Heart Health

Stay away from cardiologists and their stents

Published 6.8.2017
In my ongoing effort to stay out of the cardiologist's office, I continue to collect links to interesting items related to heart health. As always please note: I am not any sort of medical professional and I don't play one on the internet. Nothing stated here is to be construed as advice or recommendation.

Just say no to the stent.

Over 10 years of carotid artery stenting, Japanese hospitals saw nine cases (a 2.6% rate) of plaque protrusion, wherein plaque is found inside the stent during the procedure. Plaque protrusion involved open-cell stents in all cases. The complication occurred with unstable plaque in 8 out of 9 cases.

Stroke occurred by 30 days in 6 of the 9 patients who had plaque protrusion (1 major stroke, 5 minor strokes). In addition, ischemic lesions were found in 8 of the 9 cases on the treated side at 48 hours on diffusion-weighted imaging, Masashi Kotsugi, MD, of Ishinkai Yao General Hospital in Japan, and colleagues reported in the April 24, 2017 issue of JACC: Cardiovascular Interventions.

I have a bias here that I need to note. My 90 year old uncle died on the operating table as his aorta crumbled in the fingers of surgeons attempting to place a stent. He wasn’t having a heart attack, nor was his mobility of lifestyle impinged by his heart condition in any way. In my opinion, he had no business being on the table.

Lifestyle interventions earlier in life (though they work for 90 year olds too) is a better plan for long term heart health. There are other benefits to lifestyle changes too. Eating three or more fruits and vegetables may lower the risk of developing peripheral artery disease.

Any “guru” denouncing the idea that people should eat fruits and vegetables daily (ahem…Zoe Harcombe) should be shunned. They are selling snake oil.

According to a cross-sectional study of more than 3.7 million people, those who reported daily intake of at least three servings of fruits and vegetables had significantly lower risk of PAD (adjusted OR 0.81, 95% CI 0.79-0.83) than those reporting that they ate three servings less than once a month, wrote Jeffrey Berger, MD, of New York University School of Medicine, and colleagues in Arteriosclerosis, Thrombosis and Vascular Biology, an American Heart Association journal.

PAD risks were equally low among those eating three servings of fruits and vegetables most days of the week (OR 0.80, 95% CI 0.79-0.82), again compared with those with less-than-monthly consumption of three servings.

I think part of the problem is that discussion about eating fruits and vegetables often get derailed by questions of veganism or vegetarianism. Eating a lot of fruits and vegetables doesn’t make one vegan, it does make one healthier. Any amount of fruits and vegetable help, but multiple servings daily is best. Eating fruits and vegetables negates the effects of smoking.

Lowering your LDL using a pill increases the risk for cataracts?

On propensity score matching, however, cataracts were more common with very low LDL cholesterol (2.6% versus 0.8% for higher concentrations, HR 3.40, 95% CI 1.58-7.35), according to Jennifer G. Robinson, MD, MPH, of the University of Iowa in Iowa City, and colleagues, writing online in the Journal of the American College of Cardiology.

Getting cataracts didn’t change the risk of an incident— meaning a cardiac event.

A lower blood pressure is better for the heart. The question is how low should the target be? Under 140 is the current goal for most physicians’ practice, but studies had indicated that aiming for 120 was better. BUT just increasing drug dosage can cause issues in older patients taking myriad other pills. So, doctors were resistant to the new guideline.

Against that background, this new paper, published in JAMA Cardiology, supports the lower systolic blood pressure target of 120 mmHg. Jiang He, MD, of Tulane University, and colleagues analyzed data from 144,220 patients participating in 42 randomized trials. They found "significant and linear associations between average achieved systolic BP and the risk of cardiovascular disease and all-cause death." People who achieved a systolic BP level of 120 to 124 mm Hg had the lowest risk for cardiovascular disease and all-cause mortality.

Best of all would be to alter you lifestyle to lower your blood pressure. You know, all that boring stuff like eating more plants and moving a bit more.

Can a blood test determine if you’re having a mycardiol infarction?

In January, the FDA cleared the first of the new generation of high-sensitivity cardiac troponin T (hs-TnT or hs-cTnT) blood tests for the rapid diagnosis of AMI. The test has not yet been made available in the U.S., but experts believe that it could have a profound effect on the diagnosis and treatment of AMI in the ED.

ED stands for erectile dysfunction. Anything that limits unnecessary testing or procedures is welcome in my view.

Psoriasis treatments may reduce vascular inflammation. If true, this is good news.

After a year of treatment for the skin condition -- a mix of of topical therapy (60%), biological therapy (66%, mostly anti-tumor necrosis factor [anti-TNF] therapy), and phototherapy (15%) -- there was a median 33% improvement in psoriasis (P<0.001) that was linked to a 6% reduction in vascular inflammation as measured by PET/CT, even after adjusting for traditional risk factors (P=0.03), according to Nehai N. Mehta, MD, MSCE, of the National Heart, Lung, and Blood Institute in Bethesda, Md., and colleagues.

They noted in their JAMA Cardiology study that patients achieving at least a 75% reduction in skin inflammation severity had an 11% improvement in vascular inflammation (P<0.003).