Make an Appointment
1-855-UMASS-MD
Make an Appointment
BOOK NOW

Preventing Heart Disease

Topic: Preventing Heart Disease


Expert: Bryon Gentile, MD, is a cardiologist who practices at UMass Memorial Medical Center and Clinton Hospital. An assistant professor at the University of Massachusetts Medical School, Dr. Gentile is board certified in internal medicine. He completed both his residency and fellowship at UMass Medical School and was awarded his medical degree from Pennsylvania State University College of Medicine.

 

Physician

Bryon Gentile, MD


Questions

Q:

In my early 20's I was diagnosed with Grave's disease, with accompanying cardiomegaly. Would this be an issue now that I am 60? Does cardiomegaly resolve?

A:

Cardiomegaly (an enlarged heart) can be the result of multiple different processes. Some patients with hyperthyroidism (overactive thyroid), including those with Grave’s disease, can develop cardiomegaly. In some patients, with treatment of the hyperthyroidism/Grave’s disease, the cardiomegaly can resolve. Cardiomegaly is an important part of your medical history and your providers can help you determine if it has improved/resolved.  

Q:

My father died in 2002 of a heart attack and never had heart problems. Does this play a role in my health?

A:

A family history of coronary artery disease, including heart attack, is a traditional risk factor for developing coronary artery disease. However, the relationship is not linear and this must be interpreted in the context of your current symptoms, other medical history, and other cardiac risk factors. Family history is an important component of every patient’s medical history and should be discussed with your doctor.

Q:

I have been taking fish oil vitamins to lower my total cholesterol, and it has worked. I went from 236 to 200. My primary care doctor said that is good. Do you think I should keep taking it? Heart disease is high in my family.

A:

The idea behind fish oil came from ecological studies that found low rates of coronary heart disease among populations consuming a large amount of seafood. Later, it was felt that the lipids PUFA, EPA and DHA were likely the active ingredients. Under normal usage, fish oil is generally recognized as safe. 

The data on fish oil is mixed. Some studies have shown that fish oil can alter cholesterol levels, however, the results depend on the dose of fish oil you take. At higher doses, fish oil is thought to decrease triglycerides while modestly increasing HDL and LDL cholesterol levels. As for cardiovascular events, such as progression of coronary heart disease, heart attacks, or sudden cardiac death, the data is truly mixed. Some trials have suggested that fish oil is beneficial in reducing these kinds of events, however, other trials have not. The decision to use or not use fish oil is an individualized one that you should discuss with your provider.

Q:

I take Lovaza omega 3 fish oil prescription, and I am wondering about its beneficial effect on the heart, circulation, etc., and whether I should continue with this medication since recent literature somewhat indicates that its results on prevention of heart attacks is questionable. I am a 72-year-old female type 2 diabetic and also have psoriatic arthritis. I believe that the omega 3 might help fight inflammation of the joints. My physician is trying to talk me into getting off this medication, but I am resisting. I have a strong cardiac history in the family and formerly had elevated cholesterols and triglycerides. I am looking for an independent thought on to take/not to take this medication. I appreciate any advice and your particulate take on this medication. Thank you so much for your time and consideration.

A:

Please see above for fish oil discussion. Briefly, the data on the benefits of fish oil, as it pertains to cardiovascular conditions, is mixed. The decision to use or not use fish oil is an individualized one that you should discuss with your provider.

Q:

I am an active, healthy 50+ woman with a family history of cardiovascular disease. Several of my siblings take daily aspirin. Is it important to do this if I have no other risk factors? Also, I keep receiving mailings about peripheral artery disease screening. How important is this to do?

A:

Aspirin has been a cornerstone in the treatment of patients with known cardiovascular disease (i.e., patients who have coronary heart disease or have had a heart attack). In those without a prior cardiovascular history, such as yourself, the decision to use or not use aspirin is one where the benefits and risks must be considered. A study from 2012 looking at patients without prior cardiovascular events found that daily aspirin use was associated with a reduction in non-fatal heart attacks. Conversely, the major risk with aspirin is that of bleeding. Studies suggest an increased risk of bleeding within the gastrointestinal tract as well as intracranial bleeding. 

In 2009, the United States Preventive Services Task Force recommended the use of daily aspirin for prevention of cardiovascular disease in men ages 45 to 79 and women ages 55 to 79 “when the potential benefit due to a reduction in myocardial infarction outweighs the potential harm due to an increase in gastrointestinal hemorrhage.” 

In many patients the benefits of daily aspirin will outweigh the bleeding risks. However, if you are considering the use of daily aspirin, it is important that you and your provider determine your specific cardiovascular risk as well as your bleeding risk.

Q:

Can moderate exercise help with my blood pressure? Is my weight gain the cause of higher blood pressure readings?

A:

Absolutely. Exercise can provide a reduction in both systolic and diastolic blood pressure (top and bottom numbers). The mechanism is incompletely understood. Weight loss can certainly assist with improved blood pressure. In the Framingham Heart Study (as in Framingham, MA), sustained weight loss was associated with a significant risk reduction in developing hypertension. My take is that for lifestyle changes to be effective in lowering blood pressure, increased physical activity (i.e., exercise) should always be added to dietary adjustments (including a low salt diet).

Q:

My husband, who is on a 40 mg cholesterol lowering medicine, just had a cholesterol test that came back high. He doesn't want to increase the medicine. Besides changing his diet, is there anything else he can do to lower the cholesterol?

A:

Remember, not all cholesterol is bad. HDL (high density lipoprotein, aka good cholesterol) is thought to be beneficial and thought to help reduce plaque in arteries. Therefore, having high levels may be beneficial. LDL (low density lipoprotein, aka bad cholesterol) is thought to be responsible for the buildup of plaque within the arteries. Having high levels is a common reason patients are placed on cholesterol lowering medications. Diet and exercise are an important component of lowering LDL and potentially increasing HDL. When diet and exercise are not effective in reducing cholesterol levels, medications (including statins) are added. 

Q:

I'm 60 and female, and my blood pressure has been changing over the last year. My doctor wanted me to take medications to protect my heart and kidneys. How long can I put this off? I tried the medications for a week and didn't like how they felt, so stopped. I've been taking my pressure and it’s 131 over 83 the last time and my heart rate is 76. I have high cholesterol but my doctor did the calculations, and I'm not in a statin-taking group and probably won't have a heart attack. I have good “good” cholesterol and good triglycerides. Do I really have to take this drug? What can I do to change these numbers besides lose weight which I try to do all the time? I have no thyroid which makes it harder to lose the weight.

A:

Elevated blood pressure (or hypertension) is a common condition that is a risk factor for cardiovascular disease including coronary heart disease, myocardial infarction (heart attack), stroke and other conditions, such as kidney dysfunction. It’s often silent and many patients are unaware that they have hypertension. We also know that blood pressure tends to increase with age. 

It’s great that you are checking your blood pressure at home. One suggestion would be to bring your home blood pressure machine into your primary doctor’s office and compare it to the readings obtained in their office. Your blood pressure machine may be giving inaccurate readings, so it’s always important to verify. Thyroid dysfunction can lead to hypertension so it’s important to verify with your primary doctor that your thyroid levels are in the appropriate range.

Treatment of blood pressure and a goal blood pressure are individualized decisions that you need to discuss with your provider. A one-size-fits-all approach doesn’t work. Ways you can lower your blood pressure without medications is through weight loss, as you mentioned, and exercise. When diet and exercise aren’t effective, then medications are often considered. There are many different types of medications that can lower your blood pressure to prevent cardiovascular disease. Side effects experienced with one class of medications may not be experienced with another class. 

Q:

I have a stent and have another artery with 60 percent blockage. Can a blocked artery be reduced with eating healthy and taking my meds?

A:

Excellent question. We believe that plaque can regress. With diet and exercise you can lower your LDL cholesterol and increase your HDL cholesterol. While LDL cholesterol is thought to be a component in plaque deposition, HDL cholesterol is thought to help reduce plaque buildup in the arteries. Statins (a class of medications used to lower cholesterol) are beneficial in patients with coronary heart disease. We know that statins help stabilize plaque in the arteries by reducing the amount of cholesterol within the plaque. We think this renders plaque less likely to rupture and cause a heart attack. Additionally, there are some studies using ultrasound that have suggested that statins help with regression of plaque within the carotid artery (an artery in the neck that supplies blood to the brain). Newer studies using CAT scans and MRIs have suggested that statins may help with plaque reduction in the arteries of the heart.

Controlling other risk factors, such as high blood pressure and diabetes; quitting smoking; reducing weight; and increasing exercise can help reduce your risk of progression of coronary heart disease and heart attack.

Q:

If you have a patient who gets frequent palpitations and has reoccurring pericarditis and reoccurring unexplained low potassium and tachycardia, and said patient tells you that her father and two of her children have significant cardiac history to include one child having major heart surgery at four months old and the other passing away at two weeks old, but yet this same patient also has a history of depression, how do you treat this patient when between episodes all tests come back within normal limits, and this patient tells you that is the same thing that their father felt with when they were at the patient’s age (age 30).

A:

Palpitations are a common problem and have both cardiac and non-cardiac origins. Cardiac causes can include premature heartbeats and arrhythmias – all of which have different treatment options. Non-cardiac etiologies can be gastrointestinal, endocrine and muscular in nature.

Pericarditis is a condition that refers to inflammation in the pericardium, the sac that surrounds the heart. There are multiple different causes, and each is treated differently.

Heart disease is often used as a catchall phrase, and cardiac history can mean many different things. For example a patient may have coronary heart disease where plaque builds up in the arteries of the heart, other patients may have problems with heart valves or the electrical system within their heart.

In patients with a family history of heart disease, it is important to know the type of heart disease each family member (including children) had, and discuss this with your primary care provider and cardiologist.

Q:

Can clopidogrel cause low iron in your blood?

A:

Clopidogrel (Plavix) works by inhibiting platelets (cells in your blood that assist with clotting). Clopidogrel has several uses and is most commonly used after a stent is placed in the arteries supplying blood to your heart. Clopidogrel does not itself cause low iron directly. One reason for low levels of iron is slow on-going blood loss which can happen from the gastrointestinal tract. Some patients may not even notice blood in their stools. If there is slow blood loss, clopidogrel can worsen this by inhibiting the function of platelets (cells in our blood that assist with clotting). If you have low iron levels, you should discuss this with both your primary care physician and cardiologist. Also, I always recommend that patients speak with their cardiologist/prescribing physician prior to holding/stopping clopidogrel.

Q:

How can you lower cholesterol naturally without medication? Medications have long-term side effects. I want to focus on non-medication approach. Too many drug dependent Americans. Thank you.

A:

According to the National Institutes of Health, coronary heart disease (CHD) is a leading cause of death for both men and women in the United States. Each year, about 370,000 Americans die from coronary heart disease. High cholesterol is a risk factor for developing coronary heart disease. That said, not all cholesterol is bad and understanding the breakdown of the types of cholesterol is important. LDL, often referred to as "bad cholesterol," is thought to contribute to coronary heart disease (build up of plaque in the arteries of the heart). HDL, often referred to as "good cholesterol" is thought to help prevent such plaque buildup. The best non-pharmacologic method for improving cholesterol is through lifestyle modifications, including weight reduction, dietary changes (low fat, low salt, low sugar), and increased exercise. If lifestyle changes do not achieve adequate results, medications can be considered. There are several risk calculators available that you and your provider can use to help determine what your CHD risk is and whether or not medications are appropriate.

Please note: Latex Balloons No Longer Allowed at Medical Center

Due to allergic reactions to latex and the possible choking hazard for our pediatric patients, these balloons are no longer allowed. Mylar balloons are acceptable to bring into the hospital.