Medical Issues published by the Daily Dish

[ami]

Age and Your Heart
Age can impact heart health -- but lifestyle and genetics can provide protection.
By Arthur Agatston, MD, Everyday Health heart expert
For both men and women, age is a major risk factor for heart disease. The older you are, the more wear and tear there has been on your artery walls, the longer and harder your heart has had to work, and the more time you've had to accumulate arterial plaque. It's not surprising, then, that four out of every five deaths due to heart disease occur in people over age 65.

Men, on average, show signs of cardiovascular disease about 10 years earlier than women do, and on average, men are 5 years younger when they have their first heart attack. Because men tend to get heart disease earlier than women, many women believe that they are at low risk for heart disease. They are mistaken.

Women do get heart disease, but usually later than men because their female hormones generally offer special protection for the heart while they are premenopausal. However, once a woman reaches menopause, usually in her late forties or early fifties, her estrogen levels sharply decline and her risk of having a heart attack dramatically increases. And by age 65, women are even more likely than men to develop high blood pressure. Notably, a woman who undergoes early menopause is at greater risk for heart disease than her peers who are still menstruating and still cycling estrogen.

Chronological age alone does not tell the whole story. I want to stress that just because you are in your sixties or seventies doesn't mean that your heart health is deteriorating. Recently, I reviewed the heart scan of a 74-year-old male patient who exercised daily and followed a healthy diet. There was absolutely no calcified plaque in his coronary arteries, which meant that his risk of having a heart attack was extremely low. He may have indeed chosen the right parents, but that still doesn't completely account for his good health. Some credit must go to his heart-healthy lifestyle.

That same day, I reviewed the scan of a 58-year-old woman who was overweight and sedentary. Her arteries were loaded with plaque, which put her at much greater risk of having a heart attack than my older male patient. My point is that you can have healthy arteries well into old age if you make the right lifestyle and therapeutic choices and take steps to reduce those risk factors that are within your control.

What is really important is the "physiologic" age of your arteries. Just as we are impressed by the sharp minds of many elderly people, we have also seen that they can have young arteries despite their advanced years. In many non-Western societies, where food is not overprocessed and exercise is part of everyday life, the arteries of the elderly are clean and heart attacks and strokes are rarities.

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]

According to the American Diabetes Association, 57 million Americans are at risk for developing type 2 diabetes — magnifying the problem is the fact that many of those in danger don’t realize it. That's because all but the most serious cases of diabetes may manifest with symptoms that seem harmless — like thirst and fatigue. November marks American Diabetes Month, and the American Diabetes Association encourages you to be proactive and take steps to reduce your risk of getting this prevalent and debilitating disease. The first step is educating yourself about the risk factors; then learning the best strategy to prevent it.

People with type 2 diabetes have too much glucose in their blood and not enough insulin to break it down. Large concentrations of blood glucose can cause irreparable damage to the kidneys, eyes, and nervous system. You should watch out for the following factors, which put you at increased risk:

* Obesity or being overweight
* High blood pressure (above 130/80)
* Insulin resistance
* Impaired glucose tolerance or impaired fasting glucose
* Inactivity or sedentary lifestyle
* Family history of diabetes
* History of gestational diabetes
* Women with polycystic ovary syndrome (PCOS)

How to Prevent Type 2 Diabetes

The most effective ways to avoid this dangerous disease are to maintain a healthy weight, participate in daily exercise, and eat a diet low in saturated fat and rich in fresh fruits, vegetables, and whole grains. If you’re living the South Beach Diet lifestyle, you’re off to a good start!

[ami]

Ask Dr. Arthur Agatston
Trans Fat Confusion?

Q: I'm trying to avoid trans fats, as you suggest, but I don't know how to determine which foods they're in. How do I read and interpret the food label to find trans fats?
— Bonnie, Seattle
Dr. Arthur Agatston A:

The U.S. Food and Drug Administration (FDA) requires food manufacturers to display the amount of trans fats on all of their product labels. You'll see this number listed on the Nutritional Facts panel after Total Fat and Saturated Fat. Dietary supplements (such as energy and nutritional bars) will also list trans fats on their Supplement Facts panel if the product contains 0.5 grams or more of trans fat.

Trans fats are created when manufacturers turn liquid oils into solid fats through a process called hydrogenation, which was originally done to increase the shelf life of foods. But we now know that consuming trans fats contributes to clogged arteries -- which can lead to heart disease or stroke.

Besides listing the amounts of trans fats, these labels will also tell you the amounts of saturated fats and cholesterol so you can compare products and choose the ones with the lowest amounts. Why should you be concerned about these numbers? Consuming trans fats raises your LDL ("bad") cholesterol levels, which in turn increases your risk for heart disease, stroke, obesity, and other conditions. These fats also lower your HDL, the good, protective form of lipids. Foods high in saturated fats and cholesterol can also increase your risk for heart disease, but since trans fats have a negative effect on both HDL and LDL, they probably pose an even greater risk than saturated fats.

Try to minimize your intake of trans fats as much as possible, and instead focus on eating products containing the "good" fats, such as extra-virgin olive and canola oils.

Learn more in the Everyday Health Heart Health Center.
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]

Exercise Your Way to a Healthy Heart

Aerobic exercise not only helps you lose weight (and keep it off for the long haul), but it also makes your heart stronger. Dr. Arthur Agatston, author of the bestselling South Beach Diet Supercharged and South Beach Heart Health Revolution, recommends a minimum of 20 minutes of interval walking (during which you alternate periods of fast walking with periods of slower recovery walking) every other day. Stuck indoors? No problem. Do your interval-training program on a treadmill, a stationary bike, or an elliptical machine.

To determine whether you are working at the right level, follow the intensity levels described here. (Note: On days when you’re not doing interval training, take a recreational walk for 15 to 20 minutes or do some core training so that you’re participating in some form of exercise every day.)

Easy Pace: When you’re working at a low level of intensity, you’re constantly moving, but you could easily carry on a conversation with a friend. This is the pace at which you will usually be doing your warm-up before beginning the actual intervals.

Moderate Pace: When you’re working at a moderate level of intensity, you’re walking at a brisk pace. You are breathing faster and can still carry on a conversation — but doing so is more difficult.

Revved Up: When you’re Revved Up, you’re really moving! You’re a bit short of breath, and it’s difficult — but not impossible — to maintain your pace. You should have difficulty carrying on a conversation at this level of intensity.

Supercharged: When you’re walking at top speed, you are truly Supercharged! You won’t be able to sustain the pace for long, but as you get fitter, the pace that once tired you out will become relatively easy and even your Supercharged pace will get faster.

As your fitness improves, you should adjust your speed, incline, and resistance (if you’re using a machine) to match your new level of ability for each of the paces. Overall, speed is better than resistance. Increase resistance only to add intensity when you have achieved all that you can at maximal speed.

Treadmill

* Start at an Easy Pace and gradually increase your speed to Moderate Pace.
* When you reach Revved Up, adjust the incline so that you’re working at a higher resistance. At this point you are ready to begin doing your intervals.
* Tip: When selecting a higher resistance level, know that you should be able to do the more-intense intervals yet easily drop back into your slower recovery pace when you need to.

Stationary Bike

* Adjust the seat so that you’re comfortable. Each leg should be only slightly bent at the bottom of each pedal stroke.
* Start cycling slowly to warm up. Change your intensity by either cycling faster or increasing the resistance level. To work at the Revved Up or Supercharged level, you will have to increase both.
* Tip: You use your muscles differently on a bike than you do when walking, so allow your body to get used to the new interval patterns and be sure you’re maintaining your proper form.

Elliptical Machine (cross trainer)

* The workout for an elliptical machine is similar to that for a stationary bike or a treadmill, but the way you use your muscles is different on this machine.
* Once you’ve achieved your maximum speed, increase the intensity.
* Tip: Experiment with both the incline and resistance levels to see what combination is most effective for you.

[ami]

What Your Waistline Says About Your Heart
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.

[ami]

Triglyceride levels provide insight into your heart disease risk.
By Arthur Agatston, MD, Everyday Health heart expert
Triglycerides are the form in which fat is stored in your body's fat cells. Your triglyceride level is almost always strongly influenced by lifestyle. A low-fat, high-refined carbohydrate actually elevates your triglycerides. Two decades ago, when I first began putting my patients on this type of diet, which was recommended back then, I was often dismayed to see their triglycerides go up. This, of course, was the opposite of what I was hoping to achieve. We now know that it was not the carbohydrates per se that raised the triglycerides, but the bad carbohydrates — sugars and starches devoid of fiber and other nutrients — that did it.

The same thing happened when I experimented with an extremely low fat diet that was also popular at the time. When I put one patient with a moderately high triglyceride level of 220 mg/dL on it to lose weight, he did not lose weight, and his triglycerides soared to over 500. His was just one of many cases like this that made me begin to question the conventional dietary wisdom of the time. Today, I recommend a diet that contains lean protein and moderate amounts of good fats (those found in oily fish, olive oil, and nuts) and good carbs (those found in vegetables, fruits, and whole grains). If patients follow this plan, reductions in triglycerides can be dramatic.

If you have high triglycerides (over 150 mg/dL is borderline high) and low HDL (less than 40 mg/dL if you're a man and less than 50 mg/dL if you're a woman), your risk of heart disease is compounded. To find out if you have this added risk, divide your triglyceride count by your HDL count. Ideally, the resulting number will be 2 or lower. For example, if your triglyceride level is 200 and your HDL is 40, divide 200 by 40 and you get 5. This is much higher than the desirable ratio, and it tells you that you have a heightened risk of a heart attack that will need to be addressed.

Your triglyceride level can also give you insight into your LDL particle size. In general, the higher your triglycerides and the lower your HDL, the smaller and denser your LDL and the greater your risk of heart disease. If your triglycerides are higher than 200 and your HDL is lower than 45, it is very likely that you have too much small, dense LDL.

There are a number of ways to lower your triglycerides. In addition to eating the healthy diet that I describe in Step 1, losing weight and getting more exercise can help. Medications such as niacin and fibrates are also effective at lowering triglycerides, increasing HDL, and enlarging LDL particle size.

THE NCEP GUIDELINES FOR TRIGLYCERIDES
149 mg/dL or under is normal.
150–199 mg/dL is borderline high.
200–499 mg/dL is high.
500 mg/dL is very high.
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]

Ask Dr. Arthur Agatston
Upping Intake of Omega 3s

Q: What are the best foods to eat to get more omega-3s in my diet, and how much should I eat per week?
— Mark, New York
Dr. Arthur Agatston A:

I’m glad that you’re trying to get more omega-3 fatty acids into your diet, Mark. And since you’re presenting your question to a cardiologist, I assume it’s because you hope omega-3’s will help your heart. Well, they can. According to a scientific statement published by the American Heart Association in its journal Circulation, members of the association’s nutrition committee concluded that “omega-3 fatty acids have been shown in epidemiological and clinical trials to reduce the incidence of cardiovascular disease.” And studies have shown that eating a diet rich in omega-3s can help lower triglycerides. Over the years, I have seen this in my own practice.

As you may already know, the three major types of omega-3 fatty acids found in foods are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Once ingested, the body converts ALA to EPA and DHA, the types that are more readily used by the body.

Unfortunately, it is estimated that the average American consumes only about 23 milligrams of omega-3 fatty acids per day. This is far lower than the National Institutes of Health (NIH) recommendation that adults get at least 650 to 950 milligrams of EPA and DHA and 2.22 grams of ALA daily. Moreover, for adults with coronary heart disease, the American Heart Association (AHA) recommends getting 1 gram daily of EPA and DHA from an omega-3 fatty acid supplement (such as fish oils). And for those with high cholesterol levels, the AHA recommends getting 2 to 4 grams daily of EPA and DHA in the form of a fish oil supplement. For healthy adults, the AHA simply recommends eating fish at least twice a week, a number that seems way too conservative to me.

Whether you're trying to prevent heart disease or simply improve your general health, you can go a long way toward bumping up your omega-3 consumption by adding just three foods to your diet: walnuts, flaxseed, and wild-caught salmon (such as chinook). A quarter cup (1 ounce) of walnuts contains about 2.3 grams of ALA; 1 tablespoon of flaxseed contains about 1.5 grams of ALA; and a 4-ounce piece of salmon contains about 1.5 grams of EPA and DHA.

Most commercial fish-oil capsules, however, only contain about 180 milligrams of EPA and 120 milligrams of DHA. (So, you’ll have to take a lot of them to meet the AHA guidelines). But there are prescription forms of fish oil available with higher amounts of these omega-3’s. Interestingly, a study published in The American Journal of Clinical Nutrition showed that omega-3 fatty acid levels in the blood rose equally whether subjects took fish oil capsules or ate fatty fish.

Besides salmon, other good marine sources of EPA and DHA include herring (both Atlantic and Pacific), anchovies, sardines, Atlantic halibut, bluefish, tuna, and Atlantic mackerel.

Besides flaxseed and walnuts, other good plant sources of ALA include flaxseed oil and dark-green vegetables such as purslane, broccoli, kale, and collards.

I cannot in good conscience answer this question without a reminder to control your intake of potentially inflammatory omega-6 fatty acids, which are found mainly in grains and grain-fed beef and poultry, and in oils such as corn, safflower, and sesame. Though a healthy diet definitely includes some omega-6’s, the typical North American diet contains about eight times too many! This is certainly one of the reasons why heart disease and so many other inflammatory disorders are prevalent in this country.

Learn more in the Everyday Health Heart Health Center.
Last Updated: 05/20/2009
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]

Ask Dr. Arthur Agatston
Time for a Cholesterol Drug?

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 - High Cholesterol Center 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 more in the Everday Health High Chloesterol Center.
Last Updated: 12/15/2008
Heart health expert Arthur Agatston, M.D., answers your frequently asked questions about heart health and high cholesterol, including questions on high cholesterol treatment, medications, management, and resources. Dr. Agatston is a preventive cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. Dr. Agatston is well known as the bestselling author of The South Beach Diet. He maintains a cardiology practice and research foundation in Miami Beach.
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]

What to Eat for a Healthy Heart

The American Heart Association recognizes February as American Heart Month, which means there’s no better time than now to learn more about heart disease prevention. Heart disease is the leading cause of death in men and women in the United States — but steps can be taken to reverse this dangerous trend, starting with eating the South Beach Diet way, exercising, and partnering with your doctor for early detection.

"The good news is that due to recent advances in understanding, detecting, and treating heart disease, I believe we have reached a point where the great majority of heart attacks and strokes can be prevented," explains Dr. Arthur Agatston, leading preventive cardiologist and author of the South Beach Heart Health Revolution and The South Beach Diet Supercharged. "One of the most important things you can do to prevent heart disease is to practice heart-healthy eating," he says. "By enjoying the wide range of nutrient-dense, fiber-rich foods that we emphasize on the South Beach Diet you take a big step toward reducing your risk of heart attack and stroke."

Here are Dr. Agatston’s basic guidelines for heart-healthy eating:

* Eat good fats. Choose good fats from extra-virgin olive oil, canola oil, peanut oil, flaxseed oil, walnut oil, avocados, nuts, and fish. Omega-3 (fish oil) supplements are also fine.
* Eat good carbohydrates. Good carbs include high-fiber, nutrient-dense fruits, vegetables, legumes, and whole grains.
* Eat lean protein. The best sources include eggs, low-fat dairy foods, nuts, seeds, legumes, skinless white-meat poultry, fish, shellfish, lean cuts of meat, and soy-based options such as tofu.

If you follow these guidelines, you can put together delicious, satisfying, and healthy meals and snacks — and take the first step toward a healthier life

[ami]

If you’re following the South Beach Diet, you already know the heart-health benefits of making nutritious food choices and exercising regularly. But if you have a moderate or high risk of heart disease, lifestyle changes alone may not be enough to ensure a healthy heart. While leading a healthy lifestyle is always recommended, your doctor may also suggest certain medications and/or supplements that will help lower your risk of heart disease. Here's a snapshot of some commonly prescribed medications and supplements that protect your heart.

Statin drugs: Over the past 30 years statin drugs such as Mevacor, Pravachol, Lescol, Zocor, Crestor, and Lipitor have changed the prognosis for tens of millions of people who are at risk for heart disease or who already have it. Not only can statins reduce levels of LDL cholesterol by 20 to 60 percent with few side effects, they can also mildly lower triglycerides and raise good HDL. Furthermore, numerous clinical trials have shown that these drugs may help prevent heart attacks and strokes: When combined with other drugs or with prescription niacin, statins can cause the regression of soft plaque, which is the primary cause of heart disease. Statins can also reduce inflammation and improve the overall health of the blood vessels.

Aspirin: Taking aspirin every day or every other day if you are at risk for heart disease thins the blood slightly and makes the blood less sticky and thus less likely to form clots that typically precipitate heart attacks and strokes. Be aware, however, that aspirin has been shown to have very little effect in those who have no risk factors for heart disease. Consult with your doctor about whether aspirin therapy is right for you.

Fish-oil supplements: Just as Dr. Arthur Agatston, author of The South Beach Diet Supercharged, advises people to eat fish high in beneficial omega-3 oils (such as wild salmon and sardines) at least twice a week, he also follows the current American Heart Association (AHA) guidelines with regard to omega-3 supplements. The AHA recommends combined eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — the two major types of omega-3 fatty acids — in a dose of approximately 1,000 mg/day in patients with coronary heart disease. For people with high triglycerides, Dr. Agatston agrees with the FDA recommendations for considerably higher doses of omega-3s in the form of four grams of prescription fish oils per day (but Dr. Agatston advises you to be certain your doctor monitors your cholesterol, since prescription fish oils can raise levels of bad LDL in some people).

Niacin: This B vitamin (B3) is available over the counter as a dietary supplement, though Dr. Agatston recommends higher doses, available by prescription only, for those at risk for heart disease. In combination with a statin, niacin can be a very effective agent for slowing or reversing atherosclerosis and preventing recurrent heart attacks and strokes. Niacin can increase HDL (the "good" cholesterol) and it also can lower LDL as well as triglycerides. While certain forms of niacin are associated with flushing and itching of the skin in some people, this unpleasantness generally disappears within an hour. In some people with diabetes, niacin can raise blood-sugar levels; however, this effect is generally mild. If you think niacin could help you, discuss its use with your doctor.

While diet and exercise can go a long way toward improving your health, sometimes medications and/or supplements are also required. Your doctor will help you determine what prevention program is right for you.

[ami]

Ask Dr. Arthur Agatston
The Link Between Magnesium and Heart Health

Q: What is the role of magnesium in heart health?
— Susan, Georgia
Dr. Arthur Agatston - Heart Disease Center A:

Magnesium has hundreds of important functions in the body, from energy production and proper nerve function to muscle relaxation. Studies are mixed about whether its potential heart benefits come from the magnesium itself or from a combination of magnesium and other beneficial nutrients (such as potassium and fiber). Or perhaps it’s simply that people who eat a magnesium-rich diet are more health conscious in general. But there is no question that this important mineral plays a key role in the prevention of cardiovascular disease. Here’s a crash course in what magnesium can do to help your heart:

Regulate heart rhythm. Just as it helps nerve function throughout the body, magnesium is important for coordinating the activity of the heart muscle and the nerves that initiate the heartbeat. If your magnesium levels are low, you are more likely to be at risk for arrhythmias (irregular heartbeats) and heart palpitations. While doctors can temporarily stabilize irregular heartbeats with injections of a magnesium compound, this is generally not done except in an emergency situation.

Prevent angina. Magnesium helps keep coronary arteries from having spasms, which is what causes the intense chest pain known as angina. In fact, a deficiency of magnesium is the most common cause of such arterial spasms.

Control high blood pressure. By relaxing the muscles that control blood vessels and allowing blood to flow more freely, magnesium may play a role in reducing elevated blood pressure, an important factor in decreasing the risk for heart attack and stroke. Magnesium’s effect on high blood pressure is further enhanced because it helps equalize the levels of potassium and sodium in the blood.

Limit complications of congestive heart failure. Because magnesium can help lower blood pressure and reduce the risk of arrhythmia, two frequent complications in those with congestive heart failure, a weakened heart may benefit from getting more of this mineral.

Reduce incidence of prediabetes and diabetes and improve insulin resistance. Several important studies have demonstrated that getting insufficient amounts of magnesium increases the risk of metabolic syndrome (prediabetes), type 1 and type 2 diabetes, and the development of diabetes complications. Moreover, a magnesium deficiency can negatively affect fasting blood glucose and insulin levels in nondiabetic individuals (which often leads to diabetes). I believe, however, that more research is needed on the role of magnesium in diabetes prevention.

[ami]

Ask Dr. Arthur Agatston
Upping Intake of Omega-3s

Q: What are the best foods to eat to get more omega-3s in my diet, and how much should I eat per week?
— Mark, New York
Dr. Arthur Agatston A:

I’m glad that you’re trying to get more omega-3 fatty acids into your diet, Mark. And since you’re presenting your question to a cardiologist, I assume it’s because you hope omega-3’s will help your heart. Well, they can. According to a scientific statement published by the American Heart Association in its journal Circulation, members of the association’s nutrition committee concluded that “omega-3 fatty acids have been shown in epidemiological and clinical trials to reduce the incidence of cardiovascular disease.” And studies have shown that eating a diet rich in omega-3s can help lower triglycerides. Over the years, I have seen this in my own practice.

As you may already know, the three major types of omega-3 fatty acids found in foods are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Once ingested, the body converts ALA to EPA and DHA, the types that are more readily used by the body.

Unfortunately, it is estimated that the average American consumes only about 23 milligrams of omega-3 fatty acids per day. This is far lower than the National Institutes of Health (NIH) recommendation that adults get at least 650 to 950 milligrams of EPA and DHA and 2.22 grams of ALA daily. Moreover, for adults with coronary heart disease, the American Heart Association (AHA) recommends getting 1 gram daily of EPA and DHA from an omega-3 fatty acid supplement (such as fish oils). And for those with high cholesterol levels, the AHA recommends getting 2 to 4 grams daily of EPA and DHA in the form of a fish oil supplement. For healthy adults, the AHA simply recommends eating fish at least twice a week, a number that seems way too conservative to me.

Whether you're trying to prevent heart disease or simply improve your general health, you can go a long way toward bumping up your omega-3 consumption by adding just three foods to your diet: walnuts, flaxseed, and wild-caught salmon (such as chinook). A quarter cup (1 ounce) of walnuts contains about 2.3 grams of ALA; 1 tablespoon of flaxseed contains about 1.5 grams of ALA; and a 4-ounce piece of salmon contains about 1.5 grams of EPA and DHA.

Most commercial fish-oil capsules, however, only contain about 180 milligrams of EPA and 120 milligrams of DHA. (So, you’ll have to take a lot of them to meet the AHA guidelines). But there are prescription forms of fish oil available with higher amounts of these omega-3’s. Interestingly, a study published in The American Journal of Clinical Nutrition showed that omega-3 fatty acid levels in the blood rose equally whether subjects took fish oil capsules or ate fatty fish.

Besides salmon, other good marine sources of EPA and DHA include herring (both Atlantic and Pacific), anchovies, sardines, Atlantic halibut, bluefish, tuna, and Atlantic mackerel.

Besides flaxseed and walnuts, other good plant sources of ALA include flaxseed oil and dark-green vegetables such as purslane, broccoli, kale, and collards.

I cannot in good conscience answer this question without a reminder to control your intake of potentially inflammatory omega-6 fatty acids, which are found mainly in grains and grain-fed beef and poultry, and in oils such as corn, safflower, and sesame. Though a healthy diet definitely includes some omega-6’s, the typical North American diet contains about eight times too many! This is certainly one of the reasons why heart disease and so many other inflammatory disorders are prevalent in this country.

[ami]

Bringing your cholesterol numbers down is an important part of improving your heart health.

If you have established heart disease or are at high risk, aggressive cholesterol lowering is beneficial no matter what cholesterol levels you start with. There are a number of studies that demonstrate this.

The 1998 Air Force/Texas Atherosclerosis Coronary Prevention Study was different from prior statin investigations. In this study, the participants started with normal levels of total and LDL ("bad") cholesterol and no obvious signs of cardiovascular disease. Understandably, many people thought that giving statins to people with normal LDL cholesterol was "overkill." In truth, it turned out to be lifesaving. Compared to people who were given a sugar pill (placebo), those who took a statin had a 37 percent lower risk of having a heart attack, unstable angina, or sudden cardiac death.

A more recent study, the 5-year Heart Protection Study, reported in 2002, backed up these results. In this study, a statin was given to half of 20,536 subjects with risk factors for heart disease other than a bad LDL cholesterol level. In fact, some of the study volunteers had a relatively good level of LDL (below 116) to begin with. The results showed that cholesterol-lowering statin therapy decreased heart attacks equally in those starting with an LDL level of less than 116 and in those who had a higher initial level of LDL.

In yet another study, published in 2005 and known as the "PROVE-IT trial," more than 4,000 patients with an elevated LDL cholesterol level who were hospitalized for either a heart attack or unstable angina were given one of two statin drugs and followed for up to 2 years. In one group, LDL levels were decreased to less than 70 mg/dL, as compared with a decrease to about 100 mg/dL in the other group. Those who had their LDL lowered to at least 70 had significantly fewer cardiac events, and there was even further incremental benefit as the LDL was lowered into the 50s and 40s.

Despite these studies, some physicians and researchers believe that using medications to lower cholesterol to very low levels may be dangerous. As far as I'm concerned, there is a danger, but it is from the high levels of cholesterol caused by our modern lifestyle, not the low levels we get by using cholesterol-lowering drugs. Newborns and people living in most preindustrial societies have a "normal" total cholesterol level of 120 mg/dL or less. In the United States, our "normal" is about 200 mg/dL. From my perspective, one could say that aggressive statin therapy simply reduces cholesterol to "natural" levels.

Would You Benefit from Taking a Statin?
How do you know if you would benefit from taking a statin or another cholesterol-lowering medication? This is something you will need to discuss with your doctor. In my practice, I lower my patients' cholesterol levels until I believe I have arrested or reversed the underlying disease. The ultimate level, of course, varies from patient to patient. One patient with an LDL cholesterol of 160 mg/dL might have little or no plaque and not require a statin. Another with the very same cholesterol level but a more significant amount of plaque might benefit from aggressive statin treatment.

[ami]

The higher your calcium score, the greater your heart attack risk.
By Arthur Agatston, MD, Everyday Health heart expert

When you have a heart scan, you are given an overall number called the Calcium Score, or Agatston Score, which represents the total amount of plaque in your coronary arteries. The number can range from 0 to 1,000 or more. The higher your number, the more plaque you have in your arteries and the greater your risk. If your score is more than 400, for example, you have an increased likelihood of developing symptomatic heart disease — angina, heart attack, or even sudden death — in the next 2 to 5 years. If your score is more than 1,000, you have a 25 percent chance of having a heart attack within a year without intervention.

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

Keep in mind that there's no absolute way to predict who is going to have a heart attack, but your Calcium Score is an excellent way of predicting the likelihood of it happening to you. Of course, when you are trying to predict the future, you must consider other variables beyond your Calcium Score. For example, if you smoke, a low Calcium Score will not protect you. Smokers tend to have very sticky blood. This can result in a much larger blood clot developing after a plaque rupture than would develop in a nonsmoker. On the other hand, someone with a moderately high Calcium Score can forestall a heart attack indefinitely — or even prevent one entirely — simply by controlling risk factors. And even if your Calcium Score indicates a high likelihood for a heart attack in the near future, if you begin an aggressive prevention program immediately, your level of risk can sharply decline within months.

[ami]

What Your Waistline Says About Your Heart
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.
Belly fat, diabetes, and heart disease.

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