cardiac
HEALTH ON TIME
TM
FALL 2013
inflammation at the heart of the matter INFLAMMATION OF THE ARTERIES MAY INDICATE FUTURE HEART ATTACKS AND STROKES
R
ecent evidence suggests that inflammation of the arteries may be an important indicator of future heart attacks and strokes. Researchers have found that blood levels of a protein called C-reactive protein (CRP), which indicates underlying levels of inflammation, are found to be elevated many years before a first heart attack or stroke. According to several studies, the one-third of subjects with the highest levels of C-reactive protein had twice the risk for coronary heart disease and stroke compared to the bottom one-third with the lowest levels of the protein.
Inflammation may lead to narrowing of the coronary arteries, which may increase your risk for heart disease. Inflammation occurs when the body responds to injury. What causes inflammation of the arteries is not known. But infection—possibly caused by bacteria or a virus—might contribute to or even start the narrowing process. Other possible factors that may cause an inflammatory response in the body are: • smoking • high blood pressure • diabetes • high cholesterol levels These risk factors may cause inflammation of the coronary and carotid arteries, which may lead to narrowing of these vessels. This may in turn increase your risk for coronary heart disease and stroke. The process that triggers the body’s inflammatory response needs to be investigated in large randomized clinical trials. There are research projects underway at the moment to help explain what triggers the body’s inflammatory response to each risk factor for coronary heart disease and how the body responds to damage and stress of blood vessels. There is
T H E I N F L A M M AT O RY T H E O RY Inflammation is part of the body’s healing of infections, but new research suggests it also may cause heart disease when the immune system mistakes certain fats for germs and attacks them.
Coronary artery
1
LDLs — molecules carrying cholesterol — accumulate in the artery, change chemically and attach to artery wall.
2
Immune system is alerted and sends white blood cells, which normally ingest germs and send out chemicals to kill them.
3
White blood cells swallow LDLs, turn into foam cells filled with fatty LDL droplets and form plaques on artery walls.
New LDLs
White blood cell
Plaque
Foam cell
4
Foam cells fatten and release free radicals, creating more LDLs; immune system sends more white blood cells.
5
Ongoing inflammation can make plaque rupture and release debris that can form a blood clot and block the artery.
New LDLs
Rupture
Source: American Source: Scientific Scientific American Graphic: Graphic: Hayoun HaynounPark Parkand andTerance TerenceHoran, Horan,Chicago ChicagoTribune/KRT Tribune/KRT
strong evidence that CRP should be routinely considered along with standard cholesterol evaluation for those at immediate risk—for example, someone considered to have a 10 to 20 percent risk for heart attack in the next 10 years based on his or her health status. For the rest of us, the American Heart Association does not recommend CRP testing—just regular cholesterol testing and blood pressure screening.
Coronary Calcium Scans This easy, 15-minute test is up to 10 times more accurate at predicting your heart attack risk than traditional diagnostic methods. To schedule, call 706-721-9729 or visit gru.edu/cardio.
how does inflammation affect the heart?
“C
hronic inflammation may contribute to the formation of plaque in the walls of blood vessels,” says Sheldon Litwin, MD, a cardiologist at Georgia Regents Cardiovascular Center. “Perhaps more importantly, inflamed plaques are more likely to become unstable and to become the site of clot formation. This is the situation
that most commonly leads to a heart attack or stroke.” People with poor health habits, especially those who are obese or sedentary, tend to have higher levels of inflammation. “If you are overweight, particularly in the mid-section, you are at increased risk of having high blood pressure, insulin resistance, or high triglycerides that are caused in part by inflammation,” says Dr. Litwin.
Take Heart!
Georgia Regents University 1120 15th St., AD 1114 Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID GEORGIA REGENTS UNIVERSITY GRU-006
Fortunately, the following lifestyle changes can help reduce or prevent chronic inflammation: •E at a healthy diet rich in fruits and vegetables. Eliminate trans fats and reduce saturated fats found in red meats, butter and other products. •E xercise regularly.
•R educe stress and get plenty of sleep. •L ose weight, if needed. •D on’t smoke and avoid secondhand smoke. Use of certain medications, particularly statins, may help to prevent heart attack or stroke in patients with elevated inflammatory markers, even when cholesterol levels are normal. “Good health habits can reduce inflammation and possibly lower your risk for heart disease and stroke,” Dr. Litwin says.
For more information, please visit gru.edu/cardio.
hearts at risk
how angioplasty is saving lives
You’re not alone According to the American Heart Association’s Heart Disease and Stroke Statistics
955,000
WHEN ANGIOPLASTY ISN’T POSSIBLE
angioplasties were done in the United States in 2010; 642,000 for men and 313,000 for women.
Bypass surgery may be needed due to various reasons, such as an angioplasty that did not sufficiently widen the blood vessel or blockages that cannot be reached by or are too long or hard for angioplasty. Individuals with multivessel disease may also be better candidates for bypass than angioplasty. While bypass surgery has generally been performed with the heart still and the patient on a heart-lung machine, some surgeons have recently begun performing the procedure “off-pump” when possible, keeping the heart beating and reducing complications.
Who needs it?
People who need angioplasty have coronary artery disease, a condition caused by atherosclerosis. and KRT Check out new premium Web feature Angioplasty is also an effective, lifesaving emergency treatment for a heart attack. //online.presslink.com/new-cgi/waisgate/Providers/KRTgate.pl http://www.krtdirect.co http://www.krtdirect.com/weatherquiz
additional graphics and KRT products,
The procedure Angioplasty is a catheter-based procedure performed by an interventional cardiologist to open a blocked coronary artery and restore blood flow to the heart muscle. It is used as an alternative treatment to coronary artery bypass surgery (see box at right). Angioplasty is less invasive, less expensive and faster to perform, with the patient usually returning home the next day. A drawback is restenosis, where the artery closes again within six months. Stenting reduces this chance to less than 20 percent, while drug-eluting stents reduce the risk to less than 10 percent. See Drug-eluting stents below.
1 Also known as “bypass
1
surgery,” a coronary artery bypass graft operation uses a piece of vein taken most often from the leg (called the saphenous vein).
OPENING CLOGGED HEART ARTERIES WITH A STENT Obstructed
Stent expanded
Fatty plaque reduces blood flow through the artery.
New tissue
The balloon is inflated, flattening plaque against the artery wall.
END VIEW
2 2 The vein is attached to
The saphenous vein is used to bypass blockage
After the catheter is removed, the stent holds the artery open.
Blockage in right coronary artery
Balloon
Plaque
A strong option Stent
Catheter
A catheter is threaded through an artery in the leg and to the heart; a deflated balloon is at its end; a stent is around the balloon.
Plaque
Stent
The stent, an expanding metal cage, spreads open and is pressed against the plaque and into the artery wall. Stent
Balloon (deflated)
Catheter
SIDE VIEW
Stent
According to the American Heart Association, 219,000 coronary artery bypass graft operations were done in the United States in 2010.
Blood flow improves immediately, relieving heart disease symptoms. Within two to four weeks, the stent is coated by a new artery lining.
Blockage in right coronary artery
Plaque
Artery grows around stent
Balloon (inflated)
Blooddeprived region of heart
friends
11/24/99
Drug-eluting stents To combat restenosis, scientists have devised “drug-eluting,” or medicated, stents that slowly release a drug during the first few weeks after angioplasty, when scar tissue buildup is most likely to occur. These stents have reduced the incidence of repeat angioplasties to less than 5 percent. The first of these drug-coated stents were approved for use in 2003. Soon after they were introduced, it was reported that patients with these devices were slightly more likely to develop blood clots. According to the U.S. Food and Drug Administration (FDA) research, drug-eluting stents are associated with a lower number of repeat revascularization procedures when compared with bare metal uncoated stents.
KEYWOR
RELATED PRODUCTS AND STORIES
heart, stent, balloon, angioplasty, artery, disease, health, surgery, greer, national, ph, contributed, 1999
With HEART5, Knight Ridder by Donald C. Drake With 19991110 ARTERY STENT, KRT News In Motion
family
Many first heart attacks and strokes are fatal, so it’s important to know your risks.
© Copyright 1999 Knight Ridder Tribune, Inc. Reprint with permission only.
Catheter is
credit Ï Knight Ridder TribuneÓor Ï KRTÓmust appear with all uses of this graphic image. 2. L ower levels of LDL cholesterol in theThe blood indicate: inserted into
. higher risk for heart disease B. lower risk for heart disease A C. higher risk for heart disease for only those with diabetes D. none of the above
More and more evidence suggests a relationship between the risk for cardiovascular disease and environmental and psychosocial factors, according to the American Heart Association. These factors include job strain, social isolation, and personality traits. But more research is needed on how stress contributes to heart disease risk. We don’t know if stress acts as an “independent” risk factor for cardiovascular disease. Acute and chronic stress may affect other risk factors and behaviors, such as high blood pressure and cholesterol levels, smoking, physical inactivity, and overeating.
practice risk reduction
1. Each day, an average heart “beats” (expands and contracts) ___ times. 790 NATIONAL PRESS BUILDING, WASHINGTON, D.C. 20045 A. 40,000 B. 100,000 C. 200,000 D. 80,000 e-mail:
Women 55,000
work
how well do you know your heart?
(202) 383-6064
Men 164,000
ARE YOU STRESSED?
Site of coronary artery blockage
Drawings by American Heart Association, Guidant Vascular Intervention; Source: Dr. John Hirshfeld, American Heart Association, Guidant Vascular Intervention; Graphic: Cynthia Greer, Philadelphia Inquirer/KRT
ORY: NATIONAL AME: HEART stent.fh8 RATOR: Cynthia Greer RCHER: Staff N: Philadelphia Inquirer HIC SIZE: 3 col. x 4.5Ó D: 11/24/99
the heart artery above and below the narrowed area, thus making a bypass around the blockage. Sometimes, more than one bypass is needed.
Heart and artery images © 2004 A.D.A.M., Inc.
If your doctor recommends angioplasty for you or a loved one, there is every reason to feel confident. The nonsurgical procedure is a proven winner for unclogging arteries and helping patients feel better in just a matter of days.
the femoral artery at the top of the leg
At Georgia Regents Heart & Cardiovascular Services, specialists in interventional cardiology, coronary artery disease, congestive heart failure, electrophysiology, cardiac imaging, and open-heart surgery work as a team to diagnose and treat the full range of cardiovascular diseases.
3. E ach day, an average heart pumps about ___ gallons of blood. A. 500 B. 1,000 C. 2,000 D. 4,000
4. T rue or False? Cholesterol is an important part of a healthy body because it’s used to form cell membranes, some hormones, and other needed tissue.
5. W hich of the following is a controllable risk factor for atherosclerosis (hardening of the arteries)? A. h igh blood cholesterol B. family history C. being male D. all of the above
To schedule an appointment, call 706-721-2426.
ANSWER KEY: 1-B; 2-B; 3-C; 4-True; 5-A. If you got most or all of the answers right, you’re heart smart!
YOUR HEART HEALTH LIFELINE
0-25 YEARS
25-40 YEARS
Build a healthy body now. Atherosclerosis begins in childhood. To reduce this fatty buildup in the arteries, cigarette smoking should be discouraged and obesity should be avoided or reduced.
Get moving. In 2011, only 2 in 10 Americans engaged in the recommended levels of physical activity. Nearly 50 percent did not meet standards for aerobic or strengthening activity.
40-55 YEARS Eat a low-saturated fat, lowcholesterol diet, which can help reduce your risk for heart attack.
Adults younger than age 45 who have risk factors for heart disease, such as diabetes or a family history of high cholesterol, should have their blood lipid levels checked regularly—at least once a year.
DIABETES
55-75 YEARS Women should discuss the pros and cons of hormone replacement therapy (HRT) with their physicians.
New guidelines recommend all adults have their first cholesterol screening at age 20, or at least by age 35 in men and 45 in women.
Increasing age is a risk factor that cannot be changed. That’s why it’s important to focus on the risk factors you can control like smoking and inactivity.
75+ YEARS Fit physical activity into your everyday life. Both aerobic and muscle-strengthening exercises are important to ongoing health.
Comply with your physician’s treatment and medication directions.
blood sugar screening every 3 years after age 45
BLOOD PRESSURE screening annually CHOLESTEROL screening every 5 years
screening more frequently after age 45 for men or 50 for women
HEART DISEASE
56789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919 stroke risk zone OBESITY
People who have excess body fat—especially if a lot of it is in the waist area—are more likely to develop heart disease and stroke even if they have no other risk factors. If you can lose as little as 10 to 20 pounds, you can help lower your heart disease risk.
For more information on our services and physicians, visit us online at gru.edu/cardio.
Spotlight on our heart and vascular team Dr. Amin is the newest member of the Georgia Regents heart and cardiovascular team. He is board-certified in pediatric cardiology and comes to us from Rush University Medical Center in Chicago.
Dr. Neal Weintraub Kupperman Eminent Scholar in Cardiovascular Medicine
Dr. John Thornton Director of Coronary Care Unit
Dr. Zahid Amin William B. Strong Endowed Chair Section Chief, Pediatric Cardiology
Dr. Thornton is board-certified in cardiology. His clinical interests include congestive heart failure and psychosocial, behavioral, and neurohormonal factors in patients with heart disease.
Dr. Weintraub’s research and clinical interests include vascular biology and physiology, inflammation, ischemia/ reperfusion injury, aortic disease, and heart failure. He is internationally recognized for his work in aortic aneurysm disease.
Check out videos of our physicians and heart healthy tips at gru.edu/cardio.
Q&A Oftentimes, yes—men are more likely to experience chest pain or pain that radiates to the left arm. For women, the symptoms can be the same, but differences do occur. If you or any woman you know suddenly begins to experience any of the symptoms identified on the right, contact a physician or cardiologist right away. Cardiovascular disease is the No. 1 cause of death in American women, yet statistics show that only 1 in 5 women consider heart disease to be their greatest health threat. If you experience any persistent symptoms of heart attack, call 911 or go to a hospital emergency room. Even if you have doubts, seek medical help. Don’t take chances with your health.
HEART ATTACK SYMPTOMS Feelings of anxiety and lightheadedness
Pain in the neck or upper back
Exertional breathlessness, often without chest pain of any kind
Nausea, sweating or sudden flu-like symptoms
Pain or discomfort in one or both arms, radiating downward
How much exercise do I need each week to lower my risk for heart disease?
Choose an aerobic exercise. Aerobic exercise causes you to breathe more deeply and makes your heart work harder to pump blood. It also raises your heart rate (which helps to burn calories). Examples of aerobic exercise include walking, jogging, running, swimming, and bicycling.
Exercise makes your heart stronger. It can lower blood pressure and reduce levels of LDL (“bad” cholesterol), which clogs the arteries and increases risk for a heart attack. At the same time, exercise can raise levels of HDL (“good” cholesterol), which helps protect against heart disease. The American Heart Association recommends at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise—or a combination of the two—per week. The AHA also recommends strength-building activity two or more days per week in addition to aerobic activity. Be sure to start slow and work your way up to the recommended time and intensity. Before beginning any exercise, always consult your doctor, who may have recommendations based on your individual health factors.
TIP: Slowly work up to 30 minutes of aerobic exercise, four to six times a week. S
M
T
W
Th
F
S
breaking news ups and downs A study published on February 11, 2013, in the journal Hypertension suggests that gradually reducing sodium intake over a period of 10 years to 2,200 milligrams could save 280,000 to 500,000 lives, while instantly cutting daily sodium to half that—1,500 mg, or half a teaspoon—could save some 60 percent more lives. While current guidelines recommend a daily sodium intake of no more than 2,300 mg, the study calls for further reduction for optimal heart health.
no sleep? no good! A study published on June 5, 2013, in the Journal of Psychiatric Research links poor sleep to an increased risk of heart disease and heart attack in women due to increased inflammation. The study reported on 626 patients with coronary heart disease after five years. Women who reported poor sleep (defined as less than 6 hours per night) had 2.5 times the levels of increased inflammation as men who reported sleeping poorly. This difference may be related to lower estrogen levels in the study’s postmenopausal subjects, the researchers speculated.
The Georgia Regents Chest Pain Center A BEHIND-THE-SCENES LOOK Everything the Georgia Regents Chest Pain Center does is designed to speed the time it takes to move heart attack patients from “door to balloon,” or arrival at the hospital to the opening of the blocked artery in the catheterization lab. And the action often begins before the patient hits the hospital. Interfacing with Emergency Responders “If you have heart attack symptoms, call 911,” says Deepak Kapoor, MD, an interventional cardiologist who manages Georgia Regents Cardiac Catheterization Lab. “We have trained emergency responders and purchased special equipment so EMTs can begin care and communicate with us en route to the hospital.” EMTs perform 12-lead EKGs and transmit the results to the center. “This lets us activate the cath lab, so heart attack patients can bypass the emergency department altogether, if needed,” Dr. Kapoor says. Opening a blocked artery quickly and safely in a patient having a heart attack requires considerable skill and experience. “As an academic medical center, we are unique in this region to staff our emergency cath lab exclusively with cardiologists who have not only undergone advanced training but bear special expertise in this field,” Dr. Kapoor says. Responsive Triage and Chest Pain Pathway “If patients walk in with chest pain, our nurses can perform 12-lead EKGs in the triage area and send the patient straight to the cath lab,” Dr. Kapoor says. If there is any suspicion that the pain is heart related, patients go on “chest pain pathway” for 12-24 hours of monitoring. “This helps us determine the best plan of care and make sure patients are ready for discharge before sending them home,” says Dr. Kapoor. Your Heart, Your Choice! If you experience heart attack symptoms, call 911 and ask to be taken to Georgia Regents Chest Pain Center.
To schedule an appointment with a cardiologist, call 706-721-2426.
For more information on our services and physicians, visit us online at gru.edu/cardio.
Copyright © 2013 GLC, Northbrook, IL 60062 U.S.A. This publication is not meant to replace professional medical advice or service. Personal health problems should be brought to the attention of appropriate medical professionals.
Are the symptoms of heart attack different in women than in men?