Health and Disease, Uncategorized

Could Mammograms Screen for Heart Disease?

Could Mammograms Screen for Heart Disease?

 

By screening for breast cancer, mammography has helped save hundreds of thousands of lives. Using the test to also screen for heart disease might someday help save many thousands more.

Though expert guidelines vary, generally women are advised to have a mammogram every year or two starting at age 40 or 50. Nearly 40 million mammograms have been performed in the U.S. during the past year, government figures show.

The prospect of leveraging a test that already is so widely administered, without additional cost or radiation exposure, is tantalizing to researchers hoping to find a new way to fight heart disease, the No. 1 cause of death among U.S. women.

Besides revealing masses that may be tumors, digital mammography – a technique in which low-dose X-ray images are captured and enhanced using computer technology – can reveal buildup of calcium in the arteries in the breast. About 13% of women are estimated to have this buildup, called breast arterial calcification, or BAC, including about 10% of women in their 40s and around half of women in their 80s.

Early studies so far have found BAC’s presence appears to signal an elevated risk for heart attack, stroke and other cardiovascular consequences. Research has begun to reveal a link between calcium buildup in the breast and coronary artery calcification, an established measure that helps predict cardiovascular disease risk.

“Mammography has the potential to alter the course of two leading causes of death in women, breast cancer and heart disease,” said Dr. Quan Minh Bui, general cardiology fellow at the University of California, San Diego. “We believe that there is truth to the sentiment that ‘a picture is worth a thousand words,’ and that seeing calcifications in the breast arteries may empower patients to participate in their medical care.”

Last month at the American Heart Association’s Scientific Sessions conference, Bui and his UCSD colleagues presented preliminary research examining the utility of BAC in predicting existing or future heart failure, a condition in which the heart is weakened and doesn’t pump properly.

The study looked at records from 2006-2016 for 278 middle-aged and older women who had both a mammogram and coronary calcium test within a one-year window.

Almost one-third of the women had BAC, and 7% had heart failure. Even after accounting for age, diabetes and high blood pressure, all heart failure risk factors, women with calcium buildup in the breast arteries had 2.2 times the odds of having or developing heart failure.

Heart failure is a particular challenge in women, said Dr. Erin Michos, director of women’s cardiovascular health for Johns Hopkins School of Medicine in Baltimore. An estimated 3.6 million U.S. women have the condition, and more than 40,000 women die of it annually.

Compared with men, Michos said, women with heart failure tend to be older and have more symptoms such as shortness of breath.

They also have stiffer hearts but normal ejection fraction, a measure of pumping ability. Effective treatments for this type of heart failure are lacking.

“That’s why preventing heart failure from developing in the first place is so important, by identifying at-risk individuals and applying appropriate lifestyle and pharmacology strategies,” she said.

While a mammography finding of breast artery calcification should prompt women to pursue better heart health, it’s still unclear what doctors should do about it, Michos said. For instance, she asked, should those patients be given cholesterol-lowering statins?

It may turn out that BAC is better at predicting some conditions than others. It occurs in a different layer of the blood vessels than coronary artery calcium and may be more closely linked to hypertension and vessel stiffening – major risk factors for heart failure, Michos said. By contrast, “coronary artery calcium likely captures lifetime exposure to risk factors that are key for formation of coronary (plaques), such as high levels of LDL cholesterol.”

Bui’s team is reviewing additional mammograms from women diagnosed with cardiovascular conditions related to arterial plaque buildup, such as coronary artery disease. That effort may help fuel future studies to track breast artery calcium findings and heart health in real time, he said.

Meanwhile, the California researchers hope mammography reports will start to include more information about breast artery calcium.

“Incidental calcification is reported on other diagnostic studies such as CT scans, and we envision BAC not being any different,” Bui said. “We suggest that reports include a statement in fine print noting an association of BAC with cardiovascular disease.”

 

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-People Start to Heal The Moment They Are Heard-
Health and Wellness Associates
EHS Telehealth

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Lifestyle, Uncategorized

Just 2 Weeks On The Couch Starts To Damage Your Body

Just 2 Weeks On The Couch Starts To Damage Your Body

News Picture: Just 2 Weeks on the Couch Starts to Damage Your Body

A new study proves that the old adage “use it or lose it” is definitely true when it comes to fitness.

After just two weeks of sedentary behavior, formerly fit people had:

  • A decline in heart and lung health
  • Increased waist circumference
  • Greater body fat and liver fat
  • Higher levels of insulin resistance

“The study showed that two weeks of reduced physical activity — from approximately 10,000 steps per day down to 1,500 per day — caused changes in health markers that are associated with type 2 diabetes and cardiovascular disease,” said study author Kelly Bowden Davies. She’s a lecturer at Newcastle University and the University of Liverpool in the United Kingdom.

But the good news from the study is that the body seems to quickly bounce back once you start moving again.

“It’s important to note that when people resumed their normal activity levels after this period, the negative health changes were reversed,” she said.

The researchers recruited 28 healthy, regularly active adults. Eighteen were women. The average age of the study volunteers was 32. Their average body mass index (BMI) — a rough measure of body fat based on height and weight measurements — was just over 24. A BMI under 24.9 is considered normal weight.

The study volunteers had been quite active, normally clocking about 10,000 steps daily. Bowden Davies said most of this was just from daily activity, rather than structured exercise. She said they usually participate in no more than two hours of structured exercise weekly.

The researchers asked the volunteers to cut their activity drastically. They dropped an average of just over 100 minutes a day, the researchers said.

After two weeks of couch potato life, the study volunteers underwent a battery of testing. These results were compared to findings measured when the study started.

Bowden Davies said cardiorespiratory fitness levels dropped by 4% in just two weeks.

Waist circumference rose by nearly one-third of an inch. Liver fat increased by 0.2%. Total body fat went up by 0.5%. Insulin resistance increased and triglyceride (a type of blood fat) levels went up slightly.

Fourteen days after resuming activity, these measures all bounced back, the investigators found.

“Even subtle increases in activity can have a positive effect on health. Moving more and breaking up sedentary activity is encouraged,” Bowden Davies added.

Dr. John Osborne, an American Heart Association spokesman, said this was a very interesting, and somewhat surprising, study. The findings validate advice he gives his patients. “If you can be a shark or a turtle, be a shark — always moving. This study showed you can lose the benefits of exercise very quickly, but the good news is that when they became sharks again, all the benefits came right back.”

Another expert who reviewed the study, Dr. Edmund Giegerich, chief of endocrinology and vice chairman of medicine at NewYork-Presbyterian Brooklyn Methodist Hospital in New York City, was also somewhat surprised by the magnitude of changes that happened in just two weeks.

Giegerich said the study confirms how important it is to stay active.

“Going from being sedentary to more active can help a great deal in preventing the onset of type 2 diabetes. Just try to be more active. You’ll feel better, and if you’re trying to lose weight, it can help a little. You don’t have to run a marathon. Walking is fine. Just get up and get moving,” he advised.

Both experts pointed out that the study was small, and in a larger group, the findings might be different. The study was also only done for a short period of time.

Bowden Davies, Osborne and Giegerich all suspect that if people who are at a lower fitness level stop almost all of their activity that the results might even be worse.

The study was presented Wednesday at the European Association for the Study of Diabetes meeting, in Barcelona. Findings presented at meetings are typically viewed as preliminary until they’re published in a peer-reviewed journal.

 

Remember, We are In This Together

Health and Wellness Associates
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Health and Disease, Uncategorized

Gut Bacteria Supplements Might Boost Obese People’s Health

Gut Bacteria Supplements Might Boost Obese People’s Health

 

Supplements of a type of gut bacteria may benefit people at heightened risk of diabetes and heart disease, a preliminary study suggests.

Researchers found that the supplements, containing bacteria called Akkermansia muciniphila, appear safe and potentially effective.

Over three months, volunteers who used a pasteurized version of the supplement lost an average of 5 pounds. Meanwhile, their cholesterol levels dipped and the progression of their “pre-diabetes” slowed.

The study was small, and designed as a “proof-of-principle” — aimed at showing the bacteria can be packaged into a supplement and taken safely.

The researchers said the initial results were promising.

“The aim is now to design a larger study,” said senior researcher Patrice Cani, a professor at the Catholic University of Louvain, in Brussels, Belgium.

Researchers have known for years that Akkermansia is less abundant in the guts of people who are obese or have type 2 diabetes.

“But that was just a simple correlation,” Cani said. So several years ago, his team started to look deeper. First, they found that in lab mice, Akkermansia — given as live bacteria — helped prevent weight gain from a high-fat diet.

The reason, Cani explained, seemed to be that the bacteria were “reinforcing the gut barrier.” That led to less leaking of substances into the blood — which allowed the body to better control blood sugar, and use sugar and fat more efficiently.

Later experiments showed that pasteurizing the bacteria boosted the benefits of live Akkermansia.

But until now, no one had tried giving the bacteria to people.

The study was published online July 1 in Nature Medicine. It’s the latest to delve into the gut “microbiome” — the trillions of bacteria and other microbes that populate the digestive tract.

Research has been revealing that those microbes may have wide-ranging effects on our health — from metabolism to immune defenses to brain function. The makeup of the gut microbiome has been linked to the risks of conditions as diverse as obesity, autoimmune diseases and depression.

The new findings are encouraging, according to researchers not involved in the work.

“The important conclusion is, this type of supplement is safe and feasible,” said Ken Cadwell, an associate professor of microbiology at NYU Langone Health in New York City. “It also shows that a larger, longer study is worth doing, and I’m excited to see that happen.”

Dr. Elena Barengolts is an endocrinologist at the University of Illinois at Chicago. She agreed with Cadwell. “This is top-notch research,” she said.

She and Cadwell noted that the supplement is pasteurized, which can improve safety.

And unlike live bacteria, Cadwell said, pasteurized bugs do not actually “colonize” the gut. In fact, the researchers found no change in volunteers’ overall microbiome composition.

“The reason this might be good is that you don’t have unintended consequences of changing the microbiome,” Cadwell explained. “It also means you can stop the treatment if you don’t think it’s working, and not have to worry about a permanent change to the microbiome.”

The study involved 32 volunteers who were overweight or obese and had metabolic syndrome. That’s a collection of risk factors for type 2 diabetes and heart disease — including elevated blood pressure, cholesterol and blood sugar, and unhealthy amounts of belly fat.

The participants also had insulin resistance — a precursor to diabetes where the body gradually loses its sensitivity to the hormone insulin, which regulates blood sugar.

Twelve study participants were randomly assigned to take the pasteurized Akkermansia supplement; nine were given live bacteria; and 11 took a placebo (inactive) supplement.

After three months, people on the pasteurized supplement had lost 5 pounds, on average. Their insulin sensitivity improved by 30% in relation to the placebo group, whose sensitivity worsened. And their total cholesterol dipped by about 9% versus the placebo group, the findings showed.

To Barengolts, the weight loss — while small — is an important finding. Many people struggle with shedding extra pounds, she noted, and this was done without diet changes.

That said, no supplement can replace a healthy diet and exercise, Barengolts stressed.

Cani agreed, noting that any Akkermansia supplement would be an addition to lifestyle changes and standard medications.

Cani and a co-researcher have founded a company, A-Mansia Biotech, that is developing an Akkermansia food supplement to bring to the market.

Remember we are in this together!
Reviewed by P Carrothers
Foods, Uncategorized

Cheesy Chicken and Rice Casserole

Cheesy Chicken and Rice Casserole

 

Chicken and rice casserole recipe - Dr. Axe

 

INGREDIENTS:

  • 2–3 cups wild rice, cooked
  • 1 cup goat milk
  • 6 medium mushrooms, quartered
  • 4 chicken thighs, chopped
  • 1 shallot, minced
  • 4 sprigs thyme
  • 1½ cup kale, chopped
  • 1 teaspoon garlic, minced
  • 1 cup goat cheese, grated
  • 2 cups chicken broth
  • 2 tablespoons butter or avocado oil
  • 2 tablespoons arrowroot starch
  • 1 teaspoon sea salt
  • 1 teaspoon pepper

 

DIRECTIONS:

  1. Preheat oven to 350 degrees F.
  2. In a small saucepan over medium heat, create roux by whisking butter and arrowroot starch until it bubbles, about 2 minutes.
  3. Add broth, whisking continuously to thicken for about 10 minutes.
  4. Once the mixture is visibly thicker, add goat milk and continue to whisk for about 5 minutes, allowing to thicken a bit more.
  5. Combine all ingredients except for goat cheese in a casserole dish, mixing thoroughly.
  6. Top with goat cheese and bake for 40 minutes.

 

I think you’ll find that not only is this chicken and rice casserole recipe super tasty and comforting, it’s also energizing, filling and gentle on your stomach.

The week nights can get very busy, and we often find ourselves rushing to make dinner choices that are quick, easy and inexpensive. When you need to throw a bunch of ingredients in a pot and call it a day, there’s nothing better than slow cooker recipes and casseroles.

Unlike most casserole recipes that are made with refined carbohydrates and other processed ingredients that can be hard on your digestive system, my chicken and rice casserole is made with gluten-free wild rice, chicken thighs, mushrooms, kale and goat cheese. It’s also made with a tasty roux that’s made with arrowroot, one of my go-to gluten-free flours, and goat milk.

The Healthiest Rice Option

When you roam through the rice options at the grocery store, you may be a bit confused about all of the options. There’s white rice, brown rice, black rice, wild rice, jasmine rice — the list goes on. Do you need some help choosing the healthiest rice options for your home cooking? Well, I’ve got you covered.

One of the healthiest rice options out there is wild rice. Did you know that wild rice is actually a grass and not a grain? It’s a semi-aquatic grass that grows naturally in waterways throughout the United States. It’s completely gluten-free and rich in antioxidants.

Chicken and rice casserole recipe - Dr. Axe

Wild rice has a nutty flavor and texture, so it really adds depth to a recipe. Plus, you may notice that after eating a meal with wild rice, you feel energized, which is because of the magnesium content.

Aside from the wild rice in my chicken and rice casserole, some other ingredients that make this a healthy and filling dinner option are the goat milk, chicken broth and arrowroot flour that makes up the roux. You get a creamy texture and rich flavor, but this roux is easy on your digestive system.

Plus, the combination of mushrooms, kale, garlic and shallot gives this chicken and rice casserole a boost of vitamins and minerals that will support your immune system and help to reduce inflammation. Who knew a casserole can do so much for your health?

 

Remember We Are In This Together!

Health and Wellness Associates
EHS Telehealth

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Foods, Health and Disease, Uncategorized

Heart-Healthy Eggs Benedict Recipe with Asparagus

Heart-Healthy Eggs Benedict Recipe with Asparagus

 

Eggs benedict recipe - Dr. Axe

 

INGREDIENTS:

  • 1 bunch asparagus (16 pieces)
  • 1–2 teaspoons coconut or avocado oil
  • ¼ tomato, sliced
  • ½ avocado, sliced
  • 2 eggs, poached
  • hollandaise sauce  ( recipe below)

 

DIRECTIONS:

  1. In a medium-size frying pan over medium heat, add coconut or avocado oil.
  2. Add the asparagus to the frying pan and pan fry until for tender, about 8–10 minutes.
  3. In a small pot, bring 2–3 cups of water to a boil.
  4. Once boiling, gently lower the eggs into the water and allow to boil for 3 minutes. Remove the eggs once finished and set them aside for assembly.
  5. Divide the asparagus on two separate plates and add sliced tomato and avocado on top.
  6. Add the eggs and drizzle on the hollandaise.
  7. Top with chives.

Eggs Benedict is one of those items that you’ll always see on a breakfast or brunch menu. It’s a breakfast classic. But, when prepared with the traditional ingredients, it can be hard on your waistline, heart, brain and digestion.

In my eggs Benedict recipe, I use immune-boosting, heart healthy, anti-inflammatory foods like avocado, asparagus and tomato. This low-carb breakfast is also high in healthy fats that are key for maintaining optimal health. So give this eggs Benedict recipe a try — you’ll never go back to the traditional dish again.

5-Minute Blender Hollandaise Sauce Recipe

Hollandaise sauce recipe - Dr. Axe

INGREDIENTS:

  • 2 tablespoon grass-fed butter or ghee
  • 1 egg yolk
  • ¼ teaspoon dijon mustard
  • 1 tablespoon lemon juice
  • ¼ teaspoon sea salt
  • ½ tablespoon water

DIRECTIONS:

  1. In a small sauce pan, melt the butter or ghee over medium-low heat.
  2. Add all the ingredients into a high-powered blender until well combined.

 

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Health and Wellness Associates
EHS Telehealth

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Health and Disease, Uncategorized

Subtle Signs You May Have Clogged Arteries

How common are clogged arteries?

 

coronary artery angiography ,Coronary artery disease , left coronary angiographyEach year in the United States, according to the Centers for Disease Control and Prevention (CDC), about 735,000 people suffer a heart attack and 610,000 people die of coronary heart disease (CHD). That’s one in four deaths. Preventing heart disease in patients is a physician’s main goal, but early detection is the next best thing. This can lead to changes in lifestyle and medical therapies that can delay or deny the onset of a heart attack; almost 80 percent of heart disease is preventable with lifestyle changes. Many of my patients are shocked to learn about the following clues to underlying clogged arteries and heart disease.

 

Erectile dysfunction (ED)

 

Closeup shot of male waist with hand in pocket dressed in black pants, belt, grey shirt, black tie and watch with brown watch strap. Formal wear.

 

Men have a built-in warning system for silent CHD. When achieving an erection is difficult or impossible, it can be a sign of clogged arteries in the pelvis that presents before a heart attack hits. There are, on average, three to five years between the onset of ED and the finding of CHD, which is plenty of time to detect and work on preventing heart issues. If you and your partner are worried about sexual performance, it’s smart to look for and treat the root causes of diseased arteries before automatically turning to a blue pill.

 

Calf pain when you walk

 

7 Silent Signs You May Have Clogged Arteries

This is known as claudication (from the Latin for “to limp”). Atherosclerosis can block leg arteries, particularly in smokers, before CHD is diagnosed. This symptom requires an evaluation without delay. Your doctor will examine the pulses in your legs and perform simple measurements of leg blood pressure and blood flow to confirm a diagnosis of poor circulation. It is crucial that heart disease be diagnosed as early as possible because there are many dietary and medical treatments that can help reverse the problem. I advise my patients to eat more plant-based foods and fewer animal products and to start a walking program. Their calf pain completely resolved within weeks and has not recurred for years. Anyone with any of the above signs of silent CHD should know his or her numbers (blood pressure, cholesterol, and fasting glucose). Ask your doctor if you should be checked for heart disease with an EKG, a coronary calcium CT imaging, or an exercise stress testing.

Tight jaw

 

woman with cheek pain or chin pain.Acute pain in a woman Salivary gland . Female holding hand to spot of nape-aches. Concept photo with read spot indicating location of the pain.

This symptom of clogged arteries occurs more often in women, but men should be aware of it, too. According to the Harvard Medical School, aches and pains in the jaw and neck are common symptoms of angina, which is the discomfort that results from poor blood flow to part of the heart. The pain occurs because the vagus nerve (the main nerve that carries pain signals from the heart) is in constant contact with the neck, jaw, head, and left arm. Visit your doctor to find out if your jaw pain is the result of something benign, such are teeth grinding, or if it’s something you’ll want to monitor with caution.

 

Lower back pain

 

Pain in back. Cropped image of young African man touching his back

Your lower back pain might not be a simple sign of aging muscles. According to the Physicians Community for Responsible Medicine, the lower back is also often one of the first parts of the body to accumulate plaque. You’ll feel pain because the reduced blood flow to the area can weaken the disks that cushion the vertebrae.

 

Smoking habit

 

7 Silent Signs You May Have Clogged Arteries

The chemicals in tobacco damage the structure and function of your blood vessels and damage the function of your heart. This damage increases your risk of atherosclerosis, according to the National Heart, Blood, and Lung Institute. One of the best things you can do to decrease your risk of CHD is to quit. The Centers for Disease Control and Prevention offers help for quitting smoking.

 

Joel K. Kahn, MD.

 

Remember, We are in this Together!

 

Health and Wellness Associates
EHS Telehealth

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Health and Disease, Uncategorized

Magnesium and Heart Disease

 

Magnesium and heart health are linked.

 

For years, the medical industry thought cholesterol was the most important factor in heart disease.

But that idea is being flipped on its head…

A decade-long study looking at cardiovascular disease found that low magnesium contributed more to heart disease than cholesterol or saturated fat. That’s amazing!

The simple act of taking a high quality magnesium supplement can help prevent heart problems better than obsessing about cholesterol levels.

More and more doctors are turning to magnesium as the first line of defense to protect the heart.

It makes sense! Magnesium…

  • Regulates heart rhythm (preventing arrhythmia)
  • Wards off angina (the intense chest pain caused by arteries having spasms)
  • Keeps electrical signals firing properly
  •  And reduces high blood pressure

Supplementing is even more important as you age, since older people have a harder time absorbing magnesium, they store less of it in their bones, and lose more of it in their urine.

It can be difficult to get enough magnesium through food alone. That’s why most doctors recommend supplementing…

In all my studying, I’ve found your heart deserves all the help it can get.

Heart disease is the number one cause of death in the U.S.

But it doesn’t have to be this way. Prevention is possible.

And magnesium is one of the best ways to keep your heart beating pain-free.

Like any medication, you have to make sure the right magnesium and the amount you take is right for you.  Also magnesium can not be taken alone.

Contact us, and we can help you figure this out for YOU!

Remember we are in this together,

Health and Wellness Associates
EHS Telehealth

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Health and Disease, Lifestyle, Uncategorized

AHA: New Report Emphasizes Safety of Statins

AHA: New Report

Emphasizes Safety of Statins

(American Heart Association) — The benefits of the cholesterol-lowering medicines called statins far outweigh any risk of side effects, according to a new analysis of decades of scientific research.

AHA1210182

In fact, side effects of statins are rare, according to a new American Heart Association scientific statement published Dec. 10 in the journal Arteriosclerosis, Thrombosis and Vascular Biology.

Lynne Braun, a heart disease and stroke prevention expert who co-authored the statement, said she hopes the results put to rest any misconceptions patients or health care providers have about what she calls a lifesaving medication.

“This is a category of medications where it is clear, very clear, what the benefits are,” said Braun, a nurse practitioner and a professor of nursing and medicine at Rush University in Chicago.

Statins are used primarily to reduce low-density lipoprotein, or LDL, cholesterol, a waxy, fat-like substance that builds up in arteries. Research shows statins may lower heart attack risk by at least 25 percent and may also help patients with heart disease avoid cardiac procedures such as coronary stents.

The statement comes 16 years after a clinical advisory issued by the AHA, the American College of Cardiology and the U.S. National Heart, Blood, and Lung Institute reported similar findings. The authors of the new report reviewed dozens of studies dating back at least 20 years. Most were clinical trials, which are considered the most scientifically sound type of study.

The scientific statement addresses muscle pain, muscle weakness and type 2 diabetes, the most commonly reported side effects of statins, among others.

Muscle pain and weakness were rare complaints in statin clinical trials. When muscle symptoms do occur, they often are linked to the drug’s dosage, the study authors said.

Statins may slightly increase the risk for type 2 diabetes, a condition that can lead to heart disease or stroke. But most people on the drugs already had a high risk for diabetes. Overall, people with diabetes who are on statins see an insignificant increase in blood sugar levels, the study authors said.

The authors suggested health care providers keep a close eye on certain patients who need or take statins, especially older adults who take multiple medications for chronic illnesses.

For example, some studies suggest that people who’ve had a brain hemorrhage and are on a statin are at risk of a second brain attack or hemorrhage. People living with HIV may suffer muscle weakness and muscle pain, in part because of statins’ chemical interplay with HIV drugs. Studies show people of East Asian heritage may be more susceptible to statin-related side effects, especially muscle pain and muscle weakness.

Dr. Roger S. Blumenthal, a cardiologist at Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore, said the AHA’s report is a comprehensive review of the pros and cons of taking statins.

“The main takeaway is that statin therapy is much safer — even more effective — than most of the general public has been led to believe,” said Blumenthal, who was not involved in writing the report.

Braun encourages patients who are concerned about taking statins to talk to their health care providers about finding the best medication for them. Patients shouldn’t stop taking statins without consulting their doctor because that could be dangerous, she said.

Health and Wellness Associates

Preventative and Restorative Healthcare

Dr P Carrothers

healthwellnessassociates@gmail.com

 

Health and Disease, Uncategorized

Lipoprotein(a): the Other ‘Bad’ Cholesterol

Health and WEllness Associates

EHS – Telehealth

 

Lipoprotein(a): the Other ‘Bad’ Cholesterol

There’s a simple blood test your doctor can order to detect Lp(a).

lipidprofile.jpeg

YOU’VE PROBABLY HEARD about low-density lipoprotein, or “bad cholesterol,” but did you know there’s another cholesterol that may be equally bad? Called lipoprotein(a), or Lp(a) – L-p-little-a – for short, it’s a cause of heart attacks, strokes, aortic valve disease, peripheral vascular disease and blood clots. And it’s not picked up by standard cholesterol tests you may receive at a doctor’s office. So, what’s the good news? There is a simple blood test your doctor can order to detect Lp(a), and there are potential treatment options if your level is high. Here’s what you need to know about Lp(a).

 

What Is Lp(a) and Why Is it Important?

 

Lp(a) is structurally similar to LDL or “bad cholesterol.” Like LDL, it’s a small protein carried in the bloodstream that transports cholesterol, fats and proteins to organs in the body. At high levels, Lp(a) may deposit in blood vessels and cause atherosclerosis, or plaque buildup, in vessel walls. Plaque buildup causes blood vessel narrowing and reduces the blood supply to vital organs such as the heart, kidneys and brain. Lp(a) may also get in the way of other molecules in the body that help break up clots. As a result, people with high Lp(a) levels are more prone to developing blood clots that may manifest as heart attacks and strokes.

 

The standard cholesterol/lipid panel of tests taken at a doctor’s office doesn’t include an Lp(a) blood test. They measure total cholesterol, high-density lipoprotein (HDL) – or “good” cholesterol – and fats called triglycerides. LDL is typically calculated from these values. Historically, clinicians have focused on LDL because high levels were shown to cause heart attacks and strokes. Like Lp(a), LDL enters blood vessel walls and may cause significant atherosclerosis. However, recent studies have discovered that other cholesterol particles, such as Lp(a), may also independently cause heart disease irrespective of LDL values.

 

According to the Lipoprotein(a) Foundation, nearly 63 million Americans and approximately 1 billion people globally have high Lp(a) values. Nearly 1 in every 5 people have elevated Lp(a). With cardiovascular disease remaining the No. 1 killer of Americans, identifying all risk factors, including Lp(a), that lead to cardiovascular disease is critical.

 

 

What Are the Risk Factors, and Who Should Be Screened?

 

Lp(a) is inherited – the value is determined primarily by genes passed along from both parents. People with high Lp(a) levels have a 50 percent chance of passing on high Lp(a) to their children. Other factors such as age, sex and medical conditions such as diabetes and high blood pressure don’t appear to affect Lp(a) value. Without treatment, Lp(a) values tend to remain constant throughout life.

 

Lp(a) may be measured by a simple blood test, which is offered by most major laboratories across the U.S. Values are reported in two ways: either in milligrams per deciliter or nanomoles per liter, with milligrams per deciliter indicating the mass or amount of Lp(a) proteins in circulation and nanomoles per liter reflecting the concentration of all Lp(a) particles present in the blood. Typically, values above 50 milligrams per deciliter or above 125 nanomoles per liter are considered high, but these may vary slightly depending on the lab.

 

Experts advise that the following people may particularly benefit from Lp(a) testing:

 

 

Those with premature heart disease or a family history of early heart disease, defined as a heart attack or stroke in men under age 55 or women under age 65.

People with a condition called familial hypercholesterolemia, in which LDL levels are very high (often above 190 milligrams per deciliter) beginning at birth.

People with a family history of elevated Lp(a), since Lp(a) is genetically inherited.

People with progression of heart disease despite being treated with cholesterol drugs such as statins.

People with more than 10 percent 10-year heart attack and stroke risk according to U.S. guidelines – a recent study in the Journal of the American College of Cardiology found that in women, Lp(a) was more associated with heart disease in those with high cholesterol.

People with premature aortic valve calcification or peripheral vascular disease.

If a person is found to have high Lp(a), first-degree family members (parents, siblings and children) are encouraged to undergo screening as well because of the inheritance risk of Lp(a). As an important recognition that elevated Lp(a) is a specific disease-causing entity, there are now new International Classification of Diseases-10 diagnosis codes for elevated Lp(a) (E78.41) and a family history of elevated Lp(a) (Z83.430) that will go into effect in October of this year. ICD-10 codes are used in health care to classify all diagnoses, symptoms and procedures as a way of recording and identifying health conditions.

 

 

What Are the Treatment Options?

 

While diet and exercise are recommended overall as part a healthy lifestyle to reduce cardiovascular disease, and they can improve other components of a person’s lipid panel, unfortunately lifestyle choices seem to have little effect on explicitly reducing Lp(a) levels. Even statins, which are used to reduce the amount of plaque caused by LDL, have no impact on Lp(a).

 

No specific medication is commercially available to specifically lower Lp(a). If Lp(a) levels are high, a prescription version of the dietary supplement niacin (vitamin B3) may be considered to lower Lp(a) values by as much as 40 percent, however evidence for this approach isn’t conclusive. In severe cases, an option is weekly plasmapheresis, a procedure similar to dialysis in which a machine can help filter out Lp(a) particles from the blood.

 

Research has been promising in the development of drugs specifically targeted for reducing Lp(a). In a 2015 landmark article published in The Lancet, volunteers with elevated Lp(a) levels were randomized into three groups to be administered the new drug ISIS-APO(a)Rx, which specifically targets the genetic material encoding for Lp(a). People in the group receiving the highest dose of this drug experienced an average decrease of nearly 78 percent in Lp(a) values after 30 days. According to a recent article in JAMA Cardiology, it was found that large reductions in Lp(a) are likely needed to produce meaningful benefit in reducing the heart disease risk. With these results, more clinical trials to test the safety and efficacy of these new agents are eagerly awaited.

 

For now, if a person is diagnosed with high Lp(a), experts recommend lifestyle changes and therapies to decrease the overall cardiovascular disease risk attributable to other modifiable risk factors. Strategies may include focusing on lowering blood pressure, eating a heart-healthy diet, losing weight, increasing physical activity, quitting smoking and reducing LDL levels. Aspirin, a platelet blocking drug, can be considered to prevent clots. An individualized plan should be made with a clinician trained in treating elevated Lp(a).

 

 

Take-Home Points

 

Lipoprotein(a), or Lp(a), is another “bad” cholesterol that increases your risk for heart disease and stroke, even when other cholesterol numbers are normal.

Lp(a) isn’t measured in a standard cholesterol/lipid blood test, but blood tests are available to measure a person’s Lp(a) level.

Patients at unusually high risk for cardiovascular disease should ask their doctors about measuring Lp(a). These patients include those with early heart disease or a family history of premature heart disease, familial hypercholesterolemia, a family history of elevated Lp(a) and progressive cardiovascular disease despite optimal medical management.

While we await clinical trials testing the safety and efficacy of new Lp(a) drugs, current treatment revolves around using established therapies to reduce modifiable cardiovascular risk factors.

 

 

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Health and Disease, Uncategorized

10 TESTS TO AVOID AT THE DOCTOR’S OFFICE

Health and Wellness Associates
EHS Telehealth

 

10 TESTS TO AVOID AT THE DOCTOR’S OFFICE

 

10teststoavoid

 

10 TESTS TO AVOID AT THE DOCTOR’S OFFICE

 

 

Bulletin, doctors are warning that some of the medical tests routinely taken by Americans do more harm than good, waste billions of health care dollars annually and could endanger your health or even your life.

Some of the tests that are overused by prestigious panels of doctors include annual Pap smears, regular PSA tests, regular EKG’s, and even routine yearly physicals.  Doctors are saying that the overuse of such tests can lead to dangerous side effects, pain, radiation exposure, unnecessary surgery, even death.

 

The American Board of Internal Medicine Foundation asked more than 50 medical societies—of family

doctors, oncologists, cardiologists, and other specialists—to identify tests and treatments that are often unnecessary.  AARP is a consumer partner with this campaign, called Choosing Wisely.

 

Another Choosing Wisely partner is John Santa, M.D., medical director at Consumer Reports, and he says that these screening tests often yield false-positive results that lead to a spiral of unneeded invasive procedures, medications and even surgeries.  If you have symptoms or certain risk factors, these tests can be valuable—even life-saving—but they’re performed on far too many people.

 

Nuclear stress tests, and other imaging tests, after heart procedures:

 

Many people who have had a heart bypass, stent or other heart procedures want to be reassured that their hearts are functioning properly, which is understandable because they feel as if they’ve had a brush with death.  A common way to reassure their patients is for doctors to perform tests like a nuclear stress test or other tests, to make sure their hearts are beating strongly.  But according to William Zoghni, M.D., performing these tests every year or even every two years in patients without symptoms rarely results in any change in treatment.  “More testing is not necessarily better,” he says. In fact, it can lead to unnecessary invasive procedures and excessive radiation exposures without helping the patient improve.

 

Instead, patients and doctors should focus on what does make a difference in keeping the heart healthy: managing weight, quitting smoking, controlling blood pressure and increasing exercise.

 

Yearly electrocardiogram or exercise stress test

 

A survey of nearly 1,200 people ages 40 to 60 who have never had heart diseases or any symptoms found that 39% had an EKG over the previous five years, and 12% said they had an exercise stress test.  The problem with this is that someone at low risk for heart disease could be 10 times more likely to get a false-positive result than to find a real problem, says John Santa of Consumer Reports, which conducted the 2015 survey.

This could lead to unnecessary heart catheterization and stents.  Instead, have your blood pressure and cholesterol checked.  If you’re at risk for diabetes, have your blood glucose level checked, as well.

 

PSA to screen for prostate cancer

 

Cancer is always scary, but the PSA test often finds slow-growing cancers that won’t kill men.  “The evidence is extremely convincing that in a man with usual risk and no symptoms, the PSA test causes more harm than benefit,” says Reid Blackwelder, M.D., president of the American Academy of Family Physicians (AAFP).

 

He also says that as a result of the test, men often have ultrasounds, repeat lab tests and even biopsies for a problem that isn’t there—an estimated 75% of tests that show high PSA levels turn out to be false alarms.  When men do have treatments like surgery or radiation, 20-40% end up with impotence, incontinence or both.

 

Not all doctors agree with AAFP’s recommendation against routine PSA screening, but many agree that the test is overused.  Even the American Urological Association, which supports the use of PSA testing, says that it should be considered mainly for men age 55 to 69.  The American Society of Clinical Oncology recommends against PSA testing for prostate cancer screening in men with no symptoms when they are expected to live less than 10 years.  A recent study published in the journal Cancer found that Medicare spent almost $450 million a year on PSA screenings, one-third of which was for men over the age of 75.

 

PET scan to diagnose Alzheimer’s disease

 

Until recently, the only way to accurately diagnose Alzheimer’s was during an autopsy.  In the last few years, doctors have begun using PET scans with a radioactive dye to look for beta-amyloid protein that  is found in the brains of people with the disease.  Although this test has promising use for research, there are serious questions about whether it should be used on those who complain of fuzzy memory.  PET scans in older people consistently find the protein in 30 to 40% of people whose memories are just

fine.

 

Although beta-amyloid plaques are present in all of those who have Alzheimer’s, it’s not known if or when everyone with the plaques will develop the disease, says Peter Herscovitch, M.D., president-elect of the Society of Nuclear Medicine and Molecular Imaging.

 

What’s more, even if a PET scan could accurately diagnose the disease, it’s untreatable.  If you’re concerned about your memory, the better course would be a complete medical evaluation by a doctor who specializes in diagnosing and treating dementia.  Many other medical conditions, like stokes, thyroid deficiencies and vitamin deficiencies can cause the same symptoms, and these are treatable.

 

X-ray, CT scan or MRI for lower back pain

 

Unfortunately, back pain is incredibly common—80% of people will suffer from back pain at some point in their lives.  It can be both excruciating and debilitating.  Of course, people want to know what’s wrong with them.  Here’s the catch:  The best imaging machines in the world often can’t tell them what’s wrong.  Many older people with no back pain can have terrible-looking scans.

 

Most back pain goes away in about a month and imaging tests tend to lead to expensive procedures that often don’t help recovery.  One study found that people who got an MRI during the first month of their back pain were 8 times more likely to have surgery than those who didn’t have an MRI—but they didn’t get relief any faster.  If you don’t feel better in a month, talk to your doctor about other options like physical therapy, yoga or massage.  But if you’re experiencing numbness or weakness in your legs, you have a history of cancer or you have had a recent infection, see your doctor as soon as you can.

 

Yearly Pap tests

 

The yearly Pap smear is a common part of women’s health checklists, but it doesn’t need to be.

Women at average risk only need them every three years, since cervical cancer generally takes 10 to 20 years to develop.  If women have also had negative tests for the human papillomavirus (HPV), which is now known to cause the cancer, they only need a Pap test along with the HPV test every five years.  And women older than 65 who have had several normal Pap tests in a row can stop having them altogether.  Do note, however, that a yearly visit to an ob-gyn stays on the to-do list.

 

Bone density scan for women before age 65 and men before age 70

 

For the estimated 10 million people—mainly women—in the U.S. who have osteoporosis, bone-strengthening medications can lower the chances of breaking a bone.  A bone density test for anyone over the age of 70 is unnecessary.   You can no longer prevent osteoporosis at this age.

 

But many experts argue that for those age 50 to 65 who have osteopenia—mild bone loss—testing and subsequent drug prescriptions may be a waste of time and money also.

Not only is the risk of fracture often low, medications like Fosamax (alendronate) and Boniva (ibandronate) have been linked to throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss in the jaw and thigh-bone fractures.  And there’s scant evidence that people with osteopenia get much benefit from the drugs.

 

To help keep your bones strong, try walking and weight-bearing exercises, says Blackwelder.  Get enough calcium and vitamin D in your diet.  If you smoke, quit.

 

Follow-up ultrasounds for small ovarian cysts

 

Many women receive repeated ultrasounds to verify that ovarian cysts have not become cancerous, but current research says that these tests are not necessary.  For one thing, premenopausal women have harmless ovarian cysts regularly.  For another, about 20% of postmenopausal women also develop harmless cysts.

 

“The likelihood of these small simple cysts ever becoming cancer is exceedingly low,” says Deborah Levine, M.D., chair of the American College of Radiology Commission on Ultrasound and a professor of radiology at Harvard Medical School.

In postmenopausal women, only cysts larger than 1 centimeter in diameter need a follow-up ultrasound.  For premenopausal women, who typically have benign cysts every monthly when they ovulate, cysts smaller than 3 centimeters aren’t even worth mentioning in the radiologist’s report, Levine says.

 

Colonoscopy after age 70

 

Most people should have screening for colon cancer at age 50 and then every 5 to 10 years after that, if the first test is normal.  By age 70—if you’ve always had normal colonoscopies—you can stop taking this test altogether.  That should be good news, because a colonoscopy can cause serious complications in older people.

 

“Just the preparation for colonoscopy can be exceptionally harsh,” says James Goodwin, M.D., director of the Sealy Center on Aging at University of Texas Medical Branch, who studies overuse of colonoscopies.  Some patients become incontinent or experience weeks of pain, diarrhea and constipation.

 

In worst cases, the procedure can perforate the colon.  Despite such risks, recent studies have found that substantial numbers of people over 75, even over 85, are still getting screening colonoscopies.

 

To protect your colon, eat plenty of fruits, vegetables and whole grains for fiber.  Cut down on fatty foods, red meat and processed meats.  Lose weight if you’re overweight and exercise.

 

Sound familiar?  It should, because that’s the best advice for protecting the rest of your body—and mind—as well.

 

Yearly physical

 

There’s little evidence that having an annual checkup can keep you healthy.  Many tests that doctors regularly perform—to diagnose anemia, liver disease or urinary tract infections, for example—don’t make sense unless there’s a reason to suspect a problem.  “A healthy 52-year-old does not need to see the doctor once a year,” says Jeremy Sussman, M.D., an internist for the VA system and assistant professor at the University of Michigan who was on the Societof General Internal Medicine task force for making the ChoosingWisely recommendation.

 

“We certainly don’t think people should never see doctors—quite the opposite.  We question the value of seeing someone for the sake of seeing someone.”  Your specific needs should determine how often you go to the doctor’s office, he adds.  If you have an illness that needs treatment, you should see your physician.  And do talk to your doctor about how often you need to have your blood pressure and cholesterol tested.  “Our real point is, don’t do these things for the sake of a calendar,” he says. “Do them for the sake of your health.”

 

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