Tag Archive for: American Heart Association

Melatonin: Stay the Course

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As we continue to examine the results that appeared to suggest that the chronic use of melatonin in people diagnosed with insomnia could result in an increased risk of a diagnosis of heart failure, heart failure hospitalizations, and death from all causes, let’s put the unreviewed abstract in perspective. One correction from Tuesday. The researchers did not track the subjects for five years; the gathered data from the past five years. That’s an important difference

The simplest way to is to convert the percentage of risk into real percentages. The study reported that the risk of developing heart failure was over 90%. That’s true, but it’s based on the percentage of insomniacs that didn’t use melatonin at 2.7% versus 4.6% in those that did use melatonin. The same logic was used for hospitalizations (19.0% vs. 6.6%), and mortality (7.8% vs. 4.3%). It still seems like a significant risk, but there’s one more number that’s important: the total number of subjects in the study.

Insomnia: The Numbers

In the United States, the average number of adults that are diagnosed with insomnia is 12%. With 268 million adults in the U.S., that means that 32.2 million people have chronic insomnia. The percentage diagnosed is about the same in all high-income countries around the world. The researchers used a database that claims to have 150 million de-identified electronic medical records in its database, so how did the number of subjects get to only 120,000? It should have been at least 15 million.

Yes, the subjects were matched for a variety of criteria including age, gender, medications, and other factors but still, that’s an awful lot of lost subjects. Even without the diagnosis of insomnia, other diagnoses such as depression and other mental health diagnoses result in insomnia. They can also predispose people to heart failure as well. Those subjects would also have been lost.

The most significant information that was not collected was any data on over-the-counter melatonin use. To their credit, they do cite that as an issue, but there are no data as to how much melatonin was actually used by the subjects who took melatonin. There’s no record of melatonin use by people in the non-melatonin group if they didn’t report it as a supplement they use to their physician. There are more questions, but that’s enough to call the results into question.

The Bottom Line

Perhaps after the peer-review process, the data collection will be more clear. But as for right now, the best thing that could be said is that they distributed a great press release that caused a lot of concern. But as for actual research evidence? There’s no reason to modify melatonin use at this point. However, it’s always a good idea for you to report any supplements you’re taking to your healthcare provider.

What are you prepared to do today?

        Dr. Chet

Reference: American Heart Association Scientific Sessions 2025, Abstract MP2306

Melatonin: CVD Risk?

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Medical conferences are always a great source of controversy; studies are presented that haven’t been peer reviewed but have great press releases to advertise them. The American Heart Association met last week, and the Scientific Sessions didn’t disappoint. The abstract that caught my attention was based on an analysis of a large database of subjects from a variety of countries that demonstrated that melatonin used to treat insomnia could lead to an increased risk of cardiovascular disease (CVD) and hospitalization.

Researchers chose subjects who were diagnosed with insomnia and took melatonin for at least a year based on their medical charts. They were matched with control subjects on a variety of characteristics including age, height, weight, and many more variables, who were also diagnosed insomniacs but did not report melatonin use. They were tracked for five years.

The abstract stated that there was a 90% greater risk of CVD diagnosis in the melatonin group. Further, there was a 350% increased risk of being hospitalized in the melatonin group and a 100% increased risk of dying from all causes as well.

Is it time to throw out the melatonin? I’ll give you some perspective on this study on Saturday.

Tomorrow night is the Insider conference call and, wow, there is a lot to talk about! If you become an Insider by 8 p.m. tomorrow night, you can join in on the call. Protein intake. Creatine. Bike paths and medical costs. And even more.

What are you prepared to do today?

        Dr. Chet

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

Another Buffalo Bill’s Cardiac Arrest

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I hope that you took 60 seconds to watch the video from Tuesday’s Memo and learn CPR. As I said, it’s simpler than when I taught it, and it may just save someone’s life—someone you love or maybe a stranger.

In the close, I mentioned another Buffalo Bill who suffered a cardiac arrest several months before Damar Hamlin’s on-field experience. The owners of the Bills and Buffalo Sabres and CEO of the Buffalo professional sports teams are Kim Pegula and her husband Terry. One night last June, Terry was awakened by Kim going into cardiac arrest. One of her grown daughters happened to be staying with her parents and performed CPR until emergency services arrived. She saved her mother’s life.

In an open letter in The Players Tribune, Kim’s daughter Jessica, a top-ranked tennis player, told the story of her mom. This time, without the immediate attention from a couple dozen experts, Kim’s brain was without oxygen for longer. While she continues to improve every day, she suffers from expressive aphasia. She can probably understand almost everything, but she sometimes can’t get the correct words to communicate well. No one knows whether she’ll regain lost function, but she’s alive to make that journey because of CPR. It’s a very moving story and I urge you to read it.

Who can do CPR? Almost anyone. The American Heart Association has no minimum age for learning CPR. They say, “The ability to perform CPR is based more on body strength than age. Studies have shown that children as young as nine years old can learn and retain CPR skills.” Now—are you going to take the time to learn CPR in 60 seconds? Just click this link.

Aging with a Vengeance

After the Super Bowl Webinar on Taking Back Your Muscle last Sunday, I had inquiries about the prior Super Bowl Webinar Reclaiming Your Power. I’m happy to let you know you can purchase both replays in the Store at drchet.com. If you order one or both, make sure you use the correct email address; it’s the only way you can get the link to listen to the replay. And if you want to gift the replay to someone, you can; when you’re checking out and get to the billing details page, enter their email address instead of your own.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.heart.org/en/damar-hamlins-3-for-heart-cpr-challenge
2. https://www.theplayerstribune.com/posts/jessica-pegula-tennis

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.

 

What Would You Pay for More Time?

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What price would you pay if you could gain an extra month of life? How about a year? How about five years? I think the longer you get, the more incentive to pay a higher price. It seems a large group of subjects agree with me according to a study reported this past weekend at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2018.

Researchers surveyed over 1,300 people to determine what price they would be willing to pay for a longer life if they were diagnosed with high blood pressure. Subjects could choose from a daily pill, a daily cup of tea, regular exercise, or a monthly injection. The kind of treatment didn’t matter; the more additional time they got, the more willing the respondents were to consider the treatment.

Which was most appealing? The pill and the cup of tea. The least appealing? The injection. All treatments exceeded 93% if they would give a person an extra five years.

How about you? If you’re diagnosed with hypertension, what would you be willing to do for an extra month, year, or five years? While you think on it, Thursday’s Memo will be about something I found surprising in the study.

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH