Q: Are there any supplements worth taking to protect your heart?
That said, if you are having active chest pain, if you become really winded when you exert yourself, if you are having heart rhythm problems, that could indicate a problem. You should not exercise in those situations; you should consult with your doctor.
Almost everybody whos had a heart attack deserves to be on aspirin; there is very solid evidence for secondary prevention. For primary prevention the evidence is really dubious. Daily aspirin increases the risk of internal bleeding to a degree that raises questions about any net benefit.
Dr. Michael D. Shapiro:In our cardiac rehabilitation programs, we find it to be incredibly safe. All of the science data support that. People with heart disease who do not exercise are taking a greater risk. Even outside of cardiac rehab, exercising is incredibly safe.
With surgery there is the upfront risk, and a much more difficult recovery. They crack your chest open and its painful. It takes patients months to really be back to their baseline. But the good news is, if all goes well with surgery, once youve recovered, you are not as likely to need repeat procedures. Its a more complete therapy.
Hassell:The evidence for benefit is huge. In a German study published in 2004, a group of patients all had single-vessel coronary artery disease and chest pain when they exercised. Half got a stent and the other half got sent home with a stationary bicycle to exercise on every day. After one year, the exercisers experienced 60 percent fewer cardiac events.
But in some other situations, you are better off having bypass surgery. This is particularly true if you have a blockage in your left main artery. If you have triple vessel blockages, especially if there is heart damage or diabetes, bypass could be better. Surgery will be a more complete procedure then stenting.
Dr. Sandeep Garg:Be suspicious of any food that comes in a convenient package. Be suspicious of any foods advertised on TV. I firmly believe that best way to prevent heart disease is a plant-based diet. Minimize animal ts and focus on eating more fruits, vegetables, legumes and whole grain foods, and nothing that is packaged or processed. Remember that there is no shortcut to a healthy lifestyle. Adopt these habits, turn your back on processed foods and never look back, never go back there again. For me it is not a diet, but a lifestyle choice.
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Garg:A lot of patients who were getting bypass surgery in the past are getting stents, but I dont think surgery will ever become obsolete. There are some blockages where we cant put in stents. And in some patients who have stents, arteries become blocked again and they need to have bypass surgery. Surgery is evolving and becoming less invasive. Minimally invasive techniques allow surgeons to operate on a beating heart. Hybrid approaches involve stenting one artery and minimally invasive bypass on another artery. For the patient needing to choose a treatment, it comes down to individual ctors. Some patients may not be strong enough to undergo surgery. For others, you really dont want to put in stents because of anatomical issues.
Its under-appreciated that there is strong evidence to show that refined carbohydrates -- sugary drinks, white flour and white rice -- contribute to heart disease more than saturated t. Diet drinks appear to be just as bad as sugary soft drinks in their association with heart disease and diabetes.
your heart patients Guide to heart health: Oregon cardiologists dish about diet, supplements, surgeryour heart patients Guide to heart health: Oregon cardiologists dish about diet, supplementy,Our experts:
I almost had a heart attack reading this! Theres hope for the medical community, after all. Now it will only take another 20-30 years to convince people to eat real food again since so many are convinced that eggs, butter and meat are the work of the devil.
We know that with people who get stents the procedure is a much easier process. You go to the hospital, get a stent, leave the next day with really no serious disability. You are back to your normal self in a few days. But over the long term, people who get stents are likely going to need repeat procedures.
Garg:I dont think any supplement is going to make any difference for the general population. If you eat fruits and vegetables and healthy foods to begin with, you dont need tablets. In specific populations, patients with high triglycerides for example, fish oil may be appropriate. For secondary prevention in people whove had a heart attack or diabetes, history of stroke, peripheral vascular disease, the evidence for a baby aspirin a day is excellent. For those who are at very high risk of having a first heart attack, there is some role for a baby aspirin a day.
But if youve got a heart problem, start in a rehab program to build up your confidence. If you are feeling frail, start in tiny doses. You can do just 5 minutes and do it many times a day.
Dr.Michael D. Shapiro, director of preventive cardiology, assistant professor of medicine and radiology, Oregon Health & Science University
Dr.Sandeep Garg, cardiologist with Pacific Heart Associates practicing at Legacy Meridian Park Medical Center
Q: How safe is it to do aerobics and strength training if you have heart disease or heart ilure?
Dr.Miles Hassell, medical director for integrative medicine, Providence Health & Services
Hassell: The supplements that are probably worth doing are fish oil and vitamin D. If you dont eat a lot of oily fish, it may have a benefit. It may reduce blood pressure a tiny bit. Most studies seem to show a reduction in total mortality. In people who are at low risk of heart disease, fish oil still seems to be protective.
The benefits that patients glean from performing exercise are more than just effective for the heart. Exercise improves quality of life, improves mood, gives you more energy. Studies show that the reductions in morbidity and mortality from exercise are as good or maybe even better than medical therapy alone. Its impressive.
Dr. Miles Hassell:If we go by evidence, studies where we see an actual measure of outcomes -- fewer heart attacks, fewer strokes, lower mortality -- you are forced to conclude that the foods that are healthy are vegetables, nuts, fish, probably whole grains and beans, all used in the least-processed form.
It really looks like extra virgin olive oil is probably the best oil. We encourage that; we dont tell people not to use butter. Milk, eggs, butter, meats -- all the traditional foods people like can be part of a healthy diet. People who drink a small amount of alcohol are less likely to die of heart disease. Its not hard to adopt a heart-healthy diet, but it forces people to cook and it does require avoiding things that are highly processed.
Shapiro:There are pros and cons to either approach. When youre having a heart attack, generally speaking, stenting is the way to go. You want to get the arteries open as soon as possible and stenting is ster than surgery. Its also safer when somebody is having a heart attack.
Q: Is bypass surgery obsolete now that stents work so well?
And its not just heart disease. Stroke, cancer, disabling joint disease, osteoporosis -- all are strikingly diminished when people exercise regularly. Exercise elevates mood and energy. Its kind of unbelievable how much good exercise can do. We tell people it should be one of their highest priorities every day, above their work and right below God and mily.
I am so glad to hear Dr. Miles Hassell say the traditional foods can be part of a healthy diet. My mily and I had been on a Mediterranean diet for many many years, as I have always been a health nut staying on the latest and greatest of what the experts recommend. We are alyour heart patientsl slim and exercise but still had health issues-so puzzling! Not until we cut out grains and most dairy and legumes, and increase our saturated ts did the health of our entire mily improve. I feel like I was starving my kids brains by feeding them low-t. Adding coconut oil to my diet has helped my mental focus and mood so much I want to shout it out to the world. I had my best blood work results in the 7 years Ive been tracking a year after eating this way. So has my husband. My children are doing better in school and sports and especially their moods. We eat local grass fed and pastured meats, wild caught fish, lots of veggies, & some yams/sweet potatoes. We use grass-fed butter/ghee, coconut oil, and extra virgin olive oil. We avoid sugar or processed foods. We occasionally indulge but I am finding I get sick when consuming gluten again. I know everyone cannot eat this way but small steps can make a difference. Support your local rmers and rmers markets and keep our local economy and your health strong.
-- Joe Rojas-Burke
MoreThe Oregonian&8217;s continuing coverage of health issues, including its Guide to a Healthy Heart.Q: Every food maker seems to claim their products are heart healthy. What should you really eat to prevent or minimize heart disease?
Weve heard too many loud claims about heart healthy super foods, miracle diets and medical breakthroughs. If theres evidence to back them up, its often overstated. And the next week, were given contradictory advice. Eating eggs clog your arteries. Eating eggs is just fine. Anti-oxidant vitamins fight inflammation. Anti-oxidants might shorten your life. We talked to cardiologists and preventive health experts to cut through the noise about preventing and treating heart disease, still the leading cause of death in the U.S.
For many other supplements, evidence is accumulating that they are going to do more harm than good. Vitamin E may increase mortality rates. Other anti-oxidant supplements appear to be harmful. Even folic acid appears to have problems.