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The Big Heart Disease Lie

The Big Heart Disease Lie is a book written by doctors who are members of the International Truth In Medicine Council they are also the authors of The Big Diabetes Lie. In this book you will be getting over 500 pages of scientifically proven, doctor verified information that you will not find anywhere else, not even bookstores.If you have high blood pressure or cholesterol, fatigue, shortness of breath, irregular heartbeat, swollen feet or ankles, chest pain, fainting, diabetes, asthma or allergies, pain, fatigue, inflammation, any troubling health issue, or simply want to discover the most powerful health and anti-aging program, then you really need to read this book. The book is a step by step guide that contains techniques scientifically verified and proven by doctors to reverse the symptoms of heart disease, and normalize blood pressure and cholesterol levels. These techniques have been used successfully by tens of thousands of people all over the world, and allowed them to take health into their own hands, ending the need for drugs, hospitals, doctors' visits, expensive supplements or grueling workouts. Continue reading...

The Big Heart Disease Lie Summary


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Heart Attack at Twenty Four

He assumed he had pulled a muscle, though he couldn't pinpoint the event that caused this injury. He tried to ignore the discomfort, but as the weeks went by, the pressure in his chest grew more intense whenever he exercised, and he started to get short of breath with less and less activity. He began to worry that he might have a more serious problem, like the heart disease that had hospitalized his father at forty-four. But Peter was sure that at age twenty-four that couldn't be the explanation. On a cool, brisk Saturday afternoon, while biking through the autumn foliage in a distant Boston suburb, Peter's pain began again. This time, it did not subside after half an hour, as it had on all the previous occasions. Peter asked a friend on the bike trip to drive him to the local emergency room. Several hours later after Peter's cardiac catheterization, angioplasty, and stent placement were completed he found himself wondering what having a heart attack at twenty-four...

Therapeutic Strategies in Diabetes and Cardiovascular Disease

Prakash Deedwania, who has had a long and productive interest in diabetes and cardiovascular disease, was willing to organize and contribute to articles on this topic. This broad topic has been divided between two issues of the Cardiology Clinics. The first issue (November 2004) dealt with pathophysiology, clinical epidemiology, and the relationship between diabetes and other diseases such as heart failure and hypertension. The second issue deals with management strategies for preventing and treating the cardiovascular complications of diabetes. I am indebted to Dr. Deedwania and the group of experts he has assembled for these two important issues. Editing one issue is a big job, let alone two. However, Dr. Deedwania has had a long-standing academic and clinical interest in diabetes and metabolic syndrome in cardiovascular disease. His dedication to improving care for these individuals is evident in these two issues of the Cardiology Clinics.

What Is Heart Disease

Coronary artery disease (CAD) begins with a buildup of plaque in either the left or right coronary artery or their branches. This reduces the blood flow to the heart, but early on, this reduction is not severe enough to compromise heart muscle function or to produce any symptoms. Later, as the plaque enlarges and further reduces blood flow, blood flow interruption can reach the Ischemia is the medical word for this interruption. A temporary or partial interruption in the supply of blood, known as mild ischemia, will injure the myocardium and cause the chest pain known as angina. A prolonged or complete interruption, known as severe ischemia, will kill myocardial cells and cause a heart attack. You can think of a coronary blockage as a car accident that blocks the flow of traffic through one of a handful of roads that serve a very important city. The more neighborhoods served by a road, the more disruptive a blockage is to the life of the city. Generally, the more heart muscle a...

How Heart Disease Happens

What causes the blockages that set off these events In a word, atherosclerosis. The term is a combination of two Greek words athere, meaning pudding, and sclerosis, meaning hardening. The root words describe what happens in atherosclerosis the artery walls become filled with soft, mushy deposits that eventually harden to make the artery stiff and narrow. Put simply, the arteries get clogged in the same way the pipe in your bathroom sink might when too much debris sticks to its walls, blocking the flow of water. Though the pipe analogy might make artery clogging seem straightforward, it's a fairly complicated process. There are four steps that occur in what is known as the coronary cascade to a heart attack (see Figure 2.2).

Coronary heart disease CHD

Correlation study of 24 developed countries showed that the supply of a-tocopherol was strongly related to CHD and explained the low rates of heart disease in some European countries (Bellizzi et al, 1994). For example, Spain, with low rates of CHD, has estimated intakes of 18-25mg day vitamin E, whereas in the UK, where the number of deaths from CHD is one of the highest, the intake of vitamin E is only 4.7-11.9 mg day. Biochemical evidence to support the epidemiological data suggests that the susceptibility of LDL-cholesterol to oxidative modification to an atherogenic form is key in the development of atherosclerosis. Oxidised LDL is taken up by monocytes, which are attracted to a site of injury on an arterial wall. Monocytes are transformed to macrophages and oxidised LDL appears to decrease the ability of macrophages to leave the arterial wall. The enhanced uptake of oxidised LDL may then convert macrophages into foam cells, the precursors of plaque, which block the artery....

Step 4 Clot Causes Heart Attack

Though the reduced blood flow caused by the plaque and inflammation taxes the heart, it doesn't usually cause a heart attack. Heart attacks occur when the plaque ruptures. Plaque deposits teem with inflammatory cells (particularly macrophages and other inflammatory cells called T-lymphocytes) as well as cholesterol. The more inflammatory cells and cholesterol and the thinner the cap that covers them the more unstable the plaque. This sets the stage for disaster. T-cells slow the production of the fibrous materials that strengthen the cap (such as collagen), and macrophages produce enzymes that degrade collagen. This two-pronged attack degrades 20, the cap until it breaks. Large plaques, of course, narrow the arteries more than small plaques (think of a truck blocking a tunnel as opposed to a car), but that doesn't necessarily mean they are more dangerous. In fact, research suggests the reverse. About two-thirds of all heart attacks result from the rupture of smaller plaques those that...

What a Heart Attack Feels Like

I hope you'll get diagnosed and treated long before heart disease leads to a heart attack, but you should know the warning signs just in case. Unlike in the movies, where a person having a heart attack gropes his chest (and in the movies, unlike reality, it's 21 Although LDL is thought to be the major cholesterol-carrying culprit causing heart disease, there is still scientific controversy over the form LDL must take to cause atherosclerosis. For nearly twenty years, atherosclerosis researchers have hypothesized that LDL must change once it's in the artery wall in order to cause artery blockages. The dominant view has been that LDL must first be oxidized to a more inflammatory form in order to cause serious artery wall damage. Oxidation is the chemical reaction that causes metals to rust by changing the structure of the metals' molecules. Similarly, oxidation may change the chemical structure of LDL molecules by breaking down large fat-containing molecular chains. Although there are...

Word About Heart Attack Risk

The process that leads to an MI is complex. Not only does the LDL have to get into the artery wall, but all of the subsequent steps described must also occur for a plaque to rupture and cause a heart attack. In addition to a person's cholesterol level, genetic and environmental variables influence all of the steps in the process. This is why a doctor can't predict with certainty whether a person will have a heart attack simply based on an LDL cholesterol level. Children and young adults with rare genetic abnormalities that produce LDL levels that are five to ten times higher than normal are the exception to that statement. Without appropriate therapy, heart disease is a certainty for them. The rest of us have to rely primarily on statistical predictions based on our current understanding of all of the risk factors that predispose to heart disease. (You can calculate your risk using the Heart Attack Calculator in Chapter 5.) Severe fatigue (the least specific symptom, usually not...

What to Do if Youre Having a Heart Attack

If you or someone around you experiences the heart attack warning signs previously listed, follow these three simple steps 1. Call 911. You may be reluctant to call for help, especially if you're not sure whether your discomfort is caused by a heart attack or indigestion, but doing so will get you better and safer treatment. Calling for an ambulance is like bringing l23 Another good reason for emergency transport is quicker treatment once you get to the hospital. Heart attack victims who arrive by ambulance receive appropriate treatment sooner than those who arrive by car. If, for some reason, you have a family member or friend drive you to the hospital, tell the person at the desk, I think I'm having a heart attack in no uncertain terms. Don't be wishy-washy about it. Sitting in the waiting room because you told the desk clerk that it wasn't an emergency won't do you any good. Whatever you do, don't drive yourself to the hospital.

Time Is Not on Your Side if Youre Having a Heart Attack

The average person waits two hours or more after the onset of heart attack symptoms to call for help, and one in four people waits more than five hours. It's not ignorance it takes the aver-24, age doctor who is having a heart attack two hours, too. Most peo ple wait because they aren't sure if they're really having a heart attack and can't decide whether to seek medical care. It's easy to write off heart attack symptoms as something else. Chest pain can arise from stress- or activity-related angina. That hot, heavy feeling in the chest could be heartburn or gas. An ache in the left arm or jaw could be arthritis or the aftermath of snow shoveling. Unfortunately, there's no simple rule of thumb that separates a heart attack from a false alarm. And you'll probably have a hard time being objective about it, which is why it's so important to let a professional make an informed and unbiased judgment. Another deterrent is more personal. People don't want to look foolish if it's a false...

Role of Insulin Secretagogues and Insulin Sensitizing Agents in the Prevention of Cardiovascular Disease in Patients

Cardiovascular disease is the leading cause of death among patients who have diabetes mellitus. Patients who have diabetes mellitus have a greatly increased relative risk of cardiovascular disease when compared with patients who do not have diabetes mellitus 1 . Furthermore, in patients who have established cardiovascular disease, the rate of subsequent cardiovascular events is significantly higher than in individuals who do not have diabetes mellitus 2 and is associated with greatly increased morbidity and mortality. Epidemiologic studies showed that diabetic patients are more prone to develop complications following cardiovascular events 3 . Moreover, diabetic patients who have ischemic heart disease have a substantially worse outcome after coronary interventional procedures compared with nondiabetic patients 4 . The basis for these differences in outcome remained unclear. In most animal studies, diabetic myocardium demonstrates an enhanced sensitivity to the detrimental effect of...

If You Know You Have Heart Disease

Once you've received a diagnosis of coronary artery disease whether or not you've had a heart attack you face the question of what's the best way to treat it. This question is complex, and the answer continues to evolve as new therapies become available and new studies clarify which patients benefit most from which treatments. However, one basic principle holds true you'll need a close, continuing relationship with your primary care physician and a cardiologist. The goals of treatment are to keep your condition stable, prevent further damage to your heart, and, ideally, reverse some of the atherosclerosis in your coronary arteries. It's not surprising that measures for preventing heart disease are also effective in controlling it. Keep that in mind when you're reading about the risk factors you can change on pages 50-66. You'll also want to look over Chapters 6 and 7, which discuss lifestyle changes to improve cholesterol and lower your chance of heart disease. All patients with...

Effect of glycemic control on cardiovascular disease

The Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI) trial is particularly relevant to the impact of glycemic control for cardiology practice. A total of 620 patients were studied 306 were randomized to treatment with insulin-glucose infusion that was followed by multi-dose subcutaneous insulin for at least 3 months and 314 were randomized to conventional therapy. After 1 year, 57 subjects (18.6 ) in the infusion group and 82 subjects (26.1 ) in the control group had died (relative mortality reduction 29 , P 0.027). The mortality reduction was particularly evident in patients who had a low cardiovascular risk profile and no previous insulin treatment (3-month mortality rate was 6.5 in the infusion group and 13.5 in the control group relative reduction 52 , P 0.046 1-year mortality rate was 8.6 in the infusion group and 18.0 in the control group relative reduction 52 , P 0.020 ). Insulin-glucose infusion that was followed by a multi-dose insulin...

Potential beneficial effects of insulinsensitizing agents on cardiovascular risk factors

Several epidemiologic studies showed that hyperinsulinemia is an independent risk factor for cardiovascular disease 18 . Correction of insulin resistance clearly is important in the management of type 2 diabetes mellitus and may decrease the risk for cardiovascular disease. In the UKPDS, patients who had type 2 diabetes melli-tus and were treated with metformin, which decreases hyperinsulinemia and insulin resistance, had a 30 reduction in cardiovascular disease events and mortality compared with those who received conventional treatment 11 . The thiazo-lidinediones also improve insulin sensitivity and may exert numerous nonglycemic effects in patients who have type 2 diabetes mellitus 19,20 . Additional clinical trials are being conducted to evaluate whether treatment of diabetes mellitus with agents that reduce insulin resistance, such as the thiazolidinediones, is superior to treatment with agents that stimulate insulin secretion, such as the sulfonylureas.

Folate homocysteine and cardiovascular disease CVD

Cardiovascular disease remains one of the main causes of mortality in the western world and approximately two-thirds of cases are attributable to traditional environmental and genetic factors. However, in the last decade it has emerged that a moderate rise in the amino acid homocysteine in plasma constitutes a risk factor for atherosclerotic vascular disease in the coronary and peripheral blood vessels (Ward, 2001). The B vitamins folate, Bj2 and B6 all play a key role in homocys-teine metabolism and deficiencies of any one of the three B vitamins can result in homocysteinaemia. However, folate appears to be the most important and has been shown to lower plasma homocysteine concentrations at doses of 0.2-10mg day in both healthy and hyper-homocysteinaemic subjects (Ward, 2001) (see Fig. 3.3).

Sometimes requires discontinuation Contraindicated in active hepatic renal and coronary artery disease

In the UKPDS, treatment with metformin (another drug that decreases hyperinsulinemia and insulin resistance) produced greater reduction in cardiovascular disease events and mortality than sulfonylureas and insulin 8 . The latter drugs decreased blood glucose level to a similar degree as metformin but did not decrease plasma insulin concentrations. This effect may have been mediated through a decrease in insulin resistance, although other effects of metformin, such as improvement in lipid profile, improved fibrinoly-sis, and prevention of weight gain, may be important 8 . Metformin has a favorable, albeit modest, effect on plasma lipids, particularly in decreasing triglycerides and low-density lipopro-tein (LDL) cholesterol however, it had little, if any, effect on HDL cholesterol levels 78 . Met-formin use was associated with decreased plas-minogen activator inhibitor (PAI-1) activity which led to improved endothelial dysfunction (see Table 1). 86 . Epidemiologic studies have...

Risk Factors for Heart Disease

Over the past several decades, many careful studies have identified personal traits and habits that increase the risk of developing heart disease. Some of these risk factors are stronger than others some are under your control, and some are beyond it. The impacts of some risk factors have been well documented, while others are just emerging. No matter which risk factors you have, it's important to remember that they reinforce one another the more you have, the greater your chances of developing heart disease.

Case 4 End Stage Heart Disease in a 70Year Old Woman

Twenty years after her first myocardial infarct (heart attack) this 70-year-old college professor was having more and more difficulty with her heart repeated episodes of congestive heart failure and moments of sudden prolonged rapid heartbeat requiring an implanted defibrillator. Usually their recurrence was unpredictable, and so they were all the more distressing for her and her family. After one of these events, while she was still unconscious, I called her husband and daughters together to talk about the poor prognosis. They declined the opportunity to declare, Do not resuscitate, and they became angry that I had even opened the subject. The patient again recovered, and two years passed, during which several more episodes occurred and her health continued to decline. During this time, I often asked her alone or together with her husband, How are things overall for you What's all this like for you She was displeased whenever I included her husband in the conversations, and at her...

Diabetes as a coronary heart disease riskequivalent

Based on the observations from several epidemiologic studies, diabetes is designated a coronary heart disease (CHD)-risk equivalent by the National Cholesterol Education Program's Adult Treatment Panel III (ATPIII) 1 . The 10-year risk of major CHD events in patients who have diabetes is greater than 20 this is comparable to the rates that are observed in nondiabetic patients who have established CHD. This inference has been borne out, particularly by data from a population study in Finland 2 and a multi-national study, the Organization to Assess Strategies for Ischemic Syndromes 3 , of patients who had type 2 diabetes who frequently had multiple, coexisting risk factors for cardiovascular disease (CVD). The increased risk for CHD may precede the clinical diagnosis of diabetes by many years. This was documented best in the long-term study of more than 117,000 women in the Nurses' Health Study nearly 6000 women developed diabetes during 20 years of follow-up. There was an approximately...

Step 2 Determining if You Have Heart Disease or Diabetes

People who have heart disease have a much greater chance of having a heart attack than those who don't. In fact, more than twenty out of every one hundred people with heart disease will have recurrent heart disease within ten years. Heart disease, for the purpose of estimating this risk, is broadly defined and includes coronary artery disease as well as diseases of the arteries outside of the heart. Atherosclerosis in the arteries outside of the heart is generally called peripheral artery disease and can include blockages or enlargements (aneurysms) that affect the neck (carotid), abdominal (aortic), or leg arteries. Symptoms of peripheral arterial disease depend on the site of the blockage, but they can include sudden loss of vision pain in the calf, thigh, or buttocks when walking or impotence. 195 We now know that diabetes carries similar risks for heart health. So if you have any of the previously mentioned heart conditions, especially in combination with diabetes, you'll probably...

Step 4 Calculating Your Heart Attack Risk

Tors determine their risk of having a heart attack in the next ten years. You can use it to add up your points and then determine your risk level. Note that a 3 percent risk means that three out of one hundred people with your risk profile will have a coronary event in the next ten years, a 10 percent risk means that ten out of one hundred people with your risk profile will have a coronary event in the next ten years, and so on. Also note that there are separate heart attack calculators for men and women.

Chromium Supplementation And Cardiovascular Disease Risk

Two epidemiologic studies have evaluated the relationship between Cr levels in toenails (a measure proposed that best reflects long-term intake of trace elements) and risk of coronary heart disease in men. The Health Professionals' Follow-up Study (HPFS) evaluated 33,737 male health care professionals in the US who were free of chronic disease and who provided toenail samples in 1987. They were followed prospectively for 7 years. It was reported in this study that there were 367 confirmed myocardial infarctions (MIs). Two control subjects were matched to each case subject. The risk for MI was reported to be significantly reduced in men in the highest quintile for toenail Cr3+. However, this relationship was only significant for subjects with BMI > 25kg m2 75 . In a second study conducted by the HPFS 76 , mean toenail chromium (microgram per gram) was 0.71 in healthy control subjects (n 361), 0.61 in diabetic subjects (n 688), and 0.52 in diabetic men with prevalent CVD (n 198, P...

Epidemiology of ethnic differences in the risk for cardiovascular disease

It has long been recognized that there is a differential risk for CVD in people of different ethnic groups. For example, as early as the 1950s Asian Indian males were reported to have seven times higher prevalence of CHD (defined as coronary artery disease with myocardial involvement) than Chinese men in a series of nearly 10000 autopsies in Singapore (Danaraj etal., 1959). Consistently similar reports of higher prevalence of CHD among South Asian populations (originating from India, Pakistan, Sri Lanka and Bangladesh) compared with European-origin and other non-South Asian-origin people have emerged over the last few decades in different parts of the world, such as the UK, Singapore, Fiji, South Africa, Trinidad and North America (McKeigue, Miller and Marmot, 1989 McKeigue, Shah and Marmot, 1991 McKeigue etal., 1993 Enas etal., 1996 Wild and McKeigue, 1997 Lee etal., 2001). ethnic populations when compared with European White populations (Yusuf etal., 2001). In the UK non-White...

Pulseless Leg 9 Days after a Myocardial Infarction

A 32-year-old woman developed preeclampsia during her first pregnancy. Premature labor progressed to delivery of a viable infant at 31 weeks' gestation. The mother remained hypertensive, and one week postpartum awoke with severe chest pain. Emergency room evaluation was notable for systolic blood pressure 50 mm Hg, heart rate 75 bpm, and chest auscultation revealed bilateral rales. Chest radiograph interpretation was cardiome-galy with pulmonary edema. Electrocardiogram showed sinus rhythm and ST elevations in leads I, AVL, and V2, consistent with an acute anteriolateral myocardial infarction.

Comprehensive Risk Reduction of Cardiovascular Risk Factors in the Diabetic Patient An Integrated Approach

Cardiovascular (CV) diseases are the leading cause of morbidity and mortality in the general population. This baseline risk of CV disease is multiplied two- to fourfold in persons with diabetes mellitus, and the case fatality rate is higher than in nondiabetic patients 4 . CV disease accounts for 65 of deaths in persons with type 2 diabetes mellitus. Much of the morbidity and mortality is from atherosclerotic coronary artery disease, congestive heart failure, and sudden cardiac death. Efforts to reduce the mortality and morbidity related to CV diseases have borne fruit with substantial reduction in CV mortality over the past few decades. Advances in medical therapy and interventional techniques have resulted in only modest improvements in mortality from CV disease in men with diabetes, however, and during the last decade mortality rates of diabetes and CV disease have risen for women (Fig. 1) 5 . Fig. 1. Change in age-adjusted 8- to 9-year CV mortality in National Health and Nutrition...

If You Have Heart Disease

A lot of my patients wonder about the point of lowering cholesterol after a heart attack or other sign of heart disease. Isn't it a waste of time they ask. The answer is an emphatic NO. Once you've had a heart attack, you're at a much greater risk of having another. Because the risk is higher, the treatment benefits are even greater. This statement isn't my medical opinion it is one of the best-studied issues in all of medicine. The 1994 4S trial discussed earlier was the first to document the benefit of lowering choles- ,193 terol in patients who had preexisting heart disease, but even as recently as 2004, the PROVE-IT trial showed the benefit of lowering LDL to under 65 mg dL in individuals with recent heart attack symptoms. (This was one of the studies that led the NCEP to add 70 mg dL as an optional goal LDL level for people with heart disease.) In the decade that separated those two reports, many other studies that used a variety of statins have showed a benefit on either...

Coronary Artery Disease

Coronary artery disease is the buildup of fatty deposits and fibrous tissue inside the arteries that supply blood to the heart. This buildup, called atherosclerosis, can cause the coronary arteries to become significantly narrower, which decreases the blood supply to portions of the heart muscle and triggers a specific type of chest pain called angina. Complete blockage of the arteries causes a heart attack, the damage and death of heart muscle otherwise known as a myocardial infarction (MI). Circadian factors affect the timing of heart attacks, with the highest frequency occurring between 6 a.m. and noon. Obstructive sleep apnea changes the timing of them, with more heart attacks and death occurring between midnight and 6 a.m. in OSA patients.

Heart attack on a plate

The discovery of the link between smoking and lung cancer gave a great impetus to the quest for some similar causative agent of coronary heart disease (CHD), another condition which caused a rapidly increasing death toll from the 1920s onwards. Mortality from coronary heart disease grew at an even faster rate, reaching twice the rate of lung cancer in the early 1950s and three times the rate in the 1960s. Sudden death from a heart attack, particularly affecting men in middle age a condition virtually unknown before the First World War became familiar throughout the Western world. The coronary death rate in Britain reached a plateau in the late 1970s and then slowly declined (in the USA, this fall began a decade earlier). The cause of the rapid increase in CHD was (and largely remains) a mystery, as does the reason for its more recent decline (which began before any of the familiar preventive interventions had been implemented on a large scale). In the 1950s, studies of differences in...

The Role of Intensive Glycemic Control in the Management of Patients who have Acute Myocardial Infarction

Individuals who have diabetes mellitus (DM) have a twofold to fourfold increased risk of cardiovascular disease and nearly twice the early mortality from acute myocardial infarction (AMI) compared with nondiabetic subjects 1-5 . Furthermore, the mortality difference between diabetics and nondiabetics continues to increase throughout the first year 4 . For more than 70 years it has been recognized that glucosuria is present frequently in nondiabetic patients who have AMI 6 . Acute hyperglycemia is documented in up to half of all patients who have AMI, whereas previously diagnosed DM is present in only 20 to 25 of these patients 7,8 .

Coronary Artery Disease and Its Risk Factors

What's bad for your heart is also bad for your brain. Conditions that are risk factors for cerebrovascular disease and heart disease, such as high cholesterol, hypertension, and diabetes, increase the risk of memory problems. Controlling these disorders with medication, dietary changes, and exercise can help keep your memory in optimal condition.

Surgical treatment for an index acute myocardial infarction

In the setting of an index AMI, a patient's condition can vary from STEMI, non ST elevation myocardial infarction (NSTEMI) (subendo-cardial), or cardiogenic shock. The approach begins with medical management (previously outlined) and then proper diagnosis. Surgery is an essential part of the treatment armamentarium in approaching all clinical scenarios. With a STEMI, PCI can identify and address the culprit vessel. With NSTEMI, PCI is less likely to identify a single culprit lesion, and CABG for complete revas-cularization may be exercised as an option with higher frequency. The long-term effects of ischemia and infarction that occur after AMI must be considered in the evaluation of initial treatments. Of these effects, LV dilation and remodeling are well documented as sequelae of AMI. Two thirds of cases of CHF are from coronary artery disease (CAD) with most these after MI 153 . Studies show that ventricular enlargement begins early and continues years after AMI. Pfeffer and...

Heart Disease Primer

Cholesterol seems to have taken on a life of its own in today's society. People brag about their levels or bemoan them, but often without any real understanding of the role cholesterol plays in causing heart disease. Some of my patients expend enormous emotional energy worrying about their cholesterol levels, while ignoring other issues that play an equally important role in causing the coronary arteries to be blocked. In most people, cholesterol is only one factor though a very important one in the complex process that leads to atherosclerotic heart disease. And atherosclerotic heart disease has been the number one killer of Americans every year since 1921. Lowering your blood cholesterol is one of the five basic health-care steps that will keep you from becoming a heart disease statistic, along with not smoking, eating right, exercising, and controlling your blood pressure.

Heart Attack Plan

Of course you don't want to think that you'll have a heart attack. But with about a million Americans having one each year, it's better to be safe than sorry. Here are some additional steps you can take to make sure you get the best care possible if you have a heart attack Make packages that include a list of medications you're taking and those you are allergic to, as well as the name(s) of an emergency contact. Keep a package near the phone at home and work and another in your car. If you know you have heart disease, also include instructions or a letter from your doctor and a copy of your latest electrocardiogram (EKG). Think through what you would do if you had heart attack symptoms at home, at work, or somewhere else. Go over with your family and friends the warning signs of a heart attack and the importance of quickly calling 911 if those signs last for more than a few minutes.

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Antioxidants are an increasingly important ingredient in food processing, as they inhibit the development of oxidative rancidity in fat-based foods, particularly meat and dairy products and fried foods. Recent research suggests that they play a role in limiting cardiovascular disease and cancers. This new book provides a review of the functional role of antioxidants and discusses how they can be effectively exploited by the food industry, focusing on naturally occurring antioxidants in response to the increasing consumer scepticism over synthetic ingredients.

Definition of the Disease

Data from 1999 estimates that 25 million Americans have tried cocaine at least once and that 1.5 million people were active users during the data collection period.1 Cocaine is noted to be the most frequent drug used in patients who present to the emergency department and is listed by medical examiners as the most common cause of drug-related deaths.2-5 The risk of myocardial infarction increases to 24 times that of baseline in the first hour following cocaine use, and the risk of nonfatal myocardial infarction is 7 times greater in cocaine users versus nonusers. Acute myocardial infarction is defined as an imbalance between oxygen supply and demand that results in injury and necrosis of the myocytes.6 The European Society of Cardiology and the American College of Cardiology outline the diagnosis of acute, evolving or recent myocardial infarction to include either (1) a characteristic rise and fall of the biochemical markers cardiac troponin I or T and CKMB within 24 hours of the...

Dietary components and health

The availability of food in Europe has never been as good as in recent decades. Affluent though European countries are, sub-groups of populations experience the deficiency of minerals and micronutrients that play a vital role in health and development (Serra-Majem, 2001). A significant proportion of European infants and children are today experiencing a low dietary intake of iodine and iron (Trichopoulou and Lagiou, 1997a WHO, 1998). The iodine deficiency leads to several disorders collectively referred to as Iodine Deficiency Disorders (IDD), with goitre (hyperplasia of thyroid cells), cretinism (mental deficiency) and severe brain damage being the most common. It is estimated that IDD may affect approximately 16 of the European population. Furthermore, inadequate levels of folate have been implicated with a rise in the blood homocysteine levels, leading possibly to increased risk of cardiovascular disease (CVD). European policies address such deficiencies either by recommending the...

Three Hundred Is a Healthy Cholesterol Level

During her appointment with a specialist, the doctor told her that though her total cholesterol level was above 300, she was not at very high risk for heart disease because her HDL (good) cholesterol was high, while her LDL (bad) cholesterol was low. He made a few simple recommendations about her diet ones that she knew she could stick with and encouraged her to get a little more exercise. He said he would write a note to her regular doctor explaining why Mary did not need to take a cholesterol medication.

Differential Diagnosis

The most important diagnostic decision to make in the setting of chest pain following cocaine use is to determine whether the patient has actually sustained acute myocardial damage that requires prompt medical and surgical management. It is estimated that only 6 of persons who present to the emergency department with chest pain after the ingestion of cocaine will actually have an acute myocardial infarction. This small percentage of persons likely to have myocardial ischemia together with the fact that distinguishing chest wall and skeletal pain from acute myocardial ischemia is challenging because three of the main criteria for a diagnosis of AMI are similar in both settings. Frequently the patient's presentation is atypical for myocardial infarction, the electrocardiogram demonstrates nonspecific abnormalities, and the serum markers CK and CKMB, which lack specificity for cardiac muscle, are elevated. Also, although it is widely recognized that myocardial infarction can occur after...

Nutritional Background

In the U.K., this reevaluation was brought to public attention by the publication of two major reports which were, respectively, the so-called NACNE Report, produced in 1983 by the National Advisory Committee on Nutrition Education (NACNE, 1983), and Diet and Cardiovascular Disease, known as the COMA Report, produced in 1984 by the Committee on Medical Aspects of Food Policy (COMA) (Department of Health and Social Security, 1984). The recommendations of the NACNE Report were oriented toward a diet that would benefit the nation's health generally, whereas those of the COMA Report were intended more specifically to prevent coronary heart disease (CHD). The major recommendation of both reports was to reduce the intake of fat from the 42 at the time to 34 (NACNE) or 35 (COMA) of total food energy in the diet. Furthermore, they recommended that the intake of saturated fat should be reduced to 10 (NACNE) or 15 (COMA) of food energy. They also advised a reduction in salt intake and increased...

Grafting in Diabetic Patients185

Clinical outcomes in diabetic patients following coronary revascularization procedures with bypass surgery (CABG) or percutaneous coronary intervention (PCI) are worse than in nondiabetics. Current evidence suggests that CABG is preferable to PCI for revascularization in patients who have diabetes and multi-vessel coronary artery disease. Most trials have not used contemporary adjunctive therapies, such as GP Ilb IIIa inhibitors and prolonged dual antiplatelet therapy. It is conceivable that implementation of these evidence-based therapies may improve clinical outcomes significantly in diabetic patients who undergo PCI. In the future, emerging technologies, such as drug-eluting stents and soluble receptor for advanced glycation end products, may further improve outcomes after PCI and make it the preferred revascularization modality in diabetics.

Monoclonal antibodies

The 2004 survey of biotechnology medicines conducted by the Pharmaceutical Manufacturers Association (now PhRMA) has identified over 70 monoclonal antibody-based products in various stages of clinical trials.16 Monoclonal antibodies have many possible diagnostic and therapeutic applications in the management of human carcinomas, including colorectal, gastric, ovarian, endometrial, breast, lung, and pancreatic cancers. Cytotoxic drugs can be linked to monoclonal antibodies for targeting to specific tumor-associated antigens.17 Similarly, radioisotopes can also be directed to specific sites using monoclonal antibodies. A monoclonal antibody has also been developed for imaging myocardial necrosis associated with acute myocardial infarction. The product (Myoscint , Centocor, Malvern, PA) was on the market and had a high degree of sensitivity for detecting infarction and specificity for excluding a recent ischemic event in patients admitted with chest pain syndrome but is now withdrawn...

Valve Pathology in Heart Failure Which Valves Can Be Fixed289

Heart transplantation has evolved to become the gold standard treatment for patients who have symptoms of severe congestive heart failure associated with end-stage heart disease. From an epidemiologic perspective, this treatment is ''trivial'' because less than 2800 patients in the United States are offered transplantation because of limitations of age, comorbid conditions, and donor availability. New surgical strategies to manage patients who have severe end-stage heart disease have therefore evolved to cope with the donor shortage in heart transplantation and have included high-risk coronary artery revascularization, cardiomyoplasty, and high-risk valvular repair or replacement.

Key Terms and Concepts

After learning of the drug s successful use hi heart disease, nervous exhaustion, addiction to alcohol and morphine, and several other psychological and physiological problems, the doctor decided to try the drug on himself. He was quite pleased with the results. To him, the drug had a pleasant aroma and an unusual effect on the lips and mouth. More importantly, however, was the drug s therapeutic effect on his serious depression. In a letter to his fianc e whom he had not seen in a year, he reported that during his last severe depression, he had taken small quantities of the drug with marvelous results. He wrote that the next time he saw her he would be like a wild man, feeling the effects of the drug. He also told his fianc e that he would give her small amounts of the drug, ostensibly to make her strong and to help her gain weight.

Vascular Growth Factor Therapy In Cardiac Disease

Several clinical angiogenesis trials have been conducted in patients with coronary artery disease. The investigators have either used synthesized recombinant vascular growth factor proteins or the genes encoding these proteins. Both methods have advantages and disadvantages. The optimal growth factor therapy to induce angio-genesis in ischemic myocardium can be defined as a therapy with 1) local accumulation of or stimulation of the production of growth factors, 2) to a certain therapeutic concentration, 3) for a certain appropriate period, 4) in an isolated ischemic tissue area, and 5) with a minimal overflow of growth factors into non-ischemic tissues far away from the tissue area of interest. The used growth factor formulations and the methods used for application of the treatment in clinical trials have fulfilled these demands to a varying degree.

High Density Lipoproteins HDL

HDL is basically the opposite of LDL. Instead of having a lot of fat, HDL has a lot of protein. Instead of ferrying cholesterol around the body, HDL acts as a vacuum cleaner sucking up as much excess cholesterol as it can (see Figure 1.1). It picks up extra cholesterol from the cells and tissues and takes it back to the liver, which takes the cholesterol out of the particle and either uses it to make bile or recycles it. This action is thought to explain why high levels of HDL are associated with low risk for heart disease. HDL also contains antioxidant molecules that may prevent LDL from being changed into a lipoprotein that is even more likely to cause heart disease. Lifestyle changes affect HDL levels exercise can increase them, while obesity and smoking lower them. As for diet, in general, the high-fat diets that raise LDL also raise HDL, while low-fat diets lower both. However, by carefully choosing the right foods, you can eat a diet that lowers LDL without lowering HDL, as I'll...

Can Epilepsy Be Prevented

Many cases of epilepsy can be prevented by wearing seatbelts and bicycle helmets, putting children in car seats, and other measures that prevent head injury and other trauma. Prescribing medication after first or second seizures or febrile seizures also may help prevent epilepsy in some cases. Good prenatal care, including treatment of high blood pressure and infections during pregnancy, can prevent brain damage in the developing baby that may lead to epilepsy and other neurological problems later. Treating cardiovascular disease, high blood pressure, infections, and other disorders that can affect the brain during adulthood and aging also may prevent many cases of epilepsy. Finally, identifying the genes for many neurological disorders can provide opportunities for genetic screening and prenatal diagnosis that may ultimately prevent many cases of epilepsy.

The Etiology of Major Depression

One-quarter of patients hospitalized for acute stroke develop major depression in the weeks after their cerebrovascular accident. These poststroke depressions are more common with left frontal (cortical or subcortical) lesions, and few remit, if untreated, at six-month follow-up, even if there has been significant improvement in the neurologic deficits. Typical major depressions occur in Parkinson disease, human immunodeficiency virus (HIV) infection, and Huntington disease (in which mania can also be seen). All of these symptomatic depressions respond well to antidepressant medication.

Healthrelated roles of Pcarotene

(a) The alpha-tocopherol, beta-carotene (ATBC) Cancer Prevention study, was a randomised-controlled trial that tested the effects of daily doses of 50mg (50 IU) vitamin E (all-racemic a-tocopherol acetate), 20 mg of p-carotene, both or placebo in a population of more than 29 000 male smokers for 5-8 years. No reduction in lung cancer or major coronary events was observed with any of the treatments. What was more startling was the unexpected increases in risk of death from lung cancer and ischemic heart disease with p-carotene supplementation (ATBC Cancer Prevention Study Group, 1994). (b) Increases in risk of both lung cancer and cardiovascular disease mortality were also observed in the beta-Carotene and Retinol Efficacy Trial (CARET), which tested the effects of combined treatment with 30mg d p-carotene and retinyl palmitate (25000IU d) in 18000 men and women with a history of cigarette smoking or occupational exposure to asbestos (Hennekens et al, 1996). (c) The third study was the...

Coronary Intervention211

Coronary artery disease (CAD) is the most common cause of heart failure in Western countries. Selected patients who have low left ventricular ejection fraction (LVEF) and CAD clearly benefit from coronary revascularization with coronary artery bypass grafting (CABG). CABG results seem to be superior to percutaneous coronary intervention (PCI) in the few comparative studies of the two approaches in patients who have CAD and low LVEF completed to date. Clinical improvement should be expected in most patients who undergo CABG. This is important for patients who have a limited life span that they could spend with a good functional status rather than being hospitalized for multiple repeat PCIs or symptomatic deterioration.

Eliseo J Prez Stable MD Anna M Npoles Springer PhD

THE HEALTH STATUS OF Latinos often has been referred to as an epidemiologic paradox. On the basis of the lower socioeconomic status of Latinos compared with non-Latino whites (henceforth called whites), one would predict higher indicators of morbidity and mortality for most diseases. Despite major barriers to health care, including lack of access to primary care and less preventive care, epidemiologic data indicate that Latinos have a better health profile for the leading causes of death (heart disease, cancer, and cerebrovas-cular diseases) than do whites. National surveys indicate that this finding may be attributable to lifestyle factors, which may be culturally influenced, such as lower smoking rates. Nonetheless, Latinos continue to be disproportionately affected by selected conditions such as human immunodeficiency virus (HIV) infection, diabetes mellitus, cirrhosis of the liver, homicides, and cancers of the cervix, liver, gallbladder, and stomach. Much of this disproportionate...

VWFGPIbIXV Interactions in Arterial Thrombogenesis

Epidemiological studies uncovered a link between elevated plasma vWF levels and the incidence of heart disease caused by arterial thrombosis (Folsom et al. 1997). The plasma of patients with acute myocardial infarction exhibit elevated plasma vWF concentrations and support enhanced shear-induced platelet activation (SIPA), suggestive of a causative role for vWF in acute coronary thrombosis (Goto et al. 1999). Moreover, upregulated vWF antigen contributing to platelet recruitment has been found in atherosclerotic plaques, after balloon angioplasty (Bosmans et al. 1997) or collar placement (De Meyer et al. 1999) and in hyperplastic intima of autogenous arterial grafts (Qin et al. 2001).

Definition of the metabolic syndrome

For some other ethnic groups) and two or more of the folowing blood pressure, triglyceride and HDL-cholesterol cut-points as for the ATP-III definition and fasting plasma glucose 5.6mmol l. The application of this definition will increase the prevalence of the metabolic syndrome but its effect of risk of diabetes and cardiovascular disease has yet to be established and is not considered further here.

Impaired insulin secretion and insulinstimulated glucose uptake

In the Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI) trial 14-16 , acute treatment for at least 24 hours with intravenous GIK until blood sugar was controlled, coupled with aggressive subacute treatment with subcutaneous insulin, resulted in a 29 relative reduction in 1-year mortality in a cohort of patients that predominantly had type 2 DM. As compared with 43 of control patients, 87 of GIK-treated patients were discharged on insulin. Patients who had previous insulin use and a low CV risk profile had the most promising results (58 reduction in in-hospital mortality and 52 reduction in 1-year mortality). Hypoglycemia occurred in 15 of patients who received insulin infusion however, only 10 of patients required discontinuation of their insulin infusion. There was appropriate use of cardioprotective drugs during AMI in the DIGAMI-2 trial. At hospital discharge, beta-blockers were given to over 80 of the patients, aspirin was given to nearly 90 of...

Step 1 Weakened Lining

The first step in the road to heart disease appears to require an elevated level of blood cholesterol, carried in one of the lipoprotein particles, particularly LDL. When there's excess LDL in the bloodstream, some of it moves out of the blood and into the artery wall. The higher the LDL level, the more LDL finds its way into the artery wall. i figure 2.2 How Heart Disease Happens depriving the heart of blood and oxygen, leading to a heart attack.

Longterm Diabetes Complications As Used For Defining Diabetes Thresholds

Diabetes mellitus is characterised by hyperglycaemia, which is associated with long-term damage, dysfunction and failure of various organs. Several studies30,31 have confirmed relationships between hyperglycaemia and the risk of developing such micro- and macrovascular complications as retinopathy, neuropathy, nephropathy and cardiovascular disease. However, many have compared the rates of each condition in subjects already classified according to the diagnostic criteria as having diabetes or not. Few studies consider whether the current diagnostic glucose levels represent the best level for predicting an increased risk of such complications, and no formal statistical threshold for any complication has been consistently demonstrated. Using Receiver Operating Characteristic (ROC) curves, it is possible to determine the value of a diagnostic test which provides maximum sensitivity and specificity for predicting the occurrence of a given complication associated with diabetes32. A ROC...

Background And Significance

In Western societies, high consumption of dietary fat has been linked to obesity, coronary artery disease, and certain types of cancer, and it is regarded as the top dietary problem in America (Drewnowski, 1990). Currently, dietary fat comprises nearly 36 of the energy content of the American diet. The guidelines of a number of health organizations recommend that no more than 30 of daily energy be derived from dietary fat in order to reduce the incidence of related morbidity and mortality (National Resource Council, 1989 U.S. Department of Health and Human Services, 1989).

Pedigree Can Help Distinguish Genetic from Other Risk Factors

A pedigree can be just as useful in determining that a condition is not genetic as in establishing that a condition is inherited in a family. This is particularly true for common complex health conditions such as mental illness, heart disease, and cancer. For example, Jean is a 42-year-old premenopausal woman with unilateral breast cancer. Her mother is healthy at age 65 years, but Jean's maternal grandmother, Pamela, died of breast cancer at age 63. This limited family history may raise your initial suspicion for a familial breast cancer. Yet when you take an extended family history, you find that Jean's mother has three healthy sisters between the ages of 68 and 72 years. You also find that Pamela had two sisters who were cancer free in their mid-70s when they died of heart disease. This negative family history is just as important as the positive family history of cancer in risk assessment and determining cancer screening protocols.

Of Ischemic Heart Failure Trial237

If the Surgical Treatment of Ischemic Heart Failure (STICH) trial demonstrates that surgical therapy is superior to medical therapy, early aggressive evaluation of coronary artery disease as a potentially correctable cause of new-onset heart failure would be the preferred strategy. This strategy could tremendously change the treatment of ischemic heart disease. Confirming the STICH revascularization hypothesis will dramatically increase the use of coronary artery bypass grafting among the millions of patients now being medically treated without evaluation for an ischemic cause.

Obesity and Physical Activity

Excess body weight appears to place Mexican Americans at higher risk than whites for certain diseases such as diabetes and cardiovascular disease. National data indicate that the proportion of the population that is considered overweight (defined as a body mass index > 25) has grown for both Latinos and whites over the last 20 years (National Center for Health Statistics 2000). Among Mexican Americans aged 20-74 years, combined age-adjusted data for 1988-1994 showed that 67.0 of the men and 67.8 of the women were considered overweight (vs. 59.9 of white men and 45.7 of white women) (National Center for Health Statistics 2000). The same trend has been observed in children and adolescents aged 6-17 years. Approximately 15.8 and 14.8 of Mexican American girls and boys, respectively, were found to be overweight based on combined data for 1988-1994 (compared with 11.9 and 11.8 of white girls and boys, respectively) (National Center for Health Statistics 2000). An analysis of NHANES III...

Pedigree Can Help Identify Medical Screening Needs for Healthy Individuals

Nancy. (Tay-Sachs disease is an autosomal recessive neurodegenerative disease leading to death usually by the age of 5 years. Approximately 1 in 30 Ashkenazi Jews carries this mutation as compared to 1 in 300 individuals of non-Ashkenazi heritage.) Serum cholesterol screening can be considered for someone with a strong family history of coronary artery disease. For a person with a significant family history of colon cancer, colonoscopy should be offered at a younger age than usual (Burke et al., 1997b). A young woman with a strong family history of breast cancer should have screening mammography (or possibly breast ultrasounds) at an earlier age than is usually recommended (Burke et al., 1997a).

Snoring Is Annoying but Harmless

There's no doubt that snoring is annoying. In some cases it is harmless, but in others it's a sign of obstructive sleep apnea, a sleep disorder characterized by pauses in breathing that prevent air from flowing into or out of a sleeping person's airways. As we will see in Chapter 11, sleep apnea increases a person's risk of heart disease and causes severe daytime sleepiness. Snorers who temporarily stop breathing during the night or experience severe daytime sleepiness should consult a physician.

And Interventional Cardiologists Talk of Regenerative Cell Therapy245

That cardiac regeneration is remotely feasible elicits thoughts of curing one of the most debilitating of human diseases. The term stem cell brings to the surface many hopes, and concerns, among physicians and the public alike, both of which have come to expect frequent advances in medical therapeutics. The evolution of public opinion toward embryonic stem cell research is clear and positive, and, unfortunately, overshadows, even confuses, that of adult stem cells, despite their use in essentially all clinical studies of cardiovascular disease to date. Strange, perhaps, that the voices of cardiovascular specialists are not to be heard.

Diseasenutrient interactions

There are also other groups within industrialised countries where there may be risks associated with elevated intakes of vitamin C. In North European communities, genetic haemochromatosis has a gene frequency of 1 in 20, such that approximately 1 in every 300 individuals are at risk of iron overload. Although they appear apparently healthy, giving vitamin C without an iron-chelating agent to such people can potentially produce serious clinical effects (Halliwell, 1994). As indicated above, iron is usually bound to transport, storage or tissue proteins and the body is therefore protected from its damaging reactions. If localised or more general breakdown of tissue integrity should occur during infection, inflammation, strenuous exercise or other traumas resulting in an acute phase response, then metal ions are potentially released into the circulation. In addition as we get older, we get sicker and in humans with advanced atherosclerotic lesions, catalytic metal ions capable of free...

Causes of Memory Problems

Like Michael, many patients with memory problems who come for evaluation discover that the cause is something that they never imagined could impair their ability to think and remember. Often, the cause is a common condition (such as depression) or a disorder that increases the risk of cerebrovascular disease and heart disease (such as poorly controlled high blood pressure or diabetes). Other causes of memory loss are hormonal changes that occur naturally during certain stages of life. For women, hormonal fluctuations following childbirth and around menopause can make them feel less sharp. Men also go through a phase of significant hormonal change as they age a drop in testosterone level has been linked with age-related memory problems. Still other causes of memory loss are unhealthy habits (such as excessive alcohol use and getting too little exercise or sleep) or a lack of intellectual challenge. Fortunately, many causes of memory dysfunction are preventable or treatable. You can...

Racial and Ethnic Disparities in Health

Rates of illness such as asthma are much higher among African Americans than among whites, as are levels of obesity, diabetes, and other cardiovascular risk factors that are often established in adolescence and young adulthood. For example, the prevalence of obesity among African Americans is 29.3 percent and that among Hispanics is 21.5 percent, whereas it is 18.5 percent among whites (CDC, 2002). In 2000, the rate of diabetes-related mortality in non-Hispanic African Americans was 49.4 (per 100,000), whereas it was 32.4 in Hispanics and 20.8 in non-Hispanic whites (CDC, 2001b). Rates of death due to HIV AIDS are 31.9 among African Americans and 3.7 among whites (CDC, 2000). Some of the racial and ethnic differences in health status may be associated with the fact that minority populations often encounter the health care system in very different ways in terms of both access and quality of care (Fiscella et al., 2000). For a variety of reasons both structural (having to do with the...

Consumer Attitudes To Diet And Health

In 1993, the Leatherhead Food Research Association (Leatherhead Food RA) in the U.K. undertook a program of qualitative and quantitative consumer research based on group discussions and in-home interviews, respectively, in order to gain a better insight into consumer issues affecting market developments in reduced-fat foods and, as a consequence, the potential market need for fat replacers (Cathro, 1993). In group discussions, respondents agreed that the high fat content of many foods was one of the most important health issues facing them today. Quantitatively, 58 of 509 respondents interviewed in the home rated dietary fat intake as the most important health issue. This was followed by additives (49 ) and sugar contained in foods (41 ), while salt and fiber were rated as the least important issues, cited by 24 and 16 of respondents, respectively. One of the most worrying aspects about fat intake and cholesterol from a consumer's point of view was that there were no outward signs of...

Work Related Conditions and Health

It has been hypothesized that job strain (the combination of a psychologically demanding workplace and a low level of job control) leads to adverse health outcomes, and findings show that job control is an important component of health-promoting work environments (Johnson et al., 1996 North et al., 1996 Bosma et al., 1997, 1998 Theorell et al., 1998). Schnall and colleagues (1994) found that lower levels of job control (the opportunity to use and develop skills and to exert authority over workplace decisions) were predictive of adverse cardiovascular disease outcomes in 17 of 25 studies, whereas high psychological demands of work had similarly negative effects in only 8 of 23 studies.

Calcium channel blocker See calcium entry

Calcium entry blocker Any of group of drugs that act by slowing the influx of calcium ions into muscle cells, resulting in decreased arterial resistance and myocardial oxygen demand. These drugs are used in treating angina hypertension and supraventricular tachycardia, but may cause hypotension. They have been shown to provide protection against coronary artery disease. Included in this group are nicardipine, nifedipine, verapamil, and diltiazem.

Angiotensin Converting Enzyme ACE Inhibitors

ACE inhibitors are a class of blood pressure drugs that works by dilating blood vessels. In addition to controlling high blood pressure, ACE inhibitors have long been prescribed for people with heart failure. Recent studies have shown that these drugs also help people with coronary artery disease and those at high risk for developing it. The HOPE (Heart Outcomes Prevention Evaluation) trial, an ongoing study of heart disease prevention, has found that ACE inhibitors not only dilate blood vessels but also help slow the progression of atherosclerosis.

Inhibition of Platelet Deposition on the Vessel Wall

Anti-adhesive anti-platelet drugs with antithrombotic potential, reducing neointima formation, have been studied in animal models. The murine antihuman GPIba monoclonal antibody 6B4 (Cauwenberghs et al. 2001) prevented arterial thrombosis in a baboon model of femoral artery stenosis, without prolonging the bleeding time (Wu et al. 2002). Even in combination with a neutralising anti-human aIIb p3 antibody, a strong antithrombotic effect was achieved without bleeding time prolongation. Likewise, the mouse anti-vWF monoclonal antibody AJvW-2 is a potent inhibitor of GPIba-vWF interactions. In vitro and ex vivo, AJvW-2 inhibits SIPA, as well as high shear stress-induced platelet adhesion and aggregation onto surface coated collagen (Kageyama et al. 1997). It also inhibits the enhanced SIPA in platelet-rich plasma of patients suffering from acute coronary syndromes (Eto et al. 1999). In several animal models, AJvW-2 prevents both arterial and venous thrombosis it exerts a protective effect...

Adenoviruses In Clinical Trials A Look Into The Future

Due to their several advantages AdVs are the most common vectors for clinical gene therapy trials Excluding a transient elevation in serum CRP values, transient fever and production of anti-AdV antibodies, low and intermediate doses of AdVs have been well tolerated and safe in cardiovascular gene therapy trials 21, 23, 31-34 . Unfortunatelly, very little positive results have been obtained in these trials. Increased myocardial perfusion was detected in patients with coronary artery disease (CAD) six months after intra-coronary AdVEGF gene transfer 21 . In contrast, patients that received either Ringer's lactate or VEGF in a plasmid vector did not show increased myocardial

Treatment and Outcome

One-third of long-term survivors will have enough weakness to interfere with their daily activities, and a few will be left with lung or heart problems. Between 20 and 40 percent will have significant ongoing problems as a result of the side effects of the corticosteroids. There is concern that the powerful immunosuppressive medications may lead to later development of malignancy, and they may also cause bone marrow damage.

Calcium Channel Blockers

In contrast to beta-blockers, there is thus far no evidence that calcium channel blockers improve survival after a heart attack in patients with coronary artery disease. But they are useful for patients who don't get adequate relief from beta-blockers or nitrates. And calcium channel blockers are more effective than

Memory Loss Following Heart Surgery

More than 500,000 Americans undergo coronary artery bypass surgery each year for the treatment of angina and vascular insufficiency. People who've undergone bypass surgery for heart disease often have trouble concentrating and remembering. The exact cause of these cognitive problems is not clear, but there are probably many factors. They include the impact of anesthesia and major surgery, disruption of oxygen flow to the brain during the procedure, damage to blood vessels, and a generalized inflammatory response with increased permeability of the blood-brain barrier (a physiological mechanism that modifies capillaries, preventing certain substances from entering the brain). A crucial question is whether these troubling effects are temporary or permanent. A related question is, to what extent did these deficits exist prior to surgery brain imaging studies suggest that increased blood pressure can cause small strokes, which can then cause dementia. Hypertension also increases the risk...

Populationlevel Preventive Interventions

Preventive interventions at the population level may be classified as universal, selective, and indicated, borrowing the classification developed by Gordon (IOM, 1994b). A universal measure is one that would be desirable for everyone in an eligible population. It would focus on shifting the entire population distribution rather than on targeting only relatively high-risk individuals, as illustrated earlier in this chapter. It would likely involve an agreed-on public policy requiring broad-based public understanding and political support. A selective preventive measure is one that is desirable only when an individual is a member of a subgroup of the population whose risk of becoming ill is above average. These are the more traditional population-oriented public health education interventions targeted toward the high-risk segments of the population. Finally, an indicated preventive measure is one that is applicable to persons who, on examination, manifest a risk factor, condition, or...

Hormone Replacement Therapy HRT

Until recently, doctors often prescribed hormone replacement therapy to postmenopausal women, not only to help control the symptoms of menopause, but also to reduce their risk for coronary artery disease. They had reason for doing so numerous large observational studies concluded that those taking estrogen after menopause were one-third to one-half as likely to have heart attacks or develop cardiovascular disease as those who didn't. But more recent randomized controlled trials burst the HRT bubble. Several large trials have concluded that hormone replacement therapy doesn't help prevent heart problems and may even cause them. The American Heart Association now advises physicians not to prescribe hormone replacement therapy solely to prevent heart attacks and strokes in women with cardiovascular disease. But some experts believe that future research may still determine that, for some women, hormone replacement therapy helps prevent heart disease. Most of the clinical trials thus far...

Hypoglycemia that is most likely to affect the elderly those who have worsening renal function and those who have

Nontraditional risk factors for cardiovascular disease. An early trial by the UGDP 23 , which explored the effectiveness of oral agents versus insulin, found increased cardiovascular mortality in the cohort of patients that was randomized to sulfonylureas. Widespread criticism of the project's methodology placed the validity of its findings in doubt 24 . Nevertheless, concern about cardiovascular risk remains and the package insert for sulfonylureas that is mandated by the US Food and Drug Administration includes a warning about possible cardiovascular risks. In addition, a retrospective analysis of patients who had diabetes mellitus and underwent balloon angioplasty after myocardial infarction reported increased early mortality (odds ratio 2.7 after adjustment for several covariates) in 67 persons who took sulfonylureas and in 118 who used insulin or lifestyle therapy alone 31 . Concern about cardiovascular risk associated with sulfonylureas has been supported by description of a...

Atherothrombosis Phases

Phase 4 lesions are characterized by acute complicated type VI lesions, with fixed or repetitive, occlusive thrombosis. This process becomes clinically apparent in the form of acute coronary syndrome (ACS), although not infrequently it is silent (31,32). In about two-thirds of ACS, occlusive thrombosis occurs on a nonstenotic plaque. In the remaining one-third, the thrombus occurs on the surface of a stenotic plaque (33). In Phases 3 and 4, changes in the geometry of ruptured plaques, as well as organization of the occlusive or mural thrombus by connective tissue, can lead to occlusive or significantly stenotic and fibrotic plaques. Lipids do not play a direct role in the development of the Phase 4 lesion however, increased lipid deposition within plaques can make Phase 4 more severe by increasing the thrombus size (34). Lipid-rich atheromatous plaque core contains the most concentrated amount of tissue factor thus, if disruption of the plaque results in exposure of the lipid core, a...

Measurement The Myers Briggs Type Indicator

Tegano, 1990), and innovation as business managers (Berr, Church, & Waclawski, 2000). Sensation types are overrepresented among people with coronary heart disease (Thome, Fyfe, & Carskadon, 1987). Other analyses consider combinations of these dimensions For example, Thinking types score high on a psychological test of assertiveness if they are also extraverted (Tucker, 1991).

Series Editors Introduction

It often takes time for a new therapeutic modality to mature into an accepted treatment option. After initial approval, new drugs, devices, and procedures all go through this process until they become vetted by the scientific community as well as the medical community at large. Thrombolysis for treatment of stroke is no exception. Thrombolytic Therapy for Acute Stroke, Second Edition comes four years after the first edition and provides a very comprehensive, updated perspective on the use of intravenous rt-TPA in acute stroke. The authors provide longer term follow-up on the pivotal clinical trials that led to Food and Drug Administration approval, data concerning phase 4 trials in larger numbers of patients, and, most importantly, the community experience that has accumulated since its release. They add to this the latest promising information concerning intra-arterial thrombolysis, which is still under investigation and more speculative sections concerning possible new avenues of...

Procedures to Open Blocked Arteries

With the help of medications, most patients with coronary artery disease can live normal lives that have few limitations. However, some patients benefit from procedures that restore blood flow to areas of the heart muscle that have been affected by a blocked artery. The two main procedures are angioplasty which is performed by cardiologists and coronary artery bypass graft surgery (CABG) which is performed by heart surgeons. These procedures can relieve angina and improve life expectancy, but they also carry a small risk for heart attack, stroke, and other complications, including death. Therefore, they are generally reserved for patients whose symptoms can't be adequately controlled with medications and those who are at very high risk for a heart attack.

Creutzfeldt Jakob Disease Foundation Inc

Congenital condition characterized by a kittenlike mewing cry caused by a small larynx. The cry usually disappears after the first few weeks, but the syndrome is usually linked with mental retardation, poor muscle tone, heart problems, unusual facial characteristics (such as widely spaced eyes), small head, and short stature.

Coronary Artery Bypass Graft CABG Surgery

In coronary artery bypass graft (CABG) surgery, the cardiac surgeon takes a length of blood vessel from elsewhere in the body and uses it to shunt blood around a narrowed or blocked coronary artery. The attached vessel thus permits blood to bypass the blockage so the heart muscle ordinarily supplied by that coronary artery can once again receive nourishment. About 366,000 Americans undergo CABG surgery each year. The operation can dramatically improve the quality of life and boost life expectancy for some (but not all) people with coronary artery disease. If you should undergo CABG surgery, you might also be scheduled for a cardiac-rehabilitation program, which you will attend after leaving the hospital. Cardiac rehabilitation helps you and your heart gain strength. It also teaches you heart-healthy practices that will help protect you from future heart disease, such as observing a low-fat diet and exercising regularly.

Neuromuscular Reanimation

The first clinical applications of this technology have aimed to prevent or reverse disuse atrophy of paretic muscles (Dupont et al., 2004). One clinical trial now under way involves stimulation of the middle deltoid and supraspinatus muscles of stroke patients to prevent chronically painful subluxation of the flaccid shoulder. Another involves strengthening the quadriceps muscles to protect an osteoarthritic knee from further stress and deterioration. Other applications in the planning phase include prevention of venous stasis and osteoporosis in patients with spinal cord injuries, reversal of equinus contractures of the ankle in cerebral palsy patients, and correction of footdrop in stroke patients. Still other clinical problems that may be candidates for such intramuscular stimulation include sleep apnea, disorders of gastrointestinal motility, and fecal and urinary incontinence. For most of these applications, clinical utility is as yet uncertain, morbidity would be unacceptable,...

The 10 Essential Public Health Services

Many units within CDC have contributed to strengthening the public health infrastructure. The National Center for Chronic Disease Prevention and Health Promotion, for example, has led the effort to develop statewide population-based cancer registries, a tracking system for cardiovascular disease, and a program for the early detection of breast and cervical cancer (CDC, 2002). The National Center for Environmental Health also contributed to the improvement of public health monitoring and assessment functions when it developed a biomonitoring program to measure people's exposures to 27 different chemicals by analyzing human blood and urine samples. This program offers the first national assessment of people's exposure to 24 chemicals for which exposures were not previously assessed and 3 for which exposures were previously assessed. In 2002, the center began developing a nationwide environmental public health tracking network in response to a Pew Environmental Health Commission report...

Choose the Treatment Thats Right for

Because of the different degrees of heart disease and its different causes, no one treatment style will suit all. For some, diet and exercise will work well enough that no medication is needed. For others, lifestyle changes will have to be supplemented with a medication or two. And for still others, their heart disease is so serious that they need surgery to correct it. It's important to remember that changing your diet, exercise, and smoking habits are important ways to keep heart disease at bay, even if you're on other treatments as well.

The Hypertensive Accountant

He denied headaches, palpitations, sweating episodes, muscle weakness, paresthesia, urinary tract symptoms, or any past history of renal or other cardiovascular disease. He was a nonsmoker, drank little alcohol, tried to follow a no-added-salt diet, and had noticed no recent weight change. There was no family history of hypertension. Physical examination revealed a patient of normal weight for height (72 kg and 175 cm) who did not appear Cushingoid. Heart rate was 84 bpm and BP 144 96 lying down and 148 100 standing. Respiratory and abdominal examinations were unremarkable. The apex beat was not thrusting or displaced, there were no signs of congestive cardiac failure, no radiofemoral pulse delay, no renal or carotid bruits, and no abdominal masses, and peripheral pulses were normal. An echocardiogram was consistent with mild left ventricular hypertrophy and early diastolic dysfunction. A chest x-ray was normal.

Coping With Intraoperative Emergencies

Performing anesthesia can be much more dangerous than it looks, however. For all types of operations, anesthesiologists perform difficult tasks in a life-threatening environment. Always concerned that something may go wrong, anesthesiologists mentally prepare for any potential disasters during every case. Many describe their job as being 90 routine care, 10 sheer terror. When patients deteriorate during surgery, they can crash fast. Whether the problem involves massive acute hemorrhaging, intra-operative myocardial infarction, or dropping oxygen saturation, anesthesiologists must think fast, act quickly, and draw on their vast medical knowledge to make on-the-spot decisions.

Cranston Gonzalez National Affordable Housing

C-reactive protein (CRP) A protein released by the body in response to injury, infection, or other inflammatory stimuli. A new assay for CRP has enabled researchers to use this protein as a marker of systemic inflammation. Studies have shown a high correlation between presence of this protein and atherosclerosis. It is one of many predictors for heart disease that doctors use today. An HIVpositive person may see tests for this protein on lab reports. It is a surrogate marker of lipids in the blood that cause inflammation. It also is useful if a person is already on statin drugs, because those drugs lower inflammation, so a person with high CRP numbers after taking statins may be at high risk for further heart disease.

Dont Take Two Aspirin and Call Me in the Morning

A 13-year-old girl presented to the emergency department of a tertiary medical center complaining of a severe headache and her heart beating too fast. Her mother reported a 3-month history of headaches occurring 2-3 times per week, bilateral in nature, occurring with sudden onset at any time of day, and lasting less than one hour. The headaches had been increasing in severity. The patient denied nausea, vomiting, photophobia, paresthesias, and aura. She was sleeping 8-10 hours each night and was not allowed any caffeinated beverages. She had not begun menses. Over-the-counter analgesics were ineffective and used only a few times. The patient had no history of upper respiratory infection, seasonal allergies, or sinusitis during the previous 3 months. She had no significant past medical history she had received all her immunizations. Family history included hypertension, coronary artery disease, and thyroid cancer in her deceased paternal grandfather, migraine headaches in her mother,...

Avoidable Risk Factors

Fortunately, most of the risk factors for coronary artery disease can be partially or totally addressed. Many are unhealthy habits, such as smoking and lack of exercise. Others, such as high blood cholesterol and obesity, can be partly or mostly due to poor diet choices, although genetic susceptibilities can dramatically influence the response to those choices. Some are treatable illnesses such as depression and high blood pressure. And still others are circumstances, such as social isolation and stress, that can be mitigated to some degree. By addressing the risk factors that you have some control over, it's possible to reduce your vulnerability to coronary artery disease by a third or more.

Pharmacology of Plasminogen Activators

The recommended dose of rt-PA alteplase, Activase (Genentech, South San Francisco), Actilyse (Boehringer Ingelheim, Ingelheim) for the treatment of acute myocardial infarction was 100 mg administered as 60 mg in the first hour (of which 6-10 mg was given as a bolus over the first 1-2 min), 20 mg over the second hour and 20 mg over the third hour. Later it was proposed to give the same total dose of 100 mg but front loaded, starting with a bolus of 15 mg followed by 50 mg in the next 30 min and the remaining 35 mg in the following hour (Neuhaus et al. 1989). In the GUSTO trial, a dose of 15 mg intravenous bolus of alteplase followed by 0.75 mg kg over 30 min (not to exceed 50 mg) and then 0.50 mg kg over 60 min (not to exceed 35 mg) was utilised (GUSTO Investigators 1993). In the COBALT (1997) trial, double bolus administration of rt-PA (50 mg given 30 min apart) was evaluated in patients with myocardial infarction. Whichever regimen is used, it is important to co-administer...

Introduction Inflammation and atherosclerosis

Vascular disease, particularly atherosclerotic disease, manifests a strong age dependence and plagues more affluent nations partly because of lifestyle, but also because of the sharp discordance in life expectancies and healthcare availability and delivery in developed versus emerging nations. Average global life expectancy is about 63 years, but ranges from a low in most of Africa of less than 55 to a high of 75-85 in countries such as the United States, Europe, and Japan. Infection remains the primary cause of death in the world, but deployment of improved healthcare into underdeveloped parts of the world are expected to markedly raise average global life expectancies to the point where prevalence of cardiovascular disease takes the lead as the world's number one health problem. Atherosclerosis-based diseases such as coronary artery disease and cerebrovas-cular disease frequently strike without warning and account for 35 of all deaths in the United States 1-3 . In about one-third of...

Monitoring health outcomes

For the moment it is a fact of life that the measurement of process is usually our best mechanism for predicting rather than measuring outcome and thus quality of care, but it does require that we measure quality by degree of adherence to very clearly defined and agreed standards. Unfortunately, these are only available in a limited number of clinical instances. For example, the percentage of premenopausal women with node-positive breast cancer receiving chemotherapy or the percentage of patients with myocardial infarction receiving thrombolysis within a set time. Medical managers need to make clear judgments about the validity of the criteria that are going to be used as gold standards of quality. This in turn leads back not only to the validity of EBM as a process but also to an awareness that bureaucratisation of the process can lead to the original measure being misrepresented or inappropriate. For example, concerning the management of breast cancer, when breast conserving surgery...

Anger Whats Your Score

Several studies have demonstrated that people with a low threshold for anger have a greater probability of high blood pressure and heart disease. When compared with calmer people, these individuals experience rage and fury more often, more intensely, and for longer periods of time. a heart-healthy lifestyle featuring a lot of aerobic exercise and a diet low in saturated and trans fats. It's no accident that this program works well for the waist as well as the heart.

Selection of antihypertensive drug in diabetes mellitus

In the CAPPP trial, diabetic patients who were on captopril had less cardiac mortality and all-cause mortality than did those who were on bBs or TDs 26 . The report did not further divide the impact of captopril over bBs or TDs. However, the STOP-2 did not find any difference in major CV events and total mortality among patients who were randomized to TDs bBs versus ACE inhibitors versus CCBs 67 , although there was a statistically significant reduction in myocardial infarction (MI) in those who were on ACE inhibitors compared with those who received CCBs (see Table 5). The data from CAPPP and STOP-2 are based on post hoc analysis because only a small percentage of participants were diabetic thus, such analyses may suffer from inherited bias (eg, violation of randomization). In contrast, the UKPDS, ABCD, and FACET trials included only diabetic patients who had hypertension. Results from these three trials seem to be more convincing in favor of ACE inhibitor use in diabetic patients....

How does atherosclerosis develop

A comprehensive description of the sequence of events in atherogenesis is beyond the focus of this review, but has been well described in several review papers 4-7 . The hallmark feature of atherosclerosis is focal and chronic inflammation in the arterial wall. Inflammation constitutes the first response of innate immunity after a threat is detected, indicating that atherosclerosis is first and foremost an immune-based disease 4 . Virtually all major and minor cellular effectors of the immune system have been shown to be present and in most cases instrumental in the development of plaque 4, 8-11 . Briefly, development of atheromata begins when lipoproteins are retained within the arterial subendothelial matrix 12 (Fig. 1). Why serum lipoproteins become trapped in the arterial subendothelium remains unclear. The Framingham Heart Study and many others unequivocally established that risk of myocardial infarction or stroke increases linearly with serum low-density lipoprotein (LDL)...

Supplementing Dietary Supplements Nutrient Boosts

Precisely how much of each vitamin or mineral should be in the human diet has long been a matter of research and discussion. In 1941, an official body of experts in the United States published a compendium of Recommended Dietary Allowances (RDAs) that has been updated periodically ever since. For each nutrient, this book lists the daily ingestion levels judged adequate to meet the standard nutritional requirements of a normal healthy person of given age, sex, and physical condition. The adult RDA for zinc is 15 mg, for example, and that for riboflavin (vitamin B2) is 1.7 mg. The lists were later expanded as a series of Dietary Reference Intakes (DRIs) that also include upper bounds on tolerable ingestion levels. These are important too, because there is circumstantial evidence that particular vitamins in large doses reduce the risk of cardiovascular disease and some cancers, or slow the aging process and, on the other hand, that high-dose levels may also have some toxic effects.

Treatment and Monitoring

Currently available drug therapy focuses on suppression of bone resorption. Because of the relationship between estrogen and bone resorption, hormone replacement therapy was for many years the first therapeutic option. But this changed in 2002 when data from the Women's Health Initiative suggested increased risks of breast cancer, coronary artery disease, stroke, and pulmonary embolism with a combined estrogen-progesterone formula. Although these risks were not found with other estrogen therapies, there was concern that for many women the risks outweighed the bone benefits. For these women, and when hormone therapy is contraindicated, there are other options. The bisphospho-nates are probably the most frequently prescribed drugs for the treatment of osteoporosis and osteopenia. Alendronate, the most widely used of the class, acts by inhibiting farnesyl diphosphate synthase within the osteoclast, causing the cell to undergo premature apopto-sis. Second- and third-generation...

Emerging Risk Factors

You may have heard about new tests such as those that measure homocysteine or C-reactive protein levels (see page 68) that can estimate risk for heart disease. There are four critical questions that must be answered about any new risk factor before it can be recommended that the general population get screened for it 3. Will treatment of the risk factor, or use of the information it provides to treat other risks, lead to a reduction in mortality, heart attacks, or strokes 4. Does the risk factor predict risk in the population in which it is going to be used For example, it is possible that risk in individuals who have already had a heart attack will not prove very useful in predicting risk in individuals who have never had a heart attack.

Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

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