Heart Health Archive

Problems in arteries supplying the legs, kidneys, and elsewhere pose problems for the heart, too.

The arteries that supply the heart (coronary arteries) and the brain (carotid arteries) get far more attention than the vast network of arteries below the heart. These so-called peripheral arteries are often overlooked — and a study suggests that problems in these blood vessels are often undertreated — even though they cause as much mayhem as problems in the coronaries and carotids.

The more pills a person needs to take each day, the less likely he or she will do it day in and day out. That's one reason British researchers proposed what they called the polypill. It would combine low doses of several generic (and thus inexpensive) heart-protecting medications — aspirin, a cholesterol-lowering statin, and two or three different drugs to lower blood pressure — into a single pill.

Putting theory into action, the Program to Improve Life and Longevity (PILL) Collaborative Group set out to test the polypill concept in people without heart disease but at higher-than-average risk for developing it. In a 12-week clinical trial conducted in seven countries, use of a polypill (see figure) lowered systolic blood pressure by 10 millimeters of mercury and LDL (bad cholesterol) by 30 milligrams per deciliter of blood compared with an identical-looking placebo pill (PLoS ONE, May 2011). Although these respectable reductions should, in theory, translate into a 50% reduction in heart disease, the study was too small and too short to track the pill's effect on heart disease or survival.

If you are one of the millions of Americans trying to quit smoking, keep up the good work. It isn't easy, but the payoffs are huge. If you are using the quit-smoking drug Chantix (varenicline), there's a new bump in the road: for people with heart disease, the FDA says the drug slightly increases the chances of having a heart attack or other cardiovascular problem. A Canadian study concludes that use of the drug increases the risk of heart attack, stroke, and heart failure in all users (CMAJ, July 4, 2011).

The FDA approved Chantix in 2006 based on clinical trial results that it doubled the quit rate (10% for placebo, 23% for Chantix). The drug works by latching onto nicotine receptors in the brain and activating them, much as nicotine does. This reduces a smoker's craving for nicotine and eases withdrawal symptoms.

For some time olive oil has been touted for its ability to protect the heart. Its popularity may be getting another boost — a study has linked consumption of olive oil with reduced risk of stroke. In the ongoing Three-City Study in France, participants who used olive oil for cooking as well as for dressing salads and sprinkling on grains and vegetables were 41% less likely to have had a stroke over a five-year period as those who rarely or never used olive oil (Neurology, published online June 15, 2011).

Before you rush out to stock up on olive oil, keep in mind that a study like this shows that olive oil and lowered stroke risk are associated. It wasn't a clinical trial, and so can't show that consuming olive oil prevents stroke. It is possible that people who take in more olive oil eat more vegetables and whole grains, or don't consume as much saturated fat, and it's these things that influence stroke risk, not olive oil.

Although heart failure seems to have little in common with broken bones, accumulating evidence suggests they are somehow tied to each other.

Mayo Clinic researchers followed the health of nearly 1,000 men and women newly diagnosed with heart failure and an equal number without it, matched for age and gender. The investigators tracked their health for at least seven years and sometimes for as long as 20 years. Those with heart failure had more broken bones — mostly broken hips — both before and after the onset of heart failure than those without failing hearts (American Journal of Medicine, May 2011).

When the heart suddenly stops beating, an event known as a cardiac arrest, the combination of cardiopulmonary resuscitation (CPR) and a shock from an automated external defibrillator offers an arrest victim the best chance of survival. If the cardiac arrest is seen by someone, and CPR is started right away, there's no need for mouth-to-mouth breathing. Doing this hands-only form of CPR means pushing hard on the chest about 100 times a minute without stopping.

Preparing the arrest victim to receive a shock from the defibrillator sometimes temporarily stops CPR. The shorter the pause, the better. A study of more than 800 victims of cardiac arrest showed that stopping chest compressions for 20 seconds before delivering the shock reduced the odds of surviving by 50% (Circulation, July 5, 2011).

Sodium is often blamed for boosting blood pressure while potassium is praised for keeping it in check. It really doesn't make sense to look at these two minerals separately, though, since they work in tandem throughout the body. The ratio of sodium to potassium in the diet may be more important than the amount of either one alone.

Our Paleolithic hunter-gatherer ancestors took in about 11,000 milligrams (mg) of potassium a day from fruits, vegetables, leaves, flowers, roots, and other plant sources, and well under 700 mg of sodium. That's a sodium-to-potassium ratio of 1 to 16. Today, we get more sodium (3,400 mg) than potassium (2,500 mg), for a ratio of 1.36 to 1.

Q. I'm 64 and have had lone atrial fibrillation for about a decade. I have an echocardiogram every year to make sure the rest of my heart is okay. (It is.) My doctor hasn't prescribed any medications for me, but she wants me to take a blood thinner when I hit my 65th birthday. I'd rather not do this. Should I follow her recommendation? Also, is it possible that the endurance-type exercise regimens I have performed over many years led to my developing lone atrial fibrillation?

A. The decision to start taking warfarin (generic, Coumadin, Jantoven) for lone atrial fibrillation (atrial fibrillation not caused by underlying heart disease) or any other type of this heart rhythm disorder depends on several factors, not just age. Most cardiologists use the CHADS2 score (it stands for Cardiac failure, Hypertension, Age, Diabetes, and Stroke [doubled]) to help make the decision. As you can see in the table, age does not accrue any points until 75 years and older. If your CHADS2 score is zero, and you truly have lone atrial fibrillation, then it should be fine to hold off on taking warfarin. Some doctors recommend anticoagulation for people who are often or always in atrial fibrillation even though they have a CHADS2 score of zero, but this approach is not part of current guidelines for treating atrial fibrillation.

Q. My doctor told me to check my heart rate when I feel certain symptoms, but I don't know how to do it. Can you explain?

A. Here is a good do-it-yourself method for checking your heart rate: Put two fingers on your wrist below the thumb. Move them around until you locate the pulse in the artery supplying the hand. When you can feel it, look at a clock or watch and count the number of beats in a 15-second period. Multiply by four and you have your heart rate. You can also check your heart rate by putting two fingers on the artery in your neck (the carotid artery). But press gently, because pressure on that artery can trigger a reflex that makes the heart slow down.

The carotid arteries carry oxygen-rich blood from the heart to the front half of the brain. But these crucial arteries can become narrowed by the cholesterol-laden plaques of atherosclerosis. Blood clots, or thrombi, can form on the plaques, then break off and travel as emboli to the brain, where they lodge in small arteries, interrupting the vital flow of blood to brain cells. If the interruption is partial or brief, the brain cells recover; the patient experiences a transient ischemic attack (TIA) with no permanent damage. But if the blockage is complete, brain cells die, producing a stroke.

In many cases, a TIA warns of a future stroke, giving doctors time to perform a carotid ultrasound test to see if the artery is mildly (less than 50%), moderately (50% to 69%), or severely (70% to 99%) narrowed. Once the diagnosis of carotid stenosis (narrowing) is established, several treatment options must be considered.