Tag Archive for: heart attack

When In Doubt, Check It Out

/in /by

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

/in /by

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

/in /by

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

/in /by

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 . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.

The Silent Killer

/in /by

On Tuesday, I told you about an article sent to me by a long-time reader. Today’s message is about an email sent to me the same day as the other, but it’s quite different.

In the second email, a woman let me know that her husband had passed away in his sleep several months ago. He was not overweight and seemed healthy. When the medical university nearby did an autopsy, they found he had an enlarged heart, most likely due to high blood pressure. That’s one of the reasons hypertension is called the silent killer.

I . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.

Death by Donut

/in /by

There are times when the topics I write about seem to align like astronomical events; it’s as if I’m compelled because of a series of apparently unrelated actions. This time, emails from two people prompted me to write about heart disease. Yes, it’s American Heart Month and I generally write about it every year. But what would get your attention? What might drive you to take action? Let’s see if the messages this week will do it.

Thanks to S.B., a longtime reader, for sending me a link to a story about a man who . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.

Expert Advice on Snow

/in /by

We’ve talked about the science behind the increase in heart attacks with heavy snowfalls. Today I’ll share some expert advice from Randy in Fredonia, New York; here’s what he recommends when you’re dealing with heavy snowfalls:

  • “Pry open your wallet and pay someone with a big machine to take care of the bulk of the snow if necessary.
  • “Hire a kid to dig out your walk.
  • “Wait a few days for it to melt. A couple of days after the snow stopped, it got up to 60 degrees and most . . .

    We're sorry, but this content is available to Members and Insiders only.

    If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.

Why Snow Causes Heart Attacks

/in /by

This week’s messages were inspired by the recent extraordinary snowfall in Buffalo. Continuing with why heart attacks seems to happen more when shoveling show than other types of strenuous activity, let’s consider other factors besides breath holding that occur during a heavy snowfall.

One of those is the actual snowfall itself. A couple of inches of light fluffy snow weighs next to nothing, but heavy wet snow is more like lifting water itself—it’s heavy. For those of you who’ve never had the pleasure, fill a five gallon pail with water, put it on a shovel . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.

Snow and Valsalva

/in /by

I got an email from a long-time friend and reader of my messages who lives in a suburb of Buffalo. You won’t be surprised the topic was snow in light of the recent eight feet of snow that blanketed the area. What you may not know is that I’m originally from a suburb of Buffalo myself, but living in Grand Rapids, we get our share of lake effect snow including the day before that storm hit Buffalo. In our yard, the snow was close to 18 inches.

He emailed me to share some thoughts on how to . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.