usually be readily diagnosed with an echocardiogram, or ultrasound of the heart.
As I told DailyRx.com, heart complications of pregnancy are often preventable and usually treatable. It’s important that pregnant women see their obstetricians regularly, and get referral to a high-risk OB when needed. Maintaining a healthy weight and making smart choices about diet and lifestyle are critical for all pregnant women. A cardiologist can be a valuable member of the team when high blood pressure and other heart-related conditions occur. You can read more about this study, and find my comments on DailyRx.com by following the link.
A study presented at the recent American Heart Association Scientific Sessions in Dallas reported as much as a 75% lower risk of death in people who exercised regularly, whether or not they had been treated for heart disease. Put into perspective, exercise is more powerful than most prescription drugs at reducing heart attacks and mortality.
As I explained to DailyRx.com, “Anyone who has heart disease or who has been sedentary should check in with their doctor before starting an exercise program. Aim for at least 2.5 hours per week of moderate intensity exercise. If you’re new to working out, start slowly and build up your endurance gradually.”
A healthy smile may mean more than just pretty teeth. People with good oral hygiene and healthy gums are also at lower risk for cardiovascular disease. Exactly why the two are linked is not fully understood, but the key is probably inflammation.
Dr. Moise Desvarieux and colleagues at Columbia University published their findings of a study on periodontal (gum) health and carotid artery abnormalities in the Journal of the American College of Cardiology last month. The carotid arteries send blood from the heart to the brain. When cholesterol build up in these arteries, the risk for stroke rises. Abnormal carotid arteries are more common in people who also have disease in the heart arteries. In this study, the researchers measured the thickness of the walls of the carotid arteries in people with gum disease who were tracked for three years. As gum health improved, so did the thickness of the artery walls. Conversely, in those whose gum disease worsened, the carotids were also more apt to look worse.
In an interview with reporter Don Rauf, I emphasized that “Now we have one more reason to brush at least twice daily and to floss every night. By taking five minutes every day to keep our teeth and gums healthy, we may also lower our chances of developing heart disease and stroke. It’s also important to visit the dentist at least every six months to keep problems at bay.” You can read more about the study by clicking on the link to the DailyRx.com website
Testosterone, sometimes called the “male hormone”, has been aggressively marketed to men as a treatment to improve virility, energy, and strength, among other things, yet research into the effects of testosterone on heart health has been lacking. Now a study from UT Southwestern Medical Center in Dallas reports that the therapy may have unintended consequences, raising the risk for heart attacks and strokes.
As I told DailyRx.com reporter Katti Gray, “Testosterone is often prescribed for men with erectile dysfunction (ED). In fact, ED is often an early indicator of cardiovascular disease. Just like the heart and brain, the blood vessels supplying the penis can be constricted by cholesterol buildup.
“While many men turn to pharmaceuticals and supplements for ED, treating risk factors for heart disease (including high blood pressure, diabetes, sedentary lifestyle, obesity, and high cholesterol) may also improve ED. There is even good evidence that the Mediterranean diet can improve ED, although it may take several months.
In my interview, I cautioned that this new study “provides important information for men who are considering testosterone therapy … Diagnosing testosterone deficiency can be tricky, since levels typically vary throughout the day, yet prescriptions for hormone therapy have soared. Now that we have strong evidence that the therapy can raise heart attack and stroke risk, it is critical that doctors and their patients discuss these issues carefully — and consider other options — before choosing testosterone treatment.”
To learn more about the study and its implication, follow the link to the article on DailyRX.com
Menopause can be challenging for many women, although a lucky few breeze through with hardly a hot flash to show for it. For women whose symptoms are intolerable, hormone replacement with estrogen can make all the difference. Choosing amongst the options can be tricky, but there is a way to make some sense of it all.
First, if you have not had a hysterectomy then you will need to take progesterone. That’s because estrogen alone can raise the risk of uterine cancer. If you don’t have a uterus , then you don’t need progesterone. This is a good thing, because progesterone appears to raise the risk for cardiovascular disease substantially more than estrogen alone.
Whether you need combo therapy or simply estrogen, there is a variety of pills to choose from, as well as patches and creams. How should you decide? Most of the studies of hormone replacement have used Premarin pills. However, this drug, made from the urine of pregnant horses, is quite different from our own natural estrogen, known as 17-beta-estradiol. This may possibly account for some of its negative effects, such as inflammation of the blood vessels and higher risk for blood clots. Fortunately, there are a number of other FDA-approved pill forms of estrogen that are plant-based and much more like our own natural estrogen. (Sometimes this property is referred to as bio-identical.) Examples include Estrace and Ogen.
Although these pill forms of estrogen appear safer than Premarin, an even better choice is the estrogen patch. This allows a natural level of estrogen to be delivered into the blood stream. It bypasses the liver, so that triglyceride and CRP levels are not affected in the way that they are with the pills. Small studies have found that estrogen patches appear to be safer than the pills, with lower likelihood for heart attacks, strokes, and blood clots.
An analysis of over 93,000 women treated with hormone therapy was recently reported by researchers at the Cedars-Sinai Heart Institute and published in the peer-reviewed medical journal Menopause. Overall, the patch appeared to be safer for the heart and brain than Premarin.
You can read about the study by following the link below. For even more detailed information about hormone therapy and your choices, I devote a chapter of my book, Best Practices for a Healthy Heart, to this controversial and timely topic.
Although bad things may happen to good and happy people, a new study from Denmark suggests that keeping a good attitude can help heart patients live longer.
In an interview with DailyRx reporter Don Rauf, I elaborated on the study by explaining that “Sometimes it’s hard to put on a happy face, but other research shows us that sometimes you really can fake it ’til you make it. Just pretending to be in a good mood can often lead to healthier choices which in turn will make us feel better and keep the good work going. Choosing friends who are positive, rather than hanging out with others with a negative attitude, can also help.”
To read more about this study and its implications, follow the link below. In my book, Best Practices for a Healthy Heart, I devote a chapter to “Attitude and Stress,” explaining how personality type and optimism vs pessimism can have far-reaching health effects.
The use of supplements is increasingly controversial. Some, such as high dose folic acid, may actually promote the growth of cancer cells, while others, such as selenium, may raise the risk of other diseases such as diabetes when taken to excess.
A new analysis of 14 studies of B vitamins suggests that B-vitamin supplements might lower the risk for stroke. However, the effect appears to be fairly small, and some of the the studies showed no benefit at all. As I discussed with DailyRx.com reporter Katti Gray, “Although when the combined studies are taken as a whole there does appear to be a small benefit, it’s hard to draw strong conclusions about supplements. It’s always best to get our nutrition from food, rather than from a pill. In nature, foods rich in B vitamins, such as fish, green leafy vegetables, and dairy products, also are full of important antioxidants and other nutrients that support brain and heart health.”
You can read more about the study by following the link to the article.
Although doctors and other medical professionals are highly skilled at caring for patients with heart attacks, what happens after the patient leaves the hospital can make the difference between life and death or disability. Controlling blood pressure, cholesterol, and diabetes are critical. So is exercising, losing weight, and quitting smoking. Taken together, these interventions are known as “secondary prevention”.
A study published in the Journal of Women’s Health evaluated how these important risk factors are addressed in patients hospitalized for heart attacks. 19 different medical centers were included. The majority of patients studied were male and Caucasian. Ninety percent had at least one risk factor for heart disease, 70 percent had two or more, and 40 percent had at least three. However, amongst the black women studied, 60 percent of older black women (and 54 percent of younger black women) had three or more risk factors, meaning that their likelihood of having another heart attack was higher than average.
Despite this, male and female black patients were less likely to receive blood pressure and cholesterol medications, and received less counseling on health management strategies for weight loss and tobacco cessation. As I told DailyRx health reporter Don Rauf, “The study doesn’t offer any specific insights into why the care differed so substantially. The study took place in 2003-2004, when many important drugs were not available in generic form. Fortunately, we now have a wide variety of medications that work extremely well and can be had for $4 per month for cash-paying patients.” Indeed, the black patients studied were less likely to have conventional insurance than their white counterparts, which conceivably may have impacted their doctors’ decision-making.
Of course, cultural barriers and preconceptions could have also played a role. The ethnic and racial makeup of the the physicians caring for these patients is not reported, nor is their gender. That would have been very interesting information to have collected, and would probably offer more insights into the way we deliver care.