Warning: Attention Grabbing Headline Below

Who's at risk of dropping dead?
Take the test online:

The HeartAware test is a free online screening available to anyone but especially recommended for men over 40 and women over 50. It takes about seven minutes. Those who test at higher risk of heart disease can receive a free screening from the University of Miami. You can take the test at www.umiamihospital.com.

BY TERESA MEARStmears@mindspring.com

Everyone seems to know someone who appeared healthy and then suffered a sudden fatal heart attack. The death of celebrities such as NBC news commentator Tim Russert at 58 and TV product pitchman Billie Mays at 50 has brought new attention to the issue of sudden cardiac death.

It's an issue we're likely to hear about more as more Baby Boomers reach the vulnerable age for heart problems, 40 for men and 50 for women.

Dr. William W. O'Neill is executive dean for clinical affairs, professor of medicine and chief medical officer of the University of Miami Health System. He is a leader in interventional cardiology and in research into the diagnosis and treatment of obstructed heart arteries.

He also has a personal interest in heart disease. His father had a heart attack at 47, and his mother suffered from heart problems. When he and his three brothers underwent CT screening, three of them were fine but his youngest brother needed heart surgery, even though he had suffered no symptoms.

We asked O'Neill about sudden cardiac death. His answers have been edited for space.

Q: Everybody seems to know someone who appeared healthy and one day dropped dead of a heart attack. How common is that?

A: It's not surprising that everybody knows somebody because in the United States about 300,000 people a year drop over dead with sudden cardiac death.

Q: What causes sudden cardiac death?

A: The overwhelming culprit, in 90 percent of cases, is blockages of coronary arteries and a plaque rupture. The sudden rupture of a plaque in a blood vessel causes blood flow to lessen acutely in one of the arteries and leads to a severe irregularity of the heartbeat called ventricular fibrillation. The plaque ruptures, a severe arrhythmia occurs, and the people drop over dead. In about 10 percent of cases, there are other abnormalities, such as congenital problems or myocarditis, an intense inflammation of the heart muscle.

Q: Are there any symptoms?

A: About a third of the time, people have described symptoms that they ignored: pressure in the chest or discomfort while exercising. Unfortunately, more than half the time the first manifestation of the problem is sudden death.

Q: Are some people more at risk than others?

A: This is an illness of middle-aged people. In men it starts around age 40 and in women it starts around age 50. The risk factors for sudden death are the same as the risk factors for coronary artery disease: diabetes, high blood pressure, family history of heart disease, smoking, high cholesterol.

Q: What causes some people with those risk factors to suffer sudden cardiac death while others live a long life?

A: In people who drop over dead, blockages occur at very specific locations in the arteries that supply blood to the heart, the left main coronary artery and the anterior descending artery. We don't know why some people with coronary disease develop these plaques in these specific locations and other people in less dangerous locations. We think there may be some genes that predispose people to develop blockages in particular areas.

Q: What should people do if they fall into the high-risk group?

A: The best thing you can do is try to control risk factors. If you're got high blood pressure, be on medication. If your cholesterol is high, get it down with pills. If you're smoking, stop. If you're not exercising, try to do moderate regular exercise. It's not sexy. But those are the things you can do to dramatically lessen your risk. If you really have a concern, I'm a very strong advocate of CT angiography, a noninvasive procedure that puts dye in the veins to look specifically at the coronary arteries to see if there is plaque in dangerous locations.

Q: For which patients do you recommend CT angiography?

A: People who have three or more risk factors for heart disease.

Q: What is the HeartAware program?

A: There are a lot of people who don't even know they have risk factors for heart disease. We offer this online test and we offer a free screening where a nurse will actually check a blood pressure and do some other very simple things to let people know whether they have a risk for heart disease. If they're at medium or high risk for heart disease, then more screening can be performed.

Q: Beyond research into a genetic link, what other research is under way?

A: The holy grail that cardiology is facing now is to try to predict why a plaque would rupture. There are lots of plaques in the blood supply. Inexplicably, some of these plaques break open. If they break open in a dangerous location, people drop over dead. There is a lot of interest in trying to identify people with these vulnerable plaques.

Q: What's the most important thing for people to know?

A: Get to know your risk factors and modify them. There are a lot of risk factors that can be very easily modified while we're waiting for the major answer and the magic cure for sudden cardiac death.

Health Q&A runs every other week.

© 2009 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com

Oral (Birth) Control Pills?

My heart attack received much speculation in regards to oral contraceptives.  Normally this is a topic I would relegate to my private blog, but it seems that somehow many people outside of my immediate friends/own mother knew about my method of birth control.  That being said, my blood pressure was regularly monitored because of a different medication I was taking in addition to the oral birth control pill.  My blood pressure was always at a healthy range.  The day I was taken to the emergency room my cholesterol levels were also at healthy levels (as in previous testings).  Despite my weight gain over the last several years my blood pressure and cholesterol have been and remain extremely good.  As for the cause of my blood clot's and subsequent heart attack, the cardiologist and oncologist who ran extensive tests were unable to come to a conclusion.  When pressed, my cardiologist has told us that I had 'bad luck and a tremendous amount of stress'.  Lastly, I had an EKG just a few months prior to my heart attack in preparation for surgery unrelated to my heart.  It is very difficult not having a diagnosis; not knowing exactly what to avoid (as if I could control the situation in any way).  It's the ultimate fear of the unknown (and I am the type of person who likes to know).

Nonetheless, here is an article regarding the same, very serious subject, oral contraceptives:

Is There Any Risk For Heart Disease With Birth Control Pills?


Sharonne Hayes, M.D., Director, Women's Heart Clinic; Associate Professor of Medicine;
Mayo Clinic, Rochester, Minnesota
February 6, 2008

Question: As A 30-Year-Old Woman, Should I Be Concerned About Taking Oral Contraceptive Pills And Is There Any Risk For Heart Disease With These Pills?

Answer: Oral contraceptives are some of the most effective birth control methods. And so, if you have chosen to be on oral contraceptives, presumably you're trying to prevent pregnancy. Where oral contraceptives got a bad rap, in a sense, was the first generation of oral contraceptives, which were 10 to 20 times higher doses of estrogen and progesterone than currently available oral contraceptives. So the oral contraceptives we're using today are much safer.

That said, even today's oral contraceptives, many of them can slightly increase blood pressure, they can adversely affect your cholesterol -- particularly by lowering the good cholesterol -- and they can slightly increase the risk of blood clots. So all of these things need to be taken into consideration.

There is no evidence that taking oral contraceptives today increases your risk of having a heart attack down the road after you stopped it as an older person. So that's very reassuring. If you choose to be on oral contraceptives, because that's the best method, one thing you should know, is that the risk, the cardiac risk of going through a completed pregnancy is actually much higher than taking oral contraceptives. So that's important to compare those risks. Taking care of yourself and reducing your cardiac risk factors, making sure your blood pressure is under control after you start, is a good way to reduce that risk.

The other thing is there are a number of newer oral contraceptives, and ones in development, that may actually reduce cardiac risk. Several that contain drospironone, which actually can lower blood pressure and has some other beneficial effects, are available now.

And so, we recommend you take the lowest dose for the time that you need it for oral contraception, but the cardiac risk shouldn't weigh too heavily when you make that decision.

I've Been Wearing My Seat Belt All Along Thanks to My Cardiologist!

I have been extremely happy with the cardiologist who saved my life and continues to see me as a patient (insert big happy smile HERE!). Over time, I have realized that "my" cardiologist keeps very up to date with all things heart related. So it is no surprise to me to read the article below. A statin prescription has been in my daily regimen post heart attack. At first I was confused by the need for cholesterol prescription because I knew the lab results taken by the emergency room determine all of my cholesterol levels to be "good". My cardiologist explained that the statin was being prescribed because it was shown to help heal the heart (given that I had 10% damage/die off of my heart during my heart attack).

Regretfully, I have visited many doctors for various reasons and found advocacy to be a quality found few and far between. No fault of the doctor; I can't begin to imagine the amount of patients they see and the ongoing problems with insurance companies. So, three cheers for my awesome doctor being not only a phenomenal doctor/surgeon, but also an advocate for his patients!!!

Another doctor I see has recently suggested a vitamin supplement since I am taking a statin. I'll share why and what in the future.

Statins cut heart problems after artery surgery

Inexpensive drug that lowers cholesterol also decreases risk of dying

The Associated Press

updated 7:48 a.m. PT, Thurs., Sept . 3, 2009

NEW YORK - Score another victory for the cheap, cholesterol-lowering wonder drugs known as statins. People getting an artery unclogged or repaired were much less likely to die or have a heart attack afterward if they took preventive doses of the pills before and after their operations, a Dutch study showed.

Patients given Lescol had half the risk of having a heart attack or dying of a heart problem in the following month compared to those given dummy pills, the study found.

“You get a bonus with the treatment of statins,” said Dr. Don Poldermans, who led the study at the Erasmus Medical Center in Rotterdam, the Netherlands. The results are in Thursday’s New England Journal of Medicine.

Statins are widely prescribed to reduce cholesterol and prevent heart disease. Doctors wanted to see if statins could also protect against heart problems that are a common complication of blood vessel surgery — operations like repairing a bulging abdominal artery or unclogging arteries in the neck.

The stress of surgery on arteries can destabilize plaque buildup, causing it to rupture and blood clots to form, particularly in heart arteries. Statins are thought to help by reducing inflammation and stabilizing the plaque.

The researchers enrolled nearly 500 patients who were not on statins and were going to have operations on their aorta or leg or neck arteries. For about a month before and a month after their surgery, half the patients took a statin; the rest got a dummy pill.

Within a month of the operation, 12 patients in the statin group, about 5 percent, had died or had heart attacks, compared to 25 patients, or 10 percent, of those who took a dummy pill. Other signs of heart damage also were less common among those who had taken statins. There was no difference in side effects between the two groups.

When the study began in 2004, Poldermans said, statins were not as widely recommended as they are today for people with peripheral artery disease — stiff and narrow arteries, often in the legs. The patients in the study probably weren’t on statins before their surgery because their cholesterol levels were normal or near normal, he said.

“There’s no reason whatsoever to withhold statins anymore” from these patients,” Poldermans said.

Current guidelines recommend the drugs for everyone with peripheral artery disease, regardless of the need for surgery.

The Dutch study was partially funded by Swiss drug maker Novartis, which makes and supplied Lescol, also known as fluvastatin. Poldermans has received grants and consulting fees from Novartis; two other researchers have received fees and grants from medical companies.

Other statins on the market would likely achieve a comparable effect, said Dr. Alan T. Hirsch, director of the vascular medicine program at the Minneapolis Heart Institute and a spokesman for the American Heart Association. He said statins aren’t being used enough in people with peripheral artery disease, and he hopes the study draws attention to their benefits at the time of surgery, as well as throughout the lifetime of the patient.

“A statin is a seat belt when you drive a damaged artery,” he said.

© 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

URL: http://www.msnbc.msn.com/id/32661411/ns/health/