This life-saving test is an essential screening tool for heart disease.
By Arthur Agatston, MD, Everyday Health heart expert
What is it? A heart scan is a noninvasive procedure that shows the amount of calcified plaque you have in your coronary arteries. Currently, two types of heart scanners are being used. The first is the multislice computed tomography (CT) scanner, which creates an extremely detailed cross-sectional image of your arteries using x-ray cameras. The second is the electron-beam tomography (EBT) scanner, which creates images of the heart using an electron gun. Both types of scanners are excellent, and the one you choose depends on what your doctor recommends and what type of equipment is available at your medical center. It may also depend on how much money you are willing to spend.
There are advantages to each. The advantage of the EBT scanner is that it acquires images faster than a multislice scanner. This is particularly important when imaging a moving organ such as the heart. But while an EBT scan will provide an accurate Calcium Score and show the extent of your coronary disease, it cannot consistently show the presence and extent of soft plaque. That is the true benefit of the state-of-the-art 64-slice scan. Remember, it is the cholesterol-filled soft plaque that can grow, rupture, and cause a heart attack, so it is good to know if there is soft plaque lurking inside the lining of your artery walls.
The 64-slice scanner is simply the latest in a long line of multislice scanners, many of which are still being used. The first multislice scanner was the 4-slice, introduced in the early 1990s. It was followed by 8-, 16-, and 32-slice scanners. Some centers are still using this earlier technology but, while some of these scans can give you an accurate Calcium Score, the 64-slice scan is the best at imaging soft plaque with a dye injection (as I mentioned earlier, this is called a noninvasive angiogram). You may have been told that the 64-slice scanner can actually quantify the percentage of obstruction in your arteries. While it may be able to do this in certain patients, results are often unreliable. The invasive angiogram is still the best technique for determining the percentage of blockage. That said, a noninvasive angiogram is useful for excluding obstruction. In other words, if your scan looks completely normal, you can be confident that it is accurately showing that there are no blockages.
From a patient's perspective, getting a heart scan is quite easy. You lie down fully clothed on an examination table, the scanner passes over you for a minute or two, and then it's over. If a contrast dye is used, you may have to fast beforehand and the examination can take a little longer. One caveat: If you've ever had an allergic reaction to a contrast dye or iodine or have an allergy to shellfish, you should consider a scan that involves contrast dye injection only under special circumstances. Be sure to tell your doctor about any such allergies or reactions. Premedication can be used to minimize an allergic reaction to the dye. Caution must also be used in patients with compromised kidney function (often found in people with diabetes) since the dye can worsen the situation. You should also tell your doctor if you are or might be pregnant; if so, you should not have a scan at all. Once the scanned image of your heart has been analyzed, it's converted into a number ranging from 0 to several thousand. This number is called your Calcium Score. The higher your score compared to others of your age and sex, the more calcified plaque you have in your arteries and the greater your risk for a future heart attack.
UNDERSTANDING YOUR CALCIUM SCORE
Calcium Score for a 55-Year-Old Man or Woman
Relative Amount of Plaque
0–10 Minimal
11–100 Moderate
101–400 Increased
401+ Extensive
As I mentioned earlier, one of the real benefits of the heart scan is that I can show my patients pictures of their actual coronary arteries and the extent of plaque buildup. It's one thing to tell patients — especially those who don't have any overt symptoms — that there's a buildup of plaque in their artery walls and that they have to take a medication and make some lifestyle changes. It's quite another to have them see their plaque firsthand (coronary calcium shows up as bright white spots on the scan). I've found that a compelling visual provides strong motivation for patients to stay on their treatment program, and in particular to keep taking their medications. Moreover, follow-up heart scans can help you and your doctor keep track of your progress and make the necessary adjustments to your treatment program if need be.
Follow-up. If you have few or no calcium deposits, you need not repeat the heart scan for at least 5 years. If you do have signs of calcium buildup, the test can be repeated every 2 to 5 years, depending on your other risk factors.
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Time for a Cholesterol Drug?/dd/8/14/09
by ami » Fri Aug 14, 2009 4:14 pm
Q: My recent physical showed I have an HDL level of 99. My cholesterol level is 239, up from 220 last year in spite of a healthy diet. Should I be on a cholesterol-lowering drug?
— Carolyn, Ohio
Dr. Arthur Agatston A:
The good news, Carolyn, is that your protective high-density lipoprotein cholesterol (HDL) is considerably higher than the National Cholesterol Education Program (NCEP) guideline of 60 mg/dl for both women and men. It's likely that your somewhat high total cholesterol number reflects your high good cholesterol, and that your ratio of HDL to LDL (the bad low-density lipoprotein cholesterol) is good. That said, if you are postmenopausal, high HDL on its own is not always protective.
One of the problems with doing the most basic lab blood test for evaluating cardiac risk (the standard lipid profle) in a doctor's office is that the results only tell you your total HDL and LDL and not the size of these particles. And what many people don't know is that size does matter when it comes to both. The smaller and denser your LDL particles, the greater your chance for a heart attack. This is because these smaller and denser particles move through the inner cell lining of your arteries (the endothelium) more efficiently, depositing more cholesterol and creating more plaque. Likewise, the smaller your HDL particles, the less protective they are. If you have large HDL particles, it shows that cholesterol is being successfully transported back to your liver for excretion. What I've found is that if a person has high HDL, as you do, the particles are almost always large. In such cases, I generally prescribe diet and lifestyle changes, including plenty of exercise, rather than a statin.
For those with low or borderline HDL, I often recommend an advanced blood test known as a lipoprotein subfraction test, which shows the size of the person's HDL and LDL. If the test finds that the individual has large-particle HDL (in combination with high total HDL), as well as large-particle LDL, then it is unlikely that the person would need a statin drug.
Another test I often do to determine whether or not to treat someone with cholesterol-lowering medications is carotid artery ultrasound, which measures the thickness of the inner lining of the carotid arteries (the arteries that run under the skin on each side of the neck and carry blood to the brain). The measurement is called intimal medial thickness, and it is a good predictor of early onset atherosclerosis, or "hardening of the arteries." If the results show thickening, or if there is moderate or high risk of heart disease based on overall risk factors, then I also recommend that the patient get a heart scan for coronary calcium, which measures the amount of calcified plaque in the coronary arteries and indicates the degree of atherosclerosis present.
While some of these more advanced tests may not be covered by health insurance, they are well worth the cost, especially if it means avoiding a statin and feeling reassured about your cardiac health. Looking at your numbers, though, it looks to me as though you don't need these advanced tests. However, they are certainly worth discussing with your own doctor.
Learn how to eat to improve your health.
Last Updated: 12/15/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
— Carolyn, Ohio
Dr. Arthur Agatston A:
The good news, Carolyn, is that your protective high-density lipoprotein cholesterol (HDL) is considerably higher than the National Cholesterol Education Program (NCEP) guideline of 60 mg/dl for both women and men. It's likely that your somewhat high total cholesterol number reflects your high good cholesterol, and that your ratio of HDL to LDL (the bad low-density lipoprotein cholesterol) is good. That said, if you are postmenopausal, high HDL on its own is not always protective.
One of the problems with doing the most basic lab blood test for evaluating cardiac risk (the standard lipid profle) in a doctor's office is that the results only tell you your total HDL and LDL and not the size of these particles. And what many people don't know is that size does matter when it comes to both. The smaller and denser your LDL particles, the greater your chance for a heart attack. This is because these smaller and denser particles move through the inner cell lining of your arteries (the endothelium) more efficiently, depositing more cholesterol and creating more plaque. Likewise, the smaller your HDL particles, the less protective they are. If you have large HDL particles, it shows that cholesterol is being successfully transported back to your liver for excretion. What I've found is that if a person has high HDL, as you do, the particles are almost always large. In such cases, I generally prescribe diet and lifestyle changes, including plenty of exercise, rather than a statin.
For those with low or borderline HDL, I often recommend an advanced blood test known as a lipoprotein subfraction test, which shows the size of the person's HDL and LDL. If the test finds that the individual has large-particle HDL (in combination with high total HDL), as well as large-particle LDL, then it is unlikely that the person would need a statin drug.
Another test I often do to determine whether or not to treat someone with cholesterol-lowering medications is carotid artery ultrasound, which measures the thickness of the inner lining of the carotid arteries (the arteries that run under the skin on each side of the neck and carry blood to the brain). The measurement is called intimal medial thickness, and it is a good predictor of early onset atherosclerosis, or "hardening of the arteries." If the results show thickening, or if there is moderate or high risk of heart disease based on overall risk factors, then I also recommend that the patient get a heart scan for coronary calcium, which measures the amount of calcified plaque in the coronary arteries and indicates the degree of atherosclerosis present.
While some of these more advanced tests may not be covered by health insurance, they are well worth the cost, especially if it means avoiding a statin and feeling reassured about your cardiac health. Looking at your numbers, though, it looks to me as though you don't need these advanced tests. However, they are certainly worth discussing with your own doctor.
Learn how to eat to improve your health.
Last Updated: 12/15/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Ami in OH
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ami - Posts: 4579
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Drinking and Heart Health/DD/8/13/09
by ami » Thu Aug 20, 2009 7:41 pm
Q: I've heard that drinking red wine is good for the heart. I don't drink, but should I start drinking for the heart benefits?
— Alice, Massachusetts
Dr. Arthur Agatston A: While recent studies have shown that an antioxidant compound in red wine called resveratrol can have a beneficial effect on heart cells, protecting the lining of the coronary arteries and possibly raising good HLD cholesterol, I don't recommend that you take up drinking just to get these benefits. There is much research left to be done in this area, and there are better ways to achieve heart health, including maintaining a healthy blood pressure and body weight, eating a diet full of phytonutrient-rich, high-fiber fruits, vegetables, and whole grains, exercising regularly, and — of course — not smoking.
For those who do already drink, one or two five-ounce glasses of red wine daily with or after a meal is okay. But do stop at two glasses. More than two drinks daily may increase your risk of heart disease, as well as the risk of several types of cancer (especially breast cancer in women). Furthermore, alcohol is high in calories, so if you need to lose weight, drink it only on an occasional basis.
Learn how to eat to improve your health.
Last Updated: 10/13/2008
— Alice, Massachusetts
Dr. Arthur Agatston A: While recent studies have shown that an antioxidant compound in red wine called resveratrol can have a beneficial effect on heart cells, protecting the lining of the coronary arteries and possibly raising good HLD cholesterol, I don't recommend that you take up drinking just to get these benefits. There is much research left to be done in this area, and there are better ways to achieve heart health, including maintaining a healthy blood pressure and body weight, eating a diet full of phytonutrient-rich, high-fiber fruits, vegetables, and whole grains, exercising regularly, and — of course — not smoking.
For those who do already drink, one or two five-ounce glasses of red wine daily with or after a meal is okay. But do stop at two glasses. More than two drinks daily may increase your risk of heart disease, as well as the risk of several types of cancer (especially breast cancer in women). Furthermore, alcohol is high in calories, so if you need to lose weight, drink it only on an occasional basis.
Learn how to eat to improve your health.
Last Updated: 10/13/2008
Ami in OH
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ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
Should I Pick Up the Pace?/dd/8/22/09
by ami » Sat Aug 22, 2009 12:19 pm
Q: My doctor told me that I need to get more aerobic exercise, but I hate going to the gym! I do like to walk, but how fast and how long should I go to improve my cardiovascular health?
— Sara, Georgia
Dr. Arthur Agatston A:
I understand exactly what you mean about going to the gym; I'm not a big fan of it either. Personally, I prefer to exercise outdoors or at home. And like you, I really enjoy walking.
Recently, I've begun recommending what's known as interval walking to many of my patients. With interval walking, you alternate between short bursts of intensive effort and easier recovery periods, as opposed to walking at a steady, continuous, and potentially monotonous pace. In fact, studies show that you can get better results in 20 minutes of interval exercise than you would in an hour of steady-state exercise. And you can apply the principles of interval walking to a treadmill or elliptical trainer, to biking or swimming, or even to doing jumping jacks in your living room.
So how do you do interval walking? Instead of walking at a constant pace for your entire workout, as you've probably been doing, you should mix it up. That is, after a three-minute warm-up where you walk at an easy or moderate pace, you should alternate short bursts of very fast walking (15 to 60 seconds, depending on your conditioning) with recovery periods of slower walking after each fast burst. You can repeat each interval six to 12 times, or more depending on your fitness level. Aim for walking a total of 20 minutes to start. In general, the more intense the workout (in other words, the faster you go), the shorter the duration of that interval and the longer the recovery period. Conversely, when you're not working as hard, your work period will be longer and your recovery period will be shorter. For example, if you like taking an hour-long walk on weekends, you can certainly do intervals, but don't try to spend the entire hour working at high intensity. And always end with a two-minute cooldown at an easy pace.
I recommend that you do interval walking every other day, alternating it with some core-strengthening exercises. Not only will this type of walking improve your cardiovascular health, it will boost your metabolism so you burn more calories and fat, and that translates into faster weight loss.
Interval training is not only for the very fit. It works just as well for people who are less fit, and is even being used to help cardiac patients and people with lung disease get back in shape. That said, I do recommend that you talk with your doctor before embarking on this or any other exercise program.
— Sara, Georgia
Dr. Arthur Agatston A:
I understand exactly what you mean about going to the gym; I'm not a big fan of it either. Personally, I prefer to exercise outdoors or at home. And like you, I really enjoy walking.
Recently, I've begun recommending what's known as interval walking to many of my patients. With interval walking, you alternate between short bursts of intensive effort and easier recovery periods, as opposed to walking at a steady, continuous, and potentially monotonous pace. In fact, studies show that you can get better results in 20 minutes of interval exercise than you would in an hour of steady-state exercise. And you can apply the principles of interval walking to a treadmill or elliptical trainer, to biking or swimming, or even to doing jumping jacks in your living room.
So how do you do interval walking? Instead of walking at a constant pace for your entire workout, as you've probably been doing, you should mix it up. That is, after a three-minute warm-up where you walk at an easy or moderate pace, you should alternate short bursts of very fast walking (15 to 60 seconds, depending on your conditioning) with recovery periods of slower walking after each fast burst. You can repeat each interval six to 12 times, or more depending on your fitness level. Aim for walking a total of 20 minutes to start. In general, the more intense the workout (in other words, the faster you go), the shorter the duration of that interval and the longer the recovery period. Conversely, when you're not working as hard, your work period will be longer and your recovery period will be shorter. For example, if you like taking an hour-long walk on weekends, you can certainly do intervals, but don't try to spend the entire hour working at high intensity. And always end with a two-minute cooldown at an easy pace.
I recommend that you do interval walking every other day, alternating it with some core-strengthening exercises. Not only will this type of walking improve your cardiovascular health, it will boost your metabolism so you burn more calories and fat, and that translates into faster weight loss.
Interval training is not only for the very fit. It works just as well for people who are less fit, and is even being used to help cardiac patients and people with lung disease get back in shape. That said, I do recommend that you talk with your doctor before embarking on this or any other exercise program.
Ami in OH
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ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
Cholesterol-Lowering Snacks-DD-8-25-09
by ami » Tue Aug 25, 2009 3:15 pm
Q: I can't stop snacking between meals, but I want to try to eat things that will help me lower my cholesterol (instead of raising it!). What would you recommend?
— Steven, Colorado
Dr. Arthur Agatston A:
The good news — or the bad news, depending on what you're snacking on — is that "bad" low-density lipoprotein (LDL) cholesterol is sensitive to diet, though less sensitive than triglycerides and good high-density lipoprotein (HDL) cholesterol. Fortunately, the same foods that can help lower LDL may also improve HDL and triglycerides. So instead of snacking on chips and doughnuts, consider these healthier options:
Nuts and seeds. Sunflower seeds, pistachios, pumpkin seeds, sesame seeds, pine nuts, flaxseeds, and almonds are particularly high in plant sterols, which can help reduce LDL. But it's easy to overdo it on nuts and seeds (and they are calorie dense), so I suggest limiting your total intake to about one ounce, or 1/4 cup, a day if you are also trying to lose weight.
Apples. Research shows that eating two apples a day can slow down the oxidation of LDL cholesterol and help prevent plaque buildup. The protective antioxidants are in the apples' skin, so don't peel them.
Oat bran. An important source of water-soluble fiber, oats have long been recognized as a potential cholesterol-lowering dietary component. The soluble fiber in oat bran binds with bile acids in the intestine to block the absorption of cholesterol by the body. According to a study conducted at the Jean Mayer USDA Human Nutrition Research Center on Aging in Boston, antioxidant compounds found in oat bran called avenanthramides can also prevent white blood cells from sticking to the artery walls, which is an important step in preventing plaque formation. So why not have a bowl of unsweetened oat cereal as a midmorning or mid-afternoon snack? Not only is it filling, it's good for your heart.
Grapefruit. Studies show that the phytochemicals called liminoids in pink and red grapefruit make them powerful LDL busters. But this snack is not for everyone. Because grapefruit can interfere with the breakdown of certain medications, including statins and calcium channel blockers, don't eat a lot of grapefruit or drink the juice as a snack if you're on these medications.
Learn how to eat to improve your health.
Last Updated: 09/30/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
— Steven, Colorado
Dr. Arthur Agatston A:
The good news — or the bad news, depending on what you're snacking on — is that "bad" low-density lipoprotein (LDL) cholesterol is sensitive to diet, though less sensitive than triglycerides and good high-density lipoprotein (HDL) cholesterol. Fortunately, the same foods that can help lower LDL may also improve HDL and triglycerides. So instead of snacking on chips and doughnuts, consider these healthier options:
Nuts and seeds. Sunflower seeds, pistachios, pumpkin seeds, sesame seeds, pine nuts, flaxseeds, and almonds are particularly high in plant sterols, which can help reduce LDL. But it's easy to overdo it on nuts and seeds (and they are calorie dense), so I suggest limiting your total intake to about one ounce, or 1/4 cup, a day if you are also trying to lose weight.
Apples. Research shows that eating two apples a day can slow down the oxidation of LDL cholesterol and help prevent plaque buildup. The protective antioxidants are in the apples' skin, so don't peel them.
Oat bran. An important source of water-soluble fiber, oats have long been recognized as a potential cholesterol-lowering dietary component. The soluble fiber in oat bran binds with bile acids in the intestine to block the absorption of cholesterol by the body. According to a study conducted at the Jean Mayer USDA Human Nutrition Research Center on Aging in Boston, antioxidant compounds found in oat bran called avenanthramides can also prevent white blood cells from sticking to the artery walls, which is an important step in preventing plaque formation. So why not have a bowl of unsweetened oat cereal as a midmorning or mid-afternoon snack? Not only is it filling, it's good for your heart.
Grapefruit. Studies show that the phytochemicals called liminoids in pink and red grapefruit make them powerful LDL busters. But this snack is not for everyone. Because grapefruit can interfere with the breakdown of certain medications, including statins and calcium channel blockers, don't eat a lot of grapefruit or drink the juice as a snack if you're on these medications.
Learn how to eat to improve your health.
Last Updated: 09/30/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Ami in OH
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ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
Women, Hormones, and Heart Disease/DD/8/27/09
by ami » Thu Aug 27, 2009 10:11 pm
Estrogen provides protective benefits that may help women delay heart disease.
By Arthur Agatston, MD, Everyday Health heart expert
It may appear as though women don't get heart disease because they tend to develop it later in life than men, largely due to the protective effects of natural estrogen. As long as women are having regular menstrual cycles, they enjoy a significant, although not absolute, level of protection. Naturally produced estrogen is linked with lower levels of LDL ("bad") cholesterol and triglycerides and higher HDL ("good") cholesterol. When a woman's estrogen production plummets in her late forties to early fifties, she begins to lose her hormonal advantage.
For decades, experts advised women to take hormone replacement therapy (HRT) to protect their hearts as well as to relieve menopausal symptoms and strengthen their bones. Estrogen's heart-protective properties looked so promising that nearly half of all postmenopausal female physicians took HRT, a rate higher than that of the general public, according to a 1997 study.
That all changed in 2002, when preliminary results from the Women's Health Initiative, a 15-year research program, caused a dramatic turnaround in the thinking about HRT. Compared with women who did not take HRT, women who took Prempro, a combination of estrogen and progestin, had a startling 29 percent increase in deaths from heart disease, along with a 22 percent increase in total cardiovascular disease. These results stunned the health community and caused a great deal of confusion in the general public.
But as it turns out, the HRT story is probably far from over. A review and analysis of many of the published HRT studies recently appeared in the Journal of General Internal Medicine. The authors pointed out possible explanations for the disparities between the earlier observational HRT studies of women who had chosen, in consultation with their physicians, to be on HRT and the more recent controlled trials. One factor that appears to be important is the timing of when HRT is started. Those women who begin it later appear to be more likely to experience heart attacks than those who begin HRT soon after menopause. In addition, much of the increased risk seems to occur in the first year HRT is started and may be due to an increased tendency to develop blood clots in the first year of HRT use.
I wish I could give women more definitive advice on this subject, but at this time the research is just too inconsistent. Whether beginning HRT earlier after menopause and perhaps at lower dosages is safer is frankly unknown at this time. Therefore, any decision on whether to begin HRT should be made with your physician after careful review of the potential risks and benefits for your particular situation.
JoAnne's Story
"I feel younger now than I did 2 years ago."
I'm 85 years old, and I have pulmonary hypertension (high blood pressure in the arteries that supply the lungs). It can be very serious. When I went to see Dr. Agatston 2 years ago, I wasn't doing well. I couldn't walk across the room without getting out of breath. I was overweight and I felt terrible. He put me on a healthy diet and told me to get some exercise. Thanks to that, I've lost 40 pounds. I breathe a lot better now and I can do a lot more things. I like to walk, but I'm not a youngster. I go to the gym three times a week to walk on the treadmill and do the bike. I do as much as I can. When I get tired, I stop, but I feel much happier and I look much better.
I feel younger now than I did 2 years ago. I used to eat a lot of sugar and a lot of junk. Now I don't eat fried foods, and I don't eat sugar. I don't keep it in my house. If you visit me and you want sugar, you have to bring your own! Now I eat a lot of chicken soup with fresh vegetables. I take care of myself. I do my own shopping and my own cooking. I'm still driving. I never expected to make it to this age. But here I am, thanks to a great lifestyle.
Learn how to eat to improve your health.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
By Arthur Agatston, MD, Everyday Health heart expert
It may appear as though women don't get heart disease because they tend to develop it later in life than men, largely due to the protective effects of natural estrogen. As long as women are having regular menstrual cycles, they enjoy a significant, although not absolute, level of protection. Naturally produced estrogen is linked with lower levels of LDL ("bad") cholesterol and triglycerides and higher HDL ("good") cholesterol. When a woman's estrogen production plummets in her late forties to early fifties, she begins to lose her hormonal advantage.
For decades, experts advised women to take hormone replacement therapy (HRT) to protect their hearts as well as to relieve menopausal symptoms and strengthen their bones. Estrogen's heart-protective properties looked so promising that nearly half of all postmenopausal female physicians took HRT, a rate higher than that of the general public, according to a 1997 study.
That all changed in 2002, when preliminary results from the Women's Health Initiative, a 15-year research program, caused a dramatic turnaround in the thinking about HRT. Compared with women who did not take HRT, women who took Prempro, a combination of estrogen and progestin, had a startling 29 percent increase in deaths from heart disease, along with a 22 percent increase in total cardiovascular disease. These results stunned the health community and caused a great deal of confusion in the general public.
But as it turns out, the HRT story is probably far from over. A review and analysis of many of the published HRT studies recently appeared in the Journal of General Internal Medicine. The authors pointed out possible explanations for the disparities between the earlier observational HRT studies of women who had chosen, in consultation with their physicians, to be on HRT and the more recent controlled trials. One factor that appears to be important is the timing of when HRT is started. Those women who begin it later appear to be more likely to experience heart attacks than those who begin HRT soon after menopause. In addition, much of the increased risk seems to occur in the first year HRT is started and may be due to an increased tendency to develop blood clots in the first year of HRT use.
I wish I could give women more definitive advice on this subject, but at this time the research is just too inconsistent. Whether beginning HRT earlier after menopause and perhaps at lower dosages is safer is frankly unknown at this time. Therefore, any decision on whether to begin HRT should be made with your physician after careful review of the potential risks and benefits for your particular situation.
JoAnne's Story
"I feel younger now than I did 2 years ago."
I'm 85 years old, and I have pulmonary hypertension (high blood pressure in the arteries that supply the lungs). It can be very serious. When I went to see Dr. Agatston 2 years ago, I wasn't doing well. I couldn't walk across the room without getting out of breath. I was overweight and I felt terrible. He put me on a healthy diet and told me to get some exercise. Thanks to that, I've lost 40 pounds. I breathe a lot better now and I can do a lot more things. I like to walk, but I'm not a youngster. I go to the gym three times a week to walk on the treadmill and do the bike. I do as much as I can. When I get tired, I stop, but I feel much happier and I look much better.
I feel younger now than I did 2 years ago. I used to eat a lot of sugar and a lot of junk. Now I don't eat fried foods, and I don't eat sugar. I don't keep it in my house. If you visit me and you want sugar, you have to bring your own! Now I eat a lot of chicken soup with fresh vegetables. I take care of myself. I do my own shopping and my own cooking. I'm still driving. I never expected to make it to this age. But here I am, thanks to a great lifestyle.
Learn how to eat to improve your health.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
Ami in OH
-
ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
Tackling Triglycerides/DD/9/2/09
by ami » Tue Sep 01, 2009 7:45 pm
Q: My doctor says my triglycerides are a bit high, but my cholesterol is within the normal range. Are triglycerides something I should worry about?
— Susannah, Maine
Dr. Arthur Agatston A:
Yes, you need to keep an eye on triglycerides, which are the most common type of fat found in the body. When you eat, any calories not used immediately for energy are converted into triglycerides and stored in fat cells. Triglycerides also circulate in your bloodstream.
High triglycerides combined with low HDL ("good") cholesterol are a risk factor for heart disease and type 2 diabetes. A normal triglyceride level is below 150; 150 to 199 is borderline high; levels above 200 are considered high. For high-risk patients, my goal is a triglyceride level of less than 100 mg/dL.
I call triglycerides and HDL lifestyle lipids because they are both very sensitive to changes in diet and exercise. Losing weight, taking prescription niacin and fish oil supplements, and avoiding starchy and sugary carbohydrates as well as saturated fat and trans fats are all effective ways of reducing elevated levels of this bad type of blood fat.
Learn how to eat to improve your health.
Last Updated: 07/07/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
— Susannah, Maine
Dr. Arthur Agatston A:
Yes, you need to keep an eye on triglycerides, which are the most common type of fat found in the body. When you eat, any calories not used immediately for energy are converted into triglycerides and stored in fat cells. Triglycerides also circulate in your bloodstream.
High triglycerides combined with low HDL ("good") cholesterol are a risk factor for heart disease and type 2 diabetes. A normal triglyceride level is below 150; 150 to 199 is borderline high; levels above 200 are considered high. For high-risk patients, my goal is a triglyceride level of less than 100 mg/dL.
I call triglycerides and HDL lifestyle lipids because they are both very sensitive to changes in diet and exercise. Losing weight, taking prescription niacin and fish oil supplements, and avoiding starchy and sugary carbohydrates as well as saturated fat and trans fats are all effective ways of reducing elevated levels of this bad type of blood fat.
Learn how to eat to improve your health.
Last Updated: 07/07/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Ami in OH
-
ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
Diabetes, Prediabetes, and Metabolic Syndrome/DD/9/3/09
by ami » Wed Sep 02, 2009 3:45 pm
Having these conditions could be just as harmful to your health as a prior heart attack.
By Arthur Agatston, MD, Everyday Health heart expert
If you are an American age 40 to 70, the odds are about 40 percent that you've been diagnosed with prediabetes, diabetes, or metabolic syndrome. Shocked by this statistic? You should be! Not long ago, diabetes and prediabetes were rare. Now they are virtual epidemics in the United States, putting tens of millions of Americans at high risk for heart disease. In fact, diabetes is such a strong risk factor for heart disease that medical professionals define it as a "coronary heart disease risk equivalent." This means that a person with diabetes has the same high risk of a heart attack as someone who has already had one. Up to 70 percent of people in coronary care units have prediabetes or diabetes. Women, take note: If you have diabetes and have suffered a heart attack, you have an even greater risk of having another heart attack or heart failure than a man who has diabetes and has suffered a heart attack.
Diabetes is well known as a disease characterized by the body's inability to process sugars and starches. Less well known are the problems that people with diabetes have processing fats in their diet. There are two common types of diabetes: juvenile-onset, or what's now known as type 1 diabetes (which usually appears abruptly before age 30), and adult-onset, or type 2, diabetes. About 90 percent of all those with diabetes in the United States have type 2. Prediabetes, sometimes called metabolic syndrome, insulin resistance, or Syndrome X, will lead to full-blown type 2 diabetes if it goes unchecked. The difficulty with processing fats and the risk of heart attack and stroke begin in the prediabetes phase, which is defined as a blood sugar level of 100 to 125 mg/dL.
The problem with type 2 diabetes and prediabetes is that people who have these conditions process fats abnormally, leading to low levels of good HDL and elevated levels of triglycerides. They also have more small HDL and more small, dense LDL (see the explanation of Question 9, page 51). In addition, they often have high blood pressure and more inflammation in their arteries.
To help reduce these risks, national guidelines recommend that people with diabetes keep their blood pressure below 130/80. Giving up cigarettes is even more important for people with diabetes than it is for others, because smoking and diabetes are a deadly combination. Type 2 diabetes is also closely linked with obesity (see Chapter 5), which explains why, as the American population gets fatter, the rate of type 2 diabetes is soaring. What is even more alarming is that there are millions more "diabetics in training" in our country today. I am speaking of our children, who, as they grow fatter and less fit, are rapidly becoming prediabetic or even diabetic. Type 2 diabetes can no longer be called an "adult-onset" disease.
Luckily, type 2 diabetes is largely a "man-made" disease that we can unmake if we set our minds to it. Exercise, weight loss, and strategic dietary changes — particularly eliminating the highly processed "bad carbs" found in baked goods, breads, snack foods, and other starchy and sugary favorites — are all very effective in reversing insulin resistance.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
By Arthur Agatston, MD, Everyday Health heart expert
If you are an American age 40 to 70, the odds are about 40 percent that you've been diagnosed with prediabetes, diabetes, or metabolic syndrome. Shocked by this statistic? You should be! Not long ago, diabetes and prediabetes were rare. Now they are virtual epidemics in the United States, putting tens of millions of Americans at high risk for heart disease. In fact, diabetes is such a strong risk factor for heart disease that medical professionals define it as a "coronary heart disease risk equivalent." This means that a person with diabetes has the same high risk of a heart attack as someone who has already had one. Up to 70 percent of people in coronary care units have prediabetes or diabetes. Women, take note: If you have diabetes and have suffered a heart attack, you have an even greater risk of having another heart attack or heart failure than a man who has diabetes and has suffered a heart attack.
Diabetes is well known as a disease characterized by the body's inability to process sugars and starches. Less well known are the problems that people with diabetes have processing fats in their diet. There are two common types of diabetes: juvenile-onset, or what's now known as type 1 diabetes (which usually appears abruptly before age 30), and adult-onset, or type 2, diabetes. About 90 percent of all those with diabetes in the United States have type 2. Prediabetes, sometimes called metabolic syndrome, insulin resistance, or Syndrome X, will lead to full-blown type 2 diabetes if it goes unchecked. The difficulty with processing fats and the risk of heart attack and stroke begin in the prediabetes phase, which is defined as a blood sugar level of 100 to 125 mg/dL.
The problem with type 2 diabetes and prediabetes is that people who have these conditions process fats abnormally, leading to low levels of good HDL and elevated levels of triglycerides. They also have more small HDL and more small, dense LDL (see the explanation of Question 9, page 51). In addition, they often have high blood pressure and more inflammation in their arteries.
To help reduce these risks, national guidelines recommend that people with diabetes keep their blood pressure below 130/80. Giving up cigarettes is even more important for people with diabetes than it is for others, because smoking and diabetes are a deadly combination. Type 2 diabetes is also closely linked with obesity (see Chapter 5), which explains why, as the American population gets fatter, the rate of type 2 diabetes is soaring. What is even more alarming is that there are millions more "diabetics in training" in our country today. I am speaking of our children, who, as they grow fatter and less fit, are rapidly becoming prediabetic or even diabetic. Type 2 diabetes can no longer be called an "adult-onset" disease.
Luckily, type 2 diabetes is largely a "man-made" disease that we can unmake if we set our minds to it. Exercise, weight loss, and strategic dietary changes — particularly eliminating the highly processed "bad carbs" found in baked goods, breads, snack foods, and other starchy and sugary favorites — are all very effective in reversing insulin resistance.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
Ami in OH
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ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
Heart Scan Imaging/DD/3/9/09
by ami » Thu Sep 03, 2009 3:20 pm
Q: What is heart-scan imaging and why is it beneficial?
— David, Wisconsin
Dr. Arthur Agatston A:
According to the National Heart, Lung, and Blood Institute, about 1.1 million Americans experience heart attacks each year. I believe that number could be greatly reduced if we took more aggressive steps toward preventing heart disease. Often, the usual prescription of improving diet and exercise is not enough. That's why I recommend that most men (over the age of 40) and women (over the age of 50) work with their doctor to undergo a noninvasive heart scan.
A heart scan (also known as computed tomography, CT, or CAT scan) uses a combination of X-rays and computer imaging to provide a picture of the heart's arteries. Using new, fast CT scanners is currently one of the best methods to detect the buildup of arterial plaque years before it causes symptoms of heart disease. Fast CT scans can detect even the slightest buildup of calcium on the artery walls, and can be used to diagnose early coronary artery disease in people with no symptoms. The higher the calcium buildup score, the greater the risk of a future heart attack or stroke. Early detection is the key to heart attack and stroke prevention.
Fast CT scans are best used in people with some risk factors of heart disease, such as high cholesterol, pre-diabetes, diabetes, smoking, high blood pressure, obesity, and/or a family history of heart attack and stroke. Keep in mind, however, that the procedure is fairly expensive and may not be covered by all health insurance providers. Check with your insurance company and physician before undergoing a CT scan.
Learn how to eat to improve your health.
Last Updated: 06/26/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
— David, Wisconsin
Dr. Arthur Agatston A:
According to the National Heart, Lung, and Blood Institute, about 1.1 million Americans experience heart attacks each year. I believe that number could be greatly reduced if we took more aggressive steps toward preventing heart disease. Often, the usual prescription of improving diet and exercise is not enough. That's why I recommend that most men (over the age of 40) and women (over the age of 50) work with their doctor to undergo a noninvasive heart scan.
A heart scan (also known as computed tomography, CT, or CAT scan) uses a combination of X-rays and computer imaging to provide a picture of the heart's arteries. Using new, fast CT scanners is currently one of the best methods to detect the buildup of arterial plaque years before it causes symptoms of heart disease. Fast CT scans can detect even the slightest buildup of calcium on the artery walls, and can be used to diagnose early coronary artery disease in people with no symptoms. The higher the calcium buildup score, the greater the risk of a future heart attack or stroke. Early detection is the key to heart attack and stroke prevention.
Fast CT scans are best used in people with some risk factors of heart disease, such as high cholesterol, pre-diabetes, diabetes, smoking, high blood pressure, obesity, and/or a family history of heart attack and stroke. Keep in mind, however, that the procedure is fairly expensive and may not be covered by all health insurance providers. Check with your insurance company and physician before undergoing a CT scan.
Learn how to eat to improve your health.
Last Updated: 06/26/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
Ami in OH
-
ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
What Your Waistline Says About Your Heart/DD/9/4/09
by ami » Fri Sep 04, 2009 8:49 pm
Carrying excess weight around your middle could have a profound impact on your heart.
By Arthur Agatston, MD, Everyday Health heart expert
There is an important medical condition so obvious that I can diagnose it without performing a single diagnostic test. I can spot it the instant a patient walks into my office. It's so common that I see it everywhere — at malls, in restaurants, on the golf course, and strolling down the street. It has reached epidemic proportions in the United States. I'm sure you've seen it, too, among your family and friends, and maybe when you look in the mirror.
The ailment has many names, including metabolic syndrome, insulin resistance, Syndrome X, and the name I will use, prediabetes. Why is it so easy to diagnose? There's one clue that's a dead giveaway: It's your waistline. One of my colleagues says that when a patient's belly is the first body part to enter his office, the diagnosis is made. If you have gained weight in middle age and most of it is in your belly, you are likely part of the American epidemic of prediabetes. And if you don't start eating better and exercising, full-blown diabetes will almost certainly be in your future.
Why would a cardiologist be so concerned with your waistline? The reason has less to do with how you look on the outside than it does with how you look on the inside. I'm worried about what prediabetes and diabetes are doing to your arteries. Both conditions can injure the lining of your vessels and accelerate the production of plaque, greatly increasing your risk of having a heart attack or stroke.
After a meal, it is the job of insulin to help transport fats as well as sugar from the blood into the tissues. As you develop insulin resistance, fats accumulate in your bloodstream and hang around much longer than usual. During this time, changes in your blood fats occur — your LDL particles and your HDL particles become smaller and your total HDL is reduced. These changes favor the movement of cholesterol from your bloodstream into your artery walls. The smaller and denser the LDLs are, the more likely they are to move into your vessel walls. And the smaller and denser the HDLs are, the less efficient they are at removing the cholesterol from those vessel walls. These changes are also associated with high blood fat levels measured in the form of triglycerides. The fact that these fats are in your bloodstream longer also favors their accumulation in the vessel walls.
So, if you have gained predominantly belly fat as an adult and there is diabetes in your family (even if it occurred in a parent or grandparent late in life), you probably are insulin resistant and have prediabetes. The diagnosis of prediabetes is made if you meet three of the five following criteria:
* Central obesity: A waist circumference of greater than 40 inches for men and 35 inches for women
* Elevated triglycerides: Greater than or equal to 150 mg/dL
* Low total HDL: Less than or equal to 40 mg/dL for men and less than or equal to 50 mg/dL for women
* Elevated blood pressure: Systolic blood pressure of greater than or equal to 130 mm Hg and diastolic blood pressure of greater than or equal to 85 mm Hg
* Elevated fasting glucose: Greater than or equal to 100 mg/dL
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
By Arthur Agatston, MD, Everyday Health heart expert
There is an important medical condition so obvious that I can diagnose it without performing a single diagnostic test. I can spot it the instant a patient walks into my office. It's so common that I see it everywhere — at malls, in restaurants, on the golf course, and strolling down the street. It has reached epidemic proportions in the United States. I'm sure you've seen it, too, among your family and friends, and maybe when you look in the mirror.
The ailment has many names, including metabolic syndrome, insulin resistance, Syndrome X, and the name I will use, prediabetes. Why is it so easy to diagnose? There's one clue that's a dead giveaway: It's your waistline. One of my colleagues says that when a patient's belly is the first body part to enter his office, the diagnosis is made. If you have gained weight in middle age and most of it is in your belly, you are likely part of the American epidemic of prediabetes. And if you don't start eating better and exercising, full-blown diabetes will almost certainly be in your future.
Why would a cardiologist be so concerned with your waistline? The reason has less to do with how you look on the outside than it does with how you look on the inside. I'm worried about what prediabetes and diabetes are doing to your arteries. Both conditions can injure the lining of your vessels and accelerate the production of plaque, greatly increasing your risk of having a heart attack or stroke.
After a meal, it is the job of insulin to help transport fats as well as sugar from the blood into the tissues. As you develop insulin resistance, fats accumulate in your bloodstream and hang around much longer than usual. During this time, changes in your blood fats occur — your LDL particles and your HDL particles become smaller and your total HDL is reduced. These changes favor the movement of cholesterol from your bloodstream into your artery walls. The smaller and denser the LDLs are, the more likely they are to move into your vessel walls. And the smaller and denser the HDLs are, the less efficient they are at removing the cholesterol from those vessel walls. These changes are also associated with high blood fat levels measured in the form of triglycerides. The fact that these fats are in your bloodstream longer also favors their accumulation in the vessel walls.
So, if you have gained predominantly belly fat as an adult and there is diabetes in your family (even if it occurred in a parent or grandparent late in life), you probably are insulin resistant and have prediabetes. The diagnosis of prediabetes is made if you meet three of the five following criteria:
* Central obesity: A waist circumference of greater than 40 inches for men and 35 inches for women
* Elevated triglycerides: Greater than or equal to 150 mg/dL
* Low total HDL: Less than or equal to 40 mg/dL for men and less than or equal to 50 mg/dL for women
* Elevated blood pressure: Systolic blood pressure of greater than or equal to 130 mm Hg and diastolic blood pressure of greater than or equal to 85 mm Hg
* Elevated fasting glucose: Greater than or equal to 100 mg/dL
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
Ami in OH
-
ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
How long to Improve Cholesterol-DD-9-7-09
by ami » Mon Sep 07, 2009 4:21 pm
Q: How long does it usually take to improve very bad cholesterol levels? Is a month an unreasonable amount of time?
— Joanne, Delaware
Dr. Arthur Agatston A:
It depends on which part of your lipid profile is elevated and how you're going about lowering your cholesterol. Ultimately, the results will be different for every person.
Elevated triglycerides (fats present in the blood plasma) tend to come down the fastest, usually in a few months or even less. This will often result in a corresponding drop in your total cholesterol. Total cholesterol is a combination of HDL (good cholesterol) and LDL (bad cholesterol); therefore, a sudden drop or increase can be potentially misleading. You'll need to pay close attention to your levels of HDL and LDL to determine if you've really decreased bad cholesterol and increased good cholesterol. If triglycerides are not elevated, it may take longer to see a decrease in your total cholesterol.
The speed with which your cholesterol levels improve also has to do with the method you've employed. Changing your lifestyle through diet and exercise is great for overall health, but it may take some time for cholesterol levels to improve. If, in addition to a healthy lifestyle, you're taking cholesterol-lowering drugs per doctor's orders, you could see improvement in as little as one month. Consult with your doctor to see if you're on the right track.
Learn how to eat to improve your health.
Last Updated: 06/26/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
— Joanne, Delaware
Dr. Arthur Agatston A:
It depends on which part of your lipid profile is elevated and how you're going about lowering your cholesterol. Ultimately, the results will be different for every person.
Elevated triglycerides (fats present in the blood plasma) tend to come down the fastest, usually in a few months or even less. This will often result in a corresponding drop in your total cholesterol. Total cholesterol is a combination of HDL (good cholesterol) and LDL (bad cholesterol); therefore, a sudden drop or increase can be potentially misleading. You'll need to pay close attention to your levels of HDL and LDL to determine if you've really decreased bad cholesterol and increased good cholesterol. If triglycerides are not elevated, it may take longer to see a decrease in your total cholesterol.
The speed with which your cholesterol levels improve also has to do with the method you've employed. Changing your lifestyle through diet and exercise is great for overall health, but it may take some time for cholesterol levels to improve. If, in addition to a healthy lifestyle, you're taking cholesterol-lowering drugs per doctor's orders, you could see improvement in as little as one month. Consult with your doctor to see if you're on the right track.
Learn how to eat to improve your health.
Last Updated: 06/26/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
Ami in OH
-
ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
Sleep Apnea and Your Health/DD/9/10/09
by ami » Thu Sep 10, 2009 9:20 pm
Do you snore loudly? Are you tired during the day even after what you thought was a full night's sleep? If so, you may be suffering from sleep apnea, a common sleep disorder. People with untreated sleep apnea stop breathing periodically while they sleep; this is dangerous and leads to many health complications. The good news is that the South Beach Diet lifestyle may help.
In the most common form of sleep apnea (known as obstructive sleep apnea), the muscles in your larynx collapse, preventing the flow of air to the lungs. The brain, recognizing a decrease of oxygen in the blood, sends a signal to the body to arouse you from sleep to take a breath. In addition to preventing a good night's sleep for you (and your partner!), sleep apnea can cause high blood pressure and an increased chance of heart failure or stroke. If you suffer from sleep apnea, you may find yourself unable to stay awake at work, while watching TV, or even while driving.
Men over the age of 40 are most commonly affected by sleep apnea, but any person who is overweight or obese has a higher risk of developing the condition. Excess weight, especially around the neck, can obstruct the breathing passages. Losing weight by following the South Beach Diet lifestyle may relieve the obstruction, lessen snoring, and help you to breathe easier.
Sleep apnea should not be taken lightly. Consult your doctor if you believe you suffer from the condition and weight loss is not helping. Your doctor can recommend alternative treatments.
In the most common form of sleep apnea (known as obstructive sleep apnea), the muscles in your larynx collapse, preventing the flow of air to the lungs. The brain, recognizing a decrease of oxygen in the blood, sends a signal to the body to arouse you from sleep to take a breath. In addition to preventing a good night's sleep for you (and your partner!), sleep apnea can cause high blood pressure and an increased chance of heart failure or stroke. If you suffer from sleep apnea, you may find yourself unable to stay awake at work, while watching TV, or even while driving.
Men over the age of 40 are most commonly affected by sleep apnea, but any person who is overweight or obese has a higher risk of developing the condition. Excess weight, especially around the neck, can obstruct the breathing passages. Losing weight by following the South Beach Diet lifestyle may relieve the obstruction, lessen snoring, and help you to breathe easier.
Sleep apnea should not be taken lightly. Consult your doctor if you believe you suffer from the condition and weight loss is not helping. Your doctor can recommend alternative treatments.
Ami in OH
-
ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
How Not to Have a Heart Attack/DD/9/10/09
by ami » Thu Sep 10, 2009 9:36 pm
Advice on heart disease prevention from author and leading cardiologist Arthur Agatston, MD.
A study presented at the American College of Cardiology meeting and published online in the New England Journal of Medicine has raised questions about whether the majority of people treated with a popular invasive procedure to reduce chest pain actually need the surgery. This study is turning up the spotlight on noninvasive prevention rather than surgical intervention, just as Dr. Arthur Agatston, preventive cardiologist and author of The South Beach Diet® does in his book The South Beach Heart Program. According to Dr. Agatston, who has been practicing aggressive prevention for many years, "this study is further evidence that we have been doing too much intervention and not enough prevention."
Following a trial involving more than 2,280 patients, researchers concluded that the use of surgical angioplasty and stenting (coupled with medication) provides no long-term advantage to a patient over a preventive treatment plan that includes appropriate medication, diagnostic testing, and lifestyle improvements. This news has stirred up controversy among the medical community. Over the past three decades the use of invasive angioplasty and stenting — a two-part procedure that involves manually opening a blockage by inflating a balloon at the end of a catheter and then using a wire tube to "prop open" the once-blocked artery — has become the initial strategy in the treatment of stable coronary artery disease. In fact, recent data indicate that more than 1 million coronary stent procedures are performed in this country each year, and nearly 85 percent of these procedures are elective. This finding comes as no surprise to Dr. Agatston, who says that for nearly three quarters of the patients who undergo stenting — those with stable heart disease — it may be unnecessary. According to Dr. Agatston, elective angioplasties and stents almost never prevent heart attacks. Practicing aggressive prevention is the more effective approach.
Dr. Agatston likens this invasive approach for managing heart disease to a plumbing model. In The South Beach Heart Program, he explains that doctors formerly believed that the gradual growth of plaque narrowed the arteries and, thus, reduced blood flow to the heart. Eventually, a clot would develop, resulting in a heart attack. The logical solution seemed to be to open the artery with angioplasty and stenting (or to bypass it) to improve blood flow. But, as Dr. Agatston notes in his book — and as the latest studies confirm — the plumber's approach is outdated and inaccurate.
"While the great majority of patients are presently being treated according to this plumbing model, the treatment of the future belongs to doctors who I characterize as 'healers,'" says Dr. Agatston. "We now know that most heart attacks occur when a soft, cholesterol-rich plaque bursts, resulting in the formation of a blood clot that suddenly blocks the flow of blood to the heart. These soft plaques occur in the lining of the artery wall, not in the artery itself, which is why merely opening up a blocked artery will not prevent a heart attack or stroke," he explains.
"The healer's approach that I present in The South Beach Heart Program is an aggressive prevention model that focuses on reducing the amount of soft plaque in the artery walls and improving the health of the arteries so that plaques do not form in the first place. Doctors who practice the healer's view, myself included, recommend a heart-healthy diet, regular exercise, advanced diagnostic testing to detect heart disease in its earliest and most treatable stages, and lifesaving medications," he says. This noninvasive approach was found to be more effective than stents in the latest study.
"I'll let you in on a big secret," says Dr. Agatston. "Physicians who practice aggressive prevention have seen heart attacks and strokes practically disappear from their practice. It's that simple — this approach can literally prevent heart attacks and strokes and save lives. My goal in writing The South Beach Heart Program was to speed the pace of the cardiac prevention revolution currently taking place in this country." To that end, Dr. Agatston has performed pioneering work in noninvasive cardiac imaging that has resulted in computerized tomography (CT) scanning methods and measures that bear his name: the Agatston Score and the Agatston Method, which are used to screen for atherosclerosis — and are recognized worldwide. The Agatston Score derived from the CT scan is the single best predictor of your risk for a future heart attack.
According to Dr. Agatston, studies like this continue to lend support to a noninvasive, aggressive prevention approach. "All of the latest research and evidence suggests that we already have the tools and knowledge to prevent the majority of heart attacks and strokes. Now we just need to put these methods into practice — and start saving more lives." For more information on Dr. Agatston's life-saving strategies, order your copy of The South Beach Heart Program today, or visit southbeachdiet.com.
Photo Gallery: The 13 Best Foods for Your Health!
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
A study presented at the American College of Cardiology meeting and published online in the New England Journal of Medicine has raised questions about whether the majority of people treated with a popular invasive procedure to reduce chest pain actually need the surgery. This study is turning up the spotlight on noninvasive prevention rather than surgical intervention, just as Dr. Arthur Agatston, preventive cardiologist and author of The South Beach Diet® does in his book The South Beach Heart Program. According to Dr. Agatston, who has been practicing aggressive prevention for many years, "this study is further evidence that we have been doing too much intervention and not enough prevention."
Following a trial involving more than 2,280 patients, researchers concluded that the use of surgical angioplasty and stenting (coupled with medication) provides no long-term advantage to a patient over a preventive treatment plan that includes appropriate medication, diagnostic testing, and lifestyle improvements. This news has stirred up controversy among the medical community. Over the past three decades the use of invasive angioplasty and stenting — a two-part procedure that involves manually opening a blockage by inflating a balloon at the end of a catheter and then using a wire tube to "prop open" the once-blocked artery — has become the initial strategy in the treatment of stable coronary artery disease. In fact, recent data indicate that more than 1 million coronary stent procedures are performed in this country each year, and nearly 85 percent of these procedures are elective. This finding comes as no surprise to Dr. Agatston, who says that for nearly three quarters of the patients who undergo stenting — those with stable heart disease — it may be unnecessary. According to Dr. Agatston, elective angioplasties and stents almost never prevent heart attacks. Practicing aggressive prevention is the more effective approach.
Dr. Agatston likens this invasive approach for managing heart disease to a plumbing model. In The South Beach Heart Program, he explains that doctors formerly believed that the gradual growth of plaque narrowed the arteries and, thus, reduced blood flow to the heart. Eventually, a clot would develop, resulting in a heart attack. The logical solution seemed to be to open the artery with angioplasty and stenting (or to bypass it) to improve blood flow. But, as Dr. Agatston notes in his book — and as the latest studies confirm — the plumber's approach is outdated and inaccurate.
"While the great majority of patients are presently being treated according to this plumbing model, the treatment of the future belongs to doctors who I characterize as 'healers,'" says Dr. Agatston. "We now know that most heart attacks occur when a soft, cholesterol-rich plaque bursts, resulting in the formation of a blood clot that suddenly blocks the flow of blood to the heart. These soft plaques occur in the lining of the artery wall, not in the artery itself, which is why merely opening up a blocked artery will not prevent a heart attack or stroke," he explains.
"The healer's approach that I present in The South Beach Heart Program is an aggressive prevention model that focuses on reducing the amount of soft plaque in the artery walls and improving the health of the arteries so that plaques do not form in the first place. Doctors who practice the healer's view, myself included, recommend a heart-healthy diet, regular exercise, advanced diagnostic testing to detect heart disease in its earliest and most treatable stages, and lifesaving medications," he says. This noninvasive approach was found to be more effective than stents in the latest study.
"I'll let you in on a big secret," says Dr. Agatston. "Physicians who practice aggressive prevention have seen heart attacks and strokes practically disappear from their practice. It's that simple — this approach can literally prevent heart attacks and strokes and save lives. My goal in writing The South Beach Heart Program was to speed the pace of the cardiac prevention revolution currently taking place in this country." To that end, Dr. Agatston has performed pioneering work in noninvasive cardiac imaging that has resulted in computerized tomography (CT) scanning methods and measures that bear his name: the Agatston Score and the Agatston Method, which are used to screen for atherosclerosis — and are recognized worldwide. The Agatston Score derived from the CT scan is the single best predictor of your risk for a future heart attack.
According to Dr. Agatston, studies like this continue to lend support to a noninvasive, aggressive prevention approach. "All of the latest research and evidence suggests that we already have the tools and knowledge to prevent the majority of heart attacks and strokes. Now we just need to put these methods into practice — and start saving more lives." For more information on Dr. Agatston's life-saving strategies, order your copy of The South Beach Heart Program today, or visit southbeachdiet.com.
Photo Gallery: The 13 Best Foods for Your Health!
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
Ami in OH
-
ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
Getting the Right Diagnostic Tests-DD-9-12-09
by ami » Sat Sep 12, 2009 4:33 pm
The right test can determine heart attack risk long before a problem occurs.
By Arthur Agatston, MD, Everyday Health heart expert
Doctors now have the diagnostic tools to detect cardiovascular disease in its earliest stages, years if not decades before a heart attack or stroke occurs. Unfortunately, too few people are taking advantage of these tools. For this reason, I encourage you to read this part of the program and discuss what you learn with your doctor. It describes the most up-to-date tests for predicting whether you're a candidate for a heart attack or stroke, as well as the appropriate follow-up tests.
Although sophisticated tests are becoming more and more widely used, there are still some places in the United States where they may not be available. If so, I recommend contacting the nearest major medical center affiliated with a university to seek a referral to a prevention-oriented physician or a prevention clinic. Because the quality of testing, particularly of the imaging tests, can vary widely from facility to facility, it's important to seek out the best center near you. A well-respected department of radiology will usually have a specialist in the area of cardiac CT. An experienced radiologist or cardiologist is essential for an accurate scan and its proper interpretation.
Why These Tests Are Needed
It's critical to remember that a healthy percentage of all heart attacks occur in people who have none or one of the obvious risk factors for heart disease. These men and women don't smoke, they don't have a bad family history, and even their total cholesterol and LDL and HDL cholesterol levels may be fine by conventional laboratory standards. Some cardiac risk factors can only be detected through the more sophisticated diagnostic tests.
For example, getting advanced blood testing is the only way to find out the size and density of your LDL particles, whether your HDL is the right size, or if you have high levels of lipoprotein (a). Many individuals whose numbers look normal on a Standard Lipid Profile may nevertheless be building up plaque and harboring these potentially dangerous cholesterol particles. Without advanced blood testing, these people would never know they are at risk for a heart attack.
I realize that this involves getting diagnostic tests that may not be covered by your health insurance plan. But to really assess your level of risk for heart disease, you must go beyond conventional testing, even if it means investing some of your own money. While a noninvasive angiogram (heart scan) that includes dye injection, performed with the state-of-the-art 64-slice scanner, can cost about $1,000, you can get your Calcium Score alone for about $400. Advanced blood tests are more likely to be covered but can cost an additional several hundred dollars. I realize that some of you who are already paying hefty insurance premiums may be dismayed by the prospect of having to pay more. However, I believe that getting these tests is one of the best investments you will ever make.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
By Arthur Agatston, MD, Everyday Health heart expert
Doctors now have the diagnostic tools to detect cardiovascular disease in its earliest stages, years if not decades before a heart attack or stroke occurs. Unfortunately, too few people are taking advantage of these tools. For this reason, I encourage you to read this part of the program and discuss what you learn with your doctor. It describes the most up-to-date tests for predicting whether you're a candidate for a heart attack or stroke, as well as the appropriate follow-up tests.
Although sophisticated tests are becoming more and more widely used, there are still some places in the United States where they may not be available. If so, I recommend contacting the nearest major medical center affiliated with a university to seek a referral to a prevention-oriented physician or a prevention clinic. Because the quality of testing, particularly of the imaging tests, can vary widely from facility to facility, it's important to seek out the best center near you. A well-respected department of radiology will usually have a specialist in the area of cardiac CT. An experienced radiologist or cardiologist is essential for an accurate scan and its proper interpretation.
Why These Tests Are Needed
It's critical to remember that a healthy percentage of all heart attacks occur in people who have none or one of the obvious risk factors for heart disease. These men and women don't smoke, they don't have a bad family history, and even their total cholesterol and LDL and HDL cholesterol levels may be fine by conventional laboratory standards. Some cardiac risk factors can only be detected through the more sophisticated diagnostic tests.
For example, getting advanced blood testing is the only way to find out the size and density of your LDL particles, whether your HDL is the right size, or if you have high levels of lipoprotein (a). Many individuals whose numbers look normal on a Standard Lipid Profile may nevertheless be building up plaque and harboring these potentially dangerous cholesterol particles. Without advanced blood testing, these people would never know they are at risk for a heart attack.
I realize that this involves getting diagnostic tests that may not be covered by your health insurance plan. But to really assess your level of risk for heart disease, you must go beyond conventional testing, even if it means investing some of your own money. While a noninvasive angiogram (heart scan) that includes dye injection, performed with the state-of-the-art 64-slice scanner, can cost about $1,000, you can get your Calcium Score alone for about $400. Advanced blood tests are more likely to be covered but can cost an additional several hundred dollars. I realize that some of you who are already paying hefty insurance premiums may be dismayed by the prospect of having to pay more. However, I believe that getting these tests is one of the best investments you will ever make.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
Ami in OH
-
ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
Shut In After a Heart Attack/DD/9/15/09
by ami » Tue Sep 15, 2009 3:23 pm
Q: My husband had a heart attack last year, and since then, he barely leaves the house. He doesn't want to do anything active and spends all of his time watching TV or surfing the Internet. How can I help him participate in life again?
— Gail, New York
Dr. Arthur Agatston A:
Although you didn’t use the term, your husband’s lack of action is a classic sign of depression, which is very common after a heart attack or stroke. I'm glad that you are determined to help him. Depression after a heart attack has been linked to abnormal heart rhythms, inflammation, increased blood pressure, high cholesterol levels, and increased plaque buildup, all of which significantly increase the risk of another heart attack.
There are certainly plenty of reasons why your husband might be depressed. Worrying about having another heart attack and fear of dying are probably paramount, but he may also be concerned about caring for you and the rest family, when he can return to work, or if he can ever play full-out basketball or 18 holes of golf again.
It's very common for depressed people to lose interest in their self-care and to give up the activities that once made them happy. Just like your husband, those who are depressed are more likely to be sedentary, eat poorly, and start smoking and/or drinking alcohol. They may also skip their medications.
The good news is that treatment helps between 80 and 90 percent of people with depression. The place to start is with your husband’s cardiologist to discuss the problem and re-evaluate the medications he’s on (sometimes beta-blockers, which are often given after a heart attack to slow heart rate, can cause or aggravate depression). Depending on the depth of his depression, it may be that he will need to be prescribed an antidepressant. Beginning talk therapy with a psychotherapist or family counselor can also help.
I would also recommend that your husband get back to exercising (in consultation with his doctor, of course). Many people fear that exercising will cause another heart attack, but it's actually beneficial. Begin with short daily walks and gradually work up to longer walks and more strenuous cardiovascular and core-strengthening exercises if his doctor permits. Not only will regular exercise stimulate the mood-boosting brain chemicals called endorphins, it will also boost his energy and strengthen his heart muscle.
Interacting with supportive people outside the home can also help. Consider contacting a support group for heart attack survivors and their families, such as Mended Hearts, which is sponsored by the American Heart Association and has chapters in communities throughout the United States and Canada.
Last Updated: 05/29/2009
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
— Gail, New York
Dr. Arthur Agatston A:
Although you didn’t use the term, your husband’s lack of action is a classic sign of depression, which is very common after a heart attack or stroke. I'm glad that you are determined to help him. Depression after a heart attack has been linked to abnormal heart rhythms, inflammation, increased blood pressure, high cholesterol levels, and increased plaque buildup, all of which significantly increase the risk of another heart attack.
There are certainly plenty of reasons why your husband might be depressed. Worrying about having another heart attack and fear of dying are probably paramount, but he may also be concerned about caring for you and the rest family, when he can return to work, or if he can ever play full-out basketball or 18 holes of golf again.
It's very common for depressed people to lose interest in their self-care and to give up the activities that once made them happy. Just like your husband, those who are depressed are more likely to be sedentary, eat poorly, and start smoking and/or drinking alcohol. They may also skip their medications.
The good news is that treatment helps between 80 and 90 percent of people with depression. The place to start is with your husband’s cardiologist to discuss the problem and re-evaluate the medications he’s on (sometimes beta-blockers, which are often given after a heart attack to slow heart rate, can cause or aggravate depression). Depending on the depth of his depression, it may be that he will need to be prescribed an antidepressant. Beginning talk therapy with a psychotherapist or family counselor can also help.
I would also recommend that your husband get back to exercising (in consultation with his doctor, of course). Many people fear that exercising will cause another heart attack, but it's actually beneficial. Begin with short daily walks and gradually work up to longer walks and more strenuous cardiovascular and core-strengthening exercises if his doctor permits. Not only will regular exercise stimulate the mood-boosting brain chemicals called endorphins, it will also boost his energy and strengthen his heart muscle.
Interacting with supportive people outside the home can also help. Consider contacting a support group for heart attack survivors and their families, such as Mended Hearts, which is sponsored by the American Heart Association and has chapters in communities throughout the United States and Canada.
Last Updated: 05/29/2009
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.
Ami in OH
-
ami - Posts: 4579
- Joined: Mon May 31, 2004 4:05 pm
- Location: Dayton, OH
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