Heart Health Archive

Articles

Ask the doctor: What is a good plan for serious heart failure?

Q. My 69-year-old husband has had cardiomyopathy and diabetes for several years. Lately, his ankles are always swollen. At his last doctor's visit, my husband's cardiologist said his heart has leaky valves and his ejection fraction is 10%. What would be the best plan for him?

A. The combination of leaking valves and a low ejection fraction is serious indeed. Your husband needs to work very closely with his physicians to make sure he is getting optimal care. The ideal scenario would be if he can work with a team that specializes in caring for people with heart failure.

On call: Simvastatin in the morning?

Q. My doctor just started me on Zocor to lower my cholesterol. I have had just one side effect, forgetfulness. It's not as bad as it sounds, since my memory remains excellent, except that I often forget to take my pill in the evening. So I'd like to know if it would be okay for me to take Zocor in the morning with my other pills, which I never forget.

A. Many people have trouble remembering to take medications; drugs that are administered several times during the day are particularly troublesome.

Blockages in tiny heart arteries a big problem for women

About 10% of women who have heart attacks seem to have clear, unblocked arteries. They don’t, really. Instead, they have a problem inside tiny arteries supplying the heart muscle, called microvessels. Traditional diagnostic tests can’t “see” into microvessels. In larger coronary arteries, the buildup of cholesterol-filled plaque creates distinct bulges that narrow the vessel at a particular spot, reducing blood flow. In microvessels, plaque uniformly coats the inner layer. This reduces the space for blood flow and makes the arteries stiff and less able to expand in response to exercise or other stress. Researchers are still trying to determine the best ways to diagnose and treat microvessel disease. Talking to cardiologists at Harvard-affiliated Brigham and Women’s Hospital, Dr. C. Noel Bairey Merz said that the erectile dysfunction drug Viagra (sildenafil), which was originally developed to improve blood flow to the heart, is being tested as one possible therapy.

Cancer can be tough on the heart in more ways than one

The death of Kara Kennedy, the only daughter of the late Senator Edward M. Kennedy, at age 51 from an apparent heart attack while exercising offers a reminder of the possible long-term effects of cancer and its treatment. In 2002, Kennedy was diagnosed with lung cancer. After having part of her lung removed, she underwent chemotherapy and radiation therapy. She lived for another nine years, in apparently good health. One of the hazards of some cancer survivors face is that the treatments used to fight cancer—drugs, radiation, and hormones—sometimes damage the heart and arteries.

Doctors can confuse heartburn and heart disease, even in themselves

Many people have trouble telling whether they are having heartburn or a heart attack. “Many people” includes doctors. A personal story from a Harvard physician describes how he treated himself with strong acid-suppressing pills until a near heart attack made him realize he had heart disease. His story appears in an updated Special Health Report from Harvard Medical School called “Heart Disease: A guide to preventing and treating coronary artery disease.”

Change: One man’s steady struggle to become healthier

It isn’t easy to get rid of a harmful habit like drinking too much, or to make healthy changes like losing weight and exercising more. Media stories often sugar-coat changes like these, making them seem easier than they really are. In a moving essay in the American Journal of Health Promotion, Michael P. O’Donnell (the journal’s editor) describes his dad’s efforts to become healthier for his sake and the sake of his family. There was no monumental struggle, no epiphany—just a regular guy doing his best each day to become healthier for his sake and for his family. It’s a truly inspiring story.

Abundance of fructose not good for the liver, heart

Another reason to avoid foods made with a lot of sugar.

The human body handles glucose and fructose — the most abundant sugars in our diet — in different ways. Virtually every cell in the body can break down glucose for energy. About the only ones that can handle fructose are liver cells. What the liver does with fructose, especially when there is too much in the diet, has potentially dangerous consequences for the liver, the arteries, and the heart.

Sodium, potassium together influence heart health

When it comes to salt and food, the sodium in table salt gets most of the attention for its role in boosting blood pressure and contributing to cardiovascular disease. Potassium should get equal billing for its role in keeping blood pressure in check. Before processed foods became widely available, humans consumed much more potassium than sodium. Today, we get almost twice as much sodium as potassium. A new report from the National Health and Nutrition Examination Survey suggests that this imbalance — more sodium than potassium — contributes to heart disease and premature death. Here are some foods rich in potassium and low in sodium. Note the huge differences between unprocessed foods and the processed or salted foods marked in italics. (A more extensive list of potassium in foods, ranked high potassium content to low, is available from the US Department of Agriculture.)

Food

Amount

Potassium (mg)

Sodium (mg)

Potassium to sodium ratio

Banana, raw

1 medium

422

1

422:1

Black beans, cooked without salt

1/2 cup

305

1

305:1

Orange

1 medium

232

1

232:1

Orange juice

3/4 cup

357

2

178:1

Grapefruit juice

3/4 cup

252

2

126:1

Peanuts, dry roasted, no salt

1 1/2 ounces

280

3

93:1

Peanuts, dry roasted, with salt

1 1/2 ounces

280

346

0.8:1

Avocado

1/2 medium

487

7

69:1

Raisins

1/2 cup

543

8

68:1

Prune juice

3/4 cup

530

8

66:1

Baked potato, plain, with skin

1 medium

926

17

54:1

Fast-food French fries

1 medium order

655

266

2.5:1

Peanut butter, without salt

2 tablespoons

208

5

42:1

Peanut butter, with salt

2 tablespoons

208

147

1.4:1

Brussels sprouts, steamed

1/2 cup

248

7

35:1

Applesauce (jar), no salt

1/2 cup

92

3

31:1

Applesauce (jar), with salt

1/2 cup

78

36

2.2:1

Oatmeal, regular

1 cup

164

9

18:1

Quaker’s Instant Oatmeal

1 packet

116

249

0.5:1

Cantaloupe

1/4 medium

368

22

17:1

Halibut, baked

3 ounces

490

59

8:1

Spinach, boiled

1/2 cup

420

63

7:1

Salmon, baked

3 ounces

244

39

6:1

Salmon, canned

3 ounces/em>

311

399

0.8:1

V8, low-sodium

1 cup

820

140

6:1

V8, regular

1 cup

470

480

1:1

Carrots, raw

1/2 cup

205

44

5:1

Beet greens

1/2 cup

655

173

4:1

Milk, 1%

1 cup

366

107

3:1

Cheerios

1 cup

171

186

0.9:1

Marinara sauce, prepared

1/2 cup

406

527

0.8:1

Pork and beans, canned

1 cup

726

1075

0.7:1

Fast-food cheeseburger

1 regular

444

1176

0.4:1

French bread

1 medium slice

82

416

0.2:1

Cornflakes

1 cup

33

266

0.1:1

Source: USDA National Nutrient Database

September 2011 references and further reading

COURAGE not followed by action

Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS. Optimal medical therapy with or without PCI for stable coronary disease. New England Journal of Medicine 2007; 356:1503-16.

Borden WB, Redberg RF, Mushlin AI, Dai D, Kaltenbach LA, Spertus JA. Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention. JAMA 2011; 305:1882-9.

Ask the doctor: Have I given up steak for nothing?

Q. I read that Harvard researchers found no association between eating red meat and developing heart disease and diabetes. Have I been depriving myself of steak for more than 20 years for no good reason?

A. In 2011 some of my colleagues at the Harvard School of Public Health reported findings from a meta-analysis that summarized the results of 20 studies. You're right: they didn't find an association between consumption of unprocessed red meat and heart disease and diabetes. On the other hand, one serving per day of processed meat was associated with a higher risk of developing those diseases. In this and other studies, red meat is defined as beef (including hamburger), lamb, pork, and game, and processed meat as any meat preserved by smoking, curing, salting, or chemicals, which would include bacon, hot dogs, sausage, and cold cuts. The processed meat was primarily processed red meat, but in some of the studies in the meta-analysis, poultry cold cuts were also included in the processed meat category.

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