Cardiovascular disease
Heart and coronary conditions and care

Cardiovascular health and illness,
General information about

What Is Coronary Heart Disease? National Heart, Lung, and Blood Institute, NHLBI)
Your Guide to Living Well With Heart Disease (free PDF, NHLBI) Excellent primer
Health topics (A-Z, National Heart, Lung and Blood Institute, NHLBI) Blood diseases and disorders; Heart and blood vessel diseases; Lung diseases; Obesity; Sleep disorders; Tests and procedures.
Heart & Vascular Disease fact page (useful NHLBI links)
Cardiology's 10 Greatest Discoveries of the 20th Century (Nirav J. Mehta and Ijaz A. Khan, Texas Heart Institute Journal, on PMC, 2002) Electrocardiography, preventive cardiology and the Framingham Study, "lipid hypotheses" and atheriosclerosis, coronary care units,echocardiography, thrombolytic therapy, cardiac catheterization and coronary angiography, open-heart surgery, automatic implantable cardiac defibrillators, and coronary angioplasty.
Acetaminophen Is the Best Pain Reliever for Heart Patients (Orly Avitzur, Consumer Reports, 6-19-16) "Tylenol is a good choice for those needing relief from the physical pain caused by osteoarthritis in the joints or from headache pain and who also have heart troubles such as high blood pressure, heart failure, heart attacks, chest pain due to narrowed coronary arteries (angina), or stroke. Using acetaminophen is a much safer bet than most over-the-counter pain relievers like ibuprofen (Advil and generic) and naproxen (Aleve and generic)....That’s because acetaminophen is unlike other common, over-the-counter pain medications, like ibuprofen and naproxen, which can aggravate high blood pressure, and in turn raise a person's risk of having a heart attack. "
When Evidence Says No, but Doctors Say Yes (David Epstein and Pro Publica, The Atlantic, Feb. 2017) Long after research contradicts common medical practices, patients continue to demand them and physicians continue to deliver. "Atenolol did not reduce heart attacks or deaths—patients on atenolol just had better blood-pressure numbers when they died."
Links to important information on heart disease (NHLBI)
Resources for a healthy heart (PBS Take One Step Health Campaign)
Heart Disease (HealthLine)
How to Draw a Human Heart (Emon Hassan's short video about Laura Ferguson's art and anatomy class at NYU for medical students, faculty, and staff)
A welcome side effect: Novartis anti-inflammatory may cut risk of lung cancer, study finds (Meghana Keshavan, STAT, 8-27-17) The "biologic drug canakinumab from Novartis (NVS) — which has thus far only been approved to treat a rare disease — lowered the incidence of cardiovascular complications by 15 percent" -- in line with the hypothesis that "by targeting an inflammatory pathway seen in heart disease, one could lower the risk for heart attack, stroke, and cardiovascular death." It also appears to reduce the risk of lung cancer. "The reason we have to be careful about this: It’s very exploratory, and needs to be confirmed. And while the biology is obviously very exciting and makes a lot of sense, it’s not yet clear how one would translate that into treatment algorithms for someone who already has lung cancer."
A bad heart and housemaid's knee (Pat McNees's story about Marian P. and a genetic disorder called sitosterolemia, in which the body absorbs abnormal amounts of plant cholesterol (sitosterol) and, unable to excrete it, deposits it in xanthomas and in the arteries, which leads to heart disease.
Heart diseases (also called cardiac diseases) (Medline Plus)
Calculate your risk of heart attack (Heart to Heart)
The NNT The Number Needed to Treat -- a tool to communicate benefit and harm that both patients and doctors can understand (traditionally, the number required to prevent one death). See also the Lancet article, Numbers needed to treat (needlessly?) by Peter Bogaty and James Brophy, suggesting that the NNT obscures the reality that many patients are treated without benefit. Figures on such questions as whether taking an aspirin prevents a heart attack (or does harm), whether beta blockers prevent myocardial infarction (or do harm), is the Mediterranean diet helpful after heart attack, do statin drugs given for five years (with or without known heart disease)help or harm health, in what ways? and so on.
Answers to Questions About Heart Disease (Elizabeth Nabel, NY Times, 4-17-07)
Heart disease (many articles, from the New York Times)
Waltzing helps mend hearts (Marilynn Marchione, WaPo story)
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Preventing or surviving myocardial infarction (MI, or heart attacks)

A Sea Change in Treating Heart Attacks (Gina Kolata, NY Times, 6-19-15). The death rate from coronary heart disease has dropped 38 percent in a decade. One reason is that hospitals rich and poor have streamlined emergency treatment. "The National Heart, Lung and Blood Institute, the primary federal agency that funds heart research, says this decline has been spurred by better control of cholesterol and blood pressure, reduced smoking rates, improved medical treatments — and faster care of people in the throes of a heart attack." Based on detailed analysis of the holdups in treating patients and a nationwide campaign led by the American College of Cardiology and the American Heart Association, "Hospitals across the country have adopted common-sense steps that include having paramedics transmit electrocardiogram readings directly from ambulances to emergency rooms and summoning medical teams with a single call that sets off all beepers at once." Also in this article: a clear explanation of how the heart works or fails to work. One letter to the editor also praised a broad-based effort to educate people on heart attack symptoms, so that more people know that you don’t have to have crushing chest pain to be experiencing a heart attack -- that less recognized symptoms like jaw and shoulder pain can be symptoms. Other stories in the Mending Hearts series:
---Putting Stents to the Test (Kolata, NY Times, 6-22-15)
---Medical Mysteries of the Heart (Editorial Board, NY Times, 7-3-15)
---New Alternatives to Statins Add to a Quandary on Cholesterol (Kolata, NY Times, 8-29-15)
---Blood Pressure, the Mystery Number (Kolata, NY Times, 6-23-15)
---Blood Pressure, a Reading With a Habit of Straying (Kolata, NY Times, 11-30-15)
---Data on Benefits of Lower Blood Pressure Brings Clarity for Doctors and Patients (Kolata, NY Times, 11-9-15)
---F.D.A. Approves Repatha, a Second Drug for Cholesterol in a Potent New Class (Kolata, NY Times, 8-27-15) See also FDA Approves Evolocumab (Repatha) to Prevent CV Events (Megan Brooks, Medscape, 12-1-17) "After priority review, the US Food and Drug Administration (FDA) has approved a supplemental application for evolocumab (Repatha, Amgen), making it the first proprotein convertase subtilisin/​kexin type 9 (PCSK9) inhibitor indicated to prevent MI, stroke, and coronary revascularization in adults with established cardiovascular disease (CVD). The FDA also approved evolocumab as an adjunct to diet, alone or in combination with other lipid-lowering therapies such as statins, for the treatment of adults with primary hyperlipidemia to reduce LDL cholesterol."
---Building a Better Valve (Kolata, NYTimes, 6-20-15) A new approach to replacing narrowed heart valves allows older, sicker, frailer patients to survive treatment.
---A New, Life-or-Death Approach to Funding Heart Research (Kolata, NY Times, 10-16-15)
Fact Check: NY Times Heart Disease Series Gets It Right-- Mostly ( Larry Husten, Forbes, 6-24-15)
Beware the Beer Belly (Nicholas Bakalar, Well, NY Times, 11-10-15) "It has been known for some time that having an “apple” shape increases the risk for disease and death. But the new study found that a man of normal B.M.I. with an abnormally large belly has an 87 percent higher risk for death than a man with the same B.M.I. but a normal waist-to-hip ratio. Pot-bellied women of normal B.M.I. have a 48 percent higher risk than women with normal B.M.I. and normal belly fat." Moreover, "“People with normal weight according to B.M.I. can’t be reassured that they don’t have any fat-related health issues,” said the senior author, Dr. Francisco Lopez-Jimenez, a professor of medicine at the Mayo Clinic. “Having a normal weight is not enough. It’s good only if the distribution of fat is healthy.”
Time Is Muscle: Understanding Heart Attacks (NY Times graphic, 6-20-15) Graphic shows what a heart attack is, and how a heart attack is treated. In treating heart attacks, doctors often say that “time is muscle.” Quick diagnosis and treatment can save lives and reduce or prevent damage to the heart.
CDC: One-Fourth Of Heart Attack And Stroke Deaths Preventable (Scott Hensley, Shots, Health News from NPR, 9-3-13)
Division for Heart Disease and Stroke Prevention (Centers for Disease Control and Prevention, CDC)
Interactive Atlas of Heart Disease and Stroke
My Telltale Heart (Robert G. Kaiser, Washington Post, 2-29-04) "It's a horror story, all right. One moment, your life is normal -- endless. The next, a surgeon saws open your chest, freezes your brain and scrambles to keep you alive, literally holding your heart. "
Depression Among Heart Attack Survivors Can Be Deadly, Yet Is Often Ignored (Liz Szabo, Kaiser Health News, 7-20-17) One in 5 heart attack patients suffers from severe depression, yet many get little or no treatment that could ease their suffering or save their lives.
Study: Waltzing Helps Mend Hearts (Marilynne Marchione, AP, 11-12-06, in Wash Post) "proved to be just as effective as bicycle and treadmill training for improving exercise capacity in a study of 110 heart failure patients. Dancers also reported slightly more improvement in sleep, mood, and the ability to do hobbies, do housework and have sex than the others."
Heart attack risk rises after anger outbursts (Catharine Paddock, Medical News Today, 3-4-14) Harvard researchers who analyzed decades of evidence on links between anger and cardiovascular events, concluded that in the 2 hours following an outburst of anger, there is a higher risk of heart attack, stroke or other cardiovascular event.
Higher B.M.I. in Teenagers Tied to Heart Risks Later (Nicholas Bakalar, Ask Well, NY Times, 4-15-16)
The Heart Disease Conundrum (Sandeep Jauhar, NY Times, 11-28-15) SOUTH ASIANS today account for more than half of the world’s cardiac patients. The NIH has started a Framingham-type study (Mediators of Atherosclerosis in South Asians Living in America, or Masala), enrolling about 900 South Asian men and women in two large metropolitan areas, the San Francisco Bay Area and Chicago. Researchers are focusing on novel risk factors, including malignant forms of cholesterol (previous research has suggested that South Asians may have smaller and denser cholesterol particles that are more prone to causing hardening of the arteries), as well as other social, cultural and genetic determinants.
10 Ways to Lower Cholesterol Without Statins (Charlotte Libov, NewsMax, 11-14-13)
Raising ‘good’ cholesterol doesn’t protect against heart disease after all, study finds ( Damian Garde, Stat News, 10-31-16) "HDL has been thought to lower cardiovascular risk by cleansing the bloodstream of “bad” cholesterol and scrubbing the inner walls of blood vessels, so your levels of HDL were thought to predict your risk of heart attack or stroke. But this new data suggests HDL may just be a fatty substance along for the ride." The study, published in the Journal of the American College of Cardiology, will sound familiar to the drug industry, which has repeatedly failed to design a pill that might improve patients’ lives by increasing HDL. “It’s not just [about] increasing HDL; it might be that only a specific population will respond to that increase positively.”
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Stroke (or cerebrovascular accident, CVA): Causes, prevention, rehabilitation, and recovery

Ischemic strokes occur when blood flow to the brain is blocked (usually by a blood clot) and part of the brain becomes deprived of oxygen.
Hemorrhagic strokes occur when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations(AVMs). (An aneurysm bursts, or a weakened blood vessel in the brain leaks into the brain.)
Suspect a stroke is happening? Ask the person to SMILE, TALK, AND RAISE BOTH ARMS.
Spot a stroke F.A.S.T. (American Stroke Association and American Heart Association)
FACE drooping, ARM weakness, SPEECH difficulty, Time to call 911.
Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." Is the sentence repeated correctly?
Time to call 9-1-1 – If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you'll know when the first symptoms appeared. Beyond FAST--further symptoms:
Beyond F.A.S.T. – Other Symptoms You Should Know
•Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body
•Sudden CONFUSION, trouble speaking or understanding speech
•Sudden TROUBLE SEEING in one or both eyes
•Sudden TROUBLE WALKING, dizziness, loss of balance or coordination
•Sudden SEVERE HEADACHE with no known cause
Stroke, information about (National Institute of Neurological Disorders and Stroke, or NINDS).
"Symptoms include
---Sudden numbness or weakness, especially on one side of the body
---Sudden confusion or trouble speaking or understanding speech
---Sudden trouble seeing in one or both eyes
---Sudden trouble with walking, dizziness, or loss of balance or coordination, or
---Sudden severe headache with no known cause.
Stroke warning signs and symptoms (American Stroke Association)
Stroke treatment (American Stroke Association)
Next Step Program (American Stroke Foundation) Aimed at maintaining and improving health, wellness, and participation for individuals who have moved beyond their stroke and wish to take their next steps in life. Targeted activities in four areas: Communication, Health Behaviors, Communication, Life After Stroke, and Physical Fitness.
Stroke (Medline Plus's informative site)
Patient Voices: Stroke (NY Times, 4-14-08) By temporarily severing the brain's blood supply and damaging the body's vital control centers, a stroke can change every aspect of the sufferer's life. Here, in their own words, are the stories of people coping with the aftermath of stroke.
NINDS clinical trial
What Is Stroke? (National STROKE Association)
Stroke (PubMedHealth fact sheet)
Men without caregivers at greater risk for nursing home placement following stroke (Liz Seegert, Covering Health, AHCJ, 11-29-17) Male stroke survivors over age 65 may be three times as likely to end up in a nursing home within five years if they lack a caregiver compared with those who have someone to assist them, according to a new study. A similar risk was not seen in female stroke survivors. The findings suggest that clinicians should remain aware of the critical role of caregivers in helping older adults remain independent.
REGARDS Study The REasons for Geographic and Racial Differences in Stroke (REGARDS) project, sponsored by the National Institutes of Health (NIH), is a national study focusing on learning more about the factors that increase a person's risk of having a stroke. Much to learn here!
My Invincible Summer (Diana Hardeman, Health Care in America, 12-22-16) "You’ve likely heard me describe my summer as a Netflix murder mystery set in a small town. In this series, I was the victim, the detective, and then the judge. The killer, as you know, was a stroke — my second stroke in the past three years. Luckily, it was just an attempted murder....I wanted to show you how painstaking every decision was, how necessary it is to be your own advocate, and how medicine can sometimes be a mystery."
Bad Year for Boars (Diana Hardeman, Medium, 12-30-13) "I’m a 30-year-old woman. I’m taller than your average girl, probably thinner than your average girl, and more active than your average girl. Yeah I run an ice cream business for a living, but like to think I’m healthier than your average girl, too. No prior medical history. Nothing....On day 3 we still didn't know the cause of the stroke."
New Research on Stroke Rehabilitation and Recovery (listen online to Diane Rehm show, WAMU-FM, host Susan Page, 9-26-13) or read transcript ). Guests Peter Turkeltaub, Alex Dromerick, and Audrey Holland. There are two kinds of strokes; one kind is a bleeding event in the brain; a blood vessel bursts and blood inside the brain causes damage; the more common kind is a blood clot that prevents blood flow to a portion of the brain, which, deprived of enough blood or oxygen, is damaged. The larger the stroke, the less likely you are to survive; you are also more likely to survive the second type, from a blood clot that prevents flow--get to an emergency room immediately! Excellent program--listen or read!
Hidden Stroke Victims: The Young (Anna Gorman, Kaiser Health News, 8-24-16) "The headaches were excruciating and wouldn’t go away. Her doctor said they were migraines. Then, one morning a few weeks later, Jamie Hancock stood up from the couch and discovered she couldn’t move the right side of her body. When she spoke, her speech was slurred." The 32-year-old was having a stroke.
My Beautiful Broken Brain (documentary, Netflix streaming) She was social, articulate, capable. Now she's relearning the alphabet. With her post-stroke brain, who will she become? The film details the experience of Dutch-French filmmaker Lotje Sodderland, after she suffers a hemorrhagic stroke and embarks on a journey of rehabilitation and recovery.
Resources for Caregivers of Stroke Survivors (Very Well)

CDC: One-Fourth Of Heart Attack And Stroke Deaths Preventable (Scott Hensley, Shots, Health News from NPR, 9-3-13)
Stroke Risk Scorecard
Stroke Prevention (National Stroke Association)
Nearly All Strokes Globally Have Avoidable Element (Gloria Rothenberg,Medpage Today 6-30-16) Behaviors, metabolic factors, and air pollution found key contributors. "Globally, stroke is almost entirely caused by modifiable risk factors, with air pollution emerging as a significant contributor....Potentially modifiable behaviors -- smoking, poor diet, and physical inactivity -- contributed to 74.2% of strokes...Metabolic factors -- high systolic blood pressure, high body mass index (BMI), high fasting plasma glucose, high total cholesterol, and low glomerular filtration rate -- were attributable for 72.4% ...The five risk factors associated with the strongest impact on disability-adjusted life years in developed countries were high systolic blood pressure, high BMI, diet low in fruits, diet low in vegetables, and smoking." And stop drinking sugary drinks! See Strokes Information Center (Medpage Today)
Stroke rates appear to be rising steadily in young adults (Jia Naqvi, NY Times, 4-15-17) Although overall mortality rates from strokes have significantly decreased in last 50 years, hospitalization rates for stroke nearly doubled for men between ages 18 and 44, from 1995 through 2012. "The likelihood of having three or more of five common risk factors — diabetes, hypertension, lipid disorders, obesity and tobacco use — doubled in men and women hospitalized for acute ischemic strokes." Prescription: eat your fruits and veggies, be physically active, maintain a healthy weight, don't smoke!
Empathy is a long climb (Fred Clark, Patheos, 1-3-13) Senator Fred Kirk decided "to take a closer look at funding of the Illinois Medicaid program for those with have no income who suffer a stroke, he said. In general, a person on Medicaid in Illinois would be allowed 11 rehab visits, he said. “Had I been limited to that, I would have had no chance to recover like I did,” Kirk said [after suffering a stroke]. “So unlike before suffering the stroke, I’m much more focused on Medicaid and what my fellow citizens face.”
The Best News About Stroke Prevention...Chocolate (Heidi Moawad, MD, on VeryWell, 7-27-16). Both milk chocolate and dark chocolate (both made from cocoa) provide some protection against stroke; white chocolate does not contain the same cocoa element. Nor do foods made with "chocolate flavoring" and imitation chocolate, so read the label! In the study group, the highest amount of chocolate consumed was "the equivalent of eating between 10 chocolate chips per day up to one regular size chocolate bar, or a few snack size chocolate bars per day."
National Aphasia Association
Brain stimulation helps stroke recovery (Nick Collins, The Telegraph, UK 11-17-13) Early treatment with magnets could help stroke sufferers recover their ability to speak, according to a new study.
The gray beyond: A family copes after tragedy (Keith Alexander, Linda Davidson and Sandi Moynihan, Washington Post, 7-27-13) "Thomas “TC” Maslin easily reads to himself the local newspaper or latest issue of the Economist. Reading aloud a simple children’s book is another story.
My Mother’s Stroke (Joyce Wadler, NY Times, 10-24-14) An 87-year-old woman’s carefully planned exit is knocked off course by a stroke.
My Mother’s Make-Believe Boyfriend (Joyce Wadler, NY Times, 4-21-16). "My mother’s brain has been melting since she had a stroke, and now the major territories include pastrami, kittens and a man in her nursing home. Hunks of her brain are gone, and she is still trying to gaslight her daughter...What do you do when your mother spends half her time on another planet, a snowbird of dementia?" Joyce Wadler's humor (I Was Misinformed) may help carry you through. See also Dealing With Ma’s Dementia, and That Trip Out West (Wadler, NY Times, 10-6-16)

Texas Tech Health Sciences Center’s STAR Program Offers Musical Therapy For Victims Of Aphasia (print and audio, Ariel Walden, KFYO News Talk, 7-25-13)
Oklahoma State University-Tulsa's aphasia camp is hearing kind words (Shannon Muchmore, Tulsa World, McClatchy-Tribune Information Services, 7-29-13)
Woman survives being 'locked in' after a stroke (MedStar National Rehabilitation Network). When she came to MedStar National Rehabilitation Hospital for therapy, she was in a ‘locked in’ state, meaning she could understand what you might be saying to her, but the words wouldn’t come out at all. Her rare ‘locked in’ state also affected all of her motor skills.
Fact Sheet: Coping psychologically after a stroke (PubMed Health, 12-21-12)
Jill Bolte Taylor's stroke of insight. Fascinating, informative, inspirational TED talk (on video), partly about how the brain works. Taylor (whose brother has schizophrenia) got a research opportunity few brain scientists would wish for: She had a massive stroke, and watched as her brain functions -- motion, speech, self-awareness -- shut down one by one. You can also read her book: My Stroke of Insight: A Brain Scientist's Personal Journey (a story that provides hope for the brain-injured, not just those who have had a stroke, as this young brain scientist did)
After the Stroke by May Sarton. The poet's journal about recovering from a mild stroke when she is in her seventies.
Children Don’t Have Strokes? Just Ask Jared (Jonathan Dienst, writing about his son, Jared, NY Times, 1-18-10)

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Heart surgery

Open heart surgery, explained at MedlinePlus.
The Open Heart Companion: Preparation and Guidance for Open-Heart Surgery Recovery by Maggie Lichtenberg
Organ and tissue transplants. See also Donating your body or body parts
Recovering From Heart Surgery (For Heart Bypass, Heart Valve Surgery and other Open Heart Surgery Patients) (DVD, RecoverRite)
Opening My Heart: A Journey from Nurse to Patient and Back Again (about her own open heart surgery) by Tilda Shalof.
Heart surgery (overview, Texas Heart Institute)
Minimally invasive heart bypass surgery (Medline Plus)
What Is Coronary Artery Bypass Grafting? (National Heart, Lung, and Blood Institute, NHLBI)
Cut to the Heart (PBS series on radical but promising new form of heart surgery)
• Nova has useful material online: Map of the Human Heart (images showing bloods flow path through the heart), Troubled Hearts (images, PBS, Nova)
DNA Links Deadly Germs, Tainted Heart Surgery Devices To German Factory (JoNel Aleccia, KHN News, 7-12-17) Heater-cooler devices made at the LivaNova PLC plant in Munich, Germany, were contaminated during production. Researchers also found that some hospital water systems and Maquet heater-coolers were contaminated, raising concerns about local contamination.
Treating a Sick Heart (PBS, Nova)
Narrating and imaging an aortic dissection (Edward Tufte)
Surgical corrective procedures for congenital heart disease (LearningRadiology)
The Richer You Are, the Better You May Do After Heart Surgery (Nicholas Bakalar, Well, NY Times, 10-20-15) They have found a relationship between income and survival, but that doesn't mean there is a causal effect.
More than half a million heart surgery patients at risk of deadly infection (Lena H. Sun, Washington Post, 10-13-16) "More than half a million patients who had open-heart surgery in the United States since 2012 could be at risk for a deadly bacterial infection linked to a device used during their operations, federal health officials said....The device in question is a piece of medical equipment known as a heater-cooler unit, an essential part of life-saving surgeries because they help keep a patient’s organs and circulating blood at a specific temperature during the operation....About 60 percent of these procedures use the German-made model that has been linked to the infections."
Heart Surgery, Unplugged (Jerome Groopman, New Yorker, 1-11-99). Making the coronary bypass safer, cheaper, and easier
Top-scoring hospitals for heart surgery in USA (Consumer Reports, June 2014)
Best Hospitals for Cardiology & Heart Surgery (U.S. News & World Report)
Mortality rates after surgery for congenital heart defects in children and surgeons' performance (J. Stark et al., Lancet, 18 March 2000.
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Heart disease in women

Heart Disease in Women (National Library of Medicine)
'Just A Little Heart Attack': PSA Sheds Light On The Number One Killer Of Women "While men often experience the "classic" symptom of chest pain, women's top symptoms are usually shortness of breath, weakness, fatigue, dizziness and nausea, according to the Harvard Medical School."
Anxiety in Women May Mask Heart Disease Symptoms, Researchers Say (HealthDay News, Medline Plus, 2-23-16) Women with an anxiety disorder may have less blood going to their heart when exercising, according to a new study -- and researchers suggest doctors may sometimes miss signs of heart disease in these women. ""If you're a woman and you say you're tired, short of breath, and really anxious about it, and you have no pre-existing heart disease, it's possible that doctors are confounding the two problems." Know the signs of a heart attack:
The signs of a heart attack can be different for women than they are for men.
---Chest pain (heavy ache or pressure)
---Pain in your upper body (arms, neck, jaw, back or upper stomach)
---Shortness of breath
---Breaking out in a cold sweat
---Unusual or unexplained tiredness
---Feeling dizzy or light-headed
---Feeling sick to your stomach (nausea)

More Evidence That Even 'Moderate' Exercise Helps Women's Hearts (HealthDay, 2-15-15) A few sweat-inducing workouts per week are enough to cut risks in middle age, study finds.

6 Symptoms of Women's Heart Attacks (Lisa Fields, WebMD -- symptoms for women often differ from symptoms for men, and more women die from heart attacks than from breast cancer).
Cardiac Rehab Improves Health, But Cost And Access Issues Complicate Success (Julie Appleby, Kaiser Health News, 8-31-16) In a medically supervised cardiac rehabilitation program you learn about exercise, diet and prescription drugs. "Despite evidence showing such programs substantially cut the risk of dying from another cardiac problem, improve quality of life and lower costs, fewer than one-third of patients whose conditions qualify for the rehab actually participate.... women and minorities, especially African Americans, have the lowest participation rates....Uninsured patients simply can’t afford cardiac rehab. And for those with some form of coverage, “the No. 1 barrier is the cost of the copayment, which is frustrating.”
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Pros and cons, ins and out, of various tests, treatments, habits

EKG Screening for College Athletes (Sandeep Jauhar, Opinion, NY Times, 1-26-16) "We should begin targeted screening of some groups of college athletes — starting with those in sports that recent research indicates pose a high cardiovascular risk, such as basketball and soccer."
Should you fast before a cholesterol test? ( Roni Caryn Rabin, Ask Well, NY Times, 5-24-16) ""Cholesterol levels change extremely slowly in response to food intake. That is why it is so difficult to get your cholesterol down by changing food habits."
When Evidence Says No, But Doctors Say Yes (David Epstein and ProPublica, The Atlantic, Feb. 2017) First, listen to the story with the happy ending; then listen to the one with the unhappy ending. What the patients in both stories had in common was that neither needed a stent. By dint of an inquiring mind and a smartphone, one escaped with his life intact. The greater concern is: How can a procedure so contraindicated by research be so common?Long after research contradicts common medical practices, patients continue to demand them and physicians continue to deliver. The result is an epidemic of unnecessary and unhelpful treatments.
Ankle-brachial index: Why it's done (Mayo Clinic)
Ankle Brachial Index Exam for Peripheral Artery Disease (PAD) (American Heart Association). This YouTube video shows how to administer the test (for medical professionals) but you may realize a) that it takes time and b) you have never been given the test--as I hadn't). The American Heart Association recommends it for individuals 60 and above or who are suspected of PAD problems.
Paging Cardiology (Geoffrey Rubin, Pulse--voices from the heart of medicine, 12-9-16). Choices, as seen from the beginning doctor's viewpoint.
As Part of Choosing Wisely® Campaign, SCAI Issues List of Tests and Treatments to Avoid (Choosing Wisely, ABIM, 3-31-14)
Big Health Benefits to Small Weight Loss (Roni Caryn Rabin, Well, NY Times, 2-25-16) "Obese individuals who lose as little as 5 percent of their body weight can improve their metabolic function and reduce the risk of developing Type 2 diabetes and heart disease, a new study has found."
Taking a Daily Aspirin (Roni Caryn Rabin, Ask Well, NY Times, 5-6-16) "Adults ages 50 to 69 who are at high risk for heart attack or stroke should take a daily low-dose aspirin to prevent both heart attacks and strokes as well as colorectal cancer. That’s the latest advice from the United States Preventive Services Task Force...If you’ve ever had a gastrointestinal bleed or ulcer, you probably should not take aspirin.
Cardiac Rehab Improves Health, But Cost and Access Issues Complicate Success (Julie Appleby, Kaiser Health News, 8-31-16) In a medically supervised cardiac rehabilitation program you learn about exercise, diet and prescription drugs. "Despite evidence showing such programs substantially cut the risk of dying from another cardiac problem, improve quality of life and lower costs, fewer than one-third of patients whose conditions qualify for the rehab actually participate.... women and minorities, especially African Americans, have the lowest participation rates....Uninsured patients simply can’t afford cardiac rehab. And for those with some form of coverage, “the No. 1 barrier is the cost of the copayment, which is frustrating.”
The NNT The Number Needed to Treat -- a tool to communicate benefit and harm that both patients and doctors can understand (traditionally, the number required to prevent one death). See also the Lancet article, Numbers needed to treat (needlessly?) by Peter Bogaty and James Brophy, suggesting that the NNT obscures the reality that many patients are treated without benefit. Figures on such questions as whether taking an aspirin prevents a heart attack (or does harm), whether beta blockers prevent myocardial infarction (or do harm), is the Mediterranean diet helpful after heart attack, do statin drugs given for five years (with or without known heart disease)help or harm health, in what ways? and so on.
Hospital Chain Inquiry Cited Unnecessary Cardiac Work (Reed Abelson and Julie Creswell, NY Times Business, 8-6-12) Award-winning articles on how unnecessary — even dangerous — procedures were taking place at some HCA hospitals, driving up costs and increasing profits. HCA is the largest for-profit hospital chain in the United States. Implications of the piece: Borrowing money to pay dividends to investors, HCA turned partly to (sometimes unnecessary) cardiac care to fund its business needs.
Bright Review of VitaPulse. This "infomercial scam buster" discourages purchase of this supplement sold by Princeton Nutrients. In its review of Probiotics ("The Good, the Bad, and the UGLY"), it reminds consumers that probiotics are not regulated, so you should buy them in a store or online, and tells you what to watch for.
What Is Transesophageal Echocardiography? (NHLBI) TEE is a type of echocardiography (echo), a test that uses sound waves to create high-quality moving pictures of the heart and its blood vessels. Echo shows the size and shape of the heart and how well the heart chambers and valves are working.
Cardiac Imaging Tests Beget More Tests, but No Benefit (Michael O'Riordan, Medscape, 2-10-14). See Nonivasive heart imaging tests lead to invasive tests but not to better outcomes (Gary Schwitzer, HealthNewsReview, 2-22-14) Researchers found that "noninvasive cardiac imaging actually led to a lot of invasive tests. The hospitals that do more noninvasive imaging do more invasive angiography. But none of this results in better outcomes."
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The Statin Wars (for managing cholesterol)

2 Studies Back Guidelines for Wider Use of Statins (Andrew Pollack, NY Times, 7-14-15). See Health News Review of article (rating 5 stars out of 5) But read on.
Am I heading for a heart attack? (Dan Roberts, The Independent UK, 4-18-11). Roberts weighs the evidence-based pros and cons of taking statins when his cholesterol is high. (Scoring for cholesterol is different in Canada and the UK than in the U.S., so cholesterol numbers here might confuse U.S. readers)
The statin wars expose 2 factions in medicine (Saurabh Jha, Kevin MD, 9-30-16) The latest fight between orthodoxy and free inquiry is about the benefits and harms of statins for primary prevention, with various factions arguing about whether the benefits are real, the harms are exaggerated, etc. Both sides are right, neither is wrong, yet both are wrong. Is the role of medicine to heal the sick or to stop people from being sick? Neither question is easy to answer.
More People Should Get Statins, Report Says (Maggie Fox, NBC, 7-14-15) . See Health News Review (4 stars of 5). "NBC did a better job than the Times in answering the question about risks. NBC wrote that statins “can damage muscle in 5 to 15 percent of patients. In 2012, the Food and Drug Administration updated labeling on statins to include warnings about confusion and memory loss, elevated blood sugar leading to Type 2 diabetes, and muscle weakness.” This is a nice addition to the overall coverage of the new statin studies and a step we wish more reporters had taken."
Controversy Over Statins for Older Patients (in their 70s and 80s--Judith Graham, NY Ties, 10-22-13) There is "scarce scientific evidence supporting the use of statins by 70- or 80-year-olds without pre-existing cardiovascular disease," according to a study by AMDA, a professional group representing physicians working in nursing homes. Some doctors disagree, but "There is evidence of harm linked to statin use in seniors... including muscle aches, liver toxicity and gastrointestinal distress; growing evidence of impaired memory and a heightened risk of diabetes; and some evidence of an increased risk of cancer."
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Hypertension, blood pressure, and stress

Hypertension and cardiovascular disease (World Heart Federation)
Data on Benefits of Lower Blood Pressure Brings Clarity for Doctors and Patients (Gina Kolata NY Times, 11-9-15) Driving systolic blood pressure to levels far below what current guidelines recommend — less than 120 instead of 140 or 150 millimeters of mercury — can save lives and prevent heart disease and strokes. Prescribing drugs to lower hypertension can save lives and prevent heart failure. That study answers the questions posed in Blood Pressure, the Mystery Number (Gina Kolata, NY Times, 6-22-15) However, read the following:
Drugs Not Always Best for Mild High Blood Pressure? (Veronica Hackethal, MD, Medscape Medical News, 9-24-14) and read this, too:
Aiming for blood pressure targets lower than 140/​90 mmHg is not beneficial (Arguedas JA, Perez MI, Wright JM. Cochrane report (evidence-based medicine), 7-8-09). Treating patients to lower than standard BP targets, ≤140-160/​90-100 mmHg, does not reduce mortality or morbidity. Because guidelines are recommending even lower targets for diabetes mellitus and chronic renal disease, we are currently conducting systematic reviews in those groups of patients.
Blood pressure lowering drugs reduce stroke and heart attack in elderly people with hypertension (Musini VM, Tejani AM, Bassett K, Wright JM. Cochrane abstract. "Treating healthy persons (60 years or older) with moderate to severe systolic and/​or diastolic hypertension reduces all cause mortality and cardiovascular morbidity and mortality. The decrease in all cause mortality was limited to persons 60 to 80 years of age."
The Economics & Politics of Drugs for Mild Hypertension (David Cundiff, co-author of the Cochrane systematic review, “Pharmacotherapy for Mild Hypertension, for HealthNewsReview, 11-4-13) "The Cochrane Collaboration’s Hypertension Group published a systematic review of drug treatment for mild hypertension in August 2012 showing no evidence that drugs benefit patients while about 11% have side effects severe enough to stop treatment. As coauthor of that review, I will comment on the economics, politics, regulatory intrigue, financial conflicts, and subsequent media coverage involved."

Why we're hardwired to hate uncertainty (Marc Lewis, The Guardian, 4-4-16) A new study shows that uncertainity is even more stressful than knowing something bad is definitely going to happen. But you can learn to live with it ‘There’s good evidence that gamblers are hooked, not by sure wins but by lucky wins, unpredictable good fortune.’

Making Art Will Lower Your Stress Level (Tom Jacobs, Pacific Standard, 6-16-16) A new study shows that even a short burst of creative activity can lower stress levels, Turn off cable news and start molding some clay.

The Best Exercise to Reduce Blood Pressure (Gretchen Reynolds, Ask Well, NY Times, 9-18-15) The "best way to fight hypertension may be to divvy up your workout into bite-size pieces. In a 2012 study by Dr. Gaesser, three 10-minute walks spread throughout the day were better at preventing subsequent spikes in blood pressure — which can indicate worsening blood pressure control — than one 30-minute walk....'Exercise intensity does not appear to play any significant role' in helping people control blood pressure, Dr. Gaesser says. Movement is what matters. So go for a stroll a few times during the day or simply stand up more often to develop healthier blood pressure."

Health experts have figured out how much time you should sit each day (Brigid Schulte, Wash Post, 6-2-15) According to a journal of sports medicine, "Americans should begin to stand, move and take breaks for at least two out of eight hours at work. Then, Americans should gradually work up to spending at least half of your eight-hour work day in what researchers call these 'light-intensity activities.'"

One Thing I Taught Our National Management Team: How to Do Squares (Christa Bedwin, LinkedIn, 1-14-16) A breathing exercise. The ritual or distraction of the counting is part of the calming effect.

Lower Blood Pressure Guidelines Could Be ‘Lifesaving,’ Federal Study Says (Gina Kolata, NY Times, 9-11-15) How low should blood pressure go? The answer: way lower than the current guidelines. Below 120 is the number to shoot for. One of three adults have high blood pressure, and half of those being treated for it still have systolic pressures over 140. The results of a major study make "below 120" supersede the old goal of "below 140" suggested in a June 22 article: Blood Pressure, the Mystery Number (Gina Kolata, NY Times, 6-22-15)

What a Compelling Blood Pressure Finding Means for Patients (Gina Kolata, NY Times, 9-11-15) The government stopped a blood pressure study a year early because the results were so clear: You're better off with BP below 120. "The nearly 90 approved [blood pressure] drugs fall into four main categories: drugs like diuretics that reduce blood volume by increasing water excretion, ones like calcium channel blockers that make blood vessels expand, ones like angiotensin receptor blockers that block hormones that make blood vessels constrict, and ones like beta blockers that slow the heart. Many patients in the study took two or three or even more of these drugs."

Blood Pressure Fluctuations May Signal Risk (Nicholas Balabar, NY Times, 7-30-15) Large variations in blood pressure readings from one doctor’s appointment to another are associated with and appear to be a big risk factor for cardiovascular disease and death.

High Blood Pressure Medications (, by type of medication. Click on name of medication to find side effects. Diuretics (increase urination which reduces sodium and fluid in the body); beta blockers (lower blood pressure by acting directly on the heart); Ace inhibitors (angiotensin-converting enzyme (ACE) inhibitors decrease the production of angiotensin (a hormone that causes blood vessels to narrow) and, in turn, that helps lower blood pressure; Angiotensin II receptor blockers ( prevent angiotensin from binding to receptors on the blood vessels, which helps lower blood pressure); calcium channel blockers (lower blood pressure by relaxing blood vessels and reducing heart rate); and so on (click on numbers at top to get to them) -- with alpha blockers, alpha-2 receptor agonists, central agonists, Peripheral adrenergic inhibitors, and vasodilators.

The Therapeutic Science Of Adult Coloring Books: How This Childhood Pastime Helps Adults Relieve Stress (Dana Dovey, Medical Daily, 10-8-15)
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Evidence-based cardiovascular care

Improving Evidence-Based Care for Heart Failure Patients (Gregg Fonarow, Medscape, 11-9-16)
Choosing Wisely (Coronary Care)
As Part of Choosing Wisely® Campaign, SCAI Issues List of Tests and Treatments to Avoid (Choosing Wisely, ABIM, 3-31-14)
Translating Evidence into Clinical Practice: Cardio Care (Evidence-Based Practice Network, Links to articles about specific evidence-based practices
Heart attack risk rises after anger outbursts (Catharine Paddock, Medical News Today, 3-4-14) Harvard researchers who analyzed decades of evidence on links between anger and cardiovascular events, concluded that in the 2 hours following an outburst of anger, there is a higher risk of heart attack, stroke or other cardiovascular event.
The Proof: Why Evidence-Based Medicine Improves Cardiac Care (Lisa Fratt, Cardiovascular Business, 1-1-08) "Take for example the common scenario of acute myocardial infarction (AMI) detection. Physicians can vary in the marker level used to launch the AMI order set, resulting in variability or delays in treatment. A standard cutoff—one derived from evidence-based data—levels the playing field. Another common process prone to human error is administration of aspirin and beta blockers at admission. Appropriate administration of meds is linked to positive outcomes, but the full regimen requires a precisely timed mix of medication. A standard order set helps ensure compliance and boosts patient outcomes. Such changes not only improve clinical care but also can boost the bottom line by eliminating duplicative and unnecessary tests."
The role of cardiac registries in evidence-based medicine (European Heart Journal, 1-10-10)
Evidence-Based Medicine on Coronary Care (MDLinx, which sorts, ranks, and summarizes medical news articles and journals for easy and accessible viewing)
Evidence-based medicine, generally (Writers and Editors site)
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Eminence-based medicine

"Eminence based medicine—The more senior the colleague, the less importance he or she placed on the need for anything as mundane as evidence. Experience, it seems, is worth any amount of evidence. ExperThese colleagues have a touching faith in clinical experience, which has been defined as 'making the same mistakes with increasing confidence over an impressive number of years.' The eminent physician's white hair and balding pate are called the 'halo' effect." from Seven alternatives to evidence based medicine (David Isaacs and Dominic Fitzgerald, BMJ, 1999; 319 doi: http:/​/​​10.1136/​bmj.319.7225.1618) (The other six: Vehemence based medicine, Eloquence based medicine, Providence based medicine, Diffidence based medicine, Nervousness based medicine, and Confidence based Medicine. The latter is restricted to surgeons.)

The Big Dirty Secret Every Doctor Knows (Larry Husten, Medpage Today, 8-2-16) The culture of medicine rewards the hubris of eminence and actively punishes or offers subtle disincentives to anyone who question this process. " I've been told by several cardiologists that large portions of the Maryland cardiology community had been aware for years that Mark Midei implanted stents in patients who didn't need them. No one said anything."
Pioneering Interventional Cardiologist Defends Unorthodox Practices (Larry Husten, CardioBrief, 8-1-16) –Bernhard Meier explains why he seals plaques and thinks PFO closure is ‘the best procedure in interventional cardiology’
Interventional Cardiology and the Rejection of Science (Larry Husten, CardioBrief, 7-22-16) Prominent interventional cardiologist Bernhard Meier (University Hospital of Bern, Switzerland) says clinical trials are slowing progress. "In their eagerness to embrace a glorious future of ever more spectacular technology-based advances, interventional cardiology— a subspecialty never exactly known for caution, patience, or self reflection— is poised to reject science, evidence-based medicine, and randomized controlled trials. "Generating and publishing evidence is a tedious job," writes Meier one of the top interventional cardiologists in the world, in the European Heart Journal. “Waiting for the results of randomized trials may preclude patients from an apparently good thing while the trials are ongoing.” "The problem, it should be unnecessary to point out," writes Husten, "is that what often seems like “an apparently good thing” turns out, after careful scrutiny with good evidence, to be not good at all, and perhaps even harmful."
Eminence Based Medicine And Cardiac Surgery (Larry Husten, CardioBrief, 7-26-16) Did a top surgeon perform a nonrandomized, semi-prospective, historically controlled clinical trial without IRB approval or patient consent? (One comment: "Among the many well deserved criticisms, I will say it is refreshing to know the surgeon rejected his own hypothesis."
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Books and other resources about
heart, stroke, and other cardiovascular disease

Knocking on Heaven's Door: The Path to a Better Way of Death by Katy Butler is an important book to read if you are, or are caring for, a patient with heart disease. Through the story of her father, and with final chapters that provide concise practical advice, she provides "a map through the labyrinth" of a health care system that is geared more to saving lives (no matter the cost and extended suffering) than to helping people die a good death, when death is inevitable. In her father's case, a pacemaker was installed when he was in the early stages of dementia, without fully informing the family about what that meant, or consulting about what he wanted, and it kept him alive long past when he would have wanted to die the natural death that would have come, without it. Full of essential knowledge and practical explanations in the final two chapters.
Cri de Coeur (Naderge Pierre, Pulse: Voices from the Heart of Medicine, 10-27-17) A surgical resident learns after a tense heart surgery experience that her own heart is in trouble.
• Martha Weinman Lear's memoir, Heart-Sounds: The Story of Love and Loss "Martha has done a remarkable job balancing her love story with Hal, her desperate, angry struggle to save him, along with tough, specific reportage on the medical profession. . . . What a sense Martha has for anecdote, for character, for time and place . . . for life.” —Patricia Bosworth (about heart disease, among other things)
The Sanctuary of Illness: A Memoir of Heart Disease by Thomas Larson. ''This powerful book conveys one man's struggle fighting heart disease. Thomas Larson describes multiple heart attacks, interventions, and his decision to try to change his fate with a plant-based diet. His example and dramatic rebound are truly inspiring.'' --Neal Barnard, M.D.¸ featured in the film, ''Forks Over Knives.''

Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal by Donna Jackson Nakazawa. How childhood trauma, adversity, and stress affect our physical and emotional health as adults--and are linked to adult illnesses such as heart disease, autoimmune disease, and cancer--and how to heal).

At the Will of the Body: Reflections on Illness by Arthur Frank (explores what illness can teach us about life, drawing on his experience having a heart attack and cancer)

Death: Living to Talk about It by Brian M. Hayden. "For over twenty-years I have found myself on the verge of death and fought to stay alive. My heart attack in 1989 marked the beginning of a life and death struggle that has lasted more than twenty-years. I have been in hospice, and my family told I had three weeks to live. I was on a heart transplant list, but was removed because they said I was too sick to survive surgery."

My Father’s Heart: A Son’s Journey by Steve McKee (a tender memoir about suburban life in York, PA and Buffalo, NY -- in the 1960s, in every sense a “family history,” shedding light on heart disease, especially as inherited in families). Check out Steve McKee’s blog, too.

The Open Heart Companion: Preparation and Guidance for Open-Heart Surgery Recovery by Maggie Lichtenberg

Back to Life After a Heart Crisis: A Doctor and His Wife Share Their 8 Step Cardiac Comeback Plan by Marc Wallack and Jamie Colby

Recovering From Heart Surgery (For Heart Bypass, Heart Valve Surgery and other Open Heart Surgery Patients) (DVD, RecoverRite)

Remind Me Who I Am, Again by Linda Grant. About how her mother's vascular dementia (brought on by small strokes) exacerbates Grant's troubled relationship with the woman.

After the Stroke (the poet May Sarton’s journal about recovering from a mild stroke when she is in her seventies)
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