Heart Health Q&A Archive

Heart Health Q & A answers your questions on timely topics in cardiac care, including questions on your heart and medications, exercise, diet and hormones. Browse through our previous topics!


Topic: Early menopause and risk of heart failure

There is growing evidence that age at menopause influences risk of cardiovascular disease, including recent studies on stroke and coronary heart disease that found younger age at menopause to be a significant risk factor. However, many of these studies were based on small populations and did not follow a group of women over a long period. Now, in the first large-scale (including more than 22,000 postmenopausal women) and long-term study, researchers from the Karolinska Institute in Sweden determined that women who experience early menopause are at higher risk of developing heart failure compared to women who experience menopause at the usual age. Smoking, current or past, raises the risk even more, according to the study published in the journal Menopause, and publicized in Science Daily on May 14, 2014.

Q&A

A: The researchers defined early menopause as occurring between 40 and 45 years of age. This was defined as age at last menstrual period and was self-reported by the women in this study. Menopausal onsets and rates are influenced by a combination of factors including heredity, smoking, diet and exercise.

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A: Heart failure is a condition in which the heart muscle is unable to pump enough blood to meet the body's needs. The investigators reported 2,532 first-time hospitalizations for heart failure among the early menopause population. This population of women who entered menopause between 40 and 45 years of age had a 40 percent increased risk for heart failure compared with women who entered menopause between age 50 and 54 years. For every one-year increase in the age when a woman began menopause, there was a 2 percent lower risk of heart failure.

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A: The researchers speculate that early menopause may predispose women to early coronary artery disease and eventual heart failure by adversely altering their cholesterol levels. Menopause is a process during which a woman's reproductive and hormonal cycles slow and eventually stop, as the ovaries produce less estrogen and progesterone.

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A: This study was possible using the Swedish National Patient Register, which captures Sweden's hospitalization and outpatient diagnoses; Sweden's Cause of Death Register; and voluntary health surveys of some 90,000 women in the Swedish Mammography Cohort. This is an example of a “population study,” which is an examination of a group of individuals taken from the general population who share a common characteristic, such as age, sex, or health condition.

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A: Research has shown that smokers reach menopause, on average, two years earlier than non-smokers do, so quitting smoking may delay the onset of menopause. Risk factors for heart and vascular disease start very early in life, even though heart attacks, heart failure, and strokes occur later in life. Unfortunately, young women often receive very little education and instruction on the prevention of heart and vascular disease, most likely because heart and vascular disease are believed to occur only in men and older women. Managing risk factors when women are young will likely prevent or postpone heart attacks, heart failure, and strokes when they age. Strategies to reduce the risk of developing heart disease include special attention to blood pressure control as well as lifestyle modifications, such as eating a healthy diet, weight loss, stress management, and regular exercise.

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Team Specialist: Lee Jordan, MD, FACC Medical Director, Heart Failure OhioHealth Healthcare System, Columbus, Ohio

Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Topic: Gender-specific research improving coronary heart disease diagnoses in women

For many years, health care providers used a male model of coronary heart disease testing to identify the disease in women, focusing on the detection of obstructive artery disease. However, women with heart disease are more likely than men to develop dysfunctions of the smaller coronary arteries and the lining of the coronary arteries, often not detected through the male-model testing. As a result, symptomatic women were not diagnosed with coronary heart disease and did not receive appropriate treatment, increasing their risk of heart attack. Recently, however, gender-specific research that clarifies these differences has made diagnosing coronary heart disease in women more accurate, according to a new scientific statement published in the American Heart Association journal Circulation and publicized in a June 16, 2014 press release.

Q&A

A: Ischemic Heart Disease occurs when there is a lack of blood supply to the heart which is either temporary (angina), occurring only with stress, or permanent, resulting in a heart attack. When one or more of the coronary arteries of the heart are blocked, the blood supply becomes endangered and ischemia (deficient supply of blood to the heart) occurs. This blockage occurs over many years. The precursors of blockage, called fatty streaks, are present in the coronary arteries of many individuals under the age of 20.collapse
A: Over time, fat (lipid) and smooth muscle cells proliferate, building a lump called an atheroma. This lump eventually encroaches into the middle (lumen) of the artery through which blood flows. Some of these lumps develop a firm cap and are stable; if these atheroma are big enough, ischemia may develop when there is increased blood flow such as during exercise. Other, very dangerous atheroma have a very thin cap that can tear and attract a clot to that segment of the artery. The clot or thrombus completely occludes the artery, causing an acute loss of blood flow to that area of the heart resulting in a heart attack. An important difference between men and women is that women may have disease of the microvasculature, or very small branch vessels. This type of disease does not show up on common cardiac tests such as heart catheterization, and may be extremely difficult to diagnose and frequently overlooked.collapse
A: It is imperative to realize that heart disease remains the number one killer of both women and men so one must have a high level of concern when unusual symptoms occur, keeping in mind that prompt medical attention can save lives. The most common symptom for both sexes is chest discomfort, occurring in 80 to 90 percent of patients. However, women are more likely to have fatigue, shortness of breath, back pain, indigestion and weakness when compared to men. Women also are more likely than men to have discomfort in the upper abdomen, throat, neck and jaw. For both men and women the pain is usually not sharp, but more frequently a feeling of pressure or tightness. Whereas men usually will have cardiac symptoms when exerting themselves, women may more typically suffer them during emotional stress or at rest.collapse
A: If there are sudden symptoms of chest, arm, jaw, neck or back pain, or weakness, indigestion, shortness of breath, lightheadedness/passing out or sweating sensation, and these sensations do not go away quickly the best approach is to call 911. Delaying going to the hospital or driving one’s self to the hospital is extremely dangerous and can be lethal. The more time that passes before a heart attack is treated, the more chance of severe disability or death – so rapid medical attention is imperative.collapse
A: The risk factors for arterial vascular disease leading to heart attack and stroke are well known, and most are preventable. Tobacco or nicotine use in any form is a major risk factor for coronary heart disease, stroke and peripheral vascular disease. Ingesting any amount of tobacco, including by secondhand smoke exposure, raises these risks. Smokers have double to four times the risk for heart disease than nonsmokers. The risk of coronary heart disease is 25% higher for women who smoke compared with men who smoke. In fact, smoking bans have been shown to significantly reduce heart attack deaths. Being overweight and inactive are major risk factors that contribute to other important risk factors for hypertension or high blood pressure, diabetes and high cholesterol. The American Heart Association recommends 30 minutes per day of moderate physical activity at least five days a week. This link provides useful information about eating healthy for weight control and heart disease prevention. Cholesterol, blood pressure and diabetes management can be achieved working with one’s primary care provider. Making these lifestyle changes will substantially reduce the risk of a fatal or disabling heart attack or stroke.collapse
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Team Specialist: Mary Alton, MD, FACC North Region Medical Director, Non-invasive Imaging OhioHealth Healthcare System, Columbus, Ohio

Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Topic: Heart Health and the Loss of a Loved One

We all know that it can be heartbreaking to lose a loved one. Now a new study published in the Journal of the American Medical Association (JAMA) Internal Medicine and reported February 24th, 2014, by NBC News finds that the heartbreak can be more than symbolic. The researchers found that the rates of heart attack and stroke increased within 30 days of a partner’s death, compared to rates for those who did not lose a partner.

Q&A

A: The research team conducted a study using information available in a large United Kingdom primary care database of more than 100,000 persons, 60 to 89 years old. The investigators determined the number of heart attacks and strokes in patients who had just had a significant other/partner die. They compared those numbers to a control group of patients who did not have a recent death of a significant other. The researchers found a two-fold increase in the risk of having a heart attack or stroke during the first month after the partner’s death. This increase in risk was the same for both women and men. The risk of heart attack and stroke returned to that of the control group following the first month. These findings demonstrate that patients have a higher risk of having a major cardiovascular event in the first month after a loved one’s death. 

Reference: JAMA Internal Medicine, Increased Risk of Acute Cardiovascular Events After a Partner Bereavement, February 24th, 2014.

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A: Although we do not have a single study that completely identifies why bereavement increases the risk for a heart attack and stroke, it is likely a combination of several factors. For example, in the year prior to a loved one’s death, patients are much less likely to seek routine medical assessment for high blood pressure and cholesterol, which are major risk factors for heart attack and stroke. In addition, during the 3 months around the loved one’s death, patients are less likely to take their own prescribed cardiovascular medications. Not surprisingly, blood pressure and heart rate have been demonstrated to be higher in patients experiencing grief. Increased blood pressure and heart rate place greater strain on the heart and the blood vessels. Finally, depression causes changes in body chemistry that increase stress hormone, inflammation markers, and clotting factors that can lead to increased blood clotting and damage to the heart blood vessel wall. These conditions can lead to plaque rupture and heart attack or stroke.collapse
A: There are several things patients can do to help during stressful life events. One of the most important is to take advantage of the restorative benefits of sleep. Sleep can reduce levels of stress, resulting in better control of weight, blood pressure and inflammation, and improvement in symptoms of depression. All of these risk factors have been shown to be associated with heart disease and stroke. Keeping in contact with your health care provider after a stressful life event and taking blood pressure and cholesterol medications as prescribed are important interventions to lower cardiovascular risk, especially in patients experiencing grief. Regular exercise has been shown to signal release of chemicals called endorphins in the brain that help a person relax and feel better. Moreover, exercise has been shown to help protect against the physical effects of stress and grief. Regular exercise also reduces the risk factors for developing a heart attack or stroke by its beneficial effect on blood pressure and cholesterol. Although it can be challenging during times of grief, it is very important to maintain a healthy diet with fruit, vegetables, nuts, and lean meat to reduce the risk of future cardiovascular events. Finally, patients often benefit from seeing a psychologist or mental health professional who can provide evaluation, education and counseling to patients. This can assist in dealing with stress, depression and anger, and help in obtaining and using social support, all of which can greatly affect heart health and recovery.collapse
  1. Shah SM, Carey IM, et al. Impact of partner bereavement on quality of cardiovascular disease management. Circulation. 2013; 128:2745 - 53. 
  2. Buckley T, Mihailidou AS, et al. Haemodynamic changes during early bereavement: potential contribution to increased cardiovascular risk. Heart Lung Circ. 2011; 20(2):91-8. 
  3. Wallén NH, Goodall AH, Li N, Hjendahl P. Activation of haemostasis by exercise, mental stress and adrenaline: effects on platelet sensitivity to thrombin and thrombin generation. Clinical Science. 1999; 97,:27–35
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Team Specialist: David Nicholson, DO, FACC Non-interventional Cardiologist OhioHealth Healthcare System Columbus, Ohio

Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Topic: Dementia Link with Atherosclerosis (Artery Stiffness)

A new study appears to reinforce a link between atherosclerosis (artery stiffness) and increased risk of developing dementia. The researchers found that atherosclerosis is associated with the buildup of a type of plaque (beta-amyloid) in the brain that is a hallmark of Alzheimer’s disease. The study was published in the online edition of JAMA Neurology and publicized by WebMD March 31, 2014. 

Q&A

A: Atherosclerosis is a disease that occurs in blood vessels, involving the buildup of plaque (fat, cholesterol, calcium and other substances). The lining of the artery becomes damaged by factors that include smoking, high blood pressure, high cholesterol, obesity and diabetes. This damage causes the plaque to accumulate in the wall of the blood vessel, and the artery becomes stiff. Aging and genetic factors also contribute to stiffness.collapse
A: Given the results of this study, it makes sense to reduce or modify the risk factors listed above. This can be done by improving blood pressure control and blood sugar levels if diabetes is present, and by not using tobacco. A healthy diet, weight control and exercise are very important first steps toward heart health. In addition to lifestyle changes, many individuals may require medications to achieve the best levels for cholesterol and blood pressure, and to manage diabetes.collapse
A: The incidence of Alzhiemer’s disease is higher and the disease progresses faster in women than men; this cannot be explained simply by how long women live compared to men. Researchers have found through brain imaging that carrying the gene variant ApoE4, a potent risk factor for dementia, disrupts brain function in normal older women but has little effect on men. A recent analysis of 5000 normal older people who carried this gene showed that women had twice the risk of men of developing mild brain impairment or Alzheimer’s disease. Fifteen percent of the population carries at least one copy of this gene.collapse

A: This study involved 81 participants over the age of 83 who had no signs of dementia. The researchers used PET scans, which produce three-dimensional images, and examined the brain images for deposits of a substance that is associated with dementia - called beta-amyloid (Aβ) plaques. Scans were performed twice, two years apart. At the time of the second PET scan, the researchers also examined blood vessels that carry oxygenated blood away from the heart (arteries) to determine their stiffness. The investigators found that 48% of the individuals studied had Aβ plaques at the start of the study, and this increased to 75% after two years. They also found the stiffness of certain arteries was significantly higher in those who were Aβ positive. Increased stiffness of certain larger arteries corresponded with increased Aβ deposits observed in the scans. The researchers did not find a link between the brain deposits and age, sex, body mass index or use of blood pressure medication. They did, however, find a relationship both with a history of cardiovascular disease and the presence of a type of gene named ApoE4. 

Reference: Arterial Stiffness and β-Amyloid Progression in Nondemented Elderly Adults, JAMA Neurology, March 31, 2014.

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A: This study is small and should be confirmed in a large trial in which patients are followed for a number of years to see if they develop clinical evidence of dementia. If the results are consistent, perhaps the focus should move to examining the cause and how best to prevent the arterial stiffness that may be related to the beta-amyloid deposits. For many years, the emphasis has been on battling the beta amyloid plaques themselves. Recent studies have shown disappointing results from two drugs that inhibit beta amyloid formation. These results have prompted researchers to consider whether the deposits are a marker rather than a cause of dementia. As there appears to be an association between a history of arterial stiffness and beta amyloid, an extremely important question is whether taking action to prevent cardiovascular disease would, in fact, prevent dementia.collapse
A: As ongoing studies take shape, concerned individuals should be asking themselves whether they are doing everything possible to decrease their cardiovascular risks. As outlined above, a healthy lifestyle is well worth pursuing for the benefits of improved life expectancy, quality of life, and now possibly prevention of dementia. Regular visits to your primary care physician and measurements of your blood pressure, cholesterol, and blood glucose(sugar) levels will help you monitor, on a yearly basis, any changes that may require the addition of medications to reduce your risk factors.collapse
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Team Specialist: Mary Alton, MD, FACC North Region Medical Director, Non-invasive Imaging OhioHealth Healthcare System, Columbus, Ohio

Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Topic: Celiac Disease and Risk of Coronary Artery Disease

Celiac disease is a chronic inflammatory condition that can damage the small intestine, interfering with the absorption of key nutrients. In a study that adds to evidence of the role chronic inflammation may play in heart health, researchers found that people with celiac disease may have nearly double the risk of coronary artery disease compared with the general population. The data for this study, the first to look at this association, were presented at the American College of Cardiology’s 63rd Annual Scientific Session and publicized in Healthline News on March 31, 2014. 

Q&A

A: For people with celiac disease, the consumption of gluten triggers an immune response in their small intestine. An immune response is how your body defends itself against foreign substances that appear harmful.  The body responds by releasing substances such as white blood cells, chemicals such as histamine, and proteins to combat foreign material in a process called inflammation.  Although inflammation initially occurs locally (in celiac disease the inflammatory response occurs in the gut), it can travel via the blood to affect other organs such as the heart.  In fact, it has long been known that low-level inflammatory conditions such as rheumatoid arthritis, inflammatory bowel disease or lupus erythematosus can accelerate coronary artery disease (CAD) – or the blockage of the arteries that supply blood to your heart.  

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A: Although this study suggests a link between celiac disease and CAD, it still needs to be determined what steps are appropriate to actually reduce the risk of heart disease in patients with celiac disease.  This study also doesn’t address people who have gluten sensitivities without having true celiac disease. For people with gluten sensitivities, further investigation is needed to evaluate their risk of CAD and to determine what future steps may be helpful to protect against heart disease. Even so, it is important for those with gluten sensitivities to be alert to the possible increased risk of CAD if gluten is allowed to trigger inflammatory responses.

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A: Researchers discovered the link between celiac disease and CAD by performing a retrospective study where they reviewed the records of more than 22.4 million patients from 13 healthcare systems over 14 years.  They identified 24,530 patients with celiac disease and compared those patients to patients without the disease.  After ensuring that the two groups were similar in factors including gender, race, diabetes, high blood pressure, cholesterol levels, and smoking, the researchers found that patients in the celiac group had an almost two-fold increase in the risk of CAD.  Interestingly, this association held true for younger patients under the age of 65.  Additionally, people with celiac disease had a slightly higher risk for stroke, almost a 1.5-fold increase.

Reference: Celiac Disease Linked to Increased Risk of Coronary Artery Disease, American College of Cardiology press release, March 29, 2014.


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Dr. Gregory Lam
Team Specialist: Gregory K.W. Lam, MD, FACC, Non-Invasive Cardiology; Peripheral Vascular Disease, OhioHealth Heart & Vascular Physicians

Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Topic: Sugary foods and the risk of cardiovascular disease

Epidemiological studies have suggested that eating too much added sugar increases the risk for cardiovascular disease, but few studies have examined mortality risk. Now a new study has found that eating sugary foods increases the risk of dying from heart disease. This new study, published online in JAMA Internal Medicine and publicized in The New York Times February 6, 2014, says that most adults get 10 percent or more of their calories from added sugar. Importantly, this study says that this is a risk factor that can be modified.

Q&A

A: Individuals who consume too much sugar, especially sugar-sweetened beverages, have a tendency to gain more weight. As a result, this leads to a higher risk of obesity and related health concerns including diabetes, high blood pressure and elevated cholesterol levels. These risk factors lead to an increased chance of developing heart and vascular disease.

Increased intake of sugar leads to increased levels of “bad” cholesterol, or LDL, and triglycerides as well as a decrease in the “good” cholesterol levels, or HDL, made by the liver. Elevated triglycerides and LDL are known risk factors for heart and vascular disease. If the liver continues to process all of the excess sugar, this ultimately leads to high levels of sugar being converted to fat. This in turn can lead to insulin resistance, which is a fundamental problem in obesity, and the development of diabetes.

“Added sugar” is any sugar or syrup that has been added to a food or food product. Much of the sugar in processed or packaged foods is considered added sugar. These are considered “empty calories,” meaning your body cannot utilize them for energy and, as a result, turns them into fat. Major sources include soft drinks, cereals, candy, cookies, pies, dairy desserts and milk products. For example, one 360ml can of regular soda contains 35 grams (8.75 teaspoons or 140 calories) of sugar. The American Heart Association recommends 100 calories/day (6 teaspoons) of added sugar for women and 150 calories/day (9 teaspoons) of added sugar for men.

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A: Added sugar was not a significant component of our diet until the advent of modern food-processing methods. Sugar has no nutritional value other than to provide calories. Learning how to read nutrition labels is essential. Be on the lookout for these key words: “high fructose corn syrup, corn syrup, molasses, malt syrup, corn sweetener, honey, lactose, maltose, dextrose, glucose, fruit juice concentrate, sucrose, sugar.” Always avoid “low fat” options and anything advertised as “light.” Manufacturers will have taken the fat out of the item but add sugar to improve the flavor. A general rule to follow: “If it contains more than 3 grams of sugar per 100 grams, don’t eat it!” Another good rule to follow is to “never drink your sugar.” Choose either still or sparkling water as your beverage, or drink unsweetened tea instead of a soft drink. Remember that the foods lowest in sugar content tend to be displayed around the outer aisles of the supermarket. Learn to “shop the perimeter.”collapse

A: To estimate the intake of added sugar, the authors of the study used both the U.S. Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES) and the U.S. Department of Agriculture’s MyPyramid Equivalents Database (MPED). Some foods were estimated to the closest USDA food codes to estimate added sugar content from the study participants’ dietary recalls. Using complex statistical analysis, the study authors found that regular consumption of sugar-sweetened beverages (more than 7 servings per week) was associated with increased risk of cardiovascular disease mortality. This increased risk was independent of any other risk factors for dying from heart disease, including high blood pressure and cholesterol levels. This association between sugar intake and risk of dying of heart disease was seen regardless of age groups, sex, race (except non-Hispanic blacks – for reasons yet to further investigated), educational level, body mass index (BMI), and physical activity levels.

Reference: Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults, JAMA Internal Medicine, online Feb. 3, 2014 http://archinte.jamanetwork.com/article.aspx?articleid=1819573

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Team Specialist: Jayme Rock-Willoughby, DO — Non-invasive Cardiologist OhioHealth Healthcare System, Columbus, Ohio

Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Topic: Post-Traumatic Stress Disorder (PTSD) and increased risk of cardiovascular disease

Previous studies, based mostly on self-report measures, show that individuals with Post-Traumatic Stress Disorder (PTSD) are at increased risk of cardiovascular disease. Now in a new study in

Biological Psychiatry, reported December 2, 2013

by the online research news site Science Daily, investigators detected chest pain related to arterial blockage in 17 percent of the study participants with PTSD and only 10 percent of participants without PTSD. (All of the participants were recruited from U.S. Veterans Affairs Medical Centers.) “Increased risk for cardiac ischemia may turn out to be an important new concern for individuals suffering from long-standing untreated PTSD,” commented Dr. John Krystal, Editor of Biological Psychiatry and Chair of Yale’s Department of Psychiatry.


Q & A

A: Persons with PTSD, a common anxiety disorder in both veteran and non-veteran populations, have been reported to have an increased risk of high blood pressure, high cholesterol levels, obesity, and cardiovascular disease. PTSD has been linked to high levels of stress hormones, inflammation and blood clotting. These factors have been associated with disruption of cholesterol plaque in the blood vessel wall leading to blood clot formation in the blood vessel supplying the heart muscle, which ultimately can cause a heart attack. 

However, researchers are not sure why PTSD is associated with these risk factors. The evidence so far suggests that PTSD may affect different parts of the nervous system, resulting in increased blood pressure and changes in heart rate (either higher or lower), and may be associated with an increased susceptibility to serious abnormal heart rhythms. These processes may cause or worsen coronary artery damage or blockage. The types of stressful life events that can commonly lead to PTSD include assault, violence, experiencing combat in war, natural disasters, divorce, loss of job or retirement savings, business failure, major family conflict, major personal injury, death of a spouse, or illness, death or major illness of a close family member.

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A: Most of the studies on PTSD and heart disease risk have been conducted with war veterans, the majority of whom are men. Unprecedented numbers of U.S. military women have returned from Iraq and Afghanistan after experiencing combat, and Women’s Health Research at Yale and the U.S. Department of Veterans Affairs are collaborating on a nationwide study to see if there are gender differences in how female and male combat veterans readjust to civilian life – with PTSD as a major focus of this investigation. We’ll have to wait for the study to be completed. We already know, in general, that PTSD is twice as common among women as it is in men, and heart disease is the leading cause of death among women. So PTSD could very well play a more important role for women than it does for men in the development of coronary heart disease. Unfortunately, there is limited research examining PTSD and heart disease in civilian populations, especially women. However, in one study of civilian women, those found to have high levels of PTSD symptoms linked to traumatic life events such as assault, accidents, or natural disasters had three times the risk of future coronary heart disease compared to women reporting no PTSD symptoms. What is clear is that this area of women’s health needs more investigation.

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A: There is indeed a growing trend towards what we call “integrative care” in cardiovascular health. Currently, many physicians still work in isolation, with psychiatrists or other mental health providers treating depression, stress and other psychological issues, and cardiologists treating cardiovascular disease. But experts are increasingly proposing that health care providers work together in a multidisciplinary “Psychocardiology” subspecialty. Psychocardiology has arisen as research on the effect of psychological and behavioral factors on heart disease risk and recovery has shown to affect treatment and recovery outcomes

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Team Specialist: Ruth Goldberg, PhD, Clinical Psychologist, McConnell Heart Health Center, OhioHealth Healthcare System, Columbus, Ohio

Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Topic

A new study on reduced cardiovascular disease risk as a result of quitting smoking, presented at the American Heart Association annual meeting and reported November 20, 2013 by Reuters, found that some smokers over 65 who kick the habit may be able to reduce their risk of dying from heart-related problems to the level of never-smokers faster than previously believed.

Q&A

A: Among people who smoke, the greatest contributor to cardiovascular disease risk is their smoking, when compared with other factors such as high blood pressure, cholesterol levels, and diabetes. Quitting smoking can significantly decrease the risk of heart attack, sudden cardiac death, and stroke for both individuals with and without a prior history of heart and vascular disease. Within a year of stopping smoking, heart and vascular risk can decrease by nearly 50 percent. Five years after quitting smoking, the risk drops to nearly the same risk as for persons who never smoked, though the added risk of heart disease from smoking is never completely eliminated. The overriding message is that stopping smoking improves health and decreases cardiovascular disease risk substantially. 

Reference: Hurt RD, Weston SA, Ebbert JO, McNallan SM, Croghan IT, Schroeder DR, Roger VL. Myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, before and after smoke-free workplace laws. Arch Intern Med. 2012;172 (21):1635 

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A: Women can metabolize nicotine more quickly than men, making it easier for them to become dependent on nicotine. Once they become dependent on smoking, women can find it more difficult than men to quit smoking for several reasons. First-line smoking cessation medications using nicotine replacement therapies (such as nicotine patch or gum) do not appear to be as effective for women. This is because, in addition to experiencing nicotine withdrawal that causes cravings for cigarettes, women find it difficult to quit because they use smoking, more so than men, to reduce negative mood and anxiety, and to manage stress, appetite and concerns about weight gain. Moreover, women can be more easily drawn back to smoking by external cues such as being around other smokers, seeing someone light up, and even the smell of a lit cigarette. If their partner smokes, it can be particularly hard for women to quit. 

Resource: WHRY Video: It’s Harder for Women to Quit Smoking

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A: Recent and ongoing studies indicate that there are ways for women to improve their chances for success in quitting. Emerging evidence points to the fact that support from family, friends, and their partner in the quit attempt can play an important role in whether a women succeeds at quitting. Menstrual cycle factors can play a role, and recent research is attempting to determine whether success at quitting varies by when women attempt to quit during their cycle. Counseling to deal with negative mood and concern about weight gain can help improve a woman’s chance for success at quitting. Regular exercise can be quite helpful, as well as attention to a healthy diet. Most of the time it is not advisable to try to lose significant amounts of weight during a cessation attempt, however. Evidence shows that women who accepted a modest amount of weight gain when quitting actually gained the least amount of weight and were more successful in quitting. Combining counseling with either a health professional or telephone Quitline, along with FDA-approved medication (bupropion, nicotine replacement therapy, varenicline) for smoking cessation also can greatly increase the chance of success. 

Resource: SmokeFreeWomen (sponsored by U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute) Smoking and Mood

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Team Specialist: Tom Houston, MD, FAAFP, FACPM, Smoking Cessation Program, McConnell Heart Health Center, OhioHealth Healthcare System, Columbus, Ohio


Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Topic

The number of hospital stays for the most common form of irregular heartbeat, atrial fibrillation or AF, nearly doubled in the 12 years between 1998 and 2010, and is expected to continue increasing throughout this decade, according to findings presented at the American Heart Association’s annual meeting and reported November 18, 2013 by HealthDay News and WebMD.

Q&A

A: Atrial fibrillation or AF is the most common arrhythmia, a medical term for abnormal heart beat. AF is more common in people 65 and older, and the increase in hospitalization for AF may relate to an aging population. With aging, AF increases in frequency and typically occurs in people who have underlying heart disease. Almost any heart disease can increase the risk of this abnormal rhythm. But the most common causes are conditions such as high blood pressure (hypertension), heart valve disease, prior heart attack, and heart failure. High blood pressure is called “the silent killer” because individuals with this condition often feel no symptoms. However, high blood pressure increases risk of stroke, heart attack, and arrhythmia. Longstanding untreated high blood pressure, which is more commonly noted in women than men, is frequently a cause of atrial fibrillation. As obesity is also a cause of atrial fibrillation, the current obesity epidemic may be playing a role in the increase in hospital stays for AF. Other conditions and lifestyles related to increased risk of AF include obstructive sleep apnea, thyroid disorders, diabetes mellitus, reactions to and side effects of medications, excessive caffeine consumption, and smoking. Many of these factors are inter-related, and contribute to the overall increase in diagnoses and hospitalization for atrial fibrillation.

Reference: American College of Cardiology – Atrial Fibrilation web page

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A: The most common risk factors for AF include advancing age, heart disease, high blood pressure/hypertension, obesity, obstructive sleep apnea, over- or under-active thyroid disease, and heart valve disease. Lifestyle factors such as excessive alcohol consumption, sleep deprivation, smoking, and excessive caffeine consumption can also increase AF risk. Atrial fibrillation can also occur in individuals without risk factors. Certain athletes, such as long distance cyclists, rowers, and runners, have been reported to experience AF. Most people who develop AF are older than 65 years of age. Although atrial fibrillation is more common in men than women, women tend to have more difficulty with AF symptoms and often report a poorer quality of life than men after diagnosis. These symptoms include heart palpitations, lightheadedness and dizziness, being short of breath, fatigue, and chest tightness and discomfort. Some patients do not have any arrhythmia symptoms. While experts are not sure why women experience more AF symptoms, they speculate that it may be because women have faster heart rates and smaller bodies than men.collapse
A: Many patients are not limited by symptoms with AF. However, AF plays a significant role in risk of stroke whether or not a person feels symptoms. Doctors consider multiple factors when estimating someone's risk of stroke when diagnosed with AF, including heart failure, age 75 years or greater, diabetes, hypertension, and prior stroke or transient stroke. Studies also show that, compared to men, women have a greater risk of stroke when diagnosed with atrial fibrillation. A stroke resulting from AF is caused by a blood clot that blocks blood flow to the brain. In people with AF, the risk of stroke begins when the electrical signals that control the heartbeat become abnormal. As a result, the top two chambers of the heart stop pumping effectively, and blood that should move out of these chambers pools and can form clots. If dislodged, these clots can travel up to the brain through the blood vessels, causing strokes. In many cases, taking a medicine to thin the blood to prevent the formation of blood clots is a key part of reducing risk of stroke for women who have AF. There are multiple medications available that function as blood thinners to reduce women's stroke risk. Keeping blood pressure and diabetes well controlled also helps lessen a woman's AF -related stroke risk.collapse

Team Specialist: Anne Albers, MD, PhD, RVT
 Fellow of the American College of Cardiology American Society of Echocardiography, American Heart Association Cardiologist, OhioHealth Heart & Vascular Physicians OhioHealth Healthcare System, Columbus, Ohio


Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Topic

Several studies suggest that eating a healthy diet that includes regular servings of nuts lowers risk of cardiovascular disease. An observational study published in The New England Journal of Medicine and reported November 20, 2013 by NBC News examined nut consumption and mortality in nearly 119,000 women and men over 30 years – and found that people who ate a handful of nuts daily were 20 percent less likely to die from cardiovascular disease, cancer, respiratory disease and other illnesses.

Q&A

A: : Nuts contain several important nutrients that are linked to health benefits, including unsaturated fat and plant sterols that may help lower levels of “bad” cholesterol or LDL-cholesterol. Nuts are a good source of an amino acid called L-arginine, which can help maintain healthy blood vessels and decrease the risk of blood clots. Some nuts, including walnuts and cashews, contain omega 3 fatty acids, which may reduce inflammation and abnormal heart rhythms. Nuts are also a good source of many vitamins, minerals and antioxidants, including, folate, Vitamin E and magnesium. Compared to other foods, nuts have high amounts of calcium, magnesium, and potassium. Moreover, the sodium content of raw or roasted but otherwise unprocessed nuts is very low. A high intake of calcium, magnesium and potassium, together with a low sodium intake, is associated with protection against bone loss, high blood pressure, diabetes, and lower overall cardiovascular risk. To obtain the fullest nutritional value, eat nuts that are raw, as roasting nuts reduces the quality of their antioxidants. Because nuts are low in carbohydrates, they are a good source of nutrients for people with diabetes. Nuts are also gluten-free, making them a good choice for individuals with gluten sensitivity.collapse
A: The question of whether increasing the amount of nuts in your diet - and thus increasing calorie intake – might lead to unwanted weight gain and related health problems is an important one. Contrary to what many people may suspect, studies suggest that eating nuts regularly is unlikely to contribute to obesity. People who eat nuts regularly are leaner, more physically active and often do not smoke. Nuts are high in calories, but can actually help with weight loss. This is because nuts are an excellent source of unsaturated fat, fiber and protein, which are digested slowly and promote a feeling of fullness. A small serving of nuts can be a very satisfying snack and a great alternative to chips. However, a one-ounce serving of nuts contains 160-200 calories, so portion control is important. Consider adding a few nuts to oatmeal, yogurt, salads or stir-fry meals to add flavor and texture without adding too many calories.collapse

A: Peanuts are legumes, but they provide the same health benefits as tree nuts with similar nutrients. Peanuts and peanut butter are healthy additions to your diet as long as they are consumed in moderation. Peanuts contain antioxidants, B vitamins, magnesium, potassium, fiber, protein and unsaturated fat. Research suggests that moderate amounts of peanuts and peanut butter, just like tree nuts, can help with weight loss and reduce cardiovascular risk. The health benefits from tree nuts and peanuts are similar for both men and women. Peanuts, like tree nuts, are an important source of unsaturated fat and high-quality vegetable protein for both men and women – who do not have a food allergy to nuts. Overall, a healthy diet regularly includes vegetables, fruits, legumes, nuts, whole grains, lean protein sources and low-fat dairy products.


Resource: “Association of Nut Consumption with Total and Cause-Specific Mortality,” New England Journal of Medicine, November 21, 2013

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Team Specialist: Joann Schaumburg, MS, RD, LD
 Clinical dietitian - McConnell Heart Health Center OhioHealth Healthcare System, Columbus, Ohio


Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Topic

New statin-therapy cholesterol and heart disease prevention and treatment guidelines from the American College of Cardiology and the American Heart Association appear to abandon LDL cholesterol levels as targets for statin therapy and, instead, recommend an "Omnibus Risk Estimator," as detailed in a November 29, 2013 article in The New York Times, for determining whether taking a statin is necessary.

Q&A

A: The “Omnibus Risk Estimator” is just one part of the new guidelines for determining risk of heart disease and reducing risk with the use of statins and lifestyle changes. Many people are confused with these new guidelines and specifically with how to use the new risk estimator. In simple terms, the estimator is a spreadsheet in which the individual enters information on nine factors, including age, sex, race, cholesterol levels, systolic blood pressure (the pressure in the arteries when the heart beats), and whether the individual is being treated for high blood pressure, has diabetes, and smokes or not. Any risk calculator can be imprecise, especially if the information entered is not accurate. However, this new risk estimator can be helpful in charting the 10-year and lifetime risk of cardiovascular disease, though it should be viewed as a starting point for dealing with cardiovascular risk, and should not drive all decision-making. Ascertaining an accurate lifetime risk estimate of cardiovascular disease, heart attack and stroke is the overriding goal. The primary use of lifetime risk estimates like the one derived from the new estimator is to facilitate a very important discussion between the individual and the primary care physician on reducing risk through lifestyle changes that include diet, exercise, managing weight, smoking cessation if necessary, and the use of cholesterol-lowering medications or other medications (for high blood pressure) when called for by individual circumstances. Quitting smoking, eating a healthy diet, getting enough exercise, maintaining a healthy weight, and controlling blood pressure, cholesterol and blood sugar are all important ways to improve cardiovascular and overall health. However, you should talk to your health care provider about your risk factors and lifestyle changes - before taking any actions. 

Reference: 

American College of Cardiology, American Heart Association – 2013 Prevention Guideline Tools and Risk Calculator 


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A: The panel reviewed the latest scientific studies and concluded there was no strong evidence to support treating with statins to achieve specific LDL cholesterol targets as a means to prevent heart attack or stroke. Instead, the panel relied on the results of studies of geographically and racially diverse groups of people, such as the Framingham Heart Study and the Cardiovascular Health Study, and state-of-the-art statistical methods to develop new guidelines and risk estimates that consider “the whole patient,” not simply an individual’s cholesterol numbers. The new guidelines focus on estimating and reducing risk in adults between the ages of 40 and 79, because the panel concluded that the strongest evidence supports the use of interventions in this age bracket. Within this age bracket, the panel established four major groups with varying levels of risk in which cholesterol-lowering statin treatment is advised – at varying dose intensities based on the risk level. The risk estimator described in the answer above is a tool to accompany these guidelines and to prompt discussion between patient and health care provider. Lifestyle changes are also recommended as part of these guidelines. 

Reference: 

Pooled Cohort Equations, Appendix 4. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 

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A: Gender is factored into the new guidelines, so women and men should find them generally helpful in determining risk and prompting discussions about prevention options with their health care providers. But keep in mind that these guidelines and risk estimates are based on group averages so they produce a “rule of thumb” that is then applied to individual patients in practice. And, although the treatment guidelines apply to both women and men, there are differences in how some specific risk factors affect the average woman versus the average man. For example, diabetes and smoking seem to increase the risk of cardiovascular disease more in women than men. The risk increases significantly in women with the onset of menopause, due to hormonal changes and the related increase in triglycerides (the major form of fats, or lipids, stored by the body – coming from the foods we eat and produced by the body) and decreases in HDL or “good” cholesterol that typically occur. Thus, it can be particularly important for women to pay attention to lifestyle changes and treatment options that focus on these risk factors in the context of reducing lifetime cardiovascular disease risk. Moreover, making cardiovascular health part of a lifestyle over a lifetime should be the goal. 

Resource: 

National Heart, Lung and Blood Institute “Lower Heart Disease Risk,” The Heart Truth 

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Team Specialist: Scott H. Merryman, MD, Diplomate of the American Board of Clinical Lipidology and American Board of Family Medicine Cardiovascular Prevention Services Lipid Clinic Director – McConnell Heart Health Center OhioHealth Healthcare System, Columbus, Ohio


Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health. 

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.