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Heart Disease

Live Healthier and Lower Your Risk for Heart Disease

  • Posted Jan 29, 2019
  • hchadmin

Did you know that according to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States?

February is American Heart Month and Holy Cross Hospital would like to encourage you to care for yourself, and your loved ones, by reminding you of the importance of preventive care. 

The most common type of heart disease is coronary artery disease (CAD), according to the CDC. The great news is that you can greatly reduce your risk for CAD through lifestyle changes and preventive care, including embracing a healthier spirit.

To keep your heart healthy, the American Heart Association recommends the following:
•    Maintain a healthy weight
•    Quit smoking and avoid secondhand smoke
•    Control your cholesterol levels and blood pressure
•    Drink alcohol only in moderation
•    Get regular exercise and eat healthier
•    Ask your doctor about taking aspirin every day (if you are a man over the age of 45, or a woman past menopause)
•    Manage stress

While controlling physical risk factors is obviously a great way to help prevent any condition, so is maintaining a healthier spirit. For example:
•    Remain optimistic. Research shows that happiness and a positive attitude are associated with lower rates of disease.
•    Control stress. Stress relievers like deep breathing and muscle relaxation exercises, as well as keeping a journal, can be helpful in controlling the impact stress has on your body.
•    Do everything in moderation. Don’t try to do too much at one time – make sure to have time for proper nutrition, sleep, work and play.
•    Create a network. Maintaining a close circle of family and friends can provide you with emotional support when you need it.

Lastly, getting annual physicals and tests from your doctor is key in sustaining your health and preventing heart disease. Having a primary care physician (PCP) who can coordinate your care is vital to your good health. A PCP typically specializes in family medicine, internal medicine or general practice.
If you don’t have a PCP, finding one is easy! Just visit your insurance carrier’s website, look for the “find a doctor” area and follow the instructions.

As your trusted health partner for life, Holy Cross Hospital is committed to helping you Live Your Whole Life by nurturing well-being through body, mind and spirit.


For Those Living with Heart Disease

  • Posted Feb 11, 2019
  • hchadmin

Learning that you or a loved one has heart disease can change your life. However, educating yourself about this disease is the first step toward feeling better and making choices that can help you live a longer and healthier life.

According to the Centers for Disease Control and Prevention (CDC), approximately 11.5 percent of Americans have been diagnosed with heart disease. February is American Heart Month. Join us for a health lecture or Mended Hearts Support Group, and heed the following suggestions to help navigate treatment if you or a loved one has been diagnosed:

•Making lifestyle changes. Not smoking, following a heart healthy eating plan, maintaining a healthier weight and becoming more physically active can go a long way in helping to keep your heart disease from worsening.  View Antoinette's Smoking Cessation story | Learn more about free Smoking Cessation help at Holy Cross

•Taking medication. Medications are often used to treat high cholesterol, high blood pressure or heart disease itself. Be sure to take your medication exactly as your doctor prescribes. If you have uncomfortable side effects, let your doctor know. 

•Following doctor’s orders. Your doctor may recommend procedures to open an artery and improve blood flow. These are usually done to ease severe chest pain or to clear blockages in blood vessels.

As you know, having a primary care physician (PCP) who can coordinate your care is vital to your good health. If you don’t have a PCP, finding one is easy. Just visit your insurance carrier’s website, look for the “find a doctor” area and follow the instructions.

When you’re being treated for a disease or condition, it may not always be easy to decide where to go for care. For anything that is considered a life-threatening situation (like chest pain, major injuries or sudden and severe pain) it’s best to go to the emergency room. 

For less severe matters that still require immediate attention, if you can’t get in to see your PCP, going to an urgent care facility can save you time and money. 

As your Trusted Health Partner for Life, Holy Cross Hospital is committed to helping you Live Your Whole Life by nurturing well-being through body, mind and spirit.

 

Blame it on the Y

  • Posted Feb 28, 2012
  • Alan Niederman, MD, FACC, FACP

Men and women are different.  Besides the obvious aspects of that statement, men and women differ in their development of coronary disease.  Even though that statement is true, equal numbers of men and women die each year from cardiovascular causes. Cardiovascular death remains the leading cause of death in both men and women in the United States.  In fact, in each decade of life, many more women die from cardiovascular disease than breast cancer. One of the many things we don't understand is why women rarely develop symptomatic coronary disease before age 60, and when they do,  they do not equal men's rates until they are roughly 80 years old.  Why this is true is not well-understood.  When women achieve equal status with men, the women do poorly.  It is felt that this is because women in general have smaller heart arteries than men.  This is not a genetic issue, it is a stature issue. Now comes an article that might explain some of this difference.  Reported in the Lancet doi:10.1016/S0140-6736(11)61453-0 and available online is an article showing that the Y chromosome which confers "man-ness" is associated with an independent risk factor for developing coronary artery disease. Some fun facts from Wikipedia:  X and Y chromosomes evolved about 30 million years ago.   The human Y chromosome has already lost 1,393 of its original 1,438 genes.  Within the next 10 million years, the Y chromosome will disappear and with it weird-looking cars and man caves.  Although long believed by women, a human male's Y chromosome is only 30% different from that of a chimpanzee.  This is the reason that old men look like chimps. (See picture of George Burns when he was old).  The Y chromosome is pretty lazy in that it codes for only 23 distinct proteins and represents only 2% of male DNA. Y chromosomes do not recombine with the X chromosome, so it represents a way to follow human development.  In this study, 3,233 British men were found to have nine different ancient lineages.  Each lineage is called a haplogroup.  Two of the haplogroups accounted for 90% of the men studied.  One of these haplogroups had a 50% increase in the risk of developing coronary disease.  This risk of developing coronary disease was not related to the other known risk factors for developing coronary disease.   It seems that it is an independent risk factor.  Obviously, but I will point it out anyway, women cannot develop coronary disease in this way, so this might explain why men develop the illness earlier. What does the gene identified do?  It seems it has a powerful effect on inflammation and immunity.  This goes back to other blogs I have written about the hypothesis of inflammation and coronary artery disease.  This finding may be the missing piece of the puzzle as to how inflammation causes the illness and why not everyone who has an infection developed the illness. Before we all (men) run out and have ourselves tested, let me point out that this work will need to be reproduced in other groups of men.  Nonetheless, this information serves as a jumping off point for other interesting studies before we can definitely blame it on the Y.


Defining Ideal Cardiovascular Health

  • Posted Jan 26, 2011
  • Vicente Font, MD, FACP, FCCP, FACC

heartscopeThe concept of cardiovascular health reframes important questions regarding how best to approach cardiovascular disease (CVD), which have long been the focus of numerous professional organizations including the American Heart Association (AHA). The AHA Impact Goal for 2010 focused primarily on reducing coronary heart disease (CHD), stroke death rates and the prevalence of risk factors. The unspoken assumption was that this would improve health. However, it is increasingly evident that health is a broader, more positive construct than just the absence of clinically evident disease. Although there appears to be substantial overlap between the components of cardiovascular health and general health, the AHA acknowledges that there are other components to general health related to physical, mental, and social functioning -- among other things -- that have not been addressed well in the past. Future efforts should include consideration of these important aspects of health and their impact on cardiovascular health and disease as the science evolves.

Earlier this year the American Heart Association published their position statement on the definition of national goals for cardiovascular health promotion and disease reduction. To summarize this article that appeared on Circulation in January 2010, the following table was provided:

fontchart1

For the next decade, the AHA has committed itself to achieving the following Impact Goal: “By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%.” There is a lot of work ahead of us…

To read future blog posts by Dr. Vicente Font, visit the Jim Moran Heart & Vascular Center Blog.


Time to Change Insurance? OK, But How Do You Choose Your Cardiologist?

  • Posted Nov 24, 2010
  • Vicente Font, MD, FACP, FCCP, FACC

All right, it's that time of the year again, chestnuts roasting on open fire, Jack Frost nipping at your nose, evenings by the fireplace reassessing your PPO, HMO, and flexible spending accounts. That's right, people, it's open enrollment season; that time of year when those annoying announcements from your HR office encourage you to ponder your health benefits — the yearly window from November through December when employees can make changes to their health coverage for the new year. It’s also that time of the year when many of our Medicare patients are evaluating their options and their benefits. Well, I am not going to sit here and tell you what plan is better for you, but what I will do is to guide you through the process of choosing the best cardiologist for you.

How to Choose a Cardiologist
If you suffer from health problems related to your heart or cardiovascular system (veins and arteries), you'll need a cardiologist to provide advice and care. Cardiologists find, treat and help prevent diseases of the heart and blood vessels by recommending lifestyle changes, prescribing medication when necessary, performing surgical procedures in some patients or even recommending surgery on the heart, blood vessels and sometimes lungs in other patients.

A Cardiologist's Training and Credentials
A cardiologist begins his or her training with four years of medical school. There are two types of medical schools: one leads to a Medical Doctor (MD) and the other leads to an Osteopathic Doctor (DO). Both paths require a similar amount of education but focus differently: a MD practices allopathic medicine, considered to be conventional medicine in the United States, and looks at the body as a series of separately functioning systems. A DO learns more about the human musculoskeletal system and approaches the body as a whole system. In actual practice, the medical education received by both MDs and DOs today is quite similar.

The next step is a minimum three years of residency in internal medicine. Once the residency is completed, the physician must "subspecialize" to become a cardiologist, meaning he or she continues on to a fellowship, usually an additional three or more years in cardiovascular education. For pediatric cardiology, the training is a little different. Pediatric cardiologists will train first in pediatrics (rather than internal medicine), learning about the body systems of developing fetuses, infants, children, adolescents and young adults. They then go on toward a fellowship in cardiology, lasting another three years or more.
On the surgery side, cardiac surgeons begin with five years of general surgical training, then an additional two to three years of cardiothoracic training (heart and lungs). Transplant surgeons will require still more training, even crossing over into pediatric surgery.

Assuming we’re talking about cardiologists who treat adult patients, once a physician has completed these aspects of education, the physician may apply to be a certified member of the American Board of Internal Medicine for a subspecialty in cardiovascular disease or the American College of Osteopathic Internists with a subspecialty in cardiology. For those doctors that finished their training after 1990, Board membership requires frequent recertification, and to accomplish that, the physician must complete annual coursework requirements and take a recertification test.

How to Choose the Right Cardiologist
To find the right fit between you and your cardiologist, you'll want to identify possibilities and research credentials and then assess the doctor's capabilities for partnership.

Make a List of Possibilities
• Find other patients who are satisfied with their cardiologist, and ask them for names of the doctors they like to work with. To me, this is one of the most important questions…WORD OF MOUTH!
• Do an internet search for the names of physicians in your area.
• Check with your insurance company for a list of cardiologists who work with your insurance.
Compare these lists to find names in common with your needs. You will want to spend time learning more about your selections by researching their credentials and capabilities.

Research a Cardiologist's Credentials
Using the list of names you have collected, look for the following information
• A MD or DO degree from an accredited medical school and residency program
• Completion of a fellowship in cardiology, cardiac surgery (if you will require surgery) or pediatric cardiology.
• Board certification from the board that makes sense for your needs. This may be the American Board of Internal Medicine, for doctors that have a subspecialty in cardiovascular disease, or the American College of Osteopathic Internists, for those with a subspecialty in cardiology.
• Obviously, licensure from the state in which you will seek care.
• A review of possible disciplinary actions. This information can be difficult to find. Information can sometimes be found by inputting the doctor's name and location into a search engine.
Assess a Cardiologist's Capabilities
Once you have vetted your list based on the criteria above, you'll want to ask the following questions to determine which doctors are worth meeting:
• Is this doctor on the list of providers who work with my insurance?
• Does this doctor have admitting privileges at my choice of hospitals?
• Is this doctor's location convenient to me? What are the office hours? Is the office nearby, located on a bus route or easy to access if I use a wheelchair?
• What happens if I call this doctor in an emergency? How quickly will I get a return call?
• Does this doctor offer tests in house or do you need to go somewhere else to have the tests ordered (stress tests, pacer checks, blood tests, echocardiograms, etc.)
• Of the tests that the doctor can perform in the office, has he/she obtained lab accreditation from the various organizations (e.g. ICAEL, ICANL, ICACTL, ICAVL, ACR, etc.?)
If you are satisfied with these answers, you'll need to make an appointment and consider these questions:
• Does the doctor see you within a fair amount of time from your appointment time? This is important!
• Does the doctor listen to your questions and not interrupt you?
• Is the doctor respectful?
• Does the doctor explain the meaning of difficult terms and otherwise communicate effectively with you?
• Does the doctor spend enough time with you?
• Are you comfortable with this doctor?
Finding the right cardiologist may seem like a long, involved process, however, knowing that this doctor may partner with you for the rest of your lifetime makes it worth your time and effort. Remember, it is not about the diploma hanging on the wall, it is about the person you are going to trust as your advocate.

Click here to visit the Jim Moran Heart and Vascular Center Blog and for future posts from Dr. Vicente Font.


Post Traumatic Stress Ups Heart Disease Risk in Vets

  • Posted Nov 22, 2010
  • Vicente Font, MD, FACP, FCCP, FACC

font-iraqIt has been almost two years now since I returned home from Tikrit. All told, I was in Iraq for just a few months. But the time I spent there, the men I served with, and the people we saved, these memories will stay with me forever. We took care of our own military personnel (about 75%), civilian contractors (about 20%), and the rest were the “bad guys” (yup, that’s right, the Geneva Convention requires it). As with any other war conflict in the history of the Nation, one of the challenges in dealing with our returning veterans includes the restoration of their physical and mental well-being and overall health.
U.S. military veterans who have post-traumatic stress disorder (also known as PTSD) -- a condition marked by severe anxiety, sleep disruptions, hyperarousal and impaired concentration -- have double the risk of dying and a greater risk of developing cardiovascular disease, researchers reported.
Study results, presented at the scientific sessions of the American Heart Association meeting held in Chicago this month, suggest that doctors should provide early and aggressive evaluation and treatment of cardiovascular risk factors in patients with the disorder.
The interesting thing is that it is not just the anxiety component of the disorder. "This study for the first time appears to point to the mechanism for the cardiovascular part of that excess mortality risk: accelerated atherosclerosis," said Dr. Naser Ahmadi, a researcher at the Greater Los Angeles Veterans Administration Medical Center.
Atherosclerosis is a condition in which fatty material collects along the artery walls and when the material thickens, forming calcium deposits, it can eventually block blood flow through the arteries. This is the first trial to make a direct association between PTSD and atherosclerosis.
Researchers studied the medical records of 286,194 veterans. During an average follow-up of almost a decade and after adjusting for age, gender and cardiovascular risk factors, they found that veterans diagnosed with PTSD had 2.4 times the rate of death from all causes compared with non-PTSD veterans.
Of that group, 637 veterans were studied using a noninvasive technique to measure the amount of coronary artery calcium. Researchers found that more than three-quarters of the veterans with PTSD had more severe disease of their arteries than non-PTSD veterans.
The findings are important because they show that PTSD predicts death independently of known cardiovascular risk factors. As the non-military physicians and cardiologists become more familiar with the post-war health issues of our returning young men and women in the Armed Forces, we need to focus on early detection and management of cardiovascular risk factors in veterans with PTSD. This way, we might be able to improve their risk and delay the onset of cardiovascular disease.
My tour with the 345th Combat Support Hospital (CSH) taught me many things. Things that not only had to do with general medical care in a third world country in very austere conditions and within a very broken civilian medical infrastructure, but also things that pertained to battlefield trauma and newer concepts (surgical and medical) in the management of casualties. I wouldn’t change this experience for anything.
Last, but not least, I want to wish Godspeed and a safe return to Colonel Chance Kaplan  (M.D.) on his deployment to the Middle East next year. The photo in “full battle rattle” was taken somewhere in Iraq on Christmas Eve on my way to Tikrit. Go Army! (sorry, Dr. Guzman and Dr. Kotler, I know you guys root for the Navy…nobody is perfect!)

Click here to visit the Jim Moran Heart and Vascular Center Blog and for future posts from Dr. Vicente Font.


The Truth about Diet and Heart Disease

  • Posted Dec 21, 2009
  • Alan Niederman, MD, FACC, FACP

When I talk with families after an angioplasty,  the most common comment is “will you tell him (it’s usually him) to eat better.”  Unfortunately people have long memories when it comes to some things, and we as physicians failed in our early attempts to inform patients about how to avoid heart disease.  Diet was held out as a way to avoid the illness and alternatively, if you eat terribly, you would get it.  Neither is true.  Frankly, if diet really caused heart disease, then we would all be dead.  Those "billions and billions” served have to count for something.  Diet makes you fat and being fat leads to diabetes.  The Diabetes Life Style study showed that strict diet and exercise can lead to a halting of the diabetic process and allows patients to stop medications.  It unfortunately has little or nothing to do with heart disease.

Genetics is the root cause of this illness and unquestionably cigarette smoking accelerates the process.  If your father or mother had coronary disease in their 30’s or 40’s then watch out.  If they lived to be 90, then the high likelihood is you will not be afflicted with it.  This is not exact but in general it fits.  Much of this is related to cholesterol and its metabolism.  90% of your cholesterol level is created by you on a daily basis to serve as the building blocks of cells and proteins.  10% is consumed.  In general you cannot lower your cholesterol by diet because of a “feedback loop” in the liver, which senses the amount of cholesterol and then increases the production of it to make up for the loss.  This is where statins come in as they terminate the feedback loop.

We are now in the middle of the holidays and it is a time where we often gain weight and then on New Year’s Day resolve to lose it.  The day after New Year's the gym is full and it usually remains that way for two or three days.  Then we are just heavier. 

Please do not take this as a pass.  People should attempt to do what’s right.  People should weigh as close to their ideal weight as possible, and study after study has shown that if you weigh less you live longer.  The seminal studies on mice show that if you feed them 30% less than “required” the study mice live significantly longer than control mice.  This is difficult to do with humans but provocative none the less.  You will be much less likely to develop diabetes and have hypertension that is difficult to control.  This is where exercise comes in since it “burns” some of those excess calories.

We now have perhaps the ultimate example of fat doesn’t equal heart disease and that will be the subject of my next blog.


Blog Dedicated to Research Launched

  • Posted Jun 01, 2009
  • Alan Niederman, MD, FACC, FACP

bright-ideaWelcome to the JMHVRI blog. My purpose in hosting this blog is to be personal and educational. I will strive to bring the practice of cardiology and the groundbreaking research that my colleagues and I do to your attention. We are here for our community as Holy Cross and the Sisters of Mercy have been for over 50 years.

Heart disease is the leading cause of death in the United States for both men and women. Much has been learned over the past years but significant issues still remain. Information is now widely available on the Internet but much of it requires interpretation and some is just incorrect. This site will be a place to discuss these issues and concerns.

The JMHVRI is involved in groundbreaking research. We are the only site in South Florida for some of this work. I will highlight these studies so that you can participate or pass the information on to others who might be in need.

Our research institute is currently working on Adult Stem Cell therapy for the treatment of angina which can not be remedied with medication, surgery or angioplasty and as a treatment for heart failure which is still problematic in spite of all known therapies.

We are working on new therapy to replace Coumadin, as well as a new class of drugs known as Thrombin inhibitors for the treatment of clots. On new ways to treat high cholesterol, on new treatments for heart attacks, on novel drugs for the treatment of congestive heart failure to name just a few of our projects. I will inform you in depth about all these projects and more.

It is an exciting journey and I welcome you to join me.


About Holy Cross Hospital

Holy Cross Hospital is a nonprofit, Catholic hospital in Fort Lauderdale, Florida, dedicated to innovative, high quality and compassionate care. For nearly six decades, Holy Cross has continuously expanded its services to provide leading-edge care for their patients in Florida and for those from elsewhere in the United States. Holy Cross also offers an International Services program to ensure that patients from outside the U.S. receive the care they need.

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