cardiac
health on time
TM
winter 2014
the cholesterol question a new look at an old problem
B
y now, the evidence is rock solid: Keeping your cholesterol levels in check can dramatically reduce your risk of heart disease. Multiple studies have shown that exercising, eating right, and avoiding smoking can be enough to lower moderately high cholesterol in many people. Cholesterol-lowering drugs can reduce cholesterol levels dramatically—substantially lowering the risk of heart attack and stroke. Yet high cholesterol remains a serious health threat to millions of Americans. Why?
Good vs. bad cholesterol While we tend to say that high cholesterol is bad for us, there is one form of cholesterol that is helpful. While LDL (lowdensity lipoprotein) or “bad” cholesterol tends to build up on the walls of blood vessels, HDL (highdensity lipoprotein) sweeps the bad cholesterol away from the tissues to the liver, where the body can process and eliminate it.
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They don’t know. About 1 in every 3 American adults has high cholesterol. Since there are no symptoms, many have never been tested and don’t realize they are at risk.
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They don’t act. Among those who know that they have unhealthy levels of cholesterol, some are unable or unwilling to adopt a healthier diet or a healthier lifestyle. In November 2013, the American College of Cardiology and the American Heart Association (AHA) released a new guideline for treatment of blood cholesterol in people at high risk for cardiovascular diseases. The guideline, prepared by a panel of experts, addresses the rising rate of cardiovascular disease, the leading cause of death and disability in the U.S. The guideline identifies patients who have the greatest chance of preventing stroke and heart attacks with cholesterol-lowering statins, and it emphasizes the importance of adopting a heart-healthy lifestyle to prevent and control high blood cholesterol. Neil J. Stone, MD, chair of the panel, says “Statins were chosen because their use has resulted in the greatest benefit and the lowest rates of safety issues.” Statin medications have been used for more than two decades in the United States by millions of people. Although all medications have some side
heart failure on the rise
Take These Offensive Moves
T
hanks to improved medications and advanced procedures, increasing numbers of people are surviving heart attacks and coronary artery disease. Yet many of these people are struggling with heart failure, also known as congestive heart failure.
get moving The AHA recommends the following physical activity for adults (1 or 2, plus 3):
A Closer Look
1. At least 30 minutes of moderate-intensity
A woman’s risk of heart disease may occur later in life than a man’s, but her odds of having elevated cholesterol are actually higher. Beginning at age 20, more women than men have a total blood cholesterol of 200 or higher, studies show. Overall, 16.2 percent of women age 20 and over have dangerously high total cholesterol (240 and above), compared to 13.5 percent of men. What’s more, many women with high cholesterol aren’t getting the treatment they need. Women are less likely than men to be aware of their condition and are less likely than men to have their cholesterol managed.
aerobic activity five days a week; or
2. A t least 25 minutes of vigorous aerobic activity
three days per week—or a combination of the two.
3. A nd—moderate to high intensity muscle-
strengthening activity two or more days per week for additional health benefits.
effects, statins are considered to be very safe when used properly. They are available in brand-name and generic formulations and are covered by virtually all prescription insurance plans. They are also easy to take—usually only once a day at bedtime. While statins are effective at reducing LDLs (“bad cholesterol”), an important issue facing physicians is how aggressive to be when prescribing for individual patients, who may or may not be successful in changing their habits to combat cholesterol. Talk with your physicians about your lifestyle and the benefits of medication therapy for managing your cholesterol.
According to John Thornton III, MD, a cardiologist at Georgia Regents Cardiovascular Center who directs the outpatient heart failure program, the condition occurs when the heart becomes too weak to circulate enough blood to meet the body’s needs. This chronic, progressive disease causes shortness of breath and fluid retention. “Heart failure is often caused by other conditions that damage the heart muscle, such as coronary artery disease, heart attacks, high blood pressure, or heart valve problems,” says Dr. Thornton. Like coronary artery disease, heart failure is largely preventable.
What’s the Best Defense? Dr. Thornton suggests you take these steps to prevent heart failure: n Control your blood pressure. n Eat a low-fat, low-salt diet. n E xercise regularly and maintain a healthy weight. n Don’t smoke.
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.
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D rink alcohol only in moderation, if at all. Take medications as prescribed.
Heed these Warnings Contact your physician if you experience these signs of heart failure: n Weight gain of three pounds or more in one day n Fatigue and weakness n P ersistent coughing or wheezing n Swelling in the abdomen, legs, ankles, or feet n S hortness of breath and reduced ability to exercise n Rapid or irregular heartbeat “Although most cases of heart disease can’t be cured, early diagnosis and good medical management can help patients live longer, more active lives,” says Dr. Thornton.
Call 706-721-2426 now to schedule an appointment with a cardiologist who specializes in heart failure. gru-008
Georgia Regents University 1120 15th St., AD 1114 Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID georgia regents university
staying in rhythm
severe arrhythmias can be life-threatening The human heart is a pump designed to circulate Know your risks blood in and out of the lungs and through the body. But what a pump! This small muscle beats Atrial fibrillation is the most 100,000 times a day, or the equivalent of about common form of arrhythmia, affecting about 3.4 million 2.5 billion heartbeats in an average lifetime. It adjusts its rate with exquisite precision, depending Americans. This dangerous form of arrythmia increases the on how active we are, moment by moment. risk of blood clots and is Unfortunately, heart rhythms can become abnor- responsible for 15 to 20 mal, causing arrhythmias that may increase the risk percent of ischemic strokes. of heart disease and sudden cardiac death. Severe arrhythmias can be life-threatening. Fortunately, new tests and treatments can effectively diagnose and control arrhythmias, preventing further complications. Here’s what you need to know about the risk and what can be done.
When the Beat Goes Wrong
normal heart rhythm
Detecting Heartbeat Irregularities In some cases, doctors can detect arrhythmias simply by taking the pulse or by listening through a stethoscope. sinus bradycardia
electrocardiogram
The simplest diagnostic test is an electrocardiogram (ECG or EKG), which creates a graphic image of the electrical signals that cause a heartbeat.
holter heart monitor
Because some arrhythmias come and go, cardiologists sometimes use an ambulatory ECG, during which patients wear a portable ECG machine called a Holter monitor, usually for 24 to 48 hours. A button is pressed to record the EKG reading if symptoms are experienced. But arrhythmias are also detected when no symptoms occur. echocardiogram
ventricular tachycardia
The Heart’s Timekeeper Arrhythmias take many different forms, from abnormally slow heartbeats, called bradycardia, to dangerously fast beats, called tachycardia. Importantly, arrhythmias may occur as premature atrial or ventricular beats, which are usually not serious. When the two upper chambers beat erratically, blood doesn’t fully empty from the chambers. Some blood pools inside the left atrium, increasing the risk of clots that can lead to strokes or obstruction of arteries. To help prevent this increased risk, patients with permanent or intermittent atrial fibrillation are usually placed on anti-coagulant drugs. Arrhythmias can also occur in the heart’s lower chambers, or ventricles. One rare but dangerous ventricular arrhythmia is called long QT syndrome, which can result in rapid ventricular tachycardia or fibrillation of a special type called torsade des pointes. People with this syndrome are at increased risk of sudden cardiac death.
echocardiogram
An echocardiogram uses sound waves to show the size and thickness of a heart’s walls and the size of its chambers. The echocardiogram can also detail the pattern of contraction of the chambers, and identify abnormalities such as enlarged chambers or diseased valves that may cause atrial fibrillation.
transducer
electrophysiologic study
sudden cardiac death
An electrophysiologic study can pinpoint the exact location where an arrhythmia is occurring. Catheters can be used to trigger different areas of the heart to induce an arrhythmia, allowing cardiologists to observe exactly what’s happening, and when indicated, physicians can often effect a cure with a technique called catheter ablation.
NORMAL HEARTBEAT A normal heartbeat is triggered by an electrical impulse which starts in the Sinoatrial (SA) Node.
a fish story with a happy ending
60%
The impulse then travels across the Atrioventricular (AV) Node and triggers the ventricles to contract.
Studies have shown that adding fish oils to heart cells prevented some arrhythmias. The findings may explain why diets that include at least two servings of fish a week dramatically reduce the risk of heart attacks.
Almost half a million Americans die every year from severe arrhythmias, which occur when the heart’s electrical system goes badly awry, causing complex ventricular tachycardias and/or ventricular fibrillations which are often fatal. These are usually due to heart attacks Sudden cardiac or other structural heart problems. Although death accounts for some cases are never explained, research shows that most occur from structural abnormalities in the heart or from inherited arrhythmias. Recent of the nation’s findings suggest that up to 75 percent of deaths yearly death toll. in young victims are linked to inherited heart problems. Many cardiologists advise immediate family members of victims of sudden cardiac death to be tested for arrhythmias and other signs of heart abnormalities.
Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna, bluefish, and salmon are high in healthful fatty acids.
omega-3
how much do you know about heart disease and its risks?
Restoring Normal Heart Rhythms
Test your knowledge by completing this quiz, then check your answers below. 1. E motional stress can cause irregular heart rhythms. A. True B. False 2. T he leading risk factors for arrhythmias are: A. A family history of coronary artery disease and/or heart rhythm problems. B. Smoking. C. Diabetes. D. Current heart disease. E. All of the above. 3. T he risk of developing arrhythmias increases with age. A. True B. False
Savvy Substitutions for Your Favorite Recipes
Cardiologists have many ways to get the heart beating normally again. Drugs called beta-blockers slow abnormally fast heart rhythms and limit the effects of adrenalin on the heart. Calcium channel blockers can also slow the heart rate and suppress tachycardias. Several anti-arrhythmic drugs also help maintain normal heart rhythm. When the heart rate is too slow, permanent pacemakers can be inserted that take over and set the pace. For patients who are at risk of life-threatening ventricular arrhythmias, cardiologists usually use an implantable cardioverter-defibrillator. This device detects ventricular fibrillation and delivers an electrical shock to the heart in order to restore normal rhythm, but other arrhythmias can be treated as well. Another treatment that has shown great success is radio-frequency ablation, in which radio-frequency energy, via an electrode catheter, is used to freeze or destroy the small area of the heart that is found to be the cause of irregular heart rhythms. Abnormal tissue is usually identified during an electrophysiological study.
4. C utting back on sodium, or salt, in the diet can lower an adult’s heart disease risk by: A. 3 percent B. 12 percent C. 26 percent D. Salt doesn’t affect heart disease risk. 5. A ccording to the latest surveys, what percentage of Americans are now overweight or obese: A. 25 percent B. 68 percent C. 77 percent
Some drugs can help slow abnormally fast heart rhythms.
An implantable defibrillator sends an electrical shock to the heart to help restore normal rhythm.
Help keep your weight-loss resolutions by substituting tasty low-fat options for high-fat ingredients. For example, fruit purees such as applesauce can replace some of the oil or shortening in a recipe and add extra moistness. Try substituting one whole egg and two egg whites for every three eggs in a recipe. Nonfat regular or Greek yogurt can replace sour cream, and evaporated skim milk can add creaminess without the fat in many sauces.
ANSWER KEY: 1. A; 2. E; 3. A; 4. C; 5. B.
your heart health lifeline
0-25 years
25-40 years
uild a healthy body now. B Atherosclerosis begins in childhood. To reduce this fatty buildup in the arteries, cigarette smoke and obesity should be avoided or reduced.
Get moving. In 2013, only about 20 percent of American adults meet aerobic and strengthening exercise guidelines, while 32 percent do not engage in any regular physical 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.
The National Heart Foundation recommends that all adults age 45 and older have regular blood tests to check their cholesterol and triglyceride levels.
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. Take short walks or go for a bike ride during the day.
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 every 3 years after age 50
heart disease
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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. Losing just 5 to 10 percent of your weight can lower your heart disease risk.
For more information, call 706-721-2426 or visit gru.edu/cardio.
on our heart and vascular team Dr. Vishal Arora Interventional Cardiology Dr. Arora’s clinical interests include endovascular treatment of peripheral vascular disease, coronary artery interventions, coronary angioplasty, and stenting.
Dr. Vijay Patel Cardiothoracic Surgery Dr. Patel’s clinical interests include adult cardiac surgery, cardiac transplantation, cardiac mechanical assist devices, and lung transplantation.
Check out videos of our physicians and heart healthy tips at gru.edu/cardio.
Q&A Are athletes at higher than normal risk of sudden cardiac death? No. When a high-profile athlete suddenly dies, the news makes headlines. Athletes are not necessarily at increased danger for sudden cardiac death. Actual risk factors include a history or family history of arrhythmias, obesity, and recreational drug use. Because athletes push their bodies to the limit, it’s important for them to be screened for heart disease risk factors. But being athletic doesn’t increase the danger. People who have been diagnosed with certain heart rhythm abnormalities may be advised against playing strenuous or competitive sports. The decision is best made between the patient and his/her physician.
Sudden Cardiac Death in Sports n
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he No. 1 killer of young athletes is T sudden cardiac arrest. young athlete dies from a cardiac A incident once every three days in the U.S. I t is usually due to a pre-existing condition, such as an undetected structural heart defect or a problem with the heart’s electrical circuitry, which could have been treated.
What dietary changes can I make for a healthy heart?
breaking news
A study published in the American Journal of Respiratory and Critical Care Medicine links severe obstructive sleep apnea (interrupted breathing during sleep) to an increased risk of cardiovascular disease. The study monitored sleep patterns of 1,645 middle-aged or older participants, none of whom had heart disease or heart failure before the study. The study found a link between obstructive sleep apnea (OSA) and an increased level of high-sensitivity troponin T. According to the researchers, heart disease and heart failure can be predicted by this increased risk, suggesting that treating OSA and measuring hs-TnT levels in patients with OSA may prove beneficial.
When medications fail
A
trial fibrillation, the most common type of rapid heartbeat, occurs when the heart’s electric signals go awry, causing the top chambers to quiver in a quick, irregular rhythm. “The condition can result from high blood pressure, heart disease, or unknown causes,” says Adam Berman, MD, a cardiac electrophysiologist, or heart rhythm specialist, with Georgia Regents Heart & Cardiovascular Services.
Increased risk of stroke Without treatment, atrial fibrillation decreases blood flow to the body and increases a patient’s risk of stroke by a whopping fivefold. “Blood can pool in the heart’s upper chamber, causing clots to form. These clots can break off and travel to the brain,” Dr. Berman says. One of the primary goals of treatment is to prevent the formation of clots.
Medications may help
You know you should eat healthy, but how? Start by adding more fruits and vegetables to your diet. Whole, fresh, or minimally processed foods are best, and use herbs, spices, and heart-healthy oils instead of salt and butter for seasoning. Try substituting fiber-rich grains and legumes for meat in some dishes, and limit processed foods, saturated fats, and sugar-sweetened beverages.
Better sleep, healthier heart
treating atrial fibrillation
Say ‘no’ to trans fats The Food and Drug Administration (FDA) is stepping up its efforts to get food manufacturers to stop using partially hydrogenated oils (PHOs, or trans fats) by issuing a statement that PHOs are no longer “generally recognized as safe.” If finalized, PHOs would come under further scrutiny as a food additive. The FDA estimates that ridding the U.S. food system of trans fats would prevent 20,000 heart attacks and 7,000 deaths from heart disease in the U.S. each year.
People with atrial fibrillation often take blood thinners to reduce the risk of clots, as well as medications to slow the heart rate. But when these fail, Georgia Regents Cardiovascular Center offers the area’s only Stereotaxis® Remote Magnetic Navigation system. This advanced technology allows physicians to ablate, or destroy, the tissue causing the arrhythmia.
The Stereotaxis difference Traditional cardiac ablation relies on stiff catheters pushed through the heart to map the cardiovascular system and deliver therapy. But these catheters cannot be used in thinwalled areas of the heart, including those where atrial fibrillation originates, because they could perforate sensitive tissue. With Stereotaxis, physicians use software and a control panel to drive powerful magnets positioned near the patient to create a 3-D map of the heart. The magnets then safely guide a soft catheter through the heart, allowing the physician to position it exactly where therapy is required. “This gives us safe access to areas of the heart that we could not reach before,” Dr. Berman says. “As a result, many patients with atrial fibrillation and other arrhythmias can have their normal heart rhythm restored and resume their active lives.”
To learn more, visit gru.edu/cardio, or to make 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 © 2014 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.
spotlight
Dr. Adam Berman Cardiovascular Electrophysiology Dr. Berman’s clinical interests include complex arrhythmia ablation, including ablation for atrial fibrillation and ventricular tachycardia. He also specializes in the implantation and management of cardiac resynchronization therapy devices for congestive heart failure.