Wednesday, August 21, 2013 – Noon
Dr. Steven Nissen, Chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, hosts a monthly Tweet-Chat @ClevClinicHeart:
A review of recent heart news and answers to your questions
HeartRN: Welcome to twitter chat.
HeartRN: Question for you from a participant: I read The Great Cholesterol Myth. Are too many people taking statins?
Dr. Nissen: Probably exactly the opposite. Too few people are taking statins. Like many popular books, The Great Cholesterol Myth is written by a non-scientist with little or no medical knowledge; the apparent purpose of such books is notoriety - not informing the public. Of course, statins are not a substitute for good health habits including diet, exercise and other health measures, but... if your cholesterol is high and cannot be managed by diet, statins offer a 25 - 35% reduction in the risk of death, stroke, and MI.
HeartRN: What do you think about President Bush’s recent stent? A lot in the news about this topic.
Dr. Nissen: What seems to happen is that prominent individuals undergo so-called “executive physicals.” During executive physicals, many unnecessary tests are performed, including a stress test. All authorities agree that performing a stress test in a person without symptoms is a very bad idea.
Unfortunately, a month after riding a 100 km bike trip, former President Bush had a physical with a stress test. Since the major benefit of stents in stable patients is reduction of symptoms of chest pain .....it is impossible to make a patient who can ride 100 km on a bike feel any better.
The bottom line - if you have no symptoms, don't have a stress test.
Heart RN: What tests should people who are concerned about heart disease have?
Dr. Nissen: An annual physical exam is a reasonably good idea as long as over testing is avoided. Most adults should have their cholesterol checked periodically and their blood pressure.
If you are overweight, its a good idea to have your blood sugar checked since diabetes is common in overweight individuals. No other heart tests should be performed routinely in people without symptoms during a regular check up.
Of course, there are other regular procedures that are indicated for other diseases such as mammography in women [Breast cancer screening guidelines], and colonoscopy in individuals over 50 years of age. [Colorectal screening guidelines – correction from chat]
HeartRN: Study in the news - antagonistic people may increase heart attack - what do you think?
Dr. Nissen: We have seen lots of hype over the last 30 years over personality type and heart disease. I remain unconvinced. We all prefer to interact with nice people. Having an aggressive personality does not necessarily indicate a higher risk of coronary artery disease.
HeartRN: Anti-oxidants, Type I Diabetes and link to coronary artery disease. Study in the news.
Dr. Nissen: This is a poor quality study that didn't really test using anti-oxidants in patients at risk for coronary disease. After 30 yrs. of promotion, there remains not one good quality study showing the benefits of anti-oxidant vitamins. Until proper studies are done, patients should avoid the urge to take so-called anti-oxidant vitamins.
HeartRN: More in the news about vitamin D.... what do you think?
Dr. Nissen: Amazing amount of hype about the benefits of vitamin D which remain unproven. We are finally getting some decent scientific studies and most show no benefits. A recent study gave Vitamin D to patients with high blood pressure and showed no effect. Our best advice is to avoid these trendy dietary supplement treatments. Wait for good evidence.
HeartRN: There have been articles in the news about the lack of counseling to patients after a heart attack about return to sexual activity.
Dr. Nissen: I agree with the American Heart Association (AHA) - physicians do not often do a good job about counseling patients about sex after a heart attack. Physicians should bring the topic up even if patients are too embarrassed to ask. Sex is perfectly safe and even beneficial for many patients with heart disease, but we must help patients overcome fears. Whether you are a man or a woman, please talk to your doctor about these issues.