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Ask The Expert Archive

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Preventive Cardiology Archive Questions

Below are Dr. Miller’s answers to Preventive Cardiology questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 63.

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Q : 1

I heard that there is no clinical evidence showing that statins can prevent heart attacks in women. I understand they are good for people who already have had a heart attack, but not to prevent one initially. Is that true?

Not true. In the "Jupiter" study, women with no history of a heart attack but with high CRP (and generally other risk factors) who took a statin reduced their risk of a first heart attack. Same is true in the "AFCAPS TEXCAPS" study where women with a low HDL (and generally other risk factors) as well as the "ASCOT" study also found reduced risk of a first heart attack when a statin was prescribed in women.

Q : 2

My 83-year-old mother has episodes of very high blood pressure and then will have a low. She has watched her diet all of her life, has been active and has had little salt intake in her diet. Her medications have been adjusted without success. All tests are normal. What can be done to stabilize her blood pressure?

Some older people can have very stiff blood vessels with dramatic fluctuations in blood pressure depending upon diet, medication use, as well as salt and water intake. She needs to be closely followed by a good internist or blood pressure expert.

Q : 3

What do you do when you have both high blood pressure and hydrostatic hypotension, even after medications for the high blood pressure has been removed? Any suggestions?

I would recommend an endocrinologist who can further evaluate whether there may be a glandular or neuroendocrine issue contributing to these blood pressure fluctuations.

Q : 4

How effective are beta-blockers in lowering hypertension in African-Americans? Is it safe to take Tenormin with Prilosec?

They are effective although we have had better success with calcium blockers. And yes, it is safe to take Tenormin with Prilosec.

Q : 5

My total coronary artery calcium score was 464 after a CT scan. Can this score be lowered?

No, but treating your underlying risk factors for heart disease may reduce your risk of a heart attack which is considerably higher as compared to men and women with a coronary calcium score of 0.

Q : 6

I have been researching familial hypercholesterolemia and noticed that it's been labeled as autosomal dominant. Does that mean that in order for a person to have FH, he would have to have a parent with FH?

You are correct that FH is transmitted as AD which means that inheriting the gene from one parent (FH heterozygote) will produce high levels of LDL cholesterol and an increased risk of premature heart disease. What makes FH unusual from a genetic standpoint is that a "double-hit" (inheriting the gene from each parent) in an AD transmitted disorder is usually not compatible with life. However, FH homozygotes do survive birth but at a high price as they have significant build-up of cholesterol plaque during the first two decades of life, leading to heart attacks at a very young age.

Q : 7

Is it okay for heart patients to drink alcohol twice a month?

In general, small amounts of alcohol are protective for your heart but there are medical conditions where alcohol can cause problems even in small amounts. This is something you should discuss with your doctor.

Q : 8

How is smoking related to heart disease?

Smoking just one cigarette directly impairs the endothelium (inner blood vessel lining), which serves as our protective barrier against heart disease. Impairment of the endothelium can lead to the increased risk of blood clots, inflammation and plaque formation, all of which contribute to the development and progression of heart disease.

Q : 9

What happens when atherosclertic plaque ruptures?

A heart attack ensues if the ruptured plaque completely blocks the coronary artery. However, in many if not most cases, plaque rupture does not cause any significant blockage and therefore no symptoms of chest discomfort or heart damage become evident.

Q : 10

What kind of drug do you administer for hypertention? Does it depend on age?

The answer really depends upon other factors including the presence of coronary artery disease, degree of fluid retention, presence or absence of kidney disease, etc.

Q : 11

I am 68 and starting an exercise program. Will a stress test determine my maximum heart rate or will it top out at a target heart rate of about 130 beats per minute?

Your maximal heart rate is approximately 152 (220-age).

Q : 12

How does tea prevent or reduce the risk of a heart attack? It is recommended that regular exercise can prevent MI, but I am suffering from heart disease and feel severe pain in my chest when exercising. Do you have any other suggestions?

Antioxidants present in tea may have cardioprotective properties, although it has not been established that tea per se reduces heart attack risk. Regular exercise offers many cardioprotective properties including improvement in blood pressure, lipids, glucose and blood vessel pliability. A person with heart disease should not engage in exercise if he is experiencing chest pain. Rather, that chest pain should be promptly evaluated by a physician.

Q : 13

Does working at night effect blood pressure?

Even though it has been suggested that night shift work might elevate blood pressure, a large, well-conducted study in nurses did not find increases in blood pressure or an increased rate of hypertension.

Q : 14

I was recently told I have a low triglyceride count. What does that mean and how can it be corrected?

A low triglyceride count means that your body can efficiently handle fat and levels less than 100 are now considered "optimal." Unless you are malnourished, those levels would not need to be corrected.

Q : 15

I am allergic to nickle and was told that all stents had some nickle in them. Are there any stents made of another material?

Current stents contain nickel but future "bio-absorbable" stents may lack nickel. In the meantime, if you have a clogged artery and need to have it opened, a balloon angioplasty may be the most suitable option.

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