Tag Archive for: heart attack

Are Heart Meds Forever?

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The prevailing thought on pharmacological treatment of cardiovascular disease (CVD) is that once you’re on a class of medications, you’re on them for life—new meds may be developed to replace some, but treatment continues forever. That contributes to the conspiracies about big pharma and the greed of the medical community. I’m not going to say that never happens, but maybe a recent study can reveal a ray of hope.

Beta-Blocker Study

Researchers selected a very specific group of potential subjects from three countries. The subjects must have had a myocardial infarction (MI), also known as a heart attack; they must have had both angiography and an echocardiogram; they must have an ejection fraction equal to 50% or more; and they were tracked for 3.5 years.

This is the important part: On a randomized basis, half were given the typical treatment of beta-blockers while the other half were not. There were two intermediate analyses of the data to make sure the non-beta blocker group were not at greater risk for problems such as another MI, or worse yet, death.

The analyses demonstrated that there were no differences in outcomes related to any CVD condition between the groups. In other words, the beta-blocker did not provide any additional benefit. There are more trials underway to confirm these results, but we now have a first step on the path to determining whether medications are necessary for life or not.

The Bottom Line

Let me be clear: Do not stop any medication without discussing it with your physician! All physicians were aware that their patients were in the trial and who was and was not on beta-blockers. Also, the standard for ejection fractions (amount of blood pumped per beat) was relatively high. But it illustrates this point: Every visit to your physician or specialist should include a thorough discussion of your medications and whether you need to remain on each one.

There’s also another part to all this: What are you willing to do to help eliminate the need for the medication? Diet, exercise, reducing body weight? What will you do if it will help? In other words:

What are you prepared to do today?

        Dr. Chet

Reference:  N Engl J Med 2024;390:1372-81

The Secret to Prevention

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Consistency.

I thought I’d lead with the secret to disease prevention instead of making you wait. Whatever you want to accomplish in taking charge of your health, you have to be consistent. The polypill study proved it although the scientists, being conservative in their conclusions, don’t come out and say it—but I will. Here’s why.

Why the Polypill Was the Difference

The subjects taking the polypill were more consistent in taking their medications than the subjects who took the exact same medications as individual pills. They didn’t ask the subjects whether it was easier to remember to take one versus three pills; that could be a factor as the mean age of the subjects was over 75. It’s also easier to keep one medication refilled rather than three. Whatever the reason, the subjects just took their medication on a more regular basis and thus saw a decrease in recurrence of cardiovascular disease events.

While this was a study about medication, it applies to reducing or changing your foods to eat healthier, reducing the risk of cardiovascular disease and diabetes, or any other health goal: we have to be consistent. Even getting a health benefit from taking a supplement requires you to take it regularly for weeks or months to see a benefit.

Weight Loss: A Special Case

Losing weight and maintaining the weight loss is the single most difficult thing humans can do. I know. I’ve been trying for decades. I don’t weigh what I used to weigh, but I’m not where I want to be. I know many of you are in that spot as well.

It’s not the losing that’s the problem—it’s the maintaining. When you consider the simplicity of it, why is it so difficult to sustain a way of eating that keeps you at a healthy weight? Scientists and physicians have examined genetics, proteomics, hormones, and more. They have looked at every psychological issue they can think of to try to help people lose the weight and keep it off. No luck so far.

I’ll go out on a limb and predict there won’t be any one answer. It’s really up to each individual to find a way to eat that can sustain a normal body weight. It will probably be slightly different for each of us as to the types of foods and exercise we use, but our solution exists. We just have to find a way to be consistent and in the case of weight loss, it has to be for life.

The Bottom Line

We face plenty of obstacles in our path to health. We may not have the best genes. We may have had a poor lifestyle for many years that we have to compensate for. We may not have all the resources we need. But if we can pick a couple of things at a time and make them our habits for life, we can begin the process. We just have to be consistent, day in, day out. Where we end up may not be perfect, but it can be better than you are right now. That’s what aging with a vengeance is all about.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

Will the Polypill Reduce Second Heart Attacks?

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One of the issues with prevention is having people stick to a plan, even after an event as serious as a heart attack. Lifestyle changes are challenging to stick with, but so is something as simple as taking medications. Remember, this isn’t to prevent a heart attack; it’s to prevent a second one. That’s serious.

The concept of a polypill has been around for close to 15 years. The idea was to put medications together in one pill as a preventive that would reduce the risk of getting cardiovascular disease. For a long time, that idea never went anywhere, but recently researchers decided to resurrect the concept. This time, the objective was to monitor subjects with recent heart attacks. Would there be a difference in the rate of secondary events between subjects who took the polypill and those who took the same medications as individual pills? The medications used were aspirin, ace-inhibitor, and a statin. After three years of follow-up, the subjects in the polypill experienced significantly fewer secondary events, 9.5% versus 12.7%.

Can you figure out why the subjects who took the polypill did better than the subjects who took the same medications individually? I’ll tell you the secret to disease prevention on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

Taking Biotin? Tell Your Doctor

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Biotin is a B vitamin often used for skin health among other benefits; it’s involved in many metabolic processes in the body. Due to its chemical nature, it’s used as a coenzyme in several tests. One of those tests is for troponin, a protein released from the heart into the bloodstream during a heart attack. There are no large trials that have tested the effects of biotin on troponin testing, but a physician or lab tech needs to know if you’re taking extra biotin.

The amounts in multi-vitamins appear to cause no issues, but adding the biotin in products to improve hair, skin, and nails could be enough to impact the test. Did it in our subject’s case? Maybe. We don’t know for sure.

As we approach this long holiday weekend, take a minute to add up all the biotin you’re taking in supplements. If it’s more than one gram, and if you end up in the ER because of a suspected heart attack or stroke, tell the lab tech. It doesn’t impact your having a heart attack; it impacts the test as to whether you may have damage to your heart as a result of a heart attack. You don’t want that test to be inaccurate because it’s important to arriving at the correct diagnosis.

Enjoy the July Fourth holiday, check out the audios on sale for men and women, and I’ll be back next week.

What are you prepared to do today?

        Dr. Chet

Still in Doubt? Check It Out Again

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In the last Memo, I said we weren’t done with the person who had waited three days. We spoke again after a couple of days, and she still had the same pain profile: back and chest, not as intense. She’d had a heart catheterization that came back clear: no blockages in any of her coronary arteries. Still the discomfort bothered her.

I’ve talked to many people over the years who were going through the same thing. I always recommend they go to the ER immediately. She had done that, albeit a couple of days later, and the diagnosis was indeterminate. She did have extremely high blood pressure which had come down with treatment in the hospital, but like most people, she disliked some of the side effects and didn’t want to take the meds. As we talked, she mentioned that she also had dizziness going up a flight of stairs and her vision was blurry. That was it—that’s a symptom of a stroke, so I recommended she go back to the ER if someone was there to drive her.

They ran more tests including and MRI of her head. No blockages or evidence of a stroke; her blood pressure was still way too high, but that could be managed at home. Still there was a diagnosis of a heart attack based on enzyme levels even though the ECG didn’t show it. She is working on lifestyle changes to get off blood pressure medications if possible.

But the enzyme level triggered something in my memory, and I’ll tell you about that on Thursday. Make sure you read it before the holiday weekend begins. Remember, the audios Dr. Chet’s Health Tips for Women with Dr. Pam and Health Tips for Men are still on sale through the Fourth of July.

What are you prepared to do today?

        Dr. Chet

Three Freaking Days!

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When it comes to health, my experience has shown that women tend to take a little better care of their health than men do. I checked back to when I began to use the phrases, “Never, never, ever, ignore chest pain” and “When in doubt, check it out!” It was about 20 years ago. And yet I’m still surprised when people don’t do it.

In fact, it happened within the past two weeks. A reader called me about some health issues. She wasn’t a stranger; we had talked before about her issues. This time it was an inquiry about discomfort in the chest and back—not really pain, but not nothing either. Doing some yoga and deep breathing seemed to help. I always tell people that the safest, most conservative approach is to go check it out at the emergency room. That’s the only way you know for sure. We left it at that.

Finally, a couple of days later, the discomfort got worse and moved toward her left arm. She finally went to the ER—three freaking days after the symptoms began. At least she didn’t wait ten days like my friend Jim.

I understand the hesitation; I’ve faced it myself. No one wants to seem alarmist or silly, and not everyone has health insurance to cover the costs. Still it’s better to be alive with a hospital bill than with a damaged heart or worse for delaying.

The Bottom Line

Let me be very clear about this: when it comes to your heart or your head, when in doubt, check it out. Delaying may make things worse.

Or the problem may turn out to be nothing. You thought we were done with this person? Nope, but I’ll save it for next week.

Women’s hearts are different and the symptoms related to heart disease may be different. This may be a great time to pick up Dr. Chet’s Health Tips for Women with Dr. Pam. As an incentive, I’m lowering the price on the MP3s to $4.95 for Health Tips for Men and Health Tips for Women through the Fourth of July.

What are you prepared to do today?

        Dr. Chet

When In Doubt, Check It Out

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Father’s Day reminded me of some of the wonderful men I’ve known who’ve passed on. The one I miss the most is my best friend Jim even though he’s been gone over 20 years. I can’t help but believe he might still be with us if had done just one thing: check it out.

Jim started having chest pain at Thanksgiving Dinner; he told his wife that he was just tired and stressed from the holidays. He actually went to work on the following Monday, but as the week went on, he felt worse and worse. He was having a heart attack for nine days! By the time his family insisted on calling an ambulance on the following Saturday, it was too late. He died in the ER.

When in doubt, check it out. That’s where the phrase came from, although the symptoms in Jim’s case were clear. It doesn’t apply only to chest pain or other symptoms of a heart attack. If you have blurry vision, a sudden headache, or your face is drooping, that could be a sign of a stroke. Even if the symptoms subside, you have to get them checked out. Better a trip in an ambulance than a hearse.

Jim left behind a family. His wife, three kids, and grandkids needed him desperately at times over the following years; I needed him, too. I want you to be safe and healthy, not the gaping hole left in the family photo. So when in doubt, check it out.

If you haven’t heard my Health Tips for Men, now might be a good time to purchase a copy. There’s more to Jim’s story and nine other health issues that impact men. But what about women? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Omega-3s and A-Fib: More Analysis Required

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I hope that you took the time to review the paper on atrial fibrillation as well as the research letter on omega-3s and atrial fibrillation. If you haven’t, especially the primer on A-fib, please do it. It’s a serious condition that requires attention if you have it; in most cases, fixing it is surprisingly simple.

The research letter included five studies. I decided to look at each of those research papers individually to see how each trial was conducted, especially on the populations used in those experiments. Here’s what I found.

The Subjects

The subjects in the studies had several characteristics in common. First, they were, on average, in their mid 60s and older. Second, they had already had a myocardial infarction (heart attack) or were at high risk for cardiovascular disease due to factors such as obesity, hypertension, elevated triglycerides, and others. Third, most were taking multiple medications.

They definitely were not healthy and free of disease. The potential for a cardiac event increases if you’ve already had a cardiac event. On top of that, in the trials that used prescription fish oils, the attempt was to lower triglycerides in those patients who were taking a maximal dose of statins. There may be some interaction that hasn’t been identified yet between very high doses of omega-3s, equal to or greater than four grams, and statin medications or other pharmaceuticals the patients were taking to control blood pressure, heart rate, etc.

In short, this does not apply to everyone. In fact, in the concluding statement of the research letter, the researchers state that physicians should be cautious when prescribing high-dose omega-3s in patients with high triglycerides and an increased risk of cardiovascular disease.

Additional Analyses

As I alluded to in the prior paragraphs, I think the analysis should include factors such as exercise, diet, and especially prescription medications. It may be that the number of subjects might not be able to be broken down by statin intake, beta blocker intake, or ace inhibitors, but I think that it should at least be examined to see if there’s any trend.

Also, the data could be separated into those people who’ve had a heart attack and those that haven’t, even though they may have significant risk factors for cardiovascular disease. After a heart attack, there may be morphological changes such as damage to nerve conduction or the buildup of scar tissue that could impact how omega-3s impact the heart itself.

Are all of these possible? I would think it would be with over 150,000 subjects from all the studies included in the meta-analysis.

Two More Things

I still have not found a single nutritionist involved in any of this research. When you look at prior studies that seemed to benefit heart rhythms, it’s DHA omega-3, not EPA, which is the factor related to better heart rhythms.

Take a look at the map that’s in the primer on atrial fibrillation. It applies to those on Medicare who are 65 and older, but there’s an amazing and obvious trend. I’m even going to give it a name; I’ll tell you that next Tuesday. The only clue that I’ll give you is to think maps and what they’re typically used for.

The Bottom Line

While interesting, the Research Letter on the update of omega-3s in relation to atrial fibrillation leaves more questions than answers. So far, it applies only to people over 65 with high triglycerides and other risk factors for cardiovascular disease. If you already take omega-3 fatty acids, there’s probably no reason to stop, but it’s a discussion you should have with your physician.

It’s also obvious that if you do have high triglycerides, you can work on changing that by changing your diet first. Reducing refined carbohydrates is the key; eating more vegetables helps as well.

It always comes back to this: eat better. Eat less. Move more.

What are you prepared to do today?

        Dr. Chet

References:
1. European Heart Journal – CVD Pharm. 2021 doi:10.1093/ehjcvp/pvab008
2. Curr Atheroscler Rep. 2020. https://doi.org/10.1007/s11883-020-00865-5
3. Atrial Fibrillation Primer. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm

Omega-3s and Cardiac Events

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There was another study this week on omega-3 fatty acids. While the study I talked about last Thursday was small with only 21 subjects, this trial contained over 13,000 subjects from 675 hospitals and clinical centers all around the world. In this five-year study, one of the omega-3 fish oil medications was being tested to see if it would reduce cardiac events such as heart attacks, stroke, and death when compared with subjects taking a corn-oil placebo. The study was stopped early when it was clear there were going to be no significant differences in any of the outcomes that were being studied. In other words, the prescription fish oil did not reduce cardiovascular disease events.

While that may seem disappointing, there are some factors that most likely impacted the outcome and a couple that may have but could not be tested.

The Subject Pool

The subjects in this clinical trial had significant risk for CVD; they were required to have established coronary artery disease or significant risk factors to be included in the clinical trial. Those risk factors included being a type 1 or type 2 diabetic, with at least one additional risk factor including chronic smoking, hypertension, hs-CRP higher than two mg/L, moderately increased protein loss, or being older with similar factors as the diabetics.

The Data Not Collected

In reading the study, there were three criteria that came to mind that could have impacted the outcome if the corresponding data had been collected and considered in the statistical analysis. I emailed the relevant author and got the answers.

1. Were data collected on exercise habits of the subjects? No.

2. Were nutritional data collected on the subjects? No.

3. Was the form of omega-3 used, a highly purified carboxylic acid form, assessed as to how the metabolism impacts the omega-3s’ mechanism of action? No.

It seems to me that if the data could be analyzed on exercisers versus sedentary as well as using nutritional factors, even just daily caloric intake, there may have been significant results. As for the form of omega-3s, the CA form is highly absorbed and doesn’t require a fat in the diet to assist with that process. There might have been something else that happens during metabolism that normally assists in the risk reduction. We just don’t know.

The Bottom Line

The authors acknowledge that this subject pool was at high risk for cardiac events. One explanation is that the progression of disease may have already been too advanced and could have impacted the efficacy of the medication. For people with less established CVD, the omega-3s might have been more effective.

Many in the medical field wrote about the failure of omega-3s in medication or supplement form to prove that they have any impact on CVD events or mortality. I think they’re wrong. The one outcome they never test is the quality of life. Granted, it’s difficult to assess but if people can live their lives even 10% better, regardless of CVD events, that seems worth it. Paula and I are still taking our omega-3 supplements; in fact Riley takes one, too, even though he’s only five and we’re not concerned about his heart. Whether you’re worried about your heart or not, omega-3s have many benefits. This study shows no reason why you or I should stop taking them.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA. 2020;324(22):2268-2280. doi:10.1001/jama.2020.22258

You’ve Got the Ball

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Two emails. Two men. Two deaths. In each case, the men likely didn’t know what they didn’t know. If they had known they had coronary artery disease or hypertension, they probably would have done something about it. Or maybe like many people, they wouldn’t have—“that couldn’t happen to me” syndrome or simply ignoring the facts. As I said on Thursday, this is American Heart Month. I’m going to give you three things you should do to reduce your risk of sudden death, the most extreme symptom of heart disease.

 

Graded Exercise Test . . .

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