WBEZ | heart disease http://www.wbez.org/tags/heart-disease Latest from WBEZ Chicago Public Radio en Can Dementia be Prevented? Education May Bolster Brain Against Risk http://www.wbez.org/news/can-dementia-be-prevented-education-may-bolster-brain-against-risk-114829 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/knowledge-tree_slide-231995ee55735ba2fb011e8ab30272470c8e9df7-s800-c85.jpg" alt="" /><p><div id="res466433587" previewtitle="Nanette Hoogslag/Getty Images/Ikon Images"><div data-crop-type=""><img alt="Nanette Hoogslag/Getty Images/Ikon Images" src="http://media.npr.org/assets/img/2016/02/11/knowledge-tree_slide-231995ee55735ba2fb011e8ab30272470c8e9df7-s800-c85.jpg" style="height: 413px; width: 620px;" title="(Nanette Hoogslag/Getty Images/Ikon Images)" /></div><div><div>&nbsp;</div></div></div><p>The odds of getting Alzheimer&#39;s disease or other forms of dementia are declining for people who are more educated and avoiding heart disease, a study finds. The results suggest that people may have some control over their risk of dementia as they age.</p><p>This isn&#39;t the first study to find that the incidence of dementia is waning, but it may be the best so far. Researchers looked at 30 years of records from more than 5,000 people in the famed Framingham Heart Study, which has closely tracked the health of volunteers in Framingham, Mass.</p><p>They found that the incidence of dementia declined about 20 percent per decade starting in the 1970s &mdash; but only in people who had at least a high school education. The decline in people diagnosed with Alzheimer&#39;s wasn&#39;t statistically significant, but there were fewer people with Alzheimer&#39;s, which could have affected that result.</p><p>The study, which was&nbsp;<a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1504327">published</a>&nbsp;Wednesday in the&nbsp;<em>New England Journal of Medicine</em>, also looked at risk factors for heart disease and stroke, including smoking, obesity and high blood pressure. They found that the people who had better markers for cardiovascular health, such as normal blood pressure, were also less likely to develop dementia.</p><p>&quot;That&#39;s telling us that perhaps better management of cardiovascular disease could potentially help in the reduction of dementia,&quot; says&nbsp;<a href="http://profiles.bu.edu/display/49141807">Claudia Satizabal</a>, an author of the study and an instructor in neurology at the Boston University School of Medicine.</p><p>To figure out what this all means, we called&nbsp;<a href="http://micda.psc.isr.umich.edu/people/profile/566/Kenneth_M_Langa">Dr. Kenneth Langa</a>, a professor at the University of Michigan who also studies trends in dementia. Here are highlights from the conversation edited for length and clarity.</p><p><strong>One of the very confusing things about this is that even though an individual may be less likely to get dementia than they were 40 years ago, the number of people with dementia is going up. Why is that?</strong></p><p>It&#39;s an interesting and sometimes complicated concept. The number of cases in the population could still be going up in the future because of the larger number of adults.</p><p>It&#39;s very easy to get your wires crossed when you think of &quot;what&#39;s my own individual risk&quot; versus the number of people in the population.</p><p>It&#39;s certain that we&#39;ll have significantly more older people in the United States and around the world, so now the big question is &mdash; on an individual level, what&#39;s going on with the risk? Does a 70-year-old today have the same risk as one 20 years ago?</p><p><strong>And you&#39;re finding a trend similar to what the researchers reported this week &mdash; a declining risk of dementia in the United States.</strong></p><p>We&#39;ve been looking at data from the&nbsp;<a href="http://hrsonline.isr.umich.edu/">Health and Retirement Study</a>, large study funded by the National Institute on Aging and the Social Security Administration. We&#39;ve been collecting data on older folks in the United States since 1992. We&#39;re finding a decline in the prevalence of dementia and cognitive decline very much in line with the Framingham Study report.</p><p><strong>You also are finding that a person&#39;s level of education is a key driver in dementia risk. Is that because education makes your brain stronger, or that educated people are healthier overall?</strong></p><p>That&#39;s a big question, and one I&#39;ll be focusing on for the rest of my career.</p><p>I&#39;ll give you my usual researcher on-the-fence answer: I think it&#39;s a bit of both. I do think there is a direct biological effect of using your brain and having it interact with the world. You may have heard the term cognitive reserve, which means your brain gets wired up differently if it&#39;s challenged.</p><p>I&#39;m a believer that there is a causal effect of education on how your brain is challenged. But I definitely would agree that that&#39;s not the only pathway.</p><p>Education sets you off on a different path in your life; it sends you into different occupations. You may live in different neighborhoods, have less stress, have more money. That gives you access to better health care and social networks.</p><p>But still, if I do my 12 years or 14 years or 16 years of school, I don&#39;t think that 100 percent determines your risk of dementia.</p><p><strong>You&#39;ve also found that our parents&#39; level of education may affect dementia risk.</strong></p><p>It&#39;s very intriguing; a mother&#39;s education may be more important than a father&#39;s education. Again there are lots of complicated pathways you can talk about, but one that we and other researchers are trying to follow up on is whether a more educated mom may interact with a child in ways that are more beneficial to the developing brain of a child.</p><p>How your brain is nurtured throughout life is a really fascinating part of this story.</p><p><strong>The study published this week didn&#39;t look explicitly at exercise, but that does affect cardiovascular health. Could it help prevent dementia?</strong></p><p>The evidence both from animals in the cage and epidemiological studies shows that physical activity seems quite important for keeping your blood vessels healthy, and probably some specific growth factors that help the neurons in the brain. The general point that was brought out in the Framingham study is that cardiovascular fitness is very important.</p><p><strong>You and other researchers have pointed out that the trend toward more obesity and diabetes in the United States could threaten this more hopeful trend toward lower risk of dementia. When might that happen?</strong></p><p>The short answer is I think we don&#39;t know. Again, there are so many complicated interacting pathways going on here we can&#39;t really be sure what will happen.</p><p>Even though the number of people with diabetes has really skyrocketed in the past 20 or 30 years, it also seems to be that having diabetes doesn&#39;t have as many bad complications as it did 20 or 30 years ago. There&#39;s been a decline in things like heart attacks and amputations due to vascular complications. More aggressive treatment of diabetes and high blood pressure and cholesterol is probably one of the factors that&#39;s caused this decline in complications.</p><p><strong>We&#39;re all terrified of getting Alzheimer&#39;s. Given that being heart healthy seems to reduce that risk, why aren&#39;t we all exercising like crazy?</strong></p><p>It&#39;s still complicated, I think. Part of it is that it&#39;s a benefit that&#39;s going to come to you 20 or 25 years later; it&#39;s not easy to motivate people even with something as feared as Alzheimer&#39;s disease. I&#39;m an internist. I see middle-aged people with diabetes and hypertension and tell them about these findings. But it can be tough to motivate people.</p><p><strong>What else can people do to reduce the risk?</strong></p><p>These findings are optimistic; it&#39;s not a done deal. But there do seem to be things we can do not only from an individual perspective but from a public policy perspective, for instance, making education as available as possible to people in the United States and other countries.</p><p>I tell my patients, &quot;You can do everything right and still get Alzheimer&#39;s disease and dementia.&quot; It&#39;s a question of trying to change your risk to make it as low as possible.</p><p>The research that is ongoing to find medical interventions to affect the trajectory of the disease are still important to do also.</p><p>&mdash;<a href="http://www.npr.org/sections/health-shots/2016/02/11/466403316/can-dementia-be-prevented-education-may-bolster-brain-against-risk?ft=nprml&amp;f=466403316"><em> via NPR</em></a></p></p> Fri, 12 Feb 2016 11:58:00 -0600 http://www.wbez.org/news/can-dementia-be-prevented-education-may-bolster-brain-against-risk-114829 Hormones may help younger women with menopause symptoms http://www.wbez.org/news/hormones-may-help-younger-women-menopause-symptoms-113713 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/npr_menopause_wide-bdc3f0d1daeb5b077f445b6af3da34572198c086-s800-c85.jpg" alt="" /><p><div id="res455029793" previewtitle="Maria Fabrizio for NPR"><div data-crop-type=""><img alt="Maria Fabrizio for NPR" src="http://media.npr.org/assets/img/2015/11/06/npr_menopause_wide-bdc3f0d1daeb5b077f445b6af3da34572198c086-s800-c85.jpg" title="Maria Fabrizio for NPR" /></div><div><div>&nbsp;</div></div></div><p>For Linnea Duvall, a marriage and family therapist who lives and works in Santa Monica, Calif., the symptoms of menopause started when she turned 50. She felt more irritable, a smidge heavier and she started waking up two to three times a night.</p><p>And then she had a hot flash.</p><p>&quot;It felt like a nuclear bomb went off right behind my belly button,&quot; she says. &quot;The radiation went out to my fingertips, the tops of my toes, the top of my head and the ends of my hair.&quot;</p><p>But Duvall would not consider&nbsp;<a href="https://www.nlm.nih.gov/medlineplus/ency/article/007111.htm">hormone therapy</a>&nbsp;to control the flashes. She was terrified. She says she can sum up her fear in two words: &quot;breast cancer.&quot;</p><p>To understand why she feels this way, we have to look back a few decades to a time when many postmenopausal women were taking hormones to treat symptoms. At the time, hormones were thought of as something of an elixir of youth that could also prevent chronic disease. So women took hormones indefinitely. But a huge&nbsp;<a href="http://jama.jamanetwork.com/article.aspx?articleid=1745676">study</a>&nbsp;in 2002 changed everything.</p><p>Known as the Women&#39;s Health Initiative, it found that taking estrogen plus progestin hormone replacement therapy actually increased a woman&#39;s risk of heart disease and breast cancer. The study had a huge effect. Within months the number of women taking hormones in the U.S. dropped by almost half. Today, only about 10 percent of women aged 50 or over are on hormone therapy.</p><p>That was a huge overreaction, according to&nbsp;<a href="http://www.utianllc.com/">Dr. Wulf Utian</a>, director of the&nbsp;<a href="http://www.menopause.org/">North American Menopause Society</a>, particularly in light of more recent findings. A more detailed&nbsp;<a href="http://www.ncbi.nlm.nih.gov/pubmed/24084921">analysis</a>&nbsp;of the Women&#39;s Health Initiative data found that age really made a difference in heart disease risk. For women who started hormone therapy between the ages of 50 and 59, there was a protective&nbsp;<a href="http://www.futuremedicine.com/doi/full/10.2217/whe.15.24">benefit</a>, says&nbsp;<a href="http://www.hsph.harvard.edu/joann-manson/">Dr. JoAnn Manson</a>, one of the lead investigators of the study and a professor of medicine at the Harvard T.H. Chan School of Public Health.</p><p>Women who take hormones earlier after the onset of menopause may experience less plaque, blood vessel blockage, and&nbsp;<a href="http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis">atherosclerosis,</a>&nbsp;Manson says, &quot;And possibly even a reduced risk of heart attack. But for women over the age of 60 the benefit seems to disappear. This is probably because older women already have plaque buildup, Manson says.</p><p>Researchers in Denmark also&nbsp;<a href="http://www.bmj.com/content/345/bmj.e6409">found</a>&nbsp;that age makes a difference. They looked at 1,000 healthy women between the ages of 45 and 58. The women who took hormones experienced significantly reduced risk of mortality, heart failure and heart attack.</p><p>Today, menopausal women are young in the scale of things, says Dr. Wulf Utian, noting that menopause typically starts between age 45 and 60. If women start hormones within in a few years of menopause or even a few years before, he says there are numerous benefits beyond controlling hot flashes. These benefits include reduced risk of bone fractures, reduced risk of diabetes and for many women, an overall boost in their quality of life &mdash; meaning better sleep, maintenance of libido and more comfortable sex.</p><p>&quot;In my opinion, the best recommendation would be for some form of hormone therapy,&quot; says Utian.</p><p>But here&#39;s the worry. Studies do confirm an increased risk of breast cancer among women taking hormones, regardless of age. Manson says any risk is worrisome, but it&#39;s important to put this risk in perspective and understand that it is actually small.</p><p>&quot;For every 1,000 women per year not using hormone therapy about 3 would develop breast cancer,&quot; Manson says. &quot;And among every 1,000 women using hormone therapy about 4 of them would develop breast cancer, so that&#39;s about 1 extra case of breast cancer per 1,000 women per year on hormone therapy.&quot;</p><p>This is where things get tricky. There is no consensus in the medical community on whether the symptom relief is worth the extra risk. Different doctors interpret risk differently. And if you&#39;re a breast oncologist like&nbsp;<a href="http://www.labiomed.org/researchers/rowan-t-chlebowski-md-phd">Dr. Rowan Chlebowski</a>&nbsp;at Harbor UCLA Medical Center, any risk is too much.</p><p>&quot;It&#39;s a disease that I see every day,&quot; Chlebowsi says. &quot;So I think that&#39;s something to be avoided.&quot;</p><p>Chlebowski a<a href="http://www.npr.org/sections/health-shots/2015/11/09/454710392/hormones-may-help-younger-women-with-menopause-symptoms?ft=nprml&amp;f=454710392#_msocom_1" name="_msoanchor_1" style="box-sizing: border-box; margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; color: rgb(71, 116, 204); -webkit-tap-highlight-color: transparent; text-decoration: none;"></a>dds that hormone therapy also makes it more difficult to read mammograms, since hormones make the breast denser. If mammograms are more difficult to read, it&#39;s harder to diagnose breast cancer in its earliest stage when it&#39;s most treatable.</p><p>So bottom line &mdash; this really&nbsp;is&nbsp;an individual decision between a woman and her doctor, a decision based on how much risk a woman can tolerate in favor of symptom control and other potential benefits. Researcher Joann Manson says if a woman chooses hormone therapy, then the lowest possible dose for the shortest amount of time is probably safe for most women.</p><p>&mdash;<a href="http://www.npr.org/sections/health-shots/2015/11/09/454710392/hormones-may-help-younger-women-with-menopause-symptoms?ft=nprml&amp;f=454710392" target="_blank"><em> via NPR</em></a></p></p> Mon, 09 Nov 2015 16:52:00 -0600 http://www.wbez.org/news/hormones-may-help-younger-women-menopause-symptoms-113713 Surgeon General Vivek Murthy breaks his quiet on nutrition and says it will be a big part of his tenure http://www.wbez.org/news/science/surgeon-general-vivek-murthy-breaks-his-quiet-nutrition-and-says-it-will-be-big-part <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/surgeon general1.jpg" alt="" /><p><div>U.S. Surgeon General Vivek Murthy - the country&rsquo;s key spokesperson on public health - spoke last week at a luncheon for Chicago&rsquo;s Healthy Schools Campaign. Despite the deep dietary problems faced by Chicago kids, Murthy&rsquo;s speech largely <a href="http://www.wbez.org/sections/food/surgeon-general-wants-us-walk-health-113033" target="_blank">glossed over nutrition to focus on walking</a>. &nbsp;</div><div>&nbsp;</div><div>The speech came in the wake of<a href="http://www.huffingtonpost.com/laurie-david/step-it-up-coca-cola_b_8131834.html"> similar criticism</a> earlier in the month from filmmaker Laurie David and activist dietitian Andy Bellati. They said Murthy&rsquo;s approach sounded a lot like the way soda companies frame the obesity debate: It&rsquo;s not about what you eat, it&rsquo;s about how much you move. &nbsp;</div><div>&nbsp;</div><div>A pattern seemed to be emerging. It didn&rsquo;t help that Murthy&rsquo;s office offered no response to the articles and took no questions after his Chicago speech.</div><div>&nbsp;</div><div>But Monday, the surgeon general broke his silence in a call to WBEZ. He told us that he actually cares a lot about nutrition. He even plans to launch his next campaign on the topic.&nbsp;</div><div>&nbsp;</div><div>Here are some edited excerpts from our interview:</div><div><hr /><p><strong>ENG</strong>: You&rsquo;ve taken some heat recently for perceptions that you emphasize physical activity at the cost of nutrition. Is that a fair reading of your stance?</p></div><div><strong>MURTHY</strong>: There are a lot of issues that I plan to address during my tenure as surgeon general. I began talking about vaccinations during the measles outbreak in the United States. And what I said, even prior to my confirmations, is that prevention is really the central focus for me. And when I think of building a culture of prevention in America, I believe there are three core components: One of them is physical activity, one of them is nutrition and the other is emotional well being. A few weeks ago we rolled out our first initiative on physical activity and, in coming months, we&rsquo;ll be rolling out initiatives on nutrition and emotional well-being as well&hellip;. That&rsquo;s because, in my experience caring for patients, I&rsquo;ve seen that good nutrition is essential for good health, and it&rsquo;s really at the core of being healthy.&nbsp;</div><div>&nbsp;</div><div><strong>ENG</strong>: Can you give a preview on what you&rsquo;ll be saying about nutrition in that initiative?&nbsp;</div><div>&nbsp;</div><div><strong>MURTHY</strong>: &nbsp;A lot of that is still in the works but I can tell you a little bit about why I&rsquo;m concerned in particular about nutrition. My real concern is that we are as a country are not eating enough in the way of fruits and vegetables and we overconsume sugar and salt in particular. This has important consequences for our health, particularly in terms of contributing to chronic illness like diabetes and heart disease. Chronic illness accounts for seven out of 10 deaths in America and they cost us over a trillion dollars a year, which is this is why emphasizing physical activity and nutrition and changes we can make in both realms is so important to addressing chronic disease...</div><div>&nbsp;</div><div>We are also looking at how we can increase the consumption of fruits and vegetables. What&rsquo;s exciting to me is that there are innovative programs out there that are having success in terms of increasing fruits and vegetables. (Murthy cites a program in Virginia that<a href="http://www.npr.org/sections/thesalt/2015/08/10/426741473/healthy-eaters-strong-minds-what-school-gardens-teach-kids" target="_blank"> teaches kids about produce</a> and another in Michigan that <a href="http://www.npr.org/sections/thesalt/2014/11/10/361803607/how-double-bucks-for-food-stamps-conquered-capitol-hill" target="_blank">doubles the value of SNAP dollars</a> when they are spent on local produce.)</div><div>&nbsp;</div><div>So these are some of the issues we&rsquo;re examining right now: how to increase fruit and vegetable consumption and increase water consumption and reduce our consumption of sugar and salt. &nbsp;</div><div>&nbsp;</div><div><strong>ENG</strong>: Because this was the first thing you rolled out, I think people got the impression that the Surgeon General was simply going to tell us to walk, and not talk about drinking sugary drinks and getting junk out of our diets. What would you say to them? &nbsp;</div><div>&nbsp;</div><div><strong>MURTHY</strong>: We are getting to these topics. We are addressing them sequentially, but that doesn&rsquo;t mean that I don&rsquo;t talk about them all the time. When I go to communities across the country I hear about concerns folks have about the lack of availability of nutritious food. I hear concerns about neighborhoods not being safe for physical activity. I hear concerns about prescription opiate abuse, about &nbsp;measles outbreaks and range of other issues that are concerning to folks across the country. &nbsp;&nbsp;</div><div>&nbsp;</div><div><strong>ENG</strong>: It&rsquo;s no big secret that the food industry and its lobbyists have considerable influence in D.C., and those who speak out against them can find themselves on the end of some tough attacks. Does that ever work into your mind when you say, &lsquo;Ok I&#39;m going to give a speech and instead of attacking sugary drinks I&rsquo;ll focus on physical activity.&rsquo;?&nbsp;</div><div>&nbsp;</div><div><strong>MURTHY</strong>: For anyone who has paid attention to my history, not only as Surgeon General, but during my confirmation process as well, I think you know I don&#39;t shy away from controversial issues. I took a lot of heat for talking about controversial issues [gun control] during my confirmation process. And what I said, then and now, is that what drives me in my decision on what to talk about and how to talk about is science and what&rsquo;s going to improve people&rsquo;s health. I come at that as a physician who has seen far too much preventable disease and who feels a great sense of urgency around this because I feel that the longer we take to make changes in physical activity and nutrition and in other areas related to health, the more people experience illness, and the more people pass away prematurely and the more healthcare costs we rack up. So that&rsquo;s what drives me. &nbsp;&nbsp;</div><div>&nbsp;</div><div>&nbsp;</div><div><em>Monica Eng is a WBEZ producer and co-host of the <a href="http://www.wbez.org/content/chewing-fat-podcast-louisa-chu-and-monica-eng" target="_blank">Chewing The Fat </a>podcast. Follow her at <a href="https://twitter.com/monicaeng" target="_blank">@monicaeng</a> or write to her at <a href="mailto:meng@wbez.org?subject=Surgeon%20General">meng@wbez.org</a></em></div><div>&nbsp;</div></p> Wed, 30 Sep 2015 11:11:00 -0500 http://www.wbez.org/news/science/surgeon-general-vivek-murthy-breaks-his-quiet-nutrition-and-says-it-will-be-big-part List, in ascending order, of my preference for these breaded things http://www.wbez.org/blogs/claire-zulkey/2013-01/list-ascending-order-my-preference-these-breaded-things-105181 <p><div class="image-insert-image "><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/3357734683_6857601852.jpg" style="height: 225px; width: 300px; float: right;" title="Flickr/Uncle Catherine" />Jalapeno poppers</div><div class="image-insert-image ">&nbsp;</div><div class="image-insert-image "><span>Zucchini poppers</span></div><p><br />Fish-and-chips fish<br /><br />Calamari<br /><br />Fish sticks<br /><br />Fried green tomatoes</p><p>Crab cake<br /><br />Fried chicken<br /><br />Fried pickles<br /><br />Onion rings<br /><br />Mozzarella sticks</p></p> Tue, 29 Jan 2013 08:20:00 -0600 http://www.wbez.org/blogs/claire-zulkey/2013-01/list-ascending-order-my-preference-these-breaded-things-105181 The 'next big step': Preventing 1 million heart attacks and strokes http://www.wbez.org/story/2011-09-13/next-big-step-preventing-1-million-heart-attacks-and-strokes-91974 <img typeof="foaf:Image" src="http://llnw.wbez.org//npr_story/photo/2011-September/2011-09-14/hearts_vert.jpg" alt="" /><p><p>They're calling it <a href="http://millionhearts.hhs.gov/about-mh.shtml">Million Hearts</a> – a newly launched campaign to put a half-dozen simple and proven public health strategies into wider practice. Federal health officials say it can prevent a million heart attacks and strokes between now and 2016.</p><p>Federal officials <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1110421">call it "the next big step"</a> in cardiovascular prevention. There's lots of evidence it's an achievable goal.</p><p>First, deaths from cardiovascular disease <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4830a1.htm">have already been cut by 60 percent</a> over the past generation. About <a href="http://www.nejm.org/doi/full/10.1056/NEJMsa053935">half of that reduction is due</a> to better diet, smoking cessation and other public health measures. The other half comes from from better medical treatment.</p><p>"But we still have a long way to go," <a href="http://www.cdc.gov/about/leadership/leaders/Frieden.htm">Dr. Thomas Frieden</a>, director of the Centers for Disease Control and Prevention, told Shots. "We still have 107 million adults — just about half of all adults — who either have blood pressure out of control, cholesterol out of control, or who smoke."</p><p>The campaign has two parts. One aims to change the behavior of doctors and patients. The other aims to change what all of us eat. Both are summed up by the acronym ABCS – which stands for aspirin, blood pressure control, cholesterol control and smoking.</p><p>In the realm of doctors and patients, Frieden and a phalanx of other federal officials want to expand by 10 million the number of Americans who have their high blood pressure under control and by 20 million those with controlled blood cholesterol levels.</p><p>To get there will require raising blood pressure control from less than half the people with hypertension now to 65 percent. Cholesterol control will have to triple.</p><p>The other medical-care strategy is to get people at high risk of heart attacks and strokes to take a baby aspirin every day. Fewer than half now do. The government wants to get that up to 65 percent.</p><p>Another goal is to get four million smokers to quit by 2016. That target is more modest – lowering smoking prevalence from 19 percent of adults today to 17 percent five years from now.</p><p>The smoking-cessation part of the campaign is part medical, part public health. "Less than a quarter of people who smoke get evidence-based help to quit," Frieden says.</p><p>Getting doctors to urge patients to quit "doubles the likelihood of a successful quit attempt," Frieden and Dr. Donald Berwick, the chief of Medicare and Medicaid, <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1110421">write</a> in an article posted Tuesday by the <em>New England</em><em> Journal of Medicine.</em> Prescribing one of the seven approved smoking-cessation drugs further increases quit rates.</p><p>The public health part of the stop-smoking initiative is familiar. A year from now it'll be stepped up by <a href="http://www.npr.org/blogs/health/2011/06/21/137316580/be-warned-fda-unveils-graphic-cigarette-labels">graphic new warnings</a> on all cigarette packs – unless the industry <a href="http://www.npr.org/blogs/thetwo-way/2011/08/17/139700666/tobacco-firms-sue-fda-over-graphic-warning-labels">gets courts to block them</a>.</p><p>All these strategies "could save more than 100,000 lives a year," Frieden and Berwick claim. Over five years that adds up to half the Million Hearts goal.</p><p>The rest is supposed to come from two big changes in what Americans eat. Federal officials want to cut average daily salt intake by 20 percent.</p><p>But this doesn't mean throwing away the saltshaker, Frieden says. "Most Americans eat about twice as much sodium as we should get," he says. "About 80 percent of that comes in restaurant and packaged foods — it's not what you add at the table.</p><p>"What the studies show," he adds, "is that if you take half of the salt out of food and tell people 'put as much salt on as you want,' they only put back about 20 percent of what got taken out."</p><p>So the Food and Drug Administration plans to work with the food industry to cut back on the salt that's already in food when it gets on the plate. Other agencies will press for reduced salt in food the government pays for and will try to raise consumer awareness.</p><p>Similarly, the government wants to eliminate artificial <a href="http://www.heart.org/HEARTORG/GettingHealthy/FatsAndOils/Fats101/Trans-Fats_UCM_301120_Article.jsp">trans fat</a> in purchased foods — chemicals that raise levels of bad cholesterol and lower good cholesterol. Already, Americans' consumption of trans fat has been reduced by half; going the rest of the way could save 50,000 lives a year, according to Frieden and Berwick.</p><p>This is the public face of the campaign. Behind the scenes, one driving force of Million Hearts is the realization that with more doctors using electronic medical records and adopting new medical information technology systems, improving cardiovascular preventive care is "the best place to start," Frieden says.</p><p>"Most of us get reminders from our dentists or auto mechanics or our vet if our teeth or car or pet needs maintenance," Frieden says. "But we rarely get a reminder from our doctor."</p><p>If Million Hearts works as intended, that will change.</p><div class="fullattribution">Copyright 2011 National Public Radio.</div></p> Tue, 13 Sep 2011 15:03:00 -0500 http://www.wbez.org/story/2011-09-13/next-big-step-preventing-1-million-heart-attacks-and-strokes-91974 Why the cardiologist cares about your antidepressant http://www.wbez.org/story/2011-08-25/why-cardiologist-cares-about-your-antidepressant-91098 <img typeof="foaf:Image" src="http://llnw.wbez.org//npr_story/photo/2011-August/2011-08-26/heartscreen_wide.jpg" alt="" /><p><p>The Food and Drug Administration is telling doctors and patients not to use high doses of the popular antidepressant Celexa anymore because they can raise the risk for potentially harmful changes in heart rhythms.</p><p>The agency's <a href="http://www.fda.gov/Drugs/DrugSafety/ucm269086.htm">safety advice</a> says that doctors shouldn't prescribe more than 40 milligrams a day of Celexa (or <a href="http://www.nlm.nih.gov/medlineplus/druginfo/meds/a699001.html">citalopram</a>, generically) to minimize the chances of trouble. Some patients with heart conditions — or patients who are taking other medicines that can make the problem worse, such as the antacid Tagamet — should take even less.</p><p>High doses of citalopram can lead to problems with what cardiologist call the "QT interval," a sort of electronic reset of the heart between beats. If the QT interval is prolonged, as can happen with high-dose citalopram, it can cause "a very rapid, disorganized rhythm of the pumping chamber of the heart," says <a href="http://www.northshore.org/apps/findadoctor/doctor.aspx?docid=2162">Dr. Westby Fisher</a>, director of cardiac electrophysiology at NorthShore University HealthSystem in Evanston, Ill.</p><p>The episodes often don't last long, but can be dangerous if they persist. Fisher recalled the case of a woman who blacked out while driving because too little blood was being pumped to her brain. In extreme cases, called <a href="http://emedicine.medscape.com/article/1950863-overview">torsade de pointes</a>, the abnormal heart beats can be life-threatening.</p><p>Fisher praises the FDA's advice on Celexa, as well as <a href="http://bit.ly/odIPnC">similar advisories</a> on other drugs, saying the information would help raise awareness among doctors.</p><p>Fisher has seen patients with cardiac rhythm issues related to psychotropic medicines, including Celexa. The biggest risks come from combinations of drugs, he says.</p><p>It's especially important for doctors to know patients' medical histories before prescribing drugs with this kind of risk, says Fisher. If patients have congestive heart failure, or some other conditions, such as liver disease that may interfere with their ability to break a drug down, then doctors should get an electrocardiogram, before and after starting the therapy.</p><div class="fullattribution">Copyright 2011 National Public Radio.</div></p> Thu, 25 Aug 2011 15:43:00 -0500 http://www.wbez.org/story/2011-08-25/why-cardiologist-cares-about-your-antidepressant-91098