Tiny seeds of the flax plant, high in fiber and omega-3s, produce big drops in blood pressure and may prevent heart attacks and stroke, according to new research.

In the study, people with clogged leg arteries taking flaxseed supplements reduced their top blood pressure (systolic) reading by 10 points and the bottom (diastolic) by seven after six months. This change is the largest decrease in blood pressure ever shown by a dietary intervention, says Dr. Delfin Rodriquez of Cuba who presented the results at the American Heart Association 2012 Scientific Sessions.

The promising findings suggest that people with hypertension turn to the safe and inexpensive dietary supplement before starting drug therapy.

Flaxseed Slashes Blood Pressure The Saturday Evening Post

Preventing Sudden Cardiac Arrest

Every two minutes, someone collapses and dies from a malfunction in the heart’s electrical system—a condition called sudden cardiac arrest or SCA—and most of the victims have no idea they are at risk for the tragic event.

“That’s absolutely true,” says Dr. Richard Page, immediate past president of the Heart Rhythm Society and chair of the Department of Medicine at the University of Wisconsin School of Medicine and Public Health. “While a single individual’s chance of dying suddenly is quite small, there are so many people out on the street with some risk that the overwhelming majority of SCA victims have not ever demonstrated cardiac disease.”

The challenge for SCA researchers is two-fold, according to Dr. Page, who recently took time to discuss with us the latest findings on SCA risk factors and symptoms, as well as advances in preventing the heart emergency and saving lives.

“It comes down to two questions,” explains the heart rhythm specialist. “How can we better identify those at risk? And, given the fact we can’t identify all (or even most) of the potential patients: How do we address sudden cardiac arrest when it does happen?

Post: About 250,000 Americans die of sudden cardiac arrest every year. Who is at most at risk?

Dr. Page: Ongoing research confirms that heart structure is an important risk factor. People with an enlarged heart, or heart damage from a prior heart attack, are at higher risk for SCA than those with normal heart structure.

Remember, a heart attack isn’t a sudden cardiac arrest; a heart attack is death of heart tissue due to a blockage in an artery. A person who has a heart attack doesn’t lose consciousness, unless they have a cardiac arrest on top of that.

But it is clear from large, multi-center, randomized studies that many patients with prior injury to the heart or enlargement of the heart are better off with an implanted cardioverter defibrillator (ICD) than without one.

More recently, we have identified certain families who are at higher risk because of cardiomyopathy (a condition in which the heart is enlarged or thickened) or an electrical abnormality called long Q-T syndrome that can be seen on the EKG test. In addition, investigators are identifying the genetic abnormalities that underlie these conditions, as well as some genetic traits that may put one at higher risk of sudden cardiac arrest that are less subtle than abnormal heart structure or function.

Post: Is genetic screening for SCA risk available yet?

Dr. Page: Genetic tests for the general population are not ready for primetime because the genes don’t predict risk adequately. An abnormal EKG, for example, may or may not represent a significant risk to the individual. But we may have genetic tests for general screening five or ten years from now.

Likewise, there continues to be some debate as to the proper way to screen athletes. In Europe (particularly in Italy) everyone who participates in sports is screened with an electrocardiogram. The American Heart Association doesn’t yet recommend that. But they do advise that people be examined and asked about personal and family history. If someone has family members who died suddenly, he or she is clearly at higher risk for SCA and should be evaluated further.

Post: You mentioned that Italy recommends EKGs. Don’t we use echocardiograms (Echos) to screen U.S. athletes?

Dr. Page: We do both in some cases—but according to the risk. The most aggressive method of screening athletes is an exam, a history, an EKG, and an Echo. The echocardiogram defines heart structure. It provides a two-dimensional moving picture that shows chamber size and wall thickness. An EKG provides indirect evidence of structure. For example, alterations in electrical activity may suggest hypertrophy, or a prior heart attack. It doesn’t necessarily tell you if the heart is enlarged or damaged the way an Echo does, but it’s a simple and less expensive test.

Another point about universal screening: Some might say, “Well, let’s just screen everybody.” Well, the problem is that the tests aren’t perfect. If you screen a low-risk population, there will be some false positive results. I am concerned that the Italian protocols have excluded too many athletes. So universal screening of athletes might cause undue concern, and even cause some athletes at low risk to stop competing. Universal screening of low-risk individuals is a double-edged sword.

Are there any symptoms or warning signs of SCA?

Dr. Page: There may be symptoms in some cases. An important warning is passing out, or fainting. Most episodes of passing out are not a cause for alarm. But people should get checked out if they pass out while exercising, or if they experience palpitations and feel close to passing out. In addition, those with a history of heart attack or heart failure need to know their ejection fraction—a number that reflects the percentage of blood that is pumped from the left ventricle with each heartbeat. A good, efficient heartbeat pumps out more than half the blood in that chamber. When the heart is enlarged or scarred, however, the ejection fraction can drop below 35 percent or less. These people are at higher risk of SCA, and may be candidates for an ICD. A patient ought to be able to ask a doctor, “Is my heart enlarged, and if so, is there a number that would suggest I should have a defibrillator implanted?”

Post: What type of test is used to determine the patient’s ejection fraction?

Dr. Page: The most common test used to determine the ejection fraction is the echocardiogram. As I mentioned earlier, this test is basically a two-dimensional movie. Geometric calculations of the chamber volume just before and after the left ventricle squeezes suggest how much blood is pumped from the heart. For example, if the volume was a hundred before it squeezes and 50 after it squeezes, that’s an ejection fraction of 50 percent, which is good. But if the volume was 100 squeezing down to 75, that’s an ejection fraction of 25 percent, which is bad, and adds risk for sudden cardiac arrest.

Post: What should people do to lower their risk of SCA?

Dr. Page: If you have a personal or family history of recurrent pass-out spells, see a doctor. But all of us (whether or not we have heart disease) should care of our hearts. Discuss your cardiovascular risk factors with your doctor. Then, stop smoking, eat properly, exercise, control diabetes, and keep blood pressure and cholesterol in check to protect your heart and blood vessels.

Minimizing the risk of developing heart disease lowers the risk of heart damage and sudden cardiac arrest. Every day, I tell patients they ought to exercise. I don’t want to be a hypocrite, so I work out between 4:30 and 5:30 each morning, and then go to the office. I wish I ate a perfect diet, but I am trying!

Click here for more on SCA and an animation of the life-threatening emergency from The Heart Rhythm Society.

Watch for more from Dr. Page about saving lives with automated external defibrillators (AEDs) in a future Medical Update posting.

Preventing Sudden Cardiac Arrest The Saturday Evening Post

Here are 5 facts from the ongoing HRS Apples and Oranges campaign to help you understand the difference between the two heart emergencies—and why it matters:

1. SCA is a malfunction of the heart’s “wiring” or electrical system that controls your heartbeat. Heart attacks result from bad “plumbing”, or problems within the blood vessels that carry oxygen to the heart muscle.

2. SCA immediately and completely halts blood flow throughout the body, starving the entire body of oxygen. Heart attacks (also called myocardial infarctions or MIs) reduce or block circulation to a particular area of the heart muscle.

3. SCA occurs without warning and is often the first indication of unsuspected heart rhythm problems. Loss of consciousness occurs within 20 seconds. Heart attacks are usually (but not always) preceded by chest discomfort or trouble breathing and happen to people with high cholesterol, high blood pressure, or a personal or family history of heart disease. Heart attacks can trigger the deadly heart rhythm called ventricular fibrillation that causes SCA.

4. SCA has a cure. It is to “shock” the heart back to normal rhythm with a machine called a defibrillator. But the window of opportunity is short—chances of survival decrease about 10 percent for each minute spent waiting for a defibrillator. Fortunately, many therapies exist for heart attacks and getting prompt emergency treatment can avoid or reduce heart muscle damage when symptoms are recognized early.

5. SCA occurs almost 1,200 times per day in the U.S. Heart attacks claim the lives of about 600 Americans daily, including 300 who die before reaching the hospital. Most of those deaths are from SCA.

Click here for more on SCA from The Heart Rhythm Society.

Watch for more about preventing SCA and saving lives in future weeks.

Understanding Sudden Cardiac Arrest The Saturday Evening Post

The new data are consistent with previous research showing that people with migraines also tend to suffer from conditions that are risky to their hearts—diabetes, high blood pressure, obesity, and high cholesterol.

“Our results provide another reason for people with migraines to reduce other risk factors for heart disease,” said study investigator Marcelo E. Bigal, M.D., Ph.D., with Merck Research Laboratories and the Albert Einstein College of Medicine in Bronx, New York.

In the study, researchers surveyed 6,102 migraine sufferers and 5,243 healthy volunteers about headaches, treatment, general health, and any diagnosed heart problems. Findings show that 4.1 percent of those with migraines reported having a heart attack, compared to 1.9 percent of the control group.

Yet to be discovered is the precise role of migraines in the development of cardiovascular disease, and whether drug therapy to prevent migraines or blood clots might help protect the health of migraineurs.

Dr. Bigal’s study is published in the February 23, 2010, print issue of Neurology® <http://www.neurology.org/>.

Heading Off Heart Disease The Saturday Evening Post

A: Severe blockages in coronary arteries can certainly cause a heart attack. Often, such blockages can be propped open with stents, which can relieve the angina. When people have good collateral circulation (new blood vessels bypassing the blocked ones and supplying the heart with blood), then nothing further may need to be done. Imdur (isosorbide mononitrate) helps relieve angina, Taking aspirin, a statin, an ACE inhibitor, and a beta blocker may be recommended, too.

Heart Attack Risk The Saturday Evening Post

A: Unlike warfarin, a blood thinner used for decades that is regulated by blood tests, the experimental drug dabigatran prevents blood clots with a fixed dose that is taken twice daily. The FDA approval of dabigatran, the first of a new class of drugs called direct thrombin inhibitors, is expected sometime this year.

Q: A doctors says our neighbor died in his sleep of a massive heart attack. Could a defibrillator have saved him?

A: While it is possible your neighbor did have a heart attack, the event that likely killed him was an abnormal heart rhythm called ventricular fibrillation. You do not give your neighbor’s age, but assuming he/she was an adult, a heart attack could have triggered the VF. The usual heart rate at rest is around 70 beats/min. During VF, the ventricular rate surges to 400-600/min, preventing effective contraction of the major pumping chambers that deliver unoxygenated blood to the lungs (right ventricle) and oxygenated blood to the rest of the body (left ventricle). The ventricles during VF look like a bag of squiggly worms, a belly dancer gone berserk. With no blood flow to the brain, loss of consciousness occurs in 10 to 20 seconds and death in five to eight minutes. Sudden cardiac arrest occurs almost 1,000 times per day in the U.S., claiming the lives of half of those who have heart attacks before they reach the hospital. It is likely that prompt use of a defibrillator to shock the heart rhythm back to normal could have saved his life.

Questions (and Answers) About Blood Thinners and Defibrillators The Saturday Evening Post

1. Monounsaturated fats in olive oil are associated with lower rates of heart disease and colon cancer, and reduced risk of diabetes and osteoporosis.

2. Quercetin in onions is one of the most powerful flavonoids (natural plant antioxidants). Studies show it helps prevent cancer.

3. Rich in carotenoids, carrots may help lower cholesterol, regulate blood sugar levels, and protect against coronary heart disease and certain cancers.

4. An excellent source of potassium and manganese, zucchini provides your body with vitamins C, B1, and B6.

5. Several population studies associate an increased intake of garlic with a reduced risk of cancers, including stomach, colon, esophagus, pancreas, and breast.

6. Processing makes the cancer-fighting compounds in tomato paste more available to your body because heat breaks down the plant’s cell walls.

7. The type of soluble, cholesterol-lowering fiber found in chickpeas is not only heart-healthy, but helps stabilize blood sugars—particularly important for people living with diabetes.

8. Fresh basil boasts a healthy dose of blood-clotting vitamin K, and its oils and extracts are said to possess antibacterial and antioxidant properties.

9. Omega-3 fatty acids found in salmon promote heart, skin, and joint health. A study in the British Journal of Ophthalmology suggests omega-3s could also protect against age-related macular degeneration (AMD).

10. Data from a study published in Diabetes Care reported that a dietary pattern incorporating more low-fat dairy products may lower the risk of type 2 diabetes in middle-aged or older women.

11. According to a USDA Human Nutrition Research Center on Aging in Boston report, blueberries may improve motor skills and reverse the short-term memory loss that comes with aging.

12. A limited study at the University of Memphis Exercise and Sports Nutrition Laboratory found honey to be one of the most effective forms of carbohydrate gels to ingest prior to exercise, also functioning well in post-workout recuperation.

Salmon with Chickpea Ragu

Salmon with Chickpea Ragu

(Makes 4 servings)

• 1 tablespoon olive oil
• 1 small onion, chopped
• 1 large carrot, peeled and diced
• 1 large zucchini, diced
• 2 cloves garlic, minced
• 2 tablespoons tomato paste
• 4 cups low-sodium chicken broth
• 1 (15.5-ounce) can low-sodium chickpeas, drained and rinsed
• 1 cup basil leaves, sliced into ribbons, plus more for garnish
• ½ teaspoon salt (optional)
• ½ teaspoon freshly ground black pepper
• 4 (6-ounce) skinless salmon fillets

Heat oil in large skillet over medium-high heat. Add onion and cook until soft, about 3 minutes. Add carrot, zucchini, and garlic and cook, stirring, until carrots are firm-tender, about 4 to 5 minutes. Add tomato paste and stir. Add chicken broth and chickpeas and bring to boil. Reduce heat to low and cook, covered, until liquid thickens, about 10 minutes. Remove skillet from heat, add 1 cup basil and ¼ teaspoon each of salt and pepper. Stir and cover to keep warm.

To cook salmon: preheat broiler. Season with remaining salt and pepper. Broil fillets for 8 to 10 minutes per inch thickness, turning once. Serve with 1 ½ cups chickpea ragu in shallow bowl. Garnish with basil.

Nutrition Facts

Per serving: 1 salmon fillet and 1 1/2 cups chickpea ragu

calories: 460

fat: 17 g (saturated: 2.5 g; monounsaturated: 7 g; polyunsaturated: 5 g)

protein: 46 g

carbohydrate: 30 g

fiber: 6 g

cholesterol: 95 mg

sodium: 550 mg

Ellie’s Blueberry Blast Smoothie

Blueberry Blast Smoothie

(Makes 1 smoothie)

• ½ cup nonfat milk
• ½ cup plain nonfat yogurt
• 1 cup frozen unsweetened blueberries
• 1 teaspoon honey

Put all ingredients into blender and process until smooth.

Nutrition Facts

Per serving: 1 smoothie
calories: 195
fat: 1 g (saturated: 0 g; monounsaturated: 0 g; polyunsaturated: 0 g)
protein: 10g
carbohydrate: 40 g
fiber: 4 g
cholesterol: 5 mg
sodium: 134 mg

Spice Things Up!

Krieger says spices such as turmeric (found in curry) and ginger provide anti-inflammatory effects—an observation especially important for anyone suffering from rheumatoid arthritis or inflammation-related ailments.

Healthier by the Dozen The Saturday Evening Post

Lisinopril is a generic drug that is FDA approved for two brand name products—Prinivil and Zestril. It may be prescribed alone or with other medicines to treat high blood pressure and heart failure. Lisinopril may also be given to people who have suffered a heart attack. Left untreated, high blood pressure may damage the heart, kidneys, and eyes. Taking lisinopril helps relax the blood vessels and reduce the risk of heart attack and stroke.

Lisinopril is Good for the Heart The Saturday Evening Post

A: Leading cardiologist Dr. Douglas Zipes replies: Premature ventricular contractions are extra heartbeats coming from the bottom chambers of the heart (ventricles). In the vast majority of people, these beats are completely benign and nothing to fear. They are the commonest cause of palpitations affecting all age groups, and generally increase in number as one ages. I spend a lot of time in my practice reassuring patients that the palpitations they are feeling are nothing to worry about. Be happy you don’t sense them, because they can be a nuisance. I feel them occasionally, focus on what I am doing, and forget about them.

Question (and Answer) About Extra Heartbeats The Saturday Evening Post