Tag: heart disease

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Heart Disease and Your Enemy #3

Yesterday was Valentine’s Day. It must have been an evening of love and chocolates for you. That is good. Love and happiness are good for your heart. As they say, “Make love, not funeral plans.” And there is science behind that. It keeps your life active. People who have more sex live longer than those you don’t. Married people and people in healthy relationships live longer than lonely people.

Chocolates are good for your heart. But they are high in calories so if you are going to eat chocolates then you have to make adjustments to your calorie intake for that day. Evidence based recipe for a perfect meal (called polymeal) include wine, fish, dark chocolate, fruits, vegetables, garlic and almonds. Dark chocolates daily (100 grams) reduce blood pressure and cardiovascular diseases by 21 per cent.

Let us go back to our enemy No. 3 – inactivity.

Being a couch potato is hazardous to your health. Being active is good for your health. That is obvious, right? Am I insulting your intelligence by writing such simple and obvious facts?

We have couch potatoes in all age groups. They watch too much TV or spend too much time on the Internet. While they do that they eat junk food. Inactivity plus junk food equals bad news for your heart as you get older. Regular physical activity makes your heart strong.

In sedentary people or couch potatoes, the risk of heart attack was seven times higher in a German study and more than 100 times greater in a U.S. study during vigorous exertion than during lighter activity or no activity. If you compare this to among people who exercised regularly, there was almost no increased risk. Another beneficial effect of regular exercise is that it increases the blood level of HDL (good cholesterol). HDL is another line of defense against heart attack.

The type and amount of exercise required to be fit and healthy depends on your age, your health and your current state of physical fitness. There are three types of exercises: aerobic, weight lifting (resistance training) and stretching. A good exercise program should benefit all three aspects of fitness: stamina, flexibility and strength.

A study found that 150 minutes a week (two and a half hours) of a moderate exercise such as walking and 75 minutes per week (an hour and 15 minutes) of activity like easy jogging provides good health benefits.

It has been estimated that people who are physically active for approximately seven hours a week have a 40 percent lower risk of dying early than those who are active for less than 30 minutes a week.

Be active, do whatever you can and have fun. If it is not fun then don’t do it. Find a partner, join a group, get a dog and just go for a walk. You can celebrate Valentine’s Day every day. Who cares, as long as you are having fun…right?

Ok, get moving now.

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Heart Disease and Your Enemy’s Best Friend – Triglycerides

In the last column, we discussed about the harmful effects of bad cholesterol (LDL) on your cardiovascular system. I call LDL enemy number one. Today, we move on to our enemy number two – triglycerides.

Triglyceride is another type of lipoprotein which carries harmful fat-carrying particles. That means it is a bad one. It is the main constituent of vegetable oil and animal fats. It is a major component of chylomicrons and very-low-density lipoprotein (VLDL).

Chylomicron is one of the microscopic particles of fat occurring in a ‘milky’ fluid composed of fat and lymph formed in the intestine during digestion. Next, VLDL is produced in the liver and later becomes the bad LDL.

Triglycerides are the most common form of fat in the body. In fact, almost all the excess calories you consume, whether from fats or carbohydrates, are converted to triglycerides and stored in your fat cells. Once at capacity these cells divide. If you ‘lose weight’ these cells decrease in fat content but never in number. This makes it easier to get fat again.

High levels of triglycerides in the bloodstream have been linked to atherosclerosis (hardening of the arteries), and the risk of heart disease and stroke. High triglyceride levels can
cause pancreatitis, a painful and potentially dangerous inflammation of the pancreas.

What causes elevated triglycerides?

Elevated triglyceride levels can be related to your diet (high in bad fats, carbohydrates and alcohol) and your genetic makeup. In addition, high triglyceride levels can be produced by several medical conditions including: obesity, diabetes, metabolic syndrome and hypothyroidism (low thyroid).

How can we manage high triglyceride levels and reduce the risk of CAD, stroke and death?

It starts with lifestyle modification. Your diet has to change. The key is to replace bad fats with good fats in your diet.

Bad fats are: saturated fats (found in meat and dairy products, some plant foods such as coconut oil, palm oil and palm kernel oil) and trans fats (found in commercially packaged foods and fried foods).

Good fats are: monounsaturated fats (found in nuts, almonds, pistachios, avocado, canola and olive oil) and polyunsaturated fats (found in seafood, fish oil, omega-3, corn, soy, safflower and sunflower oils). Monounsaturated fats have also been found to help in weight loss, particularly in reducing body fat.

Eat plenty of fruits and vegetables. Avoid alcohol, lose weight, exercise, do not smoke, and control your blood sugar and blood pressure. Wow, sounds easy! Well, sort of. There is plenty of help around to achieve your goals. You and your doctor should work together. But you have to have the motivation to start the ball rolling.

This plan will help reduce LDL bad cholesterol, the bad triglycerides (friend of enemy number one) and increase HDL good cholesterol. Next week, look for more fodder for your healthy heart besides love and chocolates on Valentine’s Day. Who is your enemy number three?

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Early Seasonal Influenza Vaccinations may Prevent First Heart Attack

Scientists have observed increased incidence of heart attacks (acute myocardial infarction) and stroke during the winter months. The exact reason why this happens is not completely known. But it has been thought that it is due to cold weather or due to metabolic activity in the body or due to infection such as respiratory infection.

It has also been observed that significant increases in acute heart attacks occur during peak winter incidence of pneumonia and influenza, particularly during years dominated by epidemic of influenza A. So it is surmised that this association supports the notion that the increase heart attacks during winter months is caused by influenza rather than cold weather.

 Why? The favoured hypothesis is that infection triggers atherosclerotic (the stuff that clogs the arteries) plaque to rupture and cause heart attack.

A study done in the U.K., using large database of general practice patients, found that heart attacks occurred less frequently in people who had had a recent influenza vaccination than in those who had not. But the same could not be said for pneumococcal vaccination.

If influenza vaccination does have the added benefit of reducing heart attacks, then it may be important to vaccinate early in the season. 

Other studies have shown influenza vaccination within the past year was associated with a 19 per cent reduction in the rate of acute heart attack among patients aged 40 years and over. Influenza vaccination administered within influenza season was also associated with a significant reduction (20 per cent) in the rate of acute heart attack.

Similar findings by other researchers reinforce current recommendations for annual influenza vaccination of target groups, with a potential added benefit for prevention of acute heart attack and stroke in those without established cardiovascular disease. 

So, how are we doing with our annual influenza vaccination programs? Which one is better – targeted high risk groups or universal vaccination program?

In 2007, Statistics Canada said that despite increases in influenza vaccination rates across the country, the rates for high-risk groups are falling short of national targets.

Ontario, which since 2000 has provided free flu shots for residents aged six months and older, led the provinces, with vaccination rates rising from 18 per cent to 42 per cent between 1996/97 and 2005. Newfoundland and Labrador, with a 22 per cent rate in 2005, ranked lowest. Nationally, the rates of influenza immunization increased to 34 per cent in 2005.

In 1993, a national consensus conference on influenza set target vaccination coverage rates of 70 per cent for adults aged 65 or older and for all adults with chronic medical conditions. These targets were raised to 80 per cent in 2005.

An article published in 2003, compared Alberta’s regional coverage rates of influenza vaccination among Alberta seniors during the period April 1, 1999 to March 31, 2001. The rates of immunization in the health regions varied from 30 per cent to 80 per cent (mean 70 per cent).

Their conclusion was that some parts of Alberta can do better. Under-utilization of preventive influenza vaccination in Alberta seniors is associated with increased utilization of health services for community-acquired pneumonia. The per capita vaccination cost (about 10 dollars) was small in relationship to the per capita cost of hospital care for pneumonia (about 100 dollars).

There is no doubt that in the elderly, vaccination against influenza is associated with reductions in the risk of hospitalization for heart disease, cerebrovascular disease and pneumonia or influenza. The vaccination also reduces the risk of death from all causes during influenza seasons. So, get yourself immunized today.

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Is exercise beneficial or hazardous to your heart?

In the U.S. an estimated 1.5 million heart attacks occur every year. Of these, 75,000 (about five percent), occur after heavy exertion (shoveling snow, recreational jogging, sexual activity), leading to 25,000 deaths. Similar statistics are reported from Canada and Europe. Some studies report up to 17 per cent deaths after heavy exertion.

There are mainly four risk factors which are associated with complications during exercise: age, presence of heart disease and intensity of exercise.

Normally, if the muscles are deprived of oxygen and energy then they easily fatigue. Delivery of oxygen and energy and removal of carbon dioxide and lactic acid (break down product of metabolism) are essential for sustained exercise. This depends on the health of our lungs and heart.

Glycogen is the principal carbohydrate stored in liver and muscles and it is the immediate source of energy. Safe prolonged exercise depends on the amount of glycogen in the muscles. Although fat stores are a huge reservoir of potential energy, the rate at which fat can be utilized for immediate energy is approximately one quarter of the rate at which glycogen can be utilized.

Increased oxygen and energy demand by the muscles, rapidly increases the heart rate to ensure adequate supply. That means hard work for the heart, at the expense of other organs. The risk of sudden death increases.

Can we reduce the risk of sudden death during or after vigorous exercise?

Yes, we can. A prospective data from a study of U.S. male physicians confirms this. Physical activity clearly benefits cardiovascular health (NEJM November 9, 2000). It has been shown that excess risk of heart attack during strenuous exertion was limited, for the most part, to persons who did not exercise regularly. Among those who exercised at least four or five time per week, there was little or no excess risk (NEJM December 2, 1993).

Although the exact reasons why physical exertion triggers heart attacks are not known, the possible factors are the disruption of atherosclerotic plaques (the deposits which narrows the coronary arteries), and the shearing stress on the heart caused by increased heart rate and blood pressure.

In sedentary people or couch potatoes, the risk of heart attack was seven times higher in a German study and more than 100 times greater in a U.S. study during vigorous exertion than during lighter activity or no activity. If you compare this to among people who exercised regularly, there was almost no increased risk. Another beneficial effect of regular exercise is that it increases the blood level of HDL (good cholesterol). HDL is another line of defense against heart attack.

What are the other hazards of vigorous exercise?

Dehydration. Drink plenty of fluids before, during and after a workout. You should adjust your activity according to the weather and reduce it when fatigued or ill.

Hyperthermia can result in light headedness, nausea, headache, hyperventilation, fatigue and loss of concentration. Heatstroke is the most dangerous complication of hyperthermia.

Avoid injuries to bones and muscles. High-impact exercise can also damage the inner ear, causing dizziness, ringing in the ear, motion sickness or loss of high-frequency hearing.

How can you exercise safely?

Most important thing is to listen to your body’s warning signs during exercise: chest pain, irregular heartbeat, undue fatigue, nausea, unexpected breathlessness or light-headedness. It is estimated that at least 40 percent of young men who die suddenly during a workout have previously experienced and ignored, warning signs. Remember to warm up, cool down and stretch.

For the general public the message is clear – regular exercise has important health benefits over the long term. Sudden vigorous exertion by people who are unaccustomed to it can sometimes end in tragedy (NEJM December 2, 1993). Consult your doctor and fitness expert.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!