Hypertension and Stroke
It’s been a topsy-turvy few days in the world of heart health and disease. Last week, the American Heart Association and American College of Cardiology released new guidelines that upended previous recommendations for who should take a cholesterol-lowering statin. A few days later, two Harvard physicians challenged the accuracy of the calculator included in the guidelines, saying it would cause many people to unnecessarily take a statin. The story made headlines in The New York Times and prompted a closed-door review by the guidelines committee. The controversy over the calculator should serve to improve this tool. Adoption of the guidelines should help prevent more heart attacks, strokes, and premature deaths. It’s important to keep in mind that guidelines are just that—information to guide a decision, not to mandate it. The best approach is to talk about what’s best for you with a trusted physician.
Updated cholesterol guidelines released yesterday by the American Heart Association and American College of Cardiology aim to prevent more heart attacks and strokes than ever before. How? By increasing the number of Americans who take a cholesterol-lowering statin. The previous guidelines, published in 2002, focused mainly on “the numbers”—starting cholesterol levels and post-treatment levels. The new guidelines focus instead on an individual’s risk of having a heart attack or stroke. The higher the risk, the greater the potential benefit from a statin. A statin is now recommended for anyone who has cardiovascular disease, anyone with a very high level of harmful LDL cholesterol, anyone with diabetes between the ages of 40 and 75 years, and anyone with a greater than 7.5% chance of having a heart attack or stroke or developing other form of cardiovascular disease in the next 10 years.
Today is World Stroke Day. It offers a good reminder of the profound impact that stroke has on individuals and communities. Nearly 800,000 Americans have strokes each year. Worldwide, one in six adults will have a stroke during their lifetime. Although most survive, stroke is a leading cause of disability in the United States and many other countries. A report published last week in The Lancet documents a troubling trend: more and more young people are experiencing strokes. Between 1990 and 2010, the number of strokes among people aged 20 to 64 years increased 25%. This age group now accounts for one-third of strokes worldwide. Some stroke survivors recover fully and regain their previous levels of function. Others don’t. Keys to full recovery include rapid identification of stroke symptoms, immediate evaluation and treatment, early rehabilitation, and support
Getting the flu shot may do more than protect against the flu and its lingering aftermath. It also lowers a person’s odds of a having heart attack, stroke, heart failure, or other major cardiac event—including death—by about a third over the following year. What’s the connection between flu and cardiovascular problems? The body mounts an impressive immune response against the flu. That causes a lot of inflammation, which destabilizes cholesterol-filled plaque inside blood vessels. Plaque rupture can cause a heart attack or stroke. Experts recommend a flu shot for everyone six months of age and older. It is especially important for those who face the highest risk of complications: young children; adults over age 50; those of all ages with serious health conditions such as cardiovascular disease, asthma or other lung disease, liver or kidney disease, or diabetes; and those who care for young children or other individuals at high risk of flu complications.
The ability of today’s electronic books to display videos, images explained by a spoken voice, animations, interactive tools, and quizzes gives doctors new ways of explaining things. Harvard Health Publications and Orca Health have created a series of ten interactive iBooks focused on heart disease. Currently, these are available only as iBooks. Need to know what happens in the heart when a heart attack is underway, how doctors open up cholesterol-clogged arteries, or how to cope with the irregular heart rhythm known as atrial fibrillation? The answers are in these iBooks. They let users view the heart in ways and detail they’ve never seen before to learn about common heart conditions and procedures.
It’s easy to think of heart disease and stroke as an almost inevitable part of aging in a developed country like the United States. After all, they are our leading causes of death and disability. But the truth is that these are largely preventable conditions. New estimates from the Centers for Disease Control and Prevention (CDC) indicate that one-quarter of all deaths from heart disease and stroke are preventable. And that is almost certainly an underestimate. According to the report, published in Morbidity and Mortality Weekly Report, among American adults under age 75, approximately 200,000 of deaths caused each year by heart disease, stroke, and high blood pressure (hypertension) are preventable. Surprisingly, more than half of those preventable deaths occurred among individuals under age 65. The good news is that the rate of preventable death declined 29% from 2001 to 2010, the last year for which there are complete statistics.
Do-it-yourselfers, take heart. Here’s something else to do at home that can have a substantial benefit on your health: measure your blood pressure. It’s easy, inexpensive, and helps control blood pressure better than visits to the doctor. The latest evidence for the benefits of home blood pressure monitoring comes from researchers in Minnesota. In a 12-month clinical trial, 72% of those doing home monitoring had their blood pressure under control compared to 57% who received usual care. The benefits persisted six months after the program had ended. Anyone can monitor blood pressure at home. You can buy a good home blood pressure monitor at a pharmacy or online merchant for anywhere from $50 to $100. Some insurance companies cover the cost.
There’s something gratifying about volunteering. Whenever I work a charity event—which I try to do with some regularity—I often get more out of it than I give. A new study suggests that volunteering has positive implications that go beyond mental health, and may include better physical health. They study, from Carnegie Mellon University, found that adults over age 50 who volunteered on a regular basis were less likely to develop high blood pressure than non-volunteers. High blood pressure is an important indicator of health because it contributes to heart disease, stroke, and premature death. It’s impossible for this study to prove that volunteering was directly responsible for the lower blood pressure readings, but the results are in line with other findings on the topic. Aristotle once surmised that the essence of life is “To serve others and do good.” If this line of research is any indication, serving others might also be the essence of good health.
My twice-daily walks with my border collie, Clair DeNoon, are the highlights of my day. A new report from the American Heart Association will put an extra spring in my steps on these walks. A panel of experts from the American Heart Association has weighed all the available evidence on pet ownership and cardiovascular disease. The verdict: Having a pet—a dog in particular—likely lowers the risk of heart disease. Some of the connection can be attributed to the extra walks dog owners take. Companionship also contributes. If dog ownership is heart healthy, should everyone who cares about heart health have a dog? No. According to the heart association panel, “the primary purpose of adopting, rescuing, or purchasing a pet should not be to achieve a reduction in cardiovascular risk.”
Salt is a cheap, easy way to turn on taste buds. That’s one reason why it’s in so many of the foods we eat. It’s so commonly used that most Americans consume more than double the recommended daily limit for it. Three new studies in BMJ (formerly the British Medical Journal) once again confirm the relationship between salt intake and health problems. They show that reducing salt intake can help lower blood pressure and lower the odds of having a heart attack or stroke or developing heart failure. They also show that consuming more potassium is also linked to lower blood pressure and lower risk of stroke. Current dietary guidelines recommend that Americans get no more than 1 teaspoon of salt a day. That’s the equivalent of 2,300 milligrams (mg) of sodium a day. Most Americans get much more than that. It’s possible to cut back by avoiding processed and packaged foods, using herbs and spices to season food instead of salt, and other strategies. It’s best to get potassium from food, especially fruits and vegetables. Green leafy vegetables, beans, and bananas have a lot of potassium.