Stress Tests Fail to Determine Heart Attack Risk

Posted on June 17, 2008 by Gerald Pugliese

By now you probably already know, but the much beloved host of NBC’s Meet the Press, Tim Russert, has died. He collapsed from a heart attack at the NBC News studio in Washington, D.C. on Friday. Nicole Weisensee Egan of People Magazine reports:
In a statement detailing autopsy results, Dr. Michael Newman said his famous patient had passed a stress test on April 29 and had even worked out on a treadmill the morning of his death.

"Russert, age 58, was known to have asymptomatic coronary artery disease (atherosclerosis), which resulted in hardening of his coronary arteries," Newman said. "The autopsy revealed an enlarged heart and significant atherosclerosis of the left anterior descending coronary artery with (a) fresh clot which caused a heart attack resulting in a fatal ventricular arrhythmia…"

…Dr. Cyril Wecht, a nationally renowned forensic pathologist, said Newman's description of why Russert died makes sense. "The left anterior descending artery is well known among pathologists as the widow-maker," he tells PEOPLE. "That tells you a lot, doesn't it? It's a classical situation that one encounters with great frequency in sudden unexpected death where you get a blood clot, or a thrombosis, or bleeding and if he had an enlarged heart, that adds to it."

Clots can be caused by any number of things, he said. "Sometimes it's associated with stress and exertion, physical and/or emotional," he said. "Was he flying a long time? Was he tired? People shoveling snow in the wintertime can get them. People working excessively hard. Or people under great physical and/or emotional stress and that can include flying."
He PASSED his stress test, how could that be? If he checked out okay, how could be dead a couple months later? Something doesn't seem right. I called Dr. Fuhrman and asked him about stress tests. Here’s what he had to say:
A stress test is not an accurate test for determining the risk of a heart attack. A stress test only identifies obstructions, it doesn't identify vulnerable plaque—the plaque that is likely to throw a clot. A stress test can only detect a blockage of more than 80% and the propensity of plaque to rupture has nothing to do with the amount of obstruction. You could have a completely normal stress test and then have a heart attack the next day.1 Juvenile plaque, which is thinly laid down, has a higher propensity to rupture then the old plaque that is more obstructive.


Cardiologists' attempt to intervene with cholesterol-lowering drugs hoping that cholesterol-lowering will reduce the thickness of the lipid pool within the plaque, but it only partially reduces risk. Over fifty percent of Americans still die of heart attacks and strokes. About 70 percent of the clots that cause death are formed in areas of the heart with non-obstructing lesions, not visible to cardiac testing and not treatable with stenting or bypass.

Stress tests are big money-makers for doctors. They identify those people with large blockages who qualify as candidates for costly angioplasty or bypass surgery. However, drugs and medical procedures reduce risk only slightly. There is a more effective option. People who normalize their weight, blood pressure and cholesterol through nutritional excellence and exercise don't have heart attacks.
Dr. Fuhrman makes it pretty clear. Protection against cardiovascular disease will not be found by a scalpel or in a bottle of pills. The best way to prevent heart disease is through aggressive dietary intervention; specifically a nutrient-dense vegetable-based diet. He explains:
A high nutrient, plant-based diet is more effective at lowering cholesterol than drugs, but also the weight loss, blood pressure lowering and reduction of oxidative stress from the high levels of micronutrients are all important factors in dramatically lowering one’s risk of heart disease.2 Their have been numerous medical studies to document that dietary intervention is more effective than drugs, and that heart disease is preventable and reversible.3,4 That’s why my patients with advanced heart disease get well and never have heart disease again.
Maybe if less focus is placed on pointless money-making procedures that only promote a false sense of security, millions of Americans, like Tim Russert, wouldn’t die needlessly each year.
Continue Reading...
Tags: , , ,

Heart Health: No Point in Monitoring Blood Sugar?

Posted on June 10, 2008 by Gerald Pugliese

New research contends that individuals with type-2 diabetes do not lower their heart attack and stroke risk by controlling their blood sugar. More from Gina Kolata of The New York Times:
The results provide more details and bolster findings reported in February, when one of the studies, by the National Institutes of Health, ended prematurely. At that time, researchers surprised diabetes experts with the announcement that study participants who were rigorously controlling their blood sugar actually had a higher death rate than those whose blood sugar control was less stringent.

Now the federal researchers are publishing detailed data from that study for the first time. Researchers in the second study, from Australia and involving participants from 20 countries, are also publishing their results on blood sugar and cardiovascular disease. That study did not find an increase in deaths, but neither did it find any protection from cardiovascular disease with rigorous blood sugar control.

Thus both studies failed to confirm a dearly held hypothesis that people with Type 2 diabetes could be protected from cardiovascular disease if they strictly controlled their blood sugar.

It was a hypothesis that seemed almost obvious. Cardiovascular disease accounts for 65 percent of deaths among people with Type 2 diabetes. And since diabetes is characterized by high levels of blood sugar, the hope was that if people with diabetes could just get their blood sugar as close to normal as possible, their cardiovascular disease rate would be nearly normal as well.
Dr. Fuhrman was not impressed by this report. His thoughts:
That is because when you are an overweight diabetic the metabolic consequences are not the blood sugar alone and taking drugs is not the answer. Some of the drugs (especially insulin) cause weight gain and make the metabolic syndrome worse. Losing weight, exercising and eating high on the nutrient density line is the answer, not more medications.
Not more medications! But how will the drug companies make bigger profits?
Tags: , , , , ,

Salt: Hemorrhagic Stroke Risk

Posted on June 9, 2008 by Joel Fuhrman, M.D.

Risk of “bleeding” stroke a concern for vegans and others! High-salt consumption may be potentially more dangerous for vegans, vegetarians, and others who have earned low cholesterol levels by eating otherwise healthful diets. Just as we know that high cholesterol levels are associated with increased risk of coronary heart disease, low cholesterol levels are associated with increased risk of hemorrhagic stroke.
  • Small arteries vulnerable: Some studies have suggested that low serum cholesterol could enhance the vulnerability of small intraparenchymal cerebral arteries and lead to the development of stroke in the presence of hypertension.1 The plaque-building process that results in atherosclerosis and premature death may in some way protect the fragile blood vessels in the brain from rupture due to high blood pressure.A high-salt diet may dramatically increase the risk of hemorrhagic stroke in vegans because they can live longer than the general population and not to die from a heart attack first. To protect against heart attacks, ischemic strokes, and hemorrhagic (bleeding) strokes, you must dramatically curtail salt consumption.
  • Additional problems: As previously mentioned, cardiovascular diseases are not the only problems associated with salt consumption. Salt increases the body’s excretion of calcium. This could lead to loss of bone mass and osteoporosis.2 Diets high in salt appear to cause higher rates of infection with Helicobacter pylori, the bacterium that causes stomach ulcers, and salt has been shown to be associated with higher rates of stomach cancer.3 Salt also has been shown in numerous studies to be associated with asthma, and salt reduction can improve breathing.4 Some of these studies seem to indicate that salt has a stronger negative impact on the lungs of boys.5
  • The forgotten killer: There is good reason to refer to salt as “The Forgotten Killer.”6 Although it is easy to get distracted with the other diet-related topics that dominate the headlines, high sodium levels can be deadly. Eating a healthful, plant-based diet composed of unprocessed, unsalted whole foods is the best weapon we have.
Continue Reading...
Tags: ,

Thursday: Health Points

Posted on June 5, 2008 by Gerald Pugliese

Using surveillance of hospital staff to observe the ways the wipes are used routinely, researchers discovered hospital workers were using the same antimicrobial wipe on many surfaces, from bed rails to monitors, tables, and keypads. One wipe was frequently used to wipe down several surfaces or to wipe down the same surface repeatedly before being thrown away.

The research team then replicated the disinfecting methods they’d observed for laboratory analysis. The lab findings showed that some wipes were more effective than others at removing bacteria from hard surfaces but they did not kill them. When the bacteria-laden wipe was used repeatedly on one surface or on several, it spread the bacteria instead of eliminating it.
The Agriculture Department, which detected the flu in samples tested at its Ames, Iowa, laboratories, said the H7N3 strain of influenza isn't dangerous to humans. Although the Tyson flock of 15,000 chickens is being destroyed, regulators aren't blocking U.S. consumers from eating chicken raised in Arkansas, the largest poultry-producing state after Georgia.


The Tyson label has been a point of contention and confusion since it was cleared by the Agriculture Department in May 2007. As the department was moving to rescind the label, Tyson officials tried to beat regulators to the punch by announcing earlier this week that it was "voluntarily" withdrawing the label.

Removing the label quickly is a logistical and financial headache for Tyson, which said Tuesday that the Agriculture Department's June 18 deadline is "unrealistic." Tyson says it has "several months" of chicken labeled "antibiotic-free" in storage.

Agriculture Minister Chung Woon-chun said earlier Tuesday that Seoul had asked the U.S. to refrain from exporting any beef from cattle 30 months of age and older, considered at greater risk of the illness.


Presidential spokesman Lee Dong-kwan said the president told a weekly Cabinet meeting that "it is natural not to bring in meat from cattle 30 months of age and older as long as the people do not want it."

The spokesman also expressed hope that the United States would respect South Korea's position following large-scale anti-government protests over the weekend.
The risk of being hospitalized was greatest among babies 6 months old and younger, but the increased risk persisted up until the children were 8 years old, Dr. M. K. Kwok of the University of Hong Kong and colleagues found. Children who were premature or low birth weight were particularly vulnerable.


The findings suggest that secondhand smoke exposure may not only be harmful to children's respiratory tracts, but to their immune systems as well, Kwok and colleagues say.

Hong Kong banned smoking in public places in 2007, but babies and children may still be exposed to secondhand smoke at home, the researchers note in their report in the journal Tobacco Control. While the danger smoke exposure poses to children's developing respiratory systems is well understood, less is known about its effects on overall infection risks.

Scientists previously thought that fat cells were relatively passive and inert. Now they have evidence that fat cells are metabolically active, continuously communicating with the brain and other organs through at least 25 hormones and other signaling chemicals.


For example, fat cells seem to release hormones that inform the brain how much energy is left and when to stop (or start) eating, guide muscles in deciding when to burn fat and tell the liver when to replenish its fat stores.

All this cross talk can be a mixed blessing in the body, however. A healthy population of fat cells, for example, helps the immune system fight off infection by releasing chemicals that cause mild inflammation. But an overactive group of fat cells might keep the inflammation permanently in the "on" position, eventually leading to heart disease.
Adult-onset asthma, like other inflammatory diseases that disproportionately affect women such as rheumatoid arthritis and lupus, may be a relatively strong risk factor for heart disease and stroke, Dr. Stephen J. Onufrak from the US Department of Agriculture, Stoneville, Mississippi told Reuters Health.


Onufrak and colleagues used data from the Atherosclerosis Risk in Communities study to examine the association of asthma with the risks of heart disease and stroke according to gender.

They found that, compared with their counterparts without asthma, women with adult-onset asthma had a 2.10-fold increase in the rate of heart disease and a 2.36-fold increase in the rate of stroke.

There was no association between childhood- or adult-onset asthma and heart disease or stroke in men, or between childhood-onset asthma and heart or stroke in women.

Researchers found that among 9,100 middle-aged men at higher-than- average risk of heart disease, those with gout were more likely to die of a heart attack or other cardiovascular cause over 17 years.


The findings should give men with gout extra incentive to have a doctor assess their cardiac risks, lead researcher Dr. Eswar Krishnan told Reuters Health.

And if they have modifiable risk factors -- like high cholesterol, high blood pressure or excess pounds -- it will be particularly important to get them under control, noted Krishnan, an assistant professor at Stanford University School of Medicine.
Give Yourself Permission to Do Less.
If you're struggling to exercise at all, bribe yourself with a mini-workout--it's better than none. You may not need to, once you get going, but the "permission" should be sincere. It's not the end of the world to shave off 10 minutes of cardio or skip a few strength training exercises. Check your routine for duplicate exercises that work the same muscles --you may be able to alternate rather than doing them all every time. If the thought of an easier workout gets you out the door, it's well worth doing "less" sometimes.


Change Routes and Routines.
Another obvious tip, but one we don't do often enough. If you exercise outdoors and have found the "best" route available for your run or walk, it can be tempting to just stick to it until you are totally sick of it but don't even realize it. Find new routes, or if there are none, revisit rejects that seemed too hilly or busy or boring--they may make a good change of pace even if they're not perfect.
Tags: , , , , , , , , , ,

Stroke Risk: A Little Pollution Goes a Long Way

Posted on June 1, 2008 by Gerald Pugliese
According to a new study even low levels of air pollution may increase stroke-risk. More from the Annals of Neurology:
The results showed borderline significant associations between same day and previous day fine particulate matter exposures and ischemic stroke/TIA risk. Similar associations were seen with ozone. Despite the fossil fuel industry in the area, fine particulate matter exposures were relatively low relative to other regions in the US, probably because of the proximity to the coast and prevailing wind patterns. “Although the magnitude of elevated risk of stroke/TIA due to PM2.5 exposure was relatively small, the vast majority of the public is exposed to ambient air pollution at the levels observed in this community or greater every day, suggesting a potentially large public health impact.”

These findings support the hypotheses that recent exposure to fine particulate matter may increase the risk of ischemic cerebrovascular events specifically. There is experimental evidence that particulate air pollution is associated with acute artery vasoconstriction and with increases in plasma viscosity (thickening of the blood) which may enhance the potential for blood clots, although this requires further study.
The sad part is I’m not really sure what you can do to avoid this—not breathe!
Tags: , , ,