5 ways to help a parent with heart disease

As more people survive and live longer with heart disease, adult children are increasingly becoming involved in their parent’s health care. They support their parents in making diet and lifestyle changes, taking multiple medications, recognizing side effects or new symptoms, figuring out health insurance claims – the list goes on.

Having a parent with a chronic health condition is one many people can relate to – including myself. I know it sometimes can be difficult to know how to help – or how much to help – but your care and support can make an enormous difference in managing their health, as well as retaining their independence.

Some of the most successful outcomes I’ve seen in patients came in large part because an adult child was keeping tabs on how the patient was feeling, managing medications and, in some cases, making key medical decisions for them.

Helping a parent with #heartdisease can range from watching for symptoms to ultimately making medical decisions for them. via @MedStarWHC

Let’s discuss five ways you can assist in the care and support of an aging parent – and what you can do if you don’t live nearby. These suggestions can be scaled up or down depending on your parent’s health. And while I may be talking specifically about heart disease, these tips could be modified to work with any chronic health condition.

1. Learn about their heart condition

Heart disease can seem overwhelming – for the patient and their loved ones. If your parent agrees, accompany them to doctor appointments. It can help to have a second person in the room while a doctor explains things. You can take notes and ask questions. The information is more likely to stick if there’s more than one person listening in the room.

You know your parent and their needs better than the doctor. This insight can be especially valuable as health care continues to move toward a shared decision-making model, in which the doctor and patient work together to make decisions based on best practices and patient preferences and values.

It also may be a good idea to schedule an appointment in which there will be no physical exam or tests, but to simply get you up to speed on your loved one’s condition. Explain that you’re Mom’s or Dad’s helper and while they will join you, the appointment is for you.

Along with asking about what symptoms to watch for and what role you can play in their recovery and health, ask what the future looks like. This topic may be uncomfortable to discuss, but can be useful for planning if the condition progresses.

If you care for an ill parent, ask the doctor what the future may hold. It can help with planning if the condition worsens. via @MedStarWHC

2. Watch for signs of heart problems

Providing a second set of eyes and ears may be the best way you can help a parent who has heart disease. Catching problems early can mean the potential for a better outcome.  

Symptoms of heart problems may not be as obvious in older people. They may be subtler than chest pain. But if you know your parent’s health baseline, you may notice changes before a doctor – or in some cases – even your parent does.  

Signs to be aware of, particularly if they appear suddenly, include:

  • Do they seem fatigued? Are they sleeping more or longer?
  • Does their breathing seem labored or “off”?
  • Has their appetite declined?
  • Is there increased swelling in the legs or ankles?  

Your parent may not mention changes in their health. We often see in this in the “Greatest Generation.” They don’t want to be a bother. “It was just a little chest pain. I didn’t want to worry you.” Ask them direct questions about their health. For example, when I talk to my father, I ask, “How are you feeling, Dad? Anything bothering you?” And, include even more specific questions that relate to their personal health problems. For example, “How is your breathing today?”  

3. Address potential heart problems

Don’t ignore warning signs. Encourage your parent to seek help, even if the symptom seems minor. Doing so could prevent a more dangerous situation.  

Create a plan with your parent’s doctor to address potential problems. Ask the doctor:

  • How can we reach you during the day or after hours?
  • Do you offer same-day appointments?
  • When should we go straight to the emergency room?  

Knowing these answers can result in more streamlined and effective treatment. For example, a patient’s daughter may call and say, “Mom’s having some of the same symptoms she had previously when she was admitted to the hospital. But I think it’s too early to go to the ER. Can I bring her to the clinic?” We may be able to prevent an unnecessary hospital admission.  

4. Assist with treatment, recovery and prevention efforts

Your parent’s doctor likely will send them home with a treatment and prevention plan. But there are all kinds of ways that a plan can be derailed. You can plan an important role in keeping their health plan on track.  

  • Track doctor appointments: Add your parent’s doctors’ appointments – or reminders to schedule appointments – to your personal calendar. This way you can help them remember and ensure they have transportation. If your parent agrees, join them at appointments as a second set of eyes and ears.  
  • Manage medications: Medication adherence is crucial in preventing secondary events. Your parent may get frustrated or confused if they are taking multiple medications. Make sure you understand the drug’s purpose, how and when to take it, the potential side effects, and when it needs to be refilled. And, don’t be afraid to ask if any medications can be safely stopped.  This can help in several ways including helping control the number of pills your family member takes, and ensuring that each pill provides a meaningful health benefit. Find more tips to improve medication management.
  • Monitor blood pressure: Blood pressure is a vital measurement we use to assess heart health. But sometimes, the readings may not be accurate during a doctor’s visit. The stress of being in a doctor’s office can cause blood pressure to rise, a condition we call “white-coat hypertension.” The doctor may recommend regular blood pressure monitoring at home. Learn how to monitor your blood pressure at home.
  • Support lifestyle changes: Your parent may be asked to make significant changes in diet and exercise. Offer to help with grocery shopping or cooking. When possible, join them in diet changes or physical activity. The American Heart Association says people are 76 percent more likely to follow a walking program if someone is counting on them to show up.  

5. Organize health-related records such as insurance, advance directives

Navigating health insurance plans can be confusing for anyone. But it may be especially difficult for your 85-year-old mother or father. Look at their plan and know what benefits are included. This can become useful, for example, to ensure they don’t defer care they should be getting.  

Discuss your parent’s preferences regarding end-of-life-care. Who would they like to make medical decisions for them should they be unable, and which treatments would they want and not want? Although these conversations can be painful, they’re important decisions that will help ease the burden on the family should your parent’s condition worsen. Prepare an advance directive and make their wishes known to close family. 

End-of-life planning discussions can be painful, but the decisions made can help ease the burden on family later. via @MedStarWHC

What if you don’t live near your parent?

There are all sorts of creative ways to communicate and keep tabs on someone in our tech-enabled world. Many jokes are made about older generations not being able to use technology, but I’ve found my elderly patients remarkably adaptable when it comes to learning how to use some of these devices, especially if it allows them to see and talk with their children and grandchildren.

Make use of apps such as FaceTime, WhatsApp or Skype to not only talk with your parent, but also to physically check for symptoms. You could set up a standing time to talk each day to make sure they have taken their medication or completed their physical therapy.

Wearable healthcare monitoring devices, which are constantly evolving and growing in use, may allow you to remotely track your parent’s blood pressure, pulse and heart rhythm. I’ve even seen one that alerts you to someone’s body position, so if it’s noon and Mom is lying down, you can check on her. One note of caution about these devices and apps: Check out the privacy policy and be sure your parent is willing to share their healthcare information with the company.

You also could use video monitoring for some details. This may sound spooky, but it could be as simple as mounting a camera over the pill organizer to ensure that your parent is taking their medication every day.

Finally, don’t forget to look after yourself as well. Surround yourself with a support system that can give you a break from caring for a parent when you need it and to help you manage the emotions you may face from day to day. Also, heart disease can run in families, so talk to your doctor about your own heart risks and what you can do to prevent future problems.

Request an appointment to discuss your heart health or to learn more about a parent’s heart condition and treatment.

Shared decision-making: It’s no longer ‘doctor knows best’

Does this sound familiar? You go to the doctor. They diagnose you and tell you what the treatment will be. The end.

This one-sided approach to decision-making involves the doctor dictating care without much, if any, input from the patient. But this is now beginning to change. We’re moving away from that sort of “doctor knows best” model of medical decision-making and toward a newer approach known as shared decision-making.

We’ve moved away from a “doctor knows best” model of decision-making and moved toward shared decision-making. via @MedStarWHC

Here’s the big idea:  I have expertise in medicine. You have expertise in you. Shared decision-making recognizes the expertise of patients and empowers them to engage in the medical process. This is illustrated in the principle “Nothing about me without me.”  

Shared decision-making provides numerous benefits to patients. One review of 105 studies compared patients who received usual care with those who used decision aids, which are tools designed to facilitate shared decision-making. These tools can include written materials, videos or interactive web-based programs. The review found that patients who used decision aids felt more knowledgeable and confident in decisions, better understood the benefits and risks of treatment options and had a greater likelihood of receiving care aligned with their values.  

As patients increasingly play a more active role in their health care, learn how shared decision-making works and how you can take an active role in it. But first, let’s look at a hypothetical situation to see how shared decision-making can influence your treatment.  

What shared decision-making looks like in practice

You come to the hospital after having a small heart attack. You’re stable but have blocked arteries. We discuss your condition and treatment options, which include medication and bypass surgery.  

Often, I’d recommend surgery for a patient with blocked arteries. But if you’re unable to be off work for the eight weeks it will take to get back to full function after bypass surgery or you serve as the primary caregiver for an elderly parent, we may be able to delay surgery and discuss alternatives.

There’s no confrontation or hard feelings. Rather, it’s a negotiation about the interaction between a medical recommendation and your personal situation. Instead, we may tailor your medications to your situation, discuss warning signs of which to be aware, and send you home with the understanding that we may discuss surgery again in the future.  

This situation illustrates how shared decision-making is meant to work. The doctor and patient have an open, honest conversation and a decision is reached based on the perspective of both parties.  

How shared decision-making works

Shared decision-making may sound like common sense. And it is. Unfortunately, medicine got away from this type of doctor-patient collaboration as quality measures focused on enforcing care guidelines.  

In the past, if you came in with high cholesterol, quality care was defined as you leaving with a prescription for a statin – whether you wanted one or not. It didn’t matter if you didn’t understand why, didn’t agree, or threw the prescription in the garbage the second you left the doctor’s office. By gosh, the guidelines said to give you a statin, so the doctor gave you a statin.  

No one wants to have decisions made for them, or to have their thoughts and opinions not taken into consideration. We now consider quality treatment to be achieved if three steps have been followed:

  • The doctor explains the treatment options
  • The doctor and patient have a thoughtful discussion about each one
  • A decision is reached that is right for the patient

In this meeting between the doctor and the patient:

  • The doctor contributes knowledge about the condition and treatment options
  • The patient contributes their past experiences, preferences, goals and values, along with information they have from research about their condition and treatment options  

In a perfect world, the doctor’s recommendation and patient’s wishes align. But sometimes they don’t, and in those cases, we come up with another plan. Or maybe we decide it’s not right today, but we keep the topic open and talk about it later.  

I find that patients usually have valid reasons for why they don’t want to follow certain treatments. “I tried it in the past and it didn’t work.” “A friend did it and it didn’t turn out well.” “My family doesn’t think I should do it.” “My primary care doctor disagrees.”  

At the end of the day, I want my patients to feel comfortable with their care decisions. To do that, doctors need to sit down at the table and talk with you eye to eye – not stand up and dictate what you should do. We need to encourage patients to open up by asking questions and listening to the answers:

  • Do you understand your condition?
  • What do you think about the treatment recommendation?
  • Is it right for you, and if not, how can we make it right for you?
  • What are your concerns?  

Your role and responsibility in shared decision-making

Shared decision-making is a two-way street. The doctor must be willing to involve you and respect your expertise and preferences, but you also must take an active role in the process.

  • Learn about your condition and treatment options: Listen to your doctor and read the information they give you. You also can do your own research before or after appointments.
  • Speak up: Ask questions when you don’t understand something. Share your concerns, goals and preferences.  
  • Recruit family or friends to help: Needing medical care can feel overwhelming. Sometimes it helps to have a loved one with you as a second set of eyes and ears. They can take notes to help you remember details later and ask questions you may think of later.  

The first step toward making a medical decision is to fully understand your options. While each condition is different, here are a few questions to ask to get started:

  • What are my treatment options?
  • What are the risks and benefits of each?
  • What is the goal of each option? Is it to treat the condition or improve the symptoms?
  • How will each treatment make me feel?
  • What are the side effects and how will they affect my quality of life?  

When you and your doctor actively collaborate on care, you’re more likely to feel confident and satisfied in your decisions. Find a doctor who engages in shared decision-making, and play your role in it as well.  

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Why I think it’s time to make statins available over-the-counter

Heart disease and stroke are the leading cause and fifth-leading cause of death of adults in the United States, respectively. Studies show that statins – cholesterol-lowering drugs – can reduce the risk of heart attack, stroke and death from heart disease by 25 to 30 percent.

Yet of the more than 78 million adults who are eligible to take statins, 45 percent don’t. There are plenty of reasons for this: some don’t realize they’re at risk for these conditions; others don’t want to take medication or have been scared off by misinformation about statins.

But people who could benefit from a statin also face an additional barrier: it requires a prescription.

A May 2016 study estimated that giving statins over-the-counter (OTC) status would result in more than 250,000 fewer major coronary events such as heart attack, more than 41,000 fewer strokes, and reduce heart disease- and stroke-related deaths by nearly 69,000 over 10 years.

We’ve been using statins for 30 years, and they’ve proven to be some of the safest and most effective drugs for heart disease prevention. I think it’s time we remove the prescription barrier and allow people to buy them over-the-counter.

Statins as OTC medication: Why now?

Selling statins over-the-counter isn’t a new concept. It’s been discussed for years. In fact, one pharmaceutical company even began the process for developing an OTC statin before abandoning it due to sky-high requirements. But evidence found in a 2016 study really drove home for me that this is a valid idea.

“The Heart Outcomes Prevention Evaluation” (HOPE-3) study, published in May 2016 in The New England Journal of Medicine, followed more than 12,000 participants age 55-65 with at least one heart disease risk factor, such as high blood pressure or tobacco use. Half of the participants were given 10 mg of rosuvastatin, more commonly known as Crestor, and half were given a placebo. After five years, those who took a statin had a 24 percent lower risk for cardiovascular events. And, importantly, there were few if any important differences in side effects between the statin and placebo.

One interesting aspect of this study is that cholesterol levels were not used to select patients or to guide the treatment. The requirement was simply age and one heart disease risk factor. And to me, that’s the formula for an OTC medication: you don’t need a lot of fancy measurements to figure out if you could benefit from a statin. The HOPE-3 study showed statins were safe and effective in a broad population of people who didn’t already have heart disease, which I think is justification for conversion to OTC status.

A few years ago, Pfizer sought Food and Drug Administration (FDA) approval to convert its statin Lipitor to an OTC medication. The FDA set a pretty high bar for Pfizer’s study, requiring patients to measure their own cholesterol and take appropriate action based on the test results – actions no other OTC drug requires. Basically, the FDA wanted patients to act as a doctor, and it proved too complicated for most study participants. Pfizer ended the trial early.

The HOPE-3 study showed people don’t need to measure the effect of a statin on cholesterol for it to work. And by working, I mean it saves lives. So how do we narrow the gap between people who could benefit most from statins and those who take them?

Options for how to make statins available over-the-counter

There’s no question that giving a drug OTC status increases its use. One study showed an average 27 percent increase in utilization in several therapeutic drug classes, such as antihistamines and analgesics (a form of painkiller) after becoming available over-the-counter.

There are a few ways to go about expanding the availability of statins.

1. No longer require people to renew prescriptions

This is sort of a step up to true OTC status. Currently, if you have a prescription for a statin, you need to return to your doctor every year to renew the prescription. What if instead, that initial prescription was a lifetime prescription? It would be noted in your electronic medical records and you could walk up to any pharmacy window and refill it on an ongoing basis, without visiting the doctor to get a new prescription.

2.  Make statins available without a prescription

There are some people who just don’t want to see a doctor, but realize they’re at risk for heart disease or stroke. They’d take a statin if it was available like an antacid for heartburn or Tylenol for headache.

This would make statins available to anyone who stands to benefit from taking one: middle-aged individuals with one additional heart risk factor like in the HOPE-3 study. Given the poor job we do right now in getting statins to everyone who can benefit from them, it is time we begin to “think differently.”

Suggesting these options doesn’t mean I never want you to see a doctor, but it does remove a barrier to taking a potentially life-saving drug. Plus, instead of needing to discuss your statin during every visit, we can take a little extra time to focus on other topics, such as lifestyle modifications or answering questions.

How to keep people safe with OTC statins

Every medication has potential side effects. Statins are no different, although I think some concerns have been exaggerated on the internet. The most common side effect of statins is muscle pain, although it’s usually mild. Other side effects include a slightly increased risk to develop diabetes, seen as an earlier time to the diagnosis among patients likely to develop diabetes.

Have you ever bought aspirin or ibuprofen over the counter? Sure you have. In my view, statins are, in fact, safer than these drugs, and provide more benefit. Nonsteroidal anti-inflammatory drugs such as these are incredibly effective when needed, but they do have potentially serious side effects, including increased risk of bleeding in the brain and gastrointestinal bleeding. However, like statins, the benefits of these drugs greatly outweigh the potential harm.

Labels for OTC statins should carry warnings and recommended uses just like any other drug. And not every variation of statins should be available over-the-counter. For example, if you needed a dose higher than 10 mg, your doctor should have to write a prescription, just as you would for high doses of other OTC drugs.

There are still questions to be answered before statins become available over-the-counter, such as who will pay for them. Most OTC drugs aren’t covered by insurance. But statins prevent health events that insurance companies ultimately would have to pay for, so I think they should be a reimbursable expense. How that happens needs to be worked out.

Statins have a solid 30-year track record of preventing heart attacks, stroke and death from heart disease. They’re ready for prime-time. We’re entering a new era of empowering people to take charge of their health. It is time to give the public more control of their cardiovascular destiny by making statins available over-the-counter.

 

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How much caffeine is safe for you and your child?

We are a nation obsessed with caffeine: Cans of caffeinated energy drinks with flashy names line beverage shelves. New coffee shops seem to open every day. Caffeine is added to gum, jelly beans, oatmeal and the soap in our bathtub. You can even inhale it through a caffeine vaporizer.  

Eighty-five percent of Americans consume at least one caffeinated beverage each day. And unfortunately, it’s not just adults. About 73 percent of children consume caffeine on a given day. Caffeine in high amounts can be dangerous for anyone, but children especially can fall victim.  

A 16-year-old South Carolina student collapsed during class in April 2017 after drinking a latte, a large Diet Mountain Dew and an energy drink in a two-hour period. The coroner said the previously healthy teen died from a caffeine-induced cardiac event that likely caused arrhythmia, or abnormal heartbeat. Unfortunately, these stories are becoming all too common.  

Caffeine is a stimulant that can give you a boost of energy and make you feel more awake. But it also can increase your blood pressure, cause shaky hands, insomnia and an upset stomach, and in extreme cases can cause abnormal heart rhythm and seizures.

And although it’s legal and widely consumed, make no mistake: Caffeine is a drug. More than 20,000 people visited emergency rooms in 2011 for health problems involving caffeinated drinks, particularly energy drinks. That was double the number in 2007. I’ve seen this increase firsthand at MedStar Health, particularly among college students during finals. The reporting for such visits isn’t great, and I think this number is just the tip of the iceberg of the true number of people who are negatively affected by caffeine.  

To turn this disturbing trend around, we must examine the risk caffeine poses and what we need to do as individuals, as parents and as a country to keep our hearts safe.  

How much caffeine should adults and children have in a day?

The U.S. hasn’t developed guidelines for caffeine intake, but medical organizations generally recommend the following:

  • Adults: Less than 400 mg of caffeine a day
  • Age 12-18: Less than 100 mg  
  • Age 10-11: Less than 85 mg
  • Age 7-9: Less than 60 mg
  • Age 4-6: Less than 45 mg
  • Younger than 4: No caffeine  

These recommendations are based on a 24-hour period, not all at once in two or three hours. But these numbers may not be perfect for everyone. Other details must be considered. People with a heart condition such as a cardiac arrhythmia may need to be careful when consuming caffeine.  

The American Academy of Pediatrics advises that children and adolescents not consume energy drinks of any kind. Not long ago, I saw a man in a gas station about to buy a 20-ounce energy drink for a 7- or 8-year-old. I stepped in and said while I didn’t want to tell him what to do, I was worried about the effect the drink could have on the boy. The man replied, “Are you kidding me? I didn’t know that. I’m not buying this for him.”  

Body size also affects the amount of caffeine you can safely consume. A 240-pound man may be able to tolerate more caffeine than a 155-pound man. Genetics affects how your body reacts to caffeine. People who have a specific variation of a certain gene metabolize caffeine more slowly, which means they experience side effects from less caffeine than others.  

How much caffeine are you drinking?

The amount of caffeine varies dramatically between types of drinks and brands. And for coffee, it also depends on how it was prepared:

  • Brewed, drip coffee (8 ounces): 75-165 mg
  • Espresso (1 shot): 45-75 mg
  • Latte or mocha (8 ounces): 63-126 mg
  • Soft drinks (12 ounces): 30-60 mg
  • Energy drink (8 ounces): 27-164 mg  

Based on these amounts, a teen could have two 12-ounce soft drinks a day to stay within recommended guidelines while an adult could have about four 8-ounce cups of coffee or two to three 8-ounce energy drinks.

Don’t forget to check your drink size. Is that cup of coffee in front of you really only 8 ounces? Or did you order a large and it’s actually 20 ounces? How about that energy drink? Is it 8 ounces, 16 ounces or more? If so, double, triple or even quadruple the above caffeine amounts to determine how much you’re really consuming.  

How caffeine affects the heart

Caffeine affects the heart in a few ways. 

  • It stimulates the synthetic nervous system, which activates the body’s fight or flight response and causes an increased level of adrenaline in the blood. This in turn can raise your blood pressure and heart rate.  
  • It also can interfere with the heart’s conduction system, the process by which electrical impulses sent from the heart muscle cause the heart to beat.  

Both of these have the potential to trigger an abnormal heart rhythm.  

While most people develop a tolerance to caffeine over time and the effects on the heart are lessened, the risk never disappears entirely.  

When it comes to energy drinks, the amount of caffeine isn’t the only concern. These drinks tout “natural energy-boosting effects” gained from a mix of other ingredients including stimulants and additives. Unfortunately, we don’t know a lot about the safety of such ingredients, especially when paired with caffeine.  

An April 2017 study found that consuming an energy drink was associated with potentially harmful changes in blood pressure and heart function beyond those seen with caffeine alone. The researchers measured participants’ blood pressure and used an electrocardiogram (ECG or EKG) to monitor the heart’s electrical activity twice for 24 hours: once after consuming an energy drink and once after drinking another beverage with the same amount of caffeine but none of the other ingredients.  

They found blood pressure increased by five points after drinking the energy drink but less than one point after the caffeine beverage. Blood pressure also remained elevated six hours later with the energy drink. An ECG change known as QTc prolongation, which is sometimes associated with irregular heart rhythms, also was seen after drinking the energy drink but not with the caffeine beverage.  

What can we do to prevent future tragedies?

Every time I read a story in the media about a caffeine-related death, especially when it’s a child, I wonder when we as a country will wake up to the real risks caffeine poses – especially energy drinks. How many deaths will it take before we stop selling drinks containing toxic levels of caffeine over the counter to our children?  

Energy drinks are primarily marketed to kids and adolescents. The bright colors, flashy labels and names such as “Monster” and “Rockstar” seem designed to appeal to our nation’s youth. It’s reminiscent of how Joe Camel ads were used by the tobacco industry.  

The Food and Drug Administration (FDA) regulates the amount of caffeine in soda, but not energy drinks because they are considered a dietary supplement and not a food. Other countries are moving to increasingly regulate energy drinks, and I think it’s time the U.S. does so as well.  

While regulating the amount of caffeine in such drinks or requiring warning labels may take time and considerable debate, I think we can find common ground on other regulations, such as restricting their sale to minors.  

Until the FDA acts, it’s up to us to keep ourselves and our children safe. I think the biggest challenge is that too many people simply don’t know how dangerous high amounts of caffeine can be – especially for children.  

We need to talk to our children about caffeine the same way we discuss alcohol, tobacco and other drugs. Caffeine is a drug and it’s addictive. By recognizing the potential risks that large amounts of caffeine can pose, we can prevent more people from consuming dangerous amounts of it.  

The ‘other’ drug problem: Poor medication adherence

We’re always looking for the next new “wonder drug,” the medication that will take us to new heights in keeping people healthy.  But what if the best drug for a medical condition is one we already have? In many cases, it is. But too many people are not taking their medications as directed.  

According to one study, about 50 percent of people with heart disease or a major risk factor for it, such as high blood pressure or high cholesterol, have poor adherence to their medications. Nearly 25 percent of adults in the U.S. with Medicare Part D prescription drug coverage do not take their blood pressure medicine as directed–and it’s even higher in the District of Columbia at nearly 34 percent.

Medication adherence refers to taking medication: 

  • At the proper dosage
  • At the correct time or times of day
  • For the prescribed length of time 

The consequences of not taking medication correctly can be severe. For example, not properly managing your blood pressure or cholesterol can lead to heart disease or stroke. Not taking a blood thinner after getting a stent to open clogged arteries increases the risk of a heart attack. One study showed that up to 69 percent of medication-related hospital admissions are related to poor medication adherence.

The simple idea makes perfect sense: Medication only works if you take it. The most important thing you can do is talk to your doctor if you’re struggling with a particular medication or your overall medication regimen.  

In the meantime, let’s talk about some tips to better manage your medications and questions to ask when you’re prescribed a new drug.  

Common reasons for not taking medication as directed

My patients have many reasons for not taking their medication as directed or at all. Some face multiple barriers managing their condition.  

These can include:

  • Forgetting: We’re human, and that means we sometimes forget things.  
  • Complexity of medical regimen: If you take multiple medications, or take different medications at different times of the day, it’s understandable that you may become confused at times.
  • Cost: The cost of prescriptions is going up, which can prove a serious barrier for many people.
  • Side effects: Some people fear potential side effects and won’t take a drug at all. Others may experience side effects that can range from annoying to life-threatening.
  • Unable to see the benefits: We most often see this in patients with conditions that have no outward symptoms, such as high blood pressure or high cholesterol. It’s not like having a headache in which you take medication and the pain goes away. When someone with a chronic condition doesn’t take their medication, they may not see an immediate problem. In some cases, they may actually feel better when they don’t take the drug. 

5 tips to improve medication management

Medication adherence can prevent future health complications, reduce the risk of hospitalization, improve your quality of life and even help you live longer. Here are five things you can do to help lower them or remove them entirely. 

1. Be honest with your doctor

Openly share your success or problems taking your pills with your doctor–your health is at stake. Only through an honest conversation can we get to the heart of the issue and help solve a problem.   To effectively manage a health condition, it’s important to understand what’s working and what’s not. I can best tell how well a medication is working when you take it regularly. On the flip side, if I don’t know that you’re having trouble taking all your medication doses, that can complicate things further. For example, we might decide to increase your medication dosage or begin an additional medication, when the simplest solution would be to talk about ways to help you take your medication more effectively.  It’s possible that you may not need the drug at all, or you may need a different drug, but we can only know that for sure if you’re honest about your medication adherence. 

2. Understand why you’re taking it

I’m always amazed when a patient admits that they don’t exactly know why they’re taking a drug: “Well, the doctor told me to.”   Doctors must do a better job educating our patients about why we’re prescribing a medication. Pharmacists play a role in this as well by reinforcing and reminding the patient about the importance and benefits of the drug.  If your doctor prescribes a drug and doesn’t adequately explain what it does and why you need it, ask questions until you understand. When you return for follow-up appointments, ask if it’s working and how they know. In some cases, you may be able to unofficially measure the results on your own. For example, if you take medication for high blood pressure, regularly monitoring your blood pressure at home may hint at if it’s working.

3. Get organized

Forgetfulness and confusion are the most common culprits I see when it comes to poor medication adherence. Often a few simple organizational tips and tricks can help sort this out.

  • Think ahead. Prep your medications for the week or month.
  • Use a daily, weekly or monthly pill pack.
  • Set an alarm on your phone as a reminder to take your medication.
  • Try a medication reminder app.

A 2006 study I co-authored showed just how effective a little organization can be. The trial followed 200 patients 65 and older who took multiple medications. Pharmacists bundled their medications in blister packs – a type of packaging in which you pop the medication out of a foil seal – with separate packs for morning, noon and night. After six months, medication adherence soared from 61 percent to an incredible 97 percent. Patients also experienced significantly lower blood pressure and cholesterol.

After six months, half the patients continued to receive personalized blister packs and the other half returned to usual care. The group who went back to what they had been doing dropped to 61 percent medication adherence, while the intervention group remained above 95 percent.

4. Inquire about a generic version

If you have limited, or even not-so-limited income, it can be almost impossible to sustain taking an expensive brand-name drug for an extended period of time. Many medications have a generic version, allowing you to save on out-of-pocket expenses. This can minimize the so-called “financial penalty” for being ill.

5. Ask if there is an alternative version

There are few classes of medication that don’t have an alternative option. You may want to inquire about a different version of your prescription if you:

  • Take a drug multiple times a day: There may be an alternative form that can be taken once a day.
  • Take multiple drugs: In some cases, we can prescribe a combination drug that includes two or more medications in one pill.
  • Experience side effects: Not everyone can tolerate every medication, but an alternate version may produce fewer side effects.

Questions to ask your doctor or pharmacist about medications

There is much more that doctors, pharmacists, health plans and patients can do to improve medication adherence—including better educating patients, improving coordination and data-sharing between prescribing physicians and perhaps even incentivizing medication adherence.

But it all starts with ensuring the patient understands why a medication is being prescribed, what it will do for them and how they should take it.

If your doctor or pharmacist doesn’t explain it to you, speak up. Don’t leave their office until you have answers to these questions:

  • What is it for and what are the benefits?
  • How much does it cost?
  • Is there a generic version?
  • How do I correctly take it–how often, what time of day, with food, etc.?
  • Are there alternatives, such as a combination pill?
  • What are the side effects, and what is my chance of experiencing them?
  • How long will I have to take it–for life or for a short time?
  • Are there lifestyle changes I can make to help me get off this medication?

The next “wonder drug” is out there waiting to be discovered. But often the best solution is already in our hands; we just need to optimize its use.

 

Stress: As dangerous as high cholesterol and blood pressure

According to a study released in January 2017 by the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States. Many of my patients know they’re at risk for heart disease, and we work together to lower their risk by controlling their risk factors, including high blood pressure and high cholesterol.

But these aren’t the only risk factors to watch out for. People with constantly high levels of stress double their risk of heart disease. That’s equal to the risk from high cholesterol and high blood pressure. And according to real estate blog Movoto, Washington, D.C., is the most stressed-out city in the nation.

How stress may affect the heart

We’ve known about the link between stress and heart health for some time. Experts at the American Heart Association note the importance of managing stress to prevent heart disease. And in 2015, an international group of researchers identified emotional shocks as the second leading cause of stress cardiomyopathy, or broken-heart syndrome. This condition is a special kind of heart attack that isn’t caused by blockages in the heart arteries. Instead, broken-heart syndrome can happen when someone sees or learns of something traumatic, such as the death of their child.

Though we’ve known that stress can affect heart health for some time, we haven’t understood the mechanics behind how this happens. But we may be close to a breakthrough in that area of research. In January 2017, researchers showed the area of the brain called the amygdala is associated with the risk of heart disease and stroke. The amygdala contributes to the brain’s processing of emotions and helps communicate with the rest of the body on whether to get away from stress or handle it head-on. This is what many people know as the “fight or flight” response.

So we know stress is dangerous, and we have an idea of why. The question then becomes: What do we do about it? I wish I could say that we should just not have any stress. The reality is that sort of advice isn’t practical. We can’t avoid all stress in our lives.

But when it comes to your heart’s long-term health, not all stress is created equal. Some types of stress are much worse than others. It’s important to recognize these different types of stress so you can get help from your doctor before your heart is at risk.

Types of stress

I think most people would agree with me that stress is bad for you. And I think most people also would agree that stress is a part of life we simply can’t avoid. Stressors like a bad commute, a rough day at work or an argument with your spouse are part of what life throws at us.

Most sources of stress are like these. They pop up, we deal with them, and we move on. These short, intermittent episodes of stress aren’t really a problem for your heart. Even stress that comes up on a regular basis, such as rushing to get the kids to soccer practice every Tuesday, isn’t that bad for you.

The main danger of stress to your heart is when you’re constantly in a stressful situation you can’t control or get away from. We call this uncontrolled, unrelieved stress. Some examples of these types of uncontrolled stress include:

  • A terrible work environment
  • An abusive relationship
  • Ongoing depression
  • Ongoing serious financial trouble

Though these are very different causes of stress, your body can’t tell the difference. In these situations, all your body knows is that you’re under severe chronic stress that you don’t feel you can escape. And that’s a major red flag for your heart health. You need to talk to your doctor if you’re in these or similar types of stressful situations.

Get help to find stress relief

Patients don’t talk to their doctors enough about stress. A lot of patients don’t like to talk about stress with their doctors—certainly not doctors who aren’t psychiatrists or psychologists. There’s not enough time in the course of a normal visit, or they don’t think it’s a medical problem. But stress absolutely is a medical problem!

And just as patients should be willing to talk to their doctors about stress, we doctors should be asking our patients about stress. That should be part of our care for people’s overall heart risk.

When a patient brings up a source of severe stress with me, I’m always grateful. I try to point them toward resources or come up with strategies for stress management. That’s part of my job as their doctor.

It might be tempting to think, “But you can’t help me get out of my debt. You can’t fix the stress. Why bother?” And no, we can’t remove sources of stress that way, but if we identify it as a problem for your heart, it might be something you can focus on to find a solution.

We also can refer patients to get professional help for their stress from mental health professionals, if necessary, or find other ways to resolve these sources of anxiety and worry. But if it’s really to that level that you feel like you can’t control this stress, you probably need to get some help.

Recognize and address stress

Some people are more aware of stress than others. Just like beauty, stress is in the eye of the beholder. What one person might think of as no big deal could be a source of extreme stress for another person.

But some people who think they’re handling their stress might just be ignoring or suppressing it. That’s a big problem, because those people aren’t recognizing the effects of their stressors on their lives or doing enough to address it.

Whether or not you think you’re stressed, use these simple assessments to measure the stress levels in your life. You might be surprised by what you find. If your stress levels are high, talk to your doctor about it, especially if you’re already being seen by a cardiologist for a heart condition.

Stress isn’t just in your head. It’s a real, physical, medical problem. And leaving severe stress untreated could lead to your heart paying the price.

 

Know your heart-healthy numbers – including CRP

“Know your numbers.” It’s a common theme surrounding heart health. Most doctors agree you should know your blood pressure, blood sugar and cholesterol so you can make changes to improve your health and reduce your risk of heart problems.

But there’s one more number people should be aware of: C-reactive protein (CRP).

CRP is a marker for inflammation in the body. It’s been shown that, when used in conjunction with cholesterol levels, it can help us better understand a person’s risk for heart disease. In fact, one analysis showed that the risk of a future heart event was more than 50 percent higher when CRP levels were over 3 mg/L.

Unfortunately, people often emphasize their cholesterol levels without considering any other factors. They think if their cholesterol is low, they are at low risk for heart disease. That may not always be the case. Knowing both your CRP and cholesterol levels is more powerful than knowing one alone.

Let’s take a closer look at how your CRP affects your heart risk. That way, the next time your doctor prepares to test your cholesterol, you can also ask about your CRP level.

What is CRP, and what does it tell us about heart health?

CRP is a ring-shaped protein produced in the liver in response to inflammation in the body. Inflammation is part of the body’s response to fighting infection. We all have a low level of inflammation at any given time. That’s normal and healthy.

While the exact role inflammation plays in heart disease is a topic of ongoing research, we do know that having a high level of inflammation over a long period of time creates heart risk. And we know we can measure inflammation in the body by testing CRP levels.

Checking your CRP involves a simple blood test. If you’re getting your cholesterol tested, we can use the same tube of blood. No extra needle sticks are necessary.

Your CRP level puts you in one of three categories:

  • Low risk: Less than 1 mg/L
  • Average risk: 1 to 3 mg/L
  • High risk: Greater than 3 mg/L

However, your CRP can’t tell us everything. It’s important to look at it in relation to your cholesterol, specifically low-density lipoprotein (LDL). LDL is considered the bad cholesterol because it collects in your arteries and can cause blockages. Your CRP modifies your LDL level.

Here’s how it works: If you have a low LDL but a high CRP, the high CRP reduces the benefit of a low LDL. You’re at increased risk. And it’s the same in reverse: If you have a high LDL but a very low CRP, that low CRP reduces the risk from the high LDL.

In fact, the American Heart Association and the Centers for Disease Control and Prevention say it’s reasonable to measure CRP as a part of heart disease risk assessment. It’s not considered mandatory, but patients and their doctors should discuss its potential benefits.

Once you know your numbers, there is a very simple online scoring tool you can use to predict your heart risk over the next 10 years.

How can you lower your CRP?

What causes a high CRP? It’s a combination of genetics, health and lifestyle factors, including:

  • Chronic inflammatory conditions such as rheumatoid arthritis, lupus, psoriasis and gum disease
  • Excess body fat
  • Low physical activity
  • Smoking

The good news is that there are many ways to lower your CRP. Most are the same things you should be doing to live a heart-healthy lifestyle: eat a healthy diet, exercise and quit smoking. If you have a chronic inflammatory condition, work with your doctor to manage it effectively.

Studies, including one I authored, have shown statins also can reduce CRP. Statins are a class of drugs typically prescribed to lower cholesterol levels and reduce the risk of heart attack and stroke. Current guidelines advise the use of statins for people with:

  • Known heart disease
  • Elevated levels of LDL cholesterol
  • Diabetes
  • An estimated 10-year risk of a heart event greater than 7.5 percent

And the JUPITER study showed statins could benefit otherwise healthy people with high CRP levels by cutting their risk of heart disease and death from heart disease by almost half. This would indicate we should take CRP into effect when assessing a person’s heart risk.

Who should get their CRP tested?

I recommend anyone who has their cholesterol checked to also have their CRP tested. As I said earlier, we can use the same blood draw; we simply check one more box for the lab to test.

Just like with cholesterol, the earlier we identify a high CRP levels, the more time we have to prevent potential heart problems through lifestyle changes and, if necessary, medical treatments.

CRP is simply one more way to optimize our understanding of someone’s heart risk. And high CRP is treatable! So the next time you’re in the doctor’s office, ask about your numbers. All of them.

Request an appointment to test your heart-health numbers.

The surprising heart risks of too much sleep and exercise

You’ve probably heard a lot about how getting exercise and sleep can help you avoid heart troubles in the future. But getting too much of either can actually increase your risk of heart disease.

It seems counterintuitive. After all, we’re constantly told that exercising regularly and getting enough sleep are vital to staving off obesity, high blood pressure, stroke and, of course, heart disease. And it’s true. Exercise and sleep are important components of a healthy lifestyle. So, wouldn’t exercising even more and getting lots of sleep make us healthier and less prone to heart disease?

Surprisingly, the answer is no. Excessive sleep and over-exercising can increase your risk for heart disease, just like not getting enough sleep or exercise can. In many disciplines, from economics to communication, this phenomenon is known as the “Goldilocks effect,” referring to the children’s story of “Goldilocks and the Three Bears.”

Here’s how can you balance your sleep and exercise to find the amount that isn’t too much or too little, but instead “just right” for your heart health.     

How sleep affects the heart

There is still some debate about the exact amount of sleep that’s ideal for adults. However, researchers have reached a consensus on the optimum range. Almost everyone needs between seven and nine hours of sleep every day. And no, you can’t “catch up” on the weekends. It’s much better for your body’s circadian rhythm–the natural sleeping and waking cycle–to go to bed and wake up at a relatively consistent time each day.

Some people are naturally long sleepers, about two percent of the population. These people need 10 to 12 hours of sleep, or they feel tired and groggy throughout the day. However, most people should not be sleeping more than nine hours per day.  

Oversleeping has been linked to increased inflammation–in which the body’s immune system attacks healthy tissue. Chronic inflammation, or inflammation that occurs over months or even years, can put you at greater risk for cancer, diabetes, heart disease and many other health problems.

Getting too little sleep or too much sleep can increase inflammation levels. But considering that fewer people are aware of the dangers of oversleeping compared to undersleeping, it’s important to emphasize that both can lead to heart problems in the future. A study of the National Health and Nutrition Examination Survey found that, compared to people who get six to eight hours of sleep, those who slept:

  • Less than six hours: Had a doubled risk of stroke or heart attack
  • More than eight hours: Had a doubled risk of angina – chest pain due to reduced blood flow – and 10 percent higher risk of coronary artery disease

If you’re having trouble getting between seven and nine hours of sleep each night, bring it up to your doctor at your next physical. While short-term sleep problems aren’t likely to cause lasting damage, developing poor sleep habits can put you at higher risk for heart trouble as well as other problems later in life.

How exercise affects the heart

On the whole, Americans don’t exercise nearly enough. About half of U.S. adults don’t get enough aerobic physical activity – the heart-strengthening exercises known as “cardio.” Aerobic exercise is one of the best ways to safeguard against future heart disease and improve your overall health. However, too much vigorous aerobic exercise can also be detrimental to your heart health.

Like a few days of getting too little sleep, brief bouts of high-intensity cardio followed by periods of rest won’t do lasting damage. In fact, it can make your heart stronger. Problems arise when extreme athletes – such as long-distance runners, rowers, swimmers and cyclists – perform vigorous exercise regularly.

Intense aerobic physical activity puts a strain on your heart. Over time, repeated strain changes the very structure of the heart, enlarging the arteries and right ventricle and causing thick scar tissue to form in the heart’s two atria. These adaptations have been linked to heart problems in some people, though more research is needed for us to draw definitive conclusions.

There are many misconceptions about how intense exercise needs to be to achieve the best results. I find that many people believe they have to be totally out of breath and drenched in sweat to get a “good workout,” but the reality is that, as far as your heart is concerned, you’ll maximize your exercise benefits with regular moderate exercise, like a brisk walk. What defines “moderate” exercise? You should sweat a little and be able to carry on a conversation with someone without too much difficulty.

The American Heart Association recommends 150 minutes of moderate physical activity per week, or 75 minutes of vigorous exercise, or some combination of both. I suggest doing 30 to 60 minutes of moderate exercise on most days of the week. That’s a healthy habit that you can continue through your whole life. 

This doesn’t mean you shouldn’t give that marathon or triathlon you’ve always wanted to do a try. I’ve finished 11 marathons and a 50-mile race, so I know the allure of such events. The positives of endurance training are many: fitness, strength, even psychological. But we need to remember that more isn’t always better. Talk to your doctor before beginning to train for such endurance events. As for me, I still enjoy running and believe strongly in the benefits of exercise, although I’ve moderated my distance over the years, opting for a morning jog on the C&O canal as my favorite run!

Most people don’t have to worry about exercising too much or oversleeping. In fact, they should be concerned about too little exercise and sleep! But for extreme athletes and chronic sleepers, these issues can lead to heart problems in the future. The trick to the Goldilocks effect of sleep and exercise is finding a balance that makes you feel “just right.”

 

Request an appointment online or call 202-877-3627 to talk to a doctor about how your sleep and exercise routine affects your heart.

 

How to monitor your blood pressure at home

Your blood pressure can lie. It changes throughout the day, but too often, we rely on one blood pressure measurement taken in a doctor’s office.

There often isn’t time to take an accurate blood pressure measurement during a doctor’s visit. To properly take a blood pressure measurement, you need to be relaxed and seated for five minutes. If the measurement is high, you need to wait five minutes and take it again.

It’s often the “relaxed” part that is most difficult. Doctor’s visits can be stressful. This can cause your blood pressure to rise. The phenomenon of blood pressure readings that are higher in a doctor’s office compared to at home is known as “white-coat hypertension,” and it can occur in 15 to 30 percent of patients.

So how do we get a more accurate blood pressure reading? By supplementing office measurements with those taken during your daily routine. There are two ways to do this: manual home blood pressure monitoring and a more formal test known as ambulatory blood pressure monitoring.

Who benefits from home blood pressure monitoring?

I’ve had many patients come to me thinking they had high blood pressure (also known as hypertension) due to measurements taken in a doctor’s office. But after home blood pressure monitoring, I can give them the good news that their blood pressure is, in fact, normal. This monitoring can save them from unnecessary treatment.

Home blood pressure monitoring also can validate high office measurements and allow us to use office time more productively, such as searching for the cause of the hypertension. This could be as simple as your favorite snack food. I once had a patient who loved a certain salty cracker. Once she eliminated the culprit, her blood pressure went back to normal.

Not everyone needs to monitor their blood pressure from home. I recommend it for people who:

  • Have borderline high blood pressure (between 120/80 mm Hg and 140/90 mm Hg)
  • Have high blood pressure (140/90 mm Hg)
  • Take medication for high blood pressure

Along with more accurately diagnosing hypertension, home blood pressure monitoring can track treatment and empower you to take an active role in your health care. With regular monitoring at home, you can see in real time how medication and lifestyle changes affect your blood pressure. And it can help us optimize your care, such as determining whether we need to alter your medication or dosage.

How to monitor your blood pressure at home

Home blood pressure monitoring is easy, but it only works if you do it correctly.

How to choose a home blood pressure monitor

Patients often ask which home blood pressure monitor is best. It doesn’t matter whether you use an arm cuff, wrist cuff or finger measurement. They all work. I tend to find that the wrist and finger monitors are easiest for people to handle because they can do it with one hand and don’t need a helper. Use what’s comfortable for you.

Once you’ve chosen a home blood pressure monitor, bring it to your doctor’s office to make sure you’re using it correctly and to check its accuracy against the doctor’s equipment.

How to check your blood pressure

Timing is everything when checking your blood pressure. If you’re rushing around, that’s not the time to take it. Wait 30 minutes before taking your blood pressure if you:

  • Are about to eat
  • Have just eaten
  • Have exercised recently
  • Have had a caffeinated drink

When you’re ready, sit quietly with your feet flat on the floor. Don’t cross your legs. After five minutes, take your blood pressure. Wait five minutes and do it again to check the accuracy. You can do this three times to get an average of the readings.

How often to measure your blood pressure

You don’t need to do go through this process three or four times a day. When you start, do it on a regular basis so you understand what your blood pressure normally is at different times of the day. Try taking it once in the morning and once in the evening. After that, you can do it periodically. Talk to your doctor about how often to measure your blood pressure.

Home blood pressure monitoring is not a substitute for a doctor’s visit. Keep a journal of your home measurements to show your doctor. Some home blood pressure monitors digitally record your measurements, so you can print them out or send them to your doctor.

How ambulatory blood pressure monitoring works

If there’s uncertainty about the accuracy of your blood pressure readings, we can do a more formal test called ambulatory blood pressure monitoring. We consider this the gold standard to diagnose high blood pressure.

We’ll send you home with an arm cuff to wear. The device measures your blood pressure at regular intervals over 24 hours. This gives us a nice visual chart of your blood pressure throughout the day.

 The information we get from ambulatory blood pressure monitoring and manual monitoring allows you and your doctor to make more effective use of your time together. For example, if your blood pressure is high in my office, but your home readings are normal, we can move on to the next thing. We don’t need to waste time focusing on something that isn’t wrong.

Don’t let one blood pressure measurement lie to you. Request an appointment online or call 202-877-3627 to talk to a doctor about whether you might benefit from home blood pressure monitoring

29 Things You Should Do for a Healthy Heart

You’re heard it many times before -- follow a healthy lifestyle for a healthy heart. Sounds simple, right?  But it’s not always so easy to pull off. A heart healthy lifestyle can reduce the risk for heart disease by as much as 80%!  But what is a “heart healthy lifestyle”?  It’s a commitment to many habits in our daily lives centered on our activity, diets, mindset and awareness.  There is no one “magic” thing. When lifestyle isn’t enough, talk with your doctor to set goals you can realistically achieve, such as losing weight or lowering your cholesterol or blood pressure levels. Sometimes, it takes medications that can be very helpful to optimizing your heart risk.

So, commit to making the many small lifestyle changes that make a healthy heart a snap! The key to success is to make small changes in many areas. No matter what you do, remember to take it day by day, and work to sustain your gains.

With that in mind, we’ve compiled 29 heart health tips. Knowledge is power!  Read on to find out what you can do to keep your heart healthy. Only you can love your heart. So start today!

1. Make time for exercise: Exercising 30 to 60 minutes on most days will cut your heart risk in half.

2. Know your heart disease risk: Calculate your risk by plugging your numbers into an online calculator.

3. Never ignore your chest pain:  Pain can be felt anywhere in the chest area, arms, your back and neck.

4. Check your blood pressure: Let the healthy blood pressure number be below 140/90. Both numbers matter!

5. No smoking: Don’t smoke, and ask your loved ones to quit.

6. Aspirin: Should you take aspirin? If you have heart disease, yes! If you don’t have heart disease, then maybe not! Ask your doctor.

7. Moderate exercise: How do you know whether you are exercising moderately? You should able to carry on a light conversation

8. Stress: Is it bad for your heart? Yes, sustained stress is, no matter the source. Learn to control your stress to prevent heart disease.

9. Second hand smoke is dangerous! Public smoking bans in the community have reduced heart attack risk by 20%.

10. Sex: Is your heart healthy enough for sex? Sex has a “heart workload” like climbing two flights of stairs.

11. Dark chocolate: Give your loved ones chocolate as a gift on Valentine’s day! Regular chocolate eaters have less heart and stroke risk!

12. Order wine with your dinner! Moderate intake is associated with lower heart risk. (Consume wisely!)

13. Red or white wine? Is one better for your heart? Wine, beer or spirits all show a similar relationship to lower heart risk.

14. The “Mediterranean diet” is the most heart healthy way to eat. Studies show this diet reduces heart attack risk up to 30%.

15. Mediterranean diet = veggies, fruits, nuts, seeds, grains, herbs, spices, fish, seafood, olive oil, poultry, eggs, cheese, yogurt and wine.

16. Take your heart meds fully and faithfully! It’s the only way to get the full benefit of the treatments!

17. Stairs burn twice as many calories as walking. Regular stair climbing reduces your risk of premature death by 15%!

18. The quantified self. Keep moving! Steps per day: Very active >10,000, active >7500, sedentary <5000.

19. Fish eaters have less heart disease! Think about fish as a first choice when eating out- let somebody else do the cooking!

20. Did you know that people who are optimistic have less heart disease? See the bright side- it is truly good for your heart!

21. If you snore, tell your doctor. Snoring can be treated, and could signal risks for your blood pressure and heart rhythm.

22. Want to really know your risk of heart attack? Get a calcium scan of your heart. Accurate, safe, and costs less than dinner for 2!

23. Do you know CPR? Simple! Learn it here and double somebody’s chance of surviving cardiac arrest. http://www.cpr.heart.org

24. Ditch the soda and energy drinks. Please.

25. Coffee lover? For your heart’s sake, it is OK! (But, skip the donut!)

26. Like music? So does your heart! Music listening lowers your heart rate, and blood pressure!

27. Are statin cholesterol drugs safe? For most patients, yes! Unfortunately, over the counter supplements aren’t very helpful.

28. Heart attack or stroke symptoms? Don’t delay! Call 911 immediately. Minutes matter to save lives!

29. Taking vitamins or other supplements for heart disease risk? Be careful- few have little, if any, proven benefit.

Have any questions?

We are here to help! Contact us for more information about heart health or to schedule an appointment. Call us at 202-877-3627.

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