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Health Headlines

FitSugar — Wed, 10 Oct 2007 02:00:00 -0700

There are some health headlines that are worth sharing. Often the stories behind the headlines live up to their tag lines. Check out these three stories with "double take" deserving headlines.

Nutrition: An Up Side to Hard Times – New York Times
An interesting analysis of the health benefits of Cuba's economic crisis. The average daily calories consumption per person dropped by almost 1000 calories and people started walking more. There were significant decreases in the rates of obesity, diabetes, coronary heart disease and stroke.

Sales Call Leads to Kidney Donation – CNN
A door-to-door vacuum cleaner salesman donated one of his kidneys to a potential client too broke to use a vacuum cleaner due to his illness.

And this just in time for Halloween...

Hair-Raising Ideas to Cure Baldness – USA Today
Could scalp transplants, donated from corpses, be the next cure for baldness? Hair restoration specialists explore the possibilities.

Source

Diabetes Awareness Has a New Face: The Rock

FitSugar — Thu, 13 Aug 2009 08:00:55 -0700

As the new national ambassador for the Diabetes Aware campaign, Dwayne "The Rock" Johnson says,

"Get outside. Play a game. Do something active together. We can make a difference in our own families through exercise, eating right, and teaching healthy behaviors to our children."

Past ambassadors include Halle Berry, Cuba Gooding Jr., and Dustin Hoffman, so hopefully The Rock can continue to raise awareness about reducing the risk of developing type 2 diabetes by living a healthy lifestyle. Diabetes Aware helps educate folks on type 1 diabetes as well.

We should be seeing Diabetes Aware public service announcements starring The Rock soon, but until then, if you want to see the most recent PSA starring Kevin Kline and Jon Lovitz, then read more.

Will the Swine Flu Affect Your Travel Plans?

FitSugar — Thu, 30 Apr 2009 04:30:00 -0700

Swine flu is continuing to spread to numerous healthy people, as over 100 cases have been reported now in 11 US states. Sadly, the swine flu has also recently claimed the life of a 23-month-old Mexican boy seeking treatment in Texas. Canada, Austria, New Zealand, Israel, Britain, and Germany have also reported cases of swine flu sickness. In Mexico, 159 people have died and more than 1,300 are being tested for the infection. In Spain, a woman who hasn't traveled to Mexico has come down with the swine flu.

This is extremely serious, as the World Health Organization has raised its pandemic alert for swine flu to phase 5 (phase 6 is the highest level). Officials from the US, Japan, Britain, France, Canada, Israel, Australia, and other countries are discouraging nonessential travel to Mexico. Even Cuba and Argentina have suspended flights to and from Mexico, so with these recent travel restrictions . . .

Source

Fittingly Green: 3 Ways to Recycle Your Sneaks

FitSugar — Thu, 09 Apr 2009 09:00:00 -0700

One great thing about running is that you don't need a lot of gear to participate in the sport. Basically you need a good pair of sneakers. When your sneakers wear out, don't just toss them away. You can recycle them and green up your running habit. Here are three different organizations that want your old running shoes:

Soles 4 Souls' tag line is "Saving the world - one pair at a time." This organization takes your tired, but "gently worn," sneakers and finds needy feet to fill your old shoes. They strongly suggest organizing shoe drives and mailing all the pairs to one of their three warehouse locations.

One World Running has been serving runners around the world since 1986. Through collection programs, they are able to provide shoes for runners to many countries including Cuba, Nepal, and Mali. Check here for drop-off locations.

To see one organization that will take your well-worn shoes, read more.

Nike Reuse a Shoe takes all brands of sneakers that are beyond "gently worn" and turns those old shoes into a recycled product known as Nike Grind. Once your recycled shoes are reformulated into Nike Grind, they are used to make tracks, indoor basketball courts, fields, and playgrounds. Just drop off your retired sneakers at any Nike store, or check here for locations.

Source

Atherosclerosis

FitSugar — Wed, 08 Oct 2008 17:34:56 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Atherosclerosis is a slow disease in which arteries become clogged and hardened. Fat, cholesterol, calcium, and other substances form plaque, which builds up in arteries. Hard plaque narrows the passage that blood flows through and causes arteries to become hard and inflexible (atherosclerosis is also known as hardening of the arteries). It leads to cardiovascular disease, which is the leading cause of death in people over 45. Soft plaque is more likely to break free from the artery wall and cause a blood clot, which can block blood flow to vital organs.

The effects of atherosclerosis differ depending upon which arteries in the body narrow and become clogged with plaque. If the arteries that bring oxygen-rich blood to your heart are affected, you may have coronary artery disease, chest pain, or a heart attack. If the arteries to your brain are affected, you may have a transient ischemic attack (TIA) or a stroke. If the arteries in your arms or legs are affected, you may develop peripheral artery disease. You may also develop a bulge in the artery wall (aneurysm).

Lowering blood pressure and LDL ("bad") cholesterol levels, quitting smoking, losing weight, and getting more exercise can prevent atherosclerosis.

Signs and Symptoms

Often, there are no symptoms of atherosclerosis until a significant percentage (40%) of an artery becomes clogged with plaque. Symptoms vary depending upon which arteries are affected.

Coronary Artery Disease

Symptoms of coronary artery disease (obstruction of the heart arteries) are usually triggered by physical exercise, sexual activity, exposure to cold weather, anger, or stress. The most common symptoms include:

Chest pain (generally a heavy, squeezing, or crushing sensation with possible burning or stabbing pains)
Abdominal, neck, back, jaw, or shoulder/arm pain
Weakness
Perspiration
Shortness of breath

Cerebrovascular Disease

Cerebrovascular disease (obstruction of the arteries that supply the brain with blood) can cause transient ischemic attack (a sudden loss of brain function with complete recovery within 24 hours) and stroke. Symptoms may include:

Weakness or paralysis on one side of the body
Trouble speaking or understanding speech
Loss of vision in one eye
Muscle weakness
Sudden trouble walking
Dizziness
Loss of balance or coordination
Sudden severe headache

Peripheral Artery Disease

Peripheral artery disease affects the arteries that supply the arms and legs with oxygen-rich blood. Symptoms may include:

Pain, aching, cramps, numbness or sense of fatigue in the leg muscles (intermittent claudication)
"Bruits" (blowing sounds your doctor can hear with a stethoscope that indicate turbulence in blood flow)
Hair loss
Thickened nails
Smooth, shiny skin surface
Skin that is cold to the touch
Gangrene

What Causes It?

No one knows the exact cause of atherosclerosis. Many researchers believe it begins with an injury to the innermost layer of the artery, known as the endothelium. The following factors are thought to contribute to the damage:

High blood pressure
Elevated LDL ("bad") cholesterol
An accumulation of homocysteine (an amino acid produced by the human body, thought to be a risk factor for heart disease, stroke, osteoporosis, diabetes, and dementia)
Smoking
Diabetes
Inflammation

Once the artery is damaged, blood cells called platelets accumulate there to try and repair the injury. Over time, fats, cholesterol, and other substances also build up at the site, which thickens and hardens the artery wall. The amount of blood that flows through the artery is decreased, and the oxygen supply to organs also decreases. Blood clots may form, blocking the artery or entering your bloodstream and blocking blood supply to other organs.

Because many people do not have the classic risk factors of atherosclerosis (such as cigarette smoking and high blood pressure), it is possible that there may be other causes, such as an infection. Research is continuing to find the causes.

Risk Factors

Being male
If female, being past menopause
High blood pressure
High LDL ("bad) cholesterol or triglycerides (fats in the blood)
Diabetes
Being overweight
Smoking
A family history of heart disease
Elevated homocysteine levels
Sedentary lifestyle
Diets high in saturated fat and trans fatty acids (trans fats)
Depression

What to Expect at Your Provider's Office

Your doctor can determine your risk for heart disease by conducting a variety of tests. Blood tests can detect high levels of cholesterol, homocysteine, and blood clotting factors. A stress test (otherwise known as an exercise tolerance test) monitors your heart rate and blood pressure while you walk on a treadmill or ride a stationary bicycle. An electrocardiogram (ECG) is used during a stress test to detect abnormal heart rhythms, scar tissue in the heart muscle from a prior heart attack, and areas of decreased blood flow to the heart. Imaging techniques used during a stress test (such as an ultrasound) can determine precise areas where blood flow to the heart may be decreased. An angiogram (or angiography), where your doctor injects a dye into your arteries and then performs a chest x-ray, can reveal areas of damage and plaque buildup.

Preventive Care

Atherosclerosis can be prevented by adopting health lifestyle choices.

Stop smoking.
Exercise at least 30 minutes a day, 6 days a week.
Eat healthy foods, such as fruits, vegetables and whole grains that are low in saturated fat and high in fiber.
Maintain a normal weight (or lose weight if you need to).
Reduce stress.
If you have high blood pressure, high cholesterol, diabetes or another chronic condition, work with your doctor to keep it in check.

Treatment Options

Healthy lifestyle choices (see "Preventive Care" section) are important in preventing and treating atherosclerosis. Your doctor may prescribe drugs to lower cholesterol or blood pressure and to prevent complications. Nutrition and dietary supplements may be helpful when used in addition to certain medications. Some herbs have also shown promise in lowering cholesterol levels and reducing the risk of heart disease.

Drug Therapies

Cholesterol-Lowering Drugs

If, after making adjustments to your diet and exercise habits, your LDL ("bad") cholesterol remains high, your doctor may prescribe medications to lower it. If your cholesterol is extremely elevated (more than 200 mg/dL), you may start drug therapy at the same time you make lifestyle changes. Drugs commonly used to treat high cholesterol include:

Statins (such as lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin, and fluvastatin) -- These are usually the drugs of choice as they are easy to take and have few interactions with other drugs. People who are pregnant or have liver disease should not take statins.
Niacin (nicotinic acid) -- in prescription form, is sometimes used to lower cholesterol. Dietary supplements of niacin should not be used instead of prescription niacin, as it can cause side effects. Take niacin for high cholesterol only with your doctor's supervision.
Bile acid sequestrants (such as cholestyramine, colestipol, and colesevelam) -- People who have high levels of triglycerides (fats in the blood) should not take bile acid sequestrants.
Fibric acid derivatives (such as gemfibrozil and clofibrate) -- effective at lowering triglyceride levels, and moderately effective at lowering LDL.

If you do not respond to one class of drugs, you doctor may use a combination of drugs from two classes.

Blood Pressure-Lowering Drugs

If, after making adjustments to your diet and exercise habits, your blood pressure remains high, your doctor may prescribe medications to lower it. Among the drugs used to lower blood pressure are:

Beta-blockers (such as acebutolol or Sectral, atenolol or Tenormin, bisoprolol or Zebeta, carteolol or Cartrol, metoprolol or Toprol XL, nadolol or Corgard, and propranolol or Inderal) -- slow the heart rate, thus lowering blood pressure.
Angiotensin-converting enzyme (ACE) inhibitors (such as benazepril or Lotensin, captopril or Capoten, enalapril or Vasotec, fosinoprol or Monopril, lisinopril or Prinivil, and ramipril or Altace) -- expand blood vessels, allowing blood to flow more freely and decreasing the burden on the heart.
Diuretics (chlorothiazide or Diuril, furosemide or Lasix, hydrochlororthiazide or Esidrix/Hydrodiuril, indapamide or Lozol) -- rid the body of excess fluid and sodium, lowering blood pressure.
Angiotensin-2 (AT-2) receptor agonists (such as candesartan or Atacand, eprosartan or Teveten, irbesartan or Avapro, losartan or Cozaar, telmisartan or Micardis) -- have results similar to ACE inhibitors but have fewer side effects.
Calcium-channel blockers (such as amlodipine or Norvasc, bepridil or Vascor, diltiazem or Cardizem, felodipine or Plendil, nifedipine or Procardia, nisoldipine or Sular, and verapamil or Calan/Isoptin/Verelan) -- block calcium from moving into the heart and blood vessels.

Sometimes drugs from these classes may be combined.

Blood-Thinning Drugs

Blood-thinning drugs -- antiplatelet agents and anticoagulants -- are used to keep blood clots from forming.

Aspirin -- reduces risk of transient ischemic attack (TIA), stroke, and heart attacks
Ticlodipine -- for people who cannot take aspirin (due to allergies, for example) or do not improve from aspirin; has more side effects than aspirin
Dipyridamole -- not as effective as aspirin when used alone but may be used in combination with aspirin or warfarin (another blood thinner)
Clopidogrel -- reduces risk of heart attacks
Glycoprotein IIb/IIIa receptor agonists (such as abciximab, eptifibatide, lamifiban, and tirofiban) -- used when awaiting or just following an angioplasty
Heparin -- anticoagulant; given by injection
Warfarin (Coumadin) -- often used after a heart attack

Surgery and Other Procedures

Several different procedures (surgical and non-surgical) may be performed depending upon the location and severity of atherosclerosis.

Non-surgical techniques

Angioplasty -- used to widen narrowed arteries. A surgeon inserts a catheter with a deflated balloon into the narrowed part of the artery. The balloon is inflated, widening the blood vessel so blood can flow more easily. The balloon is then deflated, and the catheter is removed. A permanent stent (wire mesh) may be inserted to hold the artery open and improve blood flow.
Atherectomy -- a procedure to remove plaque from the arteries using a laser catheter or a rotating shaver.

Surgical Procedures

Bypass surgery -- A surgeon uses a blood vessel from another part of your body or an artifical tube to reroute blood around clogged arteries.
Minimally invasive bypass surgery -- uses a small incision rather than the broad opening in the chest wall created during regular bypass surgery.
Endarterectomy -- used to remove plaque in the carotid (neck) or peripheral arteries.

Complementary and Alternative Therapies

Nutrition and Supplements

Healthy eating habits can help reduce high cholesterol, high blood pressure, and overweight -- three of the major risk factors for heart disease. The American Heart Association (AHA) has developed dietary guidelines that help lower fat and cholesterol intake and reduce the risk of heart disease. The AHA does not recommend very low-fat diets, because research shows that people benefit from unsaturated ("good") fats, such as those found in olive oil, in their diet.

Many fad diets are popular, but they may not help you lose weight and keep it off -- and in some cases, they may not even be healthy. Any healthy diet will include a variety of foods. If a diet bans an entire food group (such as carbohydrates), it's probably not healthy.

The AHA recommends the following for healthy eating:

Grains: 6 - 8 servings per day (half should be whole grains)
Vegetables: 3 - 5 servings per day
Fruits: 4 - 5 servings per day
Fat-free or low-fat dairy: 2 - 3 servings per day
Lean meat, poultry, seafood: 3 - 6 oz. per day (about the size of a deck of cards)
Fats and oils: 2 - 3 tbsp. per day (use unsaturated fats such as olive oil or canola oil)
Nuts, seeds, legumes: 3 - 5 servings per week
Sweets, sugars: 5 or fewer servings per week (the fewer, the better)

In addition, the AHA also recommends eating 2 servings of fatty fish (such as salmon or lake trout) per week; holding sodium (salt, including salt already added to food) to less than 2,400 mg per day; and limiting alcohol intake to one drink a day for women and two for men.

Diets for People with High Blood Pressure

People with high blood pressure especially need to lower the amount of sodium in their diet. The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes a diet rich in fruits, vegetables, and low-fat or non-fat dairy products that provide high intake of potassium, magnesium, and calcium sources. Sodium intake should be between 1,500 - 2,400 mg per day (the lower, the better). Weight loss, regular physical activity, and limiting alcohol are also very important factors for lowering blood pressure.

Mediterranean Diet

The Mediterranean style siet concentrates on whole grains, fresh fruits and vegetables, fish, olive oil, and moderate, daily wine consumption. The Mediterranean style diet is not low-fat. Instead, it is low in saturated fat but high in monounsaturated fat. It appears to be heart-healthy: In a long-term study of 423 patients who had a heart attack, those who followed a Mediterranean style diet had a 50 - 70% lower risk of recurrent heart disease compared with people who received no special dietary counseling.

Supplements and Vitamins

Talk with your doctor before taking any of these vitamins, minerals, or supplements to make sure they are right for you; to establish the proper dose for your condition; and to make sure they do not interact with any prescription drugs, or herbs or supplements you also might be taking.

Folic acid (400 mcg per day), vitamin B6 (25 - 100 mg per day), vitamin B12 (2 - 100 mcg per day) -- The B vitamins help the body break down homocysteine, an amino acid that's been linked to increased risk of heart disease and stroke. Researchers believe that homocysteine may also contribute to atherosclerosis by damaging artery walls, thus causing blood clots to form -- but so far they haven't found a definite link. Researchers also don't yet know whether taking B vitamins reduces the risk of atherosclerosis or heart disease, nor do they know how much might have an effect. If you have a number of risk factors for heart disease, talk to your doctor about checking your homocysteine levels and whether your doctor would recommend a B complex vitamin supplement. In the meantime, be sure to get enough B vitamins through your diet by eating fruits and leafy green vegetables every day.

Omega-3 fatty acids, found in fish oil (1 - 4 g per day) -- There is good evidence that omega-3 fatty acids (namely EPA and DHA) found in fish oil can help prevent and treat atherosclerosis by preventing the development of plaque and blood clots. Omega-3s can also help prevent heart disease, lower blood pressure, and reduce the level of triglycerides (fats) in the blood. The AHA recommends that people eat at least two servings of fatty fish (such as salmon) per week. For people with heart disease or those who need to lower triglycerides, fish oil supplements may be necessary. Because fish oil at high doses can increase the risk of bleeding, talk to your doctor before taking a high dose (more than 1 g per day), especially if you already take blood-thinning medication.

Beta-sitosterol (800 mg to 6g per day in divided doses about 30 minutes before meals) -- Beta-sitosterol is a plant sterol, a compound that can stop cholesterol from being absorbed by the intestines. A number of well-designed scientific studies have shown that beta-sitosterol does lower LDL ("bad") cholesterol levels in the body. Beta-sitosterol may lower the amount of vitamin E and beta-carotene absorbed by the body, so you may want to ask your doctor if you need to take extra E or beta-carotene.

Potassium -- Potassium is necessary to keep the electrolyte balance in the body and for nerves to function properly. Some diuretics may cause the body to get rid of too much potassium. If you take a prescription diuretic, your doctor may also recommend a potassium supplement.

Policosanol (5 - 10 mg two times per day) -- Policosanol is a mix of waxy alcohols usually derived from sugar cane and yams. Several studies have indicated it may lower LDL ('bad") cholesterol and possibly even raise HDL ("good") cholesterol. One study found that policosanol was equivalent to fluvastatin (Lescol) and simvastatin (Zocor) in lowering cholesterol levels. It may also inhibit blood clots from forming. However, most studies have been conducted in Cuba by a research group that uses a proprietary form of policosanol and is funded by the manufacturer, so it is hard to evaluate the evidence. Policosanol may increase the risk of bleeding, and should not be taken by people who also take blood-thinning medication.

Antioxidant vitamins (beta-carotene, C, E) -- Some large, observational studies have suggested that people who consume more antioxidant vitamins have a lower risk of heart disease than those who consumer lower amounts. However, no studies have shown a cause-and-effect relationship.

Beta-carotene -- While some studies suggest that eating a diet high in beta-carotene (found in yellow, orange, and dark green vegetables) may protect against atherosclerosis, other studies show it may increase the risk for people who smoke or drink a lot of alcohol. Researchers theorize that eating vegetables with beta-carotene also provides the body with other carotenoids (similar antioxidants) that may have the protective effect, while simply taking a supplement does not.
Vitamin C -- Several studies suggest that eating a diet high in vitamin C can help protect against heart disease, but evidence is lacking that taking extra vitamin C through a supplement will help.
Vitamin E -- One recent randomized, placebo-controlled study failed to show any reduction in heart disease among people who took vitamin E.

Selenium (100 - 200 mcg per day) -- Some studies show that people who consume more selenium in their diet have a lower risk of heart disease, but again, researchers haven't shown a cause-and-effect relationship. Talk to your doctor before taking extra selenium.

Coenzyme Q10 (CoQ10) -- Researchers believe that CoQ10 may inhibit blood clot formation and boost levels of antioxidants. One study found that people who received daily CoQ10 supplements within 3 days of a heart attack were much less likely to experience subsequent heart attacks and chest pain and were also less likely to die of the condition than those who did not receive the supplements. Still, more research is needed to say whether CoQ10 has any role in preventing or treating atherosclerosis. People who take statins may have lower amounts of CoQ10 in their bodies and may consider taking a supplement. If you take statins, ask your doctor if you need a CoQ10 supplement.

Polyphenols -- Polyphenols are chemical substances found in plants that have antioxidant properties. Test tube, animal, and some population-based studies suggest that the flavonoids quercetin, resveratrol, and catechins (all found in high concentration in red wine) may help reduce the risk of atherosclerosis by protecting against the damage caused by LDL cholesterol. However, more studies in humans are needed to confirm these findings.

One study of resveratrol in mice found that it protected against age-related damage to vital organs, including the heart and liver, even when the mice ate a high-fat diet. Although this study is promising, researchers need to confirm its findings and to determine whether resveratrol would have the same effect in humans. To equal the rate at which the mice were given resveratrol, humans would have to consume enormous quantities. In addition, resveratrol may have estrogen-like effects, and researchers don't yet know whether it would pose the same risks as estrogen supplements.

Vitamin D -- Some preliminary studies suggest that vitamin D may also help protect against heart disease, but researchers aren't sure why. One observational study found that women over the age of 65 who took vitamin D supplements to protect against osteoporosis had one-third less risk of dying from heart disease as women who did not take the supplements.

Herbs

Hawthorn (Crataegus monogyna, 160 - 1,800 mg per day in two or three divided doses) -- Hawthorn contains the polyphenols rutin and quercetin, and was used traditionally to treat cardiovascular diseases. Animal and laboratory studies show that hawthorn has antioxidant properties that help protect against the formation of plaques and may help lower high cholesterol and high blood pressure. Talk to your doctor before taking hawthorn, as it can interact with other drugs taken for heart disease and high blood pressure.
Garlic (Allium sativum, 900 mg per day of garlic powder, standardized to 0.6% allicin) -- Some clinical trials have shown that fresh garlic and garlic supplements may lower cholesterol levels, prevent blood clots, and destroy plaque. However, other studies show mixed evidence, and one 2007 study showed no effect at all. Garlic can increase the risk of bleeding and should not be taken if you are also taking blood-thinning medication.
Red yeast (Monascus purpureus, 1,200 mg two times per day with meals) -- Several studies indicate that a proprietary form of red yeast (Cholestin) can lower cholesterol levels, and that the herb acts like the prescription drugs statins (See "Medications" section). For that reason, you should not take red yeast without a doctor's supervision, especially if you already take statins to lower cholesterol.
Psyllium (Plantago psyllium, 10 - 30 g per day in divided doses taken 30 - 60 minutes after meals) -- Taking psyllium, a type of fiber, helps lower cholesterol levels as well as blood sugar levels. If you take medicine for diabetes, talk to your doctor before taking psyllium.
Guggul (Commiphora mukul, 3 - 6 g per day) -- Guggul is used in Ayurvedic medicine to treat high cholesterol levels. Scientific studies have found mixed results -- guggul appears to work in Indian populations, but not in people who eat Western-style, high-fat diets.

Acupuncture

Acupuncture may be useful for reducing risk factors for heart disease. It can help people who wish to quit smoking and some studies indicate that it may aid in weight loss as well as lowering cholesterol and blood pressure.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic remedies, professional homeopaths would recommend appropriate treatments to reduce the risk of atherosclerosis based on their knowledge and experience. Homeopathic prescriptions for atherosclerosis would include remedies to lower high blood pressure and cholesterol. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath would assess all of these factors when determining the most appropriate remedy for each individual.

Other Considerations

Prognosis and Complications

Some complications of atherosclerosis include:

Heart disease
Heart failure
Abnormal heart rhythms
Stroke
Heart attack
Inadequate blood supply to certain parts of the body (such as the legs or intestines)
Kidney failure
Death

The outlook for atherosclerosis varies from person to person. People with atherosclerosis should work closely with their doctor to make sure they make the right lifestyle changes and, if needed, take the proper medications to control their condition and avoid complications.

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Review Date:
3/26/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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adam.com

Hypercholesterolemia

FitSugar — Wed, 08 Oct 2008 17:34:56 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Hypercholesterolemia, or high cholesterol, occurs when there is too much cholesterol in the body. Cholesterol is a soft, waxy, fat-like substance that is a natural component of all the cells of the body. Your body makes all the cholesterol it needs. Any added cholesterol, which comes through the foods you eat, can cause harm.

High cholesterol raises your risk for heart disease, heart attack, and stroke. When there is too much cholesterol circulating in the blood, it can create sticky deposits (called plaque) along the artery walls. Plaque can eventually narrow or block the flow of blood to the brain, heart, and other organs.

The normal range for total blood cholesterol is between 140 and 200 mg per decilitre (mg/dL) of blood (usually just expressed as a number). However, the total number doesn't tell the whole story: There are two types of cholesterol -- HDL (high-density lipoproteins, or "good" cholesterol) and LDL (low-density lipoproteins, or "bad" cholesterol). The amount of HDL relative to LDL is considered a more important indicator of your risk for heart disease. There is a third kind of fatty material, triglycerides, found in the blood, that also plays a role (generally as triglyceride levels rise, HDL or "good" cholesterol falls). High cholesterol is characterized by high levels of LDL cholesterol, normal or low levels of HDL cholesterol, and normal or high levels of triglycerides.

More and more Americans have high cholesterol. While heredity may be a factor for some people, lack of exercise plus diets high in saturated fats appear to be the main culprits. High cholesterol can be prevented, often with lifestyle changes (diet and exercise) alone. If these do not work, your doctor may recommend medications to bring down your cholesterol levels.

Signs and Symptoms

High cholesterol generally occurs without any symptoms, especially in early stages. The only way to tell if your cholesterol is high is through a blood test.

Causes

In some cases, high levels cholesterol may be inherited -- your liver may make too much cholesterol, or your body may not remove LDL from your blood as efficiently as normal. High cholesterol or triglycerides can also be associated with other diseases, such as diabetes. In most cases, however, high cholesterol is the result of a diet high in saturated fat and a lack of regular exercise. High cholesterol is more common in people who are overweight or obese, a condition that is true of as much as half of the adult U.S. population.

Risk Factors

There are certain factors that put a person at increased risk of having high cholesterol. While some factors cannot be altered by changes in lifestyle, many can be changed. The most important risk factors for high cholesterol are:

Obesity
Eating a diet high in saturated fat and trans fatty acids (found frequently in processed and fried foods)
Not getting enough exercise
Family history of heart disease
High blood pressure
Smoking cigarettes
Diabetes

Diagnosis

Since most people have few if any symptoms of high cholesterol, a blood test is the only way to check levels of cholesterol in your blood. If your levels are above 200 mg/dL or your HDL below 40, your doctor may do a fasting lipid profile (a test performed after you abstain from food for 12 hours).

Although cholesterol levels above 200 are generally considered high, the optimal level for LDL cholesterol depends on whether you are at risk for or have heart disease.

Total cholesterol levels:

Desirable: Below 200 mg/dL
Borderline high: 200 - 239
High: Above 240

LDL cholesterol levels:

Optimal for people with heart disease or at high risk: Below 70 mg/dL
Optimal for people at risk of heart disease: Below 100
Optimal: 100 - 129
Borderline high: 130 - 159
High: 160 - 189

HDL cholesterol levels:

Poor: Below 40 mg/dL
Acceptable: 40 - 59
Optimal: 60 or above

Triglyceride levels:

Optimal: Below 150 mg/dL
Borderline high: 150 - 199
High: Above 200

Adults with normal total and HDL cholesterol levels should have their cholesterol checked every 5 years. If you have high cholesterol, you should be checked every 2 - 6 months and have liver function tests as well if you are on cholesterol-lowering medication.

Preventive Care

Most people can lower cholesterol levels by eating a well-balanced diet, getting regular exercise, and losing any excess weight.

Diet

A healthy diet can help you lose any excess pounds. Even losing just 5 or 10 pounds may help you lower your cholesterol. To eat a healthy diet:

Cut down on saturated fats and trans fats. No more than 10 percent of your daily calories should come from saturated fat, and you should avoid trans fats completely. Choose unsaturated fats, such as olive oil and canola oil, instead.
Eat whole grains -- whole wheat bread and pasta, oatmeal, oat bran, and brown rice.
Eat more fruits and vegetables, which are high in fiber and can help lower cholesterol levels.
Limit cholesterol in your diet. The highest amounts are found in egg yolks, whole milk products, and organ meats.
Eat fatty fish. The American Heart Association recommends that people eat at least 2 servings of fatty fish (such as salmon or herring) each week.

The American Heart Association (AHA) has developed dietary guidelines that help lower fat and cholesterol intake and reduce the risk of heart disease. The AHA does not recommend very low-fat diets, because new research shows that people benefit from unsaturated ("good") fats, such as those found in olive oil, in their diet.

The AHA recommends the following for healthy eating:

Grains: 6 - 8 servings per day (half should be whole grains)
Vegetables: 3 - 5 servings per day
Fruits: 4 - 5 servings per day
Fat-free or low-fat dairy: 2 - 3 servings per day
Lean meat, poultry, seafood: 3 - 6 oz. per day (about the size of a deck of cards)
Fats and oils: 2 - 3 tbsp. per day (use unsaturated fats such as olive oil or canola oil)
Nuts, seeds, legumes: 3 - 5 servings per week
Sweets, sugars: 5 or fewer servings per week (the fewer, the better)

In addition, the AHA also recommends eating 2 servings of fatty fish (such as salmon, herring, or lake trout) per week; holding sodium (salt, including salt already added to food) to less than 2,400 mg per day; and limiting alcohol intake to one drink a day for women and two for men.

The Mediterranean style diet concentrates on whole grains, fresh fruits and vegetables, fish, olive oil, and moderate, daily wine consumption. This diet is not low-fat. Instead, it is low in saturated fat but high in monounsaturated fat. This diet is naturally rich in fiber, antioxidants, and omega-3 fatty acids. It appears to be heart-healthy: In a long-term study of 423 patients who had a heart attack, those who followed a Mediterranean style diet had a 50 - 70% lower risk of recurrent heart disease compared with people who received no special dietary counseling.

Losing Weight

Being overweight increases risk of high cholesterol and heart disease. Even a 5- to 10-pound weight loss can lower LDL twice as much as diet alone. Weight loss often results in lower triglyceride levels and increased HDL, too. To maintain a healthy diet, you should aim for a gradual, weekly weight loss of 1/2 to 1 pound.

Getting Exercise

Regular exercise both reduces the risk of death from heart disease and helps lower LDL cholesterol levels, especially when combined with a healthy diet. Thirty minutes of moderate exercise three to five times per week can help you lose weight or maintain a proper weight, reduce LDL and triglyceride levels, and increase levels of HDL. Exercise may also lower blood pressure. Talk with your doctor before starting a new exercise plan.

Treatment Approach

Lowering your cholesterol level reduces your risk of heart disease and stroke. Studies have shown that for every 1% reduction in cholesterol levels there is a 2% reduction in the rate of heart disease. People who already have heart disease or are at higher risk benefit most from lowering their cholesterol.

Changes in lifestyle -- better diet, more exercise -- are the most effective means of both preventing and, in less severe cases, treating high LDL cholesterol levels. In addition to lifestyle changes, specific cholesterol-lowering medications are often prescribed.

Medications

If, after making adjustments to your diet and exercise habits, your LDL cholesterol remains high, your doctor may prescribe medications to lower it. If your cholesterol is extremely elevated (more than 200 mg/dL), you may start drug therapy at the same time you make lifestyle changes. Drugs commonly used to treat high cholesterol include:

Statins (such as lovastatin, pravastatin, simvastatin, atorvastatin, and fluvastatin) -- These are usually the drugs of choice as they are easy to take and have few interactions with other drugs. Side effects can include myositis (inflammation of the muscles), joint pain, stomach upset, and liver damage. People who are pregnant or have liver disease should not take statins.

Niacin (nicotinic acid) -- In prescription form, niacin is sometimes used to lower LDL cholesterol and can be more effective in raising HDL cholesterol than other medications. Side effects may include redness or flushing of the skin (which can be reduced by taking aspirin 30 minutes before the niacin), stomach upset (which usually subsides in a few weeks), headache, dizziness, blurred vision, and liver damage. Dietary supplements of niacin should not be used instead of prescription niacin, as it can cause side effects. Only take niacin for high cholesterol with your doctor's supervision.

Bile acid sequestrants (such as cholestyramine, colestipol, and colesevelam) -- These are used to treat high levels of LDL. Common side effects include bloating, constipation, heartburn, and elevated triglycerides. People who have high levels of triglycerides (fats in the blood) should not take bile acid sequestrants.

Fibric acid derivatives (such as gemfibrozil and clofibrate) -- These medicines are effective at lowering triglyceride levels, and moderately effective at lowering LDL. They are used to treat high triglycerides and low HDL in people who cannot tolerate niacin. Side effects include myositis, stomach upset, sun sensitivity, gallstones, irregular heartbeat, and liver damage.

Probuchol -- This medicine lowers both LDL and HDL. Its use is generally limited to certain types of hereditary high cholesterol or when other cholesterol-lowering medications have been ineffective. Side effects include diarrhea, bloating, nausea, and dizziness

If you do not respond to one class of drugs, you doctor may use a combination of drugs from two classes.

Nutrition and Dietary Supplements

In addition to eating a healthy diet -- low in saturated fat, with plenty of whole grains, fruits, and vegetables -- some specific foods and supplements may help lower cholesterol.

Fiber -- Several studies have shown that soluble fiber (found in beans, oat bran, barley, apples, psyllium, flaxseed, and glucomannan) lowers LDL cholesterol and triglycerides. Fiber can also help you lose weight because it makes you feel full faster. Your doctor will encourage you to get more fiber in your diet. You may also take a fiber supplement. Men should get 30 - 38 g of fiber per day. Women should get 21 - 25 g.

Soy -- Many studies have shown that eating soy protein (tofu, tempeh, miso) rather than animal meat helps lower blood cholesterol levels, especially when you eat a diet low in saturated fat. One study has shown that as little as 20 g of soy protein per day is effective in reducing total cholesterol, and that 40 - 50 g shows faster effects (in 3 weeks instead of 6). One study has shown that soy can help reduce triglyceride levels. The AHA recommends that people with elevated total and LDL cholesterol add soy to their daily diet, and that soy is safe when consumed as part of your regular diet. Before you take soy supplements, however, talk to your doctor. Soy isoflavones may have estrogen-like effects on the body, which might lead to an increased risk of breast and other cancers.

Omega-3 fatty acids, found in fish oil -- There is good evidence that omega-3 fatty acids (namely EPA and DHA) found in fish oil can help prevent heart disease, lower blood pressure, and reduce the level of triglycerides (fats) in the blood. However, fish oil can also raise levels of both HDL and LDL slightly. When taken as a supplement, it can also act as a blood-thinner, so people who already take blood-thinning medication should only take a fish oil supplement under their doctor's supervision. The AHA recommends that people eat at least two servings of fatty fish (such as salmon) per week, and that fish is safe when consumed as part of your regular diet. If you have high cholesterol, talk to your doctor before taking a fish oil supplement.

Alpha-linolenic acid (ALA) -- ALA is another omega-3 fatty acid that may protect the heart against heart disease. However, studies have shown conflicting results about its ability lower LDL, and it does not appear to lower triglyceride levels.

Vitamin C (100 - 200 mg per day) -- Several studies suggest that eating a diet high in vitamin C can help lower cholesterol levels, but there is no evidence that taking extra vitamin C through a supplement will help.

Beta-sitosterol (800 mg to 6 g per day in divided doses about 30 minutes before meals) -- Beta-sitosterol is a plant sterol, a compound that can stop cholesterol from being absorbed by the intestines. Several well-designed scientific studies have shown that beta-sitosterol does lower LDL ("bad") cholesterol levels in the body. Beta-sitosterol may lower the amount of vitamin E and beta-carotene absorbed by the body, so you may want to ask your doctor if you need to take extra vitamin E or carotene.

Policosanol (5 - 10 mg two times per day) -- Policosanol is a mix of waxy alcohols usually derived from sugar cane and yams. Several studies have indicated it may lower LDL ('bad") cholesterol and possibly even raise HDL ("good") cholesterol. One study found that policosanol was equivalent to fluvastatin (Lescol) and simvastatin (Zocor) in lowering cholesterol levels. It may also inhibit blood clots from forming. However, almost all the studies have been conducted in Cuba or Latin America using a proprietary form of policosanol, so it is hard to evaluate the evidence. Policosanol may increase the risk of bleeding, and should not be taken by people who also take blood-thinning medication.

Coenzyme Q10 (CoQ10) -- Researchers believe that CoQ10 may inhibit blood clot formation and boost levels of antioxidants. One study found that people who received daily CoQ10 supplements within 3 days of a heart attack were much less likely to experience subsequent heart attacks and chest pain and were also less likely to die of the condition than those who did not receive the supplements. Still, more research is needed to say whether CoQ10 has any role in preventing or treating atherosclerosis. People who take statins may have low levels of CoQ10. If you take statins you may want to ask your doctor about taking a CoQ10 supplement.

Polyphenols -- Polyphenols are chemical substances found in plants that have antioxidant properties. Test tube, animal, and some population-based studies suggest that the flavonoids quercetin, resveratrol, and catechins (all found in high concentration in red wine, and in grape juice) may help reduce the risk of atherosclerosis by protecting against the damage caused by LDL cholesterol. However, more studies in humans are needed to confirm these findings.

Resveratrol -- A recent study of resveratrol in mice found that it protected against age-related damage to vital organs, including the heart and liver, even when the mice ate a high-fat diet. Although this study is promising, researchers need to confirm its findings and to determine whether resveratrol would have the same effect in humans. To equal the rate at which the mice were given resveratrol, humans would have to consume enormous quantities. In addition, resveratrol may have estrogen-like effects, and researchers don't yet know whether it would pose the same risks as estrogen supplements.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.

Hawthorn ( Crataegus monogyna, 900 - 1,800 mg per day in two or three divided doses) -- Hawthorn contains the polyphenols rutin and quercetin, and was used traditionally to treat cardiovascular diseases. Animal and laboratory studies show that hawthorn has antioxidant properties that may help lower high cholesterol and high blood pressure. Talk to your doctor before taking hawthorn, as it can interact with other drugs taken for heart disease and high blood pressure.

Garlic ( Allium sativum, 900 mg per day of garlic powder, standardized to 0.6% allicin) -- Previous clinical trials have shown that fresh garlic and garlic supplements may lower cholesterol levels, prevent blood clots, and destroy plaque. However, more recent studies show no effect on cholesterol. Garlic can increase the risk of bleeding and should not be taken if you are also taking blood-thinning medication.

Red yeast ( Monascus purpureus , 1,200 mg two times per day with meals) -- Several studies indicate that a proprietary form of red yeast (Cholestin) can lower cholesterol levels, and that the herb acts like prescription statin drugs (See "Medications" section). For that reason, you should not take red yeast without a doctor's supervision, especially if you already take statins to lower cholesterol.

Psyllium ( Plantago psyllium, 10 - 30 g per day in divided doses taken 30 - 60 minutes after meals) -- Taking psyllium, a type of fiber, helps lower cholesterol levels as well as blood sugar levels. If you take medicine for diabetes, talk to your doctor before taking psyllium.

Guggul (Commiphora mukul, 3 - 6 g per day) -- Guggul is used in Ayurvedic medicine to treat high cholesterol levels. Scientific studies have found mixed results -- guggul appears to work in Indian populations, but not in people who eat Western-style, high-fat diets.

Other Considerations

Pregnancy

Cholesterol-lowering medications should be avoided during pregnancy.

Prognosis and Complications

Several complications may occur if high cholesterol is left untreated. These include:

Heart disease -- elevated cholesterol levels more than double the risk of heart attack. Lowering cholesterol by 1% reduces the risk of coronary artery disease by 2%.
Stroke -- low levels of HDL cholesterol have been associated with an increased risk of stroke.
Insulin resistance -- 88% of people with low HDL and 84% with high triglycerides also have insulin resistance (which leads to high blood sugar levels). Many people with insulin resistance go on to develop diabetes.

Maintaining the proper weight, eating a diet low in saturated fat, and exercising can lower cholesterol levels and improve long-term prognosis.

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Review Date:
3/23/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Myocardial infarction

FitSugar — Wed, 08 Oct 2008 17:34:55 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Myocardial infarction is the technical name for a heart attack. The heart is responsible for pumping blood, which carries oxygen, to every organ in the body – including the heart itself. A heart attack occurs when an artery leading to the heart becomes completely blocked and the heart doesn’t get enough blood or oxygen. Cells in that area of the heart start to die (called an infarct).

A heart attack is a medical emergency. If you or someone you know has any of the symptoms below, call 911 immediately. Waiting even 15 minutes can be fatal. But if you get prompt medical treatment, you can limit damage to your heart. Although heart attack is the leading cause of death in the United States, up to 95% of people who are hospitalized with a heart attack survive.

Most heart attacks are caused by blood clots, which are in turn caused by atherosclerosis (stiffening and narrowing of the arteries). High blood fats (triglycerides) and LDL or “bad” cholesterol form plaque inside arteries, narrowing the passageway and reducing the amount of blood that can flow through. Your lifestyle plays a crucial role in preventing a heart attack or recovering from one. Eating a heart-healthy diet and getting at least 30 minutes of exercise five days a week (or more) can reduce your risk of heart attack.

Signs and Symptoms

Squeezing pain, heaviness, tightness, pressure in center of chest
Pain that spreads to your back, left arm, jaw, neck
Shortness of breath
Dizziness, weakness
Nausea, vomiting
Irregular heartbeat
Sweating
Feeling of doom

Women may experience different symptoms than men. In women, along with chest pain, symptoms can include:

Heartburn or pain in the abdomen
Unusual fatigue
Clammy skin

Causes

Heart attacks happen when an artery supplying your heart with blood becomes blocked. Without blood, the heart doesn’t get enough oxygen and cells in the heart start to die.

The most common cause of blocked arteries is atherosclerosis. No one knows the exact cause of atherosclerosis, but most researchers believe it begins with an injury to the innermost layer of the artery, known as the endothelium. The following factors are thought to contribute to the damage:

High blood pressure
Elevated LDL ("bad") cholesterol
An accumulation of homocysteine (an amino acid produced by the human body, thought to be a risk factor for heart disease, stroke, osteoporosis, diabetes, and dementia)
Smoking
Diabetes
Inflammation

Once the artery is damaged, blood cells called platelets build up there to try and repair the injury. Over time, fats, cholesterol, and other substances also build up at the site, which thickens and hardens the artery wall. The amount of blood that flows through the artery is decreased, and oxygen supply to organs also decreases. Blood clots may also form, blocking the artery.

Rarely, a spasm in a coronary artery (one that supplies blood to the heart) stop blood flow and can cause a heart attack.

Risk Factors

These risk factors increase your chances of developing atherosclerosis:

Smoking
High-fat diet
High LDL “bad” cholesterol and triglycerides (fats in the blood)
Lack of exercise
Being overweight or obese
Family history of heart attack
Diabetes
High blood pressure
Being male, or a female who has gone through menopause
Stress

Also, people who have elevated homocysteine, C-reactive protein (CRP), and fibrinogen levels seem to have an increased risk of heart attack. These are markers of inflammation, but researchers aren’t sure whether they contribute to heart disease or occur when you have heart disease. High homocysteine can be treated with folic acid (see Nutrition and Supplements). More research in these areas is currently underway.

Diagnosis

If you think that you are having a heart attack, don’t wait to be sure – call 911 immediately. Treating a heart attack quickly can save your life, while delay can be fatal. In the emergency room, a doctor will ask you about your symptoms and perform a physical examination. He or she will immediately run tests to determine your heart function. They may include:

Electrocardiogram (ECG) - the first test done to check for a heart attack; you may be hooked up to a monitor even as the doctor is asking you questions. An ECG measures electrical activity of your heart.

Blood tests - Your doctor may look for certain enzymes that are released into your blood when you have a heart attack.

Other tests include:

Chest x-ray
Echocardiogram (uses sound waves to take a picture of your heart)
Coronary catheterization or angiogram (uses a liquid dye inserted through a catheter to see whether your arteries are blocked)
Stress test (involves walking on a treadmill while hooked up to a ECG machine to see how your heart responds to exercise)

Preventive Care

You can reduce your risk of heart attack by:

Stopping smoking.
Getting aerobic exercise (such as walking, biking, or swimming) for at least 30 minutes 5 days per week. If you haven't exercised much in the past, walking is a great way to start.
Reducing stress and learning stress-reduction techniques such as deep breathing and meditation. Yoga and tai chi, two forms of exercise that emphasize stretching, breathing, and meditating, can also help you reduce your stress level.
Eating a diet low in saturated fat and rich in fruits, vegetables, and whole grains.
Losing weight or maintaining a proper weight.

If you have high cholesterol, diabetes, or high blood pressure, follow your doctor’s instructions to keep these risk factors under control. You may need medications in addition to lifestyle changes. If you don't have heart disease yet or have not had a heart attack despite these risk factors, aggressive control can help prevent a heart attack. And, if you already have heart disease, aggressive control of these risk factors can prevent further heart attacks or other problems related to heart disease.

Treatment Approach

The goal when treating a heart attack is to restore blood flow to the affected area of the heart immediately, to preserve as much heart muscle and heart function as possible. If your doctor has prescribed nitroglycerin, take it while you are waiting for emergency medical personnel to arrive. Once at the hospital, your doctor may use drug therapy, angioplasty (using one of several methods to clear the blocked blood vessel, such as inflating a balloon inside it or holding it open with a device called a stent), and surgery.

Once you have been treated for a heart attack, making changes in your lifestyle (especially in your diet and exercise habits) and taking medications as prescribed is very important for avoiding recurrent heart attacks and even death. Although certain herbal remedies as well as relaxation techniques may also be used, they should never be used alone to treat a heart attack. A heart attack always requires emergency medical attention.

Lifestyle

Making lifestyle changes can improve many of your risk factors for heart disease, including high cholesterol, high blood pressure, extra weight, high homocysteine, and elevated C-reactive protein. Cardiac rehabilitation programs generally involve teaching you about diet, physical activity, and relaxation techniques. To keep your risk factors low, you will need to follow the healthy habits taught in cardiac rehab, like exercise and eating properly, for the rest of your life.

Medications

Aspirin - helps stop blood from clotting. You may be given aspirin in the ambulance or as soon as you get to the hospital.

Nitroglycerin - helps dilate (widen) blood vessels. You may be given nitroglycerin in the ambulance or as soon as you get to the hospital.

Pain reliever - Morphine is often given intravenously (IV) to relieve pain.

Thrombolytics - “Clot-busting” drugs may be used, depending on the type of heart attack. They are most effective when taken within 2 hours of the heart attack, and are not given after 12 hours have elapsed. These drugs may be given with other anticoagulants (blood-thinners).

Anticoagulants (blood-thinners) - Make your blood less likely to form clots. Heparin is often given by injection while you are in the hospital.

After you recover, other drugs are used to lower your risk of having another heart attack. They include:

ACE inhibitors - widen blood vessels and make it easier on your heart to pump blood. Side effects can include chronic cough. ACE inhibitors include

Benazepril (Lotensin)
Captopril (Capoten)
Fosinopril (Monopril)
Lisinopril (Zestril)
Enlapril (Vasotec)

Beta-blockers - slows heart rate, thus lowering blood pressure. These drugs include

Acebutolol (Sectral)
Atenolol (Tenormin)
Bisoprolol (Zebeta)
Carteolol (Cartrol)
Metoprolol (Toprol XL)
Nadolol (Corgard)
Propranolol (Inderal)

Statins - help lower cholesterol. People who are pregnant or have liver disease should not take statins. They include

Lovastatin (Mevacor)
Simvastatin (Zocor)
Pravastatin (Pravachol)
Atorvastatin (Lipitor)
Fluvastatin (Lescol)
Rosuvastatin (Crestor)

Niacin (nicotinic acid) - In prescription form, is sometimes used to lower cholesterol. Dietary supplements of niacin should not be used instead of prescription niacin, as it can cause side effects. Only take niacin for high cholesterol with your doctor's supervision.

Bile acid sequestrants - lowers cholesterol; people who have high levels of triglycerides (fats in the blood) should not take bile acid sequestrants. These drugs include

Cholestyramine (Questran)
Colestipol (Colestid)
Colesevelam (Welchol)

Fibric acid derivatives - lower triglycerides and moderately lower LDL cholesterol. They include Gemfibrozil (Lopid).

Anticoagulants (blood thinners) - help keep clots from forming. Your doctor may prescribe aspirin, warfarin (Coumadin), or Clopidogrel (Plavix)

Surgical Treatments

Percutaneous coronary intervention (PCI) – In primary PCI, the doctor performs a coronary angiogram (injecting dye into the arteries) to see where the artery is blocked. The doctor then performs balloon angioplasty (widening an artery with a balloon), often with stent placement, to keep the artery open.

Coronary artery bypass graft (CABG) – This surgery bypasses the blocked arteries by using a graft of another blood vessel (usually from your arm or leg) to restore blood flow to the heart.

Nutrition and Dietary Supplements

Healthy eating habits can help reduce high cholesterol, high blood pressure, and overweight –three of the major risk factors for heart disease. The American Heart Association (AHA) has developed dietary guidelines that help lower fat and cholesterol intake and reduce the risk of heart disease and heart attack. The AHA does not recommend very low-fat diets, because new research shows that unsaturated ("good") fats, such as those found in olive oil, are good for your heart.

Many fad diets are popular, but they may not help you lose weight and keep it off – and in some cases, they may not even be healthy. Any healthy diet will include a variety of foods. If a diet bans an entire food group (such as carbohydrates), it's probably not healthy.

The AHA recommends the following for healthy eating:

Grains: 6 to 8 servings per day (half should be whole grains)
Vegetables: 3 to 5 servings per day
Fruits: 4 to 5 servings per day
Fat-free or low-fat dairy: 2 to 3 servings per day
Lean meat, poultry, seafood: 3 to 6 oz. per day (about the size of a deck of cards)
Fats and oils: 2 to 3 tbsp. per day (use unsaturated fats such as olive oil or canola oil)
Nuts, seeds, legumes: 3 to 5 servings per week
Sweets, sugars: 5 or fewer servings per week (the fewer, the better)

In addition, the AHA also recommends eating 2 servings of fatty fish (such as salmon or lake trout) per week; holding sodium (salt, including salt already added to food) to 2,400 mg per day or less; and limiting alcohol intake to one drink a day for women and two for men.

Diets for People with High Blood Pressure

People with high blood pressure especially need to lower the amount of sodium in their diet. The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes a diet rich in fruits, vegetables, and low-fat or non-fat dairy products that provide high intake of potassium, magnesium, and calcium sources. Sodium intake should be between 1,500 mg to 2,400 mg per day (the lower, the better) . Weight loss, regular exercise, and limiting alcohol are also very important factors for lowering blood pressure.

Mediterranean Diet

The Mediterranean Style Diet concentrates on whole grains, fresh fruits and vegetables, fish, olive oil, and moderate, daily wine consumption. The Mediterranean Style Diet is not low-fat; it is low in saturated fat but high in monounsaturated fat. It appears to be heart-healthy: In a long-term study of 423 patients who had a heart attack, those who followed a Mediterranean Style Diet had a 50% to 70% lower risk of recurrent heart disease compared with people who received no special dietary counseling.

Vitamins and Supplements

Some supplements may help lower your risk factors for heart attacks, such as high blood pressure or high cholesterol. Most do not work as well as prescription medications, but some can be used along with prescription medications in your treatment. If you have had a heart attack or are at high risk of having on, be sure to ask your doctor before taking any supplements.

Folic acid (400 mcg per day), vitamin B6 (25 to 100 mg per day), vitamin B12 (2 to 100 mcg per day) - The B vitamins help the body break down homocysteine, an amino acid that's been linked to increased risk of heart disease and stroke. Researchers believe that homocysteine may also contribute to atherosclerosis by damaging artery walls, making it easier for blood clots to form – but so far they haven't found a definite link. Researchers also don't yet know whether taking B vitamins reduces the risk of atherosclerosis or heart attack, nor do they know how much might have an effect. Talk to your doctor about checking your homocysteine levels and whether your doctor would recommend a B complex vitamin supplement. In the meantime, be sure to get enough B vitamins through your diet by eating fruits and leafy green vegetables every day.
Omega-3 fatty acids (fish oil, 1 to 4 g per day) - There is good evidence that omega-3 fatty acids (known as EPA and DHA) found in fish oil can help treat atherosclerosis by preventing the development of plaque and blood clots. Omega-3s can also help prevent heart disease, lower blood pressure, and reduce the level of triglycerides (fats) in the blood. The AHA recommends that people eat at least two servings of fatty fish (such as salmon) per week. For people who have had a heart attack, several studies show that eating fish or taking fish oil reduces the risk of both fatal and nonfatal heart attacks, as well as lowers your risk of death from any cause. Because fish oil at high doses can increase the risk of bleeding, talk to your doctor before taking a high dose (more than 1 g per day), especially if you already take blood-thinning medication.
Beta-sitosterol (800 mg to 6g per day in divided doses about 30 minutes before meals) - Beta-sitosterol is a plant sterol, a chemical found in plants that can stop cholesterol from being absorbed by the intestines. A number of well-designed scientific studies have shown that beta-sitosterol does lower LDL ("bad") cholesterol levels in the body. Beta-sitosterol may lower the amount of vitamin E and beta-carotene absorbed by the body, so you may want to ask your doctor if you need to take extra E or carotene.
Policosanol (5 to 10 mg two times per day) - Policosanol is a mix of waxy alcohols usually derived from sugar cane and yams. Several studies have indicated it may lower LDL ('bad") cholesterol and possibly even raise HDL ("good") cholesterol. One study found that policosanol was equivalent to fluvastatin (Lescol) and simvastatin (Zocor) in lowering cholesterol levels. It may also help stop blood clots from forming. However, almost all the studies have been conducted in Cuba by a research group that uses a proprietary form of policosanol and is funded by the manufacturer, so it is hard to evaluate the evidence. Policosanol may increase the risk of bleeding, and should not be taken by people who also take blood-thinning medications.
Coenzyme Q10 (CoQ10) - Researchers believe that CoQ10 may help stop blood clots from forming and boost levels of antioxidants. One study found that people who received daily CoQ10 supplements within three days of a heart attack were much less likely to experience another heart attack and chest pain. They were also less likely to die from heart disease than those who did not receive the supplements. Statins, drugs that lower cholesterol, can actually interfere with the body’s natural ability to make CoQ10, so your doctor may recommend taking a CoQ10 supplement. Still, more research is needed to say whether CoQ10 has any role in preventing or treating atherosclerosis.
Psyllium (Plantago psyllium, 10 to 30 g per day in divided doses taken 30 to 60 minutes after meals) - Taking psyllium, a type of fiber, helps lower cholesterol levels as well as blood sugar levels. If you take medicine for diabetes, talk to your doctor before taking psyllium.
L-carnitine (4 to 6 g per day) - Studies suggest that people who take L-carnitine (an amino acid) soon after a heart attack may be less likely to have a subsequent heart attack, die of heart disease, experience chest pain and abnormal heart rhythms, or develop congestive heart failure. (Congestive heart failure occurs when the heart can’t pump blood properly and blood backs up into the lungs and legs.) Studies also suggest that people with heart disease who take carnitine may be better able to exercise. Most studies used a special form of carnitine called propionyl-L-carnitine.

Herbs

Herbs should not be used in place of emergency medical attention for a heart attack, nor should they be used by themselves to lower your risk of heart attack after you’ve had one. However, some can be used along with prescription medications in your treatment. If you have had a heart attack or are at high risk of having on, be sure to ask your doctor before taking any herbs.

Hawthorn (Crataegus monogyna, 160 to 1,800 mg per day in two or three divided doses) - Hawthorn contains the polyphenols rutin and quercetin, and was used traditionally to treat cardiovascular diseases. Animal and laboratory studies show that hawthorn has antioxidant properties that help protect against the formation of plaques and may help lower high cholesterol and high blood pressure. Talk to your doctor before taking hawthorn, as it can interact with other drugs taken for heart disease and high blood pressure.
Garlic (Allium sativum, 900 mg per day of garlic powder, standardized to 0.6% allicin) - Clinical trials have shown that fresh garlic and garlic supplements may lower cholesterol levels, prevent blood clots, and destroy plaque. However, other studies show mixed evidence. In one study, people who had a previous heart attack and then took a garlic oil extract for 3 years had fewer second heart attacks and a 50% reduction in death rate than those who did not take garlic. Garlic can increase the risk of bleeding and should not be taken if you are also taking blood-thinning medication.
Bilberry (Vaccinium myrtillus) and other flavonoids - A close relative of the cranberry, bilberry fruits contain flavonoid compounds called anthocyanidins. Flavonoids are plant pigments that have antioxidant properties, and researchers think they may help prevent a number of illnesses including heart disease and diabetes. Bilberry has been used traditionally to treat heart disease, but only animal and test-tubes studies have been done. Animal studies have found that anthocyanidins and other flavonoids may strengthen blood vessels, improve circulation, and prevent LDL ("bad") cholesterol from being damaged (which may cause blood clots to form in arteries).
Asian ginseng (Panax ginseng) – Ginseng may help reduce risk factors for heart disease, including lowering blood pressure and cholesterol, but more studies are needed to be sure. Ginseng can increase the risk of bleeding and should not be taken if you are also taking blood-thinning medication. Ginseng should not be used if you have high blood pressure unless your doctor recommends it.
Green tea (Camellia sinensis) - Population studies suggest that regularly drinking green tea may reduce the risk of heart attack from atherosclerosis. It also may help you lower your cholesterol and your weight, although more research is needed to know for sure.
Kudzu (Pueraria lobata) - Kudzu has been used traditionally to treat heart disease, including heart attack and congestive heart failure. A few studies suggest it may help relieve angina, but the studies were of poor quality. More research is needed to know whether kudzu has any benefit for heart disease.

Homeopathy

Homeopathy should not be used instead of immediate medical attention for a heart attack. Homeopathy may, however, be used to help reduce your risk of heart disease. Although few studies have examined the effectiveness of specific homeopathic remedies, professional homeopaths would recommend appropriate therapy to lower high blood pressure and cholesterol. Before prescribing a remedy, homeopaths take into account your constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath would assess all of these factors when determining the most appropriate remedy for you as an individual.

Acupuncture

Acupuncture may be helpful in reducing some risk factors for heart disease. Some studies show that it can help people who want to stop smoking, and it may help some people lose weight and lower their blood pressure.

Massage and Physical Therapy

Although few studies have examined the effectiveness of massage therapy for heart disease, massage has a relaxing effect and can reduce stress-related hormone levels. Lowering stress hormone levels can lower cholesterol and blood pressure, reducing your risk of heart disease. In addition, relaxation techniques may help you make lifestyle changes such as eating healthy, quitting smoking, and exercising. At least one study found that massage can lower blood pressure.

Other Considerations

Prognosis and Complications

After a heart attack, a person’s prognosis depends on how damaged the heart is. If the person is alive 2 hours after an attack, he or she has a good chance for survival, but may experience complications such as:

Irregular heart rhythm, called an arrhythmia
Congestive heart failure
Shock
Infarct extension (extension of the amount of affected heart tissue) or recurrent heart attack(s)
Pericarditis (infection around the lining of the heart)
Pulmonary embolism (blood clot in the lungs)
Complications from treatment (for example, thrombolytic agents increases the risk of bleeding)

The good news, however, is that heart attacks are not always disabling, especially when there are no complications. In fact, a full recovery is possible that allows you to do all the tings you used to do, including sexual activity. Going through cardiac rehabilitation and sticking with lifestyle changes can help lead to a positive recovery.

Supporting Research

Abbott RD, Ando F, Masaki KH, et al. Dietary magnesium intake and the future risk of coronary heart disease (the Honolulu Heart Program). Am J Cardiol. 2003;92(6):665-669.

Abrams J. C-reactive protein, inflammation, and coronary risk: an update. Cardiol Clin. 2003;21(3):327-331.

Ackermann RT, Mulrow CD, Ramirez G, Gardner CD, Morbidoni L, Lawrence VA. Garlic shows promise for improving some cardiovascular risk factors. Arch Intern Med. 2001;161:813-824.

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Alissa EM, Bahijri SM, Ferns GA. The controversy surrounding selenium and cardiovascular disease: a review of the evidence. Med Sci Monit. 2003;9(1):RA9-18.

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Bahorun T, Trotin F, Pommery J, Vasseur J, Pinkas M. Antioxidant activities of Crataegus monogyna extracts. Planta Med. 1994;60:323-328.

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Review Date:
12/26/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

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5 Regions With High Rates of Skin Cancer

FitSugar — Wed, 30 Jul 2008 03:30:00 -0700

How we protect our skin is one of the biggest ways to keep from getting skin cancer, but something we don't have much control over is a contributing factor too: Where you live. Not only do latitude and longitude play a role, but cultural norms do as well. For example, it's still quite acceptable (and coveted) to want to be tan in the United States whereas many folks in Asia actually associate a tan with the lower class. Forbes did the research and figured out the worst places to live (or be from) in terms of skin cancer incidence. Here are the top five regions with the greatest per-capita skin cancer ratios:

North America, Cuba
Eastern Europe
Europe
Australia, Asia Pacific and East Asia
Eastern Europe and Central Asia

Where does your country fall on the list?

Source

World's Fattest Countries Revealed

FitSugar — Wed, 14 Feb 2007 03:30:00 -0800

Did you know that there are currently 1.6 billion overweight adults in the world?

Forget all this small city talk, the World Health Organization (WHO) ranks the countries with the greatest percentage of overweight people of its adult population (ages 15+).

The United States used to take the cake (no pun intended) on this list but experts say it is not surprising that people across the globe are increasingly becoming overweight. They place the blame on urbanization and the influx of Western ways of life including fast food choices, little exercise and stressful jobs. This list made me realize that not only is the population growing (in mass), that I really need to brush up on my geography skills.

1. Nauru (94.5%)
2. Micronesia, Federated States of (91.1%)
3. Cook Islands (90.9%)
4. Tonga (90.8%)
5. Niue (81.7%)
6. Samoa (80.4%)
7. Palau (78.4%)
8. Kuwait 74.2%)
9. United States (74.1%)
10. Kiribati (73.6%)
11. Dominica (71.0%)
12. Barbados (69.7%)
13. Argentina (69.4%)
14. Egypt (69.4%)
15. Malta (68.7%)
16. Greece (68.5%)
17. New Zealand (68.4%)
18. United Arab Emirates (68.3%)
19. Mexico (68.1%)
20. Trinidad and Tobago (67.9%)
21. Australia (67.4%)
22. Belarus (66.8%)
23. Chile (65.3%)
24. Venezuela (Bolivarian Republic of) (65.2%)
25. Seychelles (64.6%)

Theres 75 more, so read more

26. Bahrain (64.1%)
27. Andorra (63.8%)
28. United Kingdom (63.8%)
29. Saudi Arabia (63.5%)
30. Monaco (62.4%)
31. Bolivia (62.2%)
32. San Marino (62.1%)
33. Guatemala (61.2%)
34. Mongolia (61.2%)
35. Canada (61.1%)
36. Qatar (61.0%)
37. Uruguay (60.9%)
38. Jordan (60.5%)
39. Bahamas (60.4%)
40. Iceland (60.4%)
41. Nicaragua (60.4%)
42. Cuba (60.1%)
43. Germany (60.1%)
44. Brunei Darussalam (59.8%)
45. Slovenia (59.8%)
46. Peru (59.6%)
47. Vanuatu (59.6%)
48. Finland (58.7%)
49. Jamaica (57.4%)
50. Israel (57.3%)
51. Saint Lucia (57.3%)
52. Austria (57.1%)
53. Azerbaijan (57.1%)
54. Turkey (56.8%)
55. Tuvalu (56.6%)
56. Dominican Republic (56.5%)
57. Slovakia (56.3%)
58. Cyprus (56.2%)
59. Saint Kitts and Nevis (56.1%)
60. Costa Rica (55.8%)
61. Colombia (55.6%)
62. Antigua and Barbuda (55.5%)
63. Switzerland (55.4%)
64. Montenegro (54.9%)
65. Serbia (54.9%)
66. Serbia and Montenegro (The frm state union of) (54.9%)
67. Albania (54.8%)
68. Fiji (54.8%)
69. Bulgaria (54.2%)
70. Luxembourg (54.2%)
71. Croatia (53.9%)
72. Bosnia and Herzegovina (53.8%)
73. Portugal (53.8%)
74. Armenia (53.3%)
75. Grenada (53.3%)
76. South Africa (53.3%)
77. Iran (Islamic Republic of) (53.2%)
78. Libyan Arab Jamahiriya (53.2%)
79. Lithuania (53.1%)
80. Lebanon (53.0%)
81. Czech Republic (52.9%)
82. Syrian Arab Republic (52.8%)
83. Spain (51.8%)
84. Hungary (51.6%)
85. Panama (51.4%)
86. Tunisia (51.0%)
87. Saint Vincent and the Grenadines (50.6%)
88. Brazil (50.5%)
89. Belize (49.8%)
90. Sweden (49.7%)
91. Norway (49.1%)
92. Russian Federation (49.1%)
93. El Salvador (48.7%)
94. Lesotho (48.5%)
95. Suriname (47.8%)
96. Paraguay (47.7%)
97. Guyana (47.5%)
98. Poland (47.5%)
99. Latvia (47.3%)
100. The former Yugoslav Republic of Macedonia (47.2%)

Take it with a grain of salt, as the U.S. is No. 9, with 74.1% of those over 15 years old considered overweight, but its population is nearly 20,000 times that of Nauru. To see the full list (way more than 100), check out the article on Forbes.com.