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WOMEN WITH STRESSFUL JOBS HAVE AN INCREASED RISK OF HEART ATTACK

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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.

IMPROVED HIGH BLOOD PRESSURE AWARENESS LEADS TO IMPROVED TREATMENT

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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.

Heart Attack Risk Increased By Cold Weather

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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.

Modest Fat Gain May Increase the Risk for Cardiovascular Disease.

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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.

DR. STEVEN REISMAN, A MANHATTAN CARDIOLOGIST, DISCUSSES THE RELATIONSHIP OF VITAMIN D DEFICIENCY AND THE RISK OF HEART DISEASE

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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.

DR. STEVEN REISMAN, A NEW YORK CITY CARDIOLOGIST, DESCRIBES LOWERING CHOLESTEROL BY EATING NUTS

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An article in the Wall Street Journal (May 11, 2010) has described how research has shown the benefits of eating nuts and describes that for most people consuming two handfuls of nuts a day seems to work better than one in lowering cholesterol. The type of nuts includes almonds, walnuts, pistachios, macadamia’s, hazelnuts and peanuts.

The results of the study were published in the Archives of Internal Medicine. The lead author was one of the first researchers to link nut consumption to a lower risk of heart attack several years ago. The author of the study says the study “confirms that nuts, indeed, lower cholesterol”.

In 2003 the Food and Drug Administration allowed processors to put on labels that “eating 1.5 ounces per day of most nuts…as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.” The majority of the prior studies involved almonds and walnuts. This study seems to show that the drop in cholesterol was less pronounced in obese people and in those eating a “Mediterranean diet” while a greater improvement was seen in those who consumed a “Western” diet of high-fat meats and dairy products.

Dr. Steven Reisman, a Manhattan cardiologist, who directs six locations of the New York Cardiac Diagnostic Center believes that dietary therapy along with exercise and nutrition advice is an important treatment in patients who have elevated cholesterol in an attempt to lower cholesterol prior to beginning medication.

WOMEN WITH SERIOUS ANGINA (CLASS IV) HAVE A GREATER RISK OF DEVELOPING SEVERE CORONARY ARTERY DISEASE THAN MEN

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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, a Manhattan Cardiologist, at an Invited Lecture at the F.B.I. on June 30, 2010 Discussed the Relationship of Salt Intake to High Blood Pressure

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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.

Dr. Steven Reisman, A New York Cardiologist, discusses the hidden benefits of exercise as an invited speaker at the FBI in New York.

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Dr. Steven Reisman was an invited speaker at the F.B.I in Manhattan on June 30, 2010 to discuss
heart attack prevention. As part of this lecture he discussed the advantages of exercise in the
relationship to general health and in particular, in the prevention of cardiac disease. One of the
references Dr. Reisman used was an article in the Wall Street Journal from January 5, 2010
entitled “The Hidden Benefits of Exercise”.

The article described how moderate exercise can be extremely successful in the prevention
of disease in general. This includes bolstering the body’s immune system, improving the
body’s response to influenza vaccine, and making the individual less prone to viral infections.
Dr. Reisman discussed the advantage of regular exercise including something as simple as a
thirty to forty-five minute brisk walk daily five times a week which has been shown to have a
positive effect. The article described how individuals who undergo this type of program can
reduce the number of sick days up to 50% compared to sedentary subjects. Inactivity can pose
a significant risk to one’s health contributing to heart disease, diabetes, hypertension, cancer,
depression, arthritis, and osteoporosis. In relation to heart disease, studies have shown that
exercise can lower blood pressure, reduce bad cholesterol, and decrease the incidence of diabetes.

There are guidelines developed by the Department of Health and Human Services and available at
www.health.gov/paguidelines. A survey conducted by the American College of Sports Medicine
and American Medical Association found that only four out of ten doctors talk to their patients
about the importance of exercise. Dr. Reisman, a Manhattan Cardiologist stated that at the New
York Cardiac Diagnostic Center diet and exercise in the prevention of heart disease are important
features of all patient interaction. Muscle strengthening activities two or more days a week are
also suggested along with aerobic exercise.

Early detection of high blood pressure, elevated cholesterol, and diabetes can be easily determined
on a simple office visit with a basic blood test along with a basic history and physical examination.

Cheney’s Heart Failure Treated by New Pumping Device

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The New York Times (7/19, Altman) reports that former Vice President Dick Cheney
underwent a procedure to implant a mechanical pump that is now being given to a small
number of people with congestive heart failure. It is generally used in individuals who have
severe heart failure and are at the risk of dying within several months without the device.

These pumps are partial artificial hearts also known as “ventricular assist devices”. They are
implanted as a last resort either for use as a temporary device until heart transplantation or may
at times be used as a permanent device. Former Vice President Cheney has congestive heart
failure most likely resulting from five prior heart attacks. In addition, Mr. Cheney has had
angioplasty to open up blocked coronary arteries and also stents to increase perfusion. He also
had a prior pacemaker and defibrillator.

Approximately 5.8 million people in the United States have congestive heart failure. About
670,000 people are diagnosed with heart failure each year. The most common causes of heart
failure include coronary artery disease, high blood pressure, and diabetes. Early diagnosis and
treatment can improve quality of life and life expectancy for those who have heart failure.
The symptoms of heart failure may include shortness of breath during activity, difficulty in
breathing when lying down, swelling of the legs and ankles, and general fatigue and weakness.

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