Tag Archive for: heart attack

HIIT for Everyone

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Before I get into this study on high-intensity interval training or HIIT, I want to be sure you understand that unless you’re under 30 and very fit, you need guidance and advice from your physician before you attempt a HIIT program, especially if you have cardiovascular disease, diabetes, or are on medications for these conditions. I’ve been doing interval training for over 40 years, but the intervals I do today are within the limitations of the body I have today, not the limitations I had in my 30s. With that in mind, let’s proceed.

HIIT After a Heart Attack

Researchers in China recruited over 200 subjects with a specific cardiac profile: the subjects all had myocardial infarctions (commonly known as heart attacks) that were resolved by a percutaneous coronary intervention (treatment used to open blockages in the coronary arteries) such as a stent. This group requires special attention in that they are at serious risk for another event within the next year.

As part of a 12-week cardiac rehabilitation program, researchers divided the subjects into three groups:

  • A moderate-intensity continuous training group (MICT)
  • A HIIT group
  • A group that did a combined MICT and HIIT program.

The advantage is that every exercise session was under the supervision of professionals trained in cardiac rehab who knew how to respond if something went wrong.

All groups improved their fitness levels, but the combined training program of MCIT and HIIT provided better results than either of the approaches done separately. From a fitness perspective, those in the combined group increased the amount of oxygen they could use by more than the other groups and pumped significantly more blood per beat. Most important, there were no differences in major adverse events.

The Bottom Line

I specifically chose this study because these subjects were most at risk. With a doctor’s approval and under the right supervision, they were able to do HIIT safely. For most of the rest of us, those are obstacles and advantages we don’t face.

We should be prudent and check with our physicians first. We should also get some guidance on how to begin a HIIT program; if possible, get an appointment with a physical therapist to plan your workout program, because they’re trained to understand and work around everyone’s physical limitations and avoid injury. The workout plan must be within our fitness level right now, not 20 years ago. It can be as simple as walking faster for 30 seconds at a time during the walk you already take, but the gains can be significant toward improving our healthspan.

What are you prepared to do today?

        Dr. Chet

Reference: Aging and Disease. 2025. http://dx.doi.org/10.14336/AD.2024.0642

When in Doubt…

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When I was doing a post-doc in the late 1980s, I was part of a team of researchers who tested a group of swimmers. This was one of four parts of an overall documentary on an innovative look at health by the PBS’s Nova. I had about a half-second of screen time in this PBS film and that was it; no YouTube or Instagram videos to show. But the segment that had the most impact on me was a section on what to do when you think you’re having a heart attack.

The film crew happened on a case where a man didn’t feel right and thought he was having a heart attack, so he went to see his cardiologist. The nurse said he should go to the emergency room. He drove there by himself. There were many factors pointed out by an ER doc, but here are the two most important lessons:

  • Heart attack pain can vary but most often presents itself as an elephant sitting on your chest and you can’t breathe.
  • Call 911 or if you are close to an ER, have someone drive you but don’t drive yourself. Ambulance personnel know what to do to prevent further damage to your heart if it’s a heart attack, not to mention that they’re less likely to pass out.

Since watching that documentary, my mantra is when in doubt, check it out. Now.

During tomorrow night’s Insider Conference Call, I’m going to talk about two primary topics: the potential use of vaccines to prepare for future infections and the timing of intermittent fasting. If you become an Insider by 8 p.m. ET Wednesday evening, you can participate in the call and get your questions answered.

What are you prepared to do today?

        Dr. Chet

Clock-Changing Solutions

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We’ve become so obsessed with sleep, even our watches can track the amount of quality sleep we get, so we can expect something unusual tonight. We go to bed at our usual time and for most of us in the U.S., we wake up one hour earlier than planned because the clocks have changed. As someone who adapts to sleep changes well, I empathize with those who don’t. Here are a couple of solutions I’ve found, one societal and one personal.

Don’t Change the Clocks

Researchers from Stanford undertook a very complicated theoretical study. By using county solar light patterns, time policy, and health data with circadian models, they calculated the relationship of those variable conditions and diseases. Let’s just say this would be impossible without the number crunching ability of today’s computers.

What they found was that a shift to Standard Time year-round would decrease the occurrence of stroke and obesity. A permanent shift to Daylight Savings Time would also decrease the occurrence of stroke and obesity as well, although not to the same extent. It should be noted that the impact was dependent on both latitude and longitude of people within the time zone.

How big of an impact? With Standard Time it could potentially reduce the risk of obesity by 0.78% and the risk of stroke by 0.09%. Not a big deal? Based on the current population, that could mean a reduction of the cases of obesity by 2.6 million cases and 300,000 cases of stroke per year in the U.S. While this is an emotional as well as political land mine for many proponents and opponents of time changes, this is one variable that deserves consideration.

Naps

Getting some additional sleep, even as little as a 20-minute nap, can be beneficial. Researchers in Greece found that people who took a nap in the afternoon had a lower rate of death from cardiovascular disease (CVD). How much lower? 37%!

This was confirmed by a study published last month suggesting that naps under 30 minutes reduced CVD outcomes—however, naps longer than 60 minutes increased the risk of CVD events. Speculation was that long naps interfered with nighttime sleep patterns.

The Bottom Line

We all look for an easy way to reduce our risk of heart attacks. Sometimes, the simplest solution is the correct one, and you can’t get much simpler than sleep. It can be challenging to fit in a nap during the day, but if you can do it, it may help you to be more effective in what you’re doing and lower your risk of cardiovascular disease and possibly other diseases as well. As for a permanent switch to Standard Time for more early sunlight? That will be open for debate, so we have to do what we can control.

What are you prepared to do today?

        Dr. Chet

References:
1. https://doi.org/10.1073/pnas.2508293122
2. Arch Intern Med. 2007 Feb 12;167(3):296-301. doi: 10.1001/archinte.167.3.296
3. Pub Health Rev. 2026. doi: 10.3389/phrs.2026.1609013.

Warning: Spring Ahead

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This coming weekend, the clocks are moved ahead one hour in most states here in the U.S. This seems to impact some people more than others; our bodies are more sensitive to the effects of changing sleep patterns than we think. I first wrote about this 10 years ago, and I wanted to check to see if anything has changed.

In a 2008 study, Swedish researchers found that when the clocks are turned ahead one hour in the spring, the number of heart attacks increase on the following Monday and stay elevated above the mean for the rest of that week. This was confirmed in a 2020 study that examined the same question in a larger population of Swedish and U.S. citizens.

What about the opposite situation? In the fall after the clocks are turned back, the number of heart attacks goes below the mean for the following week. One hour—that’s all we’re talking about, and it has a profound effect for about 1% of the population. Does one percent sound like no big deal? That’s over 3.3 million people who could be impacted over the next couple of weeks.

Is there a solution to this? I’ll let you know on Saturday. In the meantime, perhaps going to bed a few minutes earlier every night until then may help.

What are you prepared to do today?

        Dr. Chet

References:
1. NEJM. 2008. Oct 30;359: 1966-1968.
2 Arch Intern Med. 2007 Feb 12;167(3):296-301.
3. https://doi.org/10.1371/journal.pcbi.1007927

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