cardiac HEALTH ON TIME FALL 2015
Inflammation: The Heart of The Matter INFLAMMATION OF THE ARTERIES MAY INDICATE FUTURE HEART ATTACKS AND STROKES
RECENT 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 indicate underlying degrees 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 as the bottom one-third with the lowest levels of the protein. 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 can 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 a 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 under way 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 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.
THE INFLAMMATORY THEORY Inflammation is part of the body’s response to infection, but new research suggests it also may cause heart disease when the immune system mistakes certain fats for germs and attacks them. LDLs — molecules carrying cholesterol — accumulate in the artery, change chemically and attach to artery wall. Immune system is alerted and sends white blood cells, which normally ingest germs and send out chemicals to kill them. White blood cells swallow LDLs, turn into foam cells filled with fatty LDL droplets and form plaques on artery walls. Foam cells fatten and release free radicals, creating more LDLs; immune system sends more white blood cells. Ongoing inflammation can make plaque rupture and release debris that can form a blood clot blocking the artery and causing a heart attack.
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Coronary artery New LDLs
White blood cell
Plaque
Foam cell
New LDLs
Rupture
Source: Scientific American
Coronary Calcium Scan 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 706-721-2426 or visit grhealth.org/cardio.
GRHealth partners with American Heart Association on Life is Why campaign GRHealth is the first-ever sponsor of the American Heart Association’s (AHA) Life is Why campaign in the CSRA, one of only a few partnerships of its kind in the nation. As the area’s only academic medical center, GRHealth offers comprehensive primary, specialty and subspecialty care for patients and has demonstrated its commitment to its employees’ wellness. With this groundbreaking new partnership,
GRHealth is expanding its efforts to improve heart and finance and chief business officer at GRHealth health in the CSRA region, as well. and Georgia Regents University. “The American In collaboration with the AHA, GRHealth will Heart Association has been a major supporter of our use this marketwide sponsorship, which supports cardiovascular research, which translates to providing research funding and all AHA campaigns and better patient care. We’re excited to continue to activities in the region, to help with advancing the reinvest that in the heart health of our employees, mission of the AHA — to build healthier lives free students and community.” (Learn more about the of cardiovascular diseases and stroke. GRHealth is work of the American Heart Association on page 4.) planning mission-focused events throughout the year to TM help educate the entire CSRA community about heart disease and stroke prevention. Life is Why is a new national campaign that emphasizes the “We’re honored to partner emotional connection to the work of the American Heart with the American Heart Association (AHA). The campaign encourages people of all Association in this expanded ages, ethnicities and backgrounds to consider what or who capacity this year,” said they are living for and turn that into their personal motivation Anthony E. Wagner, executive for making small changes in their lifestyles, adding up to vice president of administration healthier, happier and longer lives with the ones they love.
ABOUT LIFE IS WHY
For more information on Life is Why or to share your “why,” visit heart.org/lifeiswhy. GRU-018
Georgia Regents University 1120 15th St., AD 1114 Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID GEORGIA REGENTS UNIVERSITY
HEARTS AT RISK How Angioplasty Is Saving Lives 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.
Who needs it?
People who need angioplasty have coronary artery disease, a condition caused by atherosclerosis. Angioplasty is also an effective, lifesaving emergency treatment for a heart attack.
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 sidebar on drug-eluting stents below.)
Coronary Artery
Plaque
955,000 angioplasties were done in the United States in 2010; 642,000 for men and 313,000 for women.
Plaque
Artery Cross-section Closed Stent
Catheters
Expanded Balloon
Widened Artery
Narrowed Artery
According to the American Heart Association’s Heart Disease and Stroke Statistics
Compressed Plaque
Expanded Stent
Increased Blood Flow
Widened Artery
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 drugcoated 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 uncoated, bare metal stents.
Call 706-721-2426 to request a same-day appointment with GRHealth Heart & Cardiovascular Services.
COMING SOON: NEW PROGRAM AND CLINIC FOR COMPLEX, HIGH-RISK PATIENTS GRHEALTH’S HEART & CARDIOVASCULAR SERVICES will soon have a dedicated interventional cardiology program and clinic focusing on high-risk patients, specifically those who suffer chronic total occlusion (CTO) — or complete blockage of the coronary artery, which supplies blood to the heart. The interventional cardiology team at GRHealth treats CTOs with angioplasty, a nonsurgical procedure during which a cardiologist feeds a deflated balloon or other device on a catheter from an artery in the groin or wrist through blood vessels to the blockage. When the catheter reaches the blockage, the balloon is inflated to open the artery, which allows blood to flow. The cardiologist will often place a stent at the site of blockage to permanently open the artery. For many years, GRHealth has been a leader in interventional cardiology, offering the most experience in the region by opening totally blocked coronary arteries. For the past three years, the team has taken on high-risk patients with complex conditions as well as blocked coronary arteries. The new clinic location and schedule will be announced, so feel free to call 706-721-2426 for updates.
ARE YOU STRESSED? friends
family
Practice Risk Reduction
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.
MANY FIRST HEART ATTACKS and strokes are fatal, so it’s important to know your risks. At GRHealth 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.
To schedule an appointment, call 706-721-2426.
work
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.
1
1 Also known as “bypass surgery,”
2
a coronary artery bypass graft operation uses a piece of vein taken most often from the leg (called the saphenous vein).
2 The vein is attached to the
heart artery above and below the narrowed area, thus making a bypass around the blockage. Sometimes, more than one bypass is needed.
Be proactive about your health! Visit us online at grhealth.org/cardio, or call 706-721-2426.
Heart Image: BSIP/Science Source
WHEN ANGIOPLASTY ISN’T POSSIBLE
PATIENTS WITH PULMONARY EMBOLISM TO BENEFIT FROM NEW DEVICE AT GRHEALTH
Q&A
In March, Timothy Yoch visited GRHealth for a follow-up appointment for the urologic surgery he underwent to treat prostate cancer. During his visit, he suddenly started to experience shortness of breath and his left leg was swollen. A sonogram showed blood clots, which resulted in pulmonary embolism. Pulmonary embolism is a potentially life-threatening condition that occurs when a blood clot travels from veins in the legs, usually, to one or more veins in the lungs. Early detection and treatment of this condition can greatly reduce the chance
ASK THE EXPERTS ABOUT IMPORTANT HEALTH ISSUES
HEART ATTACK SYMPTOMS
Are the symptoms of heart attack different in women than in men? Oftentimes, yes. Men are more likely to experience severe chest pain or pain that radiates to the left arm. For women, the symptoms can be the same, but d ifferences can 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.
Pain in the neck or upper back
Pain or discomfort in one or both arms, radiating downward
Feelings of anxiety and lightheadedness Exertional breathlessness, often without chest pain of any kind Nausea, sweating or sudden flu-like symptoms
How much exercise do I need each week to lower my risk for heart disease? 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.
of death. For large clots, the traditional treatment is to give clot-busting drugs through the veins in the arm to break up the clots. However, many patients cannot have this therapy due to high risk of bleeding. Dr. Vishal Arora, an interventional cardiologist and vascular medicine specialist at GRHealth, successfully treated Yoch with catheter-directed thrombolysis (a new procedure available at GRHealth) as well as IVC filter placement to prevent more clots from going to his lungs. This special catheter, which is a hollow tube that delivers medicine with ultrasound energy, is designed specifically for patients with pulmonary embolism. The catheter tip is placed in the blood clot so the medicine can be delivered directly to break it up. Use of this catheter has resulted in fewer bleeding complications in certain patients. For patients who wouldn’t benefit from clot-busting medicine, special equipment is used to suck the clot out of the arteries in the lungs and restore blood flow. “Since February 2014, when I was diagnosed with prostate cancer, and through my treatments for pulmonary embolism, everyone has treated me very, very well and has been concerned about me,” Yoch said. Months later, Dr. Arora removed the filter, and Yoch has been doing well since. He even quit smoking and chewing tobacco. “Once I make my mind up to do something, I follow through,” Yoch said.
Vishal Arora, MD Interventional Cardiologist
Dr. Arora is board certified in internal medicine, cardiovascular medicine, interventional cardiology, endovascular interventions, echocardiography and nuclear cardiology. He practices general and interventional cardiology and vascular medicine. His clinical interests include endovascular treatment of peripheral vascular disease and coronary artery interventions, and his research interests include peripheral arterial disease and endovascular interventions. Arora completed an interventional cardiology fellowship at the University of Virginia in 2007, a cardiology fellowship at the Medical College of Georgia (MCG) in 2006 and an internal medicine residency at MCG in 2003.
HEALTHY NEWS Ups and downs
No sleep? No good!
A study published 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 nearly 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.
A study published 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.
ABOUT THE AMERICAN HEART ASSOCIATION The American Heart Association is devoted to saving people from heart disease and stroke, the two leading causes of death in the world. The organization teams with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest volunteer organization dedicated to fighting heart disease and stroke.
Be proactive about your health! Visit us online at grhealth.org/cardio, or call 706-721-2426.
Copyright © 2015 GLC, Skokie, IL 60077 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.
Timothy Yoch received lifesaving treatment for pulmonary embolism.