Heart Health Archive

If you are trying to keep a lid on your sodium (salt) intake, keep an eye on everyday foods. Bread, cold cuts, pizza, and poultry were the four leading sources of sodium in the American diet in 2007–2008, according to a report from the Centers for Disease Control and Prevention (CDC).

Bread and rolls usually don't taste salty. But since we eat them so often, a hundred milligrams here and another hundred there add up.

Atrial fibrillation—the rapid and ineffectual quivering of the heart's upper chambers—dramatically increases a person's risk of having a stroke. In fact, doctors estimate that about 15% of all strokes arise from atrial fibrillation. But a even greater proportion of strokes—25%—have no known cause. A new study suggests that hidden atrial fibrillation could account for many of these strokes as well.

Doctors use the term "subclinical" to describe a disease that's hidden. People don't feel any symptoms of it, and nothing abnormal shows up in routine medical tests. But it's there.

Q. What's the current status of homocysteine as a risk factor for heart disease?

A. Homocysteine is a byproduct of digestion found in everyone's blood. "Normal" levels of homocysteine range from 5 to 15 micromoles per liter (?mol/L). People with levels of 50 or higher are at increased risk of cardiovascular events. A very few families have genetic defects that raise their levels to well over 100. In these families, even children younger than 10 can develop atherosclerosis and die of a heart attack or stroke.

Q. A few years ago, I switched from regular soda to diet soda—and lost 12 pounds. My husband tells me diet soda is bad for me, but isn't it better than the sugary stuff?

A. It's great that you stopped drinking sugar-sweetened soda and trimmed down. Soft drinks and other sugar-sweetened beverages are major contributors to weight gain and other bodily changes that increase the risk for cardiovascular disease. But it's not clear whether diet soda is better.

Blame it on our Puritan heritage, medical naysayers, or even nagging newsletters. Whatever the cause, many people share the view that anything that feels good or tastes good must be bad for you. Recent studies have exonerated coffee and others say that dark chocolate, nuts, and moderate amounts of alcohol may actually be beneficial. But people still worry that every pleasure has its price.

Sugar is a case in point. Perhaps because sweet foods and drinks have universal appeal, sugar has long been a target for the food police. Tooth decay is a common indictment, but sugar lovers can fight back by brushing diligently and practicing meticulous dental hygiene. When a guy with a sweet tooth hears that sugar provides only empty calories, he may simply pledge to redouble his intake of nutrient-rich foods. Although worries about obesity and diabetes have been harder to shrug off, they've failed to curb America's appetite for sweets. But new research may make it tough to stay sweet on sugar, since it links sugar with an increased risk of heart disease.

Increases in blood sugar levels

The safety information for statins now says that increases in HbA1C and fasting serum glucose levels have been reported. HbA1C is a blood test that reflects average blood sugar levels; serum glucose is just another way of saying blood sugar.

Less frequent testing or home monitoring may be options.

Despite the recent FDA approval of easier-to-use anticlotting drugs, millions of Americans continue to take warfarin (Coumadin, Jantoven, generic) to prevent dangerous blood clots. The most worrisome clots—which can cause a stroke or potentially fatal shutdown of lung function—arise from atrial fibrillation, deep-vein thrombosis, or the presence of an artificial heart valve.

Clogged gut arteries can cause pain—and much worse.

The heart's arteries are common hiding places for cholesterol-filled plaque and blood clots. Plaque can limit blood flow during exercise or stress, causing the chest pain or pressure known as angina. Clots can completely block blood flow, causing a heart attack or cardiac arrest. These two perpetrators can do similar things elsewhere in the body. When they interfere with blood flow to the digestive system, the effects can range from a stomachache after every meal to a life threatening emergency.

This increasingly common disorder often goes undetected in women until serious problems arise.

Older women are learning that cardiovascular disease isn't confined to the chest. Atherosclerosis, once known as "hardening of the arteries," is the disease process at the root of most cardiovascular problems. It affects not only the vessels that feed the heart but also those that serve the rest of the body. When atherosclerotic plaque and blood clots reduce blood flow to the legs or, less often, to the arms, the condition is called peripheral artery disease (PAD). PAD makes walking painful and slows injury healing. In the worst cases, it can result in the loss of a toe, foot, or leg — or even death.

Asking "Is this really necessary?" is always appropriate.

By Thomas Lee, M.D.
Editor in Chief, Harvard Heart Letter

Among the many uncertainties in health care today is the question of whether some doctors might recommend and deliver too much care. Stories like the one about a Maryland cardiologist who implanted hundreds of unneeded stents are rare, and the vast majority of doctors put the people they treat first, far ahead of any personal financial interests.