Harvard Health Blog
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.
Coronary artery bypass surgery (CABG) offers a new lease on life for thousands of people each year. But it has also been blamed for “brain fog,” a loss of memory and thinking skills that follows the procedure in some people. Such brain problems are often called “cognitive impairment.” But the operation itself may not be to blame, according to a review in today’s Annals of Internal Medicine. A team of mostly Veteran’s Affairs researchers concluded that intermediate and long-term cognitive impairment after cardiovascular procedures “may be uncommon.” That said, they recommend that anyone thinking about open-heart surgery or other large cardiovascular procedure should discuss with the surgeon the possibility of cognitive impairment.
The latest guidelines used to determine who should take a cholesterol-lowering statin to prevent heart disease appear to be more accurate and cost-efficient than the previous guidelines. That’s according to two studies led by Harvard researchers, both published in this week’s Journal of the American Medical Association. The new guidelines, published in 2013 by the American College of Cardiology and the American Heart Association, recommend a statin for men and women between the ages of 40 and 75 who have a 7.5% or higher risk of having a heart attack or stroke over the next 10 years. The JAMA studies show that the new guidelines provide a more accurate assessment of who would benefit from a statin and who wouldn’t, and are more cost-effective than the older guidelines. Statins aren’t a cure-all. Eating a healthier diet, exercising often, and not smoking will go a long way to preventing heart attack and stroke.
Back in 2005, the FDA warned that taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen increased the risk of having a heart attack or stroke. Last week it took the unusual step of further strengthening this warning. This was done on the advice of an expert panel that reviewed new information about NSAIDs and their risks. Because NSAIDs are widely used, it’s important to be aware of downsides of taking an NSAID and to take steps to limit the risk. The new warnings point out that heart attack and stroke risk increase even with short-term use, and the risk may begin within a few weeks of starting to take an NSAID. The risk increases with higher doses of NSAIDs taken for longer periods of time. The risk is greatest for people who already have heart disease, though even people without heart disease may be at risk.
Like millions of Americans, I plan to fire up the grill today for a Fourth of July cookout. But I’ll be adding an extra step to my routine: checking the grate for bristles that may have fallen off my cleaning brush. An article in this week’s Morbidity and Mortality Weekly Report describes six people injured by consuming grill-cleaning bristles hidden in grilled meat. Three had abdominal pain from wire bristles poking through the small intestine or colon. Three others had bristles stuck in the neck. All of the wire bristles were safely removed with open surgery or laparoscopy (“keyhole” surgery). The same team had published a report of six other cases earlier this year in the American Journal of Roentgenology. Twelve cases from one medical center over a three-year period does not an epidemic make. But it’s enough to suggest that ingesting wire bristles happens wherever home grilling is going on. Keep your grill bristle free by using a brush that’s in good shape. After you use a brush to clean your grill rack, use a towel or wadded up bunch of paper towels to wipe it down.
People with allergies to grass pollen may have cheered last year when the FDA approved a no-needles treatment —a daily tablet you dissolve under your tongue. These tables deliver low doses of grass pollen to the bloodstream. This is done to “teach” the immune system not to wage war on grass pollen. It turns out that these tablets don’t work that well. An analysis of 13 controlled clinical trials indicates that dissolvable tablets are only slightly more effective than placebos in curtailing classic symptoms of grass pollen allergy—runny nose, itchy eyes, and tickly throat. To make matters worse, more than 60% of people who used the tablets experienced irritating side effects.
Heart attack, stroke, and other cardiovascular diseases kill nearly three-quarters of a million Americans each year. They are the leading cause of death, accounting for nearly 30% of all deaths in the United States. But according to a new study published online yesterday in the Annals of Internal Medicine, many of these deaths can be prevented. Researchers from the Rollins School of Public Health at Emory University in Atlanta estimated that eliminating five key risk factors for cardiovascular disease — smoking, high cholesterol, high blood pressure, type 2 diabetes, and obesity — would prevent more than half of all U.S. deaths from cardiovascular disease. Realizing that elimination may not be possible, they asked what would happen if, as a nation, we were able to do as well as the residents of the best-performing states. The result was a more modest 10% reduction in cardiovascular disease–related deaths.
Blood clots can be lifesavers when they form outside the bloodstream to stop bleeding from an injury. But they can wreak havoc when they form inside the bloodstream. A blood clot in a coronary artery can cause a heart attack. One in the brain can cause a stroke. Blood clots that form in a leg vein cause a problem known as venous thromboembolism, or VTE. If the clot stays in the leg, it can cause swelling or pain. If it breaks away and travels to the lungs, it can cause a potentially deadly pulmonary embolism. In about half of people who develop a VTE, doctors can identify what caused it. In the other half, VTE is something of a mystery. These are called “unprovoked” VTEs. Such unprovoked VTEs often spark a search for hidden cancer. But a study published in The New England Journal of Medicine suggests that these searches are usually fruitless — and costly.
When kids pack for summer camp, sunglasses may not always top the supply list. But I made them a priority for my 12-year-old son Carson, who just started rowing camp in Florida, because eyes are vulnerable to damaging ultraviolet rays, which are especially intense near reflective surfaces. Ultraviolet rays can damage the eyes several way, ultimately leading to cataract, glaucoma, macular degeneration, and other thieves of vision. You don’t have to spend a bundle to get a good pair of sunglasses. Just make sure to pick ones that block close to 100% of ultraviolet A and ultraviolet B (UVA and UVB) rays.
Young adults with even slightly above-normal blood pressure may be more likely to have heart problems later in life, according to a new study in the Journal of the American College of Cardiology. The study focused on nearly 2,500 men and women who were 18 to 30 years old when the study began and whose health was followed for 25 years. Those with slightly high blood pressure, a condition known as prehypertension, were more likely to have had signs of heart disease in middle age. Echocardiograms showed they were more likely to have developed problems with the heart’s left ventricle.