Michigan Heart Group Blog: 2012

Monday, December 3, 2012

MICHIGAN HEART GROUP'S PHYSICIAN LIAISON IS HERE TO HELP YOU

Michigan Heart Group has a Physician Liaison on staff to assist with questions, concerns or problems you, your staff or your patients may have with our office.

Stacie Batur is available Monday through Thursday at (248) 267-5050 (x6509). She is often between two buildings or visiting referring physician offices. If you get her voice mail, please leave a message and she will call you back shortly. If you need to speak to her immediately you can reach her on her cell phone at (248) 765-4466.

Friday, November 16, 2012

MICHIGAN HEART GROUP INTERGRATES WITH WILLIAM BEAUMONT HOSPITAL

On June 1, 2012 a change occurred at Michigan Heart Group we became integrated with William Beaumont Hospital in the form of a Professional Services Agreement. Our signage will soon read Beaumont Michigan Heart Group, Beaumont Michigan Heart Rhythm Group and Beaumont Western Wayne Heart Group.

This professional agreement will integrate some of the services that we provide with the hospital as well as some of our operations including our outpatient testing and billing, but will allow Michigan Heart Group to maintain operational control of the practice. Management of these operations still occurs locally within Michigan Heart Group. We have not experienced that these changes with Beaumont have disrupted any of the services that you currently receive from your physician.

We believe that with this integration model, we will be best able to provide you with the high quality of care that you have come to expect and deserve from our practice. All of our physicians will continue practicing from their current locations and your records will remain available to your physician without any further actions taken on your part. This is intended to be essentially a transparent change to you, the patient, in terms of how your care is delivered. Such a change has been made necessary after we have experienced years of progressive cuts in insurance reimbursement while our fixed costs have steadily increased. The status quo was no longer a viable option for the future.

You will notice changes specific to billing. Beaumont will bill applicable charges to your insurance. You will receive a billing statement from Beaumont rather than from Michigan Heart Group. You may still call Michigan Heart Group for billing inquiries however questions/determinations will be advised and directed by Beaumont.

We value your loyalty and trust that you have placed in our physicians and staff over the past several years and we continue to look forward to serving you in the future. As we indicated above, we believe that most of these changes will be transparent to your healthcare needs. If you have any questions, please contact our administrator, Darlene Nichols at 248-267-5050, select option 2.

Thank you for choosing Michigan Heart Group, in affiliation with William Beaumont Hospital for your healthcare services. We look forward to serving you now and in the future.

Very truly yours,

Beaumont Michigan Heart Group

Friday, November 2, 2012

MICHIGAN HEART GROUP'S PHYSICIAN LIAISON IS HERE TO HELP YOU

Wednesday, October 31, 2012

WHAT FOODS COULD LOWER HIGH BLOOD PRESSURE?

Fewer foods.. If you're overweight, losing weight, ie eating less food, will lower your blood pressure. Avoiding excess sodium chloride (table salt) will also lower BP. There aren't any effective foods that will actively lower your BP - it's all about what you DON'T eat.

POSTED BY: STEVEN AJLUNI, MD

Monday, October 29, 2012

WHAT PHYSIOLOGICAL SIGNALS IN THE HEART CHANGE SYSTOLIC BLOOD PRESSURE WITH EXERCISE?

Sympathetic nerves During exercise the sympathetic nervous system is stimulated. The catecholamines released as well as direct stimulation on the heart result in a faster heart rate as well as increased contractility which raises cardiac output. This increases the rate of volume/pressure rise into the vasculature (dp/dt). This increases BP.

POSTED BY: STEVEN AJLUNI, MD

Friday, October 26, 2012

HEART CATHERATERZATIONS AND BRUSING

Bruising is common, typically soreness should last only a few days whereas bruising might persist for weeks. Reabsorption of blood between facial layers takes time (the cause of the bruising). If femoral nerve trauma or irritation is present the pain in the groin might persist for some time ( neuropathic).

POSTED BY: STEVEN AJLUNI, MD

Wednesday, October 24, 2012

IS A RIGHT BUNDLE BRANCH BLOCK DANGEROUS AND CAN IT CAUSE CARDIAC ARREST?

RBBB is usually safe IRBBB is usually an ECG anomaly that may speak of some right sided enlargement or strain (can occur in atrial septal defect or in pulmonary processes with right heart strain ). It can also occur innocuously and unrelated to cardiac structural changes. It does not typically imply impending conduction system collapse and is not a predictor for cardiac arrest or sudden cardiac death.

POSTED BY: STEVEN AJLUNI, MD

Monday, October 22, 2012

WHAT IS SUDDEN CARDIAC DEATH?

Arrhythmia SCD typically refers to a sudden loss of effective contraction of the heart muscle and implies a life-threatening arrhythmia. Usually this is VT or VF. It occurs primarily in patients with a damaged heart (cardiomyopathy, postMI) where there is scar tissue that alters normal electrical conduction. It can also occur in patients w nl hearts (Brugada syndrome, ARVD, long QT) which are rare.

POSTED BY: STEVEN AJLUNI, MD

Friday, October 19, 2012

WHAT AFFECT DOES EXERCIESE HAVE ON THE CARDIOVASCULAR SYSTEM?

Improves output Aerobic exercise helps the heart by improving conditioning through enhanced delivery of oxygen to the tissues and enhanced extraction of oxygen in tho muscles. Over time richer vascular networks in those muscles enhances cardiac output by reducing afterload (the "load" that the heart has to pump against). Isometric exercises (example lifting heavy weights) benefits less and increases lvh

POSTED BY: STEVEN AJLUNI, MD

Wednesday, October 17, 2012

MICHIGAN HEART GROUP INTERGRATES WITH WILLIAM BEAUMONT HOSPITAL

Monday, October 15, 2012

WHAT ARE PROLOGED QT INTERVALS?

ECG measurement QT intervals are measured on a heart electrocardiogram (ECG). They measure "repolarization". Longer QT intervals may be associated with arrhythmias (irregular heart beats) such as torsades de pointes or ventricular tachycardia (VT). There are also inherited disorders that are associated with prolong QT intervals.

POSTED BY: STEVEN AJLUNI, MD

Friday, October 12, 2012

WHAT CAN CAUSE POTS DISEASE (POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME)?

Adrenergic stimulati

Abnormal and excessive secretion of catecholamines due to sympathetic nervous system stimulation secondary to changes in position (due to gravity effects on circulating intravascular volume). This unchecked catecholamine surge causes a stimulation of heart rate.

POSTED BY: STEVEN AJLUNI, MD

Wednesday, October 10, 2012

WATCH SALT, LOSE WEIGHT...

Blood Pressure is in 90% of cases a function of genetic susceptibility (increased vascular tone) and lifestyle factors (weight,salt intake, alcohol, smoking). Body wt is 60% water, so sharp volume increases drive up BP. Improving lifestyle factors can typically drop BP 10-15 points. For many, that's not enough and meds will be required. Lowering BP <140 and="and" diabetics="diabetics" heart="heart" in="in" lowers="lowers" nbsp="nbsp" p="p" risk="risk" vasc="vasc">
POSTED BY: STEVEN AJLUNI, MD

Monday, October 8, 2012

SURVEY: SIDE EFFECTS TOP REASON PATIENTS STOP USING STATINS

MedPage Today (6/23, Kaiser) reported, "Experiencing side effects such as muscle-related pain or weakness was the top reason why patients stopped taking statins, according to results from a large survey" published online in the Journal of Clinical Lipidology. Investigators reported that, "of the 1,220 respondents who stopped taking statins, 62% cited side effects as the main reason, compared with 17% who cited cost and 12% who said the drug lacked efficacy." The survey found that "muscle pain or weakness was reported by 29% of all survey respondents, but the rate was higher among former users compared with current users (60% versus 25%

POSTED BY: STEVEN ALMANY, MD

Friday, October 5, 2012

RESEARCHERS EVALUATE RENAL NERVE ABLATIONAS HYPERTENSION TREATMENT

In an article titled "Trialists: Will Interventional Tx Tame BP?," Reported on a study that is currently "evaluating renal nerve ablation as a way to curtail" hypertension. The article also discusses another trial that evaluated the therapy. "In the nonrandomized Symplicity HTN-1 trial, the percentage of responders increased over time, reported Paul A. Sobotka, MD, from Ohio State University in Columbus, at the 2012 American College of Cardiology meeting." The researchers found that "at one month, 69% of 143 patients responded; at 12 months, it was 79% of 130 patients; at two years, it was 90% of 59 patients; and at three years, 100% of 24 patients followed for 36 months responded."

WBH Comment-Approximately 25-30% of Americans are hypertensive. Nearly 10 Million take 3 or more drugs to treat their hypertension. Renal Denervation may offer these patients a procedure

that may significantly lower their blood pressure and need for medications. There are nearly 40 start up companies currently working on devices to offer this therapy. It should be commerically available in the US in 2013-2014.

POSTED BY: Steven Almany M.D.

Wednesday, October 3, 2012

MICHIGAN HEART GROUP'S PHYSICIAN LIAISON IS HERE TO HELP YOU

Monday, October 1, 2012

LOW CARB-HIGH PROTEIN DIETS MAY PUT HEART AT RISK

By Todd Neale, Senior Staff Writer, MedPage Today

Published: June 27, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Take Posttest

Consuming a low carbohydrate-high protein diet -- like the Atkins diet -- may be associated with a greater risk of cardiovascular disease in women, researchers found.

Decreases in carbohydrate intake and increases in protein intake, as well as in a score combining carbohydrate and protein intake, were all associated with significantly greater risks of incident cardiovascular disease events in young Swedish women, according to Pagona Lagiou, MD, PhD, of the University of Athens in Greece, and colleagues.

The findings, which were reported online in BMJ, "do not answer questions concerning possible beneficial short-term effects of low carbohydrate or high protein diets in the control of body weight or insulin resistance," the authors wrote.

"Instead, they draw attention to the potential for considerable adverse effects on cardiovascular health of these diets when they are used on a regular basis, without consideration of the nature of carbohydrates (complex versus refined) or the source of proteins (plant versus animal)," they wrote.

Low carb-high protein diets have become popular because of the short-term effects on weight control, but concerns have been raised about the potential cardiovascular effects over the long term. Studies exploring the issue have given mixed results, with a U.S. study showing no relationship between such a diet and rates of ischemic heart disease.

But three European studies showed a greater risk of cardiovascular mortality with such a diet.

Lagiou and colleagues examined data from the Swedish Women's Lifestyle and Health Cohort, a prospective study conducted among women living in the healthcare region of Uppsala. The current analysis included 43,396 women, ages 30 to 49 at baseline, who completed a comprehensive questionnaire on lifestyle and dietary factors, as well as medical history. They were followed for an average of 15.7 years.

The researchers scored each participant according to their carbohydrate and protein consumption. Carbohydrate intake was scored from 1 (very high) to 10 (very low). Protein intake was scored from 1 (very low) to 10 (very high). A combined carbohydrate-protein score ranged from 2 (very high consumption of carbs and very low consumption of protein) to 20 (very low consumption of carbs and very high consumption of protein).

During follow-up, there were 1,270 incident cardiovascular events, which included ischemic heart disease, ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, and peripheral arterial disease.

After adjustment for energy intake, saturated and unsaturated fat intake, and numerous cardiovascular risk factors, each one-point decrease in carb intake was associated with a relative 4% increase in cardiovascular events (95% CI 0% to 8%). A one-point increase in protein intake also was associated with a relative 4% increase in events (95% CI 2% to 6%).

Each two-point increase in the low carbohydrate-high protein score -- equivalent to a 20-gram decrease in daily carb intake and 5-gram increase in daily protein intake -- was associated with a relative 5% increase in cardiovascular events (95% CI 2% to 8%).

There was a suggestion that the associations were stronger for women whose protein came mostly from animal sources, but the test for interaction did not reach statistical significance for nearly all of the individual outcomes.

"Although these results are based on an observational study, their biological plausibility seems self evident," according to Anna Floegel, MPH, of the German Institute of Human Nutrition Potsdam-Rehbruecke, and Tobias Pischon, MD, MPH, of the Max Delbrück Center for Molecular Medicine Berlin-Buch.

"A low carbohydrate diet implies low consumption of whole-grain foods, fruits, and starchy vegetables and consequently reduced intake of fiber, vitamins, and minerals. A high protein diet may indicate higher intake of red and processed meat and thus higher intake of iron, cholesterol, and saturated fat," they explained in an accompanying editorial.

"These single factors have previously been linked to a higher risk of major chronic diseases, including cardiovascular disease, in observational studies, so it is not surprising that this combination of risk factors is linked to a higher incidence of disease and mortality," they said.

Lagiou and colleagues acknowledged that their study was limited by the possible misclassification of diet

based on participant self-report only at the beginning of the study, the lack of information on cardiovascular medication use and blood cholesterol levels, and the possibility of residual confounding.

The study was supported by grants from the Swedish Cancer Society and the Swedish Research Council.

The study authors and the editorialists reported no conflicts of interest.

From the American Heart Association:

Primary source: BMJ
Source reference:
Lagiou P, et al "Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study" BMJ 2012; DOI:10.1136/bmj.e4026.

POSTED BY: Steven Almany M.D.

Friday, September 28, 2012

LANCET: CLASSIFY CHRONIC KIDNEY DISEASE AS A HEART DISEASE RISK EQUIVALENT

Researchers recommended making chronic kidney disease (CKD) a coronary heart disease risk equivalent after their results showed the risk of MI was similar for CKD and diabetic patients in a study published online June 19 in The Lancet. Writers in an accompanying editorial praised the study despite its falling short on its primary outcome.

Marcello Tonelli, MD, of the department of medicine at the University of Alberta in Edmonton, Canada, and colleagues posed the question: Given the high rates cardiovascular (CV) events in patients with CKD, should CKD be considered a risk equivalent for heart disease? The authors argued that the U.S. National Cholesterol Education Program Adult Treatment Panel III guidelines for cholesterol lowering therapies already classify diabetes as a risk equivalent based in part on data linking diabetes and the risk of CV events.

The researchers used the Alberta Kidney Disease Network database in Canada to obtain routine laboratory data from all patients in Alberta. They selected patients who were 18 years or older who had serum creatinine measured at least once as an outpatient between 2002 and 2009. They excluded patients with an estimated glomerular filtration rate (eGFR) indicating end-stage kidney disease. Of those remaining, they identified patients who also had been tested for proteinuria.

They defined CKD as eGFR lower than 60mL/minute per 1.73 m² (stage 3 or 4). They followed patients from their index date until March 31, 2009. The primary outcome was first MI admission to a hospital and the secondary outcome was all-cause mortality. Using the Alberta Bureau of Vital Statistics, they also assessed short-term and long-term mortality after MI.

One percent of the patients were admitted to a hospital for MI during a median 48-month follow-up. Those with a previous MI had the highest unadjusted rate of MI (18.5 per 1,000 person years). In those with no previous MI, patients with diabetes and no CKD had a rate of 5.4 per 1,000 person-years while patients with CKD and no diabetes had a rate of 6.9 per 1,000 person-years. Adjusted relative rates of MI, though, were similar for patients with CKD and severely increased proteinuria and those with diabetes.

But the proportion of patients who died within 30 days of admission for MI was much higher among patients with CKD and no diabetes, at 14 percent, than for those with diabetes and no CKD, at 8 percent. It even topped the proportion of patients with a history of prior MI, at 10 percent.

“Our findings show that the risk of myocardial infarction in people with chronic kidney disease and proteinuria is similar or greater than the risk in those with diabetes,” the authors wrote. “The rate of mortality after myocardial infarction in our study was significantly higher in participants with chronic kidney disease than in those with diabetes.”

The authors concluded that their findings support adding CKD to the list of criteria when defining those at high risk of future coronary events. “Our research suggests that there is a strong case for considering chronic kidney disease to be a coronary heart disease risk equivalent, meaning that people with chronic kidney disease are at a comparable risk of coronary events as those who previously had a heart attack,” Tonelli said in a release.

In an accompanying editorial, Tamar S. Polonsky, MD, and George L. Bakris, MD, both University of Chicago Medicine in Chicago, pointed out that the study had negative findings in the primary outcome: first MI admission to a hospital. They also addressed limitations, including the lack of information about individual patient’s medications and efforts to control CV risk factors.

But they praised the study’s use of a population-based cohort of almost 1.3 million people in a real-world setting and its findings. “Tonelli and colleagues offer new insight by comparing individuals with chronic kidney disease with those who have a history of myocardial infarction, on a very large scale,” they wrote. “Their findings emphasize the importance of primary prevention, particularly because patients with chronic kidney disease comprise a large proportion of the patients who have myocardial infarction.”

POSTED BY: Steven Almany M.D.

Wednesday, September 26, 2012

ADDING MARKERS ADDS LITTLE TO CV PREDICTION

Only slight improvements in cardiovascular risk prediction were gained by adding more blood lipid-related markers to conventional factors, researchers said.

Fewer than 5% of individuals would have their risk classifications changed by including such markers as apolipoprotein A-I, apolipoprotein B, lipoprotein(a), or lipoprotein-associated phospholipase A₂ (LpA-PLA₂) in gauging the likelihood of major cardiovascular events, reported John Danesh, FRCP, of the University of Cambridge in England, and colleagues belonging to the Emerging Risk Factors Collaboration.

At best, adding more lipid markers to the risk prediction equation brought "slight improvement," the researchers wrote in the June 20 issue of the Journal of the American Medical Association. Replacing the standard markers with the other lipoprotein-associated factors reduced the accuracy of risk prediction.

"These findings applied to clinically relevant subpopulations, including people with diabetes and people with elevated triglyceride levels," Danesh and colleagues noted.

Earlier studies have gone back and forth on whether blood lipid measurements besides total and HDL cholesterol contribute significantly to the accuracy of risk prediction. Some research groups have proposed supplementing or even replacing standard cholesterol markers with various other lipid components that appear to be associated with cardiovascular event risk.

But other research has failed to confirm the value of additional lipid parameters, leading Danesh and colleagues to perform a meta-analysis of data from 37 prospective cohorts in which blood lipids were measured and cardiovascular events systematically recorded.

Overall, these cohorts comprised more than 165,000 individuals experiencing some 15,000 cardiovascular deaths and nonfatal MIs and strokes over a median of 10.4 years of follow-up.

Measurements of apolipoprotein A-I and B and lipoprotein(a) were available in more than 130,000 of the study participants. Information on LpA-PLA₂ was obtained for about 32,000 participants.

The pooled data showed that each of these factors, except for apolipoprotein A-I, was significantly associated with increased event risk after adjusting for age, smoking status, systolic blood pressure, and history of diabetes. Hazard ratios ranged from 1.13 to 1.24 for each standard deviation of higher age and systolic blood pressure (P<0 .05=".05" a="a" and="and" apolipoprotein="apolipoprotein" b="b" for="for" lipoprotein="lipoprotein" span="span">LpA-PLA

₂.

But adding these factors to total and HDL cholesterol only rarely altered participants' classifications into low-, medium-, or high-risk groups.

Adding each marker individually changed risk classifications in fewer than 1% of participants, Danesh and colleagues found.

The researchers also looked more narrowly at the effect on the number of participants estimated to have at least a 20% 10-year risk of major events, which would qualify them for statin treatment.

The most influential additional marker in this respect was lipoprotein(a). Adding it to conventional risk factors boosted the number of participants in this risk group by 4.1%.

Adding a combination of apolipoproteins B and A-I to conventional risk factors would boost the number qualifying for statins by 1.1%, and LpA-PLA₂ would increase it by 2.7%.

Danesh and colleagues estimated that, on the basis of these calculations, it would be necessary to test from 800 to 4,500 individuals for these markers in order to prevent one major cardiovascular event over 10 years.

WBH Comment

In an accompanying editorial, Scott Grundy, MD, PhD, of the University of Texas Southwestern Medical Center in Dallas, suggested that the study's implicit basic assumption -- that accurate risk classification as currently defined is important -- can be questioned.

"These [low-medium-high] risk categories were designated more than a decade ago to guide in the use of cholesterol-lowering drugs (e.g., statins) in primary prevention, and were defined to reduce use of expensive drugs for lower-risk persons," he wrote.

Now that statins are available in cheap generic form and their safety is "well established," the need for risk categories in deciding who should get them is "less compelling," Grundy suggested.

Instead, it makes more sense to identify patients now classified as low-risk who may benefit from statins, he argued. Recent research has suggested that this may be a sizable population.

Grundy wrote that imaging methods for detecting early, sub-clinical atherosclerosis or simple risk prediction algorithms based on age, sex, LDL cholesterol, "and perhaps another major risk factor" may be the best way to select such patients.

POSTED BY: Steven Almany M.D.

Monday, September 24, 2012

WEIGHT LIFTING MAY REDUCE TYPE 2 DIABETES RISK IN MEN

ABC World News (8/6, story 8, 0:20, Stephanopoulos) reported, "And in healthy living, a new way to reduce the risk of diabetes: A study by Harvard School of Public Health" published online August 6 in the Archives of Internal Medicine "found that men who lift weights at least two and a half hours per week decrease their risk of getting type 2 diabetes by a third."

CardioSource (8/7) reports that "the risk of T2DM [type 2 diabetes mellitus] was lowered by 13 percent for every 60 minutes of weight training per week. There was a stronger association of weight training and T2DM risk in men under the age of 65 as well as in men with no family history of T2DM."

POSTED BY: Steven Almany M.D.

Friday, September 21, 2012

RED MEAT CONSUMPTION MAY BE LINKED TO INCREASED RISK OF STROKE

MedPage Today (8/7, Neale) reports, "Eating red meat -- including beef, pork, lamb, ham, hot dogs, sausage, and bacon -- may increase the risk of stroke," according to a meta-analysis published online in Stroke: Journal of the American Heart Association. Investigators found that "each one-serving-per-day increase in fresh, processed, and total red meat intake was associated with an 11% to 13% relative increase in the risk of all strokes, driven by an increase in the risk of ischemic stroke." But, the investigators reported, "there was...no relationship between red meat consumption and hemorrhagic stroke risk."

POSTED BY:Steven Almany M.D.

Wednesday, September 19, 2012

SHAPE OF LEFT ATRIAL APPENDAGE MAY BE LINKED TO STROKE RISK IN AFIB PATIENTS

"The shape of the left atrial appendage may have something to do with the risk of ischemic stroke in patients with atrial fibrillation," according to a study that was published in the Journal of the American College of Cardiology. Researchers found that "of the four shapes characterized by researchers, the one called Chicken Wing carried a 79% decreased risk of stroke or transient ischemic attack (TIA)." The investigators reported that, "compared with Chicken Wing, the other three shapes were four to eight times more likely to be associated with stroke or TIA."

POSTED BY: Steven Almany M.D.

Monday, September 17, 2012

MICHIGAN HEART GROUP INTERGRATES WITH WILLIAM BEAUMONT HOSPITAL

Friday, September 14, 2012

The cardiovascular benefits of taking statins outweigh the risk of diabetes, even in high risk individuals, according to a study published on Aug. 9 in The Lancet.

The study, the first placebo-controlled statin trial to formally report an increased risk of developing diabetes, found "in individuals with one or more risk factors, statin allocation was associated with a 39 percent reduction in the primary endpoint, a 36 percent reduction in venous thromboembolism, a 17 percent reduction in total mortality, and a 28 percent increase in diabetes." Whereas in individuals with "no major diabetes risk factors, statin allocation was associated with a 52 percent reduction in the primary endpoint, a 53 percent reduction in venous thromboembolism, a 22 percent reduction in total mortality, and no increase in diabetes."

By comparison with placebo, statins accelerated the average time to diagnosis of diabetes by 5•4 weeks (84•3 [SC 47•8] weeks on rosuvastatin vs. 89•7 [50•4] weeks on placebo, the authors add.

The trial, called JUPITER, was a randomized, double-blind trial that looked at 17,603 men and women without previous cardiovascular disease or diabetes over five years. As previous studies have suggested that statins increase risk of development of diabetes, which have led to recent regulatory changes, the authors aimed to "address the balance of vascular benefits and diabetes hazard of statin use."

In an editorial comment, Gerald F. Watts and Esther M. Ooi from the Cardiometabolic Research Centre and Clinical Services at the Royal Perth Hospital in Perth, Australia, note, "these findings reaffirm the net value of statins in the primary prevention of cardiovascular disease, but intuitively caution that the diabetogenic effect of these drugs is highest in individuals with risk factors for diabetes, including raised C-reactive protein."

POSTED BY: Steven Almany M.D.

Wednesday, September 12, 2012

ADDING CLOPIDOGREL TO DAILY ASPIRIN MAY NOT REDUCE RISK OF SECOND STROKE

HealthDay (8/30, Reinberg) reports, "Adding the clot-busting drug Plavix [clopidogrel] to a daily dose of aspirin is no better than taking aspirin alone to prevent a second stroke in people who have had a type of stroke that is typically caused by chronic high blood pressure," according to a study published in the New England Journal of Medicine.

MedPage Today (8/30, Petrochko) reports, "In the halted SPS3 trial, dual antiplatelet therapy with clopidogrel and aspirin did not significantly reduce recurrent stroke risk at follow-up compared with aspirin alone (2.5% versus 2.7%) at a hazard ratio of 0.92 (95% CI 0.72 to 1.16)." But, "compared with aspirin alone, dual therapy almost doubled the risk of major bleeding (HR 1.97 95% CI 1.41 to 2.71, P<0 .001=".001" 1.14="1.14" 1.52="1.52" 2.04="2.04" 95="95" all-cause="all-cause" and="and" ci="ci" div="div" mortality="mortality" p="0.004)." to="to">

POSTED BY: Steven Almany M.D.

Monday, September 10, 2012

GREAT CHARITY STARTED BY DR. STEVEN ALMANY- STUDENT HEART CHECK

http://www.myfoxdetroit.com/video?autoStart=true&topVideoCatNo=default&clipId=7608635

Friday, September 7, 2012

CARDIAC ARREST MAY BE MORE COMMON IN YOUNG PEOPLE THAN PREVIOUSLY BELIEVED

According to a study published online in Circulation, while cardiac arrest is fairly uncommon in young people, it may be more common than previously believed. Investigators looked at data from a 30-year period in Washington's King County. The investigators reported that the cardiac arrest rate among kids and young adults was approximately 2.3 per 100,000 annually.

POSTED BY: Steven Almany M.D.

Wednesday, September 5, 2012

TWO JAMA STUDIES LOOK AT EFFECTIVE WEIGHT LOSS APPROACHES

ABC World News (6/26, story 7, 1:45, Stephanopoulos) reported, "A surprising study" published in the Journal of the American Medical Association "that could change the way we think about dieting. When it comes to counting calories, what kind we take in may matter as how many we take in." Reuters (6/27, Pittman) reports that, according to another study, also published in the Journal of the American Medical Association, a stepped-care program may be nearly as effective as a standard weight-loss intervention for helping people lose weight, and is cheaper as well.

CardioSource (6/27) reports that one "study, 'Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance,' looked at the effect on energy expenditure and components of the metabolic syndrome of three types of commonly consumed diets following weight loss and found that decreases in resting energy expenditure and total energy expenditure were greatest with a low-fat diet, intermediate with a low-glycemic index diet and least with a very low-carbohydrate diet." The other "study, 'Effect of a Stepped-Care Intervention Approach on Weight Loss in Adults: A Randomized Clinical Trial,' showed that although a standard behavioral weight loss intervention among overweight and obese adults resulted in greater average weight loss over 18 months, a stepped care intervention resulted in clinically meaningful weight loss that cost less to implement."

Also covering the first study were the Wall Street Journal (6/27, A3, Dooren, Subscription Publication), USA Today (6/27, Hellmich), the Los Angeles Times (6/27, Brown), Bloomberg News (6/27, Ostrow), and the New York Times (6/27, Bittman) "Opin

Posted by: Steven Almany MD

Monday, September 3, 2012

MICHIGAN HEART GROUP'S PHYSICIAN LIAISON IS HERE TO HELP YOU

Friday, August 31, 2012

DAILY ASPIRIN TO PREVENT HEART DISEASE MAY INCREASE RISK OF GI OR GEREBRAL BLEEDING

Journal of the American Medical Association' raised a red flag, saying the risk of bleeding even from low dose aspirin everyday is greater than they thought."

CardioSource (6/6) reports, "The study, which looked at 186,425 patients being treated with low-dose aspirin and the same number of control patients not using aspirin, is thought to be the first longitudinal study specifically examining the role of diabetes in the incidence of major bleeding in a cohort of individuals, irrespective of the use of aspirin." The study indicates "that aspirin was associated with a 55 percent increase in major bleeding – a finding that suggests the incidence of major bleeding events is much higher than previously shown in other randomized, prospective clinical trials. There also was a higher risk of bleeding among aspirin users younger than 50, in those being treated for hypertension and those using aspirin to relieve pain."

Posted by: Steven Almany MD

Wednesday, August 29, 2012

HEREDITY MAY PLAY SUBSTANTIAL ROLE IN PRE-HYPERTENSION

MedPage Today (6/5, Baron-Faust) reports, "Heredity appears to play a substantial role in pre-hypertension -- a risk factor for high blood pressure, cardiovascular disease, and death -- according to a large cross-sectional study of identical and nonidentical twins and their siblings and family members." Researchers "found that trait heritability affected systolic pressures by about 44.6% (P≤0.001) but not diastolic pressures, while impacting plasma norepinephrine by around 65.2% (P≤0.001), and heart rate by approximately 62.2% (P≤0.001)." The investigators "also found trait heritability for other hemodynamic factors, such as cardiac index of around 60.5%, and 57.3%, for systemic vascular resistance index (P≤0.001 for both), with lesser associations for other factors, such as left ventricular pressure changes over time, they reported in the June issue of the Journal of the American College of Cardiology."

Posted by: Steven Almany M.D.

Monday, August 27, 2012

RESEARCH SUGGESTS CALCIUM SUPPLEMENTS MAY INCREASE HEART-ATTACK RISK

USA Today (5/24, Lloyd) reports, "Taking a calcium supplement to help prevent bones from thinning puts people at a greater risk for heart attacks, says a report out today in the journal Heart." The study involved about "24,000 people between the ages of 35 and 64."

The Los Angeles Times (5/24, Maugh) reports that the researchers found "that those who had a moderate amount of calcium in their diet (820 milligrams daily) had a 31% lower risk of having a heart attack than those in the bottom 25% of calcium consumption, but those with a daily intake of more than 1100 mg did not have a lower risk. There was no evidence that any level of calcium intake in the diet affected stroke risk." However, "when the team considered supplements, they found that those who took calcium supplements regularly were 86% more likely to have a heart attack than those who used no supplements." The researchers reported that "for those who took only calcium supplements, and no others, the risk doubled."

In a piece taken from Health Magazine, the CNN (5/24) "The Chart" blog reports, "Only the use of calcium supplements, and not overall calcium intake, was associated with an increased risk of heart attack. In fact, people who consumed higher amounts of calcium from foods, such as milk and other dairy, tended to have a lower risk of heart attacks than people who consumed less."

On its website, CBS News (5/24) reports, "The reasons for the differing risks aren't entirely clear, but researchers suggested the sudden burst of calcium into the system from supplements may be part of the problem."

Many experts, however, expressed skepticism. For instance, on the MSNBC (5/24) "Vitals" blog, Robert Bazell, NBC Chief Science and Health Correspondent writes that "this research...is just the type of experiment that often scares people unnecessarily and gives the science of epidemiology a bad name." According to Bazell, "the study was set up to look at cancer risk and these scientists are 'mining' the data to look for heart disease outcomes. What the researchers unearth is a confusing set of conclusions."

HealthDay (5/24, Reinberg) reports that Dr. Robert Recker, director of the Osteoporosis Research Center at Creighton University and president of the National Osteoporosis Foundation, said, "I am doubtful of these findings." According to Dr. Recker, "It's hard to understand why calcium in the diet can reduce the risk of heart attack, but supplements increase the risk." Also covering the story are the UK's Press Association (5/24) and BBC News (5/24, Gallagher).

Posted by: Steven Almany M.D.

Friday, August 24, 2012

THE FUNCTION OF ANGIOTENSIN

Angiotensin is converted from angiotensinogen and functions to help the body secrete aldosterone (which results in salt and water retention). Angiotensin I converts to angiotensin II, and Angiotensin II has potent vasoconstrictor and proinflammatory effects on the vasculature.

POSTED BY: STEVEN AJLUNI, MD

Wednesday, August 22, 2012

WHAT AN ECHOCARDIOGRAM SHOWS

An echo is designed to provide structural and functional data on how the heart contracts and performs as a pump. It also provides valuable information on valvular function, and assessment of pericardial disease. It is helpful in triaging damage after a heart attack.

POSTED BY: STEVEN AJLUNI, MD

Monday, August 20, 2012

CAUSE OF DIZZINESS

Dizziness has many causes. It could occur secondary to low BP, abnormal heart rhythms, coronary disease, obstructive valvular heart disease (cardiac reasons), or non-cardiac reasons (inner ear, cerebrovascular, psychiatric, vasovagal) .

POSTED BY: STEVEN AJLUNI, MD

Friday, August 17, 2012

MICHIGAN HEART GROUP INTERGRATES WITH WILLIAM BEAUMONT HOSPITAL

Wednesday, August 15, 2012

CAUSE OF SKIPPED BEATS

A regularly irregular rhythm typically relates to a timed premature beat (either PVC- premature ventricular contraction, or PAC-premature atrial contraction). It can occur spontaneously or as a result of extrinsic stressors than result in adrenalin secretion.

POSTED BY: STEVEN AJLUNI, MD

Monday, August 13, 2012

CAUSE OF RAPID HEART RATE

Rapid heart rates can be either physiologically appropriate or inappropriate (pathologic). Examples of physiologic appropriate sinus tachycardia might be fast HR due to stress or caffeine. Pathologic tachycardia can involve a wide spectrum of arrhythmias coming either from the atria or ventricular locations.

POSTED BY: STEVEN AJLUNI, MD

Friday, August 10, 2012

SIDE EFFECTS OF ZETIA

Zetia prevents GI absorption of cholesterol. Most of it side effects are GI --indigestion and changes in bowel habits. As with other cholesterol lowering medications it can occasionally exacerbate muscle aches.

POSTED BY: STEVEN AJLUNI, MD

Wednesday, August 8, 2012

BENEFITS OF LOW CHOLESTEROL

Low cholesterol is beneficial in that it reduces long term vascular inflammation and injury which are the hallmarks of atherosclerosis that can lead to heart attacks, strokes, and peripheral arterial disease.

POSTED BY: STEVEN AJLUNI, MD

Monday, August 6, 2012

HOW OFTEN TO MONITOR BLOOD PRESSURE

BP is an important risk factor for vascular disease. If BP is normal, checking it periodically at doctor visits is probably adequate. If BP is borderline or high orif a family risk for htn is great, spot checking or ambulatory monitoring makes sense.

POSTED BY: STEVEN AJLUNI, MD

Friday, August 3, 2012

MICHIGAN HEART GROUP'S PHYSICIAN LIAISON IS HERE TO HELP YOU

Wednesday, August 1, 2012

HOW ARHTEROSCLEROSIS AFFECTS BLOOD PRESSUE

A thickened atherosclerotic blood vessel becomes less compliant and can therefore result in a higher BP (same volume of blood traveling in smaller and stiffer pipes). Elevated BP is a potent risk factor for accelerating atherosclerosis.

POSTED BY: STEVEN AJLUNI, MD

Monday, July 30, 2012

CHEST PAIN WITH EXERCISE

Sometimes muscles in the chest wall are strained when doing an exercise like the exercise bike (if certain positions are uncomfortable or if the work is extreme). This is usually a pain that u can reproduce by pressing over the upper rib cage. However, one has to be concerned about a deeper chest discomfort that comes on after exercise, as it could signify a heart problem like angina.

POSTED BY: STEVEN AJLUNI, MD

Friday, July 27, 2012

ANATOMY OF A VASOVAGAL EVENT

Nervous stimuli of the vagus nerve can lead to low BP (hypotension) and heart rate slowing (cardioinhibitory) reflexes. This vasovagal event can lead to fainting (syncope).

POSTED BY: STEVEN AJLUNI, MD

Wednesday, July 25, 2012

DIFFERENCE BETWEEN CARDIAC ARREST AND ASYSTOLE

Asystole is one form of cardiac arrest (sudden cardiac death), but others include dangerous ventricular arrhythmias such as ventricular tachycardia or ventricular fibrillation.

Cardiac arrest refers to any situation in which the heart is not pumping blood. This may occur with abnormal electrical activity in the heart in which the heart is quivering ( ventricular fibrillation) or beating so fast in can not pump blood effectively (Ventricular tachycardia,) Asystole is a kind of cardiac arrest in which the heart is electrically silent ( flat line) on EKG.

POSTED BY: STEVEN AJLUNI, MD

Monday, July 23, 2012

CADUET AND DIABETES

Two factors that influence CV risk the most in diabetics include HTN and hyperlipidemia. Caduet contains amlodipine for BP and atorvastatin for lipid reduction. Clinical trials have demonstrated efficacy of atorvastatin in CV protection in diabetics REGARDLESS of baseline lipid levels.

POSTED BY: STEVEN AJLUNI, MD

Friday, July 20, 2012

BYPASS...NOT A CURE

By 10 years after bypass, there is a 50% risk of having experienced closure of one or more vein grafts . Bypass is not a cure. Atherosclerosis is an ongoing problem and requires lifelong treatment of risk factors.

POSTED BY: STEVEN AJLUNI, MD

Wednesday, July 18, 2012

HOW SHOULD ONE KEEP TRACK OF THEIR HEART HEALTH?

A good knowledge of your risk factors (of which family history is clearly one). Knowing your status with regards to traditional factors,like cholesterol profile, diabetes, and blood pressure. Lifestyle indicators like exercise tolerance, smoking, etc. further risk delineation might be possible with advanced screening modalities such as stress testing and coronary CT angiography might help too.

A cardiologist or internist can help define your risk profile by getting a history (family history, smoking, diabetes, hypertension, hyperlipidemia), and arranging for a fasting lipid level. In high risk settings additional risk can be found with a lipid NMR study assessing non traditional risk factors such as lipoprotein particle size. Other risk factors, PLAC, CRP, homocysteine could help.

POSTED BY: STEVEN AJLUNI, MD

Monday, July 16, 2012

MICHIGAN HEART GROUP INTERGRATES WITH WILLIAM BEAUMONT HOSPITAL

Friday, July 13, 2012

SYNCOPE AFTER GETTING SICK FROM A MIGRAINE

A migraine produces a host of changes in vascular tone in blood vessels that are in the brain. The end result of vasodilation of these vessels is a stimulation of central reflexes that stimulate the vagus nerve. This nerve in turn stimulates the stomach and has important nervous effects on the heart. The end result--vasodilation (low BP), along with nausea and a slow heart rate-a vasovagal event.

POSTED BY: STEVEN AJLUNI, MD

Wednesday, July 11, 2012

HOW ARE PRO ATHLETES DYING FROM CARDIAC ARREST

Cardiomyopathy is either linked or acquired and represents a high risk condition to trigger dangerous arrhythmias during high stress situations. Many times this predisposition can be discovered ahead of time with the appropriate screening ( history, physical exam, and ECG).

POSTED BY: STEVEN AJLUNI, MD

Monday, July 9, 2012

DIFFERENCE BETWEEN COSTOCHONDRIS AND ANGINA

Costochondris is inflammation of the junction between cartilage in the front of the rib cage and the bony rib. It is a sharp soreness that hurts particularly as the chest moves (most noticeable in inspiration or with palpating). It lasts a split second. Angina is a deeper more visceral sensation. It represents nervous stimulation due to lack oxygen in heart tissue. Lasts minutes.

POSTED BY: STEVEN AJLUNI, MD

Friday, July 6, 2012

NORMAL HEART RATES FOR ATHLETES

Typically a well-conditioned athlete's heart will run slower than normal because of well-conditioned autonomic reflexes as well as a larger stroke volume with each heart beat. It is not uncommon to see resting heart rates in 40's-60's in such cases.

Normal heart rates range from 60-100 beats per minute, though heart rates at times can easily be outside this range if other factors are present.

POSTED BY: STEVEN AJLUNI, MD

Monday, July 2, 2012

MICHIGAN HEART GROUP'S PHYSICIAN LIAISON IS HERE TO HELP YOU

Saturday, June 30, 2012

BENEFITS VS. RISK OF ASPIRIN THERAPY

Low dose aspirin has been shown to be of benefit as secondary prevention (preventing second events) in people who have suffered heart attacks or strokes. It is also of benefit as primary prevention (preventing first events) in patients with cardiovascular risk factors though it's use should be balanced by a slightly increased risk of bleeding and gastric irritation.

POSTED BY: STEVEN AJLUNI, MD

Wednesday, June 27, 2012

ATORVASTATIN (BRAND NAME: LIPITOR) SIDE EFFECTS

Atorvastatin is a statin. Side-effects include muscular aches , inflammation, LFT elevation. Dangerous toxicity such as outright rhabdomyolosis is rare (less than 0.05%), but muscle aches can occur in 10% patients.

POSTED BY: STEVEN AJLUNI, MD

Monday, June 25, 2012

SIDE EFFECTS TO ADVICOR?

Advicor contains a statin as well as niacin. Side-effects include muscular aches (statins), inflammation (both), LFT elevation (both), and flushing (niacin). Dangerous toxicity is rare, but muscle aches can occur in 10% patients.

POSTED BY: STEVEN AJLUNI, MD

Friday, June 22, 2012

DEFINATION OF ATRIAL FIBRILLATION

Fast and irregular heartbeats could imply atrial fibrillation. This is an arrythmia wherein their is an uncoupling of the electrical synchronization between the upper cardiac chambers (atria) and lower chambers (ventricles). This leads to a fast and irregularly irregular (irregular cadence). This can result in light headedness and potentially in clot formation and stroke risk.

POSTED BY: STEVEN AJLUNI, MD

Wednesday, June 20, 2012

WHAT IS HYPOKINESIS?

Hypokinesis suggests that an area of the heart is not thickening and contracting normally typically as a result of reduced blood supply and inadequate oxygen delivery to that portion of the heart.

POSTED BY: STEVEN AJLUNI, MD

Saturday, June 16, 2012

MICHIGAN HEART GROUP INTERGRATES WITH WILLIAM BEAUMONT HOSPITAL

Friday, June 15, 2012

CARDIAC ARRHYTHMIAS AND THE RISKS THEY HOLD

Arrhythmias can be either benign either (asymptomatic) or nuisance type events (palpitations), or dangerous (potentially life-threatening). Which depends on the type of arrhythmia and the structural context of the heart in which it occurs. If you think you have one, it should be check by your primary care physician.

POSTED BY: STEVEN AJLUNI, MD

Wednesday, June 13, 2012

PREGNANCY AND ELEVATED HEART RATES

During pregnancy, here is a significant increase in plasma volume, creating a dilutional effect on one's blood counts (anemia). This coupled with the large flow of blood from maternal circulation to the placenta causes a compensatory rise in heart rate to generate the necessary cardiac output and deliver enough oxygen to the tissues.

POSTED BY: STEVEN AJLUNI, MD

Monday, June 11, 2012

WHEN SHOULD ATRIAL SEPTAL DEFECTS BE CORRECTED?

ASD's are congenital heart defects wherein blood is shunted from the left atrium (oxygenated) to the right atrium (deoxygenated) circulations. When this shunt is significant (shunt ratio greater than 1.8) or if there are symptoms of dyspnea or right sided pressure/volume overload (pulmonary hypertension), the ASD'S should be corrected either surgically or by catheterization techniques.

POSTED BY: STEVEN AJLUNI, MD

Friday, June 8, 2012

TESTS THAT RULE OUT STROKE

Typically stroke risk is assessed by a good neurological exam coupled with a patient history followed by an imaging study (head CT or MRI). Stroke can be diagnosed or ruled out by assessing that.

A bleed caused by a cerebrovascular accident can be ruled out by Unenhanced CT of the head.

POSTED BY: STEVEN AJLUNI, MD

Wednesday, June 6, 2012

HOW SIGNIFICANT OF A ROLE DO GENETICS PLAY IN HEART DISEASE

One's genetics are a strong predictor for the development of heart problems when the connection is close (sibling or parent), and when the heart problems occur at a young age (less then 65)

POSTED BY: STEVEN AJLUNI, MD

Monday, June 4, 2012

MICHIGAN HEART GROUP INTEGRATES WITH WILLIAM BEAUMONT HOSPITAL

Sunday, June 3, 2012

MICHIGAN HEART GROUP'S PHYSICIAN LIAISON IS HERE TO HELP YOU

Thursday, May 3, 2012

MICHIGAN HEART GROUP'S PHYSICIAN LIAISON IS HERE TO HELP YOU

Monday, April 30, 2012

SUGARY DRINKS MAY BE LINKED TO HEART RISKS IN WOMEN

The Los Angeles Times (11/14, Roan) "Booster Shots" blog reports, "Two or more sugar-sweetened drinks a day have been associated with a larger waist and a higher risk of heart disease in adult women, according to research released" at an American Heart Association meeting. Researchers found that "women ages 45 to 84 who drank at least two sugar-sweetened drinks a day -- such as soda or flavored waters with added sugar -- were nearly four times as likely to develop high triglycerides as women who drank one or fewer of those beverages."

HealthDay (11/14, Mann) reports, "What's more, women who drank two or more sodas a day also had more belly fat, but not necessarily more weight."

POSTED BY: Steven Almany M.D.

Friday, April 27, 2012

BIOMARKERS MAY PREDICT AKI SEVERIT FOLLOWING CARDIAC SURGERY

MedPage Today (3/3, Bankhead) reported, "Several biomarkers predicted the severity of acute kidney injury (AKI) after cardiac surgery more quickly than did serum creatinine," according to a study published online March 1 in the Journal of the American Society of Nephrology. "Elevated levels of urinary and plasma neutrophil gelatinase-associated lipocalin (NGAL) -- a biomarker of structural renal tubular injury -- conferred more than a seven-fold likelihood of severe injury after heart surgery," the study found. What's more, "patients with high levels of interleukin-18 or an elevated urinary albumin-to-creatinine ratio (ACR) were three times more likely to have severe injury than patients who had low levels of the biomarkers," researchers reported.

POSTED BY: Steven Almany M.D.

Tuesday, April 24, 2012

FDA PLACES WARNING ON STATIN LABELS

The FDA today added "important safety changes" to the labeling for some widely used statins.

These products, when used with diet and exercise, help to lower a person’s low-density lipoprotein cholesterol. The products include: atorvastatin (Lipitor, Pfizer), fluvastatin (Lescol, Novartis), lovastatin (Mevacor, Merck), lovastatin extended-release (Altoprev, Shionogi), pitavastatin (Livalo, Kowa/Eli Lilly), pravastatin (Pravachol, Bristol-Myers Squibb), rosuvastatin (Crestor, AstraZeneca) and simvastatin (Zocor, Merck). Combination products include: lovastatin/niacin extended-release (Advicor, Abbott Laboratories), simvastatin/niacin extended-release (Simcor, Abbott Laboratories) and simvastatin/ezetimibe (Vytorin, Merck/Schering-Plough Pharmaceuticals).

“We want healthcare professionals and patients to have the most current information on the risks of statins, but also to assure them that these medications continue to provide an important health benefit of lowering cholesterol,” said Mary H. Parks, MD, director for the division of metabolism and endocrinology products in the Office of Drug Evaluation II in FDA’s Center for Drug Evaluation and Research.

The FDA put forth the following changes to statin labels:

The drug labels have been revised to remove the need for routine periodic monitoring of liver enzymes in patients taking statins. The agency now recommends that liver enzyme tests should be performed before starting statin therapy, and as clinically indicated thereafter. The FDA has concluded that serious liver injury with statins is rare and unpredictable in individual patients, and that routine periodic monitoring of liver enzymes does not appear to be effective in detecting or preventing this rare side effect. Patients should notify their healthcare professional immediately if they have the following symptoms of liver problems: unusual fatigue or weakness; loss of appetite; upper belly pain; dark-colored urine; yellowing of the skin or the whites of the eyes.
Certain cognitive effects have been reported with statin use. Statin labels will now include information about some patients experiencing memory loss and confusion. These reports generally have not been serious and the patients’ symptoms were reversed by stopping the statin. However, patients should still alert their health care professional if these symptoms occur.
Increases in hyperglycemia have been reported with statin use. The FDA is aware of studies showing that patients being treated with statins may have a small increased risk of increased blood sugar levels and of being diagnosed with type 2 diabetes mellitus. The labels will now warn healthcare professionals and patients of this potential risk.
Healthcare professionals should take note of the new recommendations in the lovastatin label. Some medicines may interact with lovastatin, increasing the risk for muscle injury (myopathy/rhabdomyolysis). For example, certain medicines should never be taken (are contraindicated) with lovastatin including drugs used to treat HIV (protease inhibitors) and drugs used to treat certain bacterial and fungal infections.

Reporting side effects to the FDA is important, according to the agency. Healthcare professionals and patients should report any side effects associated with statin use to FDA MedWatch program.

POSTED BY: STEVEN ALMANY, MD

Friday, April 20, 2012

WHEN STRESS IS GOOD FOR YOU

Stress: It can propel you into "the zone," spurring peak performance and well-being. Too much of it, though, strains your heart, robs you of memory and mental clarity and raises your risk of chronic disease.

How do you get the benefits—and avoid the harmful effects?

By learning to identify and manage individual reactions to stress, people can develop healthier outlooks as well as improve performance on cognitive tests, at work and in athletics, researchers and psychologists say.

The body has a standard reaction when it faces a task where performance really matters to goals or well-being: The sympathetic nervous system and the hypothalamus, pituitary and adrenal glands pump stress hormones, adrenaline and cortisol, into the bloodstream. Heartbeat and breathing speed up, and muscles tense.

What happens next is what divides healthy stress from harmful stress. People experiencing beneficial or "adaptive" stress feel pumped. The blood vessels dilate, increasing blood flow to help the brain, muscles and limbs meet a challenge, similar to the effects of aerobic exercise, according to research by Wendy Mendes, an associate professor in the department of psychiatry at the University of California, San Francisco, and others.

The body tends to respond differently under harmful or threatening stress. The blood vessels constrict, and "you may feel a little dizzy as your blood pressure rises," says Christopher Edwards, director of the behavioral chronic pain management program at Duke University Medical Center. Symptoms are often like those you feel in a fit of anger. You may speak more loudly or experience lapses in judgment or logic, he says. Hands and feet may grow cold as blood rushes to the body's core. Research shows the heart often beats erratically, spiking again and again like a seismograph during an earthquake.

Another hallmark: "Can you turn it off? Or are you a prisoner of your mind?" says Martin Rossman, an author on healing and stress and a clinical instructor at the University of California, San Francisco, Medical School. People under harmful stress lose the ability to re-engage the parasympathetic nervous system, which drives the body's day-to-day natural functions, including digestion and sleep. While individuals vary in how long they can tolerate chronic stress, research shows it sharply increases the risk of insomnia, chronic disease and early death.

Home builder Carl Weissensee used to be "addicted to stress," he says. Managing thousands of details and multiple risks for each of the multimillion-dollar houses he builds, he spent years rushing around with "one foot off the ground 20 hours a day, running the same scenarios through my mind time and time again, and being unable to put it aside," says Mr. Weissensee, 58, of Mill Valley, Calif.

In an important marker of harmful stress levels, his agitation disrupted his life. "I would sleep four to six hours a night, and even that wasn't good sleep." His wife complained, and his young daughter painted a small rock for him with the words, "You work too much."

A heart attack, followed by problems with cardiac arrhythmia, forced him to find the line between good stress and bad. "I don't believe it's possible to do a good job without a certain amount of stress. It's necessary to get things done," he says.

He has brought it down to a healthy level by using relaxation techniques, including deep breathing and guided imagery—lying still and imagining stressful tasks turning out well. After seeing Dr. Rossman, reading his book and doing one of his relaxation CDs daily, Mr. Weissensee learned to acknowledge his worries instead of recycling them in his head, then practice "skipping over" them and telling himself that "everything works out in the end," he says. He has managed to stabilize his heart condition without large doses of medication.

People who say their stress level is an 8, 9 or 10 on a 10-point scale, where 1 is 'little or no stress' and 10 is 'a great deal of stress.'
2007 32%
2008 30
2009 24
2010 24
2011 22
Source: American Psychological Association and Harris Interactive

"By practicing over and over, I seem to be changing the path my thoughts take from, 'I'm doomed,' to, 'Things will be OK,' " he says. "My goal is to worry just enough to do my job well."

That kind of positive attitude tends to produce good stress, based on research by Dr. Mendes and others. In a study of 50 college students, some were coached to believe that feeling nervous or excited before a presentation could improve performance. A control group didn't receive the coaching. When the students were asked to make a speech about themselves while receiving critical feedback, those who received the coaching showed a healthier physiological response, leading to increased dilation of the arteries and smaller rises in blood pressure than the control group.

In a similar study, students who received the same coaching before taking graduate-school entrance exams posted higher scores on a mock test in the lab and also on the actual exam three months later, compared with controls, according to a study co-authored by Dr. Mendes and published last year in the Journal of Experimental Social Psychology. They also posted higher levels of salivary amylase, a protein marker for adrenaline that is linked to episodes of beneficial stress.

People react differently to everyday stress. At-home or mobile biofeedback devices can detect spikes in the heart rate. Hand-held thermometers also can be used to note when the temperature of one's hands falls below 95 degrees, says Kenneth Pelletier, a clinical professor of medicine at both the University of Arizona School of Medicine and the University of California School of Medicine, San Francisco.

Toronto psychologist Kate Hays tells patients to imagine a stress scale "ranging from 1, where you're practically asleep, to 10, where you're climbing off the ceiling." Then, she asks them to recall a past peak performance and figure out where their stress at that moment would have ranked. Many people say 4 to 6, but responses range from 2 to 8, says Dr. Hays, who specializes in sports and performance psychology. That becomes their personal stress-management target.

For most people, hitting that target requires new skills. With practice, though, they can learn to relax completely in a few seconds, says Dr. Pelletier.

In addition to thinking positively about stressors, deep abdominal breathing and training in meditation and mindfulness, or regulating one's own mental and physical states, help moderate stress.

All have been shown in research to help heal such chronic problems as heart disease, according to a 2010 research review co-authored by Bonnie Horrigan, director of public education for the Bravewell Collaborative, Minneapolis, a nonprofit that advocates integrating health and medical care. When Ford Motor Co. tested various ways of helping employees with chronic back pain several years ago, corporate medical director Walter Talamonti says, training in reducing harmful stress to healthy levels was linked to reductions in employees' pain and medication use.

Dr. Edwards is seeing 15% to 20% annual increases in patients at his pain clinic seeking biofeedback and other help with stress and stress-related ailments. As many as 35% of them actually want to generate more good stress; many are referred by counselors, parents or coaches.

Many workplace wellness programs have also begun coaching people to hit "the optimal performance zone"—with enough stress "to be stimulating, to focus you, to challenge you" without taking a physical toll, says Dr. Pelletier.

POSTED BY: STEVEN ALMANY, MD
Taken from WSJ on Jan 24 2012, Written by: Sue Shellenbarger