Heart Health Archive

Q. I've heard that apple cider vinegar can clean out the arteries. Is there any truth to that?

A. If you believe the stories written about apple cider vinegar, it is a miracle cure for just about anything that ails you, from curbing the appetite to detoxifying the body, boosting the immune system, treating arthritis, and improving circulation. That's a tall order for a brew made from fermented apples. But there's no evidence to back up most of these apple cider vinegar claims.

Arteries are the vital channels that carry oxygen-rich blood from the heart to all the body's tissues. When blockages develop, blood flow slows and tissues suffer. Blockages in the coronary arteries cause angina and heart attacks; blockages in the arteries that supply blood to the brain cause strokes. But the peripheral arteries that carry blood to the legs and other parts of the body are also vulnerable. Heart attacks and strokes get all the publicity, but peripheral artery disease (PAD) is a major problem that deserves more attention and respect — especially since new methods make diagnosis easier and treatment better than ever before.

What is PAD?

Like most strokes and nearly all heart attacks, PAD (formerly called peripheral vascular disease) is a form of atherosclerosis. Peripheral artery disease begins when LDL ("bad") cholesterol passes from the blood into the wall of an artery. Arteries damaged by high blood pressure, smoking, or diabetes are at particular risk. As the cholesterol builds up, it triggers inflammation, which adds to the damage. Unless treatment halts the process, the cholesterol deposit builds up into a plaque, or blockage, that narrows the artery. Mild narrowing may not produce any symptoms, but moderate narrowing may prevent tissues from getting the blood they need to fuel the extra work of exercise. When blockages are severe, the tissues suffer even during rest. Blood clots can add insult to injury by increasing blockages.

Q. After my heart attack, my doctor told me that damaged heart muscle cannot be replaced. If this is true, why am I walking on a treadmill five days a week? Is this helping repair the heart muscle damage or strengthen what's left of my heart muscle?

A. Your skeletal muscles can repair themselves after an injury — pull your calf muscle and, after a few days or so, it heals. Until recently, it was believed that the human heart didn't have this capacity. But the heart does have some ability to make new muscle and possibly repair itself. The rate of regeneration is so slow, though, that it can't fix the kind of damage caused by a heart attack. That's why the rapid healing that follows a heart attack creates scar tissue in place of working muscle tissue.

Why fainting happens, and how to nip it in the bud.

Faint, black out, swoon, pass out. They're all names for the same thing — a temporary loss of consciousness followed by a fairly rapid and complete recovery. It's frightening when it comes out of the blue, more so when it happens again and again. The technical term, syncope (SIN-kuh-pee), comes from a Greek word that means to cut short or interrupt. What's being interrupted is blood flow to the brain.

Many overdoses are accidental, so the FDA may require new warnings on the popular pain reliever and lower the daily limit.

For a long time, acetaminophen, the active ingredient in Tylenol, has seemed to be the safe bet among the commonly available pain relievers.

Doctors once hesitated to prescribe medication until a patient's blood pressure reached 160/100. Anything below that level was deemed "mild hypertension" and not considered dangerous, so many doctors worried that the drugs' potential side effects might outweigh their benefits. These perceptions turned out to be false. Research has firmly established the value of treating stage 1 hypertension (140/90 to 159/99 mm Hg) with drugs, if necessary.

For those with diabetes or kidney disease, medications may be necessary at pressures as low as 130/80. And today, blood pressure can be controlled with lower doses of medications, meaning there is less chance of side effects.

About 73 million Americans — nearly half of them women — have hypertension (high blood pressure), a condition that propels blood too forcefully through blood vessels, increasing the risk of heart attack, heart failure, stroke, and kidney damage. If you have hypertension or borderline hypertension, you should be checking your blood pressure at home on a regular basis. That's the major recommendation in a joint statement from the American Heart Association (AHA), the American Society of Hypertension (ASH), and the Preventive Cardiovascular Nurses Association (PCNA).

The expert panel that issued the statement was chaired by Dr. Thomas G. Pickering of Columbia University. The statement itself was jointly published online May 22, 2008, in the journal Hypertension and the Journal of Cardiovascular Nursing and in print in the Journal of the American Society of Hypertension (May 2008) and the Journal of Clinical Hypertension (June 2008). Although other guidelines on managing hypertension have endorsed home blood pressure monitoring, this is the first time experts have given detailed advice about its use.

The predictive powers of a cholesterol test only go so far. If your LDL is low, your C-reactive protein may be a better sign of impending heart trouble.

The gap between knowing what's good for you and actually doing it can be huge, especially when it comes to something like getting exercise. (Never underestimate the appeal of the sedentary life.) Many of us need a warning-some might say a bit of a kick in the pants-before we'll change our ways and get with a heart-healthy program.

Cholesterol Tests

For decades, cholesterol testing has served as that warning for many. An elevated level of "bad" LDL cholesterol has been just the warning people needed to change their ways. It has played that role for several reasons. People like tests because the results seem objective. Reliable measurement of cholesterol is easy and relatively inexpensive. It makes sense biologically. LDL cholesterol, a protein-wrapped package containing fat and cholesterol, tends to slip out of the bloodstream and lodge in blood vessel walls, forming the plaque that leads to clots and heart attacks.

Medications for heart disease

Although lifestyle changes are an essential first step in treating coronary artery disease, you may need to take medications to reach your cholesterol and blood pressure goals and otherwise reduce your risk. In fact, most people with heart disease need to take more than one medication. The specific combination of drugs will depend on your particular symptoms and risk factors. Some of the most commonly prescribed medications are described below.

Blood pressure medications

For many years, doctors used diuretics — sometimes known as water pills — to treat high blood pressure. Although diuretics remain a mainstay of blood pressure treatment because they are cheap and effective, a flood of other drugs have become available since the 1980s. In addition, a large meta-analysis comparing the various options concluded that the five categories of drugs currently available are equally effective for most people. Work with your doctor to determine the best type of medication for you.

Excerpted from The Harvard Medical School Guide to Lowering Your Cholesterol

By Mason W. Freeman, M.D. with Christine Junge

Reprinted by permission of the McGraw-Hill Companies; © Copyright 2005 by President and Fellows of Harvard College. All Rights Reserved.