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Tweet Chat with Dr. Nissen (10/17/12)

Wednesday, October 17, 2012 – Noon

Description

Dr. Steven Nissen, Chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, hosts a monthly Tweet-Chat.

HeartRN: Dr. Nissen, in the news was an article on early menopause and heart disease. Can you comment?

Dr. Nissen: A recent study suggesting doubling of heart risk was not well done. However... ccheart we know that heart risk increases following menopause & the earlier menopause, the greater the long term risk.

HeartRN: how is sleep related to heart disease?

Dr. Nissen: people who are chronically sleep deprived have an increase risk of obesity; diabetes; and probably heart disease. Most experts consider 7 - 8 hours in adults to be adequate.

Interestingly sleep apnea is also associated with diabetes and heart disease.

HeartRN: People may be interested in the new CPR techniques.

Dr. Nissen: The old style CPR that includes breathing is actually better but people are reluctant to use it; therefore the AHA recommends hands-only CPR to encourage people to help.

The most important thing to remember is to call 911 so that professional help comes quickly. 

HeartRN: Does sitting for long periods of time increase your risk of diabetes and heart disease?

Dr. Nissen: A sedentary lifestyle is a huge risk for diabetes and heart disease. The more you move - the better. Daily exercise is best.

CCheart: Beta blockers have been in the news lately suggesting that they don't help most patients with heart disease. true or false?

Dr. Nissen: I don't fully agree. We have good studies over decades showing benefits after heart attack.  I do agree that beta blockers are NOT a good choice for hypertension, particularly atenolol (tenormin). 

CCheart: Good news? Cholesterol levels seem to be falling according to recent news stories.

Dr. Nissen: There have been major reductions in the bad cholesterol (LDL) over two decades with slight increase in the good cholesterol (HDL)Along with these cholesterol reductions, risk of heart attack and stroke have fallen significantly.  Most experts think wider use of statin drugs is the reason although lifestyle changes are important too.

CLEHeartLab: . @ClevClinicHeart LDL has dropped; HDL has slightly increased, but what about overall number of cardiac events?

Dr. Nissen: @CLEHeartLab They are going down and have been going down for the last thirty years.

HeartRN: speaking of lifestyle change, I heard the movie Exit Fire was great. What's the message?

Dr. Nissen: It is a film that criticizes the American health care system. We spend twice what other countries spend without being healthier. A major problem is unnecessary tests and procedures. Our system has the wrong incentives. We need to focus more on prevention.

HeartRN: We have had questions about the benefits of a gluten free diet on cholesterol.

Dr. Nissen: Gluten does not play a major role in determining cholesterol levels.

HeartRN: Two new obesity drugs were approved in July. Are they safe?

Dr. Nissen: The first one, Lorcaserin (Belviq) is chemically similar to one of the components in phen-fen.  It does not seem to cause heart valve problems like phen-fen; however, weight loss is modest with this drug.  Qsymia is more effective and has been tested extensively (it actually lowers BP which is good),

Bottom line, both drugs appear safe although Qsymia is more effective. A third drug Contrave is nearing FDA approval and also looks very effective. Contrave likely to be approved in about one year from now.

HeartRN: Halloween is coming up soon. Can you really be frightened to death?

Dr. Nissen: not likely, although, chronic stress can increase risk for heart disease. Acute stress can cause Takotsubo Syndrome, also known as broken heart syndrome.  Takotsubos looks like a heart attack to doctors but it is actually caused by stress and anxiety.

@FMDAdvocate: @CLEHeartLab @ClevClinicHeart, Are you seeing an increase in coronary #FMD, Fibromuscular Dysplasia?

Dr. Gornik (Director of FMD Clinic): don't think we're seeing a true increase in coronary FMD, but we are seeing it recognized more often.  Basically we have just learned (through the work of Chris Bueller and Jacqueline Saw and others) that patients with renal and or carotid FMD can have coronary artery dissections (tears).  ON the whole though in my large practice of FMD patients, this is still uncommon, my sense is < 5% of FMD patients overall.

HeartRN: Thank you for talking to us about what is in the news today.

Dr. Nissen: See you next month.

Reviewed: 10/12

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