Heart Health Archive

Q. I see in-store promotions for low-fat muffins almost everywhere. Is there such a thing as a heart-healthy muffin?

A. Yes, there is, but you're not likely to find it in the typical, store-bought low-fat muffin.

Q. I am 70 years old, and since I started taking testosterone to boost below-normal levels of that hormone, my LDL and HDL levels have dropped. What's the cholesterol–testosterone connection?

A. Testosterone is a hormone that promotes sex drive in both sexes and sperm production in men. It also supports the growth and strength of muscle and bone. There is some scientific evidence to suggest that low testosterone levels contribute to cardiovascular disease, and there is ample evidence that as testosterone levels rise, cholesterol levels fall. So the drop in your LDL and HDL levels makes sense.

Q. My 59-year-old husband just came home after being hospitalized for a mild heart attack. He was only in the hospital for five days and he feels great, though he does have to take three prescription medicines plus aspirin. I'm writing because my husband's doctor doesn't want him to go back to work for another six weeks even though his job doesn't involve any lifting. I think the stress of staying home would be worse than going to work. Please advise.

A. The treatment of heart attacks has come a long, long way in the past 30 years. Technology is responsible for many improvements; the outstanding change is that doctors can now open blocked coronary arteries with angioplasty balloons and stents or "clot-busting" drugs. Doctors have also learned how to use stress tests and echocardiograms to classify patients into low-, intermediate-, or high-risk groups at the time of hospital discharge. And most patients go home with a beta blocker, an ACE inhibitor, a statin drug, and low-dose aspirin to reduce the likelihood of another heart attack. Comprehensive cardiac rehabilitation programs can also help.

A trio of studies bolsters evidence of their benefits and long-term safety.

Cholesterol-lowering statins have been around for a quarter-century, with a generally strong record of benefits outweighing risks. Indisputably, these drugs substantially reduce the number of heart attacks in people with or at risk for heart disease.

Video game workouts work pretty well, but the initial cost can be substantial.

Doctors often say that the best form of physical activity is the one that you'll do consistently. If you're still searching for an effective routine that's actually fun, or want a high-tech take on fitness, consider active-play video games, also called exergames. No longer just for youngsters, exergames such as Nintendo's Wii Fitness and Xbox's Kinect Sports are catching on with middle-aged and older adults as an enjoyable way to get moving.

Three (more) cheers for statins

Nicholls SJ, Ballantyne CM, Barter PJ, Chapman MJ, Erbel RM, Libby P, Raichlen JS, Uno K, Borgman M, Wolski K, Nissen SE. Effect of two intensive statin regimens on progression of coronary disease. New England Journal of Medicine 2011; 365:2078-87.

Bulbulia R, Bowman L, Wallendszus K, Parish S, Armitage J, Peto R, Collins R. Effects on 11-year mortality and morbidity of lowering LDL cholesterol with simvastatin for about 5 years in 20,536 high-risk individuals: a randomised controlled trial. Lancet 2011; 378:2013-20.

Many studies have linked heart disease and depression, but heart problems may also go hand in hand with anxiety.

Several studies have shown that about a quarter of people with cardiovascular disease have some kind of anxiety problem and, in some cases, the anxiety seems to make the heart condition worse.

Q. I'm 80, and I exercise or bike for an hour and a half almost every day and eat a healthy diet. I recently had a blood lipid assessment, and my HDL was 70 and my LDL was 42. But my internist wrote me saying that my LDL was too low and that I should cut my dose of atorvastatin from 40 mg to 20 mg a day. I also take 2,000 mg of niacin daily. Is there general agreement that one's LDL should not go below a certain point? Is mine too low?

A. First, let me say that you are doing great. Most people even half your age aren't as physically active, and your cholesterol levels are impressive. An HDL level of 70 milligrams per deciliter (mg/dL) is above the 60 mg/dL threshold where the "good" cholesterol seems to afford some protection against heart disease and stroke. Your LDL of 42 mg/dL is comfortably in the optimal range for "bad" cholesterol, which is 100 mg/dL or less.

Wise lifestyle choices pay off for men, earning them enhanced vigor and longer lives. Prudent choices also pay off for stand-up comics, providing easy targets that earn loud laughs. The jokes often take advantage of the notion that anything that feels good or tastes good must be bad for you.

So it is with coffee. Its appeal is undeniable; about 150 million Americans drink coffee every day, together consuming some 400 million cups a day. Coffee is popular because it tastes good, and it makes most people feel better. Perhaps that's why it's been blamed for innumerable woes. It's true that some people experience symptoms such as nervousness, a racing heart, headaches, insomnia, heartburn, and excessive urination after just a cup or two. And it's also true that coffee can boost blood pressure, but the rise is small and short-lived, and people who drink coffee regularly are largely spared from even this modest hit.

New guidelines clarify the ifs and thens, but the choice is yours.

The release of new clinical guidelines usually gets more attention from doctors than from the people they treat. But anyone with clogged heart arteries or at risk of developing them should know about the updated guidelines on using bypass surgery and angioplasty to deal with such blockages (Circulation, Dec. 6, 2011).