Heart Health Archive

Raising HDL with niacin takes a back seat to lowering LDL with statins.

Doctors often encourage people with heart disease or at risk for it to attain high-density lipoprotein (HDL) cholesterol levels above 40 milligrams per deciliter (mg/dL). Levels lower than that, the thinking goes, diminish this "good" cholesterol's power to protect the heart and arteries. But the importance of raising HDL may be declining, especially for people with rock-bottom levels of low-density lipoprotein (LDL) cholesterol.

Stem cell type and timing of treatment seem to matter most.

Results from the first-ever trial using stem cells that normally reside in the heart had the scientific community using adjectives like "astounding" and "compelling." But as encouraging as the findings were, keep in mind that stem cell research is still in its infancy and has a long way to go before yielding effective treatments for heart disease.

Working to lower blood pressure, cholesterol, and blood sugar and to ease inflammation definitely helps the heart. It is also good for the kidneys. Now, Japanese researchers have found that treating atrial fibrillation (AF), the fast and uncoordinated beating of the heart's upper chambers, may improve the kidneys' filtering abilities.

In a study, 386 people with AF and mildly reduced kidney function received a catheter-based procedure called ablation to restore normal atrial beats. The tip of the catheter destroys (ablates) small patches of tissue in the left atrium that generate the electrical signals that incite AF (see illustration).

Catheters — thin plastic tubes that doctors route through the body's arteries and veins — can carry everything from tiny cameras to replacement heart valves. So why not clot-busting drugs?

That was the idea behind a Norwegian study that looked at nearly 200 people who had a blood clot in a leg vein (deep-vein thrombosis, or DVT). People with DVT usually take a blood thinner like warfarin to prevent the clot from growing and to stop new ones from forming. These drugs also keep the clot from fragmenting and traveling to the lungs — a potentially life-threatening complication known as a pulmonary embolism.

If you're a Medicare beneficiary, you can get one "intensive behavioral therapy" session aimed at preventing heart disease and weekly sessions for a month or more for help dealing with obesity — no copay required.

Both benefits are available only in a "primary care setting." For Medicare's purposes, that means the office of a general or family practitioner, internist, or geriatrician. Cardiologists don't seem to qualify as primary care physicians according to this definition, although some perform primary care functions. Medicare also won't pony up if these services take place in a hospital, outpatient surgery center, nursing home, or diagnostic testing facility.

If you have resistant high blood pressure (hypertension), you are probably already doing a lot to lower it. But a study suggests that people with resistant hypertension rarely get two particularly effective drugs, and often they get a drug combination that's not very helpful.

Resistant hypertension occurs when blood pressure stays high despite taking three or more drugs, or when a person needs four or more drugs to reach blood pressure goals. Colorado researchers reviewed insurance claims for more than 140,000 such people. Only 3% were receiving chlorthalidone (Hydone, generic), a diuretic (water pill) that several studies suggest is more effective at reducing blood pressure and curbing bad cardiovascular consequences than the most-often-prescribed diuretic, hydrochlorothiazide (HydroDiuril, generic).

Hospital-to-hospital transfer times need work. In the November 2011 Heart Letter, we reported the good news that hospitals nationwide have substantially reduced the time it takes a heart attack sufferer to start getting artery-opening angioplasty after arriving at the emergency room.

But not all hospitals are equipped to do emergency angioplasty. In those situations, people having a heart attack are usually transferred via ambulance to a hospital that can. The news about how long a person waits between arriving at the first hospital and leaving in an ambulance for hospital No. 2 (so-called door-in-to-door-out time) isn't so heartening.

Q. Can eggs be part of a balanced, heart-healthy diet?

A. Eggs are handy, inexpensive sources of protein. They also contain healthful fats, folic acid, and essential vitamins.

Q. I'm a fit 61-year-old who had bypass surgery 15 years ago. Recently, I've been having rapid heartbeats (what my doctor calls supraventricular tachycardia) during or just after vigorous exercise. Should I tone down my exercise?

A. First, congratulations on your commitment to staying physically fit.

Women who undergo breast-conserving surgery (lumpectomy) for early-stage breast cancer usually receive radiation therapy as a part of their treatment. Radiation kills cancer cells left behind after surgery and helps prevent them from causing a recurrence or spreading to other tissues. For example, in a 2011 study in The Lancet involving more than 10,000 women treated with breast-conserving surgery, radiation cut the 10-year recurrence rate by one-third to one-half. Numerous studies have found that mastectomy (which removes the entire breast) is no more effective than lumpectomy plus radiation in improving survival rates. (Radiation may also be given after mastectomy, depending on the size of the cancer or extent of its spread.)

The main serious downside of radiation is potential damage to the heart. Several studies have found that women who receive radiation for breast cancer have an increased risk of heart disease and death from cardiac causes. It's a special concern for women with left-sided breast cancer, because the heart is mostly in the left chest. Since the early 1990s, technical advances have been introduced to lower the risk of exposing the heart to radiation. But it's unclear how much these newer techniques help — partly because heart disease usually develops more than 10 years after exposure, and follow-up studies have been too short. Also, it hasn't been clear exactly how radiation damages the heart.