What You Must Do if You Think You Are Having a Heart Attack

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Stomach-Acid-Suppressing Drugs May Raise Risk of Death After Angioplasty

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TUESDAY, Nov. 17, 2009 (Health.com) — Heart patients who take certain stomach-acid-suppressing drugs to prevent gastrointestinal bleeding may be at increased risk of dying after a cardiac procedure, according to a study presented at the annual meeting of the American Heart Association (AHA) in Orlando.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The Slim Way to Organize Your Kitchen

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The first place to start? The refrigerator
First, ditch the soda—regular and diet (carbonation plus artificial sweetners equals bloat), and replace it with water and iced green tea. Better yet, try the CarbLovers Fat-Flushing Cocktail: Take 2 quarts brewed green tea and add the juice of 1 lemon, 1 lime, and 1 orange. Mix all ingredients together in a large pitcher. Store in the fridge for up to 3 days. If you must keep soda and fruit juice around for your family, do yourself a favor and store them out of sight. That way, you'll be more likely to grab something diet-friendly.

Invest in fridge- and freezer-friendly stackable containers so the healthy stuff—chopped veggies, herbs, sliced fruit, and all your make-ahead beans, barley, and brown rice—is easier to grab than fattening fare. These will keep your fridge clutter-free, and encourage you to cook CarbLovers meals in large batches that you can use for the whole week. Look for the "make-ahead" icon on some of the recipes. These meals can be made in advance of serving, and many are appropriate for freezing.

Your next stop is the countertop
This is a space that can make or break your diet. Keep your blender close to where you chop fruits or veggies so it's always supereasy to prepare a healthy smoothie or soup. Set out a wooden block or hang a magnetic strip for chopping knives to make it easy to trim excess fat from meat and slice fiber-filled veggies and fruit.

Next to those slicers, use decorative hooks to dangle tools like an apple corer, a citrus zester, and a handheld squeezer (to add no-fat flavor to fish, pastas, marinades, and salad dressings).

Top your countertop with a big, beautiful basket, and use it to contain kitchen-table clutter, so you won't be tempted to multitask during meals. (Also recommended: a bouquet of fresh flowers, just because you deserve it.) Cooking and eating without distractions will help you focus! Speaking of focus, plug in your iPod and listen to music that de-stresses you. Research suggests that ab fat cells expand in response to the stress hormone cortisol, but cortisol levels decrease faster in people who listen to relaxing music than in those who don't.

De-clutter the pantry
Don't keep unhealthy snacks around to tempt you into mindless munching while you're cooking meals. Instead, keep airtight containers of dry ingredients like pasta and beans on the lowest shelves, so they're convenient for everyday use (check them periodically for freshness).

An extra tip: grow your own oregano, thyme, and rosemary along your windowsill, and you'll have an easy, no-cal way to jazz up healthy foods like grilled chicken and veggies.

Cooking tips, nutrition news, and incredible, healthy recipes anyone can make.

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Scientists Map Genetic 'Blueprint' of Heart

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THURSDAY, Sept. 13 (HealthDay News) -- Researchers have identified the genetic "blueprint" for how a heart becomes a heart -- a sort of instruction manual for building a fully functioning heart from embryonic stem cells.

The scientists reprogrammed embryonic stem cells from mice into beating heart cells. Then they removed and analyzed DNA from developing and mature heart cells to determine which aspects of heart formation they encoded, using large amounts of computing tools and gene-sequencing data to do so.

The findings provide clues into the genetic basis for some forms of congenital heart disease, say the Gladstone Institutes scientists, and could lead to new treatments for life-threatening birth defects such as arrhythmias -- irregular heart beat -- and ventricular septal defects, or "holes" in the heart.

"Congenital heart defects are the most common type of birth defects -- affecting more than 35,000 newborn babies in the United States each year," Benoit Bruneau, associate director of cardiovascular research at Gladstone, said in an institute news release. "But how these defects develop at the genetic level has been difficult to pinpoint because research has focused on a small set of genes. Here, we approach heart formation with a wide-angle lens by looking at the entirety of the genetic material that gives heart cells their unique identity."

"Our findings reveal new clues as to how complex genetic and epigenetic patterns are precisely regulated during heart formation," study collaborator Laurie Boyer, from the Massachusetts Institute of Technology, said in the news release. "In particular, our identification of key segments of the genome that contribute to this process will hopefully allow us to identify the genetic causes of many forms of congenital heart disease -- an important first step in the fight against this devastating disease."

The researchers found that groups of genes work together in heart cells, switching on and off simultaneously at certain times during development. They also identified new genes involved in heart formation and figured out how they interact with previously known genes.

"Next, we hope to examine the DNA of patients living with congenital heart disease, in the hopes that we can pinpoint the specific genetic disruption that caused their heart defect," said Bruneau, who is also a professor of pediatrics at the University of California, San Francisco. "Once we identify that disruption, we can begin exploring ways to restore normal gene function during early heart formation and reduce the number of babies born with debilitating, and sometimes fatal, congenital heart defects."

The study was published online Sept. 13 in the journal Cell.

-- Mary Elizabeth Dallas Copyright © 2012 HealthDay. All rights reserved. SOURCE: Gladstone Institutes, news release, Sept. 2012

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Non-Alcoholic Red Wine May Boost Heart Health

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Non-Alcoholic Red Wine May Be Effective at Lowering Blood Pressure

By Denise Mann
WebMD Health News

Reviewed by Louise Chang, MD

Sept. 6, 2012 -- Much research has touted the health benefits that come from drinking moderate amounts of red wine.

Now, a new study may extend some of these benefits to teetotalers. Non-alcoholic red wine may be even more effective at lowering blood pressure in men who are high risk for heart attack. The study findings appear in Circulation Research.

The study included 67 men who had diabetes or three or more heart disease risk factors. When the men drank red wine with alcohol, their blood pressure went down a little, and there was no change in blood pressure levels when they drank gin.

When the men drank non-alcoholic red wine, their blood pressure went down enough to lower their risk of heart disease by 14% and stroke by as much as 20%.

The real health benefits in red wine may be found in powerful antioxidants called polyphenols, not the alcohol. In fact, the alcohol in red wine may dampen its blood pressure-lowering potential. In the study, the red wine with alcohol and non-alcoholic wine contained equal amounts of polyphenols.

The researchers were able to link polyphenol levels to a boost in men's levels of nitric oxide, which helps lower blood pressure. Nitric oxide helps blood vessels relax and allows more blood to reach your heart and organs.

During the study, the men ate similar diets and drank either 10 ounces of red wine, 10 ounces of non-alcoholic red wine, or 3 ounces of gin. All of the men tried each diet/beverage combination for four weeks.

"The non-alcoholic part of the wine -- namely polyphenols -- exert a protective effect on the cardiovascular system," says researcher Ramon Estruch, MD, PhD of the University of Barcelona in Barcelona, Spain. "Polyphenols also have anti-inflammatory and antioxidant properties that may be useful to prevent other disease such as diabetes."

He predicts that more people will turn to non-alcoholic wine in the future.

This is welcome news for people who can't or don't want to drink alcohol, says Suzanne Steinbaum, DO, at Lenox Hill Hospital in New York City. Although some alcohol is thought to be good for you, too much alcohol can increase blood pressure levels.

"Certain people don't want to drink alcohol, so here we have an alternative way for them to get the heart health benefits," she says. "It's not so much the alcohol as it is the polyphenols in red wine."

Other alcoholic drinks have also been shown to have health benefits, but they may do so differently than red wine, Steinbaum says.

SOURCES: Chiva-Blanch, G. Circulation Research, study received ahead of print. Suzanne Steinbaum, DO, preventive cardiologist, Lenox Hill Hospital, New York City. Ramon Estruch, MD, PhD, of the University of Barcelona in Barcelona, Spain. Connie Diekman, RD, director, university nutrition, Washington University, St. Louis.

©2012 WebMD, LLC. All Rights Reserved.

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Health Tip: What's a Heart-Healthy Diet?

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(HealthDay News) -- A heart-healthy diet focuses on plenty of healthy, high-fiber foods while avoiding foods that are high in fat, salt, sugar and cholesterol.

The womenshealth.gov website offers these specifics:

Eat plenty of fruits, vegetables and whole-grain foods.Eat fat-free or low-fat cheese, milk and yogurt.Choose lean proteins, such as eggs, nuts, dried beans, lean meats and poultry without skin.Choose healthier unsaturated fats, such as those found in nuts, fish and vegetable oils.Avoid saturated and trans fats, found in fried and processed foods, fatty meats and baked goods.Limit foods high in cholesterol, sodium and sugar.

-- Diana Kohnle Copyright © 2012 HealthDay. All rights reserved.

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Heavy Drinkers at Greater Risk for Stroke

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Drinking 3 or More Alcoholic Drinks a Day Raises Stroke Risk

By Denise Mann
WebMD Health News

Reviewed by Louise Chang, MD

Sept 10, 2012 -- Heavy drinkers may be at a much greater risk for a bleeding stroke, a new study suggests.

People who drank about three or more alcoholic drinks per day also had the strokes almost a decade and a half before those who didn't drink quite as much. The findings appear in Neurology.

Exactly how heavy drinking may raise risk of this type of stroke is not clear.

The study included 540 French people with an average age of 71 who had a less common type of stroke called an intracerebral hemorrhage. This type of stroke is caused by bleeding in the brain, not a blood clot.

The people in the study and/or their caregivers or relatives were asked about drinking habits. Fully 25% were heavy drinkers. This was defined as having about three or more drinks per day, or about 1.8 ounces per day of "pure" alcohol. Participants also had CT scans of their brains, and French researchers reviewed their medical records.

The heavy drinkers were about 60 when they had stroke. By contrast, the people who were not heavy drinkers were about 74 when they had a stroke. The heavy drinkers were also more likely to be smokers and did show some evidence of irregularities in their blood that would make them more likely to have a bleeding stroke.

"The study does add to our knowledge that excessive drinking is bad for our health in a variety of ways, including increased risk of bleeding into the brain," says Deepak L. Bhatt, MD, MPH. He is a heart doctor at Brigham and Women's Hospital in Boston and an associate professor at Harvard Medical School.

Still, the study is small, and larger ones will be needed before telling people not to drink past a certain level.

Heavy drinkers may be more likely to have high blood pressure, which is a major risk factor for stroke. "If someone enjoys drinking, I don't discourage them, but I will caution them even more so after this study to make sure that the amount is considered moderate," Bhatt says.

Risks of falling and liver problems are also linked to heavy drinking, he says.

However, "we do know that one glass of red wine a day, on average, lowers heart attack and stroke risk, and that is still true," says Patrick Lyden, MD. He is the chair of the department of neurology at of Cedars-Sinai Medical Center in Los Angeles.

His advice remains unchanged. "If you don't drink, don't start because you think it will protect your heart, and if you do drink, keep it moderate."

So what is moderate drinking, exactly? "My rule of thumb is one glass of wine a night, and that is the same as a glass of beer or one mixed drink," he says. "This doesn't mean you can save them up and have seven drinks on a Saturday."

Certain people should avoid alcohol, including those taking blood thinners and people with high blood pressure, Lyden adds.

Rafael Ortiz, MD, is the director of the Center for Stroke and Neuro-Endovascular Surgery at Lenox Hill Hospital in New York City. He tells WebMD that smart stroke prevention includes:

Not smokingEating a healthy dietMaintaining normal blood pressure levelsModerate drinking

"These are concrete things we can all do today to lower our risk of stroke," he says.

SOURCES: Casolla, B. Neurology, 2012, study received ahead of print. Deepak L. Bhatt, MD, MPH, cardiologist, Brigham and Women's Hospital; associate professor, Harvard Medical School, Boston. Patrick Lyden, MD, chair, department of neurology, Cedars-Sinai Medical Center, Los Angeles. Rafael Ortiz, MD, director, Center for Stroke and Neuro-Endovascular Surgery, Lenox Hill Hospital, New York City.

©2012 WebMD, LLC. All Rights Reserved.

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