Heart Health Archive

A new study explores how people fare after surgery or nonsurgical repair.

A weakened widening of the aorta (the main pipeline for delivering oxygen-rich blood to the body) can be deadly if it bursts. This widening is called an abdominal aortic aneurysm, or triple-A for short. There are two main ways to battle this bulge: traditional surgery and a newer approach called endovascular repair.

These drugs may harm more than help after a stroke linked to a degenerative brain condition.

The drugs known as statins do many good things. They are the most powerful cholesterol-lowering agents discovered so far. They help prevent heart attacks in people who have had one, as well as in those at high risk for one. They lessen the risk of having an ischemic (clot-caused) stroke, the most common kind of stroke in the United States. Use of statins has been linked to stronger bones, better brain health in old age, and other noncardiovascular benefits.

Most people with this genetic condition develop thickened heart muscle but lead normal lives.

"You have a really big heart" is usually a wonderful compliment — except when it comes from your cardiologist and the term cardiomyopathy crops up in the conversation. An oversized heart usually isn't a good sign.

Parents pass on many things to their children — genes, love, a taste for certain foods, some habits, and heart attack risk. Yet family history isn't included in the Framingham risk score, a widely used tool for gauging heart attack risk. Intriguing information from the global INTERHEART study suggests that family history — specifically if and at what age a parent had a heart attack — should be used to help calculate a person's chances of having a heart attack.

The INTERHEART investigators asked 12,000 heart attack survivors and an equal number of healthy men and women about their parents' cardiac health. The risk of having a heart attack increased with the number of parents who had one, especially before age 50 (see table). The relationship persisted even after the investigators made adjustments for age, gender, and other factors that are key contributors to cardiovascular risk. Having one parent who had a heart attack after age 50 slightly increased an individual's heart attack risk; having two parents who had attacks before age 50 substantially increased the risk.

Q. Sometimes I take a walk while wearing my blood pressure cuff. For the first few minutes, as I walk at a modest pace, my systolic blood pressure rises from 115 to 130 or so, while my heart rate hardly changes from its usual 60-something beats per minute. But when I start walking faster, my systolic pressure stays steady or sometimes goes down a bit, while my heart rate increases to 110. Is this a normal pattern? Can you explain what is going on?

A. When the average healthy person is sitting or walking at a normal pace, the heart, lungs, and blood vessels easily supply the body with all the oxygenated blood it needs. Start walking faster, or running, and the extra oxygen demanded by the leg muscles causes predictable changes in the circulatory system: the heart pumps faster and harder as it works to supply more blood to the active muscle; changes in the muscle tone of blood vessels redirect blood away from the digestive system and toward working muscle. These changes in heart rate, pumping intensity, and vascular tone usually cause a modest increase in systolic blood pressure. This is the pressure recorded as the heart contracts during systole (SIS-tuh-lee). It is represented by the upper number of a blood pressure reading.

Q. I have been diagnosed with venous insufficiency. What does that mean?

A. Venous insufficiency means that some of your veins aren't working properly. This condition often develops after veins are damaged by an injury, surgery, or blood clot. Veins drain blood and fluid back to the heart, so people with venous insufficiency usually have symptoms caused by the buildup of fluid. Venous insufficiency most commonly occurs in the legs (varicose veins are one type of this condition), where its symptoms include

For a young physician just entering practice today, life before the statins must seem like the dark ages of cardiology. Since the first statin was approved in 1987, these important medications have improved the outlook for millions of Americans with heart disease or cardiac risk factors. All in all, statins can reduce the risk of heart attacks and other major clinical manifestations of coronary artery disease (CAD) by up to 37%, with the greatest benefit going to men at the highest risk. And since heart disease is America's leading cause of death, it's no wonder that the seven statin drugs (see Table 1) are the best-selling prescription medications in the United States.

Targeting cholesterol

All seven statin drugs act in the same way, by inhibiting the activity of 5-hydroxy-3-methylglutaryl coenzyme A reductase, a liver enzyme that's better known by its short name HMG-CoA reductase. By either name, it's the key enzyme responsible for cholesterol production. When the enzyme is blocked, liver cells make less cholesterol, and blood levels of LDL ("bad") cholesterol fall. But these 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 atorvastatin and rosuvastatin lower triglycerides, another potentially "bad" lipid, to an important degree.

Hypertension is one of the most common medical problems in the United States; at present, one of every three adults in our country has high blood pressure. It's a shame since many, if not most, cases could be prevented by simple lifestyle measures such as dietary salt restriction, weight control, and moderate exercise.

Hypertension is also one of the most important medical problems in America; it sharply increases the risk of heart attack, stroke, heart failure, and kidney failure. That's also a shame, since excellent drugs are available to lower blood pressure and prevent these deadly complications.

A panel discussion at Harvard School of Public Health called “Boosting Vitamin D: Not Enough or Too Much?” highlights the current controversy over the once-overlooked sunshine vitamin. A panel of experts assembled by the Institute of Medicine recommends a daily dose of 600 IU per day for everyone from ages 1 to 70 and 800 IU for those over 70. Other experts think the IOM recommendation is too low. One way to get vitamin D is to spend a few minutes a day outside in the sun, but that’s a hot-button issue because sun exposure is a cause of skin cancer.

Heart failure, the condition that took Elizabeth Taylor’s life, affects millions of Americans. The term “heart failure” is a scary one, conjuring up images of a heart that is suddenly unable to work. In truth, it represents a gradual decline in the heart’s ability to pump enough blood to meet the body’s needs. As the heart weakens, all parts of the body suffer the consequences. Harvard Heart Letter editor PJ Skerrett explains what heart failure is, how it affects the body, and what can be done to treat it.