Heart Health Archive

When it comes to lowering cholesterol, a “portfolio” diet that includes cholesterol-lowering foods is better. In a head-to-head trial, the portfolio approach lowered harmful LDL by 13%, compared to a 3% reduction for a traditional low-fat diet. Elements of the portfolio diet included a daily handful of nuts; two teaspoons of margarine enriched with plant sterols; two servings of foods rich in soluble fiber, such as oatmeal, psyllium-enriched cereals, barley, and vegetables such as okra and eggplant; and two servings of soy-based foods, such as a glass of soy milk or a soy burger.

Whether it is best to aim for "normal" or float a bit above remains to be determined.

Blood pressure isn't a bad thing. Quite the contrary — the heart needs a certain amount of pressure to deliver oxygen-rich blood to the farthest reaches of the body and the brain. Blood pressure becomes a problem only when it rises too high or falls too low.

The target for the safest amount of "bad" cholesterol continues to drift downward.

In 1986, a "desirable" blood level of low-density lipoprotein (LDL, the so-called bad cholesterol) was 130 milligrams per deciliter (mg/dL). Today, information from medical anthropologists and some high-powered clinical trials suggests the new "desirable" should be half that. This has guideline writers, doctors, and the rest of us wondering: how low should we go with LDL?

Ideal CV health

Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010; 121:586-613.

Bambs C, Kip KE, Dinga A, Mulukutla SR, Aiyer AN, Reis SE. Low prevalence of "ideal cardiovascular health" in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study. Circulation 2011; 123:850-7.

Some people experience drops in blood pressure when they stand up. Falls are a risk. But there are often simple ways to counter the problem.

When we stand up, blood tends to pool in the lower half of our bodies, filling veins in the liver, intestines, and other abdominal organs, as well as those in the legs. The downward flow means there's a danger of not enough blood reaching the brain, which can lead to a loss of consciousness. But adjustments occur that keep that from happening. Sensors in the aorta in the torso and in the carotid arteries in the neck trigger a response that revs up the "fight-or-flight" part of the nervous system and dials down the "rest-and-digest" part. The heart beats a little faster and stronger. Blood vessels constrict, squeezing blood into a tighter space. Blood flow and blood pressure stay more or less normal.

Positive markers mean better heart health, less disease.

In 2010, the American Heart Association (AHA) added a new page to its playbook against the leading causes of death and disability in the United States. Instead of focusing solely on cardiovascular disease, the AHA is broadening its mission to include improving cardiovascular health.

It's a timely shift. The impressive decline in death rates from heart disease since 1970 is threatened by climbing rates of obesity and diabetes, the aging of the population, and early signs of heart disease in adolescents.

Aiming high is usually a good strategy for achieving a goal... except when it backfires. That's what happened with a large clinical trial dubbed AIM-HIGH. It was suddenly stopped more than a year ahead of schedule, casting a cloud over the use of niacin, a safe, effective medication with a proven track record for raising levels of protective high-density lipoprotein (HDL).

AIM-HIGH was designed to gauge whether adding a prescription form of niacin (Niaspan) to a cholesterol-lowering statin makes sense for people with low HDL. This combination had been tested in earlier trials, all of which showed a benefit. The big difference in AIM-HIGH was the very low target for low-density lipoprotein (LDL, the so-called bad cholesterol): between 40 and 80 milligrams per deciliter (mg/dL).

People with heart disease should take aspirin; the decision is trickier for those without it.

For survivors of a heart attack or a clot-caused (ischemic) stroke, and for almost everyone else with coronary artery disease, there's an across-the-board recommendation to take an aspirin a day. But what about folks who haven't been diagnosed with heart disease? Can an aspirin a day help them, too?

Coffee's reputation for being okay for cardiovascular health, or more than okay, continues to grow. Here's a roundup of study results from the first half of 2011. All of the references are listed at www.health.harvard.edu/heartextra.

Heart failure. Women who drink coffee are slightly less likely to develop heart failure than women who don't drink coffee. Coffee drinking had little effect on heart failure in men.

The carotid arteries that run up either side of the neck are prone to becoming narrowed by cholesterol-filled plaque. A test called carotid ultrasound can identify a narrowing, also called a stenosis, quickly, safely, and without any immediate potential for harm. This test makes perfect sense for someone experiencing lightheadedness, memory loss, or the warning signs of a stroke or mini-stroke.

In people who have their carotid arteries checked "just in case," ultrasound doesn't do much good. University of Wisconsin researchers tracked almost 600 people who underwent carotid ultrasound for this reason. A year later, those whose scans had shown a significant narrowing were no more likely to have their blood pressure or cholesterol under control — two key steps for managing carotid stenosis — than those whose arteries were clear, or to have made healthy changes in diet, exercise, and other long-term health behaviors (Archives of Internal Medicine, March 28, 2011).