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We Won’t Sugar Coat It: Diabetes and Heart Disease

Happy Leap Day! As February comes to a close, we would like to leave you with some information about another major risk factor for heart disease and stroke. We talked about salt, now let’s talk about sugar! We told you high blood pressure is the leading risk factor for heart disease and stroke, but did you know that diabetes is also an independent risk factor as well? According to the American Diabetes Association (ADA), at least 68% of people with diabetes die from heart disease. The ADA also reports that adults with diabetes are 2 to 4 times more likely to develop heart disease than those without. The sweet news is that there are steps you can take to prevent it. So let’s begin.


What is diabetes?
Diabetes is a disorder of glucose metabolism, the basic sugar molecule that carbohydrates are broken down into. Although that sounds fancy, it really just means that the body is unable to use its main energy source properly. The body needs a hormone called insulin in order to let glucose into cells and be used as energy. With diabetes there is either no insulin produced (Type 1) or the insulin that is produced is not as effective (Type 2). Between 90-95% of diabetics are classified as Type 2. This is mostly linked to physical inactivity and increased body weight, though family history plays a role as well.

How do you know if you have it?
Nearly 7 million Americans have diabetes and don’t know it. Years before diabetes is diagnosed, certain cells in the body become less responsive to insulin when obesity is present and activity level is low. At first the pancreas, the organ that produces insulin, is able to keep up, but as time goes on production slows and blood sugar levels rise above the normal range. Symptoms of high blood sugar include excessive thirst and increased urination, fatigue, weight loss, blurred vision and slow wound healing or frequent infections. Talk to your doctor about your concerns and have your blood sugar checked.

What can you do to control it?
The National Diabetes Education Program (NDEP) encourages diabetics to follow the “ABC’s”: keep your A1C less than 7%; maintain blood pressure less than 130/80 mmHg; and control cholesterol by keeping LDL levels less than 100mg/dL. The A1C is a measure of blood glucose over a 3 month period. This is important because tight control of blood sugar reduces the risk of heart attack, stroke of death from cerebrovascular disease by 57% according to the NDEP. According to the American Heart Association, high blood pressure is twice as likely in individuals with diabetes as in those without. Although for the rest of the population blood pressure should be kept less than 140/90, diabetics should be lower due to the combined effect of high blood pressure and diabetes on heart disease and stroke risk. For the majority of diabetics, keeping LDLs lower than 100mg/dL is enough, however, if you already have been diagnosed with heart disease your doctor may want your LDL to be less 70mg/dL to further lower your risk of heart attack and stroke. In addition to medication therapy, regular exercise decreases these bad fats and increases levels of good fats in your bloodstream.

Why are diabetics at such an increased risk?
Some explanations are more complicated than others. For starters, over time when blood sugar remains high, damage occurs to the inside lining of blood vessels. This damage puts the individual at a higher risk of a process called atherosclerosis, or plaque build up in arteries. Some research also points to increased inflammation in the vessels as a cause of this according to Joslin Diabetes Center. Diabetics also have greater rates of a process called platelet aggregation. Platelets are the sticky substance in your blood that allows your blood to clot when blood vessels are damaged. So although they have an important function, they cause problems when they stick to damaged artery walls and  narrow the artery where blood passes through. These processes are both worsened by and result in high blood pressure. This is the start of the vicious cycle of heart disease.

It is recommended that you reduce your risk through modest weight reduction and regular exercise. Getting 30 minutes of exercise 5 days a week is ideal, but talk to your doctor about what’s right for you. You may have to start small with 5-10 minutes of walking per day and work up to your goal if you experience shortness of breath or feel over-exerted.
If you smoke: set a quit date today! Visit our education page for resources on smoking cessation. This is the single most important step you can take to lower your risk of diabetes, heart disease and stroke.

Thank you all for checking in for this month’s blog series on heart disease. We hope you gained some insight into America’s leading cause of death and learned how you can reduce your risk. Make small changes today for a healthier tomorrow. You can do it, we believe in you!

Education

Let’s Get To The Heart Of The Matter: What You Need To Know About Heart Failure.

Feeling broken-hearted after being spared Cupid’s arrow this Valentine’s Day? Keep your chin up, it’s Heart Failure Awareness Week! So let’s take a look at the basics of a truly broken heart.


 

Heart failure is a condition affecting 6 million Americans. It is usually a result of other heart conditions such as coronary artery disease, high blood pressure or previous heart attack. Although we are at higher risk of developing heart failure simply by getting older, managing these other heart conditions first is very important to reduce our risk.
Although some believe the heart is the source of emotions and the soul (and years ago scholars would agree), it’s most importantly a pump. The heart pumps blood throughout the body to deliver fresh oxygen from the lungs and to remove carbon dioxide and wastes from the body. When the heart is unable to pump as effectively as the body demands, this is called heart failure. Heart failure does not mean that the heart is not working at all, rather that it’s not meeting the body’s expectations. When this starts to happen, the heart muscle gets bigger to increase its power, and it begins to pump faster. This is called compensation. When these methods are no longer effective, symptoms will start to show.
Symptoms of heart failure include:
  • Shortness of breath
  • Chronic coughing or wheezing
  • Swelling of the feet or ankles
  • High heart rate
  • Fatigue
  • Nausea or loss of appetite
  • Confusion
Although heart failure is often thought of as a condition affecting older adults, children and young adults can develop heart failure as well due to structural heart defects or certain infections. Symptoms of heart failure in infants or children can be trouble breathing, poor feeding or growth or excessive sweating.
Heart failure is divided into 4 functional classes: Class I-Mild, Class II-Mild, Class III-Moderate and Class IV-Severe. In early mild heart failure there is no limitation in physical activity. In Class II mild heart failure, the individual will begin to experience fatigue, palpitations, difficulty breathing or chest pain during ordinary activity. Moderate heart failure, Class III, results in the same symptoms with less than ordinary activity. Lastly, in Severe Class IV heart failure, symptoms may be present at rest and the individual is unable to carry out any physical activity without discomfort.
The process of heart failure begins before symptoms start to show, but by following a low sodium diet, taking prescribed medications and following your specific recommendations, the progression of the condition can be slowed. To monitor for a worsening, or exacerbation, of heart failure it is important to obtain a daily weight. This will monitor for fluid build up in the body. Weight should be taken at the same time, on the same scale, usually before breakfast. For a weight increase of 2-3 pounds over 24 hours, or 5 pounds or more in a week, be sure to call your doctor. Also watch for increased swelling in the legs or belly, increased fatigue or shortness of breath and decreased urinary output.
Unfortunately there is no cure for heart failure. Treatment is focused on management with a healthy lifestyle and consistent use of any prescribed medications. By working toward a healthier lifestyle you can slow the progression of heart failure by preventing further damage. Check out this helpful link from the American Heart Association to find out ways to adopt a healthy lifestyle.
As always, thanks for checking in! Stop by next week to close out American Heart Month with a look at Diabetes and its effect on the risk for heart disease.
Education

Sodium: The Salty Truth

Here we are, on the dreaded Monday after the Superbowl. With the sodium bloat from all of the chicken wings, pizza, various forms of cheese, chips and dip, and soda it’s amazing we were able to pry ourselves out of bed this morning! Today not only marks a day of nation-wide sick calls and diet shame, it also marks the start of the second week of American Heart Month! So on that note, we’d like to talk to you about sodium. The favorite word of anyone with heart disease or at risk of developing it! Or not so much…

The majority of people are well aware that sodium is bad for you. But do you understand why? Let’s take a look at what sodium is, what it does in your body, and how we can limit it in our diets to improve our cardiovascular health.
So sodium is bad they say? In the right amounts it’s actually a necessary mineral responsible for fluid balance, nerve impulses and muscle function. However, the average body only needs about 500 mg of it per day to sustain body function. Sodium in excess draws fluid into the bloodstream, causing increased blood volume and increased blood pressure as a result. High blood pressure over time damages the blood vessels and wears out the heart from pumping against greater resistance.
Okay, so that’s what it does, but where does it come from?
According to the American Heart Association (AHA), about 75% of the sodium we eat comes from processed or prepackaged foods and restaurant foods. I remember once hearing that as long as you don’t add additional salt at the table, you’re golden. How I wish it were true. Only about 10% comes from added salt during home preparation or from the salt shaker. The remaining ~15% of sodium intake is found naturally in foods. Added sodium serves the purpose to not only flavor, but also to preserve foods. This is why one should be wary of food items that are precooked and require little preparation, especially those that do not require refrigeration. The AHA recommends the general population take in no more than 1,500 mg sodium per day (This number does not apply to individuals who lose high amounts of sodium in sweat such as competitive athletes or workers exposed to excessive heat). To put this into perspective, this is less than 3/4 teaspoon of table salt. Ready for more bad news? About 90% of the population consumes too much sodium, with an average of 3,400 mg per day. Also, when asked to estimate, the majority of people drastically underestimate their intake.
Sometimes it is hard to see the benefit of following these guidelines, especially if blood pressure is not a current personal concern. So look at it this way, one study estimated that if the recommendations were followed, 500,000 to nearly 1.2 million deaths from cardiovascular diseases could be avoided over the next decade. This would be due to a 25.6% overall decrease in blood pressure which would save an estimated $26.2 billion in health care savings (decreased insurance coverage cost sound good to anyone?).
How can you reduce your intake of sodium?
Start with nutrition labels. You’d be surprised just how much sodium some of your favorite packaged foods include. And don’t fall victim to marketing ploys that present “diet” foods in convenient prepacked 100 calorie packs or low fat varieties. Some foods that are made to be low fat and still taste good are loaded with salt to make up the difference.
When rummaging through my own cupboards I was interested to see how some of my pantry items stacked up. To start, my wheat thins that I view as my healthier snack alternative had 230 mg of sodium per serving (16 crackers). This is compared to the 160 mg in 11 potato chips! This doesn’t seem right, as potato chips taste way more salty. But this is why reading labels are so crucial in taking your first steps to limit your intake. Another surprising find involved frozen vegetables. Asparagus is a must in our household, and so as a result I have 3 different brands of frozen asparagus in my freezer. It shouldn’t be surprising that the can of green beans in the cupboard houses 290 mg of sodium per serving, however, I was surprised that although two brands of asparagus in my freezer had 0 mg of sodium, one had 85 mg. Why is there sodium in plain frozen veggies? Moving on I was disappointed to see the 610 mg of sodium in my lean cuisine, a product marketed for health living. I wasn’t surprised to find that the product in my pantry that contained the most sodium was the canned soup, at 850 mg. Canned soup is one of the “salty six” foods identified by the AHA as contributing the most to the out of control salt consumption in America. The other five foods include bread, cold cuts/cured meats, pizza, poultry and sandwiches.
By limiting these foods, a huge dent can be made in the salt intake mound. Other preparation recommendations include; substituting salt with other seasonings like onions and garlic, vinegar and citrus; draining canned beans and vegetables; cooking by grilling, braising, roasting, searing and sauteing to bring out flavor; and incorporating foods higher in potassium into your diet to take the place of sodium. For a full list of the AHA’s recommendations on how to Break Up With Salt visit their website by clicking here.
Thanks for checking in for this week’s education update. Stop back next week for our blog about heart failure!
For more information about sodium and heart disease, visit the AHA’s Sodium 411 website directly at http://sodiumbreakup.heart.org/sodium-411/.
Education, News

Go Red To Raise Awareness And Lower Your Risk

This Friday, February 5th, people across the nation are asked to wear red to raise awareness of heart disease in women as part of the American Heart Association’s Go Red for Women campaign. Heart disease is the number one cause of death for both genders in the United States. However, heart attacks are often deadlier in women. This is partially caused by a delay in seeking treatment as a woman’s symptoms can be more subtle than those of men. Although chest pain is the most common symptom of heart attack for both men and women, women are more likely to report shortness of breath, back or jaw pain with nausea and vomiting, according to the American Heart Association (AHA). Heart disease is also a significant risk factor for stroke (the 3rd leading cause of death for women). Let’s kick start this month by raising both community awareness of heart disease and also personal awareness of your own risk for heart disease and stroke.


 

If you know the risk factors for stroke you’re ahead of the curve. Stroke and heart disease share many common risk factors such as obesity, physical inactivity, unhealthy diet, high blood pressure, high cholesterol, diabetes and smoking. Increasing age and family history are risk factors you can’t change, however, it is important to be mindful of the effect these have on your personal risk.

Small diet changes and increases in physical activity can lower your risk of heart disease by up to 80% according to the AHA. Follow a heart healthy diet rich in fruits and vegetables and low in salt (sodium). Make it a habit to check nutrition labels as processed foods such as canned products and frozen convenience foods are frequently packed with sodium. Making one change in your diet at a time will make it easier to stick with your healthy living goals. Be active throughout your day in addition to regular exercise. Walking is great exercise for beginners. Alternate your regular pace with short bursts of brisk walking to increase the cardiovascular benefits! Whatever you choose to do to be active, just get out there and do it today for a healthier tomorrow.

High blood pressure often has no symptoms, therefore checking blood pressure regularly is crucial. Blood pressure should be less than 120/80 for most people. Have your blood pressure checked at your doctor’s office or pharmacy and register for the Walk N Roll so we can check it again for you then! High blood pressure is the number one cause of stroke, so be sure you know where you run and how to control it.

Many think that all cholesterol is bad, however there are two types: HDL which is “good” cholesterol and LDL that is “bad”. Although LDL often get’s all the attention, HDL levels are important to monitor as well. HDL is thought to lower risk of heart disease by clearing the blood of an excess of LDL and also by keeping blood vessel walls clean.  Levels of HDL for women drop as estrogen production decreases after menopause. Family history also plays a role in your cholesterol levels, so make sure you know what your numbers are. The recommendation is that cholesterol be checked every 5 years starting in your 20’s for both men and women. Keep your LDL below 100 mg/dL and your HDL above 60 mg/dL to protect against heart disease.

Diabetes and cigarette smoking also increase your risk of heart disease as well. Visit our education page for a helpful link to quit smoking and stay tuned for information about diabetes and heart disease later this month.

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Education, News, Support

Support Group Guest Speaker From Albany Medical Center

This month’s stroke support group was joined by guest speaker, Dr. Laura Risley. Dr. Risley is a Vascular Neurology Fellow at Albany Medical Center, meaning she has completed her residency in the field of Neurology, and has specialized in stroke for her last year of medical training. Dr. Risley graciously volunteered her time to come discuss stroke diagnosis and treatment as well as answer questions for stroke survivors and their families. We would like to highlight the main content of this information session in hopes that it may benefit those who were unable to attend.


 

The main message Dr. Risley wanted to convey was–in the event of any stroke symptom or concern, call 911 right away! Do NOT wait. If you think that you may be having a stroke, that is cause enough to seek treatment. EMS will start IVs and check blood pressure and heart rate/rhythm on the way to the hospital. These steps reduce the amount of time needed at the hospital to provide life saving treatment. Request to go to your nearest hospital that provides tPA to get the “drip and ship” process rolling. From there you can be transferred to a stroke center such as Albany Medical Center to receive further care. (We’ll discuss tPA in further detail later in this post).

Dr. Risley explained that the majority of strokes (87%) are ischemic strokes, or caused by a clot or restriction of blood flow causing loss of oxygen to brain tissue. These clots most frequently come from cholesterol plaques that build up in the carotid arteries (the large vessels in your neck). Over time these plaques become bumpy and small pieces break off and travel to vessels within the brain. Medications such as aspirin and plavix (clopidogrel) help to prevent sticky cells called platelets from clumping up around these plaques and restricting blood flow.

For some who have heart conditions such as atrial fibrillation (AFib) clots can form in the heart by a pooling of blood in the upper chambers when they fibrillate, or twitch, rather than pump effectively. This also happens with congestive heart failure (CHF) when the heart muscle is weakened and unable to pump thoroughly. Dr. Risley compared this to paint thickening, or congealing, in the roller tray after time. These conditions are treated with anticoagulants, or “blood thinners”, such as warfarin, pradaxa or xarelto. These medications prevent the thickening and clotting of the blood in order to prevent heart attack and stroke. Some individuals have both carotid artery disease and heart conditions such as AFib and CHF and may need to take both aspirin and an anticoagulant.

Anticoagulants decrease risk of a secondary stroke by 67%. Those that have a history of ischemic stroke should be on anticoagulation to prevent a recurrent stroke, although some people may have other medical conditions that make these medications too dangerous.

Tissue Plasminogen Activator (tPA) was a prime topic of discussion. TPA is a clot busting drug that can be given within a three hour window after the first signs of stroke begin. The brain is very sensitive to injury and as soon as these cells start to lose blood flow, symptoms begin to occur. Over a million brain cells die each minute of a stroke. Death of brain cells cannot be reversed, however the area of injury surrounding the dead cells can often be saved with tPA and/or surgical clot removal. Certain conditions can prevent an individual from receiving tPA. A history of bleeding on the brain, and recent history of heart attack or surgery are a few such conditions. Use of newer anticoagulants such as pradaxa or xarelto prevent treatment with tPA as the bleeding times can’t be monitored or reversed with these types of medications. Treatment with tPA in these cases would have too high a risk of uncontrolled bleeding. Warfarin, however, can be monitored by an INR. If the INR is low enough, the decision may be made to treat with tPA to stop the progression of brain cell death associated with stroke.

For those patients that are not eligible for tPA, surgical removal of the clot may be possible in some cases by threading a catheter from the large artery in the groin up to the artery within the brain where the clot is located. For a general idea of the Penumbra device used click here. For the general idea of the Solitaire device used click here. The time frame for this procedure is longer than that of tPA, previously up to 6-8 hours after first sign of stroke. More recently however, certain cases have had successful outcomes when performed past this time period.

Stroke can also be caused by a bleeding of blood vessels, primarily caused by high blood pressure. These hemorrhagic strokes often occur deeper within the brain and account for the other 13% of strokes. Treatment for these strokes is limited, and consist mainly of controlling blood pressure and allowing the body itself to stop the bleeding on its own. For patients on the anticoagulant warfarin, correcting increased bleeding times is important as well. In severe cases, where bleeding causes a large mass of pooled blood on the brain, a surgeon can remove the blood to reduce pressure and restore brain function.

Another important topic of discussion was the recovery period. Stroke recovery takes on average 9-12 months. Although recovery can extend past the one year mark in some cases, the return of function is mostly limited to this period. Although the original area of brain that was damaged by the stroke will never heal, different areas of the brain can take over, building new connections to accomplish the same task. Although these new connections are not as effective as the original ones, with consistent therapy some degree of function can be returned.

If you missed Monday’s meeting, we encourage you to keep an eye on our Facebook page as Dr. Risley has offered to return later this spring or summer for another question and answer session. The expertise she shared was truly invaluable to the group. We hope this summary is beneficial to you in your recovery.