The Los Angeles Times (10/14, Brown) “Booster Shots” blog reports, “Heart disease prevalence in the US has declined over the last five years, the Centers for Disease Control and Prevention reported Thursday.” CDC researchers found that “more men reported having a diagnosis of heart disease than women — 7.8% versus 4.6%.” Individuals “without a high school education had higher prevalence of heart disease — 9.2% — than people with diplomas (6.7%), some college education (6.2%) and some graduate education (4.6%).”
AFP (10/14) reports, “The highest number of cases were reported by American Indians and Alaska natives, at 11.6 percent versus those who identified themselves as Asians, native Hawaiians or Pacific Islanders at 3.9 percent.”
The CNN (10/14) “The Chart” blog reports, “Lead author Dr. Jing Fang said the decrease in prevalence of heart disease was consistent with a decline in high-risk populations: People with uncontrolled hypertension, uncontrolled LDL (bad) cholesterol, and smokers.”
Blogfinger Medical Commentary: After World War II, medical scientists began to take notice of an epidemic of coronary disease in the United States and other western countries. Researchers looked at epidemiological data and began to identify “coronary risk factors” that were linked to the risk of heart attacks and cardiac death rates. Over time, strategies were developed to reduce risk including stop smoking efforts, dietary changes, cholesterol control, promotion of exercise and management of high blood pressure.
The more we learned, the more complicated the subject became. For example the link of heart trouble to blood cholesterol levels seemed like a simple idea, but now we have a whole science–lipidology–that studies how the fats in our blood interact with other factors to produce plaque inside arteries. That “cholesterol hypothesis” evolved to the present where there are now powerful drugs that can significantly improve prognosis for heart disease.
The results described above confirm that this 60+ year effort has produced positive results and should motivate everyone, especially high risk individuals, to follow prevention guidelines. That is why we re-titled our book “Prevention Does Work: A Guide to a Healthy Heart.”
This is a sphygmomanometer (aka blood pressure machine)
The CBS Evening News (9/28, story 4, 2:30, Pelley) reported, “A study out today suggests millions more Americans may be at risk of stroke.”
NBC Nightly News (9/28, story 2, 1:50, Williams) reported that research published online in Neurology suggests that “a blood pressure reading that’s just below the normal range could still point to a higher risk.”
USA Today (9/29, Lloyd) reports that individuals “whose blood pressure was just below normal — known as pre-hypertension — were 55% more likely to have a stroke compared to people with normal blood pressure, according to an analysis of 518,520 adults involved in 12 studies on blood pressure and stroke occurrence.”
CNN /Health.com (9/29, Gardner) reports that the “findings appear to at least partly vindicate the controversial decision by a National Institutes of Health panel to create the prehypertension category in 2003. At the time, critics of the decision accused the outside experts who sat on the panel of being unduly influenced by the manufacturers of hypertension drugs.”
The HealthDay (9/29, Goodwin) reports, “When the researchers split the people with prehypertension into two groups — those at the lower end of the prehypertensive range and those at the upper end — they found those in the upper range (130 to 139 mmHg systolic and 85 to 89 mmHg diastolic) had a 79 percent increased risk of stroke.”
Blogfinger Medical Commentary. High blood pressure (hypertension) is officially diagnosed when someone has recurrent readings above 140/90. (There are circumstances when your doctor might choose a lower “normal” reading.) A single high measurement at a drug store or doctor’s office does not mean that one has hypertension. Multiple readings are needed for the diagnosis.
I suggest that those at risk obtain a good home BP device. Ask your pharmacist and make sure that the cuff size is appropriate for your arm circumference. Then record your BP a couple of times per day, varying the times and keeping a written record with notes documenting time of day and circumstances (such as an argument /stress, a big meal, exercise or salt load, lack of sleep, or alcohol prior to the reading). Then review the readings with your doctor. Sometimes clarification can be obtained with a 24 hour BP monitor which I think is a vastly underused diagnostic tool.
Pre-hypertension (120-139/80-89) is a risk factor for hypertension and should be treated with life-style changes such as stress modification, weight reduction, salt reduction, and exercise. Pre-hypertension (the higher type at 135-139/85-89) is associated with increased stroke risk, although there is no evidence to say that medication should be used for this. Your doctor has to exercise his best judgement here by weighing all your cardiac risk factors.
Two related issues include isolated systolic hypertension (ISH) and “white coat syndrome.”
ISH is when only your systolic BP is consistently above 140 mm Hg while your diastolic is normal. It used to be thought that ISH was harmless, but it is risky and should be treated. Even those who have intermittent elevations (spikes) of systolic BP probably should be treated.
“White coat hypertension” is when your BP is high at the doctor’s office, but not at home. This often ties into adrenaline surges that occur when someone is stressed. You can help with the diagnosis by using home readings and see how your BP responds to an argument or other stressful circumstances. WCH should also, in my opinion, be treated, and drugs, especially beta blockers, are often needed.
I have to stop typing now. Eileen is fussing about something, and I have to go check my blood pressure.
Kaiser Health News (9/13, Boodman) reports that “increasingly, questions are being raised about the overtesting of older patients, part of a growing skepticism about the widespread practice of routine screening for cancer and other ailments of people in their 70s, 80s and even 90s. Critics say there is little evidence of benefit — and considerable risk — from common tests for colon, breast and prostate cancer, particularly for those with serious problems such as heart disease or dementia that are more likely to kill them.” Some physicians and researchers argue that the tests “trigger a cascade of expensive, anxiety-producing diagnostic procedures and invasive treatments for slow-growing diseases that may never cause problems, leaving patients worse off than if they had never been tested.”
Blogfinger Medical Commentary:
When did your doctor last check your ears?
Too many doctors rely on testing as a substitute for doctoring. They sometimes tell patients that they will order tests, while ignoring the basics of a good history and physical examination. Then, when the tests come back negative, the process is over, often without solving the problem.
Just listening to the patient may result in an accurate diagnosis without the need for expensive testing. I know of a case where a primary physician, trained at Johns Hopkins, ordered $3,000.00 of heart tests on a patient without asking any heart-related questions about chest pains, shortness of breath or palpitations. The doctor didn’t even listen to the patient’s heart. The situation was resolved by a cardiologist without any tests. (Who says that care by specialists is more expensive than primary care?) This is not about how smart a doctor is; it is about how well they do their job. Doctors must worry more about the cost of care.
Testing is often misused, and the motives are not only about defensive medicine. Sometimes it is about profits, ignorance or sloppiness. Much money could be saved under a new healthcare system if practice guidelines are intelligently applied in the best interest of patients. However, guidelines need to be flexible and they need to be written by physicians—not bureaucrats.
ABC World News (8/29, story 10, 0:30, Sawyer) reported that “chocolate may be a kind of secret weapon against heart disease.”
Bloomberg News (8/30, Torsoli) reports that “regular consumption” of chocolate “may slash the risk of developing heart disease by a third, according to research published in the British Medical Journal and presented…at the European Society of Cardiology’s conference in Paris.”
The Los Angeles Times (8/30, Stein) “Booster Shots” blog reports that investigators analyzed data from “seven studies looking at the link between eating chocolate and a reduction in heart disease that included 114,009 people.”
The Time (8/30, Melnick) “Healthland” blog reports, “Five of the seven studies showed some benefit to eating chocolate. Overall, people with the highest chocolate consumption levels had 37% lower risk of heart disease and a 29% lower risk of stroke than those who ate the least chocolate.”
The CNN (8/30) “The Chart” blog points out that “the studies, notably, did not differentiate between dark or milk chocolate and included consumption of different types of chocolate (bars, shakes, etc.).”
MedPage Today (8/30, Neale) reports that one of the researchers “noted that most commercially available chocolate products are high in fat, sugar, and calories, and that overindulging could counteract any of the potential benefits, a sentiment echoed by Janet Wright, MD, vice president of science and quality for the American College of Cardiology.” In an interview, Dr Wright said, “We tend to take a little bit of advice and think that more is better,” but “in this case, more is probably not better because of the fat content and the calorie content.”
Also covering the story were the NPR (8/30, Shute) “Shots” blog, the Grand Rapids Press (8/30, Thoms), WebMD (8/30, Laino) and HealthDay (8/30, Reinberg).
BLOGFINGER MEDICAL COMMENTARY: In our book “Prevention Does Work: A Guide to a Healthy Heart” 2011, by Eileen and Paul Goldfinger, we discuss chocolate on page 18. This is the quote: “Chocolate contains saturated fats (especially if milk is added) and traditionally is forbidden in low-fat diets, but dark chocolate also contains flavenoids, which are chemicals that can relax blood vessels and reduce the tendency of blood to clot. Flavenoids are also potent antioxidants and are found in red wine, cherries, apricots, apples and green tea. Some studies suggest a reduced cardiovascular risk with increased flavenoid intake. There may be some health benefits from chocolate, but the research so far is inconclusive. Chocolate is fattening and has too much fat. It is best to only eat small amounts.”
It should also be noted that the fats in dark chocolate are the kind, although saturated, that do not raise cholesterol levels.
The authors of the British Medical Journal article published two days ago and mentioned above, were quick to point out that this trial is not definitive. They concluded by saying, “Further experimental studies are required to confirm a potentially beneficial effect of chocolate consumption.”
My latest advice is to have small amounts of dark chocolate every few days. There is good reason to believe that it will be protective.
Lee Memorial Hospital, Ft. Myers Florida. This 330 bed acute care hospital is highly regarded by the folks in Lee County, but you won't find it on the "best hospital" list. Photo by Blogfinger
By Paul Goldfinger, MD, FACC
About 15 years ago, a patient I knew had a heart operation performed at a prestigious New York City university medical center. While he was there, he sustained a life threatening infectious complication due to an error, resulting in an extra 2 ½ weeks in the hospital.
This story illustrates that you can be a patient in one of the best hospitals in the world and still have a substantial risk of a medical mistake. It is estimated that about 33% of hospitalized patients have an adverse result, and this may be an underestimation. USA Today has reported (August 7, 2011) on Medicare data that shows high death rates in some prestigious institutions. USA today article regarding errors in top hospitals
No doubt you have seen magazine articles about which hospitals are the “best”, but what defines “best”, and how can these lists help you when most hospitals are not listed? Furthermore, how can a hospital with high death rates be considered “best? And finally, can your local hospital provide excellent care even if it is not on the list?
Most medical situations that require hospitalization include common elective and emergency situations such as surgery for gall bladder disease, medical management of diverticulitis, and acute therapy for a heart attack. Obviously, if you have an urgent condition, you most go local. But when things become elective, you have a choice.
In my opinion, most issues that require hospitalization can be ably and safely done in a community hospital provided that hospital is known to follow stringent safety and quality protocols. A fine community hospital hires the best staff it can find— especially in the area of nursing; it properly staffs the med-surg floors; it has modern equipment; it places the patient’s interest first and treats patients as individuals; and it has a board certified medical staff , ideally including hospitalists.
If you have such a hospital in your area, and there are many such places, and if you do not require technologies or expertise that are only available at major centers, then go to your nearby hospital and stay away from the massive institutions where you can get into trouble despite their fine reputations.
How to be sure about your local hospital? You could find information within Medicare’s data bank, at the web site for the American Hospital Association or in the sub-data lists of publications such as US News and World Report, but the information is difficult to translate into an individual decision. Aside from the “best ” lists, many hospitals are simply categorized as “average.” What can you do with that?
At this point in time, the only other answer is to speak to medical professionals in your area, check the internet for information, and ask former patients. There’s a good chance that you will discover that your local hospital will serve your needs admirably. But if you have a rare and baffling problem, then get on a plane to the Mayo Clinic (Rochester, Minnesota) or any other hospital on the “best” list that has a special interest in your condition.
Artery model showing fatty atherosclerotic plaques, with one straddling a bifurcation and causing partial obstruction. Paul Goldfinger, M.D. photo.
Grilled octapus with extra virgin olive oil, and orzo with olive oil and lemon: the perfect delicious heart healthy dinner–it was Eileen’s at Niko’s Greek Grill in Long Branch. (now closed 2023) Blogfinger photo
By Paul Goldfinger, MD, FACC
During the early evolution of the new specialty called “preventive cardiology,” the concept of good nutrition as a tool in the quest to halt atherosclerosis began to take shape as far back as the 1950’s.
Years later, in the 1970’s, families began to adopt the notion that they should reduce fats in their diets, particularly the saturated fat, high cholesterol kind found in red meats and dairy products. McDonald’s and other fast- food places introduced salads, and trans-fats were abolished from commercial products and restaurants.
It is now widely accepted that low fat diets will help prevent heart disease and some cancers. Unfortunately, as of 2011, there have been no large scale diet trials that conclusively prove the point.
Several years ago, some new clinical trials suggested that reducing total dietary fat may not be the most important goal in prevention. In our book, “Prevention Does Work: A Guide to a Healthy Heart” dated 2011, we made the following observations: “…the type of dietary fat may be more important than the amount of total fat.” Also, “Most low fat diets generally lower cholesterol levels by only modest amounts.” Such statements are based on recent science regarding the value of low fat/low cholesterol diets in cardiovascular disease prevention.
Recent studies have shown benefits from purposefully using “good fats” of vegetable origin such as monounsaturated olive and canola oils; and polyunsaturated fats such as corn oil, to help reduce risk— rather than reducing all dietary fats. Fish oils have also been found to be specifically beneficial.
From this new start, we have come to believe that Mediterranean diets might be the best choice in prevention, even though no large scale trials have proven this to be the case. In one small French study, (the 1999 Lyon Heart Study) of Mediterranean diets, the use of canola oil enriched with omega-3 fatty acids helped prevent heart disease even without any change in blood cholesterol levels.
In 2006, a report from a $415 million federal study of 49,000 postmenopausal women, carried out over 8 years, concluded that low fat diets do not prevent heart disease or cancer. But that trial, as amazing as it was, looked at low fat diets which were not rigorous enough and it did not look at cholesterol lowering drugs. It also did not get enough compliance in the area of eating more fruits, vegetables and other nutrients. Finally, it did not distinguish between the various kinds of fats— the good, the bad and the ugly. For those who hoped that saturated fats would someday be found to be healthy (as Woody Allen predicted in the movie “Sleeper”), the trial did not conclude that low saturated fat diets could be discarded.
The bottom line, as far as I am concerned, is that the best nutrition for prevention is still a Mediterranean style diet with significant reductions in animal fats and with the use of “good oils” without restriction. This plan includes an emphasis on vegetarian food sources, fiber, seafood, portion control to combat obesity, and other diet components such as nuts, red wine, chocolate, green tea, plant stanols and other nutrients which may help reduce risk. Protein can be obtained from fish, turkey, chicken, and small amounts of lean meats such as buffalo, ostrich,venison, or lean beef. Portion size for meats should be 4 ounces. Cholesterol levels must be brought down to “target” numbers that your doctor should be acquainted with, and this usually must be accomplished with statin drugs.
I am sorry to say that most doctors know little about nutrition and prevention, and their patients do not know enough about how to prevent heart trouble through eating and cooking properly. That is why Eileen and I wrote our book over 15 years ago and we believe that it can save lives. Young families as well as heart patients need this information. This is our fourth and best edition. We will donate all profits to the American Heart Association. It is available at Amazon.com and the Comfort Zone in Ocean Grove, NJ.
USA Today (6/9, Healy) reports that wearing a hat and protecting eyes “from harmful UV rays” is as much a part of sun protection as slathering on sunscreen. “A 2009 survey by the American Optometric Association found that one in three adults are unaware of the eye health risks of spending too much time in the sun without proper protection.” Excessive UV exposure may result in pterygium, macular degeneration, or cataracts. And, “even a few hours of intense, unprotected exposure can have consequences, says optometrist Sarah Hinkley of the American Optometric Association,” possibly leading to painful photokeratitis.
Blogfinger Medical Commentary:
Photokeratitis is like a sunburn on the conjunctiva, which is the membrane that covers the white part of the eye. It is a worrisome injury which is uncomfortable, although it is usually reversible. A pterygium is a scarring on the eye’s surface which could require surgery to repair.
According to optician Ed Faust at Optical Concepts in Chester, NJ, ultraviolet light can also cause injury to the cornea. He says that a hat offers protection mostly to the skin— with less eye protection. What is needed to protect the eyes are sunglasses for adults or children with lenses that block the high energy UV rays. Polarized lenses are the best, but your eye-care professional can suggest other types of blocking lenses. A solid frame with wide side pieces helps to cut down rays coming from the sides By Paul Goldfinger MD, FACC
When was the last time your doctor gave you information about a healthy diet?
If you answered “never,” this book is for you: Prevention Does Work: A Guide to a Healthy Heart
If Paul and Eileen Goldfinger have their way, you’ll rarely eat another burger (unless it’s turkey). Or mac n’ cheese. Or BLT. Or one of any number of cholesterol-loaded foods that can clog your arteries and threaten life. Instead, you’ll become a regular at the fish counter and stock your pantry with staples that can make even the most prosaic piece of chicken a gourmet’s delight.
Just published, the Goldfingers’ book is subtitled “A Cardiologist and a Cook Present the Facts and the Foods” It’s stuffed with facts and larded with recipes designed to make typical Americans revamp their diet.
But that isn’t all. Says Paul, “We do stress nutrition, but we also cover a variety of important topics including drug therapy, blood pressure, smoking, exercise, mental health, women’s issues and obesity. I want patients to understand that ‘prevention does work,’ meaning that scientific research has proven the life-saving benefits of measures described in our book.”
In the area of nutrition, Paul says, “I tried to cover every issue known in the field of prevention including chocolate, olive oil, red wine, the Atkins diet, and the Mediterranean diet, among other subjects.”
Paul, the founder of Blogfinger, was a practicing cardiologist for 32 years. In medical school, he estimates that no more than an hour was devoted to nutrition. Even today, doctors are focused on immediate results. They don’t push the long-term effects of diet. Nor can they. Fifteen-minute appointments barely give them time to do more than hear a complaint and check a patient’s medications.
Paul at Starbucks
During his years of practice, as one study after another suggested that diet could deter heart disease, Paul began to question the American diet. The Japanese, heavy consumers of fish and vegetables, which are low in fat, had a low incidence of heart disease, as did fish-eating Eskimos. Scandinavians, whose diet is heavy in fat-rich red meat and cheese, did not.
In time, rigorous scientific evidence proving that lowering cholesterol prevented heart attacks convinced him that a low-fat diet was essential for his patients. “As more and more results came out,” he said, “it solidified my opinion that doctors aren’t doing their job.”
Paul began to give his patients three-page informational handouts, the forerunner of Prevention Does Work. The book’s chapters are devoted to helpful definitions — from “acute myocardial infarction” [a/k/a heart attack] to “vascular,” referring to blood vessels — the basics of cardiac treatment and the fundamentals of nutrition. The language is clear and simple.
Eileen prepares a heart-healthy feast in her OG kitchen,
Meanwhile, Eileen, Blogfinger‘s food editor, developed “heart healthy”recipes for her husband’s patients. “We found out that patients and their families did not know how to prepare heart-healthy meals, especially with sea-food,” Paul says. “Eileen collaborated with me in developing recipes that met the prevention criteria: low fat. low salt, fiber, fresh ingredients, low calories and portion control. These recipes emphasize the use of seafood, vegetables and poultry. Our book is a reference source — a guide — to be kept in the kitchen”
Eileen says she aimed for recipes that were simple and didn’t require arcane ingredients. While many of the book’s 30 recipes do feature seafood and chicken, for people who can’t do without pizza there’s a low-fat version, likewise for chili.
Paul emphasizes that healthy eating “is not a diet you’re on but a lifestyle change.” At the same time, he doesn’t expect every reader to follow his advice to the letter. “If people could just find something — switch from butter to margarine, eat fish twice a week, do a little aerobic exercise,” he says, “they’d be better off.”
Prevention Does Work is currently on sale in Ocean Grove at the Comfort Zone, or it may be ordered on amazon.com, barnesandnoble.com or iuniverse.com.
2023 update by Dr Goldfinger: Although this third edition is from 2011, most of it is still true because it covers many explanations, definitions and certainly recipes which do not go out of date.
There are a number of more updated BF posts that add some knowledge such as huge clinical trials that have proven the preventive value of the Mediterranean diet. Use the search engine above right.
The purpose of this book is to fill a void where doctors do not provide sufficient information about prevention and often know nothing about it. That leaves the public to rely on Internet nonsense by snake oil salesmen.
Thanks to Mary Walton for her review and fine work in helping us in the Grove. She now lives in Philadelphia. You can Google her–she is a remarkable professional investigative reporter who has written books, reported for the Philadelphia Inquirer and Blogfinger. net, lectured at universities and more.
