Tag Archive for: AHA

BE FAST for Stroke

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So what did the Society of NeuroInterventional Surgery (actual brain surgeons) add to the mix? They added the acronym BE, which then makes the entire acronym BE FAST.

What do the new letters stand for?

B: loss of balance. I didn’t see any details about how to test that. It may be self-evident that someone cannot stand upright without tilting to one side or the other. Or it may be the while holding their arms to test their arm strength, they can be moved side to side to see how they respond.

E: loss of eyesight in one eye or blurry vision.

I think adding balance and eyesight are a good idea for the lay public. A physician or other healthcare professional may know to look for balance and eyesight symptoms, but it may not be as obvious to you and me. Here’s the whole list:

BE FAST

B: loss of balance

E: loss of or blurry eyesight

F: face drooping

A: arm weakness

S: speech difficulty

T: time to call 911

Commit those to memory and if you feel that you or someone you care about might be having a stroke, assess those symptoms and most important, take action immediately if necessary. I can’t stress that enough because the sooner treatment begins, the less function a person loses.

Enjoy your holiday weekend, and safe travels if you’re hitting the road. We’ll be back next week.

What are you prepared to do today?

        Dr. Chet

Reference: https://getaheadofstroke.org/call911/

Suspect a Stroke? Act FAST

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The other day, for no particular reason at all, I got really dizzy for a moment. I wasn’t spinning in circles or doing anything else that might have caused it, so I did what I always do: I acted FAST and looked for signs and symptoms of a stroke. The American Heart Association (AHA) has taught that acronym for years, but recently a group of neurosurgeons added more to it. Today, we review the original acronym FAST. What does it mean?

F: face drooping. Does one side of your face seem to be pulled down? If you smile—a really, really big smile—are you smiling equally on both sides of your face?

A: arm weakness. Typically, you would stand with your arms raised out to the side and parallel to the ground. You can check to see if one arm does not quite make it to parallel with the ground or if it drifts back down. I also grabbed a stick and squeezed as hard as I could.

S: speech difficulty. Try repeating a simple phrase to see if you can remember it and if it sounds clear. For some reason I chose the old “How much wood could a woodchuck chuck…” Not the easiest thing to try to repeat a couple of times, but I did.

T: time to call 911. Do you call if you just have one sign or symptom? Yes! Do you still call if these symptoms seem to resolve themselves shortly? Yes! I didn’t have any symptoms, but I still told Paula. I was going to do a song and dance, but I never could in the first place, so it wouldn’t have gone well.

The reason time is so important is that with today’s medical technology, the sooner treatment begins, the better the outcome to regain all functions. AHA says, “stroke patients who are treated with the clot-busting drug IV r-tPA Alteplase within 90 minutes of their first symptoms were almost three times more likely to recover with little or no disability.”

What did the brain surgeons want to add? I’ll tell you on Thursday. It’s Memorial Day weekend and you may need the information if you’re attending any gatherings.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.stroke.org/en/about-the-american-stroke-association/stroke-awareness-month

The Best Heart-Healthy Diet

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In assessing popular diets to find out which one follows the AHA heart-healthy dietary guidelines the best, the panel did a credible job. Instead of just using their expertise, which is substantial, they developed an objective way of assessing each popular diet. They did have one diet that received a point for each of the nine categories thus achieving 100%. That was the Dietary Approach to Stop Hypertension more commonly known as the DASH diet.

The researchers then assessed the dietary patterns and organized them into four tiers based on compliance with the AHA guidelines. I’ll break it down into the tiers for you.

Tier 1

This tier includes the DASH diet, the Mediterranean diet, the pescatarian or fish as protein, and the ovo-lacto vegetarian diets. The primary reason that the DASH diet ranked so high was its ability to get protein from every source: plant proteins such as nuts and legumes, fish and seafood, low-fat or fat-free dairy, and the ability to use lean cuts of all meats. The other diets in Tier 1 either did not recommend proteins from all sources or did not emphasize reducing the amount of salt intake, a key element of the DASH diet.

Tier 2

Tier 2 included the vegan diet and other low-fat diets. Their strength, of course, is the emphasis on vegetables and fruits as well as whole grains, but they all seek to use plant-based protein. Some of the low-fat diets can be quite extreme, such as the Esselstyn Program which restricts fat to less than 10% per day and restricts protein as well.

Tier 3

This included the very low fat diets as well as the low-carbohydrate diets. The reason these two are put together is the restriction on quality protein sources as well as whether people adhere to the diet at every meal.

Tier 4

The paleo diet and very low carbohydrate diets such as the ketogenic diet received the worst scores; that means they fall into the category of not being heart healthy at all.

Other Considerations

The panel also considered three primary issues. The first was how easy it would be to facilitate patients to adapt to the particular diet. To me, the strength of the DASH diet and to some degree the Mediterranean diet is the variety of proteins that can be used. When you get into the very low fat and the very low carbohydrate diet, the restrictions can become overwhelming for most people.

They also considered the challenges for the consumers. In my experience, there are always going to be questions about what could be included in any dietary approach, whether it’s the Mediterranean diet or the ketogenic diet. In order for people to adapt the diet, they need instruction and they need to be able to ask questions; those would be significant challenges when recommending the diets that restrict foods allowed, which could either be vegan, the very low fat, or the ketogenic diet.

The final consideration is the opportunities presented to provide patients with good information about the diet. The problem as I see it is that physicians, physician assistants, and nurse practitioners are not familiar enough with nutrition to be able to do that effectively in a medical practice, especially considering the time constraints for most healthcare practitioners. The obvious choice is to refer it to a dietetics department, but that type of consultation is not very often available in most medical practices and especially under most health insurance programs. I think the challenges are going to take years to overcome.

My Thoughts

I thought the researchers did a credible job in coming up with their recommendations. They analyzed popular diets objectively and assessed them based on the AHA Dietary Guidance.

What is lost is exactly how this is going to help people. Since 1974, more fruits and vegetables and a limit on fat intake were recommended as the foundation of every diet. No matter how many diets have come and gone, no matter how many are yet to be developed, we have not achieved the simplest and yet most obvious objectives. Food manufacturers certainly have had a role to play in this with low-fat and ultra-processed convenience food, but the choice is always with us.

There are three more things that I think must be considered. First would be the individual’s genetic tendencies. We simply don’t know enough about interaction between genes and nutrition and how that impacts input. Second, protein needs change over a lifetime. At some point, proteomics must be considered in dietary recommendations; it isn’t all about your heart.

Finally, they specifically did not consider the potential for weight loss or weight maintenance in every program. Regardless of diet, it was, it is, and it will always be about the calories. If someone can get to a normal body weight and maintain it, I think there might be room for just about any type of diet, providing it provides enough vegetables and fruits.

The Bottom Line

As the lead author suggested in an interview, there were four recommendations across all popular diets: eat whole foods, eat more non-starchy vegetables, eat less added sugar, and eat less refined grains. If we could start with that, I think our hearts would love us for it.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001146

How Popular Diets Impact Your Heart

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When the American Heart Association (AHA) speaks, news organizations tend to report what they say and people tend to listen. It’s doubly true when they rank all the popular diets according to how they relate to heart health. Because we seem to live in a society based on the “see food, eat food” diet, that can be meaningful. Here’s what a group of experts did to evaluate popular dietary approaches to diet and rank them according to AHA guidelines for a heart-healthy diet.

The AHA has ten dietary guidelines for eating a heart-healthy diet, such as “Eat plenty of vegetables and fruits” and “Choose healthy sources of proteins.” For the complete list, click on this link to the article; the scientific statement is open access on the AHA website.

Then the panel selected the most popular diets in the U.S. such as the Mediterranean diet, the DASH diet, several versions of a vegetarian diet, low-fat, paleo, and ketogenic diet. They gave each diet a full point for following each of the AHA guidelines or partial points depending how closely they followed the guidelines.

This was not an arbitrary assignment by a panel of experts; they used the best information available to determine the best heart-healthy diet. Who got the highest score? Mediterranean? Vegan? Ketogenic? I’ll let you know on Saturday along with my thoughts on the diets. One thing’s for certain: eat your fruits and vegetables. You may as well start with that right now.

What are you prepared to do today?

        Dr. Chet

2018 Cholesterol Guidelines and Evidence-Based Medicine

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I was encouraged by the AHA’s new cholesterol guidelines for one reason: the promotion of a joint decision between patient and physician on a treatment plan if one was necessary. That’s the basic tenet of evidence-based medicine: any and all treatment plans should take into consideration the wishes and desires of the patient. Many factors can go into that—the age and current physical state of the patient, the financial cost of treatment, and the physical cost of treatment compared to the potential benefit.

The only concern I have is this: will that discussion actually take place as intended or will it be a one-sided conversation with the physician making the decision for the patient? Will the physician listen or ignore the patient’s views? Paula and I have a great primary care physician and specialists who always listen to us, but I know it’s not that way everywhere. It’s easy to say, “If he won’t listen, just find another doctor,” but that isn’t always an option in rural areas or if your health insurance limits your choice.

The physician side of evidence-based medicine is just half the story. I’ll give you my thoughts on the rest of the guidelines on Saturday.

What are you prepared to do today?

Dr. Chet
Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.

 

AHA’s 2018 Guidelines on Cholesterol

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Here’s what the American Heart Association announced this past weekend: a 120-page research-based paper on new cholesterol guidelines and how the guidelines were developed. The paper was five years in the making, involved twelve medical and physician associations, and includes ten documents to explain and summarize what the guidelines say. For the foreseeable future, these will be the guidelines used by physicians trying to reduce the risk of cardiovascular disease.

The guidelines focus on control of LDL-cholesterol in combination with the state of the individual: those with and those without diagnosed disease. Primary prevention is for those who’ve not been diagnosed with atherosclerotic cardiovascular disease (ASCVD). Secondary prevention applies to those who have been diagnosed with ASCVD. The flow charts for treatment plans are complicated, even when isolated and presented on individual pages.

What I liked the most is that management of CV risk begins with a conversation between the physician and patient. The discussion revolves around risk factors, both lifestyle and the test results. The goal is to come to a consensus for treatment if a person’s CVD risk is high. What does that treatment involve? We’ll take a look on Thursday.

The Insiders Conference Call is tomorrow night. If you’re not an Insider yet, you still have time to join and take part in the call. I’ll be covering the latest research on omega-3s and vitamin D as well as answering your questions.

What are you prepared to do today?

Dr. Chet

 

Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.

 

Do You Have High Blood Pressure?

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On Monday November 13, you may have awakened with normal blood pressure, and by that afternoon, you may have joined the ranks of those with high blood pressure (HBP). That’s when the American Heart Association (AHA) released their new HBP clinical practice guidelines at their national conference. With the new guidelines, close to half of all adults will be diagnosed with HBP.

The guidelines are the topic for this week’s Memos. I downloaded the entire document—all 481 pages—and three important parts warrant discussion. The first is AHA’s new guidelines for diagnosing HBP, and those numbers are in the graphic above.

While there are numerous questions, the first one is this: is your BP being taken correctly? That’s the topic for Thursday’s Memo, and you’ll be surprised at how often it’s done poorly.

What are you prepared to do today?

Dr. Chet

 

Reference: Hypertension. 2017;00:e000-e000.