Cardio-Oncology

Cardio-Oncology

PATIENT EDUCATION

Assembling The Best Minds To Treat Cancer Patients And Protect Your Heart

A team of doctors will soon be working together to fight the two main causes of death in the United States

Cardio-oncology is a new field in cardiology. Thanks to improvements in detection and treatment, cancer survivorship has increased significantly over the past several decades. Today, more than 14.5 million cancer survivors are living in the United States. But the aggressive chemotherapy and radiation treatments can cause damage to the hearts of the patient’s life they are saving, frequently putting the survivor at a greater risk for heart disease. Cardio-oncology describes the efforts to prevent or treat patients with cancer who face heart problems caused by cancer treatments.

Dr. Heather Stahura is spearheading the developing of Capital Cardiology Associates Cardio-oncology medical team, consisting of physicians, clinicians, and medical staff in the Capital Region. “The big institutions, like Yale, have started these cardiology oncology programs. CCA would like to bring this here for our people. We want to make a team effort, working with local oncologists to address the awareness to create protocols to aid in risk assessments before treatment or cardiac functions as they are undergoing therapy,” said Dr. Stahura.

Cardio-Oncology

It’s hard to believe that the idea of including heart health in cancer treatment is a relatively new practice. “Cardio-Oncology is a new field that is coming into practice, I’d say really, over the past five years. We see a real need for it. What we are looking to address is people for traditional risk factors for heart disease or not at all, before you undergo chemotherapy,” stated Dr. Stahura. Emerging data indicates that newly developed drugs for cancer treatment have unanticipated side effects. The numbers also show that less than 30% of hospitals and medical centers offer specialized cardio-oncology services. Anthracyclines are a class of drugs used in cancer chemotherapy. While it is very effective in the treatment of breast cancer, “anthracyclines, when given in high-doses during treatment or to patients as part of the regular treatment protocol, can lead to an increased risk of congestive heart failure,” shared Dr. Stahura. Also, a variety of new drugs that are very effective in treating cancer can have other effects on the cardiovascular system.

“Just as the world of cardiology is ever changing, oncology is rapidly changing with new treatment options. I think that working in team formats to address these issues – we know these are life-saving treatments, they are what’s best for the patient. We don’t want to stop the treatments we want to keep them safe.”

Dr. Heather Stahura

Cardiologist, Capital Cardiology Associates

The goal of the Cardiac-Oncology team is to treat the complete patient safely. Simply put, kill the cancer cells without damaging other areas. “Oncologists and radiation oncologists have done a fantastic job at evaluating their treatments and procedures using machines to minimize risk to their patients. Radiation to the chest can cause advanced coronary disease, especially valvular dysfunction. These doctors have realized that we have to minimize the field of exposure to miss the heart and important internal organs while trying to target that cancer as best they can. Our job on the cardiologist side is never to interfere or stop these life-saving treatments that the oncologists are administering but rather, to work as a team format, addressing issues before they arise or catch them before your heart pump starts to fail or hypertension develops. We want to assist in your care.”

Preventive care

Cancer survivors are educated on lifestyle changes they will need to make following their successful treatments. Eating healthy, staying active, getting a flu shot, frequently washing their hands, limiting their exposure to the sun and tanning beds, and of course, staying away from alcohol and tobacco smoke. Sometimes monitoring your heart health can be lost in the massive amount of information a survivor receives. “That often can be difficult for patients to understand,” says Michelle Giwerc, a Physician Assistant at Capital Cardiology Associates. “Cancer patients are at a greater risk of developing hypertension (high blood pressure), for example. That can lead to coronary heart disease. One of the major goals moving forward is to screen people regularly, whether that is with yearly physicals with your primary doctor to look for high cholesterol, high blood pressure, or diabetes. Awareness will help in early detection to treat these symptoms.”

In all matters of the heart, Capital Cardiology Associates is consistently seeking opportunities to improve our patients quality of care. “In big cities, major institutions are responding very well. I think we can do even better in our area. We have a great medical community here. I would love to see a survivorship clinic in the future. We would get the people who are done with their treatment five, ten years down the road,” said Dr. Stahura. For those of us who live in the Northeast, a nationwide survey shows that medical centers in our area are aggressively working to establishing a team of medical professionals capable of recognizing the growing population heart disease patients in addition to collaborative cancer treatment protocols. Dr. Stahura is seeking to create such a medical community here in the Capital Region. “I know oncologists definitely talk about the risk factors of medications. But as cardiologists, we want you to keep following up with us five, ten, fifteen years after your successful treatment so that you can become a cardiac survivor as well.”

Written by: Michael Arce, Capital Cardiology Associates
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.

National Drug Take Back Day

National Drug Take Back Day

PRACTICE ANNOUNCEMENT

This Saturday You Can Dispose
of Your Old Medications – Safely

National Drug Take Back Day is on
pace to collect more almost
one million pounds of old prescriptions.

National Drug Take-Back Day is Saturday, April 27th. This is a safe, convenient, and responsible way to dispose of unused or expired prescription drugs. Between 10 AM and 2 PM your city police station or county sheriff office (with some other pharmacies and buildings) serve as collection points. To find the location near you, click here. The last Take-Back Day brought in more than 900,000 pounds of unused or expired prescription medication.

Dr. Kate Cabral is a Board Certified Cardiology Pharmacist and an Associate of the American
College of Cardiology. She regularly meets with patients at Capital Cardiology Associates to
discuss their prescriptions and medications. Dr. Carbal spoke of the importance of a “no
questions asked” drug take-back day. “This is a huge public safety and public health issue.
Six million Americans misuse controlled and prescription drugs, a majority which is obtained
from family or friends,” said Dr. Cabral. The Drug Enforcement Agency (DEA) hosts “take-back”
days twice a year to safely collected unwanted or expired medications.

President Trump has brought much attention to our nation’s opioid crisis. Opioid abuse is at epidemic levels in the U.S. and remains a top public health concern. “If you have an old pain medication just sitting in your cabinet, that can be a risk for someone you know,” said Dr. Cabral. According to a national survey, 16.8 percent of high school students took a prescription drug without a doctor’s prescription (such as OxyContin®, Percocet®, Vicodin®, codeine, Adderall®, Ritalin,® or Xanax®), one or more times during their life. The DEA warns that social media sites play a role in providing information and advice to teens on how to use prescription drugs to get high. Parents should be aware of which sites their teens are visiting and should examine credit card and bank statements that may indicate medication purchases. They should also check the browser history to see which sites their teen is visiting on their computers and phones.

National Take-Back Day also provides safe drug disposal. Many Americans are unsure of the proper way to dispose of medications; most choose to dump the unused pills in the toilet and throw the bottle in the trash. The DEA advises if you cannot reach a collection site, you follow these follow steps to dispose of most medicines in the household trash:

Most medications are safe to be flushed down the toilet. Review this list of what’s safe or not. If you still have concerns or questions, mix medicines with an unappealing substance such as dirt, used coffee grounds, or kitty litter. Take them out of their original container first. Do not crush tablets or capsules before mixing.
•Place the mixture in a container (sealed plastic bag or empty can) to prevent the drug from leaking into the garbage.
•Throw the container in the trash.
•When disposing of empty prescription bottles or packages, be sure to mark out identifying personal information to make it unreadable.

Written by: Michael Arce, Capital Cardiology Associates
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.

World Health Day

World Health Day

HEART NEWS

America’s heart problem is now the World’s

Heart disease is no longer an American problem

World Health Day is a global health awareness day celebrated every year on April 7th, under the sponsorship of the World Health Organization (WHO), to call attention to the advancement of health in all people. This year, I sat down with Dr. Brion Winston, who in addition to being a board-certified cardiologist, also has an area of interest in public health. Our discussion began with data from WHO that in 2016, more people died of heart disease than of AIDS/HIV, malaria, and tuberculosis. Heart disease is responsible for one-third of all global deaths.

Why is heart disease exploding in developing countries?

At least three-quarters of the world’s deaths from cardiovascular disease (CVD), or heart disease, occur in low- and middle-income countries. Heart disease very treatable and preventable if caught early. One factor affecting the poorest people in these places is the lack of detection. Dr. Winston explained how the diagnostic evaluation of heart disease in developing countries would be pretty basic, at best. “You would be able to find electrocardiography in many clinics but remember, in poor and developing nations, the standard of health care delivery is often a fee for service. If someone has a severe health problem, they will show up to the emergency department, often accompanied by their family, they will talk with the doctor and the patient. The doctor will say, ‘this is what I think is going on, and this is what it will cost’ and there is a fee for service right up front. With that in mind, the choices for diagnostic evaluation may be limited in some places.”

“Taking to the later phases of treatment, surgical treatment for heart disease in poorer nations are quite limited, maybe to aspirin, things like catheterization labs – you’ll find poorer countries don’t have them,” stated Dr. Winston. Treatment and procedures of heart disease like balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage), coronary artery bypass or valve repair and replacement is costly once heart disease advances. “But, with the example of India, they have many hospitals which have prospered with the economic development over the last 30 years, these sites are considered ‘medical tourism’ where Americans will travel overseas for heart procedures in India. These are for-profit hospitals that run efficiently, conducting a high volume of surgical procedures. The costs of some of these procedures would be a fraction of what a patient would pay and there are some people willing to travel for this.”

Awareness and education are an important component that is missing in developing countries. The most important behavioral risk factors of heart disease and stroke are an unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. Americans are bombarded with public health messages informing us of the increased risks of a poor diet, smoking, and lack of exercise; this is not the case in other parts of the world. “In my practice and taking with my colleagues, many of whom are from South Asia (India and Pakistan), there is a high incidence of heart disease in people from these lands when they come to the US, if they follow a US diet that is high in fat, then we may see development of heart disease even earlier,” says Dr. Winston. “Overall, while we have made substantial improvements in reducing smoking in the United States but in South Asia and China, there is still a large amount of that population that still smokes, combine that with a richer diet – that will add to this problem as well.”

A “better life” might be a slow killer

Economics is an underlying cause of fostering the bad behavior that leads to heart disease. In some countries, soda is cheaper than bottled water. This year, Canada recently updated its Food Guide to offer advice on what to eat, what not to eat, and how to eat. Half of the plate is fruits and vegetables, a quarter for whole grain foods, the final quarter for protein. They also removed dairy as a category, urging citizens to have a glass of water with meals. In the African nations of Tanzania and Zambia, clean water does not flow from their taps. A can of Coke is less than and safer than clean water. This choice adds up; according to the Human Sciences Research Council the cost of eating healthy in South Africa is 69% more than the alternative.

The opposite is true in other parts of the world. “As standards of living have improved in South Asia as well as in China, people are following more of what we tend to think of as a Western Diet, a high fat, high energy diet – we rating to see more diabetes and related heart disease. It’s both an issue that we have made progress of infectious disease as well as the economic shift which has lead to people eating richer diets putting them at greater risk for heart disease,” notes Dr. Winston.

A global problem

Heart disease is the number one killer of men and women in America. It is also responsible for one-third of all global deaths. This global problem is going to need a large solution that addresses access to health care and preventative treatment. A WHO report estimates that Africa has about one doctor for every 5000 people. In underdeveloped nations, community health care workers fill the void of serving patient’s who don’t have access to a doctor or even a hospital. In South Africa, Mexico, and Guatemala, a study shows that these health care workers were able to screen adults for cardiovascular disease when access to a physician was not available. Armed with a mobile app, instead of traditional paper, these volunteer professionals were able to diagnose patients efficiently and at less cost compared to standard care.

There is hope in solving the global heart health problem. While there will certainly be a growing demand for cardiologists worldwide, it wasn’t that long ago that the HIV/AIDS crisis seemed impossible to contain. Money for research, governments pushing for public health policies, and dedicated medical professionals will need to unite around the world to fight heart disease – together.

Written by: Michael Arce, Capital Cardiology Associates 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.

Fish Oil Controversy

Fish Oil Controversy

HEART HEALTH

Results from a new study makes fish oil a controversial topic in cardiology

“Fish oil can be a controversial topic in cardiology, partly because there is conflicting data.”

Americans spend more than $1 billion a year on over-the-counter fish oil supplements. Food companies are now adding omega-3 fatty acids to milk, yogurt, cereal, chocolate, cookies, juice, and hundreds of other foods. Natural sources can also be found in flaxseeds, chia seeds, walnuts, pumpkin seeds, and canola oil. Fish oil has been successfully promoted to protect against heart disease along with claims to relieve symptoms of depression, rheumatoid arthritis, and dry eye syndrome. There are claims that fish oil decreases the risk of cancer.

The results of the OPERA (Omega-3 Fatty Acids for Prevention of Postoperative Atrial Fibrillation) trial, published in December of 2018, provided strong evidence that fish oil supplementation does not lead to increased bleeding during surgery. Dr. Connor Healey, a board-certified cardiologist with Capital Cardiology Associates, explained the concern. “In general, for fish oil to be effective it needs to be taken in high doses but there were concerns that at these high doses there was a signal that perhaps this leads to higher bleeding. For a lot of our patients that are on aspirin, Plavix, or other blood thinners, that’s a big area of concern.” The trial also revealed that higher omega-3 fatty acid levels were associated with a lower risk of bleeding, warranting the reconsideration of existing recommendations to stop fish oil or delay procedures before cardiac surgery. This new data adds to the mixed evidence for improving heart health. .

What makes fish oil controversial?

“Fish oil can be a controversial topic in cardiology, partly because there is conflicting data,” stated Dr. Healey. In January of 2019, a study reported in the New England Journal of Medicine found that omega-3 fatty acid supplements “did not result in a lower incidence of major cardiovascular events or cancer than placebo.” Earlier research reported in the same journal in 2013 also reported no benefit in people with risk factors for heart disease. However, numerous studies show that people who eat a lot of fish have much lower rates of heart disease. “This leaves cardiologists a bit uncertain as to what we should be recommending,” adds Dr. Healey.

What is safe to surmise is that while fish oil supplements can improve many of the risk factors for heart disease, there is no clear evidence that it can prevent heart attacks or strokes.

“If you have questions on this, they should be addressed on the individual level with your doctor,” says Dr. Healey. The World Health Organization (WHO) recommends eating 1–2 portions of fish per week. As the massive amount of fish oil studies have produced ambiguous results, if you are currently taking fish oil capsules prescribed by your doctor — they are an approved and effective treatment for people with high blood triglyceride levels — continue to take them as directed by your doctor and have a conversation about their benefits or your concerns at your next visit. If you are taking fish oil capsules as a supplement, talk with your doctor or health care provider about their nutritional value. Also consider changing your diet to the Mediterranean style diet, endorsed by the American Heart Association, the American College of Cardiology, and the Mayo Clinic as “a heart-healthy eating plan.”

Written by: Michael Arce, Capital Cardiology Associates 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 and Heart Disease

Diabetes and Heart Disease

PATIENT EDUCATION

After Smoking, Diabetes is The Second Most Preventable Cause of Heart Disease

A “wake-up call” to 7.5 million Americans

Diabetes Alert Day is observed annually on the fourth Tuesday in March. Diabetes Alert Day is a one-day “wake-up call” that focuses on the seriousness of diabetes and the importance of understanding your risk.

America’s rising obesity rates along with our aging population have elevated the concern that diabetes is more than a risk factor for heart disease; the relationship of heart failure and diabetes is deadly. The CDC states that more than 30 million people in the United States (422 million worldwide) have diabetes, and 1 in 4 of them don’t know they have it. The World Health Organization (WHO) reports that the number of people with diabetes has nearly quadrupled since 1980 due to obesity and widespread physical activity. WHO also states that “a large proportion of diabetes and its complications can be prevented by a healthy diet, regular physical activity, maintaining normal body weight and avoiding tobacco use.”

What was once thought to be a disease you are born with or something that only affects people who overeat sugar now causes more deaths per year than breast cancer and AIDS combined and having diabetes nearly doubles your chance of having a heart attack.

Types of Diabetes

The two major types of diabetes are Type 1 and Type 2. Diabetes is a metabolic disease that occurs when your body cannot regulate its blood sugar (glucose) levels. Type 2 is the most common form of diabetes, accounting for about 90% to 95% of all diagnosed cases of diabetes. 1 in 3 Americans are pre-diabetic, which is not Type 1 or 2 diabetes but a red flag warning that you are dangerously close to diagnosis. The risk factors for Type 2 are an adult over 45, family history of diabetes, not physically active, and a history of gestational diabetes. Certain ethnicities are at a higher risk of a pre-disposed risk of diabetes: African Americans, Hispanic/Latino Americans, American Indians/Alaska Natives, Pacific Islanders, and some Asian Americans. Type 2 can be managed with a healthier lifestyle, weight loss, a regular activity or exercise, and by taking medication. You can prevent Type 2 diabetes but not Type 1.

Type 1 diabetes (T1D) used to be called “juvenile diabetes” and can strike at any age. Just because you are 50 years old doesn’t exclude you from being diagnosed today. When you have type 1 diabetes, your pancreas does not make enough insulin for your body, subject patients to a life-long insulin dependency through injections or wearing an insulin pump. There is no pill form or cure for T1D. Denise Nicastro is Director of Development and Outreach Manager of JDRF, Northeast New York Chapter. Her daughter was diagnosed with Type 1 diabetes when she 15 years old. “With Type 1 you can’t seem to quench your thirst, your vision is affected sometimes. I know with my daughter when her blood sugar levels were high or low, her moods would be altered. You want to look for those signs and tell your doctor,” she said.

Increasing Awareness

The death of Carson Daly’s mother, Pattie Daly Caruso, from a heart attack at the age of 73 in 2017, brought attention to the fact that people with diabetes need to be aware of their heart health. Diabetes can lead to atherosclerosis, the build-up of fats, cholesterol, and other substances in and on the artery walls. This a widespread disease with more than 3 million cases in the United States every year. Atherosclerosis has no symptoms until a plaque ruptures causing a stroke or the buildup is severe enough to block blood flow, triggering a heart attack. This condition is affecting people as young as 19, some born with Type 1 diabetes who do not regulate their insulin levels, others due to poor lifestyle choices that have led to high blood pressure and bad cholesterol.

While atherosclerosis, unless discovered during routine medical visits or investigated by your doctor after evaluating your risk, can go undetected — the other concern with medical professionals is that diabetics wouldn’t feel the onset of a heart attack. Not every patient feels the pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back that are common with heart attacks. Researchers are investigating the nerve damage (diabetic neuropathy) that over time, can lead to pain and numbness in the feet (peripheral neuropathy) to problems with the functions of the heart (autonomic neuropathy).

Carson Daly (l) and his mother Pattie Daly Caruso (r)

Searching for a cure

People with diabetes can live a long and healthy life when their disease is diagnosed and managed. Danielle Unser-Slater, Outreach Manager for the JDRF Northeast New York Chapter, explained one of the popular blood sugar monitoring methods. “Many people with Type 2 choose to manage their disease with insulin.” She described the daily regiment of meal planning, physical activity, medications, and glucose monitoring. “The hard part is diabetes takes such a mental toll on the whole family. Suddenly you go into the hospital, you are put on insulin right away, and you start to feel better. However, unlike when you have a cold or the flu, where you stop taking medicine after a while, comes the realization that you have to take an insulin shot every time I put something in my mouth – but I feel fine. Moreover, we see that happening a lot with Type 2 diabetes; people choose not to manage it properly because they feel fine when in reality they have no idea what damage is being done inside their body. It’s a challenge.”

Currently, there is no known cure for diabetes. The goal of the JDRF is to find one. There are 500 research grants worldwide that the JDRF is working on, “it turns out that 80% of our research will also affect Type 2 diabetes and other auto-immune diseases,” says Nicastro. The cure could be a vaccine in the distant future. “Closer on the timeline would be encapsulation. In an auto-immune disease, your immune system identifies something as your body and attacks it. The challenge is finding beta-cells that protect insulin produced in your pancreas to protect the immune systems attack,” Unser-Slater shared. One way researchers are studying this in human clinical trials is by using an encapsulation device made of seaweed and water, that allows the oxygen and nutrients to flow through while protecting those cells from the immune response.

In 2006, the JDRF started an extensive research project to create an artificial pancreas. The makers of the Omnipod Insulin Management System recently announced successful results in early clinical trials of its artificial pancreas system. The JDRF also is investing resources in developing ultra-concentrated insulin. “We are trying to figure out what trigger might be that causes the pancreas to stop functioning properly. Could it be a virus that settled into the organ? There are many thoughts out there, but there is no concrete evidence that proves the exact cause of T1D, like any other auto-immune disease,” said Nicastro.

With every exciting discovery, the fact remains that until a cure is found, detection and education awareness will be necessary. “We know, no matter what, the longer you have diabetes, the greater risk you have for stroke and heart disease,” Unser-Slater said.

Written by: Michael Arce, Capital Cardiology Associates
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.