Tea = Healthy Heart

Get ready to change your Starbucks order. Despite all the Starbucks coffee stores, tea is the most widely consumed beverage in the world next to water, and can be found in almost 80% of all U.S. households. But the relationship between tea/coffee consumption and coronary heart disease death/stroke has been unclear.

A recent study published in the Arteriosclerosis, Thrombosis, and Vascular Biology Journal in June of 2010, looked at the connections of both coffee and tea consumption with coronary heart disease death and stroke as well as all cause mortality. Approximately 37,000 participants were followed for 13 years. The participants were assessed for stroke, heart disease death and all cause mortality. It was found that high tea consumption (6.0 cups) per day was associated with a reduced risk of coronary heart disease death. These findings were statistically significant. However, in moderate coffee drinkers the results only suggested a slight risk reduction for coronary heart disease death and were not a statistically significant reduction. Neither tea nor coffee were found to have an effect on stroke nor do they have an effect on all cause mortality.

The heart benefits of tea consumption may be explained by the antioxidants found in tea called flavonoids. Flavonoids are also found in dark chocolate, blueberries, red grapes and red wine. Next time you plan to stop for a morning drink on your way to work or have a friend over, serve up some heart healthy tea. Tea is enjoyed all year round as it cools you down in the summertime and warms you up in the winter months.

de Koning Gans, J. Arteriosclerosis, Thrombosis, and Vascular Biology: Journal of the American Heart Association, August, 2010

Omega 3 Fish Oils Help Slow the Aging Process

Why do some people die of “old age” in their 70s and others in their 90s? Do our cells reach a point where they no longer function? Researchers from the University of California @ San Francisco (UCSF) have discovered Omega 3 fish oils help slow our aging process by protecting our DNA. We typically have a double strand of 23 chromosomes—one-half from our mother and one-half from our father. The ends of our chromosomes are protected by telomeres, much like the caps at the end of our shoelaces; thus, preventing our chromosomes from “fraying”. Each month our cells divide so they can reproduce many times. During cell division our telomeres can become shortened or “snipped” (the shorter the telomere the older the cell). If the telomere becomes too short the cell either dies or enters an inactive state-making one more vulnerable to disease; thus, the longer the telomere the longer your life potential.

Researchers completed a prospective study on 608 California outpatients with stable coronary artery disease. Researchers measured both the length of the telomere in the white blood cells and the Omega 3 blood levels at the beginning of the study and five years later at the end of the study. The study demonstrated an inverse relationship between baseline blood levels of Omega 3 fatty acids and the shortening rate of the telomere over five years. Small increases in the Omega 3 blood levels were associated with 30-35% reduced risk of shortened telomeres.

The American Heart Association recommends for individuals without heart disease to take 500 mg of the DHA + EPA. For patients with heart disease it is recommended you take 1000 mg of the DHA + EPA.

Slow your aging process: reduce stress, eat healthy, exercise and take your Omega 3 fish oils.

Ramin Farzaneh-Far, MD; et.al. JAMA. 2010;303(3):250-257.

How Much Do You Know About Cholesterol?

Take the Cholesterol Quiz..... click here

Daily Health Planner

Click below for your Daily Health Planner. It contains five daily actions to take care of the homes we are given to live in...our bodies.

After all, if we don't take care of it, where will we live?
Your Daily Health Planner Here

Who's Driving Health Care?

Can you pick out a patient with VA insurance from their medication list? Who's delivering patient care and health care policies? Check this out:

http://tinyurl.com/27mad8u

10 Tips to Improve Your Health

1. Get some exercise every day.

• Buy a Pedometer and make sure you walk 10,000 steps daily
• Take daily walks
• Use the stairs
• Park further away

2. Eat Healthy

• Lean protein and 2 colors at each meal (fruits/vegetables)
• Make sure you eat breakfast (prevents mindless nibbling throughout day and prevents overeating at lunch)

3. Stop Smoking – or don’t start

• We now have several options to help you quit smoking
• Set Quit date

4. Drink Plenty of Water daily (unless you have a fluid restriction)

5. Get 7-8 hours of Sleep Nightly

6. Floss daily

• Lots of data suggesting unhealthy gums increases inflammation markers and can lead to poor health.

7. Keep your Brain Active

• Complete crossword puzzles
• Participate in discussions and forums
• Stay aware of what is going on in the world

8. Get a Hobby

• Arts/crafts
• Blogging
• Gardening
• Restoring Cars
• Decorating
• Healthy cooking
• Record collections/Music

9. Reduce Stress

• Think Positive
• Spend 30 minutes a day doing something YOU like (visit a friend, read a book, play with your dog, listen to soothing music, get a facial, massage, meditate)
• Exercise
• Laugh more

10. Make small goals and reward yourself when meeting them

• Example: make a goal to complete at least 7 of the 10 tips daily for one month. When you meet this goal reward yourself with a new workout outfit, CD, new tennis shoes, massage, personal trainer session, etc
• Example: For every 20 sessions of exercise you complete reward yourself

Too Sweet For Your Own Good

Have you been told you are “pre-diabetic” or “borderline for diabetes”? Or perhaps you have been told you have diabetes and are beginning to make the necessary lifestyle changes to manage it with diet, lifestyle…and maybe an oral medication or two. Most of Type II Diabetes (which used to be called adult onset diabetes…only now it is affecting our kids) can be prevented through healthy eating and exercise. We used to see Type II Diabetes in people ages 50s-60s…the years people began to let themselves go-not eat as healthy, less exercise, etc. Now, our teenagers and young kids are eating bad and letting their health slide at much earlier ages. Many patients I see are surprised to learn that a fasting blood sugar of 100-125 places them in the pre-diabetic category or that 2 fasting sugars of 126 or greater diagnosis one with diabetes. Well, those are the reference points. Do you know what your fasting blood sugar is? Yes, get out your lab results from your last annual physical and check out your fasting blood sugar (glucose) number. It is important for all of us to know our fasting blood sugar levels in order to optimize our health and prevent diabetes in our life.

Fortunately Pre-Diabetes and Type II Diabetes for the most part can be prevented through diet and lifestyle. This would involve decreasing simple carbohydrates and sugars in your diet (see Curbing Your Sweet Tooth) and adding aerobic exercise to your daily regimen. As a Nurse Practitioner I often depend on supplements to assist patients in optimizing their health along with optimal diet and exercise. For patients that have sugar levels greater than 100, I often recommend CardioGT (glucose tolerance) which when used along with the proper diet and exercise regimen, can help maintain a healthy blood sugar level. CardioGT is formulated using natural ingredients which have been identified to have a positive impact on glucose metabolism. These ingredients are chromium, alpha-lipoic acid, magnesium, vanadium and cinnamon. (Click on link for more information regarding these natural ingredients.)

Diabetes, or pre-diabetes, significantly increases your risk for heart disease. If you are one of these individuals with elevated blood sugar levels, CardioGT, when combined with a healthy diet and exercise, may help assist you in improving your long-term health outlook . Click here for further information on CardioGT.

How Many Calories Do You Drink?

Beverage Serving Size Teaspoons Sugar Calories

Chocolate Milk 8 oz 6 190

Gatorade 8 oz 3 ¼ 63

Gatorade 21 oz 8 150

Sweet Tea 8 oz 5 ½ 91

Coke 12 oz 9 ¾ 155

Orange Juice 8 oz 5 ¾ 130

How Many Calories Make Up 1 Pound?

It takes 3500 extra calories to gain a pound.

Therefore…

500 extra calories a day for one week will cause you to gain one pound.

Or…

500 calories less per day for one week will cause you to lose one pound.

If you drink 2 cans of soda daily for one month, you will have consumed 12.2 cups of sugar & 9300 extra calories.

If you drink 2 cans soda daily for a year, you will have consumed 146 cups of sugar & 111,600 extra calories.

Enough extra calories to gain 31.9 pounds in 1 year!

(If you change to water or unsweetened tea you could lose 31.9 pounds in 1 year!)

Artificial Sweeteners: Blue, Pink, and Yellow Packets

When I was little, treats or “sugars” in the house were sparse. When they were available all the siblings kept an eye on them to make sure whatever it was-it was evenly distributed. Over time, these sugar products became inexpensive and have infiltrated our homes. We have traded healthy snacks for desserts three plus times per day. And we got bigger and now obese. As smart Americans, we found a way to have this same sweet taste without the calories or sugar spikes that real sugar has. Yep, out of the production lines came diet drinks and those colorful packets-the artificial sweeteners.

We really have enjoyed them. But, as a society, did we get smaller and lose weight with these products? No. In fact, we have gotten bigger and many Americans are not only obese; but more and more Americans are now morbidly obese. Why is that? It’s because we crave the taste of it, not the calories. We crave tasting the sweet stuff. Thus, the more of the sweet taste, the more we crave.

No matter what it is, a diet drink or a coffee with artificial sweetener in it, once we have it – it turns on our craving for more…and the mental agony for the day starts. About every 2 hours or so you are not hungry; but, you physically feel you need something to feel better – or stop your craving. So you feed your withdrawal symptoms so you can go back to work and concentrate on what you were doing. You might get a pretzel, grab a small handful of M&Ms off someone’s desk, pop a peppermint in your mouth, snack on some popcorn, or consume anything that is a simple carbohydrate or sugar to get the craving gone….only to have it again 2 hours later. And each time you complete the mindless nibbling or increased consumption of simple carbs and sugars you are disappointed in yourself and don’t understand why you did it….because after you have fed the craving the urge or craving is resolved and you can once again think rationally. How could you have let yourself do that?

It’s simple. We do not recommend diet drinks, artificial sweeteners or simple sugars. Once you begin consuming these substances the battle begins. You have turned on the craving for the day and for the most part…you will fight it all day long. So avoid the battle, avoid the addiction…concentrate on lean protein and fruits and vegetables at each of your meals and for your snacks. Stay Healthy from the beginning of your day to the end.

Chocolate Bunnies for Easter?

Happy Easter! For many of you this means going to church to celebrate the meaning of Easter as well as carrying on some of the Easter traditions. Which include eating candy and chocolate bunnies. There is so much information about dark chocolate and it’s benefits that many of the patients we see tell us ….“I have been eating my dark chocolate. You know, it is healthy for you.”

Well, it is true, dark chocolate is a rich source of antioxidants (containing more than milk or white chocolate), and the fat present in dark chocolate is metabolically neutral. Studies have demonstrated a small amount of dark chocolate everyday can reduce blood pressure in individuals with high blood pressure and can reduce LDL cholesterol (bad cholesterol) by up to 10 percent.

Other benefits of dark chocolate aside from protecting your heart include:

• It stimulates endorphin (happy hormone) production.


• It contains serotonin, which acts as an anti-depressant.


• It tastes good.

BUT, this isn’t a free pass to eat all the dark chocolate you can get your hands on. Chocolate is a high calorie, high fat food. Most of the studies done use 3.5 ounces of dark chocolate or less per day to get these benefits. If you are eating dark chocolate and telling yourself it is healthy; while at the same time, gaining 10 pounds, become pre-diabetic, and gaining abdominal fat (bigger waistline)-you aren’t being honest with yourself and you are hurting your own health. Also, if you are addicted to sugar; this keeps you craving for more sugar (see Curbing Your Sweet Tooth).

One bar of dark chocolate can contain up to 400 calories. If you eat half the bar of dark chocolate for the day you still have to balance out those extra 200 calories by eating less of something else.

It’s like life-everything in moderation. Enjoy the present pleasures in such a way that you do not injure future opportunities.

Happy Easter everyone! Hope you spend the day filling up your souls and keeping your body on the healthy track.

Stress and/or Binge Eating

Perhaps you don’t even know you are stress/binge eating until you have finished or are well into the moment. Here are some tips to assist you in stopping Stress/Binge eating.

• Have fewer “treats” around the house/kitchen
• Bake less
• Wait 15-20 min to eat – drink a cup of water-the urge may pass
• If something’s bothering you exercise first
• Keep a journal of what you eat and drink everyday
• Don’t bring any junk food into the home
• Sit down to eat

When you do Over Eat…

• Find healthy choices to have available in the future
• Do not buy more of the culprit binge item so it is not available to you during the next weak moment.
• Please take me for a walk. Don't binge eat again.
• Ask yourself why did this happen? What can I change?
• Don’t dwell on it. Move on. It’s done. It’s not about where you have been; but, about where you are going.
• Exercise more and eat a little less the next day.
• Change your routine to avoid this in the future.
• Engage in a new activity or hobby. You will eat less when your mind is on a new hobby.

Each day set a nutrtional goal and a physical activity goal. We all must have a goal before we can accomplish it. Stay Healthy.

Curbing Your Sweet Tooth

Are you beginning to have a hard time with the weight loss? It’s hard to help anyone lose weight if they start their day off with sugar of any kind. And so many people start their day off with sugars. Once one begins the day with sugar…the addiction begins. Every 2-3 hours they will find themselves having to feed the withdrawal symptoms of coming down from their sugar high. One might pick up a pretzel here, sip a soda or a coffee with sugar added to it, eat a peppermint, nibble on chocolate, eat popcorn, etc….until another 2-3 hours occurs again and they’ll either have a meal with more simple carbohydrates (breads, pastas, white rice, soups, crackers, etc) or simple sugars in it to calm down the withdrawal symptoms. And then the cycle repeats. Sound familiar?

I have randomly picked 4 patient charts and I thought I would share with you what their reported breakfasts are:

Chart #1 Frosted mini wheats and orange juice

Chart #2 Instant Oatmeal with raisins, cranberry juice

Chart #3 Starbucks Latte and cookie

Chart #4 Orange Juice, 2 pieces of toast, dried apricots

Do you see a trend here? There is no protein and each breakfast is loaded with sugars. If kids eat this…come 0930 or 10am they aren’t concentrating on a math problem…they are looking to where they can get 10 pieces of gum, a candy bar, soda, or a friend to give them a treat…as they are having withdrawal symptoms which are so strong they can’t concentrate…until the withdrawal symptom is resolved. Same with adults. In our office building, if you go to the vending machines from 3pm-5pm…people do not need dinner. They need to feed their withdrawal from sugar symptoms so they can get back to work and concentrate. The key is do NOT start your day off with sugar. Sugar of any kind. That includes artificial sweetners too! Yes, the blue, pink and yellow packets do not help.

Ask yourself this: Did the people in the world lose weight or gain weight after diet drinks and artificial sweeteners came about? We definitely haven’t gotten any smaller. The reason is, it is not the calories we crave-it’s the taste we crave. If we start our day off with coffee and a colored packet…the sweet taste is turned on and the addiction cycle begins.

So what is a good breakfast? I’ll keep it simple. Each meal should have lean protein and 2 colors (fruits and/or vegetables). Some examples of heart healthy breakfast would consist of apple and celery slices with all natural peanut butter, handful of healthy nuts (walnuts, almonds and pecans) with fruits and/or vegetables, egg whites with fruits and or vegetables, cooked oatmeal (instant is high in sugar-stay away from instant oatmeal) and then add handful of healthy nuts and 2 colors (blueberries, strawberries, apples, peaches, etc), left over meat from the night before with fruits and/or vegetables are all healthy breakfasts. If you need to sweetened a food item – use cinnamon- it helps to reduce your blood sugar levels by assisting your own cells in being more sensitive to your own insulin.

Remember, if you look down at your plate and you do not have lean protein and “2 colors” you are not eating to feed your organs; but, you are eating for pleasure. Feed your organs first and remember, do not begin your day and your most important meal with sugar….breakfast will set your pace for the day.

To those of you trying to lose weight: Keep at it and avoid the sugars. The first 10-14 days will be difficult as your body will be reseting to it’s new normal blood sugar levels. Once this occurs…the sugars will no longer dictate when you eat, nibble or snack…instead you will be back in charge of your body and your health.

Up Front and Personal...When the Rubber Meets the Road

The other day a patient came to the Cardio Wellness Clinic for an individualized health plan to optimize his health. When I asked how he had heard about the clinic he coldly responded, “I really don’t know why I am here. My physician insisted I come; but, my cholesterol isn’t high and I don’t believe I have any high risks for heart disease-besides I’ve heard all of this before.”

I immediately scanned his chart and looked at the many health risks this young man carried with him. I was quite alarmed that he seemed to have no knowledge of how serious his risks were. He was a male over the age of forty-five, had a sedentary lifestyle, high blood pressure, his bad(LDL) cholesterol was over 150 mg/dL (his goal is less than 100 mg/dL), his good(HDL) cholesterol was too low and his triglycerides (another form of bad cholesterol) were nearly double his targeted goal. His sugar level placed him in the pre-diabetic state and his weight in relation to his height placed him in the obese category with a high and unhealthy waist circumference. As science has proven, one risk factor plus another doesn’t equal a 2 fold increase risk for heart disease; but, can be over a 4 fold increase risk. You see risk factors for heart disease have a multiplicative effect and multiple risks can lead to significant health risks. This patient, whenever I began to speak would immediately stop me to let me know I need not waste my breath as “I’ve heard this all before.”

Each patient is unique with unique risks and unique health plans; but, among them all lies a common thread that in many ways connects them. In this particular case, it wasn’t that he didn’t believe he had risks for heart disease. After all, he drove himself over a hour to come to the appointment. He was fearful of having to change his life and facing the inevitable fact that his current lifestyle was slowly ruining his health. You see as long as no one says it-he doesn’t have to face it. That’s why he was stopping me every time I spoke, yet he drove over 60 miles for the appointment-he knew he needed to hear it-he wanted someone to hold him accountable.

For all of you who have untreated risks or who have let yourself go over the years-don’t be fearful and don’t be hard on yourself. It’s not about where you have been-it’s about where you are going. Most of heart disease can be prevented. For this young man, I informed him of all his risks (quite the list) and told him he was quite fortunate. He hadn’t had any damage to his heart and all the risks I acknowledged with the exception of his age were all modifiable-something he could change. I told him he still had control of his health he just needed to start making changes. He didn’t speak- tears rolled down his face, he understood. The rubber met the road.

What is Heart Disease?

Heart disease includes a number of problems affecting the heart and blood vessels in the heart. Types of heart disease include coronary artery disease (blockages in the heart arteries), heart failure (problems with the heart not pumping efficiently), or a heart arrhythmia

(changes in the beat of your heart). Coronary artery disease is the most common cause of heart disease. It is a narrowing or blockage of the coronary (heart) arteries. It is the major reason why people have heart attacks.

Check out the video to see how plaque in your heart arteries can lead to a heart attack or sudden death. Many people think it is because it grows slowly over time and eventually it becomes big enough to block enough blood flow to the heart to cause a heart attack or sudden death. We know today plaque will burst to cause that heart attack or sudden death. (See Video)

Heart disease remains the number one killer in both men and women today. But, this doesn’t have to be your fate. Much of heart disease can be prevented or treated with healthy lifestyle choices. That is why it is so important to take action, become aware of risks, minimize them and continually manage them. If you have risks, or have heart disease we encourage you to follow up with your health care provider or through your Cardio Wellness clinic to make sure you have minimized all your risks, stablized your plaque and are on your way to optimal health.

Six Motivational Tips for Exercise

1) Don’t Count the Calories Burned

One of the ways to keep exercising is not counting the calories burned or weight lost. There are more important things transforming in your workout. Such as new found self esteem, stress reduction, increase endorphin levels (Happy Hormone), improving memory and cognition and adding longevity to your life to name a few.

2) Accountability

Hold yourself accountable. Mark an “X” on your calendar every time you exercise. Seeing your motivation (or lack thereof) in black and white helps to keep you focused on your goal.

3) Join a club, exercise class, or exercise with a buddy

Statistics inform us that we are more consistent with exercise when we do it with a buddy. Just knowing someone is waiting for you to exercise; helps you to show up and get it done.

4) Challenge Yourself

Sign up for a local 5K walk/run or bike trip. It will help you stay focused on your exercise goal while accomplishing a new activity. Not only will you benefit from the exercise; but, from your community involvement too.

5) Reward

Put a dollar or two in the jar every time you complete a workout. When you have enough money, treat yourself to a massage, new CD, workout outfit, session with a personal trainer, or new piece of sport/exercise equipment.

6) Mood Motivation

Often people will say it’s my mood that either motivates me to exercise or not. Regardless of your mood prior to exercise—exercise has been known to improve your mood. Work out your aggressions in the gym instead of at home or work.

Let’s ring in the New Year being active and moving our bodies. Cheers to our Health!

CardioTabs Omega 3 Fish Oils: Blue Ocean to the Green Economy

CardioTabs continues to update it’s products based upon the latest scientific evidence and what’s best for our environment. The use of marine-derived Omega 3 fatty acids as therapeutic agents have been well established for a wide-range of medical conditions. (Omega 3 fatty acids, are highly concentrated in the brain, eyes, nervous system and other vital organs.) Over the past several years there have been confusion as to which omega 3 fatty acid is most crucial for our health- Docosahexaenoic acid (DHA) or Eicosapentaenoic acid (EPA). Recent studies point to DHA as the number one Omega 3 fatty acid for cardiovascular health. In general, research has demonstrated EPA did not show significant effects on blood pressure reduction and heart rate. However, DHA demonstrated significant effects on enhancing dilation mechanisms through forearm circulation, lowering blood pressure, reduction of heart rate and further triglyceride (type of cholesterol) reduction. Not only is DHA showing superior benefits in the heart health arena but also for overall human health. Recent literature suggests DHA’s health benefits extends past our heart health to other areas such as growth and development, brain function and eye function-particularly in the elderly.

Typically fish oils and fish oil concentrates unfortunately contain much less DHA than EPA. CardioTabs has always offered a higher DHA to EPA ratio in their fish oils. In fact the CardioTabs standard Omega 3, burp free, fish oil has a 2.6 to 1 – DHA to EPA ratio. But, what’s more exciting is CardioTabs is now offering us a new product to choose from. It is an Ocean Safe Omega 3 fish oil that has a 10 to 1 – DHA to EPA ratio. This Ocean Safe fish oil not only offers more DHA but it contains 400 iu of Vitamin D3- the vitamin we all seem to be deficient in -and it comes in a citrus berry flavor. If you have heart disease I would recommend 2 of these capsules daily. If you do not have heart disease one capsule should suffice. (You may even chew these fish oils if you like- citrus berry taste.)

So what makes this new product a “green” product? This oil is obtained using safe and sustainable fishing techniques that do not destroy the ocean habitat or deplete the fish stocks. The marine oil is produced from food grade calamari. Calamari has a short life span so they are in plentiful supply and they are naturally high in DHA. CardioTabs fish oil from the Blue Ocean to the Green Economy-protecting our health and the natural habitats of the ocean.

ARBITER 6-HALTS (Big win for Niaspan + Statin Combination)

The American Heart Association’s 2009 Scientific Sessions released the results of the Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6: HDL and LDL Treatment Strategies in Atherosclerosis (ARBITER 6-HALTs) trial earlier this week. And now medical office phones are ringing. Patients are asking, should I stay on my current cholesterol lowering medication or should I go on Niaspan?

This study consisted of 363 participants who were on statin (90% were on Lipitor (Atorvastatin) and Zocor (Simvastatin))medications for at least 3 months prior to enrollment into the study. The mean statin dosage was 42 mg. These participants were then divided in half. One group received Ezetimibe (Zetia) 10 mg daily while the other half received Niaspan 2000 mg daily (titrated up over 2 months ).

All participants had the following:

-LDL (bad) Cholesterol less than 100 mg/dL

-HDL (good) Cholesterol less than 50 mg/dL

-Known vascular or coronary disease risk equivalents

Baseline Statistics of both groups:

Mean LDL 84mg/dL and Mean HDL 43mg/dL (Ezetimibe group)

Mean LDL 81mg/dL and Mean HDL 42mg/dL (Niacin group)

After 14 months of treatment – the results:

Mean LDL decreased from 84 mg/dL to 66 mg/dL ; HDL decreased from 43 mg/dL to 40 mg/dL; Triglycerides decreased by 7% in Ezetimibe (Zetia) group.

Mean LDL decreased from 81 mg/dL to 71 mg/dL; HDL increased from 42 mg/dL to 50 mg/dL; Triglycerides decreased by 21%: in the Niacin arm.

Primary Endpoint:

Carotid Intima Media Thickness :

-Niaspan (Niacin) arm Statistically significant regression

-Ezetimibe (Zetia) arm Did not have significant regression but did stop progression

Secondary Endpoints Include:

Coronary Heart Disease (CHD) Death, MI(Heart Attack), Coronary Revascularization (heart stent or balloon to open artery or open heart surgery), Unstable Angina (unstable chest pain)

Ezetimibe (Zetia) group had 9 of the secondary endpoint events out of 165 participants. This is 5.5% in the 14 months of the trial.

Niacin group had 2 of the primary endpoint events out of 169 participants. This is 1.2% in the 14 months of the trial.

Dr. James O’Keefe, Cardiologist at the Mid-America Heart Institute in Kansas City, reports “This is a big win for the Niacin + Statin combination treatment. We have had other randomized studies such as HATS and FATS, both of which are smaller studies like ARBITER 6, which although not powered to show event reduction, did find significantly better cardiovascular outcomes with niacin”.

I was able to attend the meeting at the AHA Session earlier this week. The presenter and lead investigator, Dr. Allen Taylor, from Medstar Research Institute, Washington, DC, reported that in 2008 there were 9 million U.S. patients receiving treatment with Zetia and 2.5 million U.S. patients receiving treatment with Niacin. Although niacin isn’t an easy drug to use, due to its’ flushing side effect we should make strong efforts to help our patients tolerate this medication. Over time the flushing becomes less often, less intense and less in duration. In one Niaspan study, participants who took the medication for 6 months had approximately 2 flushes per month. Dr. James O’Keefe reports, “patients should avoid sustained release over the counter (OTC) niacin products, as they are more hepatotoxic (toxic to liver) than the immediate release (IR) OTC niacin or prescription, Niaspan. “

In summary, if you are taking cholesterol medications we recommend you do not stop your medications without speaking with your health care provider. If you are taking an over the counter niacin product make sure it is an immediate release niacin or we recommend taking prescription form Niaspan-which is often more tolerable. “In our experience, which is supported by this recent study, the combination of niacin with a statin such as Simvastatin (Zocor), Rosuvastatin (Crestor), Atorvastatin (Lipitor) is a great way to go both for buffing the cholesterol numbers and improving cardiovascular prognosis,” Dr. James O’Keefe.

Coronary Artery Calcium Scan

Coronary artery calcium scan is a simple 15 minute, non-invasive heart test that will assist in determining if one has coronary heart disease (plaque in coronary arteries). Coronary artery calcium (CAC) measures “hard” calcified plaque in heart arteries. This scan does not pick up soft plaque that may have formed in coronary arteries. As coronary plaque builds up, so does the threat of heart events. Arteries become more narrowed and blood has a hard time squeezing through; thus, increasing your risk for severe cardiac events (heart attack).

The Multi-Ethnic of Atherosclerosis (MESA) enrolled 6814 asymptomatic patients, of whom over half, 3563, had zero CAC score at baseline (no hard plaque found in coronary arteries). Study participants who went on to have heart catheterization (invasive procedure that visualizes inside heart arteries) due to symptoms, clinical indications, result of the coronary calcium score, abnormal stress test or preoperative risk stratification included 175 of them. In 96% of these cases, the documented baseline calcium score predicted the actual severity or extent of the obstructed coronary artery disease as found per heart catheterization. But, in the remaining 4% there was significant narrowing of heart arteries from soft plaques found via heart catheterization-despite a zero CAC score.

In symptomatic (chest pain or equivalent) or in suspected coronary artery disease (CAD) patients in the Emergency Room-a zero CAC score has a 96% negative predictive value, meaning that 4% of patients with a zero calcium score will have significant CAD, due to soft plaque. People who present with chest pain or equivalent or who are suspected of having CAD, generally need to have functional imaging (stress MPI, stress ECHO, etc.) rather than a screening calcium score.

In asymptomatic (having no symptoms) patients; but, at risk for heart disease, the CAC scan is an excellent choice. As, the main purpose for CAC scoring should be to detect early subclinical stages (before symptoms) of CAD for which specificity is virtually 100% (people w/o significant CAD will not have calcium in their vessels.)

Dr. Harvey Hecht from Lenox Hill Heart and Vascular Institute in New York, New York was quoted: “A strong argument can now be made for requiring coronary calcium screening before stress testing in asymptomatic patients. Also, less aggressive drug therapy is appropriate for zero-score patients, and at the other end of the spectrum, the presence of coronary calcium identifies the higher risk pool of patients in whom 95% to 96% of the events will emerge; it is this group that will benefit from highly targeted aggressive treatment.”

To wrap this up, if patients present to the emergency room with chest pain symptoms a functional imaging study should be recommended versus a coronary artery calcium scan. In asymptomatic patients screening for early signs of heart disease a coronary artery calcium scan would be an excellent choice. Remember, early detection is the key to preventing heart events.

Hospitalization for Heart Disease on the Decline!

The U.S. Agency for Health Care Research and Quality reported hospitalizations for coronary heart disease (blocked heart arteries) has decreased by 31% from 1997-2007. Additionally, hospitalizations for a heart attack decreased by 15%. No longer is hospital stay for coronary heart disease (blocked heart arteries) the No 1 disease treated in hospitals. It now trails behind pneumonia and heart failure (when your heart isn’t pumping efficiently).

The report included other noteworthy facts.

• Congestive heart failure rates were unchanged between 1997-2007.
• Admissions for irregular heartbeat were up 28% between 1997-2007.
• Heart catheterization (invasive procedure to assess heart arteries) is the second most common procedure among hospitalized men, and the fourth most common in women.
• Although hospital stays for blocked arteries have significantly decreased circulatory conditions (combining: congestive heart failure, heart attack, blocked arteries, and irregular heartbeat) were the most frequent major cause of hospital stays in 2007.
• High Blood Pressure was a co morbid condition (existing simultaneously with and usually independently of another medical condition) in 35% of all hospital stays in 2007.
• When pregnancy and child birth stays were excluded, women still accounted for more hospital stays (59%) than males (41%) in 2007.

We should applaud ourselves for taking better care of our hearts. However, we still have a lot of work to do. Heart disease is still the leading cause of death for both men and women in the United States. Stroke remains the third leading cause of death in the United States. If you haven’t had your heart risk assessment call your local Health Care Provider or visit your local Cardio Wellness Center to do so. Many with heart disease-their first symptom is their last. Don’t let this be you. Most of heart disease can be prevented.

One last note- heart failure hospital stays have not declined since 1997 and stroke remains our 3^rd leading cause death in the United States. High Blood Pressure is often present before heart failure and/or strokes occur. Know your blood pressure number and manage it. One in three of us have high blood pressure….do you know your pressure?

Levit, K., et al. HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2007. Agency for Healthcare Research and quality 2009.

Feel Better Now

-Sometimes we all get stuck in a rut. With the changing of the seasons now is a good time to change ourselves for the better. Check out these four key topics to better yourself.

Nutrition

Have lean protein & two colors at each of your meals.

Lean protein – healthy nuts, fish, chicken, turkey, edamame, all natural peanut butter

Two colors- fruits and vegetables

Bread- if you must have it, look for fiber content of 5 grams per slice. Remember each slice is 80-100 calories, bread raises blood sugar and contributes to weight gain.

Artificial Sweeteners- Avoid. They make you crave carbs and sugars. Since they have been developed the world has not gotten smaller.

Omega 3 Fish Oils- Helps to promote healthy cells in your body.

Improve Work/Life Balance

Rest/Reflection- schedule in rest and thinking time for yourself. Write it on the calendar.

Keep Connected- initiate daily communication with a relative or friend. Keeps you interested and aware of others.

Compliment- Compliment others on their good deeds, accomplishments, and/or good qualities every day.

Listen To Your Heart- if you want something, pursue it.

Exercise

Get Moving- be active throughout your day. Park farther away, take the stairs, walk the long way around….just because you can.

Half-hour power- walk, cycle, swim, hike 30 minutes everyday

Weights- in addition to aerobic activities, weight train to maintain bone density and add muscle strength.

Sleep Better

Caffeine – avoid caffeine and sugary snacks 12 hours before going to bed. They can cause lots of dreams and restless sleep.

Relax- take a 10-15 minute stroll prior to hitting the sack or take a hot bath

Adequate amount- try to get 7-9 hours of sleep each night.

FDA Approves New Medication to Reduce the Risk of Heart Attack in Angioplasty Patients

The U.S. Food and Drug Administration approved Effient (Prasugrel) in July 2009. Effient is approved to reduce the risk of blood clots from forming in patients who undergo angioplasty. It is a blood thinning drug that prevents platelets from clumping or sticking together, which can result in clogged arteries and may lead to heart attack or stroke.

A study enrolling 13,608 patients which compared Effient to another blood thinning medication, Plavix (Clopidogrel) was completed. These patients presented with a heart attack or threatened heart attack and were about to undergo angioplasty, a procedure where a balloon is used to open the artery that has been narrowed.

Effient is more efficacious than Clopidogrel in preventing deaths from blood clots, non-fatal heart attacks and nonfatal strokes in patients receiving stents. However, those receiving Effient had a greater risk of bleeding than those taking Clopidogrel. Patients who have a history of stroke were more likely to have another stroke while taking Effient.

Effient appears to be an excellent alternative treatment for preventing dangerous blood clots from forming and causing a heart attack in those patients who present with a heart attack and are in need of stenting.

However, it is recommended to not use Effient in those patients who have active pathological bleeding, history of transient ischemic attacks (TIAs) or strokes. Effient should not be used in patients who are in urgent need for surgery-including open heart surgery. Due to the fact, that when possible, patients should discontinue Effient at least 7 days prior to any surgery (as directed by a physician). In general, patients who are 75 years of age or older it is not recommended to use Effient because of increased risk of fatal and intracranial bleeding and uncertain benefit.

As with any treatment, physicians and patients must carefully analyze the potential benefits and risks associated with the use of Effient – as each individualized case is unique.

How Simple Modifications Can Add Longevity to Your Life

This was done a couple of years ago. I’m not very good at the interview/video thing…but the story told here is wonderful. I do not believe I have seen higher Triglycerides than this.

UltraViolet Rays and Sunscreens

Did you know the sun produces 3 types of ultraviolet (UV) Rays? There are UVA, UVB, and UVC rays. The atmosphere completely absorbs the UVC rays. However, both the UVA and UVB rays reach our bodies…but they have a different effect on us.

UVA rays are known to cause wrinkles and at high doses may be the cause of skin cancer-melanoma. UVA radiation does not have the ability to enable us to produce vitamin D. UVB radiation, however, is responsible for sunburns and vitamin D production. Since, UVB radiation can cause sunburns if in the sun too long-UVB radiation may also be part of the cause of skin cancer-melanoma. This is due to the fact that when we develop a sunburn we cause mutation to the skin cells. These skin cells replicate in a mutated state until later they appear in the form of skin cancer. Thus, the key is not to burn.

Sunscreens were first used in the 1940s. What I have found most interesting is up until the late 1990s these sunscreens only blocked UVB radiation (the UV rays that cause sunburns). These sunscreens did not protect against UVA radiation; as they were not thought to be harmful rays, since they did not cause sunburns. Thus, allowing us to absorb mega doses of UVA radiation that we would not normally be able to stay out in the sun and absorb.

Perhaps, this gives us some insight as to why melanoma rates have been increasing by 2% every year over the past thirty years. We now know, UVA radiation at high doses is thought to be one of the causes of skin cancer- melanoma. Therefore, UVB protection only sunscreens have been phased out and broad spectrum sunscreens were developed. This occurred in the late 1990s. These broad-spectrum sunscreens protect us against both UVB and UVA radiation.

Dr. Holick, our nation’s leading expert on vitamin D, completed studies involving sunscreens. His data demonstrates: sunscreens with a SPF 8, reduces vitamin D production by 97.5% and SPF 15, reduces it by 99.9%. Therefore, sunscreens almost completely prevent the body from making any vitamin D from the sun. The point to remember is that it is okay to get “raw” exposure to the sun- 10-15 minutes 2-3 times per week. The key is not to burn. After about 10-15 minutes of “raw” exposure to the sun you should utilize a broad-spectrum sunscreen to protect against having a sunburn.

Lastly, I often get asked, “Can I get a sunburn or UVB radiation from sunshine that warms the skin through a window?” No. UVB radiation from sunlight does not penetrate through glass. Thus, you will not burn and your body will not make vitamin D from sunshine through a window.

So go out in the sun responsibly. Do not burn. Use broad-spectrum sunscreens if you plan to be out in the sun longer than 10-15 minutes to prevent sunburn. Use common sense. Sunshine is not to be feared. Sunlight is the fuel that enables us to manufacture vitamin D. The benefits of vitamin D on human health are many, varied and profound. Just as with oxygen, air, water, our bodies need sunshine. Use it responsibly.

FDA Approves Triple-Drug Polypill for the Treatment of Hypertension

Do you have high blood pressure? Tired of taking multiple pills to lower your blood pressure? This just might be your solution. The FDA has approved a triple-drug polypill for the treatment of hypertension (high blood pressure). The polypill, called Exforge HCT contains the calcium channel blocker amlodipine (Norvasc), the diuretic hydrocholorothiazide (HCTZ) and the angiotensin receptor blocker valsartan (Diovan). This is the only single tablet that combines three drugs for treatment of high blood pressure in the United States. This drug may be used as add-on/switch therapy for individuals not adequately controlled on any two components of the triple combination.

There have been several studies demonstrating, the less pills one takes the more compliant they are. Three drugs that treat hypertension being contained in one pill should assist us in becoming more compliant in taking our blood pressure lowering medications. The tablet comes in the following dosages:

Tablets: (amlodipine/valsartan/hydrochlorothiazide mg)

5/160/12.5

10/160/12.5

5/160/25

10/160/25

10/320/25

If you are taking these three pills separately; you should consult with your health care provider to see about the possibility of changing over to the polypill. You may find that you miss fewer dosages, becoming more compliant with taking your medications. By doing so will allow for better management of your blood pressure and your health.

High Blood Pressure: Do You Know Your Pressure?

Many patients who come to the office have high blood pressure. What is alarming is they find excuses for the cause of their high blood pressure. Examples include:

• I was running late
• I walked in from the parking garage
• I didn’t sit long before my blood pressure was taken
• I had a disturbing phone call
• I ate at a restaurant last evening
• I had a busy day at work
• I had a hectic schedule
• I am under more stress than usual today

Sound familiar?

So many people do not believe they have high blood pressure, even when they come to the office and see their blood pressure is elevated. The other side of the coin is when we treat patients with high blood pressure; patient’s often think it is a disease that can be cured and once their blood pressure is controlled they stop their medications or reduce their current dosage of the medication. Yes, if one is overweight and sedentary they can lower blood pressure by weight loss, decreasing sodium in their diet and exercise—but it is a condition to be managed. For the most part however, once one is on a blood pressure lowering medication you are most likely going to need to stay on the medication.

The facts regarding high blood pressure are: 1 in 3 adult Americans has high blood pressure. Data from the Framingham Heart Study suggest persons 55 y.o. and older have a 90% risk of developing high blood pressure during their lifetime. High blood pressure is associated with:

• 69% of first heart attacks
• 74% of heart failure cases
• 77% of first strokes

In order to prevent these events we must monitor our blood pressures at home and discuss options with our health care provider if our blood pressure is consistently greater than 130/80. As health care consumers, we must know our own blood pressure numbers and seek help if our blood pressure is elevated in order to optimize our health.

So…do you know your numbers?

Top 3 Questions providers ask me about Vitamin D

What lab test do you order to assess Vitamin D levels?

The best lab test to assess Vitamin D levels is the “25 OH Vitamin D Level” test.

What Vitamin D level is considered deficient?

Ideal blood level: 40-70 ng/mL

Sufficient blood level: 30 ng/mL

Insufficient blood level: 21-29 ng/mL

Deficient blood level: 10-20 ng/mL

Severly deficient blood level: 0-10 ng/mL

How do you treat patients with Vitamin D levels considered less than optimal?

21-29 ng/mL: Recommend 50,000 IU of Vitamin D2 (Once per week for four months)

Less than 20 ng/mL: Recomment 50,000 IU of Vitamin D2 (Twice per week for four months)

I would also advise patients to maintain a daily dosage (over the counter) of 2,000 IU to 5,000 IU of Vitmain D3. Three months after beginning treatment, I would check up on my patient’s 25 OH Vitamin D level.