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 14 of 14.

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Q : 1 01/10/2009	Can cardiac problems occur without high cholesterol level? Yes, high cholesterol represents only 1 of several important risk factors including smoking, high blood pressure, diabetes and of course, how we deal with stress, the hardest risk factor to quantify. Having any of these factors increases our risk for heart disease even when cholesterol levels are "normal".
Q : 2 12/15/2008	Can someone have hypertensive heart disease, yet have no cornary artery disease? A 36-year-old friend of mine just died of HHD. Absolutely. Hypertension can go undetected for many years without having symptoms of heart disease. The ideal blood pressure is less than 110/70 whereas a "normal" blood pressure is less than 120/80 mmHg, prehypertension is 120-139/80-89 and high blood pressure is defined as a systolic blood pressure of at least 140 mmHg and/or diastolic blood pressure of at least 90 mmHg. Your friend may have had very high blood pressure that was not diagnosed or treated sufficiently leading to premature death.
Q : 3 09/09/2006	What is the most preferred drug for the treatment of intermittent claudication and why? There are no other heart related complications. Pletal (cilostazol) is the only FDA approved medication to demonstrate consistent benefits on both objective measures of exercise capacity and subjective measures of everyday functioning and quality of life.
Q : 4 08/07/2006	My husband has high blood pressure and feels fine. When he takes his blood pressure medicine and his blood pressure drops to 116 over 65, he feels horrible and his pulse goes up to 120 or more. When his blood pressure is high his pulse is around 65 to 70. When his pulse is really fast and blood pressure is low he feels like he is going to faint and he is very grouchy. What do you think we should do about this problem? Some medications that lower blood pressure also increase heart rate. Therefore, he needs to be re-evaluated by his physician to determine the proper regimen that effectively lowers blood pressure without adversely impacting heart rate.
Q : 5 06/16/2006	Can you describe to me what physiologically happens with smoking as a risk factor and what it does to increase risk? What happens to increase the plaquing process? Smoking has a number of adverse effects that may accelerate hardening of the arteries. They include increasing stickiness of platelets which may lead to increased blood clotting tendency. Smoking also causes the inner or protective barrier of our blood vessels (known as the endothelium) to become dysfunctional and not release protective chemicals that in turn may lead to blood vessel constriction or narrowing. Smoking lowers levels of the good cholesterol and may increase formation of cholesterol deposits in our arteries increasing our risk of heart attack, stroke and peripheral artery disease. Importantly, you do not need to smoke 1 pack a day as a single cigarette may cause some of these undesirable effects.
Q : 6 02/07/2006	Hi. I am interested in taking the low dose asprin to prevent heart disease. However, about 8 years ago, I had an allergic reaction to either Naproxin or Ibuprofen - I don't remember which. My allergist at the time (and my pharmacist) both said I don't need to worry about asprin causing a reaction. Any thoughts on the matter? Thanks. Aspirin is not innocuous so before considering taking it on a regular basis to prevent heart disease, I would suggest that you discuss it with your physician. I am not aware that having an allergy to a nonsteroidal such as ibuprofen, would translate into same with aspirin.
Q : 7 01/24/2006	Recently I went to a store and I measured my blood pressure. The systolic blood pressure was >>160. I am just worried what the impact of this high blood pressure will be. How will it affect my heart and how can I reduce it? Untreated elevations in blood pressure defined as systolic (top number) greater than 140 and diastolic (bottom number) greater than 90 mm Hg may over time lead to heart disease and stroke. One reading of a high blood pressure does not define hypertension but I would recommend a visit to your primary care doctor who can recheck the levels on separate occasions and determine the proper course of therapy.
Q : 8 12/30/2005	I am a 27 year old white male with a strong family history of heart disease. I have recently had a physical with my primary care physician and was referred to a cardiologist for "preventitive reasons". Both doctors want me to go on a medication called Advicor. My total cholestorol is around 198, which as I understand it is just within the normal range. At my age and with my cholestorol level should I seek out another opinion before I jump into medication? Is your program something that could help me without the use of drug therapy? As you know, Advicor is a medication that combines a statin (Lovastatin) with extended release niacin (Niaspan). This combination effectively lowers LDL (bad cholesterol) and triglycerides (blood fats) as well as raises HDL (good cholesterol). You did not provide your complete lipid panel. However, despite a relatively normal total cholesterol, it is still conceivable that your LDL, triglycerides and HDL are all abnormal. We do treat young patients such as yourself, with medications if there is sufficient justification, such as a very strong family history of early heart disease in a 1st degree relative (under the age of 40, for example), the presence of diabetes, or other risk factors such as elevated blood pressure with abnormal lipid values despite a seemingly normal total cholesterol. In view of your young age, your case would be highly individualized to take all of your risk factors into account. Given that both your primary physician and cardiologist have provided concordant recommendations, they likely feel that you are at high risk for early heart disease and therefore may benefit from this proactive approach. Keep in mind however, that medication is likely to be most effective when other cardiopreventive strategies such as lifestyle measures are in full force. Good luck and best wishes for a heart healthy 2006!
Q : 9 12/18/2005	My cholesterol, blood pressure, weight, and stress are under control but my calcium score is high, i.e., 2300. I have had an MI event 5 years ago with primary artery totally occluded, secondary about 60% occluded. No surgeries were performed because my body/heart generated a consideral collateral supply network which is so high that bypasses were not deemed necessary. My cardiologist said that I am in the 95th percentile for another MI, yet offers no way of reducing my calcium score. Do treatments exist that would lower my score? Calcium generally represents stability so calcified lesions are less likely to cause a heart attack, although they may well cause symptoms of angina. However, having a high calcium score suggests that you may have other lower grade blockages that may be more problematic. Therefore, the recommendation is to aggressively treat all of your heart disease risk factors. By doing so, you will also reduce your risk of a heart attack, even if the calcium score is unchanged. This is because you will make the more dangerous though less calcified areas, less likely to cause problems. That means getting your cholesterol, blood pressure, blood sugar, and weight down if they are elevated. Good Luck!
Q : 10 11/28/2005	Your program sounds as if it is just for prevention. I have been referred to see a cardiologist for palpitations, irregular heart beat and abnormal ekg. I am 47. I do not have a diagnosis yet, as of I am having a hard time getting into seeing a cardiologist for a first time visit. Is your program set up for diagnosis and treatment of cardiac problems or just rehab after diagnosis is made? Yes, our program is set up to be able to conduct evaluations within 2-3 working days. The process is initiated by contacting our ambulatory care center and requesing an urgent evaluation. You will then be set up to see one of our full-time associates who will then conduct a thorough evaluation in order to diagnose and get at the root of your problem. The number is 410 328-7877. Good luck!
Q : 11 11/11/2005	My wife has experienced high blood pressure during the past year or so, and has tried a variety of drugs and drug therapies, without noticeable change or improvement. She jokingly says she seems to feel worse than she did when she first experienced HBP, and perhaps should stop taking these medications. Is there any truth to this? Is it possible that she might actually feel better without the medications? High blood pressure may be a silent but potentially fatal disease. The good news is that if HBP is controlled, then these risks are reduced. It is well established that lifestyle and medications when necessary are important in treating elevated pressure. If your wife is experiencing side effects from the medications, then she should speak with her physician about either reducing the dose of the first agent and adding a low dose of a second agent or trying another class altogether. The goal is to find the right therapy to control her HBP without adverse effects. Good luck!
Q : 12 11/10/2005	I have experienced some minor chest pains and heart palpitations. Also, I am more tired than before (i.e. after walking up a long flight of stairs). I am only 33 and quite healthy (I believe). Do you think getting an EKG done would be good? Is it a good test to show minor problems with the heart? It sounds like you may need a more thorough medical evaluation than provided by an EKG alone and I would suggest a visit to an internist. An EKG alone, is generally insufficient by itself but can be useful when combined with your medical history, examination and blood testing. Good luck!
Q : 13 11/06/2005	Other than thinning one's blood, how is it that aspirin prevents some heart diseases and problems? Aspirin may also display anti-inflammatory properties which in turn may reduce the progression of hardening of the arteries. If inflammation is also at the root of other conditions, such as certain cancers, aspirin may also be potentially effective as well.
Q : 14 11/02/2005	I'm 64 years of age and I'm in good health and am an avid golfer. My problem is a 42 heart rate. I have just gone to a cardiologist and he says its okay. I went to another one last year same answer. I'm still concerned. Do you have an answer? At rest it runs 42 but it increases when activity increases up to about 135 to 140. My problem is when I exert myself in any way I'm out of breath or just feel wiped out. Is this related to the slow heart rate? Having a heart rate of 42 may indicate excellent conditioning or an abnormal heart conduction system. The high heart rates that you are experiencing coupled with the shortness of breath are concerning and therefore, I would strongly suggest that you seek additional cardiovascular evaluation promptly.

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