In an article in WebMD (2/14/11, Mann), a review of a recently published study found that men and women eating the most dietary fiber were 22% less likely to die from any cause including heart disease, infections, and lung disease compared to those who ate the least amount of fiber.

The importance of this study was that prior studies have described the relationship between fiber intake and cardiovascular disease but few studies have examined the relationship between dietary fiber and mortality. Diets rich in fiber help lower blood cholesterol levels and blood sugar levels which may explain its beneficial effect. It is not known how fiber reduces risk but it may have something to do with an anti-inflammatory effect. The effect in this study appeared to come from cereal fiber, grain, and beans.

The new US dietary guidelines recommend that at least half of all grains eaten be whole and unrefined. The goal for fiber is 25 grams per day for women and 28 grams per day for men. One of the easier ways to accomplish this is to eat “whole grain” breads, cereals, and baked goods as opposed to refined varieties.  Another way to increase cereal fiber would be to eat cooked cereal.  Dr. Reisman, a Manhattan Cardiologist advises increasing dietary fiber to add a beneficial effect in both men and women.

Aortic dissection, a medical emergency, occurs when there is a tear in the inner layer of the aorta. The aorta is the major blood vessel that carries blood from the heart to the rest of the body. Blood rushes into this tear causing the inner and middle layers to separate or “dissect”. When blood also breaks through the outer aortic wall this is usually fatal.

Symptoms of aortic dissection may be similar to that of other heart problems. It may cause sudden chest or upper back pain but may also cause other symptoms such as loss of consciousness, shortness of breath, and symptoms of stroke. Men have aortic dissection more frequently than women. The most common age is between 50 to 70 years old. If any of these symptoms occur suddenly, one should seek urgent medical attention or call for emergency medical assistance.

The most important feature of preventing aortic dissection is control of high blood pressure at an early age. High blood pressure is implicated in two-thirds of these cases. To reduce your risk it is also important to stop smoking if you smoke. It is also recommended to follow a low salt diet and exercise regularly. Certain congenital conditions and pre-existing aortic abnormalities predispose to aortic dissection.

Dr. Steven Reisman, Director of the New York Cardiac Diagnostic Center, advises patients to be aggressive about the diagnosis of hypertension (high blood pressure) and control of hypertension along with smoking cessation for prevention.

Women with stressful jobs have a greater likelihood for having a heart attack. Healthday (11/14/10, Gardner) has reported on a study just being presented at the annual American Heart Association meeting. The researchers have followed more than 17,000 female health professionals for over ten years evaluating job stress and cardiovascular disease.

The study looked at women with an average age of 57 at the beginning of the study and found that women with high job strain defined as demanding jobs over which they have little control were more likely to be sedentary and have elevated cholesterol. They were almost at double the risk of having a heart attack and at 43% higher risk to undergo a coronary bypass procedure.

The study also found that women with job insecurity (those who are fearful of losing their jobs) were not more likely to have a heart attack or other event but more likely to have several risk factors for cardiovascular problems including physical inactivity, elevated cholesterol, hypertension, and diabetes. They were also more likely to have an increase in weight.

The scientist who presented the study defined stressful jobs as those with demanding tasks and little authority or creativity. The study appears to be one of the longest running studies of cardiovascular effects of job strain only in women. It appears that mental tension and how demanding the job is appear to have a major effect on cardiovascular health in women.

Dr. Steven Reisman, a Manhattan Cardiologist emphasizes that at the New York Cardiac Diagnostic Center an emphasis is placed on women and heart disease with Dr. Lynn Mailloux having a special interest in treating women with heart disease and diagnosing women with heart disease. In addition, Dr. Reisman states that Dr. Alan Rozanski a top specialist in mental stress and heart disease is a consultant to the New York Cardiac Diagnostic Center.

The AP (10/28, Stobbe) has reported that in a study released by the Centers for Disease Control and Prevention (CDC), more Americans are aware that they have high blood pressure and more of them are taking medication to control it. High blood pressure also known as hypertension is called the “silent killer” because it doesn’t have symptoms and thus many people are not aware that they have this condition.

In the report from the CDC it was noted that 30% of American adults suffer from hypertension equaling approximately 66 to 74 million adults. The CDC study looked at surveys done from 1999 through 2008. One of the findings was that the percentage of adults who were aware of their condition increased from 69.6% in 1999 – 2000 to 80.6% in 2007-2008. The percentage of individuals who are being treated with medication increased from 60.2% to 73.7%. In addition, a larger percentage of adults were able to control their blood pressure over this time period. This report suggests that efforts to inform the public about the dangers of high blood pressure are succeeding but there is room for improvement.  Dr. Steven Reisman, a Manhattan Cardiologist, and Director of the New York Cardiac Diagnostic Center states that hypertension is a treatable risk factor involved in heart attack, heart failure, stroke, and premature death in the United States.   Early detection, Dr. Reisman, noted requires just a simple blood pressure check which can be done in a brief period of time and a standard office visit.

Healthday (8/10, Mozes) reports that a study of patients in the United Kingdom in those admitted to the hospital for a heart attack revealed that a decrease of just one degree celsius on a single day gives rise to a cumulative two percent rise in the number of heart attacks in the next twenty- eight days. This study shows that cold weather increases the risk for having a heart attack in particular for the elderly and those with a previous history of heart disease. It appears that those who are taking aspirin were less vulnerable to this increase in risk. The author suggested that prior research has shown that as temperatures goes down blood pressure may go up and the blood may become thicker causing the heart to work harder and may also increase the possibility of blood clotting.

Dr. Steven Reisman, Director of The New York Cardiac Diagnostic Center and a Manhattan Cardiologist states that the risk of heart attack that is associated with a drop in outdoor temperature is relatively small compared to the usual cardiovascular risk factors such as smoking, obesity, high cholesterol, high blood pressure, family history, and diabetes.

Healthday (8/9/10, Reinberg) reported that people who put on a little weight might hinder the function of cells that line their blood vessels increasing the risk for both high blood pressure and possibly cardiovascular disease. The researchers performed a controlled study in young adult healthy volunteers with one group having moderate weight gain of approximately eight pounds and the other group maintaining their weight and then measuring endothelial function which directs the ability of blood vessels to contract and dilate which controls blood flow. They measured endothelial function by measuring function of the brachial artery which is located in the arm.

The researchers measured the function of the artery before eight weeks of weight gain and again after sixteen weeks of weight loss. In particular, they measured the fat deposited in the area of the belly in both groups. They found that people who gained weight in this area showed a decreasing ability of the brachial artery to dilate and when they lost that weight the ability of the artery to dilate returned.

Dr. Steven Reisman, a Manhattan Cardiologist and Director of the New York Cardiac Diagnostic Center, advises that endothelial dysfunction may be an early marker of coronary artery disease and this study may strengthen the case for weight control as a means of diminishing cardiovascular risk. These findings suggest that endothelial dysfunction may be caused by moderate weight gain in the abdominal area and can be reversed through diet and a decrease in weight. This study is also consistent with previous studies linking cardiovascular risk to certain measures of obesity.

Med Page Today (8/25, Walsh) recently reported that a person’s vitamin D status can predict their clinical outcome in a trial of patients with heart failure. The study being presented at the European Society of Cardiology found that lower levels of vitamin D were associated with an increased risk of mortality in patients with congestive heart failure.

Dr. Reisman, Director of the New York Cardiac Diagnostic Center, describes how vitamin D deficiency is highly prevalent in the United States and a growing body of evidence suggests that diminished levels of vitamin D may adversely affect the cardiovascular system. In an article published in Circulation in 2008, the authors found that in a community based study vitamin D deficiency was associated with increased cardiovascular risk. They found this higher risk was in particular evident in individuals with hypertension. In other studies, lower vitamin D levels have been observed in individuals with heart attacks, stroke, heart failure, and other forms of cardiovascular disease.

In another study presented at the American College of Cardiology in March 2010, in patients whose blood test revealed low vitamin D levels, those who are able to raise their blood levels were 33% less likely to have a heart attack, 20% less likely to develop heart failure, and 30% less likely to die over an average follow up period of one year. Individuals can increase their vitamin D levels by taking vitamin supplements and carefully and briefly exposing their skin to the sun’s vitamin D producing ultraviolet light. Dr. Steven Reisman, a Manhattan Cardiologist recommends that people should refrain from taking supplements on their own. This should always be done under a doctor’s supervision after a blood test evaluating the vitamin D blood level.

Health Day (7/16/10 Preidt) has reported that women are three times as likely as men with severe angina to develop severe coronary artery disease (CAD).

Angina is a type of chest discomfort most frequently described as a squeezing or pressing pain in the chest. It is related to blockage of the arteries that supply the heart causing a lack of oxygen supply to the heart. Angina may also occur as other types of discomfort including chest burning, jaw pain, and back pain. Angina frequently increases with physical activity.

In the above noted study, researchers found that women with class IV angina, which is the most serious type of angina occurring at rest or with minimal exercise, are at a much greater risk of developing severe blockages then men.

Underdiagnosis and undertreatment of heart disease in women can contribute to an elevated mortality making early and accurate diagnosis of great importance. When heart disease is suspected, further evaluation, in particular, stress testing can be very useful in early detection of blockages to the heart. Dr. Steven Reisman, a Cardiologist in New York City and one of the early pioneers in the area of nuclear cardiology has stated that nuclear cardiac stress testing has been shown to be accurate in risk assessment and prognosis in women with both typical and “atypical” chest discomfort.

Dr. Steven Reisman, Director of the New York Cardiac Diagnostic Center, at an invited lecture at the F.B.I. in Manhattan on June 30, 2010, discussed the relationship of salt intake and the development of high blood pressure or hypertension. Dr. Reisman referenced an article in the USA Today from April 28, 2010 entitled “Keeping A Lid On Salt; Not So Easy”. A recent report from the Institute of Medicine emphasized the relationship of salt intake to the development of heart disease and stroke. Hypertension is a common disease in the United States and this elevation of blood pressure can be easily diagnosed by a health professional taking several readings of an individual’s blood pressure in the resting state. Since hypertension is without symptoms, early diagnosis before the development of stroke or heart attack is extremely important.

According to the article, Americans now consume an average of 3,400 milligrams of sodium a day. The U.S Department of Agriculture guidelines recommend that adults including those with high blood pressure and individuals at risk should consume no more than 1,500 milligrams a day and other adults should consume less than 2,300 milligrams of sodium a day. The problem that occurs is many prepared foods or meals in restaurants especially fast foods have a high level of sodium.

The emphasis is to decrease the risk of heart disease and stroke by decreasing sodium intake along with weight control and physical activity. The article in USA Today gives examples of how many milligrams of salt are in different entrees at popular chain restaurants and also ways of decreasing the amount of salt intake. One of the hidden ways that Americans have an increased salt intake is in processed foods such as canned foods, soups, and other foods with additives. Tips for lowering sodium may include limiting salty snacks, add fresh lemon instead of salt to fish and vegetables, and learn how to use spices and herbs to enhance the taste of food instead of salt.

Dr. Reisman also spoke at the lecture about the other important risk factors for heart disease including hypertension, diabetes, hyperlipidemia including elevated cholesterol and elevated triglycerides, obesity, family history of heart disease, and smoking. The New York Cardiac Diagnostic Center, according to Dr. Reisman, can combine a consultation with both a cardiologist and a nutritionist to guide those who have an interest in a tasty diet with a low salt intake.