Heart Health Archive

How plaque on your teeth may be connected to plaque in your arteries.

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For decades, researchers have probed the link between gum disease and cardiovascular health. Gum disease begins when the sticky, bacteria-laden film dentists refer to as plaque builds up around teeth. A completely different type of plaque — made of fat, cholesterol, calcium, and other substances found in blood — can build up inside arteries. Known as atherosclerosis, this fatty plaque is the hallmark of coronary artery disease.

People with gum disease (also known as periodontal disease) have two to three times the risk of having a heart attack, stroke, or other serious cardiovascular event. But there may not be a direct connection. Many people with heart disease have healthy gums, and not everyone with gum disease develops heart problems. Shared risk factors, such as smoking or an unhealthy diet, may explain the association. Still there's a growing suspicion that gum disease may be an independent risk factor for heart disease.

Some simple steps can help minimize or avoid muscle problems from Crestor and other cholesterol-lowering drugs.

All drugs have side effects. The trick is to weigh the potential for serious side effects against the gain you can get from the medication. The balance sheet for Crestor and other statins looks like this: These drugs cut the risk of heart attack, angina (chest pain), stroke, and death from cardiovascular disease by 30%. They cause muscle pain in under 5% of the people who take them, and these pains often stop by themselves even with continued statin use. The chance of rhabdomyolysis, a potentially deadly breakdown of muscle tissue, is less than one per million statin prescriptions.

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Q. I'm 66 and will be having my aortic valve replaced soon. My surgeon suggested a tissue valve, but he also mentioned that I could get a mechanical valve instead. What are the key differences between these two choices?

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Q. I have high blood pressure and have been checking my blood pressure more often since my doctor added another drug. But lately, my readings have been all over the place. For example, one morning it was 127/70, but then it was 170/100 in the late afternoon. What's going on?

A. You may have a condition known as labile hypertension, which refers to blood pressure that fluctuates far more than usual. Everyone's blood pressure rises and falls many times during the course of a single day, sometimes even within minutes. Many factors contribute to these changes, including physical activity, emotion, body position, diet (especially salt and alcohol intake), and sleep deprivation. However, there is no clear definition or standard criteria to distinguish between normal and abnormal fluctuations.

Q. When doctors interpret a blood pressure reading, should they also consider the heart rate? I am a 78-year-old man and have had high blood pressure (under control) for more than 40 years. I frequently monitor my blood pressure at home, resting for five minutes before I take the reading. My blood pressure is often higher when my heart rate is close to its usual resting rate (about 50 beats per minute) and lower when my heart is beating faster than that. Can the body's demands that cause higher blood pressure be partially satisfied by a faster heart rate?

A. First, let me congratulate you on monitoring your blood pressure at home. This is a great way for you to take control of your high blood pressure, and a good step toward preventing a stroke. Knowing that your blood pressure at home is under consistent control is more important than getting isolated readings at the doctor's office. You are also resting before taking the reading, and this is important to avoid spuriously high readings that happen when someone rushes around, and then sits down quickly to take a blood pressure reading. (Readers interested in monitoring their blood pressure at home can watch a video of how this is done at www.health.harvard.edu/128.)

Here's what to expect once you're home from the hospital.

Every day, thousands of people in the United States undergo open-heart surgery. This major operation leaves them with a long chest incision — and a lengthy recovery. The time it takes to fully heal will depend on the person's age and overall health and the complexity of the operation.

The most common is coronary artery bypass grafting, which uses a blood vessel taken from another part of the body to bypass a blocked heart artery. Open-heart surgery is also done to repair or replace a faulty heart valve or to repair damaged or abnormal areas of the heart.

In the 1950s, doctors offered mainly morphine and bed rest — a far cry from the many procedures and medications provided today.

During a round of golf one autumn afternoon in 1955, President Dwight Eisenhower experienced what he assumed was indigestion. After he awoke at 2 a.m. the following morning with severe chest pain, his personal physician administered several shots of morphine. It wasn't until 1 p.m. that afternoon that an electrocardiogram revealed that the president had experienced a heart attack.

Cardiologist Dr. Thomas Lee, professor of medicine at Harvard Medical School, detailed Eisenhower's experience in the Oct. 29, 2020, issue of The New England Journal of Medicine. His piece focuses mainly on how Eisenhower's cardiologist, Paul Dudley White, communicated the event to the public. As Dr. Lee wrote, "Heart attacks became less mysterious and frightening to millions of Americans that day."

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Q. In last month's Heart Letter, you described some of the ways your heart rate reflects your health. But I've also heard about another measurement, called heart rate variability. Can you explain what that's all about?

A. Heart rate variability (HRV) is a sophisticated measurement of the variation in time between each heartbeat. We know that a heart rate that's too slow, too fast, or irregular can signal a problem, so it's only natural to think that a steady, regular pulse is a sign of a healthy heart. And you might also assume that having little or no difference in the time between each beat (that is, a low HRV) is best.