Heart Disease Archive

Every year, an estimated 600,000 people in the United States develop a blood clot deep inside the leg, known as deep-vein thrombosis. These clots usually develop in the lower leg, thigh, or pelvis but occasionally the arm. The affected area may be tender or painful, swollen, red or discolored, and warm to the touch. If a clot breaks free and travels to a lung, it can cause a pulmonary embolism. Symptoms of a pulmonary embolism include difficulty breathing that happens suddenly, a fast or irregular heartbeat, coughing up blood, and chest pain or discomfort, which usually worsens with a deep breath or coughing.

Standard definitions consider a healthy body mass index (BMI), a calculation based on a person's height and weight, as between 18.5 and 24.9. Studies have found that a higher BMI increases risk for heart disease, diabetes, and some types of cancer. However, even if their BMI does not fall into the category of overweight, people who gain five or more pounds may be at risk for health problems, especially if the weight gain is belly fat. The best approach is a combination of aerobic exercise, strength training, and a healthy diet.

Tiny mesh tubes called stents, used to prop open heart arteries, can relieve stable angina (chest pain with exertion or emotional stress) in many people with coronary artery disease. But this treatment-which carries a risk of complications and a high cost-should be reserved only for people who don't get relief from drug therapy. Stents do not prevent future heart attacks or improve survival compared with drug therapy. Angina usually results from arteries that are more than 70% blocked, but most heart attacks occur in arteries that are narrowed by only about 40% or less but harbor plaque that ruptures without warning. The resulting blood clot blocks blood flow, triggering a heart attack.

Clinical trials are under way using gene therapy to treat inherited cardiovascular conditions, including familial hypercholesterolemia (one form of abnormally high cholesterol), hypertrophic cardiomyopathy (a type of heart muscle disease), and transthyretin amyloid cardiomyopathy (a form of heart failure resulting from amyloid deposits). But challenges remain in developing and delivering these therapies.

Treatments for angina include medications to lower LDL cholesterol to very low levels to help reduce artery-narrowing plaque. Drugs that slow the heart rate and widen arteries can improve symptoms.

Indirect evidence suggests that for people with atrial fibrillation who always take apixaban (Eliquis) every 12 hours as prescribed, it may be slightly better than once daily rivaroxaban (Xarelto).

When people with atrial fibrillation sleep poorly, they may be more likely to have an episode of atrial fibrillation the next day, according to a 2023 study.

The portfolio diet, which emphasizes foods rich in fiber and healthy fats, helps lower LDL cholesterol. A 2023 study suggests that the more closely people follow the diet, the lower their risk of cardiovascular disease. The diet discourages foods from animal sources and features foods from five main categories, including (1) plant protein such as legumes; (2) nuts and seeds; (3) foods rich in viscous fibers such as oatmeal, eggplant, and berries; (4) plant sterols such as phytosterol-enriched margarine; and (5) monounsaturated fats such as olive and canola oils.

The weight-loss drug semaglutide is the first obesity treatment shown to help people live longer and have fewer cardiovascular problems. Developed as a drug for type 2 diabetes, semaglutide was first marketed as Ozempic; a higher-dose version for weight loss is called Wegovy. But because the drug is so popular, it can be hard to find, and it might not be covered by insurance.

A nonsurgical approach for replacing a damaged aortic valve, known as transcatheter aortic valve replacement (TAVR), has become very popular in recent years. But it may not make sense for people in their 60s, who are likely to need a second valve replacement later in life. The valves used in TAVR only last about 10 years, on average. In addition, diagnosing and treating coronary artery disease may be more challenging in people who've had TAVR. Also, the surgery to replace a failed TAVR valve is more complicated than regular valve replacement surgery. So people who are likely to need least one traditional valve surgery are better off having the surgery in their 60s rather than in their 70s. A TAVR can be done the second time around.