What you might not know about heart health

Heart attacks are the leading cause of death in the U.S., ending the lives of nearly two million people every year. Most people have some knowledge about maintaining heart health, but following are a some tips to help you stay well.

You can have a heart attack with a minimal blockage: Most of us believe that coronary plaque accumulates and eventually blocks an artery 100 percent, resulting in a heart attack or myocardial infarction. This is not true. A small amount of unstable plaque can rupture, causing blood clots that block the rest of the artery.

This is the very reason why stress tests are not accurate screening tests. This test only detects 80% blockages. So, the key is plaque stabilization. A stabilized plaque will not cause a heart attack. Statins are excellent plaque stabilizers. Eating healthy and exercising can also help to reduce chances of unstable plaque.

Coronary stents do not always save lives: Installing a stent during a heart attack can save lives but stents placed for blockages without pain do not improve survival.

Stents are also placed for stable angina or exertional chest pain but this intervention does not improve survival either. It does, however, alleviate the pain. Why is this? The problem is that atherosclerotic plaque is often a pervasive disease. The arteries in the brain, kidneys and eyes can also be affected. Even other coronary vessels can have developing plaque. Yes, it would be nice if we had “Drano” for our blood vessels but we don't. So stenting a vessel or two doesn't improve survival because you are not eliminating the underlying disease called atherosclerosis. Even coronary bypass surgery doesn't guarantee survival in all cases.

We can reduce plaque by lowering cholesterol, reducing blood pressure, decreasing stress, lowering sugar and giving up tobacco in any form. It is best to take a systemic approach toward reducing plaque rather than localized treatments as stated above.

Aspirin doesn't work the same way in both men and women: Interestingly, aspirin helps to prevent heart attacks in men ages 45-79, and it helps to prevent strokes in women ages 55-79. Aspirin can cause bleeding yet it may help to prevent certain cancers such as colon carcinoma. One has to weigh benefits versus risks. High risk men or women may consider a baby aspirin (81 mg) daily, especially if there is no history of peptic ulcers or other GI disturbances. Aspirin works best after an initial heart attack, and is beneficial for prevention as well.

Anti-inflammatories are not good for the heart: Examples of anti-inflammatories include naprosyn (Aleve), Ibuprofen (Advil), celexicob (Celebrex), and meloxicam (Mobic). These agents can raise blood pressure, cause GI bleeds, induce kidney failure and cause blood clots. While these effects are uncommon, it is prudent to avoid or use these drugs at their lowest dosages for the shortest period of time. Consider acetaminophen (Tylenol) or tramadol (Ultram) or high dose fish oil supplements.

An earlobe crease and ED may be signs of trouble for your heart: The earlobes are fed by arteries. If the artery becomes clogged, the lobe develops a crease. If you have such a crease, it doesn't mean that you will develop heart disease but it is a warning sign.

The same is true for men with erectile dysfunction (ED). Nearly 80% of ED is due to atherosclerotic disease or blockages of the vessels leading to the penis. If you have clogged vessels leading to the earlobes or the penis, it may be an early sign of coronary heart disease. More aggressive treatment may be indicated as evidenced by improving erections with treatment of cholesterol.

Marijuana and Heart Disease: The risk of having a heart attack after using marijuana is five times that of a nonsmoker within one hour of smoking. This risk is higher than sexual intercourse or about the same as strenuous exercise, but lower than cocaine (25 times the risk of nonusers). The risk increases with age.

Also after regular exercise, the risk for heart disease goes lower than average. This is the key benefit of exercise. Marijuana, like smoking, constricts the coronary arteries and increases the risk of a heart attack. It might cause cholesterol plaque to rupture. A 2014 study conducted in France by the American Heart Association showed that both young and middle aged patients who smoke marijuana increase their cardiac risk. Two percent of patients developed cardiac disease and a quarter of those patients suffered heart attacks related to smoking marijuana.

The HDL and LDL concentrations are not as important as you think: Most people who have heart attacks have a normal concentration of LDL, or bad cholesterol. So many people will never know that they are at higher risk unless they obtain an actual LDL particle count or an APO B measurement. APO B transports bad cholesterol particles and is an inexpensive method for determining risk.

Tim Russert of the Meet the Press television show had an LDL concentration of 67 which was superb. After his death due to a massive heart attack, the LDL particle count and the APO B were sky high. Discuss these measurements with your doctor.

The HDL or good cholesterol is a black box. High levels may be associated with heart disease and low levels may be protective. This is the opposite of what you would think. It is really a matter of how well the HDL functions and not the actual number. HDL removes plaque from the arteries, but if you have a bunch of lazy HDLs then the actual number means nothing. So the function of HDL is more important than the number.

Fish oil decreases sudden death: Sudden death often occurs due to an abnormal cardiac rhythm. Since the heart cannot effectively pump blood, the person becomes unconscious and dies unless swift resuscitation occurs. According to the Physician's Health Study, patients with the highest levels of fish oil in their blood had the lowest incidence of sudden death. In fact, there was a 90 percent risk reduction for sudden death.

Don't ignore stress reduction: The subconscious harbors all the stress and it needs to be resolved. Survivors of hurricane Katrina have three times the mortality rate as controls. Bullied patients have a greater cardiovascular mortality later in life. Transcendental meditation has been shown in African-Americans with heart disease to reduce both heart attacks and stroke by 48 percent.

A simple meditation can lower both pulse and blood pressure plus reduce anxiety. Just take a breath and upon exhalation, say “peace” to yourself and do this for one minute. Take the time and reap the benefits.

Don't underestimate the power of a pet upon your subconscious. Dogs can help with both exercise and anxiety.

Control the six most critical risk factors: According to Javed Butler, M.D., deputy chief science adviser for the American Heart Association, “The problem is getting people to do what we already know they should do. This includes eating right; exercising; stop smoking; control blood pressure; lower their cholesterol and blood sugar levels, and consider preventive aspirin.”

• Evan Lipkis, M.D. is a physician, author and lecturer based in Glenview. The advice contained in this column is for informational purposes only. Readers should consult with a physician to evaluate any illness or medical condition. Contact Dr. Lipkis through his website at www.drlipkis.com.

Did you know?

• Low vitamin D levels predispose to heart disease. We are not sure if raising such levels will help but it is easy to do until more studies are done.

• Sleep apnea is pervasive and increases heart disease, atrial fibrillation and high blood pressure. Continuous positive airway pressure or a special sleep guard can help.

• Flu shots decrease heart disease by 20 percent to 40 percent.

• Alcohol remains controversial, but likely a few drinks per week is helpful. However, increasing alcohol consumption may increase the incidence of breast cancer and other solid tumors.

• Not only does the recommended 150 minutes of exercise a week reduce atherosclerosis but just running 5-10 minutes daily can reduce heart disease by 30 percent to 50 percent.

• Avoid high fructose corn syrup. It is contributing to diabetes and obesity. Also, since it is only broken down in the liver, steatosis or fatty liver can develop.

• The Mediterranean diet is the healthiest diet and consists of whole grains, fruits, vegetables, olive oil, fish and a little alcohol. The diet helps to prevent heart disease, cancer and Alzheimer's disease.

• Swedish men lowered their incidence of heart disease by 86 percent by exercising 40 minutes per day, ingesting 10-30 grams of alcohol per day, following a Mediterranean diet, stopping smoking and keeping their waist size under 38 inches. Unfortunately, less than 1 percent followed all five of these parameters. Diet seemed to have the most impact and all the interventions were additive; the more interventions you followed, the lower your risk.