Heart Health Archive

In 2010, a controversial analysis suggested that angiotensin-receptor blockers (ARBs) increased the risk of developing cancer, especially lung cancer. Not so, says an FDA safety alert issued in June 2011.

ARBs are widely used to treat high blood pressure. They include azilsartan medoxomil (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar, generic), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan). Several combination drugs include an ARB plus a diuretic or a calcium-channel blocker.

Q. I had a heart attack three years ago at age 78. My doctor started me on lisinopril, carvedilol, and aspirin. My total cholesterol is 190, and my LDL is 128. Should I be taking a statin?

A. Almost everyone who has had a heart attack should be on a statin for life. There are some exceptions, of course, such as individuals whose heart attacks stemmed from unusual causes, like an infection, and those who have had an exceptionally severe problem from taking a statin, like severe skeletal muscle breakdown (called rhabdomyolysis). I recommend that you ask your doctor why you aren't taking a statin; if he or she doesn't know, then you should see a cardiologist.

You don't have to be a brain surgeon to know it is vitally important for your brain to receive an uninterrupted supply of blood. That's because nerve cells require a constant supply of oxygen. Even a brief disruption stuns nerve cells, impairing their function, while more prolonged oxygen deprivation kills the cells. If only a small, noncritical area of your brain is affected, you may not notice the damage. Unfortunately, however, the damage is often very noticeable indeed. Brief or partial interruptions of blood flow cause transient ischemic attacks (TIAs), while prolonged or complete blockages are the major cause of cerebrovascular accidents — strokes.

Shocking statistics

Stroke is the fourth leading cause of death in the United States, taking about 136,000 lives annually. Another 660,000 Americans survive strokes each year, but many are so disabled that they cannot return to work. In human terms, it's an enormous burden of suffering; in dollar terms, it costs $74 billion a year to care for stroke victims and make up for their lost productivity.

Our April 2011 article "Meet the statins" contained an error in Table 2. The correct interactions between grapefruit juice and statin drugs are listed here:

Drug levels boosted by grapefruit: atorvastatin, lovastatin, simvastatin.

Levels not affected by grapefruit: fluvastatin, pitavastatin, pravastatin, rosuvastatin.

Q. I spend part of every summer on the coast of Maine. One of the things I love to do there is swim in the ocean for 20 or 30 minutes. The water is cold (55 F) but I don't mind. I'm almost 80. I had my mitral valve repaired five years ago, and my heart rate is sometimes irregular. Are my cold-water swims okay for my heart?

A. Swimming is an excellent exercise for the heart, arteries, lungs, and muscles. If you enjoy swimming in cold water and have been doing it for some time with no ill effects, it's probably fine for you. But your question worries me for a couple of reasons.

Millions of people take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin and others), naproxen (Aleve, Naprosyn, and others), and celecoxib (Celebrex) to relieve pain and inflammation. During the last few years, researchers have raised concerns that taking these drugs often may be hard on the heart as well. The latest study, published in the July 2011 issue of the American Journal of Medicine, suggests that regular use of NSAIDs poses a special problem for people who already have heart disease, boosting their chances of having a heart attack or stroke. This research doesn’t mean that people with high blood pressure and heart disease should stop taking NSAIDs, especially if they are used to ease pain from a chronic condition like arthritis. But it may make sense to try an alternative first.

By Richard Lee, M.D.
Associate editor, Harvard Heart Letter

When I was a newly minted cardiologist, heart attacks were feared far more than they are today. They terrified people who were having them, and their families, because they were known killers. Heart attacks made doctors nervous, too, since we were less certain about how to treat them and the therapies available to us were less effective than the ones we have at our disposal today.

Surviving a heart attack — A success story

Morbidity and Mortality Chart Book, National Heart, Lung, and Blood Institute, 2009.

Measuring blood pressure: Let a machine do it

Myers MG, Godwin M, Dawes M, et al. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial. BMJ 2011; 342:d286.

Turning off these devices can spare patients pain and suffering.

The front-page article of the March 2011 Health Letter was about implantable cardioverter-defibrillators (ICDs), devices that jolt the heart back into a normal rhythm if it starts to beat too fast or in an irregular fashion. ICDs, which are about the size of a small cell phone, are surgically implanted under the skin, just below the collarbone. The article touched on several issues, including some research suggesting that too many people are getting ICDs, partly because doctors aren't waiting long enough after heart failure is diagnosed to see if other kinds of treatments might be effective.

Comparisons have produced mixed results, but the heyday for both procedures (especially bypass) may be winding down.

Yes, it's an oversimplification, but at one level, coronary artery disease is a plumbing problem. The coronary arteries supply the heart with blood. When they get gunked up with atherosclerotic plaque, not enough blood can get through. If the blockage isn't too bad, the result is angina, the pain caused by a heart working with an inadequate blood supply. If the blockage is bigger or the plaque ruptures, the result can be a heart attack, the death of heart tissue that was suddenly starved for blood and oxygen.