The Polypill

The Polypill

HEART HEALTH

One pill with many benefits

The Polypill has the potential to
reduce cardiovascular disease in
the places that need the most help

The are several barriers for patients in the healthcare system: taking time off for appointments, reliable transportation to your doctor’s office, have a working telephone number, can afford prescription medications, that you speak English, or understand your doctor’s instructions. For cardiac patients that live in remote or rural areas, these challenges seem more overwhelming when travel time or accessibility to a pharmacy or physician are considered. A low-cost, daily pill that combines four cardiac drugs known as “The Polypill” was recently tested in rural Alabama and across Iran and has shown promise to be a solution to undertreated heart patients.

What is the Polypill

Dr. Robert Benton is a board-certified cardiologist, Chief of Cardiology at Samaritan Hospital, and is the Director of Clinical Research at Capital Cardiology Associates. He broke down the Polypill on a recent episode of HeartTalk presented by Capital Cardiology Associates. “These are medicines that we know of: aspirin, a diuretic, a statin, and a blood pressure medicine. One of the questions here is, can we take medications to an at-risk population and combine low-doses of generic medications, which are inexpensive, to see if we can decrease cardiovascular outcomes? As this study in Alabama indicates, yes, yes, we can.” Just over 300 adults living in the Mobile, Alabama participated in The SCCS Polypill Pilot Trial. The trial was made up of adults 45 to 75 years of age without cardiovascular disease. 96% of participants were African-American, with an annual income under $15,000. Their blood pressure (140/83) and LDL cholesterol levels (113 mg) fell just above normal readings. Over 12 months, the study assessed medication adherence, systolic blood pressure, and LDL cholesterol. After one year, the patients on the polypill saw their blood pressure drop, on average, seven points. Their cholesterol fell by 11 points.

“This was more proof of concept trial,” added Dr. Benton. “The Alabama study was small, not an outcome study, but it does show that people who have difficulty accessing healthcare, these medicines can make a difference. We are seeing the cost-analysis of providing generic medications versus the cost of stroke or heart attack. Now we are talking about the cost of healthcare. These generic medications cost almost nothing, maybe $20 a month.” The cost of the polypill in the Alabama trial was $26 per month, although the drugs were free to study participants. Feedback from participants noted that remembering to take one pill was easier than the routine of multiple medications for blood pressure and cholesterol. “What’s really expensive is the cost of a heart attack or a stroke. That’s at least $25,000 to $50,000. We could also analyze congestive heart failure, or a pacemaker, or defibrillator expenses. The most effective thing to do is to take care of people before heart disease,” said Dr. Benton.

Reaching patients in remote areas

In another study, this a much larger trial featuring over 50,000 participants in Iran, looked at delivering drug therapy via a polypill (comprised of a statin, two drugs to lower blood pressure, and low-dose aspirin) to a large number of patients. The study was praised as a significant effort to combat a major global health problem. “What we found, in this case, was a risk reduction of about 30%,” noted Dr. Benton. The polypill in this study was effective in cutting the risk of cardiovascular events by 40% in people with no history of heart disease and by 20% in those with previous symptoms. “These aren’t new medicines,” Dr. Benton explained. “When you develop heart disease or have a cardiac event, you are going to have more than one prescription to take every day. These medications not only lower your blood pressure, cholesterol levels, or help regulate your heart rhythms, but they also decrease the likelihood of a future event. That’s the most important goal.”

Future of the Polypill

The history of the Polypill began in 1999 when Nicholas Wald, who was director of the Wolfson Institute of Preventive Medicine in London at the time, considered combining medicines to combat cardiovascular disease. Wald predicted that around 80% of heart attacks and strokes could be averted if his proposed polypill was taken by everyone aged 55 years and over, and everyone with existing CVD. The debate that followed since Wald’s idea has been over the cost, effectiveness, and practicality of using a mass-treatment approach on at-risk and low-risk populations. There are ethical, legal, and regulatory questions involved in this decision as well. For example, fixed-dose combination pills are not legal in some countries. Dr. Benton is hopeful that time will be on the side of medical science. “The polypill is not available here yet, but we have had some version of mixing a statin and a high blood pressure medication in the past. I think eventually, you will see something like this come around. I don’t think it will be a great product of major pharmaceutical companies; these are ultimately generic medicines. Most physicians will tailor a therapy that includes these medicines, just not in the form of one pill.” Research suggests that future use of a polypill will most likely be prescribed to high-risk patients or those without regular access to a family doctor to prevent future episodes.

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.

The Future of Vaping Bans

The Future of Vaping Bans

HEART HEALTH

Up in the Air: The Year of Vaping

A look back on the newsmaker
of the year and what to expect
in 2020 on the future of vaping
in New York State

Since entering the market in 2006, e-cigarettes and vaping were once viewed as a “less harmful” aid to help smokers curb or quit their nicotine habit. For years, little was known about the chemicals in vaping products or the long-term effects of vapors to the human body. By 2008, the World Health Organization (WHO) spoke out against e-cigarettes, stating that, “electronic cigarettes (are) not a proven (safe) nicotine replacement therapy.” WHO also noted that while e-cigarettes smokers did not inhale combustible cigarette smoke, there was a danger in the “fine, heated mist, which is absorbed into the lungs.” In the summer of 2019, the Trump Administration and New York Gov. Andrew Cuomo both announced bans on flavored e-cigarettes. Today, you would be hard-pressed to find a health care provider who would recommend vaping products as a method of quitting smoking.

Smoking and heart health

While looking over the top newsmakers of 2019, vaping was a constant in headlines, articles, and discussions. This article will look back at the timeline from this summer that led to the eventual ban of vaping products in New York State. We’ll also examine future public policy that will likely be written in 2020 that will forever determine the future of vaping in our communities. It’s important to note that cardiologists have been at the forefront of advocating awareness and education on the dangers of tobacco products. The Surgeon General has warned that smoking causes heart disease since 1965. It has been long established that smoking is one of the modifiable risk factors of heart disease. The Centers for Disease Control and Prevention (CDC) reports that smoking damages the heart and blood vessels very quickly, narrowing vessels that allow clots to form in the arteries around the heart. This blockage starves the heart muscle for oxygen, leading to a heart attack.

Dating back to 2008 with the WHO press release against electronic cigarette smoking, health experts have been calling for more research and evidence on the safety and ingredients in vaping products. Outside of nicotine, little was known about the chemicals used to create the vapor. Legal questions also came about over the status of purchasing these products online. In late 2008, a study funded by Ruyan, Health New Zealand stated that their e-cigarette and cartridges were deemed as a “safe alternative to smoking,” having been found to contain carcinogens and toxicants below harmful levels. This news conflicted mounting evidence that suggested the contrary. Australia, Jordan, Canada, Hong Kong, Panama, Brazil, and Saudi Arabia all banned the sale and advertising of electronic cigarettes in 2009. Many of these countries took these steps towards protecting their citizens due to FDA testing that revealed that e-cigs contained carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze. While the U.S. government was proving these products were not a safe alternative to smoking, they could still be legally purchased in the United States. In 2010, the Marine Corps Base in Quantico became the first to ban the use of vaping products in their facilities.

From 2011 until August 17, 2019, news headlines would be mixed on vaping. Government agencies, health officials, researchers, scientists, and political leaders were pitted against the tobacco industry, vaping companies, lobbyists, and consumers in a back and forth debate. Every report that found dangers in vaping, that called for more regulation and research would be met with VapeFests (festivals and expos promoting the products), new sellers in shopping centers with new flavors and supplies flooding the market. At one point, it seemed like vaping had become “the new smoking” for the next generation when a WHO global report showed that the number of vapers increased from about seven million in 2011 to 41 million in 2018. On our “World No Tobacco Day” episode of HeartTalk, presented by Capital Cardiology Associates, Dr. Harlan Juster, Director of the Bureau of Tobacco Control New York State Department of Health was our guest. He noted the frustration in lowering the number of young people smoking over the past twenty years due to public health policy steps, only to have the work be undone with new vaping products. “Vaping is a unique problem in that predatory practices are being conducted by some of the manufacturers, like Juul, who offer flavors that appeal to young people.”

As of December 13, 2019, vaping had killed 52 people in 26 states (red) officials said. Another 2,409 Americans have been hospitalized after using e-cigarettes.

Vaping kills

What changed on August 17, 2019, was the news that the CDC was actively investigating cases of vape-related illnesses in 14 states. The number of illnesses would grow to 200 cases in 22 states. On August 23rd, the first vape-related death was reported in Illinois. The person was hospitalized with severe breathing difficulties, reportedly from using e-cigarettes. On September 3rd, Oregon’s Health Authority began investigating a similar death. Three days later in Indiana, health officials confirmed a third vape-related death followed by a fourth in Minnesota, and fifth in California. Officials from the Kansas Department of Health announced the sixth vape-related death on September 10th. During the summer, when the news was focused on shark attacks and California wildfires, vaping had become a national health epidemic. Finally, on September 11th, the Trump Administration announced a game-changer for the vaping industry: pushing a ban on all flavored e-cigarettes in the U.S., including the popular mint and menthol flavors.

In his statement, Health and Human Services Secretary Alex Azad said, “the Trump Administration is making it clear that we intend to clear the market of flavored e-cigarettes to reverse the deeply concerning epidemic of youth e-cigarette use that is impacting children, families, schools, and communities.” Four days later, New York Governor Andrew Cuomo announced that New York would be the second state to issue a ban on all flavored e-cigarettes, except tobacco and menthol. He also stated that “these are obviously targeted to young people and highly effective at targeting young people.” It was finally clear; vaping was never a healthy alternative to smoking.

New York State Ban

As discussions began on the federal level and in the New York State Legislature, communities began to decide their public health policy. Dr. Guthrie Birkhead has a strong background in public health, with an extensive record working for the New York Department of Health on the state’s HIV/AIDS prevention and control program. He sat in on a recent episode of HeartTalk, presented by Capital Cardiology, to discuss the failed ban on the sale of flavored tobacco products proposed in Albany County. “The effort in Albany County was to remove the flavors that attract kids. The goal was to remove those products from the market due to the fact that 70% of young people say they tried vaping because of the flavors,” stated Dr. Birkhead. He challenged the “safety” of vaping products, pointing to a lack of regulation and data that shows e-cigs, “aren’t helping people quit smoking, it’s keeping them hooked. If you continue to vape instead of smoking combustible cigarettes, you are still putting yourself at risk. Vaping still continues the nicotine addiction while also exposing users to the dangerous chemicals that damage your lungs.”

Two New Yorkers died from vaping this fall. The first was a Bronx teenager who died from vaping marijuana. The second was a man in his 30’s who had a history of using vape products. “One of these people who was vaping the equivalent of three packs of cigarettes a day. Is that a cessation tool for someone to quit smoking,” asked Dr. Birkhead. As more facts emerged, like the first-long term study on the health effects of electronic cigarettes that linked the devices to the development of lung disease over three years, it was clear action was needed. CannaSafe lab in California released the first findings in early October, detailing the amount of formaldehyde and hydrogen cyanide in vape pens, when combined with the heat to produce vapor, creates a fatal dose of lethal chemicals. Antonio Frazier, the vice president of operations at CannaSafe stated, “People don’t die from smoking a pack of cigarettes, which is what we’re seeing with some of these illicit vape products. People are actually dying over a month of use.”

New York state health officials took action before the end of the year to apply existing tobacco laws to vaping products. Adults must be 21 to purchase items. The state also enacted a 20% tax on e-cigarettes joining eight other states and Washington DC on vaping taxes. Sellers are required to have a license. Retailers who violate the ban will face fines of up to $2,000 per violation. “We are trying to regulate the industry under the current smoking laws. In the meantime, there is still a push for local initiatives to create public health policy to solve this crisis,” Dr. Birkhead added. The issue is time; New York’s ban was extended for 90 days (through the end of 2019) but due to pending litigation from vape store owners who say the ban will close their business, is not in effect until a judge makes a ruling.

The future for vaping in New York state is cloudy at best. The Cuomo Administration expects state lawmakers to vote on a bill that would permanently ban the sale of flavored e-cigarettes and vaping liquids in all forms in January 2020. There is also a question on President Trump’s position on forcing a ban. The president has resisted moving forward on the issue after coming under fire from his supporters and lobbyists. Even without government support, as of this past summer, roughly two-thirds of Americans said they would like to see tighter e-cigarette regulations, according to a Gallup survey. This is encouraging news for community leaders. “The importance is we need to attack this problem at all levels of government. Our experience with the Clean Indoor Air laws is that they began at the country-specific laws and initiative. At a certain level, it built up to a state issue. Local initiatives like the proposed Albany County ban will push the state to take action,” said Dr. Birkhead.

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.

Benefits of Cardiovascular Exercise

Benefits of Cardiovascular Exercise

HEART HEALTH

The benefits of
cardiovascular
exercise

Why we feel so good
after a workout and
why it is good for us

The American College of Cardiology recommends 30 minutes of exercise per day or 150 minutes of activity per week to stay healthy. We all understand that exercise burns calories, helps blood flow, and promotes muscle growth. Regular daily activity, over time, lowers blood pressure and cholesterol levels and along with a heart-healthy diet, is a factor in reaching or maintaining a healthy weight. But how intense does the exercise need to be for it to be beneficial? And then what happens to our body during cardiovascular activity?

Moderately intense exercise

Dr. Kevin Woods is a board-certified cardiologist with Capital Cardiology Associates. Dr. Woods is particularly interested in preventative cardiology and cardiovascular imaging. In his free time, Dr. Woods enjoys mountain biking, exercising, and running. He categorizes walking, ballroom dancing, moderate biking, yoga, and swimming as examples of moderately intense exercise. “Or, you could do more vigorous activity for a total of 75 minutes during the week, which includes jogging, swimming laps in a pool, or singles tennis,” he added. A brisk 30-minute walk every day is a great place to start exercising. It helps increase blood flow, boosts your endurance, and can reduce your risk of developing heart disease and type 2 diabetes.

Our hearts beat about 10,000 times a day, making it one of the most active organs in the body. The goal of cardio exercise is to increase our heart rate from 40 to 80 percent of our maximum heart rate. “Essentially, you’re trying to increase your blood flow to your muscles. Increasing oxygen delivery and your body does that in a variety of ways. Certainly, your heart rate increases. The strength of the heart contraction increases. Your blood pressure, respiratory rate, and oxygen exchange all build trying to meet the energy needs of the muscles when you’re exercising,” Dr. Woods added. This is how cardio burns fat by causing us to breath hard and sweat. Regular cardio exercise can help people with normal blood pressure maintain healthy blood pressure levels, allowing our heart to pump more efficiently and protecting our blood vessels.

How to measure intensity

The good news is: you don’t need to spend a lot of money to reap the benefits of a great workout. If you start sweating after 10 minutes or can talk but can’t sing, those are signs of moderate exercise. For example, you should expect to return from your lunch break walk breathing a little faster, maybe wiping an occasional drop of sweat from your brow. Sweating and breathing hard are clues that your run around the neighborhood was vigorous exercise. One thing you should not experience is pain. Pain indicates that you are pushing yourself too hard. As soon as you feel pain, listen to your body, and stop all activity. Talk with a fitness expert or your doctor about your level of exertion.

Exercise makes you feel good

Whether you want to improve your blood flow, lose weight, or take a break outside, there is one additional benefit to exercise: how it makes you feel. Exercise is mother nature’s painkiller because it releases neurochemicals called endorphins. These are natural hormones associated with feelings of euphoria and well-being that are delivered during aerobic exercise like running but also while swimming, cycling, or rowing. When your heart is pumping blood to all organs and parts of your body, endorphins are released to combat stress. This is why you “feel good” after a long run or bike ride. Your body is helping your muscles recover and rebuild.

An exercise plan or regime creates accountability. When you workout, regularly, you are less likely to make poor lifestyle choices. Have you ever met at healthy smoker? Exercise has been proven to people to quit smoking. Researchers found that a 15-minute brisk walk not only reduced cigarette cravings and withdrawal symptoms; it also can increase the time between cigarettes smoked. Most people would rather choose a smaller slice of dessert when they know the amount of effort needed to “work it off.” And, once you start to see changes in your body or feel stronger, you want to continue to reach your fitness goals!

It’s interesting how just 30 minutes of activity a day can improve your mood, lower your risk of heart disease, give you more energy, and help you sleep better. While we have discussed the physical and psychological effects of exercise in your health, Dr. Woods acknowledges the one plus that resonates with most patients: empowering your role in your health. “People don’t want to take pills, and if I tell them, there’s something that they can do to reduce the possibility that they will need to be on medications as well as a motivator. In addition to reducing the risk of the things we talked about before, that’s empowering to patients; they like to know that what they do matters. It can be a social activity for people as well, which is incredibly important for your lifestyle health too.”

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.

Diabetes Awareness Month

Diabetes Awareness Month

HEART HEALTH

Diabetes Awareness Month

Striving for a life free of diabetes and its burdens

November is Diabetes Awareness month. The number of Americans living with diabetes is staggering: the Centers for Disease Control reported in July of 2017 that nearly 100 million people living in the U.S. have diabetes or pre-diabetes. The report finds that as of 2015, 30.3 million Americans – 9.4 percent of the U.S. population – have diabetes. As diabetes is becoming more prevalent in our communities, culturally, there is a concern that adults are treating their diagnoses as a condition that can be managed with medication, not as a disease that can cause long-term damage if left untreated. This month on HeartTalk presented by Capital Cardiology Associates, we discussed the impact of diabetes in the Capital Region from the medical and community health perspectives.

Theresa Beshara is a Nurse Practitioner in Family Health at St. Peter’s Hospital Diabetes and Endocrine Care Center. She has almost twenty years of experience working with diabetics, their families, and caregivers. Theresa attributes bad lifestyle choices as one of the main factors contributing to our nation’s diabetes problem. “We are more sedentary (than earlier generations); we don’t tend to exercise as much. Our diets are better than they were 20 years ago, but we still enjoy fast food meals. We do eat a lot more carbs, and it’s a matter of genetics: we can’t change that piece.” Diabetes does have a hereditary element; it tends to run in families. However, for most people living with diabetes, it is usually a combination of both genetics and lifestyle choices that influence risk factors.

“I think there is a stigma right now with Type 1 that you cause yourself to have it when really it is an auto-immune disease,” says Laura Greenaway, Development Director of the American Diabetes Association in Albany. On our recent HeartTalk episode, Laura shared her family history, how her sister was diagnosed with Type 1 and how different her childhood home went without sodas, sugary snacks, and candies that could be found in her friends and neighbors kitchens. “With Type 2, there is a misbelief that you ate too much, and people aren’t aware of the hereditary factor. Diabetes is a disease that isn’t talked about because it’s not visible. What we are trying to do is help educate people about the different causes, ways to prevent it, and what their risk is.”

As diabetes detection has improved through innovations in technology and testing, nothing replaces the importance of having a yearly discussion with your health care provider on your risk. It’s a talk that needs to happen earlier in life. “If we can get our teenagers to work with their parents to make better food choices, get them involved with an exercise program or school sports, those two things will help with prevention,” said Theresa Beshara. When we talk about the long-term damage unmanaged diabetes does to the body, it’s alarming how an excessive amount of sugar in the system, over time, affects the arteries and blood vessels. As the cardiovascular system stiffens, it causes the heart to work harder to push blood throughout the body. What takes years to develop eventually becomes high blood pressure or atherosclerosis, both triggers for stroke, kidney issues, peripheral vascular disease, and heart failure. This is the mission of the American Diabetes Association, a life free of diabetes and its burdens. “Diabetes is more than blood sugar monitoring; it is a disease that affects every organ in your body and can cause long-term damage if untreated. It is something we all should want to prevent,” said Greenaway.

Awareness. Education. Engagement. Prevention. Those are the goals for the American Diabetes Association during November. “When we talk with physicians or diabetes educators, our partners in the community awareness programs, we talk about the day to day things that people can do,” stated Felix Perez, Market Director for the American Diabetes Association. Capital Cardiology Associates is proud to join the cause to encourage at least 30-minutes of daily activity or exercise, a heart-healthy diet, living smoke-free, and making responsible choices with alcoholic beverages. If you’re ready to make a difference, stand up and be counted by clicking here.

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

How aniexty, drepression, PTSD, and stress trigger heart attack or stroke

How aniexty, drepression, PTSD, and stress trigger heart attack or stroke

HEART HEALTH

Feeling good leads
to better health

How anxiety, depression,
PTSD and stress trigger heart
attack or stroke

The evidence has been mounting for years; there are ties between your mental health and your heart health. While treating the heart usually requires lab results and various levels of testing and mental health involve therapy and analysis, depression has been recognized as a major factor for heart disease. Studies have found that untreated or unrecognized depression contributes to an unhealthy lifestyle and that people who had reported high or very high levels of depression and anxiety were more likely to have had a heart attack or stroke than people without those symptoms.

“As much as cardiologists like to put the heart at the top of the pedestal, really, it’s the brain,” says Dr. Connor Healey, a board-certified cardiologist with Capital Cardiology Associates. “The brain controls everything, and it’s the most important organ. It is no big secret that when people are feeling down, it has an impact on your health. Many of the biochemical changes that happen in the brain are associated with grieving, depression, sadness, loss.” What researchers are discovering is that major depression and anxiety is about twice as common in women than men. When we are depressed, we lose motivation to do everyday things like exercise, interact with friends or family, and make unhealthy lifestyle choices, like overeating, drinking, or smoking.

Doctors at the University of North Carolina School of Medicine in Chapel Hill recently examined the role of PTSD in our veterans. They followed almost one million, middle-aged veterans who served in conflicts in the Middle East for the past decade, who, on average, had no history of stroke. What they found was veterans with PTSD were 61% more likely than others to have a mini-stroke and 36% more likely to have a stroke. “PTSD and anxiety have a negative remodeling effect on the brain that affects the body. As cardiologists, we have seen that the unexpected loss of a loved one released hormones that literally weaken the heart muscle and mimic a heart attack,” stated Dr. Healey. The medical term is takotsubo cardiomyopathy, it’s more commonly known as broken heart syndrome. Sufferers will report feeling chest pain, shortness of breath, or changes in their heart rhythm which are all symptoms of a heart attack.

In the case of the veterans with PTSD, this was the first study to show a link between trauma-induced stress disorders and the risk of stroke and mini-strokes in young and middle-aged adults. More investigation is underway to examine how intense psychological stress, medically produces chronic inflammation which triggers stroke. What we do know is stress is a problem that almost one-third of Americans surveyed say has led to a visit with their doctor. “Our parents didn’t talk about if they were feeling sad or upset. If they were feeling sad, they would be told to deal with it. Now, we have developed the disease model of mental health, where it’s not a choice, it’s based in neuroscience and biochemistry, and some changes are completely out of your control,” added Dr. Healey.

As a country, we are working to better identify mental health hazards and find more effective or healthy ways to manage stress. According to The American Institute of Stress, almost half of Americans report that 80% of workers feel stress on the job. This has led to the workplace debate on taking a “mental health day”— using a sick day to cope with stress or burnout. However, many employers do not embrace missing work due to stress. This year lawmakers in Oregon followed Utah’s lead by allowing students to use mental health days as a valid excuse to miss a day of school. Dr. Healey was raised in Eastern Ontario, Canada, and offered another solution for time off, holiday weekends. “In my homeland, we’ve made sure that every single month has a long weekend. We’ve invented holidays to allow for three day weekends. That’s something that I advocate for.”

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates © 2019.

Any medical information shared in this article is not intended as a substitute for informed medical advice and you should not take any medical action before consulting with a healthcare professional.