Heart Health Archive

People who develop yellow bumps on their eyelids often visit a dermatologist to get them removed. They may want to see a cardiologist as well.

Such a skin lesion is actually a cholesterol deposit known medically as xanthelasma (ZAN-thuh-LAZ-muh) — derived from the Greek word for yellow. (The plural is xanthelasmata. You can see what they look like at www.health.harvard.edu/166.) Xanthelasmata are strikingly similar to the cholesterol deposits that develop inside blood vessels and contribute to atherosclerosis. This raises the question of whether the eyelids might provide a diagnostic window into the heart.

A heart attack, high blood pressure, and other insults can reshape the heart in ways that derail the "beat now" signals that are vital to a healthy heartbeat. The two lower chambers, the right ventricle and left ventricle, should contract and relax together. In many people with heart failure, though, they don't. This loss of synchronized squeezing costs the heart some of its pumping power.

A biventricular pacemaker can fix this problem. It sends carefully timed signals that make the right and left ventricle contract and relax in unison. This is called cardiac resynchronization therapy. Biventricular pacemakers were initially approved for people with severe heart failure. Greater experience with them will almost certainly broaden the population of folks who could benefit from one.

For the past few years, the "obesity paradox" has been getting a lot of attention. It began when several studies suggested that people who packed on the pounds with age lived longer than those who stayed thin. But the research didn't properly account for factors such as cigarette smoking or an underlying serious illness that can trigger weight loss and contribute to an early demise.

An analysis of studies that followed 1.5 million Americans over time may finally resolve the issue (New England Journal of Medicine, Dec. 2, 2010). After excluding smokers and people with underlying illnesses, the researchers found that the death rate across various age categories was lowest for people whose body mass index (BMI*) was in the normal range (20 to 24.9), and then increased steadily with BMI. People who were morbidly obese (a BMI of 40 or greater) were 2.5 times more likely to have died during the study period than those who maintained a normal weight. Of interest to Heart Letter readers, cardiovascular disease was the most common cause of death among people who were overweight or obese.

Q. I am a 50-year-old woman with newly diagnosed high blood pressure. As diets go, mine is definitely on the healthy side. I do not exercise at a health club, but I do a lot of housecleaning and gardening, and I do walk a fair amount, which I feel is equal to what I would accomplish at a health club. I weigh 150 pounds and my height is 5 feet, 6 inches. I take Toprol-XL. My blood pressure seems to be normal in the morning, averaging 121/74, but in the afternoon the upper number is often in the 140s to 150s. Is it normal for blood pressure to rise like this as the day goes on, especially while on a medication?

A. It's great that you are paying close attention to your blood pressure readings. Beta blockers like metoprolol (Lopressor, Toprol-XL) are not great medications for lowering blood pressure when used all by themselves. So, as the day goes on, and you eat and exert yourself physically, my guess is that the metoprolol is just not strong enough to control your blood pressure. One option is to switch to another medication, such as a diuretic or an ACE inhibitor. If your doctor thinks you need the beta blocker for some other cardiac condition, adding a diuretic or ACE inhibitor to the beta blocker makes sense. In fact, combining low doses of medications that fight high blood pressure in different ways is probably a more effective way to do it than with a high dose of a single medication.

Q. You have written about low potassium in the blood and ways to improve it, but I never read about too much potassium in the blood. Can you tell me why it happens and what is done about it?

A. Relatively few people develop high levels of potassium in the blood, since the kidneys are normally quite effective in clearing this mineral from the bloodstream. A normal blood potassium measurement is 3.7 to 5.2 milliequivalents per liter.

Q. My senior center is sponsoring a test to check for "peripheral artery disease." The test is free, and they say it's safe and painless. Do you think it's a good idea?

A. Peripheral artery disease (PAD) is a form of atherosclerosis. In this case, cholesterol deposits produce blockages in the arteries that carry oxygen-rich blood to your legs. Mild blockages don't cause any symptoms, but more substantial disease can cause leg pain when you walk, which is called intermittent claudication. And severe narrowing will produce pain at rest or, worst of all, critical tissue damage that requires urgent surgery or even amputation. If that's not bad enough, PAD also indicates an increased risk for heart attacks and strokes.

High-quality chocolate may lower the risk of heart failure in middle-aged and older women when eaten once or twice a week — but not when eaten more than that. That's the conclusion of a study published online, Aug. 16, 2010, in Circulation: Heart Failure. Cocoa beans are rich in flavonoids — plant chemicals known to lower blood pressure and improve cholesterol levels and coronary artery function. Cocoa and dark chocolate are already associated with a reduced risk for heart attacks, strokes, and death from heart disease.

The study. Researchers at Harvard Medical School and Sweden's Karolinska Institute followed 31,823 Swedish women ages 48 to 83 for nine years, tracking their chocolate intake with food questionnaires completed as part of the Swedish Mammography Cohort study. At the start of the study, none of the women had a history of diabetes, heart failure, or heart attack. According to the authors, most chocolate then consumed in Sweden had 30% cocoa solids — more than is typically found in chocolate in the United States. The average serving size ranged from 20 to 30 grams (about three-quarters to one full ounce).

Cholesterol is best known for its tendency to accumulate in the inner lining of arteries. In some people, though, it can also appear in small deposits in the skin. When these yellowish deposits form around the eyes, they are known as xanthelasma (pronounced ZAN-thuh-LAZ-muh; the plural form is xanthelasmata). As described in the March 2011 Harvard Heart Letter, the presence of a xanthelasma seems to signal that an individual is at increased risk of developing heart disease.

With permission from the Digital Journal of Ophthalmology, an online journal affiliated with the Massachusetts Eye and Ear Infirmary and Harvard Medical School, here is an image of what the deposits look like:

Cereal fiber–from whole wheat bread, whole wheat pasta, brown rice, barley and other whole grains–seems to offer more protection against heart disease and other chronic conditions than fiber from fruits and vegetables. The benefit isn’t necessarily from the fiber alone, but the natural package of nutrients that comes with the fiber. Processed foods, which are often stripped of their fiber and nutrients and then “fortified” in the manufacturing process, don’t measure up.

Caution, attention should accompany routine use of any pain medicine.

For people with cardiovascular disease who need relief from aches and pains, acetaminophen (Tylenol, generic) has long been touted as a safer alternative to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. A small but important Swiss trial warns that it may not be. This work doesn't mean you should ditch acetaminophen if it helps you, but does suggest you should give it the caution that it — and every medication — deserves.