Heart Health

Reversing the effects of the new anti-clotting drugs

Samuel Z. Goldhaber, MD
Samuel Z. Goldhaber, MD, Contibuting Editor

Anticoagulants — drugs that reduce the blood’s ability to clot — are used to treat clots in the lungs and legs and to prevent strokes in people with the heart rhythm abnormality called atrial fibrillation. The anticoagulant warfarin has been used for these purposes for many years. But it is difficult and time-consuming to find the optimal warfarin dose, and it carries a risk of difficult-to-control bleeding. Newer anticoagulants offer an easier and equally effective way to control the blood’s clotting ability, but until recently, there was no way to reverse the effects of these drugs if necessary. The approval of new antidotes to these newer anticoagulants will enable doctors to prescribe these drugs with increased confidence.

Exercise: You may need less than you think

Gregory Curfman, MD
Gregory Curfman, MD, Editor in Chief, Harvard Health Publications

Getting regular physical activity is one of the most important things one can do to protect and promote health, yet many people say they don’t have time to exercise. A recent study has confirmed that even a little exercise — just 8 to 15 minutes a day — reduced the risk of death. When it comes to exercise, some is always better than none.

Do statins interfere with the flu vaccine?

John Ross, MD, FIDSA
John Ross, MD, FIDSA, Contributing Editor

The statin drugs are very effective at reducing LDL (“bad”) cholesterol and may also reduce inflammation throughout the body. Both of these properties can reduce the risk of cardiovascular problems. At the same time, research — some of it conflicting — suggests that statins may also affect the body’s immune system. In particular, they may dampen the response to vaccines.

The very high cost of very low cholesterol

Gregory Curfman, MD
Gregory Curfman, MD, Editor in Chief, Harvard Health Publications

The FDA recently approved two new drugs that quickly and effectively lower LDL cholesterol levels. This exciting development is tempered by the very high cost of these drugs. These costs can even trickle down to others on the same insurance plan as people taking these new drugs. Several politicians and institutions have spoken out against these high costs, but it is unlikely that the prices will be lowered anytime soon. For now, these drugs should be reserved only for those whose other efforts to reduce LDL have been unsuccessful.

Update on the SPRINT trial: Preliminary results pan out

Deepak Bhatt, MD, MPH

Formally published results of the SPRINT trial confirm the early conclusions released in September. A target systolic blood pressure (the top number) of 120 mm Hg or less offers real health benefits, including a lower risk for cardiovascular problems and even death. Even if you don’t have high blood pressure, the results are so compelling that everyone should know his or her blood pressure and develop a plan with a primary care physician to achieve and maintain the “ideal” blood pressure for them.

Overweight children are at risk for heart disease as adults

Nandini Mani, MD
Nandini Mani, MD, Contributing Editor

In a recent study of nearly 9,000 overweight and obese children and teens, doctors found that these young people had concerning blood pressure readings and worrisome cholesterol and blood sugar levels. In adults, such test results suggest a much higher risk for heart disease — so they are of particularly great concern in children. The good news is that with help and support, kids can lose weight — the results are a healthier, happier childhood and a greater chance of a healthier, longer adult life.

“Stress” cardiomyopathy: A different kind of heart attack

Deepak Bhatt, MD, MPH

The expression “you almost gave me a heart attack” is often used to express sudden shock or surprise. In fact, there is a specific type of heart attack commonly linked with sudden emotional stress. It is called takotsubo cardiomyopathy. Although it was once believed to be less harmful than a “typical” heart attack (which is caused by a lack of blood flow to the heart muscle), doctors are now learning more about this condition and finding that it can be just as dangerous for patients as the more common type of heart attack. More research is needed to learn how to best care for people with takotsubo cardiomyopathy and lower their risk for future heart problems.

Standing up for better heart health

Nancy Ferrari
Nancy Ferrari, Senior editor, Harvard Health

Spending less time sitting and more time standing lowers blood sugar, cholesterol, and weight — all of which translates into a lower risk for heart disease. So says a study of Australian adults published in the July 30 issue of the European Heart Journal. Every two hours a day spent sitting was associated with an increase in weight and waist size, as well as in levels of blood sugar and cholesterol. As you might expect, time spent walking rather than sitting not only lowered cholesterol and blood sugar levels, but also reduced waist size and weight. Simply substituting two hours of standing for sitting also improved blood sugar and cholesterol levels. By making slight changes in your lifestyle to incorporate more standing, you could add important health benefits.

A promising new treatment for high triglycerides

Gregory Curfman, MD
Gregory Curfman, MD, Editor in Chief, Harvard Health Publications

Say “fat in the bloodstream” and most people think of cholesterol. But there’s another type of fat shouldn’t be ignored: triglycerides. High triglycerides can increase the risk of having a heart attack. Existing drugs lower triglycerides, but aren’t that good at preventing heart attacks. That’s why a report on a new way to lower triglycerides, published in today’s New England Journal of Medicine, is generating some excitement among cardiologists. The new approach uses weekly injections of “antisense oligonucleotides,” or ASOs. These are pieces of DNA that short-circuit the liver’s production of triglycerides. The NEJM report shows that ASOs can reduce triglyceride levels by as much as 70%. Keep in mind that this was a phase 2 trial, which is designed to test whether a drug does what it is supposed to do (in this case, lower a person’s triglyceride levels). Larger, longer-term studies will be needed to see whether ASOs actually reduce the risk of heart disease, and what sorts of side effects they cause.

CPR during cardiac arrest: someone’s life is in your hands

Daniel Pendick
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch

Cardiac arrest is the ultimate 911 emergency. The heart stops sending blood to the body. Death occurs in minutes — unless a bystander takes matters into his or her hands and starts cardiopulmonary resuscitation (CPR). This keeps blood circulating until trained and better-equipped first responders arrive on the scene to jump-start the heart back into a normal rhythm. Two new studies in JAMA provide compelling proof that efforts to train people to do life-saving CPR pay off. Many organizations sponsor CPR and AED training programs. Two notable ones are the American Heart Association and the American Red Cross. Many local departments of public health also provide CPR training, including “friends and family” classes for people close to someone at risk of cardiac arrest. The investment of time and effort to learn CPR is small. The potential payoff — saving a life — is huge.