Women in Medicine

Women in Medicine

HEART NEWS

Women in Medicine

The issues women in medicine care about

September is the American Medical Association’s (AMA) “Women in Medicine Month.” As the AMA website states, ever since Elizabeth Blackwell earned her medical degree in 1849, women have been making their mark in healthcare. This month, Capital Cardiology Associates is proud to shine the spotlight on our women in medicine. Dr. Donna Phelan sat in on a recent episode of HeartTalk, presented by Capital Cardiology Associates, to discuss the issues women in medicine care about.

Editor’s note: On the desktop version of this article, you will see images of our Women In Medicine. You can learn more about each woman by following us on Facebook.

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Amanda O'Malley
Amanda O'Malley
Amanda O'Malley
Amanda O'Malley
Amanda O'Malley
Amanda O'Malley
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Amanda O'Malley
Sarah Slader-Waldorf, NP
Sarah Slader-Waldorf, NP
Sarah Slader-Waldorf, NP
Sarah Slader-Waldorf, NP
Sarah Slader-Waldorf, NP
Sarah Slader-Waldorf, NP

Underrepresented

“Gender inequality does not just affect our patients, but also remains a significant problem within the cardiology profession.” That is the opening statement in an American Heart Association article published in 2019 that examined the women in cardiology. The all-female research team found that while women make up most medical graduates, they are less than 15% of practicing cardiologists and less than 5% of interventional cardiologists. There are a couple of reasons why this finding is alarming. The first deals with perception. Fewer women in cardiology “unfortunately creates an opinion that heart disease is not a disease that affects women; if there aren’t women in the field, it must not affect them. That is incorrect as we know,” stated Dr. Phelan. Heart disease is the number one killer of men and women, responsible for about one in every five female deaths in the United States. “Women are often ill-informed or go undiagnosed for heart disease. Helping women recognize how prominent heart disease is in the female population is important, especially at a young age in making good lifestyle choices,” added Dr. Phelan. Knowing your blood pressure, quitting smoking, limiting alcohol use, managing stress levels, making healthy food choices, maintaining daily activity or exercise, and most importantly, regular visits with your health care provider are all steps to lowering the chance of developing heart disease.

“So much of what we think about preventing cancer applies to reducing the risk of heart disease.”

Donna Phelan, MD, FACC

The reality is that cardiovascular disease is largely the most important women’s health issue, mainly because it can be prevented. The American Heart Association’s “Go Red for Women” campaign has helped raise awareness of heart disease at all stages in life. This is key, as there are two points in life where physical and psychological changes can significantly impact women’s risk of heart disease. The first is pregnancy. “Pre-existing conditions like high blood pressure or other congenital issues need to be recognized as potentially problematic when planning for a family or pregnancy,” adds Dr. Phelan. Weight gain is a discussion women need to have with their healthcare provider. Researchers show that overweight or obese pregnant women are more likely to develop heart disease later in life. There are also health risks to the baby, like gestational diabetes or preterm labor, associated with weight. It’s important for women to have open discussions on their physical health, mental well-being, and family health history with their healthcare provider as they begin family planning. “There are many cardiovascular conditions that can arise during pregnancy that often require a cardiologist’s assistance to get [the mother] successfully through pregnancy. There are also conditions that can make the potential for having more children dangerous to the mother’s health.”

Later in life, menopause, which usually happens in the mid-’50s, can be problematic for some women when there are lower levels of estrogen in their body. Researchers say women are susceptible to coronary artery disease during the menopause transition due to a deficiency in estrogen from the loss of ovarian function. Post-menopausal women often have higher cholesterol levels than men and are at greater risk of developing high blood pressure, even if they had normal levels throughout life. Many women have difficulty managing some or all of these added personal well-being needs. “There are natural changes in a woman’s health as she ages that must be discussed ahead of time to try and minimize the issues that can come about,” advised Dr. Phelan.

Issues women physicians care about

A 2020 Medscape survey of more than 3000 women physicians revealed interesting insight on the issues that absorb them the most. Work-life balance was by far the most important issue for women. 64% of respondents named it as their #1 problem. “Among female physicians and I suspect across most fields that require intense work schedules, I imagine an on-going discussion on how to prioritize work and family and your children all at once,” Dr. Phelan acknowledged. Taking care of aging parents or combining parenthood and work schedules are viewed as the largest challenge for women in the workforce today. Dr. Phelan also noted how this concern has intensified during the COVID pandemic. “It’s a constant struggle, something we face regularly, and there is no real solution.” Single parents or in families where both parents work, adults have used their vacation to spend time with their family, exhausted personal time off hours to attend their children’s school functions, or in the time of COVID, utilized the work-from option to provide homeschooling support or child care this past summer. For female physicians, there is also the reality that even when mom is home, she is still on-call for patient care. “There are endless evenings and weekends when I am calling patients back or looking at their testing results after hours. That’s where that juggling is difficult. I’m at home, working, and my kids are used to it.”

Medical students considering a career in specialized medicine understand the significant time investment required to obtain their goal. After completing high school, the path to becoming a board-certified cardiologist includes graduate school, medical school, with an additional two to six years of specialty training after receiving a doctorate. Most young women may be thinking about having a family, and that is a lifestyle that is hard to juggle. This decision either leads to delaying a family’s start, spacing out the birth of children (more than four years apart), or choosing to have one child. It takes a lot of dedicating and motivation to pursue a career in the field of cardiology,” Dr. Phelan commented. An overwhelming majority of women physicians said they have had to make such tradeoffs. A professional choice may include avoiding leadership or supervisory roles in order to maintain a more flexible schedule. According to the American Medical Association, women account for 3% of healthcare CMOs, 6% of department chairs, and 9% of division chiefs. Today, there is a push for more female leaders in healthcare as about one-third of women physicians indicating they are interested in achieving a higher position.

Mentors and support

The rigors of medical school are challenging for every student. As we discussed the different desires and goals between men and women, Dr. Phelan shared the unique connection female students form during their education. “Unfortunately, during medical school and training, you don’t have time for a social life. Your colleagues are the people you spend the most time with,” she shared. We discussed the friendship Dr. Phelan formed with a fellow female student while pursuing their medical degrees at Albany Medical College in the late 1990s. Donna Phelan and Allison DeTommasi were both young women who shared an interest in math, medicine, and science. They also had a passion for taking care of others. These women were part of a change in the dynamic of the healthcare industry; more women are replacing the stereotype of a doctor being a man in a white coat wearing a stethoscope.

More than half of today’s medical students are women, while in 1915, less than 3% of med school graduates were women. In October of 2018, Drs. DeTommasi and Phelan were highlighted during WTEN/Channel 10’s Inspiring Women segment. “The proportion of young women that are going into medicine has escalated tremendously, and I think there is great value in that,” Phelan said. DeTommasi spoke about the young women who approach her, with a similar interest in medicine, seeking her advice. “You really have to love this,” Dr. DeTommasi advised. Both physicians addressed the support system that exists from women in medicine. “An important motivator and support system is having colleagues who have gone or are going through this experience together. We are one big team, looking out for our patients and taking care of our families,” said Dr. Phelan.

Written by Michael Arce, Host of HeartTalk, presented by Capital Cardiology Associates

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Mary Witkowski PA-C
Dr Donna Phelan
Dr Donna Phelan
Heather A. Stahura, MD
Heather A. Stahura, MD
Heather A. Stahura, MD
Karen Canniff
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Maryellen
Catarina Paone, NP
Barbara Hendrick, PA
Barbara Hendrick, PA
Barbara Hendrick, PA
Barbara Hendrick, PA
Barbara Hendrick, PA

How stroke affects your brain

How stroke affects your brain

PATIENT EDUCATION

How stroke effects
your brain

Only a few minutes of lost blood flow can damage the electrical signal receptors in the brain

According to the Centers for Disease Control and Prevention (CDC), every year, more than 795,000 people in the United States have a stroke. Of those cases, about 140,000 Americans are killed by stroke each year — that’s 1 out of every 20 deaths. Many myths make stroke a life-threatening health emergency. One common misbelief is that strokes only happen to older people. “Stroke can affect all segments of life, all ages, even from childhood through adulthood,” says Dr. Alan Boulos. Dr. Boulos is Chair of the Department of Neurosurgery, Director of the Neurovascular Section, and Associate Professor of Neurosurgery and Radiology at Albany Medical Center. He has invested over 20 years researching and studying disorders of the brain and spine including stroke. He joined me recently for a special episode of HeartTalk presented by Capital Cardiology Associates that explored the effect of stroke on the brain.

There was concern from the medical community on the severe drop in visits to the emergency department (ED) in April, due to COVID-19 concerns. Hospitals outside of the pandemic hotspots, like Albany, reported almost a 50% reduction in patients seeking critical care. This was alarming to cardiologists, neurologists, ED physicians, and advance care providers who noted that patients were delaying care for serious conditions like stroke or transient ischemic attacks (TIA), otherwise known as ministrokes. Ministrokes, as they are commonly called, are brief interruptions of blood flow to the brain due to clots. “These are a harbinger of bad things that could come,” Dr. Boulos commented. According to the CDC, over a third of people who experience a ministroke have a major stroke within a year if they do not receive any treatment. In the case of a ministroke, a patient may experience the classic stroke warning signs: weakness on one side of the body, vision problems, and slurred speech. Dr. Boulos explained common ministroke scenarios that could last minutes to hours. “You may suddenly drop your coffee mug because the dexterity is not there in your hand. You may temporarily lose vision or have a gray blur in your eyesight while watching TV or reading. That was an event! It’s a sign of things that could come.”

What is a stroke?

When we think of blood flow in our body, we often think of our heart as the pump that circulates blood through our vascular system. Dr. Boulos reminds patients on the importance of blood flow to the brain. “The brain is very dependent on oxygen and blood flow, more than any other organ in the body. It takes about one-fifth of our blood flow every time the heartbeats.” Dr. Boulos defines a stroke as a condition that brings a sudden change in someone’s neurological function. The term comes from an old Greek phrase meaning someone has been struck by God. “In most cases, stroke occurs when blood flow to the brain is interrupted or blocked off either by a clot or by plaque, and that results in the brain to stop working,” he added. During a common (ischemic) stroke, patients may have trouble walking, speaking, and understanding, as well as paralysis or numbness of the face, arm, or leg. “Where the brain is affected will determine what symptoms are presented. The less common variety is the opposite,” noted Dr. Boulos. A hemorrhagic stroke is when an artery in the brain leaks blood or breaks open. In these events, the artery in the brain bursts or there is bleeding in the area between the brain and the thin tissues that cover it. “When blood sits outside the brain in the skull, that can be a life-threatening event.”

One of the challenges with stroke is that it can happen at any time to anyone. “When a stroke occurs, it has symptoms that vary from patient to patient. It can be anything from a speech problem to a blind spot developing on the right or left side of your field of vision, causing a car accident.” shared Dr. Boulos. Heart attacks traditionally present with chest pain, pressure, or shortness of breath — only about 30 percent of people will have a headache with an ischemic stroke, so pain isn’t a reliable symptom. This is why stroke is the leading cause of disability in adulthood and is the number five killer in the US. As a neurologist, Dr. Boulos detailed how stroke affects the brain. “Patients often can describe when the symptoms do begin. But there is also part of the brain that controls the recognition of those symptoms, the parietal lobe; it’s related to neglect. If stroke targets that part of the brain, we won’t recognize that our right hand is part of our body. Even if our right hand may not be working, we don’t recognize that it is a problem. As part of the stroke, it may cause symptoms that prevent us from recognizing the problem. That is why our friends, family, co-workers, and the people around us are so important. They can recognize when the victim is not behaving properly. That is a clear sign that person needs medical care!”

Mind figurine

Brain damage and recovery

Scientists at the Brain Research Centre at the University of British Columbia and Vancouver Coastal Health Research Institute found that damage to the brain can happen as soon as three minutes following a stroke. As a neurosurgeon, Dr. Boulos plays an important role after the stroke has occurred. “We often get involved in the hospital to try and manage that patent. To try and reverse the stroke or at least perform procedures that minimize the damage that the event has caused,” he shared. The extent of what we know about brain damage from stroke has evolved greatly over the years. “In the old days we used to think that the brain didn’t have the ability to produce cells, it didn’t recover once it was injured, or at best, it was poorly able to recover. That has largely been wrong.”

Your brain is divided into left and right halves, called “hemispheres.” They specialize in different things. Because of this, a stroke on the left side of your brain can be very different from a stroke on the brain’s right side. Let’s look at some symptoms of a left-brain stroke.

The American Stroke Association states that the effects of a stroke depend on several factors, including the location of the obstruction and how much brain tissue is affected. Stroke on the left side of the brain, for example, will affect the right side of the body and vice versa. One significant difference is that left-brain patients may have a slow, cautious behavioral style and speech/language problems, while right-brain patients may have a quick, inquisitive behavior and vision problems. If the stroke occurs in the brain stem, it can affect both sides of the body, and patients may be unable to speak or move below the neck. “I think it’s about rewiring synapses, the tiny brain switches that relay information from one neuron to another,” said Dr. Boulos. “The brain is a complicated electric organ/system. If the connections can be re-established, if other parts of the brain can take over function, then we can see patients recover their abilities despite their being an area of the brain that was damaged.” What is common for stroke patients are physical challenges, communicating clearly, or changes in their emotions or mood.

Let’s explore some symptoms of a right brain stroke.

Grandparents with baby

It is encouraging that recovery from a stroke event is possible; this involves dedication to rehabilitation and time. While a stroke can leave a patient disabled over a lifetime, there is a good opportunity, especially in the beginning, for rehab and recovery. Part of the problem is that this occurs very slowly, up to two years in some cases. Due to the severity of the stroke, there may not be a dramatic improvement in other patients. “I have patients who have committed to the rehab process who have been able to get better over time. How that happens within the brain is poorly understood. When you look at the image of the brain, you will see areas that are damaged by the stroke. We don’t see much change over time,” mentioned Dr. Boulos. “There is also very hopeful research around stem cells and other infusions that might accelerate the recovery process for patients that have suffered from stroke. This is still very much in the early phase, but I am very optimistic about this work.”

Written by Michael Arce, host of HeartTalk presented by Capital Cardiology Associates.

Photos by David Cassolato, Jake Ryan, and meo from Pexels

Diabetes Alert Day

Diabetes Alert Day

HEART HEALTH

Diabetes Alert Day

How to avoid becoming a
statistic in America’s
diabetes trend

American Diabetes Association Alert Day is observed annually on the fourth Tuesday in March. This one-day “wake-up call” informs the American public about the seriousness of diabetes and encourages all to take the diabetes risk test and learn about your family’s history of diabetes. This year, I had a conversation with Bob Russell, Upstate New York Executive Director of the American Diabetes Associates (ADA) and Felix Perez, Market Director for the ADA in Albany.

There are some shocking stats on diabetes: Almost 10% of the American population is affected by diabetes. Nearly 1 in 4 American adults living with diabetes are unaware they have it. Bob Russell was personally compelled to change that statistic because he is one of those Americans. He was twenty-five years old when he was diagnosed with type 1 Diabetes. “I was in the best shape of my life. I wasn’t sure what it meant. I certainly didn’t realize that it was a life-long disease that I would be dealing with. I remember joking with my doctor, ‘a few less beers, a few less chicken wings, right?’ I didn’t understand the complete change in lifestyle,” said Russell.

Three types of diabetes

There are three main types of diabetes – type 1, type 2, and gestational. Understanding what type and what the options are available is part of the problem of living with diabetes. “It’s a multi-pronged disease,” Russell begins. “That’s where the confusion begins. Diabetes is often a punchline in movies and TV shows. ‘Oh, there’s a plate of chocolate; you must have diabetes.’ That’s not the reality of it. We have kids as young as ten months old being diagnosed with this; it really is an auto-immune disease.” In all types, diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin or when the body cannot make good use of the insulin it produces.

What you need to know about diabetes

Type 1.The CDC estimates that nearly 1.6 million Americans have it, including about 187,000 children and adolescents. When you have type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood glucose levels under control. Type 1 diabetes occurs at every age, in people of every race, and of every shape and size.

Type 2.Type 2 diabetes is the most common form of diabetes and accounts for around 90% of all cases. It means that your body doesn’t use insulin properly. While some people can control their blood sugar levels with healthy eating and exercise, others may need medication or insulin to help manage it.

Gestational diabetes (GDM). This type of diabetes consists of high blood glucose during pregnancy and is associated with complications to both mother and child. It happens to millions of women. GDM usually disappears after pregnancy, but women affected, and their children are at increased risk of developing type 2 diabetes later in life.

Health risks of uncontrolled diabetes

Diabetes is treatable; it does become dangerous when glucose levels are uncontrolled. Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes. “This is called ‘the silent disease,'” adds Russell. Undiagnosed and uncontrolled diabetes leads to a wide array of health problems like high blood pressure, unhealthy cholesterol levels, and high blood sugar levels. This is a long-term process, a development that occurs over the years where a normally healthy person becomes less active over time gains bodyweight, which leads to a lifetime of damage to vital organs. “By the time you realize what is happening, that damage is already done and can’t be reversed.”

Diabetes has been proven to affect your vision, one of the warning signs that Bob Russell recalled before his diagnosis. “I was having problems with my vision. I got new glasses. Two weeks later, I went for blood work. That’s when I got a call from the nurse that I needed to meet the doctor in the emergency room right now. My blood sugar levels were 790. I was feeling fine, but there were symptoms that were leading up to this. Excessive thirst, frequent urination. When you are active, you don’t think these are a sign of diabetes. That’s the problem.”

Common diabetes complications

Vision.
High blood sugar can damage blood vessels in the eyes which are the leading cause of blindness in adults age 20-74 according to the National Eye Institute. This is why a yearly eye exam is important.

Nerve damage.
High blood sugar affects the hands and feet. Uncontrolled blood sugar levels can also lead to chronic brain damage.

Heart disease.
The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease (CVD).

Kidney disease. Diabetes is a major cause of kidney failure and other kidney problems.

Pregnancy complications.
Women with any type of diabetes during pregnancy risk a number of complications if they do not carefully monitor and manage their condition.

Know your risk

Since diabetes can strike anyone at any age, at any time, the message of Diabetes Alert Day is to know your risk. “One of the tools we use is the ADA Risk Test. It’s seven simple questions you take; all it takes is 60 seconds of your time,” said Perez. The test collects your age, gender, family history, high blood pressure history, level of physical activity, race, height, and weight. A high score on the online Risk Test (five or higher) means an individual has a significant risk for having undiagnosed pre-diabetes or type 2 diabetes; however, only a blood test can determine a diagnosis. In my case, it led to having a conversation on my risk of type 2 with my doctor during my yearly visit. During my doctor’s appointment, we discussed how losing 10-15 pounds can make a big difference, as well as the role of even occasional tobacco use, affects my cholesterol levels.

Pre-diabetes affects almost 88 million Americans. The American Heart Association described pre-diabetes as a point where your blood sugar levels are higher than normal, but not yet crossing the threshold of a diabetes diagnosis. “Three years ago there were 84 million people living with pre-diabetes, meaning that they are not there yet, but they are headed in that direction. The CDC just released their latest report; the number is now 88 million people. We are going in the wrong direction,” added Russell. Many people with pre-diabetes develop type 2 diabetes within ten years. Overweight adults over the age of 45 with a family history of type 2 diabetes are at risk. We also know that African Americans, Hispanics/Latinos, American Indians, Pacific Islanders, and some Asian Americans are at higher risk. You can make lifestyle and health changes, like losing 10-15 pounds, for example, to lower your risk of advancing to type 2 diabetes.

Knowledge is key. That is the message from diabetes alert day. Take the ADA Self Test. Talk with your doctor about your family history and personal risk. Have your A1C levels checked with a simple blood test, if recommended. Most importantly, stay active and live well. You can live with diabetes. While there is no cure, millions of people live healthy lives. The American Diabetes Association has a great online resource, the ADA Support Community, a dedicated and passionate online community that shares education, health recipes, and activity/exercise workouts to keep you living your best life.

Written by Michael Arce, Marketing Coordinator. Host of HeartTalk presented by Capital Cardiology Associates.

Why Statins?

Why Statins?

PATIENT EDUCATION

Why doctors prescribe statins

How a half a billion-year war between ancient
bacteria and fungi have helped to lower
cholesterol and become a new weapon
to fight cancer

About 40 million adults in the U.S. take a statin to lower their cholesterol and to reduce their risk of heart disease, heart attack, or stroke. New research suggests a possible anti-cancer benefit for statins. Dr. Robert Benton, Director of Research at Capital Cardiology Associates, explains how statins became one of the standard medications prescribed for heart health.

The link to lowering cholesterol production

Some say the history of statins in medicine begins with Virchow, the German pathologist and one of the 19th century’s foremost leaders in medicine and pathology. He discovered a yellow, fatty substance on the artery walls of patients dying of heart disease or a heart attack before the turn of the century. That plaque was later identified as cholesterol. At that time, physicians were not convinced of the link between cholesterol and coronary heart disease. That connection would not be made until the 1950s.

The Seven Countries Study, initiated in the 1950s, brought together researchers from all over the world. It became a collective effort to study their common questions about heart and vascular diseases among countries with different traditions in diets and lifestyles. This study focused on coronary disease and cholesterol in Italy, Spain, South Africa, and Japan from 1952 to 1956 and Finland, Italy, and Greece from 1956 to 1957. We learned that cholesterol, blood pressure, diabetes, and smoking are universal risk factors for coronary heart disease. The discovery was made that when the body makes too much cholesterol, there is a higher risk of heart disease, heart attack, or stroke.

Researchers began studying how to lower cholesterol to benefit patients. They tried using diet modifications at first, promoting the eating pattern they found in Italy and Greece in the 1950s and 60s, now popularly called “The Mediterranean Diet.” By the mid-1960s, scientists were exploring for ways to alter how cholesterol was produced, chemically. In the 1970s, a microbiologist in Japan, Akira Endo, added research into how antimicrobial agents reduced cholesterol. “It’s almost like the discovery of penicillin. You find the effect of one organism on another and use that to attack a problem. This is a similar thought process that led to finding statins,” noted Dr. Benton. By 1978, the first statin, lovastatin, was discovered.

What is a statin

“A statin is an enzyme that works in your liver to help you make cholesterol, usually at night. What the statins do as a class of medicine, is prevent that long chain of metabolic steps from being completed,” explained Dr. Benton. By the mid-1980s, lovastatin became available for prescription use and was able to reduce LDL cholesterol, producing very few side effects effectively. “I don’t remember my first statin prescription; it was probably in medical school in the early 1990s. When I became a cardiologist, that’s when statins became standard in the care of patients. There were other medicines that we used before that which were not as effective,” recalled Benton.

Simvastatin (Zocor) was the second statin used clinically. Pravastatin (Pravachol) followed in 1991, fluvastatin (Lescol) in 1994, atorvastatin (Lipitor) in 1997, cerivastatin (Baycol, Lipobay) in 1998, and rosuvastatin (Crestor) in 2003. “What happens is there is one chemical entity, and science tries to make it better. Can it be better absorbed, lasts longer, have a better target, or durability? Clinical trials then test to see if it’s safe and effective in lowering cholesterol and heart disease endpoints. That’s how you make the progression through the different statins that have been prescribed over time,” outlined Dr. Benton. Today, statins are one of the most common medicines prescribed in the U.S., with about 40 million people taking them. “Statins are clearly the first-line therapy along with modifications in diet and exercise in lowering cholesterol. Certainly, for secondary prevention, a person who has had a heart attack or stroke should be on a statin. A person with diabetes should be on a stain. These are generic medicines that do not cost very much,” states Benton.

Statin controversy

For a 42-year old drug, statins have had their fair share of reviews and criticism. A bitter dispute erupted in September of 2016 among doctors over suggestions that statins should be prescribed to millions of healthy people at low risk of heart disease. The controversy focuses on who should receive statings and how common/serious are the side effects. Dr. Benton is well aware of the conflict, “like any medicine; there is a risk/benefit profile. I think there is no controversy for being on a statin for secondary prevention after a cardiac or vascular event – that’s not an issue.” In 2013, a joint task force of the American College of Cardiology and the American Heart Association released guidelines for treating cholesterol. These guidelines focused on treating the patient based on his or her risk of developing heart disease, not a target number.

GROUP I

People without cardiovascular disease who have risk factors for the disease and a higher 10-year risk of a heart attack. This group includes people who have diabetes, high cholesterol, high blood pressure, or who smoke and whose 10-year risk of a heart attack is 7.5 percent or higher.

GROUP II

People who already have cardiovascular disease related to hardening of the arteries (atherosclerosis). This group includes people who have had heart attacks, strokes caused by blockages in a blood vessel, ministrokes (transient ischemic attacks), peripheral artery disease, or prior surgery to open or replace coronary arteries.

GROUP III

People who have very high LDL (bad) cholesterol. This group includes adults who have LDL cholesterol levels of 190 mg/dL (4.9 mmol/L) or higher.

GROUP IV

People who have diabetes. This group includes adults who have diabetes and an LDL between 70 and 189 mg/dL (1.8 and 4.9 mmol/L), especially if they have evidence of vascular disease or other risk factors for heart disease such as high blood pressure, smoking or being older than age 40.

The most common side effect of statins is muscle ache or pain. “Somewhere around 5 to 10% of people have muscle ache or myalgia. That’s real,” said Dr. Benton. Typically, aches and pain can be eliminated by changing the dose, frequency, or type of statin. Please talk with your doctor about your concerns as they can usually find a statin that you can tolerate without side effects. “There are people who are at a predisposition to have mild muscle aches. In extreme rare occurrences, there is dissolution of the muscles, they become destroyed, but that is a sporadic occurrence.”

There is a controversial link between statins and memory loss. A John Hopkins review of dozens of studies on the use of statin medications to prevent heart attacks shows that the commonly prescribed drugs pose no threat to short-term memory and that they may even protect against dementia when taken for more than one year. “All medications, including stat-ins, may cause side effects, and many patients take multiple medicines that could theoretically interact with each other and cause cognitive problems,” says Kristopher Swiger, a primary author of the study. In 2015, the U.S. Food and Drug Administration (FDA) made labeling changes to statins to outline the potential for non-serious and reversible side effects, which include: memory loss and confusion, increased blood sugar, increased hemoglobin A1c levels.

Statins anti-cancer properties

Doctors at Duke University School of Medicine in Durham, North Carolina investigated whether statin use affected outcomes in veterans at a VA Medical Center who had been diagnosed with colorectal cancer. They found that after five years, those taking a statin were 38% less likely to die from colorectal cancer. How does a cholesterol drug fight cancer? Dr. Benton explained how statins block the same enzyme the body needs to make cholesterol, called HMG-CoA. This process also slows cancer cell growth. “There are multiple enzymes in cancer cells. Statins, as a class of medicines, have many different targets that they work on. Any type of chemical entity that would interfere with that pathway of growth is probably a method of preventing cancer cells from progressing. I don’t think you are going to find people treating cancer with statins; it may be an off-target approach. You need cancer medicines, chemotherapy or biologics, or radiation, but statins may have some augmented type of function.” Research is also underway on the anti-cancer properties using statins and the diabetes drug metformin (often prescribed together) in men with prostate cancer. Men who took both drugs in a study lived longer than those who only took the statin or those who didn’t take either drug. Researchers believe the drug combo may help slow the growth process of prostate cancer. Expect to see more news on clinical trials using either metformin or a statin in cancer treatment in the coming months.

Written by Michael Arce, Marketing Coordinator

The High Cost of Obesity

The High Cost of Obesity

HEART HEALTH

The High Cost of Obesity

How the obesity trend will
impact more than the American
healthcare system in ten years

“Ten years from now, nearly half of U.S. adults will be obese if current trends continue.” Those were the findings in a study published in the New England Journal of Medicine by researchers from the Harvard T.H. Chan School of Public Health. The team stated that by 2030, 48.9% of adults nationwide will be obese. Obesity affects low-income adults, minorities, and women at higher numbers. It is also one of the three major controllable risk factors in the development of heart disease. “Unfortunately, for myself and my colleagues, we see this trend increasing at an alarming rate,” commented Dr. Heather Stahura, a board-certified cardiologist at Capital Cardiology Associates.

What is obesity?

Harvard researchers shared in their December 2019 findings that they used body-mass index (BMI) data collected from the Behavioral Risk Factor Surveillance System Survey (1993–1994 and 1999–2016) and the National Health and Nutrition Examination Survey. These were large studies of over 6.2 million adults (18 and over) from all 50 states. There has been a controversy within the medical community on the relevancy of BMI. Body mass index is a measure of body fat based on height and weight that applies to adult men and women. There is an online calculator from the National Heart, Lung, and Blood Institue where you enter your height (in feet and inches) along with your weight to compute your BMI. For example, a man who is 6 feet 0 inches, weighing 220 pounds would have a BMI of 29.8. Dr. Stahura points out that this calculation is where the problem begins.

“Obesity means different things to different people. If you want to look at hard endpoints, you will look at BMI. A BMI between 18-25 is considered normal. Over 25 is overweight. Anyone above 30 would be obese. The problem with BMI is that you cannot always say that someone with a BMI of 29.8 is overweight,” explained Dr. Stahura. In this example, the person with a BMI of 29.8 is me, a 42-year old male who ran almost 30 miles in the month of January. “You have to consider the whole person. BMI because it calculates your height to weight, there are outliers. If you are very tall, you may look like you have a higher BMI but be quite healthy. Five pounds of muscle weighs the same as fat. I would say muscle weight is healthier than fat. I think it matters more where you are carrying visceral fat – it’s worse around the stomach than your legs and rear.” This discrepancy, looking at the hard data without considering the patient body composition, is one area where the Harvard study came under fire. The team reported that 1 in 4 adults are projected to have severe obesity by 2030 (BMI above 35), and the prevalence will be higher than 25% in 25 states. The locations of these obese states/areas were the second area of controversy.

Why do some areas of the country struggle with body weight?

Lead study author, Zach Ward, addressed how the obesity prevalence is lower in some states than in others. “Obesity is rising in every state in the United States. And, some states are going to be at a very high level. We find that severe obesity is growing very rapidly in about 25 states.” Three of the states with the highest levels of obesity are Alabama, Arkansas, and Mississippi. “This is a hot button topic,” replied Dr. Stahura. “Unfortunately, a lot of Southern states suffer from a lower socioeconomic status. These states have to conserve their funds, making resources stretch further.” The Harvard team acknowledged that awareness was critical in combatting the obesity crisis. “It’s really hard to lose weight; it’s really hard to treat obesity. Prevention has to be a the forefront to combat this growing epidemic,” noted Ward.

The cost of obesity

There is long-standing research measuring the effect of obesity on the American healthcare system. The medical costs of obesity in the United Staes were estimated to be around $147 billion in 2008, according to the Centers for Disease Control and Prevention (CDC). There are also concerns that this health epidemic will impact all aspects of the American economy. Obesity imposes costs in the form of lost productivity and foregone economic growth as a result of lost workdays, lower productivity at work, mortality, and permanent disability. “One of the reasons we did this study was to help state policymakers,” said Ward. “And there’s a lot that they can do. One of the most effective and cost-saving interventions is limiting the intake of sugar-sweetened beverages. Some states are implementing a sugar-sweetened beverage tax. Which we find in some areas would actually save more money than it costs to implement.”

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Do smoking and soda bans work? “There is an interest in your government, believe it or not, in having you live a healthy lifestyle,” declares Dr. Robert Benton, Clinical Research Director at Capital Cardiology Associates. “The costs of health care are huge in this country. We could save so much if people ate a healthy diet and exercised. Why not let people know that? Why not remind people of that? Not to the point of being onerous but allowing you to make your own decisions, giving you the information to be confident with your lifestyle choices.”

One of the key points stressed by every government health agency, medical professional, and healthcare expert is the need of at least 30 minutes of moderate physical activity every day to combat obesity, heart disease, and other health issues. A healthy diet that emphasizes eating whole grains, fruits, vegetables, lean protein, low-fat and fat-free dairy products, and drinking water is also recommended. “There is a notion of being ‘fit but fat.’ When I talk with my patients, I encourage any activity or exercise, just moving more, even if the scale isn’t reflecting the change they want, as long as they are getting out and moving, that’s a success,” added Dr. Stahura. Having a healthy diet pattern and regular physical activity is also important for long term health benefits and prevention of chronic diseases such as Type 2 diabetes and heart disease, both long-term by-products of obesity and a sedentary lifestyle with poor health choices.

Written by Michael Arce, Marketing Coordinator
Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.