“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.
Most health care workers, as well as much of the public, are appropriately focused on COVID-19 and its Delta variant. However, as a cardiologist I deal with heart and blood vessel issues as well. Three new studies involving sudden cardiac death, high blood pressure, and the flu caught my attention.
Sudden Cardiac Death
Sudden cardiac death (SCD) is usually triggered by an abnormal heart rhythm — ventricular fibrillation (VF) — at a rate so rapid, the heart is no longer capable of pumping blood to the brain and rest of the body. SCD claims as many U.S. lives annually as if three 747s carrying 300 to 350 passengers crashed every day of the year. Treatment is the immediate termination of VF by an automated external defibrillator (AED) that delivers a shock to the heart. The challenge lies in getting the AED to the victim rapidly since mortality increases by about 10 percent with each minute spent in VF.
Reaching an out-of-hospital sufferer can take a long time in many locations, such as crowded cities. Positioning AEDs, commonly found in airports, fitness centers, and other places, in strategic locations that could be accessed by passersby could be one approach. Swedish health care workers have gone one step further by employing drones to deliver the AED.
These Swedish health care workers placed three AEDs within controlled airspace covering approximately 80,000 inhabitants. AED drones were flown to suspected victims at locations almost two miles away and arrived within nine minutes in 11 of 12 alerts. Drones arrived prior to ambulances in 2/3 of the cases with a median time benefit of almost two minutes when it arrived first. In 61 additional tests, the drone delivery success rate was 90 percent.
Larger studies will be necessary to determine whether this approach results in lives saved, but it shows that AEDs can be delivered with targeted precision during real life emergencies and seems like a good start to use new technology to treat an old problem.
High Blood Pressure
As my age has increased, so has my blood pressure, a finding very common in older folks. Guidelines have lowered the ideal systolic blood pressure (top number) target based in part on the SPRINT trial, which showed that reducing systolic blood pressure in 67-year-olds to a goal of less than 120 mmHg as compared to a goal of less than 140 mmHg resulted in 25 percent lower rates of heart attack, stroke, heart failure, and death from any cause.
A new trial from China in 8,500 patients 60-80 years old reaffirmed those findings. This study aimed for systolic blood pressures less than 110-130 mmHg. Compared with the control group that targeted blood pressures less than 130-150 mm Hg, the treated group had 26 percent reduction in major cardiovascular events including a composite of stroke, acute coronary syndrome (acute myocardial infarction and hospitalization for unstable angina), acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes.
There are differences in the two trials, but the take home message is clear: reducing systolic blood pressure, even in the elderly, is important and achieves critically significant rewards. Drugs to control blood pressure are the mainstay of treatment (a single polypill combining quarter doses of four antihypertensive drugs is effective). Some drugs such as antidepressants, nonsteroidal anti-inflammatory drugs (NSAIDS), steroids, and alcohol can increase blood pressure. Nonpharmacologic approaches can help reduce blood pressure such as low salt diet and foods rich in flavonoids like tea, dark chocolate, apples, pears, berries and — yes! — wine.
I have emphasized the importance of getting vaccinated against COVID-19. I also want to urge everyone to get an influenza vaccination before the start of the upcoming flu season. Not only does the flu vaccine protect against influenza, it also reduces the risk of heart attacks, stent occlusions, and death in individuals with coronary heart disease. What a bargain! Get your flu shot!
Featured image: Shutterstock
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