Live Web Chat Transcript: September 25, 2007
Dr. Julie Huang
Staff physician, Cleveland Clinic’s Women’s Cardiovascular Center
Section of Preventive Cardiology and Rehabilitation
Tomsich Family Department of Cardiovascular Medicine
More information:
Cleveland_Clinic_Host: Welcome Dr. Huang and thank you for being with us today. Let's begin!
Speaker_-_Dr__Huang: Thank you for having me.
Heart Disease Prevention and Diabetes
richard: I had my blood sugar taken during a physical. My blood sugar was 103. No one in my family is diabetic. I eat right but I do eat snacks sometimes. I exercise pretty regularly but I will do better. My cholesterol was also high (234, ldl 169, hdl 51, triglycerides 72). My dad had carotid disease but he smoked. Now I don't know what to eat for snacks. I understand low fat and now I am on Zocor - but I am not sure about the glucose. What can cause high glucose? What can I have to eat for snacks that are low in fat and sugar.
Speaker_-_Dr__Huang: Getting on therapy for hyperlipidemia is very important for people with diabetes and people with prediabetes as well. So I am happy you started the zocor. Unfortunately a predisposition to diabetes is often genetic but there are some lifestyle modifications that are helpful as well.
Speaker_-_Dr__Huang: You are on the right track, trying to lower your carbohydrate and fat intake. Diets in high in whole grains, fruits and vegetables, and low fat sources of protein will be the optimal for your blood sugars.Try a handful of nuts daily such as almonds or walnuts.
Risk Factors: Cholesterol Numbers: HDL, LDL
patty: Is there anyway to increase your HDL?
Speaker_-_Dr__Huang: Unfortunately HDL is very challenging to raise. Most statins have some modest raising HDL capability. Amongst the cholesterol medications, niacin has the most potent HDL raising capability. On the order of 30 - 40%. However, this medication is sometimes difficult to tolerate.Other medications like tricor and lopid also have HDL raising capability.
Speaker_-_Dr__Huang: We normally recommend exercise for raising hdl however this only results in a 10 - 15% rise.
sab77: What are the cholesterol guidelines? If you have a family history of heart disease but no risk factors, how low should your ldl be?
Speaker_-_Dr__Huang: Technically a family history of heart disease specifically heart disease in male family members less than the age of 50 or female family members less than the age of 60 constitute a cardiac risk factor.
Speaker_-_Dr__Huang: Most practitioners would then recommend a goal LDL of less than 100 mg/dl. One can also use the Framingham Risk Score to more fully evaluate the 10 year risk for heart disease. Goals for LDL are dependent on this risk assessment.
kristen: I am a 39 year old woman. I run almost every day and eat a very healthy diet. My HDL is 85 but my total cholesterol is 240. My dad did have heart disease, so I am a little nervous, but do I need to be? With my high HDL, does it cancel out the high cholesterol?
Speaker_-_Dr__Huang: The total cholesterol of 240 and HDL of 85 suggests that your LDL (bad cholesterol) is probably within a reasonable range. However, with a family history of heart disease, we would recommend more aggressive cholesterol goals. In addition, other assessment of blood risk markers may aid in the decision whether to treat or not to treat your cholesterol. Speak with your physician.
kim: I don’t understand what ratio means – I went to my doctor and my brother asked me about my ratio. What is that? What should it be?
Speaker_-_Dr__Huang: There are many ratios including total cholesterol to HDL ratio. This is just a more specific way of looking at the components of the total cholesterol value. In our practice, we are often more concerned with the absolute value of the LDL cholesterol and HDL cholesterol.
Speaker_-_Dr__Huang: For most patients we recommend a goal LDL of at least less than 130 mg/dl. This goal may be lower depending on the presence of heart disease or significant heart disease risk factors.
olp88: My parents both have high cholesterol. My dad had a heart attack when he was 45. I am 22 years old. What should I do to prevent a heart attack? When should I be tested?
Speaker_-_Dr__Huang: You are good to start thinking about these issues at this age. Getting on top of prevention in your 20's will get you on the right track. You should definitely have your cholesterol checked. You may also consider testing of other risk markers for heart disease like lp(a) or homocysteine, as these may be early indicators of a heart disease predisposition in yourself.
Speaker_-_Dr__Huang: In terms of prevention, I would recommend vigilant attention to your diet and exercise. Depending on your cholesterol levels and other risk markers cholesterol lowering medication may even be recommended for patients in their 20's. Speak with your physician regarding your concerns.
bobs: I have high cholesterol. My total cholesterol is 300. I am not sure what the LDL is but I know I have not been able to tolerate statin medications. What can I do?
Speaker_-_Dr__Huang: First of all, it is important to document which cholesterol medications you have tried. As some people are able to tolerate some and not others in the same class.
Speaker_-_Dr__Huang: If all the statin agents have been tried, other options would include the cholesterol absorption inhibitor ezetimibe; niacin; fibrate agents; or the bile acid resins. You would need to discuss this with your physician.
Speaker_-_Dr__Huang: The level of aggressiveness of therapy of your very elevated cholesterol would depend on whether you have already had a history of heart disease or not. Strict dietary measures including a low saturated and transfat diet would be very important.
kjs34: Is there a cholesterol that would be too low. My cholesterol is 120
Speaker_-_Dr__Huang: In most instances the lower the cholesterol the better in terms of heart disease risk. However, it would be important to know the breakdown of your cholesterol, for instance is your total cholesterol low because your HDL (good cholesterol) is very low?
Speaker_-_Dr__Huang: Another important consideration would be whether your cholesterol of 120 represents a treated value or a baseline value. In instances where a patient has heart disease and is on cholesterol lowering medication, a total cholesterol of 120 would approach the goal for therapy.
Cholesterol Lowering Medications
tracy: My doctor ordered Lipitor but my insurance only covers Zocor Is there a difference?
Speaker_-_Dr__Huang: Lipitor and Zocor are both part of the class of medications called statins. Statins are the most potent cholesterol lowering medications available and have the best evidence for heart disease risk reduction.
Speaker_-_Dr__Huang: Both lipitor and Zocor act by blocking the liver's production of cholesterol. They are slightly different in chemical structure but both are very effective cholesterol lowering agents.
Speaker_-_Dr__Huang: If your insurance only covers Zocor, that would be a fine choice.
becca: I have read about Niacin to help raise HDL. I was at GNC and saw it there. If I buy niacin at the store, how much should I take?
Speaker_-_Dr__Huang: Most over the counter niacin is not available in sufficient doses to raise HDL or else it causes severe flushing. Speak with your physician about flush free brands of niacin or about prescription Niaspan.
Heart Disease Prevention after Angioplasty or Bypass Surgery, Cardiac Rehabilitation
jlp44: What is cardiac rehab? Is it really necessary? My husband had bypass surgery. I want him to go to cardiac rehab and he does not want to go. What are the benefits?
Speaker_-_Dr__Huang: Everybody should be on some form of exercise regimen following a diagnosis of coronary artery disease or following bypass. Many people are hesitant to get back into a regimen after they have undergone something like surgery. Cardiac rehabilitation is highly recommended because it provides a monitored setting for resuming exercise. It is also a good environment in which to foster improved lifestyles and reconnect with other patients with a similar diagnosis. Yes - I would recommend cardiac rehab for your husband. It is covered by most insurance plans and by medicare.
rap5643: My husband had angioplasty and stents 1 year ago. He had to have new stents put in about 6 months ago. What can he do to prevent restenosis again?
Speaker_-_Dr__Huang: Unfortunately some patients are very prone to in-stent restenosis from mechanisms that are not well understood. Use of drug eluting stents like Cypher an Taxus have helped decrease the incidence of in-stent restenosis.
Speaker_-_Dr__Huang: Our recommendations for lifestyle changes after angioplasty and stenting are no different whether has post stent problems or not. For all patients after angioplasty we recommend a goal LDL (bad cholesterol) of less than 70 mg/dl.
Speaker_-_Dr__Huang: In addition, aggressive blood pressure and diabetes control, low fat diet, and an exercise regimen of 30 minutes daily is important.
jon: I had bypass surgery in 2006. I have diabetes but I am in pretty good control. I have lost weight since the bypass surgery and take a walk everyday. I wonder what else I need to do
Speaker_-_Dr__Huang: I am sorry to hear about your surgery and hope you are currently feeling well. Being on an exercise regimen is a very important part of staying healthy after bypass surgery. As is good diabetes control.
Speaker_-_Dr__Huang: Make sure that you have regular follow up with your physician and stay on the recommended medications especially a daily aspirin and treatment for cholesterol to keep the LDL below 70 mg/dl.
Heart Disease Risk and Diet, Supplements and Vitamins
erin: If you are a woman who is at risk for heart disease, should you take soy products to lower your risk?
Speaker_-_Dr__Huang: Soy protein (25 grams per day) has a modest cholesterol lowering effect - on the order of 5 to 8 percent. So in this respect, taking in soy products can have some effect in lowering heart disease risk. Used as a replacement for saturated fat products, it can also provide a dietary change which is beneficial to heart health
pak: Does garlic really prevent high cholesterol? My father in law had vascular disease and he uses garlic all the time. He said it is to prevent heart disease. Is he really right?
Speaker_-_Dr__Huang: Unfortunately, garlic is not that useful in lowering cholesterol.
Cleveland_Clinic_Host: Dr. Huang, we have received several questions about supplements, can you give us your thoughts on these alternatives?
Speaker_-_Dr__Huang: In general most of the studies with supplements including vitamins, minerals, and nutraceuticals have been disappointing. People had high hopes for vitamin E and B vitamins lowering heart disease risk. However, large rigorous clinical trials have shown them to be equivalent to placebo. Or - in some cases, even causing harm. The nutraceutical agents like policosanol and garlic have also been disappointing.
patty: Does Benecol and those butter products really reduce cholesterol? What about oatmeal?
Speaker_-_Dr__Huang: Benecol and TakeControl are products available in the dairy case that contain plan sterols and stanols. These products taken in a daily dosage of two tablespoons have been shown to lower cholesterol approximately 10 percent.
Speaker_-_Dr__Huang: Oatmeal also has cholesterol lowering capability due to its high fiber content. The results may vary depending on the "dosage" of oatmeal.
has: What type of meat is the best meat to eat if you have heart disease? Is poultry better than lean cuts of meat?
Speaker_-_Dr__Huang: Meat in general has a higher proportion of saturated fat than vegetable or grain products. In a diet geared towards heart disease prevention, you should try to limit your intake of saturated fat to less than 7 percent of calories per day.
Speaker_-_Dr__Huang: In general lean poultry has less saturated fat than red meat. An upcoming webchat with our dietitian could be more specific.
Risk Factors: Sleep Apnea
annp: My husband snores very loudly and he sometimes sounds like he stopped breathing at times. I read somewhere there is a link to heart disease. Is that true? Should he do something for his snoring?
Speaker_-_Dr__Huang: Stopping breathing during sleep is often a sign of obstructive sleep apnea. This diagnosis can be associated with right sided heart failure and pulmonary hypertension. More importantly obstructive sleep apnea usually occurs in obese patients. Obesity is an important risk factor for coronary heart disease.
Heart Disease Prevention and Omega 3
patty: What is the purpose of Omega 3?
Speaker_-_Dr__Huang: Omega 3 fatty acids are long chain fatty acids found predominantly in animal products, especially marine fish. They are helpful in lowering triglycerides and have a modest HDL raising effect.
Speaker_-_Dr__Huang: The American Heart Association recommends 2 servings of fatty fish per week as a source of Omega 3 fatty acids. Studies have shown improved cardiovascular health with regular intake of omega 3.
What is Preventive Cardiology?
carla: What is a Prevention Clinic? Who should go there? My cholesterol is 230, LDL 160. I am not sure who should treat this – my family doctor, a cardiologist, do I go to a special lipid clinic?
Speaker_-_Dr__Huang: Any physician can help you with treatment of your cholesterol. However, here at the Cleveland Clinic Preventive Cardiology Clinic, we focus on overall risk assessment including cholesterol, blood pressure, diabetes. We are a multidisciplinary group including cardiologists, endocrinologists, nephrologists, and internists, as well as nutrition and weight loss services, and exercise physiology.
Speaker_-_Dr__Huang: We also advocate use of noninvasive imaging for further risk assessment. Noninvasive risk assessment includes calcium scoring and carotid ultrasound. These types of tests and other services may be appropriate for anybody. You do not need a referral to be seen by prevention.
Speaker_-_Dr__Huang: We also have a Women's Cardiovascular Center which specializes in cardiac risk assessment in women.
Heart Disease Prevention and Exercise
yogamom: What is the role of yoga and tai chi in heart disease prevention?
Speaker_-_Dr__Huang: The effects of yoga and tai chi in lowering circulating stress hormones is probably useful for heart disease prevention. However, neither of these exercises tends to be very aerobic. The American Heart Association recommends 30 minutes of moderate intensity exercise on most days of the week. Using yoga or meditation exercises would be a good supplement to an aerobic regimen.
EECP and Heart Disease Prevention?
jenna: I was listening to the radio and heard about eecp. I do not have heart disease but this person was talking about doing eecp to strengthen her heart to prevent heart disease. Have you heard of that?
Speaker_-_Dr__Huang: EECP stands for enhanced external counterpulsation. This is a daily therapy involving the placement of high pressure cuffs around the lower extremities inflated to very high pressures with each beat of the heart. This therapy is prescribed for patients with chronic angina despite maximal medical treatment. So - to answer your question, eecp is not recommended for patients without a known history of heart disease
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Huang . Dr. Huang, thank you again for taking the time to answer our questions today.
Speaker_-_Dr__Huang: Thank you for having me today.
Technology for web chats paid in part by an educational grant from AT&T Ohio and the AT&T Foundation (formerly SBC).
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