Wednesday, February 21, 2007

Heart Disease Prevention Suggestions: Some Good, Some Bad

It's been a while since my last post. I've been looking for something different, creative or idiotic to talk about as it pertains to the heart, but things have been a bit lean of late. Fortunately, heart disease prevention literature seemed to rise to the top this week - some good, and some bad.

In the "good" category, was the American Heart Associations's "Evidence-based Guidelines For Cardiovascular Disease Prevention in Women: 2007 Update," published in Circulation online before print this week. One amazing factoid that I did NOT hear emphasized in the media from that paper:
"In many countries, including the United States, more women than men die every year of cardiovascular disease, a fact largely unknown by physicians."
Some tidbits from that paper:
  • Don't smoke
  • Get active (Walk 30 min/d)
  • Limit saturated and trans fat intake, sodium intake (less than 2.3 grams/day) and eat more fish (at least two times/week)
  • Keep your waist less than 35 inches or body mass index between 18 and 25.
  • Consider Omega-3 fatty acids for women with coronary disease
  • Keep blood pressure under control (<140/90 for sure)
  • Keep LDL low and HDL high
  • And keep diabetes controlled with hemoglobin A1C measurements less than 7%.
  • Take a slightly higher (325 mg) aspirin rather than 160 mg, if you're at high risk of another cardiovascular event
  • Use beta blockers and ACE inhibitors (or angiotensin receptor blockers) after a heart attack
In summary, not much new here, really. But what WAS interesting are the things NOT found helpful to prevent coronary disease in women:
  • Hormone replacement therapy
  • Antioxidant vitamin supplements (Vitamin E, C, and beta carotene)
  • Folic Acid with or without B6 or B12 supplementation
  • Routine use of aspirin for women under the age of 65

Now in under the category of "bad" prevention recommendations, comes this trial from the American Journal of Clinical Nutrition that was just released today on Reuters newswire touting the benefits of caffeine at preventing heart disease deaths in the elderly. A closer look at this study demonstrates it used survey data from 1982-1984 with follow-up surveys analyzing deaths from follow-up surveys in 1986, 1987, and 1992 and used ICD9 codes to determine the cause of death from death certificates. The "study" data do not take into account improvements in cardiovascular care over that period. Thank goodness the authors admitted:
The current study was an epidemiologic study and does not prove a cause-and-effect relation. This study does not provide a valid basis for recommending increased consumption of caffeinated beverage.
Too bad the press couldn't have read this as well before publishing their piece suggesting that grandma or grandpa get stoked with coffee each morning to prevent a cardiac death.


1 comment:

Anonymous said...

I appreciate your summarization of the AHA article. Guess I'll need to read it, and also speak with my cardiologist about Omega3 and potential ASA change...I'm spot on with the other recommendations in your summary.