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Tag: heart attack

I’m an athlete. I can’t have a heart attack.

If you’ve ever thought, “I exercise so I shouldn’t have any heart issues”—this is for you.

135 people have died from sudden heart attacks during triathlons in the US from 1985 until 2016 (just last year) according to a recent Internal Medicine study1.
To continue our blog theme about raising awareness of cardiac arrest and heart attack symptoms, we continue by sharing some scary statistics such as the one above. Even serious athletes are not immune to heart conditions and heart-related deaths.

The Facts

• 67 percent of these deaths occurred during the swimming portion of the triathlon (usually the first part of a triathlon)
• 85 % of the deaths were men
• In men, the risk increased substantially with age (risk was way higher for men 60 years old and older)

The Causes

Not warming up that well: The researchers commented that warming up properly could play into the cause of these heart-related deaths. By not adequately warming up, it puts an extra strain on your heart as a competitor in a serious race like a triathlon.

Denial: Denial is probably the most serious issue of them all. And in reality, most athletes lean towards denial of health issues since they have taken active steps (literally) towards being healthy.

The Coach of the Rocky Mountain Triathlon Club, Charles Perez was interviewed in a recent article about this study and he shared “once we get over 40, we start to get into denial very, very quickly. I know myself that was very true. When I first started noticing these heart arrhythmias I was in total denial this can’t be true – I’ve been running my whole life and there’s no way I can be having any sort of heart issues. It took a long time before I finally went into the doc and had it checked out and went to a heart specialist and they told me exactly what I had and gave me some options on what I could do for it.” Mr. Perez had been competing in endurance races for over 20 years when he developed Supraventricular Tachycardia which he had surgery for in 2001.

The great news is that he recovered and was able to continue doing triathlons. What we learned from all this is that we should never be in denial no matter what our regular level of exercise is.

What to look for?

They call heart disease the “silent killer” for a reason.

Heart issues often don’t have symptoms and can appear suddenly. You don’t know if you’ve got hardening of your arteries until you have what is referred to as an “event.”

By exerting your body to its highest level, a triathlon is truly like a stress test and can aggravate things to the point that an event can occur.

Signs/Symptoms may include:

• feeling dizzy
• feeling light-headed
• shortness of breath
• chest pains
• a rapid heartbeat

If it’s so SILENT, how do we try to prevent it?

According to editorialists at The New England Journal of Medicine, “Although pre-participation screening may not be popular in this older group of athletes, education (especially men over 40) about the signs and symptoms of cardiovascular disease (including the use of performance-enhancing drugs) and the need for proper medical attention is warranted.”

A physical exam by your physician if you are over 40 is not a bad idea before you start training for an endurance race of any kind.

And don’t get lazy. As we have seen with the statistics above, someone who is in good physical condition and has been involved in endurance events/races for many years can STILL be at risk for heart issues. Therefore, follow up appointments throughout your training are also important.

In conclusion—get educated and get checked regularly!

And most importantly, next time you think that because you are an avid jogger or swimmer, or that because you go to the gym that you may be immune from any kind of heart-related issues, think again. If you are a physician or healthcare practitioner and want to further your cardiology knowledge to help your patients avoid cardiac events, visit us at The Wynn in Las Vegas for our CMHC West event May 4-5, 2018! If you would like to stay aware of signs or symptoms, check out our recent blog about risk factors or visit the The American Heart Association’s website.

1Annals of Internal Medicine. http://annals.org/aim/article/2654457/death-cardiac-arrest-u-s-triathlon-participants-1985-2016-cas. September 19, 2017. Accessed October 17, 2017.
2KUSA 9News. Erica Tinsley. Heart attacks killing triathletes during race. http://www.9news.com/news/local/study-heart-attacks-killing-triathletes-during-race-1/477472167. September 20, 2017. Accessed October 17, 2017.
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Eating your way OUT of a heart attack

A couple days ago, we shared the difference between a cardiac arrest and a heart attack with you.
We also shared that even though they are different things, they do share the SAME risk factors.
What we want to share with you today, is the good news: many of these risk factors can be eliminated.

The Facts

According to the CDC, every year about 735,000 Americans have a heart attack.1

“Heart disease needs urgent intervention. And that intervention, it is increasingly getting clear, has to be a lifestyle and diet makeover” according to Kenneth Thorpe, chairman at Partnership to Fight Chronic Disease (PFCD).2

But I’m young…

Studies have noted a marked increase in the number of young patients suffering from heart attacks.

A recent article shared a story about a 29-year-old marketing and sales professional who had suffered a heart attack. He had no family history of a heart attack.

What they did report however was that this patient’s lifestyle included heavy smoking, not enough exercise, and that he was overweight. In 2011, this same patient had a second heart attack, followed by a third in 2013. He failed bypass surgery, and ended up undergoing a heart transplant in August last year at the young age (in our opinion) of 45 years old.

In the past year, he has lost approximately 70 pounds. Abhay Singh, was 205 lbs. at the time of his first heart attack. Before his heart transplant he shot up to 253lbs.

Mr. Singh, now 46 years old and 182 lbs., leads a normal life. However, it is a different life from before.

He has to exercise every day, drink and smoke minimally, not eat as much salt, and also must keep a close eye on his lipid profile.

Listen to your body

At 29 years old, Mr. Singh thought his first heart attack was just indigestion.

When he finally got to the doctor 12 hours later, his heart had sustained significant damage.

Manage your DIET
A study published in the Journal Of The American Medical Association (JAMA) in March 2017 shows that a large percentage of deaths due to cardiovascular disease and diabetes are linked to a poor diet.

According to the study, 10 foods/nutrients associated with cardiometabolic diseases are fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats (refined oils, hydrogenated fats, etc.), sugar-sweetened beverages (SSBs), polyunsaturated fats (PUFA), seafood omega-3 fats and sodium.

NO MORE SALT
Excess sodium intake (too much salt) was connected to the highest proportion of heart disease (it was associated in 9.5% of deaths). It has been proven that high-salt diets increase blood pressure and the risk of heart disease extensively. Research (3) has found that those of us who consumed more than 13.7g of salt daily had a two times higher risk of heart failure compared to those who consumed less than 6.8g. “The World Health Organization recommends a maximum of 5g per day.” says Dr. Sundeep Mishra, professor of cardiology, All India Institute of Medical Sciences (AIIMS). Scary but true, the majority of us ingest more than 10 times the amount of salt we need to meet our sodium requirements.

Other top-of-the-list dietary patterns affecting heart health were low intake of nuts and seeds (8.5%), high intake of processed meats (8.2%) and low fruit and vegetable intake (7.6 and 7.5%, respectively).

What this proves is that diet matters when it comes to heart disease.

GOOD fat?
Apparently, not all fats are bad, and the kind of fat we eat is a big deal.

“Saturated and trans fats increase blood cholesterol and heart attack rates. PUFA (Polyunsaturated fatty acids) and monounsaturated (MUFA) fats lower the risk of heart attacks,” according to Dr. Simmi Manocha, head of department, non-invasive cardiology, Asian Institute of Medical Sciences, Faridabad.

Most of us have heard of Omega-3’s and apparently they are a type of PUFA that is really beneficial for cardiovascular health. Want proof?

Both plant-based and seafood-based omega-3 lower the risk of fatal heart attacks by about 10% according to a study by Tufts University, US. The researchers also found that Fish, walnuts and flaxseed oil are the best sources of omega-3.

Are you an apple or a pear?

So according to all of the above, we learned that a poor diet is bad for the heart.

A bad diet can lead to weight gain, and even if you are otherwise considered healthy, gaining weight raises the risk of heart attack by over a quarter!

Even if you have healthy blood pressure, blood sugar and cholesterol levels, being overweight or obese increases your risk of coronary heart disease (CHD) by up to 28% compared to those with a healthy bodyweight, according to a study published in the European Heart Journal.

A person who carries the bulk of their body fat around their stomach (an “apple” shaped body) is at greater risk of heart disease than someone whose body fat tends to settle around their bottom, hips and thighs (a “pear” shaped body) according to Dr. Manocha.

SUMMARIZE:

  • Avoid packaged foods
  • Avoid salt
  • Take Omega 3’s
  • Stick to natural, minimal processed foods like nuts or fruits – remember PUFA & MUFA (Polyunsaturated fatty acids and monounsaturated)
  • Keep an eye on your weight (avoid an apple shape)
  • Manage your lifestyle – don’t overdo drinking; try to stop smoking
  • Listen to your body (see a doctor immediately if you feel warning signs)
  • Get educated (that’s where we come in)…

At CMHC, we try to bring the latest science and research in the cardiometabolic space to physicians and allied health professionals like you. Every one of you treats heart health or deals with the risk factors listed in this article. Most of all, we try to get you the most robust education that ties all of this research into what can help YOUR patients, today. A few years ago, we launched CMHC West and are so excited to take it to Las Vegas next year from May 4-5, 2018.

Our 2018 agenda will capture the integrity and high-quality education of the annual CMHC event (that just wrapped up in Boston) as the top U.S. experts in cardiometabolic health will highlight the latest updates in heart failure, diabetes, hypertension, cardiovascular health and lifestyle management. Invest in your education and visit us in Las Vegas – register for only $99 until December 31 when the price increases!

Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29-322.
LiveMint. Are you eating your way to a heart attack? http://www.livemint.com/Science/6UgERyTXiXXdSAgJomm6kL/Are-you-eating-your-way-to-a-heart-attack.html. September 26, 2017. Accessed October 13, 2017.
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What the Loss of Tom Petty Taught Us: Cardiac Arrest vs. Heart Attack

We like to tie our blogs to current events and one very sad event was the loss of superstar Tom Petty last week. At the very young age of 66 a seemingly larger-than-life rockstar lost his life to one of the things we have dedicated our mission to here at CMHC.

Tom Petty’s death has aimed a spotlight on a heart condition that strikes suddenly and can kill in minutes. Cardiac arrests kill more than 300,000 Americans every year.

Have you ever used the term “heart attack” when describing a cardiac arrest? Or vice versa?

We are here to tell you that you are not alone. We know many of us have, and this is a blog article to try to help you learn and remember the difference.

Difference Between a CARDIAC Arrest and a Heart Attack. Wait…there is a difference?

A cardiac arrest is triggered by a heart malfunction which causes the heart to stop beating unexpectedly. When the heart stops its pumping action, blood flow to the rest of the body stops.

A heart attack occurs when there are blockages in blood vessels that nourish your heart so blood flow to the heart is blocked.

Dr. Steven Nissen, distinguished faculty member of ours at CMHC and chairman of cardiovascular medicine at Cleveland Clinic, explained in a CBS News interview that cardiac arrest “is really more of an electrical problem. A heart attack is more of a mechanical problem.”

Different Symptoms

You have probably heard about heart attack symptoms. They include:

• pain in the chest
• pain in any other areas of the upper body
• vomiting
• nausea
• cold sweats
• shortness of breath.
• Many people have even heard a pain in the left arm could be one of the “signs”.

Heart attack symptoms can happen suddenly, but it is very common for them to actually begin slowly and persist for hours and days, or sometimes, even weeks before an actual heart attack occurs!

Very differently than the above, cardiac arrest victims immediately become unresponsive and death occurs within minutes without treatment.  Basically, to put it simply, no long-lasting or persistent symptoms.

It has actually been found that about half the time, cardiac arrest victims had early warning signs including palpitations, shortness of breath, intermittent chest pain and pressure, or ongoing flu-like symptoms such as nausea and abdominal/back pain. However, most of them, in fact 80%, were found to ignore the symptoms and not seek treatment.

Unfortunately, cardiac arrest is fatal approximately 90 percent of the time.

Are they even related? What comes first?

Try not to let this confuse you. The most common cause of a cardiac arrest is a heart attack.

However, the majority of heart attacks do NOT lead to cardiac arrests.

Also, there are MANY victims that go into cardiac arrest without having suffered a heart attack.

So, let’s make this clear, HEART ATTACK ——-MAY LEAD TO—– CARDIAC ARREST.

But the majority of heart attacks don’t and most cardiac arrests (70%) are caused by coronary heart disease risk factors.

Because BOTH heart attacks and cardiac arrests are related, they share the same risk factors – diabetes, high cholesterol, smoking, high blood pressure and family history.

All the things we warn you about in our other blogs.

Cardiac Arrest Victims

Cardiac arrest victims are “often people who have had previous damage to the heart due to disease of the heart muscle or due to previous coronary heart disease where the weakened heart is more susceptible to a rhythm disturbance that leads to a cardiac arrest,” Dr. Nissen said.

There is a chance to survive a cardiac arrest, but it comes only if a victim is treated within a few minutes. In a scary statement reported by a senior author in the Annals of Internal Medicine, this is a very limited few.

Dr. Sumeet Chugh, the medical director of the Heart Rhythm Center in the Cedars-Sinai Heart Institute shared, that “no matter how fast we get there, at the most, we save 10 percent of people who have a cardiac arrest. There is no condition known to man where you have the chance of dying within 10 minutes. This is what people don’t understand. As each minute goes by, there’s a 10 percent less chance of survival. If the paramedics get there in 10 minutes, you’re gone.”

WHAT TO DO…in case…

If you think that someone around you may be going into cardiac arrest, call 9-1-1 immediately and begin to perform CPR (or find somebody that knows how to). CPR can buy minutes for emergency responders to arrive and help resuscitate the victim.

Luckily, most crowded buildings now have Automated External Defibrillators available, so look for one. They are in airplanes, airports, train stations and even concert venues and stadiums. They are very easy to use and accessible.

Now that we explained the difference between the two, shared some scary stuff and armed you with what to do in case someone you care about may be suffering from any of the symptoms, we want to honor Tom Petty and wish there was a way we could have saved him along with all the rest of the victims that heart disease has affected in 2017. Keep reading our blogs about ways to prevent cardiovascular disease and lessen your risk factors for this terrible disease and if you are a physician or healthcare practitioner, check out our next CME event to learn how to save your patients!

For more about Dr. Nissen, visit his CMHC bio or check out his keynote lecture topic on our 2016 Annual CMHC agenda.

 CBS News. Mary Brophy Marcus. Sudden cardiac arrest may have warning signs after all. https://www.cbsnews.com/news/sudden-cardiac-arrest-may-have-warning-signs-after-all/.  December 2015. Accessed October 10, 2017. 
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Stopping Cholesterol-Lowering Drugs Could be Deadly

A new study confirms that stopping a cholesterol-lowering drug can be critically dangerous. Researchers found that people who stopped taking statins, after reporting a side effect, were 13% more likely to die, or have a hear attack or stroke over the next four years.


Statins work by inhibiting the liver’s ability to produce cholesterol, while simultaneously helping the organ remove existing fats in the blood. These drugs are ‘almost universally prescribed’ to people with cardiovascular disease; moreover, the U.S. Preventive Services Task Force recommends the drugs to people ages 40-75, who have no history of heart disease, if they have one or more risk factors.

While there is extensive literature and clinical studies surrounding the efficacy of statins, a quarter to a half of patients stop taking the drugs within six months to a year, according to Dr. Alexander Turchin of Brigham and Women’s Hospital in Boston. In order to determine whether people who continue taking statins fare better than those who do not, researchers analyzed data from two Boston hospitals between 2000 and 2011.

During that period, over 200,000 adults were prescribed and treated with statins; almost 45,000 of those people reported a side effect that they thought might be from the medication: generally muscle or stomach aches. The researchers focused on 28,266 people from those 45,000 with possible side effects: most of them, 19,989 individuals, continued to take the statins.

Approximately four years after the side effects were reported, 3,677 patients had died, or suffered a heart attack or stroke. Overall, researchers found that people who stopped taking statins were 13 percent more likely to die or have a heart attack, or stroke. According to Dr. Robert Rosenson, a professor of cardiology at the Icahn School of Medicine at Mount Sinai in New York City, these new findings further confirm and expand on previous studies that demonstrated the benefits of continuing to take statins.

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Risk of Heart Disease with Painkillers

A large-scale study several years ago indicated that common painkillers like ibuprofen and naproxen are considered risky for people who have had heart attacks. New research indicates that the risk can begin within the first week of usage.

The study involved NSAIDs: non-steroidal anti-inflammatory drugs, including ibuprofen—generically known under its brand names Advil and/or Motrin.Researchers at McGill University pooled extensive studies and clinical research on NSAIDs and heart attacks, using a data pool of over 446,000 people who used the drugs, including 385,000 participants who did not have heart attacks.

The report, published in the British Medical Journal, stated that current use of a NSAID is “associated with a significantly increased risk of acute myocardial infarction,” the medical terminology for a heart attack. Moreover, the risk began within a week of usage. The data demonstrated that those who used NSAIDs were more likely to have a repeat heart attack, or die within the next 5 years. In the first year post-heart attack, 20 percent of NSAID users died, compared to approximately 12 percent of non-users. The death rate of NSAID users remained about double than that of non-users in the next few years.

A number of studies have consistently revealed similar patterns concerningNSAIDs and heart disease, coupled with biological reasons that NSAIDs could be risky for people with heart disease. Evidence suggests that the drugs may impact and affect blood clotting, blood vessel function, and blood pressure.Because NSAIDs are available over the counter, many patients and consumers believe that there is no danger involved.

The U.S. Food and Drug Administration has already added ‘black box warnings’ to NSAIDs, warning people with higher risks for heart disease and blood pressure to avoid using them without the recommendation of a physician. Dr. Gordan Tomaselli, chief of cardiology at Johns Hopkins University, advises: “if you’ve ever had a heart attack, you should use NSAIDs with caution.”

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Pass the Butter!

A new editorial published by a group of cardiologists in the British Journal of Sports Medicine argues that saturated fats, found in foods like butter, cheese, and meats, does not clog arteries and ultimately lead to cardiovascular disease. The doctors report that a Mediterranean-style diet, coupled with minimal stress and daily exercise, should be the primary focus for the prevention of heart disease.

The authors cite systematic reviews and observational studies that show no correlation or association between consumption of saturated fat and increased risk of heart disease. British cardiologist Dr. Aseem Malhotra, of Lister Hospital, argues that even reducing saturated fat intake in people with pre-established heart disease does not minimize the risk of heart attacks. Yet for decades, researchers, doctors, and scientists believed that cutting out saturated fat would lower cardiovascular disease—despite firmly solid evidence.

While some people have transitioned to diets of carbohydrates, these also play a role in the gradual development of cardiovascular disease. Malhotra states that eating too much pasta, bread, and potatoes will rapidly spike blood glucose levels; our bodies respond to carbs by over-producing insulin. When insulin levels are consistently and constantly too high, the hormone is unable to deliver glucose to cells, in order to provide energy. Ultimately, an inflammatory response occurs when the body becomes resistant to insulin, which Malhotra and his colleagues believe is the true culprit.

The editorial sheds light upon the critical importance of diet, as a dietary imbalance of nutrients can ultimately damage arteries; the lipid, soft fat plaque that is more prone to rupturing is the ultimate cause of a sudden heart attack. The combination of a healthful diet, regular exercise, and stress reduction is considered to be the optimal way to reduce cardiovascular disease, and most other chronic diseases.

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Happy Hour: Good for the Heart?

A recent large-scale study indicates that alcohol, in moderation, is healthy for the heart. New research published in the British Medical Journal adds further evidence linking alcohol consumption with lower risks of heart attack, stroke, and cardiovascular disease. While the new study is consistent with earlier results that have shown potential heart health benefits from occasional drinking, it amplifies the message due to its large sample population.

Drinking about a glass of wine for women per day, and two glasses of wine for men, showed benefits for heart health in a large group of U.K. adults; of the near 2 million subjects, none had cardiovascular disease when the study began. People who did not drink showed increased risk for eight of the heart ailments, ranging from 12% to 56%, compared to those who drank in moderation; the eight conditions included the most common heart events—such as heart attack and stroke. Non-drinkers had a 33% higher risk of unstable angina, a condition in which the heart does not receive sufficient blood flow, and a 56% higher risk of dying unexpectedly from cardiovascular disease—compared to those people who drank a glass or two of alcohol each day.

There are several potential ways that casual drinking might benefit heart health, although none have been directly proven. Alcohol consumption has been linked to increases in ‘good’ HDL cholesterol, and properties in the blood that reduce clotting. It is also possible that moderate drinking helps reduce stress levels.

Yet alcohol does not provide protection against four less common heart problems, including certain types of mild strokes. It is not clear from the current study why alcohol lowers the risk of some heart conditions and not others, but the results should reassure people who drink a few glasses of alcohol each week. Moreover, while casual drinking shows potential benefit, drinking to excess can increase risks for a variety of heart problems.

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Shoveling in Snowstorms: Bad for the Heart?

A new study published in the Canadian Medical Association has found that the days following a heavy snowfall often carry a significantly greater risk of heart attacks for men.

The medical community has long suspected that snow shoveling can increase heart attacks at a population level, yet this study concretely confirms the link between snowfall and heart attacks.

Researchers from the University of Montreal gathered reports of 128,073 hospital admissions and 68,155 deaths from heart attacks in Quebec between the months of November and April, every year between 1981 and 2014. The team also obtained weather information that corresponded to the time frames and regions included in the study.

When comparing the medical and weather data, the researchers found that the most dangerous days occurred immediately following snowfalls: almost one third of all hospital admissions and deaths due to heart attacks occurred on these days. Moreover, the risk was even greater subsequent to snowfalls that lasted two to three days.

The findings serve as a reminder that people should remain vigilant about potential cardiovascular risks, in addition to automobile accidents and snow-related falls. Furthermore, snow shoveling is challenging for the heart, and can pose an extreme strain and danger if overdone.

Because the study analyzed trends over time, it did not establish a specific cause-and-effect relationship between snow-related activities like shoveling and heart attacks. Yet the authors’ hypothesis—that men are more likely to shovel post-snowstorm, and that shoveling is responsible for the increased risk of heart attacks—is more than plausible, and reason enough to approach shoveling with care and caution.

The study further indicates that the physical exertion and cold temperatures associated with shoveling snow set the stage for an “eco-biological-behavioral perfect-storm,” particularly for those out of shape, or people with other heart disease risk factors.

While shoveling is likely the primary reason that heart attacks increase after a snowstorm, it is critical to be mindful of heart health all year round. In addition to avoiding shoveling, people should also be physically active and have a nutritious diet.

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