Heart Health Archive

The statins are the best-selling prescription drugs in the United States. That's no surprise, since heart disease is America's leading cause of death, and the statins can reduce the risk of heart attacks and other major cardiac events by up to 37%, with the greatest benefit going to the men at highest risk.

All seven statin drugs act in the same way, by inhibiting the liver enzyme that's responsible for cholesterol production; when the enzyme is blocked, liver cells make less cholesterol, and blood levels of LDL ("bad") cholesterol fall. But the drugs have another benefit: as cholesterol production falls, the liver takes up more cholesterol from the blood, so blood levels fall even further. The statins produce only small elevations in HDL ("good") cholesterol, and only two, atorvastatin (Lipitor) and rosuvastatin (Crestor), lower triglycerides to an important degree.

Q. My husband was just released from the hospital after a mild heart attack. He's never been much of a drinker, but now he wants to have wine with dinner every night. We've both heard that wine is good for the heart, but I'm worried that it may not be safe so soon after a heart attack. I hope you can either reassure me or restrain my husband.

A. Many, many medical studies have linked alcohol to a reduced risk of heart attacks, particularly in men over 60 and others at heightened risk. Although red wine gets most of the praise, white wine, beer, and liquor have similar effects, probably because all boost levels of HDL ("good") cholesterol to a similar degree. But if the type of alcohol doesn't seem to matter, the amount does, since heavy drinking takes a toll on the heart and circulation, along with the liver and other organs. For men, the best "dose" is one to two drinks a day, counting 5 ounces of wine, 12 ounces of beer, or 1½ ounces of liquor as one drink. And in case you're interested in joining your husband, women are best advised to limit themselves to one drink a day.

If you've ever sought information about how to cope with a medical condition, chances are that other patients were one of your best sources. Listening to the stories of people "in the same boat" can bolster us in many ways; for example, it can help us stick with sometimes burdensome treatments. Personal storytelling has long had a place in medicine — in support groups and doctor-patient relationships, for example. But how it affects the behavior of patients is hard to test. Now, in a trial, researchers have found that the blood pressure of patients with uncontrolled hypertension improved after they viewed DVDs of other people in their community talking about their own experiences with hypertension. Results were published in Annals of Internal Medicine (Jan. 18, 2011).

The study. Researchers at the University of Massachusetts Medical Center in Worcester, Mass., working with colleagues in Birmingham, Ala., randomly assigned 299 inner-city African Americans with hypertension (more than two-thirds of them women) to either usual care or a "storytelling" intervention in which they watched interviews with other inner-city African Americans who talked about living with high blood pressure. Some of them had their hypertension under control and others did not. All of the study subjects were given three DVDs. The intervention group received the storytelling DVDs, while the usual care group received DVDs covering health topics but nothing specifically about hypertension. Both groups watched the first set of DVDs in the clinic and were mailed the next two sets at home three months later and six months later. Blood pressure was measured at the start of the study, three months later, and then six to nine months later. Researchers also asked participants how much time they spent viewing the DVDs.

Women tend to develop heart disease about 10 years later than men — in part, it's believed, because of the heart-protective effects of ovarian estrogens, which are around until menopause. But the female advantage seems to end there. Because women develop heart disease later, they're more likely to have coexisting conditions, like diabetes, which can complicate treatment and recovery. And because they have smaller hearts and coronary vessels, surgery can be more difficult for them. Women are more likely to die after procedures such as bypass surgery and angioplasty.

But now a study suggests that one treatment for heart failure actually works better in women than men (Journal of the American College of Cardiology, Feb. 15, 2011).

Extra fat that accumulates around the abdomen goes by many names: beer belly, spare tire, love handles, apple shape, middle-age spread, and the more technical “abdominal obesity.” No matter what the name, it is the shape of risk.

The latest annual snapshot of health in America, a report called Health, United States, 2010 offers hours of browsing and food for thought for anyone interested in health trends. Harvard Health Letter editor Peter Wehrwein connects the dots between use of cholesterol-lowering statins and fewer deaths from heart disease.

Angioplasty is a simple, safe alternative to open heart surgery for restoring blood flow through a narrowed or blocked coronary artery. Results of a large international trial show that a new approach to angioplasty that begins with the radial artery in the arm is as effective and safe as the traditional approach, which begins with the femoral artery in the groin.

Not everyone needs an overnight hospital stay after this artery-opening procedure.

Artery-opening angioplasty is an amazing procedure. It lets a doctor restore blood flow to hard-working heart muscle without having to cut into the chest or split the rib cage. Assuming all goes well, the recovery time is minimal and the only physical reminder of the procedure is a half-inch scar at the top of one leg.

Q. I like smoked salmon and kippered herring, and thought that eating them was good for me. But I read in another health newsletter that the smoking process destroys all the heart-healthy omega-3 fats. Is that true?

A. I thought your question would be an easy one to answer. That didn't turn out to be the case. But with help from Heart Letter editor P.J. Skerrett, I think we can give you a solid answer.

Same-day angioplasty feasible, safe

Patel M, Kim M, Karajgikar R, et al. Outcomes of patients discharged the same day following percutaneous coronary intervention. JACC Cardiovascular Interventions 2010; 3:851-8.

Chambers CE, Dehmer GJ, Cox DA, et al. Defining the length of stay following percutaneous coronary intervention: an expert consensus document from the Society for Cardiovascular Angiography and Interventions. Endorsed by the American College of Cardiology Foundation. Catheterization and Cardiovascular Interventions 2009; 73:847-58.