Harvard Heart Letter: August 2008

Drug-coated stents were thought to cause a higher occurrence of thrombosis (clots) compared to bare-metal stents, but further research has shown the incidence to be about the same. Many people with a blocked artery could benefit from a drug-coated stent.

An echocardiogram creates images of the heart using sound waves. It can reveal a great deal of information useful to doctors in treating heart patients.

People with hypertension should be tested for diabetes. Treating both conditions with lifestyle changes (exercise, weight loss, quitting smoking) can substantially reduce the risk of a heart attack or stroke.

A hopeful outlook can help heart failure sufferers live with the condition, but hope must be tempered by reality in order to achieve a clear understanding of the limits of treatment.

Inflammation from rheumatoid arthritis, lupus, or gout has been linked to an increased risk of heart disease. Drugs are being tested, but the current advice is to exercise, eat a healthy diet, and control weight, blood pressure, and cholesterol.

Many people do not realize that smoking is as bad for cardiovascular health as it is for the lungs. Quitting has some almost-immediate benefits, and after 20 years quitters have the same risk of death as nonsmokers.

The recommendation to take beta blockers before noncardiac surgery is now tempered by the information that the drug should be started a few days prior to surgery.

While the DASH diet helps people lower their blood pressure and reduce the risk of heart disease, fewer people are following it.

Brief updates on a warfarin information booklet, a possible link between loop diuretics and bone loss, and a drug for peripheral artery disease that may also help prevent strokes.

I need to catheterize myself. I had stents put in my heart and started taking Plavix. I sometimes see a tinge of blood in the catheter bag, though lately the blood flow has been more substantial. I am 88 years old. How long will I need to take Plavix?

I had stents placed. My doctor told me to take Plavix and aspirin indefinitely. Now I need a hernia repair. My surgeon said to stop taking the drugs before the operation. My cardiologist says that would increase my chance of a clot in one of the stents.

I often get mail from companies like Life Line Screening about having tests to look for "hidden" heart risks. The events are usually held at a local church and cost about $130. Are these tests valid? Are they worth the money?

My doctor put me on a calcium-channel blocker, but after I had angioplasty and got a stent, my doctor switched me to sotalol. Now I feel tired all the time and have gained weight, even though I feel like I'm eating less. Can this be from the sotalol?

The leads of implanted cardiac devices can break or become infected over time. If this happens, the leads must be replaced. A defective lead can be left in the heart, but it is considered safer to have it removed.

After a heart attack, getting prescriptions filled and taking the medications consistently is crucial. Those who do not do so are at a much higher risk of dying within the year following an attack.