Do You Have a New Year’s Resolution?

Believe it or not, making a New Year’s resolution increases the likelihood that your resolution will succeed by ~10-fold (although sometimes it may seem like years to accomplish)!  Nevertheless it is well worth worth your while to make at least one resolution for the New Year.  Among the 3 most common New Year’s resolutions are to 1) quit smoking 2) lose weight & 3) increase exercise.  Below are tips to help successfully attain these goals in 2019.

1. Quit Smoking:  It takes the average smoker 7 trials before successfully quitting. Fortunately, we now have a solid arsenal of weapons in our cancer and heart disease prevention toolbox.  They including nicotine containing chewing gum, patches and a variety of medications.  However, the first recommendation is to avoid/remove the stimulus that triggers the first cigarette of the day.  For example, if a cup of morning java is the trigger, then switch to tea (or another drink).   In our University Cardiology practice,  what I have found successful is the nicotrol inhaler, “artificial” cigarettes that contain nicotine without the other 2,000+ toxic ingredients.   Start off with ~6 cigarette cartridges a day and titrate down to zero over the next 6 weeks.  Because cigarette smokers are used to holding a cigarette as part of their smoking experience, this method helps to wean off cigarettes by simulating cigarette smoking and using progressively lower of nicotine to help break this destructively addictive habit.
2. Lose Weight: We recommend a gradual weight loss program aiming to lose no more than 1-2 pounds a week because greater amounts over a short-period is often counterproductive. Some weight loss diet books start with an “induction phase” designed to expedite weight loss through severe caloric restriction (in other words, your body starves during the initial weeks of the diet). Most people don’t (intentionally) gain 15-20 pounds over several weeks so why try to lose so much weight so quickly?  It turns out that this approach is not only metabolically unhealthy in middle-aged and older women (weight loss is not sustained) but also potentially dangerous.   I have evaluated and treated patients who developed heart-related problems such as an abnormal heart rhythm after trying such restrictive diet programs  (check out “Heal Your Heart” for further details and for safe, heart-healthy dietary recommendations). 
3. Increase Exercise:  The good news is that you do not need to run marathons to gain benefit for your heart and overall health.  Just identify the aerobic activity (or activities) you enjoy most and set aside times each week that you can consistently follow.  For example, if you enjoy walking, aim for a total of ~30-40 minutes daily at a moderate brisk pace (3-4 mph).  Equally important is not to sit for extended periods of time (30 minutes or longer).  At work, aim to rise from your desk 2-3 times every hour, stretch and/or walk around the office.  After dinner, instead of diving into your couch, try a leisurely walk; when watching TV, stand up and stretch every 20-30 minutes or during commercials.

Wishing you and your family a Happy and Heart Healthy New Year!

Michael Miller, MD is a cardiologist and Professor of Medicine, Epidemiology & Public Health at the University of Maryland School of Medicine in Baltimore, Maryland USA.  He is Chair of the American Heart Association, Arteriosclerosis, Thrombosis & Vascular Biology Council on Clinical Lipidology.

Reflections on the Holiday Season: Part 2

As 2018 comes to an end, it’s time once again to reflect on observations made during this year as we build upon new experiences in 2019 and beyond aiming to improve heart and overall health.

1. Complete Your Dinner Meal Within 4 Hours of Bedtime:   While some might consider this to be part of an intermittent fasting program where eating is limited to a relatively short-time frame each day (ranging from 6 to 12 hours), finishing your meal hours before sleep is designed to keep the enzymes that process fats and carbs from working in overdrive during sleep.  But this is most likely to be successful if you follow #2 below.
2. Do a Light Activity After Your Dinner Meal:   Such activities might include a 20-30 minute walk or light jumping on a rebounder (mini-trampoline).  Alternatively, if you are watching TV, get up during commercial time and stretch or walk around the area.  This can also help you to gain a good night’s sleep.
3. Limit caffeine intake to within 8-10 hours before bedtime:  If you have insomnia, have your final cup of coffee of the day at least 8 hours before bedtime, due to the long-lasting effects of caffeine.
4. Hug your loved ones daily:  Hugging releases the chemical oxytocin, which was recently shown to regenerate heart cells. Can a daily hug mend a broken heart?   In fact, exciting new research suggests that oxytocin may turn out to play a more important role in heart health than previously appreciated…. so stay tuned!
5. Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  His book:  “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” focuses on natural ways to improve your heart and emotional health.

 

 

The Surprising Truth about Statins

This past week the American Heart Association released a Scientific Statement on the safety of statins, chaired by Dr. Connie Newman.  Serving as a co-author with a number of my colleagues, our task was to thoroughly review all the scientific evidence dating back several decades when statins were first introduced to treat high cholesterol. Over this period,  there is no question that statins have revolutionized the practice of medicine by consistently demonstrating benefit in women and men at increased cardiovascular risk. But a lingering concern has been the extent to which statins may be harmful.  After all, a number of books have suggested that statins are harmful…to this day, I have patients who refuse to take a statin because they believe it will cause their liver to fail, cause diabetes and cause cataracts!  If any of this were true, do you really believe that physicians would prescribe this medication?   Of course not!  The evidence is clear- if you have a normal liver, a normal fasting glucose level (less than 100 mg/dL) and normal eye function,  statins will not cause any of these problems.

That is not to say that everyone prescribed a statin can tolerate it without any difficulty. While our statement indicates that the vast majority taking statins have no problems, some will encounter statin-associated muscle symptoms (SAMS).  Listed below are some of the tell-tale signs associated with SAMS.

1. SAMS occurs on both sides of the body.  For example, if your left but  not right knee aches, it is not due to the statin.
2. SAMS is most likely to affect large and proximal muscle groups.  For example, shoulders and thighs rather than hands and feet are more likely to be related to a statin.
3. SAMS is most likely to occur in predisposed individuals.  For example, older women with small muscle mass and/or impairment in kidneys and thyroid function raises risk.
4. SAMS recedes when the statin is discontinued.   If you believe that you are experiencing SAMS, contact your physician to discuss appropriate steps to be taken. Symptoms generally recede within days of statin discontinuation.  Sometimes, a different statin may be better tolerated.  Some “tricks-of-the trade” that I’ve successfully used for my patients can be found in “Heal Your Heart“.

Michael Miller, MD is a cardiologist and Professor of Medicine, Epidemiology & Public Health at the University of Maryland School of Medicine in Baltimore, Maryland USA.  He is Chair of the American Heart Association, Arteriosclerosis, Thrombosis & Vascular Biology Council on Clinical Lipidology.

New Cholesterol Guidelines: New Insights

Five years into the making, the new cholesterol guidelines build upon the previous 2 guidelines that were released in 2001 and 2013, respectively.  The new guidelines focus on proven cholesterol-lowering therapies that reduce the risk of cardiovascular disease including myocardial infarction (heart attack), stroke, coronary bypass surgery, etc.   Having worked in the cholesterol field for the past 3 decades,  I will share some insights as to why the new guidelines have been well received to date.

1. Lowering high levels of LDL (bad cholesterol) reduces risk: At birth, the average LDL is ~30 mg/dL.  These levels will rise to ~50-70 mg/dL by a child’s 1st birthday.  In fact, if we maintain these “physiologic” LDL levels throughout life, the overall risk of heart related problems is low, provided we live a healthy lifestyle and don’t smoke cigarettes,  be physically active, manage our stress levels etc.  If you have heart disease, the new guidelines recommend to lower your LDL intensively (by at least 50% from your starting point) and to attain levels below 70 mg/dL. If you don’t have a history of heart-related problems but are at increased risk, the new guidelines recommend to lower your LDL in some cases to less than 100 mg/dL.
2. Lifestyle represents the initial treatment for high LDL: Try foods that lower LDL.  They include barley, beans and brussels sprouts (for a full list of the best LDL lowering foods, check out “Heal Your Heart“).
3. Statins represent the primary medication for treating high LDL:  When lifestyle fails to effectively lower LDL, statins are the medications of choice.  I will discuss statins in greater detail in an upcoming blog but the bottom line is this- statins have a decades long track record; study-after-study have consistently demonstrated reduction in cardiovascular risk.  Depending upon your level of risk, discuss with your physician or health care professional whether statin therapy is the right choice for you.
4. Newer non-statin therapies may now be considered if LDL levels remain elevated: The new cholesterol guidelines now recommend that if LDL levels remain elevated after diet and statin therapy or if statins are not (well) tolerated, to consider non-statin LDL lowering therapies.  These include ezetimibe and the PCSK9 inhibitors.  Both of these therapies add incremental benefit to statins and further reduce cardiovascular risk beyond lifestyle and statin treatment alone.
5. We’ve come a long way over the past 30 years.  When I entered this field, statins were not yet available and treatment options for high LDL were much less effective and not as well tolerated.    The new cholesterol guidelines build upon decades of testing and experience in this field.  It has been my privilege to have witnessed first hand the great strides made in men and women with high LDL who are now able to reduce levels to a normal range and reduce their cardiovascular risk.
6. Michael Miller, MD is a tenured Professor of Cardiovascular Medicine, Epidemiology & Public Health at the University of Maryland School of Medicine in Baltimore, Maryland USA.

3 Spices to Spruce up the Holiday Season

During the holiday season we tend to overindulge on a variety of foods that are not the healthiest for our hearts.  But the good news is that certain spices popular during the holiday season can also keep your heart healthy and boost your spirits.  Here are several spices that are a definite win-win and guaranteed to spruce up your holiday season.

1. Cloves: Clove oil is among the best natural sources containing eugenol, a powerful anti-inflammatory and antioxidant compound.  Studies have found administration of clove oil to reduce cholesterol, triglycerides and excessive fat in the liver and to inhibit blood clot formation, A small, unpublished study in diabetics also found that as little as 1 gram of cloves a day (~12 clove pieces) for 1 month was associated with decreases in glucose, cholesterol and triglycerides.  And if you don’t like cloves, you can use it as a natural repellent for ants (who detest the scent).
2. Cinnamon: Studies in diabetics have found that consuming cassia extract, capsules or raw powder (~1 teaspoon daily) produced meaningful reductions in glucose, cholesterol and triglyceride levels.  Check out our recent review paper for more details.
3. Nutmeg:  Used in popular sauces, pies and holiday drinks (e.g., eggnog), this aromatic spice can promote a “Jekyl & Hyde” response. That is, in small amounts (pinch to 1/4 teaspoon) nutmeg has a calming effect and when added to a glass of warm milk ~2 hours before bedtime can lead to a more restful sleep.  However, at high doses (~2 tablespoons), nutmeg can produce toxic effects, including heightened anxiety and hallucinations.  In other words, just a “little dab will do you”…enjoy!
4. Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  His book:  “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” focuses on natural ways to improve your heart and emotional health.