<![CDATA[Heart Disease - Health.com]]>

<![CDATA[Heart Disease - Health.com]]> en daily 1 Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationHeart disease remains a leading killer in America, but even if you have a family history, heart disease and heart attacks are not inevitable. A healthy diet, regular exercise, cholesterol-lowering drugs and lifesaving surgeries can reduce your risk of having or dying from a heart attack.Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationHeart disease remains a leading killer in America, but even if you have a family history, heart disease and heart attacks are not inevitable. A healthy diet, regular exercise, cholesterol-lowering drugs and lifesaving surgeries can reduce your risk of having or dying from a heart attack. <![CDATA[Stomach-Acid-Suppressing Drugs May Raise Risk of Death After Angioplasty]]>

Researchers at Mount Sinai Medical Center, in New York City, reported that patients who underwent angioplasty, a procedure to clear blocked blood vessels in the heart, were 30% more likely to die if they were taking proton pump inhibitors (PPIs).

It’s unclear whether the patients in the study who were prescribed these medications were sicker than those who weren’t, and thus more likely to die. The study's lead author, Joseph M. Sweeny, MD, a cardiologist at Mount Sinai, says that he will continue to follow current guidelines on prescribing PPIs, but that he will also be "very careful" in deciding which of his patients need to be on the drugs.

Before undergoing angioplasty, heart patients are typically prescribed blood-thinning drugs such as aspirin and Plavix, which increase the risk of stomach bleeding and ulcers. In a joint statement issued in 2008, the AHA, the American College of Gastroenterology, and the American College of Cardiologists indicated that PPIs could help prevent stomach bleeding in people at high risk.

But some experts have raised concerns that PPIs could make Plavix less effective because they block the action of enzymes that are crucial for metabolizing the blood-thinning drug. A number of studies have suggested that mixing the two drugs could be risky for patients, while others have not.

The study examined some 8,300 angioplasty patients who had had drug-secreting stents placed in their hearts to prop open narrowed blood vessels. In all, 17% of the patients were prescribed PPIs.

During the follow-up period, which lasted an average of two years, 602 patients died. When Dr. Sweeny and his colleagues broke patients into groups according to which PPI they were taking, they found that omeprazole (Prilosec) and pantoprazole (Protonix) were associated with an increased risk of death of 72% and 54%, respectively, in the years following the procedure.

Two other PPIs, esomeprazole (Nexium) and lansoprazole (Prevacid), were not associated with a greater risk of dying after the procedure. It’s not clear whether this means some PPIs were safer than others, says Dr. Sweeny.

“The numbers that I got were very dramatic,” Dr. Sweeny says. “You have to raise questions as to exactly what this is coming from.”

The findings need to be interpreted cautiously, he adds, because the patients who were taking PPIs may have been sicker to begin with. “What the clinical implications of this are right now I don’t know,” he says. However, the risk of death and complications after angioplasty is relatively low overall.

“The jury is still out regarding acid-suppressing medications and Plavix,” says Shoshana J. Herzig, MD, a researcher at Beth Israel Deaconess Medical Center and Harvard Medical School, in Boston, who didn’t participate in Dr. Sweeny’s study.

Because overall mortality in the current study was greater among the patients on PPIs, says Dr. Herzig, it’s definitely possible they may have been sicker in the first place.

Even so, she says, “I think that it’s fairly clear that in patients who are on Plavix and an acid-suppressing medication, we should evaluate whether they actually need that acid-suppressing medication.” Although PPIs usually aren’t intended to be taken indefinitely, patients often wind up staying on the drugs anyhow, she says.

At least in ICU patients, Dr. Herzig says, PPIs are prescribed too often, in large part because the ulcer drugs are viewed as very safe. However, she adds, rarer side effects do come to light when a drug is prescribed to millions of people.

Any patient who is prescribed a PPI, Dr. Herzig and Dr. Sweeny agree, should ask their physician why, and find out how long they need to take the medication.

At the American Heart Association's annual Scientific Sessions meeting, more than 20,000 cardiologists and other physicians from around the country give presentations on new research and on advances in the diagnosis and treatment of heart disease and stroke.

]]> Istockphoto <![CDATA[Study: Heart Attack Patients Receive High Dose of Radiation]]>

MONDAY, Nov. 16, 2009 (Health.com) — Heart attack patients are exposed to a radiation dose equal to about 725 chest X-rays over the course of their hospital stay, according to research presented Monday at the American Heart Association meeting in Orlando. The radiation comes from tests such as computed tomography (CT) scans, cardiac catheterizations, and artery-clearing angioplasties.

Too much radiation can increase the risk of developing some cancers, although the benefits of such tests typically outweigh the risks when it comes to diagnosing and treating heart attacks. The cancer risk associated with an angioplasty or with a CT scan—which delivers about 500 times more radiation than an X-ray—is hard to measure.

Prashant Kaul, MD, the lead study author and a cardiovascular fellow at Duke University Medical Center, in Durham, N.C., stresses that many cardiac tests that use radiation are necessary and appropriate.

"We’re not saying those should be withheld," he says. "We're just trying to increase awareness so that when physicians are ordering tests, they bear in mind the indications.”

The study, which was conducted over three and a half years, included nearly 65,000 heart attack hospitalizations at 49 academic hospitals across the United States. The researchers estimated radiation doses by looking at hospital records; they didn’t measure exposure directly.

A single radiation-delivering test generally poses little cancer risk, but the heart attack patients in the study averaged about four such tests during their hospital stay, potentially multiplying the risk.

Angioplasty (also known as percutaneous coronary intervention, or PCI), a procedure in which a balloon-tipped catheter is used to open a blocked artery, delivers a dose of radiation about 750 times greater than an X-ray, but that doesn’t mean doctors shouldn't perform it, says Dr. Kaul.

“No one would argue that you shouldn’t do that—it’s a lifesaving procedure,” he says.

Thomas C. Gerber, MD, PhD, a professor of medicine and radiology at the Mayo Clinic’s College of Medicine, in Jacksonville, Fla., says "it’s difficult to assess the health risk of ionizing radiation.”

It’s unclear if there’s a risk associated with a radiation dose less than 100 millisieverts, which is an amount of radiation about seven times greater than the average dose seen in the study, says Dr. Gerber.

“If there's an increased risk of cancer, it’s small, and nobody’s been able to show it,” says Dr. Gerber, who has studied radiation safety in medical testing but was not involved in the study.

The patients in the study were exposed to about 14.5 millisieverts, a dose roughly five times greater than the amount of exposure from so-called background radiation in the environment.

The U.S. Food and Drug Administration (FDA) has estimated that the amount of radiation absorbed by the body during a CT scan increases the lifetime risk of dying of cancer by a factor of 1 in 2000. The natural risk of dying from cancer is about 1 in 5, so the added risk posed by the radiation is very small.

According to the FDA, the benefits of a CT scan generally outweigh the risks for those with a medical need, but not for symptomless people who are considering a CT scan only for screening purposes.

According to Dr. Kaul, physicians should take into account a patient's total radiation exposure during a hospital stay, rather than the dose from one individual test.

Exposure to radiation during occasional tests is safer than a relatively large dose in a short period of time, experts say.

“Having 17 millisieverts in January and another 17 millisieverts in October isn’t the same as having 34 millisieverts all at the same time,” says Dr. Gerber. “Small amounts of radiation in certain increments don’t mean the same as one large dose of radiation at the same time.”

Patients shouldn’t be afraid to ask their doctor if a test is truly necessary, he says. “There's nothing wrong with patients asking their doctor, ‘How will this test change what you do for me?’ If it doesn’t, that test may not be necessary.”

Heart attack patients shouldn't forgo a test simply because of concerns about radiation, says Dr. Kaul. Doing so could prevent doctors from diagnosing a dangerous problem or treating a patient to the best of their ability.

“We don’t want to scare people into thinking they’re going into the hospital and their risk of cancer’s going to suddenly increase,” says Dr. Kaul. “It’s a balance between the hypothetical risk of cancer with the risks of not performing an imaging study."

]]> Getty Images <![CDATA[Loneliness Hurts the Heart]]>

People who lack a strong network of friends and family are at greater risk of developing—and dying from—heart disease, research shows. According to some studies, the risk of solitude is comparable to that posed by high cholesterol, high blood pressure, and even smoking.

Experts haven’t pinpointed exactly how social networks protect against heart disease, but there are a number of probable explanations. People who are socially isolated are more likely to drink, smoke, and get less exercise. And once someone has heart disease, friends and family often provide key support, such as picking up prescriptions, encouraging exercise, cooking healthy meals, and helping with household chores.

While that everyday help is important, it’s not the whole story. In recent years, researchers have begun to unravel the cardiovascular effects of social isolation, and they’ve discovered that feeling alone may hurt the heart even more than actually being alone.

“We started looking at social isolation about 20 years ago, and we found fairly quickly that objective social isolation in everyday life isn’t as important as perceived social isolation,” says John Cacioppo, PhD, a professor of psychology at the University of Chicago. “And there’s a term for perceived social isolation: It’s loneliness.”

What we call loneliness—the feeling that you have no one to turn to, that no one understands you—is a form of stress. And if it becomes chronic, it can wreak havoc on your blood vessels and heart.

What is loneliness?
Though the concepts are sometimes used interchangeably, loneliness is distinct from social isolation (also known as low social support). There’s some overlap between the two, but not as much as one might think.

Social support is typically measured using a handful of characteristics such as marital status, number of friends, and participation in group activities (such as churchgoing). Low scores on these measures don’t necessarily correspond to loneliness, however. Some people need more “me” time than others, after all, and some people are content with just one or two close friends.

To factor in these individual preferences, researchers define loneliness as the gap between a person’s desired and actual social relationships—a subjective measure that’s most easily gauged with questionnaires. To put it another way, social isolation mainly describes the extent of a person’s social network, while loneliness emphasizes quality, rather than quantity, and describes the satisfaction and comfort a person derives from their interpersonal relationships. It’s the difference between the amount of food on your plate and how good it tastes.

Fifteen years ago, after undergoing surgery to replace a heart valve, Dale Briggs, 63, of Clovis, Calif., felt anxious and isolated, not like himself at all. Briggs rated high on the social support scale—he’s married, he’s a weekly churchgoer—but he felt that he wasn’t connecting with people anymore.

“During that period I could have had 15 people in my house all the time, but I would have traded them all for someone who had been through what I’d been through and who I could talk to about it,” Briggs recalls. “I felt isolated in my mind, like I couldn’t relate to anybody.”

Next Page: How loneliness hurts the heart

Briggs’s experience illustrates how difficult it can be to draw a line between loneliness and other conditions such as anxiety and depression, which are common in people with heart disease. Loneliness shares many of the same features as depression (for instance)—and the conditions often occur alongside each other.

“Someone may be anxious and lonely, or depressed and lonely, or having medical problems and lonely,” says Jackie Gollan, PhD, a clinical psychologist at Northwestern University. Though one condition may influence the other, loneliness is independent and can be challenging to treat, Gollan says. “Even if you treat depression, loneliness may still be there.”

Though depression and anxiety can certainly have a negative impact on your heart, loneliness appears to be especially deadly.

In the 1990s, a team of Swedish researchers interviewed nearly 1,300 patients about to undergo coronary artery bypass surgery. The patients were asked to respond “yes” or “no” to 38 statements regarding their mental and physical health, such as “Things are getting me down,” “I’m feeling on edge,” and “I’m in constant pain.”

When the researchers compared the responses to the mortality rate of the patients (after controlling for risk factors such as age and smoking), they found that only one of the 38 statements—“I feel lonely”—was associated with mortality in both the short and long term. The patients who said that they felt lonely were 2.5 times more likely to die within 30 days of their surgery; five years later, their mortality rate was still nearly twice as high. Social support may have accounted for some of the outcome—but nearly half of the lonely patients were married or living with another person.

How loneliness hurts the heart
Though they may not be aware of it, lonely people tend to perceive social interactions as more negative and threatening than non-lonely people do. “The brains of lonely people are on high alert for social threats,” Cacioppo says. In studies, lonely people have also been shown to have higher levels of cortisol, a hormone released in response to stress, and this persistent stressful state produces “wear and tear” that can affect the cardiovascular system.

Atherosclerosis, the narrowing and hardening of the arteries that leads to heart attacks, is caused by inflammation—the flood of white blood cells and chemicals that our immune system unleashes to ward off damage or infection. Cortisol is a powerful anti-inflammatory that works by activating white blood cells, which would seem to suggest that lonely people would actually be less susceptible to inflammation.

In fact, Cacioppo and his colleagues have discovered that the high cortisol levels found in lonely people make their white blood cells less sensitive to the hormone. The effect is similar to what happens when you walk into a dark building after being out in bright sunlight, Cacioppo says. The overexposure to cortisol causes white blood cells to “see” cortisol more poorly when they need it most, and as a result the cells don’t fight inflammation as vigorously.

But how is loneliness any different from the stress felt by people with demanding jobs or road rage? Wouldn’t cortisol have the same effect on them? “People think about stress as general and diffuse, but it’s not,” Cacioppo explains.

Research has shown that the brains of lonely people respond differently to stress. Mild, temporary stress—such as that caused by giving a presentation at work—releases comparable amounts of epinephrine (a hormone involved in the so-called flight-or-fight response) in both lonely and non-lonely individuals. People who are lonely, however, exhibit higher activity in a part of the nervous system that is especially sensitive to social stress (and that provokes the release of cortisol). More importantly, says Cacioppo, that heightened activity is present all day long in lonely people, not just in stressful moments.

Depression, hostility, and loneliness can all cause stress, in other words, but each emotion has a specific effect on the body. The effect caused by loneliness, moreover, appears to be especially damaging to the cardiovascular system.

Hostility, for instance, affects how hard the heart muscle beats. But loneliness produces an increase in vascular resistance—it becomes harder for blood to move through the arteries. Over time this resistance can contribute to hypertension, which is associated with atherosclerosis and heart disease.

Next Page: Cure your loneliness

Cure your loneliness
If you’re at risk for heart disease, and especially if you’ve suffered a heart attack, limiting social isolation and loneliness are both critical.

If you’re feeling socially isolated or lonely, it’s important to tell a medical professional about it (in addition to friends and family who may be able to provide support). Groups such as Mended Hearts, a nonprofit organization that leads support groups and educational programs for people recovering from heart attacks and heart surgery, can help on both counts, by providing practical help as well as a sense of connection. Dale Briggs finally started to feel less isolated when he attended a Mended Hearts meeting and talked to other heart patients. (He has since become a vice-president of the organization.)

There are other steps one can take. Research suggests that adopting a pet may help alleviate stress. A 2001 study in the journal Hypertension examined nearly 50 stockbrokers (i.e., people with high-stress jobs) who were taking a medication for high blood pressure. Half of the stockbrokers were asked to acquire pets, and six months later, researchers tested the blood pressure of the two groups while the stockbrokers performed a stressful task. They found that while the medication helped lower resting blood pressure, only pet ownership mitigated the spike in blood pressure that occurs during mental stress.

People who experience interpersonal relationships as threatening may find the nonjudgmental nature of pets especially beneficial. “The nonjudgmental aspect of pets really provides support, more so than the support that would be provided by a person,” says Erika Friedmann, PhD, a professor at the University of Maryland School of Nursing who has studied the health benefits of pet ownership.

In most cases, however, lonely heart patients may want to consider talk therapy. Cognitive-behavioral therapy can help people understand their emotional and cognitive responses to social relationships, strengthen their social networks, and identify opportunities to make their relationships more meaningful, according to Gollan, who has been working with Cacioppo to translate his research into a clinical context.

“It helps somebody modify their social environment, when they feel that they don’t have the resources or access, or are out of ideas about how to do it,” says Gollan.

]]> (GETTYIMAGES) <![CDATA[What to Do When Heart Disease Hurts Your Sex Life]]>

in less than 1% of heart attacks, according to a 1996 study by Harvard Medical School researchers.

Although heart attacks during sex are rare, no one wants to be among the unlucky few who die while getting lucky. So if you have cardiovascular disease (CVD), or even if it runs in your family, it’s important to ask your doctor what type of sexual activity is safe. If you’ve just had a heart attack, for instance, you should wait three to four weeks before having intercourse, according to current guidelines. And if you have heart failure, your doctor may recommend that you avoid lying on your back during sex, because fluid is more likely to pool in your lungs in that position.

The physical danger posed by sexual activity is probably the least of your problems, however. There are plenty of other ways for heart disease to curtail your sex life. Everything from incision pain following bypass surgery to the emotional stress of living with a heart condition can get in the way of intimacy.

Sexual activity and heart conditions can interact in complicated ways, which can be difficult to tease apart. To make matters worse, heart patients (and their partners) are often uncomfortable discussing their sex lives with their doctors—and vice versa.

“I’ve found that most doctors don’t have the time—or the personality—to talk about sex with their heart patients,” says Edward Chapunoff, MD, a cardiologist in private practice in Pompano Beach, Fla., and the author of Answering Your Questions About Heart Disease and Sex. “They are evasive about it. They won’t bring it up themselves and even if the patient brings it up, a doctor might be hesitant to discuss it.”

So what’s a heart patient to do? Prepare a list of intimacy questions in advance of your next checkup and don’t let your doctor’s squirming deter you. In the meantime, here are some answers to three not-so-frequently asked questions about sex and heart disease.

Next Page: Is my sexual dysfunction related to my heart?

Is my sexual dysfunction related to my heart?
The link between cardiovascular disease and sexual dysfunction is well established, at least in men. Researchers have known for years that erectile dysfunction (ED) is disproportionately common among men with CVD (and even among those with risk factors for CVD, such as diabetes and high blood pressure). While erectile dysfunction can result from a number of factors, including psychological ones, the majority of cases can be traced to vascular problems.

The shared mechanism linking ED and CVD is believed to originate in the endothelium, the thin layer of cells that lines blood vessels. Risk factors such as high cholesterol, high blood pressure, and cigarette smoking prevent cells in the endothelium from releasing nitric oxide. This compromises the ability of blood vessels to dilate, which can lead to both atherosclerosis and erectile dysfunction.

Atherosclerosis, the hardening and narrowing of the arteries that causes coronary heart disease, can affect the arteries that pump blood into the penis just as readily as those that surround the heart. But endothelial problems can also prevent the so-called smooth muscle in the penis from relaxing properly. In either case, erections become harder to sustain.

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For a long time it was thought that ED was strictly a side effect of CVD and atherosclerosis, but experts now believe that ED may actually precede heart problems. A 2005 study in the Journal of the American Medical Association described ED as a "harbinger" of cardiovascular events. The study, which analyzed more than 4,000 men without symptoms of CVD or ED, found that the men who subsequently experienced ED were nearly 50% more likely than those who did not to experience a cardiovascular event within seven years.

“It’s important to know that just looking fine doesn’t necessarily mean you have a healthy heart,” says Dr. Chapunoff. “It’s important that both the patient and their partner talk to their doctor about any sexual dysfunction, because it could signal a cardiac problem.”

In women, the relationship between CVD and sexual dysfunction is less clear. Although sexual dissatisfaction in women has been linked to peripheral arterial disease, the mechanisms of female sexual function are thought to be less intertwined with the cardiovascular system.

Next Page: Do my heart meds have any sexual side effects?

Do my heart meds have any sexual side effects?
If your heart doesn’t cause you problems in the bedroom, the medicine you take to keep it healthy might. Several medications commonly prescribed to heart patients can have sexual side effects in both men and women, including ED and loss of libido. Two kinds of cholesterol-lowering drugs, fibrates and statins, have been linked with ED, but it is mainly blood-pressure medications that are believed to contribute to sexual dysfunction.

Beta-blockers, calcium channel blockers, angiotensin-II receptor antagonists, and diuretics are all associated with ED. Although some experts have argued that hypertension itself is responsible for ED, a 2007 study in the International Journal of Impotence Research found that men taking angiotensin-II receptor antagonists were twice as likely to experience ED than men whose hypertension was untreated. Another study of nearly 1,400 men determined that taking hypertension drugs (diuretics, beta-blockers, methyldopa, or clonidine) increased the odds of experiencing ED by 2.5 times.

Blood-pressure medications are also known to cause sexual dysfunction in women, although the phenomenon hasn’t been studied as extensively as it has in men. One reason for the disparity may be that the most common symptoms in women—loss of libido, inadequate lubrication—are more subtle than ED.

When Liz Saldana, 48, the owner of an online magazine and store in Tampa, Fla., first started taking a beta-blocker, she saw her sex drive shrink significantly. “I went from being a really vibrant woman to someone who could just live without it,” she says. “When my husband initiated anything, my attitude became, ‘Oh damn, do we have to do this?’”

She was too embarrassed to bring up the issue with her doctor. “Initially I thought my lack of sex drive pertained to all of the stress I was under, not to my heart medications,” says Saldana, who was on the beta-blocker Toprol-XL (metoprolol) before suffering a heart aneurysm in July. “None of my doctors explained that it could be a side effect of what I was on.” It wasn’t until she switched insurance companies and got a call from one of the nurses on staff that she finally got to the root of her problem: “She asked a couple of questions that acted as a trigger for me to evaluate my sex drive and realize what was wrong.”

Even though sexual problems are among the most commonly reported side effects from blood-pressure drugs, they have not been well publicized and patients may not realize that their prescriptions are to blame. If you suspect that your heart medications are interfering with your sex life, explain the problem to your doctor and ask about alternative medications. Men may be able to counteract the problem with an ED drug such as Viagra. While they can be potentially fatal when taken with “nitrates", ED drugs can be safely combined with many heart medications.

Next Page: Why can’t I get in the mood?

Why can’t I get in the mood?
Medications can dampen your sex drive, but psychological factors might also be at play. For one thing, sexual dysfunction is a common psychosomatic side effect of medication (sometimes called a “nocebo effect”). But the emotional strain that accompanies heart disease can also impact your sex life. After a cardiac episode, many patients find that any activity in the bedroom leaves them paralyzed with anxiety. “After a heart attack, not only are you physically weak, but you’re scared that something might happen during sex,” says Dr. Chapunoff.

Saldana is gearing up to have open-heart surgery in the near future. She and her husband of 15 years are sexually active about twice a month, but each time she’s terrified that she’ll have a heart attack. “I experience a lot of chest pains and when things get heated, I can’t have him on top of me,” she explains. “I haven’t shared my fear with my husband, but I’m afraid to lose control for even a moment because it feels like he’s crushing my chest.”

And then there’s the possible role of “depression”. Research suggests that heart disease and depression are closely related; depression is roughly three times more prevalent among heart attack survivors than in the general population. But depression is also independently associated with sexual dysfunction (including loss of libido and ED), which suggests that, for heart patients, both their bodies and their minds may be affecting their sex lives.

Sexual dysfunction that appears to be caused by a heart problem may also be a sign of an underlying emotional issue, according to Dr. Chapunoff. “Heart disease can become the scapegoat,” he says. “People might say, 'I had a heart attack six months ago, so I can’t have sex now,’ when really it could be unhappiness that they fail to recognize.”