Your Health Checkup: Hope for People with Heart Failure: Get a Second Opinion
“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.
Order Dr. Zipes’ new book, Bear’s Promise, and check out his website www.dougzipes.us.
Last week a friend from long ago asked for advice after he developed heart failure. I told him that such dramatic changes have occurred in the care of patients with heart disease that locating an expert familiar with the new approaches might prolong his life.
- Major advances have transformed treatment of heart valves that have become dysfunctional from either narrowing or leaking. Many of these valve repairs or replacements can be achieved without the need for open heart surgery by using catheters placed in a leg blood vessel and manipulated to treat the abnormal valve. The hospital stay is usually just overnight or even same day discharge in some instances, with prompt resumption of normal activities.
- Key advances in creating stents to prop open clogged arteries to the heart have yielded impressive results for patients with arteriosclerotic heart disease due to cholesterol-related problems. Interventional cardiologists implant these stents to restore blood flow to areas of deprived heart muscle.
- Administration of statins, a new concentrated fish oil medication called icosapent ethyl, and a complex drug called PCSK9 inhibitor have been able to drive abnormal cholesterol (LDL) levels to new lows that might even reverse some arterial obstructions.
- Innovations in treating heart rhythm problems with implantable pacemakers, defibrillators, and monitors have saved hundreds of thousands of lives. Electrophysiologists can pinpoint the precise site of abnormal rhythm activity in the heart and eliminate it by destroying the tissue with a catheter directed to that site. This approach has revolutionized treatment of arrhythmias. Early work indicates that finding and eliminating the abnormal rhythm may soon be accomplished noninvasively.
- We have also made important progress in drug development for treating weakened heart muscle responsible for heart failure. A combination drug, sacubitril/valsartan, has been shown to improve outcomes in patients with heart failure. A revolutionary group of gliflozin drugs called SGLT2 inhibitors that began as treatment for diabetes has had spectacular results in improving heart failure in patients whether or not they have diabetes or kidney disease.
Sir William Osler, a famous Canadian physician and co-founder of Johns Hopkins Hospital, once said that the young physician begins his life using twenty drugs to treat one disease while the old physician concludes his life with one drug to treat twenty diseases. This aphorism is no longer applicable, if it ever was, since the choice for treating most heart problems has expanded beyond the capability of any one drug or even one cardiologist unless they specialize in that particular area. While the choice may not be twenty drugs for one disease, but more than one is often the rule and not the exception.
Thus, my advice to patients questioning their care is to seek a second opinion from a cardiologist specializing in the area of their problem. Do not be afraid of hurting the feelings of your present doctor. Any physician truly interested in your wellbeing values a second opinion from another specialist that may help direct your care.
Finally, do not let the present pandemic prevent you from seeking appropriate medical support. Delaying needed treatment will only adversely affect your health.
Featured image: Oleh Slepchenko / Shutterstock
Your Health Checkup: Should I Eat Eggs for Breakfast?
“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.
Order Dr. Zipes’ new book, Damn the Naysayers: A Doctor’s Memoir.
I like to eat two eggs sunny side up, with hash brown potatoes, rye toast, and a double espresso for breakfast sometimes. Those breakfasts may soon be a just a memory. A new study indicates I may have to substitute egg whites for those sunny siders.
According to a report of almost 30,000 U.S. adults (45 percent men; 31 percent black) collected from six prospective cohort studies and followed for 17.5 years, each additional 300 mg of dietary cholesterol consumed per day (about 187 mg cholesterol makes up a large egg) increased the risk of cardiovascular disease (CVD) and death, by 17 percent and 18 percent, respectively. Each additional half an egg consumed per day increased the risk in a dose dependent fashion. The conclusion was that eating eggs for breakfast was associated with higher risk of cardiovascular disease and death.
Other studies support these conclusions. For example, the Nurses’ Health Study included 73,710 women from 1984 to 2012 and 92,329 women from 1991 to 2013; while the Health Professionals Follow-up Study from 1986 to 2012 included 43,259 men. None had chronic diseases to start. The authors found in over 4,833,042 person-years of follow-up that higher intake of a plant-based diet rich in healthier plant foods (like whole grains, fruits/vegetables, nuts/legumes, oils, tea/coffee) was associated with substantially lower coronary heart disease (CHD) risk, whereas a diet that emphasized animal-derived foods was associated with higher CHD risk.
One can question the results of such observational studies for several confounding reasons, including the accuracy of reporting food intake, knowing people have fallible memories and might exaggerate or underestimate intake of certain foods. However, we now have a potential explanation why plant-based diets are beneficial: reduced inflammation.
Recent studies have firmly established the role of inflammation in promoting coronary artery disease (CAD), and that reducing such inflammation can reduce cardiovascular mortality by almost a third.
It turns out that a diet emphasizing plant-based foods reduces inflammation. Researchers randomized patients with CAD to eight weeks of a vegan diet compared with those randomized to an American Heart Association-recommended diet. The two diets differed by the absence of animal protein in the vegan diet. They found that a marker of inflammation was 1/3 lower in those on the vegan diet compared to the AHA diet, with no difference in body mass index, waist circumference or glycemic control. So the vegan diet reduces inflammation, which would be expected to reduce CAD.
The Mediterranean Diet (MD) also reduces inflammation. In a recent study, baseline MD was assessed in 25,994 initially healthy U.S. women in the Women’s Health Study who were followed up to 12 years. The investigators found that a higher MD intake was associated with approximately one-fourth relative risk reduction in cardiovascular (CV) events. The largest mediators of the CV risk reduction from MD intake were biomarkers of inflammation (accounting for 29.2 percent of the MD-CVD association), glucose metabolism and insulin resistance (27.9 percent), and body mass index (27.3 percent).
The MD can be made more “potent” by supplementing it with nuts or extra-virgin olive oil. In a multicenter trial in Spain, investigators assigned 7447 participants (55 to 80 years of age, 57 percent women) who were at high CV risk, but with no CV disease at enrollment, to one of three diets: a MD supplemented with extra-virgin olive oil, a MD supplemented with mixed nuts, or a control diet (reduced dietary fat). They found that the incidence of major CV events was lower among those assigned to a MD supplemented with extra-virgin olive oil or nuts than among those assigned to a reduced-fat diet.
Sadly, I guess I will have to do without my sunny siders in the future. Maybe if I cook them with extra-virgin olive oil and eat some walnuts on the side I can mitigate the harm. After all, as I’ve said before, moderation in all things, including moderation.
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