Link Between Heart Rate and Heart Risk in Women
Today I celebrate Mothers Day from Afghanistan (as I complete my tour of duty with the U.S. Army) and felt that we could talk a little about women’s cardiac health. Although not necessarily a new discovery, the issue at hand is the observation that older women who “cruise by” with a higher resting pulse tend to have a higher risk for cardiovascular events when compared with slower pulses.
We have known on one hand that smoking, diabetes and others are well-recognized cardiac risk factors. We also know that a woman’s (and a man’s) resting pulse rate is a good predictor of risk following a heart attack regardless of other risk factors. A couple of years ago, the British Medical Journal published a report from George Washington University School of Medicine and the pharmaceutical company AstraZeneca that evaluated and analyzed records of 129,135 postmenopausal women who had no history of heart problems. Their pulse rates were measured at the start of the study. The researchers found that during almost eight years of follow-up, women with the highest heart rates — at or above 76 beats per minute — were much more likely to suffer a heart attack than the women with the lowest resting pulse rates, 62 beats per minute or less. This association held true regardless of factors such as physical activity levels and did not differ between races or women with or without diabetes, high blood pressure, or cholesterol abnormalities, according to the study authors. Even after adjusting for factors which might affect resting heart rate, including nervousness, depression, tobacco use, alcohol use and body mass index, women with higher baseline heart rates were still at greater risk for heart attack during follow-up.
The relationship between resting heart rate and coronary risk was stronger in women less than 65 years old than in women over 65. The data for the study came from the Women’s Health Initiative. Women with a history of heart attack, stroke or similar serious problems were excluded. Resting heart rate was obtained by trained observers after the women sat “quietly” for five minutes.
Although more expensive and elaborate methods are available to assess risk, the authors “found that simple measurement of resting pulse independently predicts coronary events, but not stroke, in post-menopausal women.” The connection “is less than the association with cigarette smoking or diabetes mellitus but might be large enough to be clinically meaningful and is independent of physical activity.” So, in trying to bring some common sense from the information we are learning here, there is validity in clinical practice and good reason to check pulse and consider periodic electrocardiograms in some, if not most, postmenopausal women. As most of us know, a “natural” way of getting your heart rate down is by exercising regularly as I have recommended on previous blogs.
Happy Mothers Day to my wife Vanessa as well as my Mom.
The burden of diabetes and heart disease in women
Diabetes
Diabetes is a growing epidemic in this country, affecting 25 million Americans. Type 2 diabetes is the most common type, and it results from either decreased insulin production or the body cells are resistant to the action of insulin, which is required for the cells to utilize glucose to produce energy. Certain ethnic groups such as African Americans, Native Americans, Mexican Americans and Asian Americans are at more risk for developing diabetes, and it can be especially hard on women.
The burden of diabetes on women is unique because the disease can affect both mothers and their unborn children. Diabetes can cause difficulties during pregnancy, such as a miscarriage or a baby born with birth defects. Gestational diabetes is noted in 18% of the pregnancies and usually disappears after the pregnancy. Women who have had gestational diabetes or have given birth to a baby weighing more than 9 pounds are at an increased risk for developing type 2 diabetes later in life.
Heart Disease
Women with diabetes are more likely to have a heart attack, and it occurs at a younger age. Diabetic women also do not do well after a heart attack. Silent heart disease is two to four times more frequently seen in diabetic patients. These patients also tend to have severe blockages of multiple arteries when they present with a heart attack and usually do not do well after angioplasty or stent placement.
The increased risk for cardiovascular disease such as heart attack, stroke, peripheral artery disease and heart failure is due to increased prevalence of other risk factors such as high blood pressure and lipid abnormalities. Nearly 65% of diabetic patients have high blood pressure, and all of them have some or other type of lipid abnormalities. The good news is that by taking care of the risk factors, one could substantially reduce the risk of heart attack and stroke. The target blood pressure for a diabetic patient is 130/80, which is lower than the general population. Usually it requires more than 2 blood pressure medications to reach this goal.
The desirable LDL cholesterol (bad cholesterol) without prior heart attack or stroke is less than 100 and less than 70 with a prior heart attack or stroke. Triglycerides, a form of fat, should be less than 150, and HDL (good cholesterol) should be maintained more than 40 for a man, 50 for a woman. Statin group of medications have been shown to be quite effective in lowering the risk of heart attack and stroke in diabetes patients, including women.
Diabetes can be prevented with lifestyle changes such as moderate intensity exercise for 30 minutes, 5 times a week, and a healthy diet.
Learn about the Holy Cross heart team by visiting HolyCrossHeart.com.
Cardiovascular Disease, Stroke and Aneurysms
Alan M. Rosenbaum, MD (Holy Cross Medical Group Cardiologist) explained the link between cardiovascular disease and stroke in our last blog post’s video. Now learn about the cutting-edge device offered at Holy Cross Hospital by Laszlo Miskolczi, MD (NeuroInterventional Radiologist) to patients who have limited treatment options after suffering from a certain type of aneurysm: Pipeline® Embolization Device Offered at Holy Cross Hospital.
Alan M. Rosenbaum, MD, Cardiologist: Interview with Trinity Broadcasting Network
Recently, Alan M. Rosenbaum, MD (Holy Cross Medical Group Cardiologist | Coral Springs, FL) was interviewed on Trinity Broadcasting Network’s Joy In Our Town program. Dr. Rosenbaum educated the public on the link between cardiovascular disease and stroke. Take a look at the interview below:
Learn more about the Holy Cross heart team by visiting HolyCrossHeart.com.
EP Lab Live Video: Rishi Anand, MD, Clinical Cardiac Electrophysiology
Medical Director of Holy Cross Hospital’s Electrophysiology Lab performs an atrial fibrillation ablation and discusses the available advanced technology
Click here to view the video: Rishi Anand, MD on EP Lab Live.
Rishi Anand, MD, clinical cardiac eletrophysiologist and medical director of Holy Cross Hospital’s Electrophysiology (EP) Lab appears on EPLabLive.com, as he performs an atrial fibrillation ablation and discusses the advanced technology available at Holy Cross’ EP Lab.
Learn more about the Holy Cross heart team by visiting http://www.holycrossheart.com.
Holy Cross Hospital Approved to Perform New Transcatheter Heart Valve Implantation Procedure in Patients Who Cannot Undergo Open Heart Surgery
Photo from www.newyorkcityfocus.com/photo_gallery/arellano/holy-cross-or.html
First ever artificial heart valve, recently approved by the Food and Drug Administration,
can be implanted without major surgery
Holy Cross Hospital announced it is now approved to perform transcatheter heart valve implantation (TAVI) procedures in patients who cannot undergo open heart surgery utilizing a first-of-its-kind artificial heart valve that was approved by the Food and Drug Administration in November. According to the FDA, approximately 300,000 patients in the U.S. experience valve deterioration, which means the heart must work harder to pump blood and that often leads to heart failure, blood clots and death. The new Edwards Lifesciences’ Sapien heart valve can be threaded into place through a major artery that runs from the leg up to the heart. The device is approved only for patients who cannot have open heart surgery. “This is a significant development in healthcare,” said Interventional Cardiologist Joshua Purow, M.D., of the Jim Moran Heart and Vascular Center and Research Institute at Holy Cross Hospital. “Some patients face many barriers to cardiac surgery for the replacement of valves whether it’s their age, co-morbidities or an inability to withstand rehabilitation. This new treatment option will change the lives of many patients.”
To accommodate transcatheter artificial heart valve implantations, Holy Cross constructed a new, 2,000-square-foot hybrid interventional operating room, one of the considerations that led to the hospital’s approval from Edwards Lifesciences to perform the procedure.
“We designed the hybrid OR to provide the safest, optimal environment for high-risk patient procedures,” said Holy Cross Hospital President and CEO Patrick A. Taylor, M.D. “Our newest space also advances our overall scope of surgical services and differentiates us from our competition.”
The expansive operating room offers physicians advanced technology to perform leading-edge procedures, including endovascular stent (abdominal & thoracic), balloon valvuplasty, lead extraction, surgical cardiac ablation, bypass LAD with stent, and ASD & PFO closures.
Recognized as a leader in cardiac care, Holy Cross Hospital offers comprehensive cardiac services through the Jim Moran Heart and Vascular Center and progressive research at the Jim Moran Heart and Vascular Research Institute, which specializes in groundbreaking trials enabling its physicians to offer patients access to advanced clinical therapies that would otherwise not be available in the area.
The Jim Moran Heart and Vascular Center at Holy Cross Hospital, located at 4725 North Federal Highway in Fort Lauderdale, offers a wide array of diagnostic services including EKG, stress tests, Holter monitoring, tilt table testing, regular echocardiography, cardiac catheterization, peripheral angiography, peripheral vascular ultrasound and comprehensive electrophysiologic testing. For more information call (954) 229-7970 or visit www.holycrossheart.com.
Heart Failure in Women
by Kristine Raimondo, MSN, ARNP, Heart Failure Clinic Coordinator
and Joshua Larned, MD, Cardiology, Holy Cross Medical Group
Congestive heart failure (CHF) is defined as the failure of the heart as a pump to meet the demands of the body. Heart failure affects approximately 5,000,000 Americans per year and accounts for $39 billion in healthcare expenditures per year. Statistically, heart failure has the potential to affect women in a more severe fashion than men for reasons outlined below. Therefore, it is important to identify women who are at risk for CHF before a diagnosis occurs.
Women are more likely to be under-diagnosed than men with CHF. Therefore, women are more likely to present later with a heart failure diagnosis than men and in a sicker fashion. Specifically, women are less likely to be diagnosed with and treated for coronary artery disease. A failure to diagnose structural heart disease increases the likelihood that women may respond more poorly to heart failure therapy. Fortunately, with proper identification and treatment women can lead normal lives despite a heart failure diagnosis.
There are special considerations with respect to heart failure and women.
For example, women are more likely to experience heart failure with normal left ventricular function. This type of heart failure is commonly referred to as diastolic dysfunction. Women may be more likely than men to experience heart failure related to uncontrolled hypertension or diabetes. Also, common cancers such as breast cancer expose women disproportionately to therapeutic agents, which may cure cancer but increase the risk of CHF.
Evidence suggests that women respond differently to certain heart failure therapy as than men. For example, women are potentially less likely to respond to interventional treatment such as angioplasty and stenting if they have a coexisting CHF diagnosis. On the other hand, women with CHF tend to respond more favorably to cardiac resynchronization therapy if they meet expected indications for a biventricular pacemaker.
At Holy Cross Hospital’s Heart Failure Clinic (a disease management program), we specialize in heart failure across the spectrum of illness and direct attention to each individual patient’s needs. Please contact the Heart Failure Coordinator at 954-229-7974 for any questions you may have or to schedule an appointment with our Advanced Registered Nurse Practitioner.
Learn more about Holy Cross Hospital’s Heart Failure Clinic by visiting www.holycrossheart.com.
Losing Weight (Part 2)
I wanted to continue with the topic started last week by helping you establish the five goals to losing weight. Like I said before, to lose weight, you need to burn more calories than you eat. Every good weight-loss plan has the same two parts: food and physical activity. Wise food choices can help you eat fewer calories and daily (or almost daily) physical activity helps you burn off some of the calories you consume. You lose weight more easily and you’re more likely to keep it off, too.
1. Keep portions smaller than your fist. It’s easy to overeat when you have too much food on your plate (not all foods fit the “fist” rule). The two most common exceptions are:
• Meat, chicken and fish. For these foods, keep portions the size of a deck of cards (about half the size of your fist.)
• Plain vegetables, including salads without dressing. You can have as much as you want because these foods are filling and low in calories.
2. Control your hunger with filling foods that are low in calories. Foods such as soup, salad, fruits and vegetables can help fill you up without adding a lot of calories. These foods will satisfy hunger and help you lose weight. High-fiber foods, such as fruits and vegetables, can provide a feeling of fullness and also digest slowly. That helps you feel satisfied longer so you eat less.
3. Keep track of what you eat. When you keep track of what you eat, you’re more likely to meet your food goals. Studies show that keeping a food log or diary helps people lose weight and keep it off.
4. Make trade-offs to reduce how much fat and sugar you eat. Foods high in fat and sugar are usually high in calories, too. But that doesn’t mean you have to give up your favorite foods. Learn to make trade-offs instead. If you want to indulge in your favorite dessert, eat a lower-calorie meal.
5. Enjoy more physical activity. As you already know, regular physical activity is important for keeping your heart healthy. Increasing physical activity may help you lose weight and strengthen your heart at the same time.
Here are the basics, the rest is on you. Good luck.
Losing Weight (Part 1)
A lot of people come into my office with the diet, weight loss and exercise questions. In the past, I have discussed at length many topics on exercise and risk factors, including obesity. Let me then spend a little time today addressing the issue of weight loss. I realize the topic is easy to talk about; the hard part is to comply with a plan.
Reduce calories in and increase calories out.
Losing weight means changing the balance of calories in and calories out. If we eat more calories than we need, we gain weight. If we eat fewer calories than we use, we lose weight. It’s simple. You need to start by learning how many calories you should eat each day for your individual level of activity, and then you’ll need to find ways to stay within your limits.
So start with good information: you need to know how many calories you should eat each day for your individual level of activity, and then you’ll need to find ways to stay within your limits. To successfully and healthfully lose weight—and keep it off—most people need to subtract about 500 calories per day from their diet to lose about one pound per week.
Educate Yourself
• Learn to use nutritious ingredients and follow a healthy preparation routine.
• Learn to eat healthy when you dine out.
• Learn how to read and understand food labels.
Increase Calories Burned
Regular physical activity has many proven benefits. All healthy adults should get at least 150 minutes of moderate-intensity aerobic physical activity (e.g., brisk walking) every week or 75 minutes of vigorous intensity aerobic physical activity (e.g., jogging, running) every week. In addition, you need at least two days a week of muscle-strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms).
The chart below shows the approximate calories spent per hour by a 100-, 150- and 200- pound person doing a particular activity.
|
Activity |
100 lb | 150 lb | 200 lb |
| Bicycling, 6 mph | 160 | 240 | 312 |
| Bicycling, 12 mph | 270 | 410 | 534 |
| Jogging, 7 mph | 610 | 920 | 1,230 |
| Jumping rope | 500 | 750 | 1,000 |
| Running 5.5 mph | 440 | 660 | 962 |
| Running, 10 mph | 850 | 1,280 | 1,664 |
| Swimming, 25 yds/min | 185 | 275 | 358 |
| Swimming, 50 yds/min | 325 | 500 | 650 |
| Tennis, singles | 265 | 400 | 535 |
| Walking, 2 mph | 160 | 240 | 312 |
| Walking, 3 mph | 210 | 320 | 416 |
| Walking, 4.5 mph | 295 | 440 |
572 |
One thing that has helped me in the past is to keep a food diary at first to help you learn how much you are eating and whether you’re eating out of habit instead of real hunger. You can have phone “apps” that can keep track of this information for you (provided you are dedicated enough to input the data).
Minimally Invasive Heart Therapy to Treat Aortic Stenosis
A new release of a consensus document to help guide the use of a new minimally invasive therapy for aortic stenosis was recently published. With the U.S. Food and Drug Administration’s recent approval of transcatheter aortic valve replacement (TAVR) for patients with aortic valvular stenosis, the American College of Cardiology Foundation (ACCF), along with the American Association for Thoracic Surgery (AATS), the Society for Cardiovascular Angiography and Interventions (SCAI) and the Society of Thoracic Surgeons (STS), released an expert consensus document to provide important guidance on its use.
What is Aortic Stenosis?
Aortic valvular stenosis – or aortic stenosis (AS) – occurs when the heart’s aortic valve narrows, making it difficult for the heart to pump blood through the body. Until recently, some patients with severe AS who were at very high risk for conventional surgical aortic valve replacement had few, if any, options for treatment to help prevent serious heart problems, including heart failure and death. TAVR, an innovative procedure that uses minimally invasive catheter-based technology to replace the aortic valve, represents a new therapeutic option for these severe AS patients who are either extremely high-risk candidates or are inoperable for surgical aortic valve replacement due to associated comorbidities.
Transcatheter Aortic Valve Replacement (TAVR)
“This is a new, transformational technology for our patients; we have never had this type of an approach before. It’s not like another balloon catheter,” said David R. Holmes, Jr., M.D., president of ACC and chair of the writing committee. “As this technology is introduced into practice, detailed and agreed upon protocols are needed to ensure we achieve optimal clinical results. This consensus document provides the field with clear recommendations and guidance for its use.” The new report – a detailed follow-up to the joint position statement from ACC and STS released in late 2011 – examines the current state of the evidence; offers steps to facilitate integration of TAVR into the mix of available therapeutic options for select patients; outlines how it should best be used and how to appropriately select patients to optimize clinical outcomes and encourage responsible application of this promising technology.
TAVR, which was approved by the FDA in November 2011, represents a fundamental change in the management of aortic valvular heart disease by offering an alternative to traditional surgical aortic valve replacement in carefully selected patients, according to the writing committee. Its implementation into the flow of patient care is complex and involves consideration of several key factors, such as clinical site selection; operator and team training and experience; patient selection and evaluation; procedural performance and complication management; and post-procedural care. Therefore, guidance is urgently needed to ensure it is smoothly integrated into clinical practice and followed to achieve real-world benefits and minimize risks to patients. ”Our goal in crafting this expert consensus document is to provide a clear roadmap for the use of TAVR as it reaches patients across the United States,” said Michael J. Mack M.D., president of STS and vice chair of the writing committee. “TAVR innovation is a major advance in treating aortic stenosis, and sick, elderly patients should have access to this new treatment so they can resume normal, active lives. These guidelines are a coordinated effort from the cardiovascular community to help ensure the appropriate use of TAVR therapy for optimum patient safety.”
The consensus document, which is endorsed by a dozen leading medical groups, outlines key recommendations for the successful roll out of this therapy. Among others, these recommendations provide detailed criteria on:
• Careful patient selection.
• Team-based approach given the complexity of the procedure, coupled with the high-risk profile of suitable patients, many of whom have extensive comorbid conditions that require ongoing management.
• Specialized heart centers and physician expertise in treating valve disorders. This includes the use of proctors, as needed, to serve on the heart care team during the first few cases, as well as proper facilities (hybrid operating rooms, like the one we have here at Holy Cross Hospital, or modified cath labs).
• TAVR screening tests to make informed treatment decisions
.
• Enhanced patient and family education in the risk and benefits of this procedure
.
• Ongoing evaluation and participation in national TAVR registry to assess real world outcomes.
An estimated 45,000 patients have received TAVR worldwide. Multiple single and multicenter registries, and a single randomized trial, have documented favorable outcomes using a wide spectrum of endpoints including survival, symptom status, quality of life, and need for repeat hospitalization. Clinical use of TAVR, its continued evolution and outcomes will be evaluated in the new STS/ACC TVT registry, which will further inform future recommendations on application of this transformational technology. “We have tried to collate the evidence into a coherent road map for judicious use, rational dispersion and careful post-marketing scrutiny of this promising technology,” said Sanjay Kaul, MD, a cardiologist at Cedars-Sinai Heart Institute in Los Angeles and vice chair of the writing committee. “It is now the collective responsibility of all the stakeholders to optimize its full potential for improving the duration as well as the quality of survival in patients with severe symptomatic aortic valvular stenosis.”
Which Patients Benefit from this Treatment?
While this technology has the potential to benefit many patients with AS, authors caution that it is not for everyone and stress that more data is needed to ascertain the risk-benefit ratio prior to using this approach in certain groups. At present, and as outlined in the consensus document, TAVR is not recommended in adults who have:
• An acceptable surgical risk for conventional surgical AVR
.
• Known bicuspid aortic valve.
• Severe mitral annular calcification or severe MR.
• Moderate AS
• Other (e.g., severe AR and subaortic stenosis)
The other professional medical and consumer groups represented on the writing committee and that endorse this document include: the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Society of Cardiovascular Computed Tomography, Society of Cardiac Magnetic Resonance, Society of Cardiovascular Anesthesiologists, and Mended Hearts.
About the Center
The Jim Moran Heart and Vascular Center at Holy Cross offers the latest in high-tech cardiac care. Holy Cross was the first in Broward County to offer Induced Hypothermia, which has shown to increase the odds of surviving cardiac arrest, and has been shown to improve neurological outcomes after such an event. We were also the first in Florida to use the Prime ECG Vest which, in select patients, may give physicians additional data beyond a traditional electrocardiogram. Our outstanding cardiovascular team, utilizing cutting-edge technology, can treat any heart and vascular situation especially in an emergency.