FAQS

Heart FAQs:

Does having a healthy lifestyle mean that I won't get heart disease?

Not necessarily. Many people have genetic (inherited) factors that increase their risk of heart disease despite a healthy lifestyle. One clue to this is your family history: if one of your parents or another close relative has early heart disease, you could also be at risk. Only more detailed tests can fully determine your risk and help you know how to decrease that risk.


Does taking medication to lower cholesterol really prevent heart attacks?

Thanks to lots of studies over the past 20 years, we now have proof that medication to lower cholesterol can prevent heart attacks and actually save the lives of people who are at high risk for a heart attack. That's why people who have already had one heart attack almost always need to be treated to lower their cholesterol in order to prevent another one. If you don't have any heart problems right now, it's harder to decide whether medication is needed. However, a major study showed that men without any heart disease who took a medication called Pravastatin for five years had far fewer heart attacks than the men who took a sugar pill. Therefore, if you are at higher than average risk and your cholesterol is elevated, you will probably benefit from taking mediation. Your doctor can help you make this decision.


Last time my cholesterol was checked it was less than 200, but my "good cholesterol" (HDL) was less than 35. Is this anything to worry about and if so, what should I do?


Low HDL cholesterol is a risk factor for heart disease, but not all persons with low HDL are at increased risk. Although it sounds paradoxical, low-fat diets tend to lower HDL levels. In fact, vegetarians often have low HDL levels. But in this situation, the LDL ("bad") cholesterol is also usually low and people like this are usually not at increased risk of heart disease. On the other hand, if you eat a normal diet and especially if you have other risk factors such as a family history for early heart disease, your low HDL could be a sign of increased risk. It would be worth getting a full lipid profile after a 12-hour overnight fast in order to determine your triglycerides and LDL, then talk with your doctor about the results. There is no proof that raising HDL prevents heart disease, but you should consider the following ways to raise your HDL:Stop smoking if you smoke, Lose weight if you are overweight, Get more aerobic exercise. Although alcohol raises HDL levels, it is not recommended that you begin drinking just to raise your HDL. Niacin can raise HDL but this is not usually recommended and niacin should always be taken under a doctor's care. Finally, your low HDL may be a sign that you should work harder to lower your LDL, even if it requires medication.


Should I drink a glass or two of wine with dinner to prevent heart disease?

This is truly a frequently asked question, and most doctors have developed their own response to this question. First, what are the facts? The facts are that moderate alcohol intake (1-2 drinks/day) is strongly associated with decreased incidence of coronary heart disease and heart attacks. This is apparently true of all types of alcohol (beer, white and red wine, liquors) and not just red wine. (The mystique surrounding red wine involves its content of flavenoids, antioxidants which have been speculated to decrease heart disease risk). Although alcohol raises HDL ("good") cholesterol, it is not clear that this is the way in which alcohol decreases risk of heart attacks. Alcohol should never be used simply as a "medication" to raise HDL or to prevent heart disease. There are certainly abundant risks associated with drinking alcohol, from driving under its influence to the risk that use could escalate and cause liver disease. However, the fact remains that moderate alcohol use appears to decrease risk of heart attacks. This is one of those questions that, once armed with the information, everyone has to decide for his or her self.


I've heard that the vitamin nicotinic acid is used to lower cholesterol and treat heart disease. Should I start taking it?

Niacin is a very effective medication for treating high cholesterol and triglycerides, and it also raises levels of HDL cholesterol. However, although it is a vitamin in low doses, it should be taken for cholesterol only under the care of a doctor. Its most common side effect is flushing, a warm sensation soon after taking niacin that can be associated with redness and itching and can be bothersome. The body adapts fairly quickly to niacin and usually the flushing will go away over time. To avoid flushing, the starting dose should be 100 mg 3 times per day and it should always be taken after meals. The dose can gradually be increased over weeks to at least 500 mg 3 times per day, and in some cases to 1000 mg 3 times per day. Niacin can also make diabetes worse, elevate uric acid (a cause of gout), and elevate liver enzymes. However, for the right person it can be extremely effective. You should discuss with your doctor whether or not you should consider niacin.


My cholesterol is high but no one in my family has heart disease. Does this mean that I don't need to worry about my cholesterol?

Not everyone with high cholesterol is destined to develop early coronary heart disease. First, a breakdown into the LDL ("bad") and HDL ("good") cholesterol should always be done. Some people with high cholesterol have normal LDL but high HDL (which is a good situation to be in!). Second, there may be other inherited factors which help to offset the effects of high LDL cholesterol. Third, some people are just lucky and defy the odds. In any case, the lack of a family history, though a good sign, does not make anyone immune to the effects of high cholesterol. Watching your diet, exercising regularly and taking an aspirin a day would make sense as ways of decreasing risk. Whether medication is advisable would depend on your cholesterol level, your age, and the presence of other risk factors.


Can't I just prevent heart disease by taking the right vitamins?

The concept of taking vitamins to prevent heart disease is a great one – the problem is that we don't have any proof that they really do. Our only evidence is based on nutritional surveys that suggest that people who eat foods richer in vitamins E, vitamin C and other vitamins are less likely to have heart disease. However, these same people could be getting more exercise and watching their health in many other ways, so these studies don't prove that it's the vitamins that make the difference. Quite a few studies are going on right now to try to investigate this question. Until we have more information, it's hard to recommend any vitamins on a routine basis. However, your doctor may have specific reasons for recommending certain vitamin supplements.


Is it true that just taking one aspirin a day helps to prevent heart attacks?


Yes, amazing but true: aspirin has been proven in many studies to help prevent both heart attacks and strokes. Aspirin thins the blood a little in a way that decreases heart disease risk. Acetominophen and ibuprofen will not do the same thing. Aspirin should be a routine part of any effort to decrease the risk of developing heart disease, but talk with your doctor before starting it.


How can I make my heart disease go away?


You are asking about the potential for "regression," the process by which heart blockages can be made to partially get better. There is now evidence that this is possible in some people through a combination of lifestyle changes, exercise, diet, and when needed, cholesterol lowering. However, in general the major issue is not making heart blockages go away, rather just making sure that they don't get worse or cause another heart attack. We now have tremendous evidence that future heart attacks can be prevented, especially by aggressive treatment to lower cholesterol.


Can't I wait until I get heart disease and then have angioplasty or bypass?


If only things were that easy! First, having a heart catheterization and bypass surgery is no fun and to be avoided if at all possible. But even more importantly, almost half of the people who have heart attacks die of their first heart attack before they ever have the chance of having things fixed. Therefore, it's better to try to figure out if you're at risk and to try to decrease your risk to prevent heart disease.


Does the Dr. Dean Ornish program apply to coronary artery blockage?


The Dean Ornish program is a lifestyle modification program that reduces risk of heart disease. Several of Dr. Ornish's studies were performed in people with definite blockages, but the same lifestyle changes are probably beneficial for anyone at risk of having a heart attack in the future. Of course, some people are at such high risk that lifestyle changes are not enough; high blood pressure, diabetes and high cholesterol should always be addressed, even if they require medication. In addition, aspirin is an easy and safe way to further decrease risk.



What is heart failure?


The earliest descriptions of heart failure date back to ancient Egyptian, Greek, and Roman medical literature. In the last two centuries, as our knowledge of the structure and function of the heart has advanced, so has our understanding of the abnormal or diseased function of the heart advanced. We currently define heart failure as the inability of the heart to pump out sufficient blood to meet the needs of the body. The mechanisms behind this are incredibly complex, and we continue to make significant strides in the unraveling of these processes. The pumping function of the heart is divided into two phases: firstly, the ability of the heart to relax properly so that blood can return into the relaxed heart, and secondly, the ability to be actively pumped out to the body. The first phase is called diastole; the second is called systole. When the heart begins to malfunction, both of these functions usually become abnormal. The issue in treatment is what are the relative percentages of diastolic or systolic dysfunction in each particular person with heart failure. We know the most about the systolic mechanisms of heart failure and less about diastolic mechanisms of heart failure. This is heavily reflected in our ability to treat heart failure, with the most known treatments directed to systolic dysfunction and the least known treatments for diastolic dysfunction. The most significant advances recently have been in our understanding of how the rest of the body adapts to the dysfunction of the heart in an attempt to correct and counteract these changes. These adaptations, which initially keep things functioning the same, eventually become maladaptations and actually worsen the situation. This new knowledge has translated into the most important improvements in therapy.



What is hypertension?


The control of blood pressure involves incredibly sophisticated and complex checks and balances. Blood pressure represents a measure of the amount of blood pumped out by the heart and then the vessels into which this blood is pumped. The amount of blood pumped out by the heart is controlled by two factors: firstly, the volume of blood returning to the heart from the rest of the body and, secondly, the actual muscular pumping of the heart itself. The vessels into which this blood in turn is pumped are also controlled by two major mechanisms: the sympathetic nervous system (central control by the brain) and, secondly, by the inner lining of the actual vessel (called endothelium), which produces an enormous quantity of chemical substances which in turn control the tone of the vessel (either dilating or constricting the vessel). It is obvious that anything going wrong with any of the above mechanisms can and, in fact, will result in abnormalities of blood pressure. Most people with elevated blood pressure (hypertension) have some abnormality with more than one of the above mechanisms and often have two, three or more reasons why pressure is up! This explains why many people with hypertension need two or more therapeutic agents to treat their hypertension. As we learn more about blood pressure and its mechanism of control, it becomes more compelling than ever to try to counteract the various abnormalities for maximal protection against the ravages of elevated pressure, such as stroke, heart attack, heart and kidney failure, and the development of vascular disease generically.


Stroke FAQs:

What is a Stroke?

A stroke or brain attack occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain. When a brain attack occurs, it kills brain cells in the immediate area. Doctors call this area of dead cells an infarct. These cells usually die within minutes to a few hours after the stroke starts.

When brain cells in the infarct die, they release chemicals that set off a chain reaction called the "ischemic cascade." This chain reaction endangers brain cells in a larger, surrounding area of brain tissue for which the blood supply is compromised but not completely cut off. Without prompt medical treatment this larger area of brain cells, called the penumbra, will also die. Given the rapid pace of the ischemic cascade, the "window of opportunity" for interventional treatment is about six hours. Beyond this window, reestablishment of blood flow and administration of neuroprotective agents may fail to help and can potentially cause further damage.

When brain cells die, control of abilities which that area of the brain once controlled are lost. This includes functions such as speech, movement, and memory. The specific abilities lost or affected depend on where in the brain the stroke occurs and on the size of the stroke (i.e., the extent of brain cell death). For example, someone who has a small stroke may experience only minor effects such as weakness of an arm or leg. On the other hand, someone who has a larger stroke may be left paralyzed on one side or lose his/her ability to express and process language. Some people recover completely from less serious strokes, while other individuals lose their lives to very severe strokes.


What are symptoms of a Stroke?


Call 911 if these symptoms occur:

Sudden numbness or weakness of face, arm or leg, especially on one side of the body.
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination Sudden severe headache with no known cause

Other less common symptoms are:

Sudden nausea, fever and vomiting - distinguished from viral illness by the speed of onset (minutes vs. several hours or days)
Brief loss of consciousness or a period of decreased consciousness (fainting, confusion, convulsions or coma)

Diabetes FAQs:

Do You Need to Lower Your Risk of Type 2 Diabetes?


There are several factors that increase the risk of type 2 diabetes -- some that you can control and some that you can't.

Age 45 years or older
Being overweight
Having a parent, brother, or sister with diabetes
Being of African-American, American Indian, Asian-American, Pacific Islander, or Hispanic-American/Latino descent
Having had diabetes that developed during pregnancy (called gestational diabetes) or giving birth to at least one baby weighing more than nine pounds
Having blood pressure of 140/90 or higher
Having abnormal cholesterol levels -- either HDL "good" cholesterol of 35 or lower or triglyceride levels of 250 or higher
Exercising fewer than three times a week
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Fitness FAQs:

Why is drinking water so important?

Water helps carry waste from your system and improves performance. Studies show that a 2% reduction in hydration, the amount of water in your body, can cut your performance by up to 25%. Also, in many people the thirst reflex is so weak, it is often mistaken for hunger! Drink a minimum of eight 8-ounce glasses of water daily, more when exercising.

Why is warming up and cooling down important?

Warming up, usually slow stretches to limber the body before exercise, help increase blood flow. This helps loosen tight muscles, joints and ligaments and can help prevent injury. Remember: Warm up to exercise!
A cool-down allows the heart rate to slowly and safely return to normal. Cooling-down also helps to ease muscle tension and feelings of soreness.


Do I REALLY need special shoes for each activity?

No. For most activities such as walking, yoga, tai chi, etc., comfortable shoes that provide adequate foot and ankle support are all that is needed. For vigorous sports such as tennis and running, a shoe made especially for that activity could help enhance performance because they are designed to withstand more stress.

What is the best diet to lose weight and keep it off?

The best diet to lose and maintain a healthy weight is no diet. The best diet is a healthy lifestyle. Only by adopting healthy, permanent diet and life changes will weight loss become permanent. That's why diets don't work! Make small healthy changes, and lose weight gradually and permanently.

Why does exercise have to be so boring?

It doesn't! Every extra movement you make counts as physical activity. Resolve to create fun or interesting things to do to stay active. Exercise can range from visiting a new park or museum to painting a few rooms in your home. Establish a goal for activity, and keep it interesting.