The Heart Beat

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How do you celebrate Earth Day?  It turns out that many of the same strategies we use for a healthier planet can also make us more heart healthy.  Try these five tips to make your Earth Day last all year long.

1) Have a Meatless Monday.

This international campaign, started back in 2003, encourages people worldwide to eat no meat on Mondays.  The potential health benefits are less saturated fat, less salt, less processing, and more fiber from fruits and vegetables.  And the environmental benefits include less methane from cow waste and less deforestation or loss of ground vegetation that absorb carbon dioxide. (more…)

The latest American College of Cardiology meeting in New Orleans has passed, and I wanted to update you on some of the answers to the research questions that I explored in my last blog post. Here’s a quick update. (more…)

Picture this: twice a year, over 30,000 cardiologists from all over the United States — and increasingly throughout the world — get together to discuss the latest and greatest research findings that will shape the way they provide care.  It may not sound like your idea of a party, but it’s an amazing tour de force which ultimately will impact the treatments that become available to you down the line.

Here are three of the hottest questions that we hope to get answered at the upcoming American College of Cardiology meeting in New Orleans, which center around the invasive procedures that we do — or perhaps should be doing differently. (more…)

Now that I have your attention, take a minute to check out this heart-wreck check-list.  If you or your loved ones are taking bad advice to heart, it’s time to pause, recharge, and reboot. (more…)

You’ve heard it all before. Eat right. Exercise. Stop smoking. But now it’s time to take that advice and finally figure out how to fit it all into your life.  Think outside the box and take some risks while tackling your own risk factors. (more…)

Barbra Streisand reached out to WebMD for a heart-to-heart about her quest to transform women’s cardiac health research. The two-time Academy Award–winning actor, director, and singer has taken on a new, highly public role to help raise funds for research at Cedars-Sinai’s Women’s Heart Center in Los Angeles. Here she explains her passion for matters of the heart.

Women have broken through some of the hardest glass ceilings. We’ve had women explore the depths of outer space, a woman run for President of the United States, and we’ve had a woman serving as Speaker of the House, a position that is just two heartbeats away from the Presidency. Many consider politics as one of the last bastions of the boys club and thankfully — although slowly — women are finally making real inroads. (more…)

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Many of us were intrigued by Walmart’s recent announcement to make some improvements in the nutritional quality of the products sold in its stores.  Between eliminating trans fats from its shelves by 2015 and reducing sodium by 25% over the next few years, Walmart may ultimately have a greater impact on the public’s health than many of us who are supposedly doing this for a living.  Is this surprising? (more…)

When I first told my wife I was going to write a diet book, she thought I was crazy.

“You’re a cardiologist, not a diet guru!” she said, laughing…and it’s true. As a heart specialist with the Providence Heart and Vascular Institute in Portland, Oregon, I don’t believe in fad nutrition programs, flimsy infomercial fitness equipment (although I admit I’ve bought it!), or carb-melting supplements advertised on the back cover of magazines or pitched by your favorite reality television runner-up. So I guess I’m not a guru.

But I am a doctor. And particularly now, during one of the most challenging times ever in health care, doctors are still trying to solve problems. We have all seen the footage on the evening news of faceless, overweight Americans struggling through shopping malls, food courts, and sports venues — with intended warnings about the epidemic of obesity. But the truth is that overweight people do have a face — many faces, really — and they are all different. Most of us have struggled with our weight at one point or another. I have. You might have too. And even though the Internet, mobile phone apps, and social networking sites give people access to helpful information more than ever, we continue to look for solutions.

As a health care provider, I have realized that the science is out there. The research studies have been done. The data is available. But what’s been missing is the message. The health care system has transformed useful recommendations into strict guidelines that seem impossible to achieve. Think about the last time you went to the doctor. Were you given the same tired exercise prescription that was handed out to everyone else? The same laminated dietary advice? It’s time to get personal…and personalized.

Welcome to The Flex Diet.

Inspired by my patients and the people here in the WebMD community, I have created a personalized wellness (and heart-healthy weight loss!) program that I believe can be adapted to fit anyone’s lifestyle. The Flex Diet shares 200 evidence-based solutions to eat, drink, exercise, act, and live a more healthful life — on your terms. You pick the ones that work for you. Rather than offer inflexible approaches that are hard to maintain and that invite frustration and discouragement, The Flex Diet is scientifically designed to be empowering — because even with just a few changes in your lifestyle, you will succeed. And success feels good. We’re talking New Year, New You,Your Way.

Start by embracing the idea that small changes yield real results. My hospital believes so strongly in this concept that it is taking the first step in “walking the talk” by providing copies of The Flex Diet to thousands of people here in my community. It’s a different sort of health movement, because it actually begins…with you. Revolutionary, isn’t it? So consider taking a flexible approach to your health in this New Year. The Flex Diet bends so you won’t break.

It’s time for a solution.

Phrases like “game-changer” or “magic bullet” are thrown around a lot in medical circles, when doctors and researchers dream about changes in the medications we use to treat our patients. For example, one of the most elusive targets in our quest to prevent heart disease is a medication that will safely raise HDL cholesterol and reduce the risk of future heart attacks. But score one for medical research with the recent FDA approval and cost-effectiveness analysis for dabigatran (Pradexa).

Dabigatran is a medication designed to thin the blood and reduce the risk of blood clots and strokes in individuals with atrial fibrillation, a common heart rhythm disorder which affects millions of Americans. In addition to concerns related to symptoms of palpitations or less efficient heart function with increased heart rates, atrial fibrillation can increase the risk of strokes considerably — particularly in people who are at baseline higher risk. For years, we have used warfarin (also affectionately known as “rat poison”) to thin the blood and reduce stroke risk. However, warfarin is a challenging medication to take. It requires some dietary modifications and regular blood testing. It takes several days to wash out of your system, which can be challenging in the setting of bleeding or the sudden need for surgery.

Previous attempts at a substitute for warfarin have been complicated by dangerous side effects. So with recent FDA approval of dabigatran for stroke prevention in individuals with atrial fibrillation, we at least have a base hit. And with the newest data suggesting that dabigatran may even be more cost-effective than warfarin, it’s looking more like a home run.

One of the challenges of introducing a new medication into the health care system is that being effective is only part of the picture. If a new drug works well but will bankrupt patients, it’s not going to work out. This is why a recent study from Stanford allows patients and physicians to breathe a sigh of relief. Researchers decide that a medical intervention (medication, procedure, or treatment) if it costs less than $50 000 per quality-adjusted life-year (QALY) gained. In the case of dabigatran, the number falls somewhere in the neighborhood of $45,000. This assumed a daily cost of about $13 for the medication, although it has been recently reported that wholesale price will actually be closer to $6.75. This would make dabigatran significantly more cost-effective than the recent study would suggest. Grand slam?

As you can tell, I’m pretty excited about dabigatran. I have no relationship to the company that makes it, but do have hundreds of patients who take warfarin, many of whom ask me at every visit when there might be a safe and effective alternative. It’s looking like the time has come.

Another drug bites the dust. In the past few weeks, we have seen sibutramine (Meridia) pulled from the shelves due to an increased risk of heart attacks, and now lorcaserin (Lorqess) has failed to pass muster with the FDA because of concerns about cancer. Many years and millions of research dollars later, our only remaining pharmaceutical arm in the fight against obesity is orlistat (Xenical), with the convenient side effects of bloating, stomach upset, and the need to have a public restroom app on your iPhone in case of emergencies.  So what’s a health care system to do?

On one hand, you might argue that Big Pharma has failed us in the obesity space.  So should they throw in the towel? The drugs work poorly, have gross side effects, and increase our health risks in other ways. Some say, why don’t we save the millions of dollars spent on drug research and instead invest them in education, legislation, and regulations that will help us eat better and exercise more? Put the money towards the health costs of the uninsured. Or, use it to fund research in diabetes, heart disease, or any of the other countless complications of obesity.

But is it too early to admit defeat?  If we had done the same for cholesterol medications or diabetes medications, or even smoking patches and pills, we’d be paying for it in countless ways.  So is there something unique about developing medications for obesity?  Obesity is considered by many to be purely a “lifestyle” disease, and some are biased against the obese as a result.  Given that we already have proven treatments (eat less and exercise more), some argue that we are wasting our time by investing heavily in a pharmaceutical solution.

As a physician who believes strongly in the power of personal choice to influence one’s health outcomes, I tend to favor an investment in healthy lifestyles.  But in all fairness to the other side of the debate, one can also argue that prevention hasn’t worked out so well either.  Despite the fact that we have effective treatments, we are not very effective in their prescription or compliance.  For example, aggressive lifestyle modification can lower heart disease risk as effectively as cholesterol medication for many people — but the fact of the matter is, some people would rather take a pill.  Obesity has skyrocketed despite our efforts at communication.  So, it looks like the health care system has failed as well.  Could our failure as health care providers actually position obesity drug research and development as the most important pharmaceutical goal of the decade?

Where do you think we should put our resources?  Do you accept the recent obesity drug hurdles in stride and want the pharmaceutical companies to take on the challenge to develop more anti-obesity medications?  Or do you think we should concentrate our efforts on non-pharmaceutical interventions?  Would you take an obesity drug if it were safe, effective, and available? I’d love to hear what you think!

Join the conversation — share your comments with the Heart Disease Community.