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

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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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

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

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.