Source: Cedars-Sinai Medical Center Released: Tue 27-Jan-2004, 07:10 ET
Cardiologist Says New Findings Keep More Hearts Ticking
In addition to hosting Valentine’s Day, February happens to be designated American Heart Month. Just in time, one of the nation’s top cardiologists and researchers in atherosclerosis is available to describe new advances and tried-and-true techniques to keep the old ticker aflutter – in a good way.
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Newswise — Before you pick up a five-pound box of milk chocolates for that special someone you’re trying to impress this Valentine’s Day, think about his or her heart. You might reach instead for a lovely bag of walnuts.
“The oils that come from walnuts and peanuts actually help reduce bad cholesterol levels,” says cardiologist Prediman K. Shah, MD. And although Cupid might argue the romantic impact of a handful of walnuts on a loved one’s heart, Dr. Shah knows about the internal workings and the development of plaque in the arteries. He directs the Division of Cardiology and the Atherosclerosis Research Center at Cedars-Sinai Medical Center. He also holds the Shapell and Webb Family Endowed Chair in Cardiology at Cedars-Sinai.
On the other hand, if chocolates are absolutely essential, make sure they’re dark chocolate, not mixed with milk. Small amounts of dark chocolate can have beneficial antioxidant effects, which could also be healthy for the heart, but a recent paper showed that linking dark chocolate with milk markedly reduces the antioxidant benefits.
“Another interesting fact that is emerging is that cinnamon may be very helpful,” Dr. Shah says. “Recent studies in humans suggest that cinnamon, either boiled extract of cinnamon or just a teaspoon of cinnamon in a cup of tea, may help diabetics better control their blood sugar, it may also lower cholesterol levels, and there’s very little downside.”
February is designated as American Heart Month, and Dr. Shah says that while medical and scientific advances are beginning to make heart disease more preventable and manageable, heart specialists are very concerned that many Americans appear to be headed toward even more cardiac problems.
“Obesity continues to be a major problem in the United States, especially when obesity is concentrated around the waistline and abdomen. This markedly increases the risk of insulin resistance, and we are seeing not only obese adults but obese children developing Type 2 diabetes. Of course, diabetes is a major risk factor for future development of cardiovascular disease. Therefore, there is a major emphasis on drawing attention to the epidemic of obesity, which will lead to an epidemic of heart disease,” says Dr. Shah.
With myriad diet plans and pills competing for consumer’s appetites, Dr. Shah says a modified Atkins diet appears to help many people lose weight. “It turns out that low carbohydrate diets actually work. But unlike what Atkins used to propose – which was to replace carbohydrates with saturated fats – we recommend a reduced caloric intake and what we call ‘Atkins Lite,’ low carbohydrates with simple sugars being replaced by high-quality proteins, fruits, vegetables, and modest amounts of mono- and polyunsaturated fats that come from fish, fruits and oils such as olive and canola.”
Dr. Shah says most of the standard advice remains the same: Exercise 30 to 40 minutes three or four times a week. If you smoke, quit. If you don’t smoke, don’t start. Avoid diet pills and diet drugs, such as ephedrine and amphetamines, which carry major cardiovascular risks. Having one or two drinks of alcohol a day may be helpful.
But one thing that used to be considered helpful – hormone replacement therapy for women – is now on the caution list. “The only reason to use hormone replacement is for women with severe menopausal symptoms, not to protect them from heart disease, which it increases,” he says.
And next time a careless driver cuts you off in traffic or your boss shows up at 4:45 in the afternoon with another stack of paperwork, take a deep breath and count to 10 or 20. “Don’t get angry. Learn to roll with the punches,” suggests Dr. Shah. “Hostility and anger increase the risk of heart attacks and sudden death.”
In addition to lifestyle changes, new medications, often prescribed in combination with established therapies, are helping to prevent heart disease. Statin drugs, which reduce LDL or bad cholesterol, have been available for about 15 years. But they may reduce heart disease risk by only 30 to 50 percent, and five to 10 percent of the population cannot take them at all because of intolerances and side effects. Blood-pressure reducing medications called Angiotensin Converting Enzyme (ACE) inhibitors were added in the past few years because it was found that they also lowered cardiovascular events.
“Now we’re raising the good cholesterol, or HDL, with drugs such as niacin and fibrates, drugs that affect the expression of genes involved in lipid metabolism. The goal is to raise HDL and lower LDL and triglycerides, so we’re combining two lipid-modifying drugs,” Dr. Shah says.
“We’re learning that we really don’t know how to define ‘high’ cholesterol because even at so-called normal levels, people can develop disease,” he adds. “Therefore, our recommendations now are that people who are at high risk of disease or who have disease in the arteries should be on a cholesterol-modifying medication regardless of what their baseline cholesterol level. This is a major new development in prevention.”
For certain patients with congestive heart failure, a special pacemaker available in the past few years is able to synchronize the pumping action between the right and left ventricles, leading to dramatic improvement in heart function and reduction in mortality. And for patients who have undergone angioplasty to open blocked heart arteries, two new drug-coated stents are helping to prevent re-narrowing within the stent to keep the arteries open.
Research directed by Dr. Shah and conducted with colleagues at Cedars-Sinai and in Italy has led to several discoveries that may bring significant advances in heart disease prevention in the next few years. Over the past 12 years, a synthetic form of HDL was developed and shown to be protective in animal studies at Cedars-Sinai. Last November, researchers at the Cleveland Clinic reported similar results in a human trial: In five weeks of once-a-week intravenous injections, this synthetic HDL (apo A-1 Milano protein) actually shrank existing plaque in the coronary arteries. Assuming a large-scale trial also proves the drug effective and safe, it could be widely available within about three years.
Dr. Shah and his researchers are now turning their attention toward a related gene therapy. Instead of administering the apo A-1 Milano protein, they intend to use the apo A-1 Milano gene itself, enabling the body to produce its own supply of good, protective HDL. “We now have proof of principle that this approach works in the mouse,” says Dr. Shah. “The advantages are that you don’t have to produce the protein in the laboratory and you don’t have to keep giving repeated injections.”
The researchers also recently announced that they are developing a vaccine from the LDL cholesterol molecule that significantly reduces plaque buildup in animals in spite of high cholesterol levels. Their goal is to create a vaccine that could be given to children as part of their routine immunizations, protecting them from atherosclerosis and heart disease.
“It sounds far-fetched,” he admits, “But based on what we’re seeing in the animal model, it may not be all that far-fetched.”
Until these next generations of preventive medicines come along, see your doctor, get to the gym or take a walk, choose fewer fats and carbs and more fruits and veggies, and request a heart-healthy cinnamon stick for Valentine’s Day.
Cedars-Sinai is one of the largest nonprofit academic medical centers in the Western United States. For the fifth straight two-year period, it has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities.