Heart Health Archive

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Ask the doctor: Would moving to a lower altitude help my heart rate?

Q. My doctor told me I have bradycardia. I live at an altitude of 5,765 feet — would moving to a lower altitude help my heart rate? Recent cardiac tests, including a nuclear stress test, were normal. My cardiologist said I did not need a pacemaker, and to keep on doing what I've been doing. I used to jog five miles a day and now, at age 85, walk three miles a day.

A. I wholeheartedly agree with your cardiologist that you should keep doing what you are doing. Walking is wonderful medicine.

Experts urge intensive lifestyle measures for lowering triglycerides

When cholesterol is measured, so are triglycerides, another type of blood fat that's an independent risk factor for heart disease. High triglycerides increase the likelihood of developing heart disease even when cholesterol levels are normal, especially in postmenopausal women. But triglycerides haven't gotten as much attention as LDL (bad) cholesterol and HDL (good) cholesterol, partly because their role in heart disease and stroke hasn't been well understood.

In recent years, scientists have learned more about how triglycerides are metabolized and how they contribute to atherosclerosis, the clogged arteries that raise the risk of heart attack, stroke, and other cardiovascular problems. High triglyceride levels are often correlated with low HDL and a type of LDL cholesterol that is particularly likely to produce harmful deposits in the arteries. High triglyceride levels are also a component of another heart disease risk factor — metabolic syndrome, a condition that occurs in most people with type 2 diabetes and includes high blood pressure and a large waist size. The American Heart Association (AHA) issued a scientific statement about triglycerides and cardiovascular disease that sets a new, lower optimal level of triglycerides and recommends intensive lifestyle measures for reducing elevated triglycerides. The AHA statement and a review of research were published online April 18, 2011, in the journal Circulation. Here are some of the highlights:

Alternative to warfarin

People with atrial fibrillation are at higher risk of having a stroke because they are more susceptible to the blood clots that cause stroke. When the atria (the top two chambers of the heart) fibrillate (beat chaotically), blood collects in the heart, giving clots a chance to form. One of those clots can travel to the head, get stuck in a blood vessel there, and cause a stroke by depriving a part of the brain of the oxygen and nutrients it needs; some of the cells of the brain die, possibly taking with them the ability to move, speak, feel, think, or even recognize people.

Warfarin prevents blood clots by making the platelets in the blood less sticky. It's a good, time-tested drug. But warfarin is tricky to use. Some experience bleeding problems like nosebleeds. Yet if you take back the dose too far to avoid bleeding, you're back to where you started: running the risk that a blood clot may form and cause a stroke.

Cut salt - it won't affect your iodine intake

Iodized salt provides only a small fraction of daily iodine intake.

The surplus of sodium in the American diet contributes to a host of cardiovascular problems, from high blood pressure and stroke to heart attack, heart failure, and more. Cutting back on salt is generally good for the heart and arteries. But could this strategy have the unintended consequence of making some Americans deficient in iodine?

June 2011 references and further reading

Reduce salt — get your iodine elsewhere

Markel H. "When it rains it pours": endemic goiter, iodized salt, and David Murray Cowie, MD. American Journal of Public Health 1987; 77:219-29.

Dasgupta PK, Liu Y, Dyke JV. Iodine nutrition: iodine content of iodized salt in the United States. Environmental Science and Technology 2008; 42:1315-23.

Health by the numbers

Statins and lower cholesterol …

According to the National Center for Health Statistics (NCHS), the percentage of Americans ages 45 and older taking a statin drug jumped from 2% in 1988–94 to 25% in 2005–08. There are roughly 117 million Americans over age 45, so that means there are almost 29 million statin users, or the equivalent of the entire populations of Florida and Georgia combined. Here is a graph from the NCHS that shows the increase:

The fact that one in every four Americans older than the mid-40s is taking a statin is really kind of stunning (presuming, of course, that there hasn't been a big fall-off since 2005–08).

Abdominal aortic aneurysms: Triple A, double trouble

The aorta is the largest artery in the body; it's also the strongest. But size and strength are not enough to protect this crucial blood vessel; in fact, the aorta is one of the body's most vulnerable arteries.

Although many things can go wrong with the aorta, the most common is an aneurysm; it's an unfamiliar term, but it's a well-chosen name based on the ancient Greek word that means "to widen."

Specialized care improves stroke survival

If you are having a stroke, a stroke center may be the place to go.

When talking about stroke, doctors often say that "time is brain." The faster you get medical help, the greater the chances of surviving and recovering from a stroke. A movement to establish special stroke centers across the country is ushering in a seemingly contradictory phrase: the old real estate adage "location, location, location." The rise of stroke centers means that emergency medical crews could bypass a nearby hospital and take a few extra minutes to reach a more distant one.

Weight-loss surgery can help - and harm - the heart

Understand the risks and limitations before embarking on this last-ditch option.

An operation that changes how the stomach and intestines digest food has been hailed as a potential lifesaver for people who are severely overweight. It can dramatically improve blood sugar, lower blood pressure and cholesterol, lessen sleep apnea (a dangerous pattern of breath holding during sleep), and improve heart function. But these benefits, which accrue only with a lifelong commitment to healthy eating and exercise, must be balanced against possible risks.

The shape of cardiovascular risk

Apple, pear — it doesn't matter which of these fruits your body shape resembles. Extra body fat, whether you carry it around your midsection (apple shape) or your thighs (pear shape), is bad for your heart and health. So say researchers who reviewed the health records of more than 220,000 men and women taking part in 58 long-term studies (The Lancet, published online March 10, 2011).

The findings are the latest salvo in a spirited debate about the best way to gauge the health effects of overweight and obesity. The three most common measures are as follows:

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