Geography of the Vote (link to map) Patient Protection and Affordable Care Act

House Vote 163 - On Agreeing to the Resolution Providing for consideration of the Senate Amendments to H.R. 3590 , Patient Protection and Affordable Care Act, and providing for the consideration of the bill H.R. 4872, Reconciliation Act of 2010. On Agreeing to the Resolution Other Recent Votes MARCH 21, 2010 H.RES.925: On Motion to Suspend the Rules and Agree, as Amended Expressing the sense of the House of Representatives regarding the meritorio... MARCH 21, 2010 On Agreeing to the Resolution: Providing for consideration of the Senate Amendments to H.R. 3590 , Patient ... MARCH 21, 2010 On Ordering the Previous Question: Providing for consideration of the Senate Amendments to H.R. 3590 , Patient ... MARCH 21, 2010 H.RES.900: On Motion to Suspend the Rules and Agree, as Amended Supporting the goals and ideals of a Cold War Veterans Recognition Day to ho... MARCH 21, 2010 Will the House Now Consider the Resolution: Providing for consideration of the Senate Amendments to H.R. 3590 , Patient ... Result: Passed by 18 votes Date of Vote: March 21, 2010 Roll Call Number: 163 Related Story: House Clears Path for Final Health Vote Geography of the Vote Complete Roll Call Yes Votes (224) Member Party Dist. Gary L. Ackerman D N.Y.-5 Jason Altmire D Pa.-4 Robert E. Andrews D N.J.-1 Joe Baca D Calif.-43 Brian Baird D Wash.-3 Tammy Baldwin D Wis.-2 Melissa Bean D Ill.-8 Xavier Becerra D Calif.-31 Shelley Berkley D Nev.-1 Howard L. Berman D Calif.-28 Marion Berry D Ark.-1 Timothy H. Bishop D N.Y.-1 Sanford D. Bishop Jr. D Ga.-2 Earl Blumenauer D Ore.-3 John Boccieri D Ohio-16 Leonard L. Boswell D Iowa-3 Allen Boyd D Fla.-2 Robert A. Brady D Pa.-1 Bruce Braley D Iowa-1 Corrine Brown D Fla.-3 G. K. Butterfield D N.C.-1 Lois Capps D Calif.-23 Michael E. Capuano D Mass.-8 Dennis Cardoza D Calif.-18 Russ Carnahan D Mo.-3 Christopher Carney D Pa.-10 André Carson D Ind.-7 Kathy Castor D Fla.-11 Judy Chu D Calif.-32 Yvette Clarke D N.Y.-11 William Lacy Clay D Mo.-1 Emanuel Cleaver II D Mo.-5 James E. Clyburn D S.C.-6 Steve Cohen D Tenn.-9 Gerald E. Connolly D Va.-11 John Conyers Jr. D Mich.-14 Jim Cooper D Tenn.-5 Jim Costa D Calif.-20 Jerry F. Costello D Ill.-12 Joe Courtney D Conn.-2 Joseph Crowley D N.Y.-7 Henry Cuellar D Tex.-28 Elijah E. Cummings D Md.-7 Kathy Dahlkemper D Pa.-3 Danny K. Davis D Ill.-7 Susan A. Davis D Calif.-53 Peter A. DeFazio D Ore.-4 Diana DeGette D Colo.-1 Bill Delahunt D Mass.-10 Rosa DeLauro D Conn.-3 Norman D. Dicks D Wash.-6 John D. Dingell D Mich.-15 Lloyd Doggett D Tex.-25 Joe Donnelly D Ind.-2 Mike Doyle D Pa.-14 Steve Driehaus D Ohio-1 Donna Edwards D Md.-4 Keith Ellison D Minn.-5 Brad Ellsworth D Ind.-8 Eliot L. Engel D N.Y.-17 Anna G. Eshoo D Calif.-14 Bob Etheridge D N.C.-2 Sam Farr D Calif.-17 Chaka Fattah D Pa.-2 Bob Filner D Calif.-51 Bill Foster D Ill.-14 Barney Frank D Mass.-4 Marcia L. Fudge D Ohio-11 John Garamendi D Calif.-10 Gabrielle Giffords D Ariz.-8 Charlie Gonzalez D Tex.-20 Bart Gordon D Tenn.-6 Alan Grayson D Fla.-8 Al Green D Tex.-9 Gene Green D Tex.-29 Raúl M. Grijalva D Ariz.-7 Luis V. Gutierrez D Ill.-4 John Hall D N.Y.-19 Debbie Halvorson D Ill.-11 Phil Hare D Ill.-17 Jane Harman D Calif.-36 Alcee L. Hastings D Fla.-23 Martin Heinrich D N.M.-1 Brian Higgins D N.Y.-27 Baron P. Hill D Ind.-9 Jim Himes D Conn.-4 Maurice D. Hinchey D N.Y.-22 Rubén Hinojosa D Tex.-15 Mazie K. Hirono D Hawaii-2 Paul W. Hodes D N.H.-2 Rush Holt D N.J.-12 Michael M. Honda D Calif.-15 Steny H. Hoyer D Md.-5 Jay Inslee D Wash.-1 Steve Israel D N.Y.-2 Jesse L. Jackson Jr. D Ill.-2 Sheila Jackson-Lee D Tex.-18 Eddie Bernice Johnson D Tex.-30 Hank Johnson D Ga.-4 Steve Kagen D Wis.-8 Paul E. Kanjorski D Pa.-11 Marcy Kaptur D Ohio-9 Patrick J. Kennedy D R.I.-1 Dale E. Kildee D Mich.-5 Carolyn Cheeks Kilpatrick D Mich.-13 Mary Jo Kilroy D Ohio-15 Ron Kind D Wis.-3 Ann Kirkpatrick D Ariz.-1 Larry Kissell D N.C.-8 Ron Klein D Fla.-22 Suzanne Kosmas D Fla.-24 Dennis J. Kucinich D Ohio-10 Jim Langevin D R.I.-2 Rick Larsen D Wash.-2 John B. Larson D Conn.-1 Barbara Lee D Calif.-9 Sander M. Levin D Mich.-12 John Lewis D Ga.-5 Dave Loebsack D Iowa-2 Zoe Lofgren D Calif.-16 Nita M. Lowey D N.Y.-18 Ben Ray Lujan D N.M.-3 Dan Maffei D N.Y.-25 Carolyn B. Maloney D N.Y.-14 Betsy Markey D Colo.-4 Edward J. Markey D Mass.-7 Doris Matsui D Calif.-5 Carolyn McCarthy D N.Y.-4 Betty McCollum D Minn.-4 Jim McDermott D Wash.-7 Jim McGovern D Mass.-3 Michael E. McMahon D N.Y.-13 Jerry McNerney D Calif.-11 Kendrick B. Meek D Fla.-17 Gregory W. Meeks D N.Y.-6 Michael H. Michaud D Me.-2 Brad Miller D N.C.-13 George Miller D Calif.-7 Alan B. Mollohan D W.Va.-1 Dennis Moore D Kan.-3 Gwen Moore D Wis.-4 James P. Moran D Va.-8 Christopher S. Murphy D Conn.-5 Patrick J. Murphy D Pa.-8 Scott Murphy D N.Y.-20 Jerrold Nadler D N.Y.-8 Grace F. Napolitano D Calif.-38 Richard E. Neal D Mass.-2 James L. Oberstar D Minn.-8 David R. Obey D Wis.-7 John W. Olver D Mass.-1 Solomon P. Ortiz D Tex.-27 Bill Owens D N.Y.-23 Frank Pallone D N.J.-6 Bill Pascrell Jr. D N.J.-8 Ed Pastor D Ariz.-4 Donald M. Payne D N.J.-10 Ed Perlmutter D Colo.-7 Tom Perriello D Va.-5 Gary Peters D Mich.-9 Collin C. Peterson D Minn.-7 Chellie Pingree D Me.-1 Jared Polis D Colo.-2 Earl Pomeroy D N.D.-1 David E. Price D N.C.-4 Mike Quigley D Ill.-5 Nick J. Rahall II D W.Va.-3 Charles B. Rangel D N.Y.-15 Silvestre Reyes D Tex.-16 Laura Richardson D Calif.-37 Ciro D. Rodriguez D Tex.-23 Steven R. Rothman D N.J.-9 Lucille Roybal-Allard D Calif.-34 C.A. Dutch Ruppersberger D Md.-2 Bobby L. Rush D Ill.-1 Tim Ryan D Ohio-17 John Salazar D Colo.-3 Linda T. Sanchez D Calif.-39 Loretta Sanchez D Calif.-47 John Sarbanes D Md.-3 Jan Schakowsky D Ill.-9 Mark Schauer D Mich.-7 Adam B. Schiff D Calif.-29 Kurt Schrader D Ore.-5 Allyson Y. Schwartz D Pa.-13 David Scott D Ga.-13 Robert C. Scott D Va.-3 José E. Serrano D N.Y.-16 Joe Sestak D Pa.-7 Carol Shea-Porter D N.H.-1 Brad Sherman D Calif.-27 Albio Sires D N.J.-13 Louise M. Slaughter D N.Y.-28 Adam Smith D Wash.-9 Vic Snyder D Ark.-2 Jackie Speier D Calif.-12 John M. Spratt Jr. D S.C.-5 Pete Stark D Calif.-13 Bart Stupak D Mich.-1 Betty Sutton D Ohio-13 John Tanner D Tenn.-8 Harry Teague D N.M.-2 Bennie Thompson D Miss.-2 Mike Thompson D Calif.-1 John F. Tierney D Mass.-6 Dina Titus D Nev.-3 Paul Tonko D N.Y.-21 Edolphus Towns D N.Y.-10 Niki Tsongas D Mass.-5 Chris Van Hollen D Md.-8 Nydia M. Velázquez D N.Y.-12 Peter J. Visclosky D Ind.-1 Tim Walz D Minn.-1 Debbie Wasserman Schultz D Fla.-20 Maxine Waters D Calif.-35 Diane Watson D Calif.-33 Melvin Watt D N.C.-12 Henry A. Waxman D Calif.-30 Anthony Weiner D N.Y.-9 Peter Welch D Vt.-1 Charlie Wilson D Ohio-6 Lynn Woolsey D Calif.-6 David Wu D Ore.-1 John Yarmuth D Ky.-3 No Votes (206) Member Party Dist. Robert B. Aderholt R Ala.-4 John Adler D N.J.-3 Todd Akin R Mo.-2 Rodney Alexander R La.-5 Michael Arcuri D N.Y.-24 Steve Austria R Ohio-7 Michele Bachmann R Minn.-6 Spencer Bachus R Ala.-6 J. Gresham Barrett R S.C.-3 John Barrow D Ga.-12 Roscoe G. Bartlett R Md.-6 Joe L. Barton R Tex.-6 Judy Biggert R Ill.-13 Brian P. Bilbray R Calif.-50 Gus Bilirakis R Fla.-9 Rob Bishop R Utah-1 Marsha Blackburn R Tenn.-7 Roy Blunt R Mo.-7 John A. Boehner R Ohio-8 Jo Bonner R Ala.-1 Mary Bono Mack R Calif.-45 John Boozman R Ark.-3 Dan Boren D Okla.-2 Rick Boucher D Va.-9 Charles Boustany Jr. R La.-7 Kevin Brady R Tex.-8 Bobby Bright D Ala.-2 Paul Broun R Ga.-10 Henry E. Brown Jr. R S.C.-1 Ginny Brown-Waite R Fla.-5 Vern Buchanan R Fla.-13 Michael C. Burgess R Tex.-26 Dan Burton R Ind.-5 Steve Buyer R Ind.-4 Ken Calvert R Calif.-44 Dave Camp R Mich.-4 John Campbell R Calif.-48 Eric Cantor R Va.-7 Anh Cao R La.-2 Shelley Moore Capito R W.Va.-2 John Carter R Tex.-31 Bill Cassidy R La.-6 Michael N. Castle R Del.-1 Jason Chaffetz R Utah-3 Ben Chandler D Ky.-6 Travis Childers D Miss.-1 Howard Coble R N.C.-6 Mike Coffman R Colo.-6 Tom Cole R Okla.-4 K. Michael Conaway R Tex.-11 Ander Crenshaw R Fla.-4 John Culberson R Tex.-7 Artur Davis D Ala.-7 Geoff Davis R Ky.-4 Lincoln Davis D Tenn.-4 Charlie Dent R Pa.-15 Lincoln Diaz-Balart R Fla.-21 Mario Diaz-Balart R Fla.-25 David Dreier R Calif.-26 John J. Duncan Jr. R Tenn.-2 Chet Edwards D Tex.-17 Vernon J. Ehlers R Mich.-3 Jo Ann Emerson R Mo.-8 Mary Fallin R Okla.-5 Jeff Flake R Ariz.-6 John Fleming R La.-4 J. Randy Forbes R Va.-4 Jeff Fortenberry R Neb.-1 Virginia Foxx R N.C.-5 Trent Franks R Ariz.-2 Rodney Frelinghuysen R N.J.-11 Elton Gallegly R Calif.-24 Scott Garrett R N.J.-5 Jim Gerlach R Pa.-6 Phil Gingrey R Ga.-11 Louie Gohmert R Tex.-1 Robert W. Goodlatte R Va.-6 Kay Granger R Tex.-12 Sam Graves R Mo.-6 Parker Griffith R Ala.-5 Brett Guthrie R Ky.-2 Ralph M. Hall R Tex.-4 Gregg Harper R Miss.-3 Doc Hastings R Wash.-4 Dean Heller R Nev.-2 Jeb Hensarling R Tex.-5 Wally Herger R Calif.-2 Stephanie Herseth Sandlin D S.D.-1 Peter Hoekstra R Mich.-2 Tim Holden D Pa.-17 Duncan D. Hunter R Calif.-52 Bob Inglis R S.C.-4 Darrell Issa R Calif.-49 Lynn Jenkins R Kan.-2 Sam Johnson R Tex.-3 Timothy V. Johnson R Ill.-15 Walter B. Jones R N.C.-3 Jim Jordan R Ohio-4 Peter T. King R N.Y.-3 Steve King R Iowa-5 Jack Kingston R Ga.-1 Mark Steven Kirk R Ill.-10 John Kline R Minn.-2 Frank Kratovil Jr. D Md.-1 Doug Lamborn R Colo.-5 Leonard Lance R N.J.-7 Tom Latham R Iowa-4 Steven C. LaTourette R Ohio-14 Robert E. Latta R Ohio-5 Christopher Lee R N.Y.-26 Jerry Lewis R Calif.-41 John Linder R Ga.-7 Daniel Lipinski D Ill.-3 Frank A. LoBiondo R N.J.-2 Frank D. Lucas R Okla.-3 Blaine Luetkemeyer R Mo.-9 Cynthia M. Lummis R Wyo.-1 Dan Lungren R Calif.-3 Stephen F. Lynch D Mass.-9 Connie Mack R Fla.-14 Donald Manzullo R Ill.-16 Kenny Marchant R Tex.-24 Jim Marshall D Ga.-8 Jim Matheson D Utah-2 Kevin McCarthy R Calif.-22 Michael McCaul R Tex.-10 Tom McClintock R Calif.-4 Thaddeus McCotter R Mich.-11 Patrick T. McHenry R N.C.-10 Mike McIntyre D N.C.-7 Howard P. McKeon R Calif.-25 Cathy McMorris Rodgers R Wash.-5 Charlie Melancon D La.-3 John L. Mica R Fla.-7 Candice S. Miller R Mich.-10 Gary G. Miller R Calif.-42 Jeff Miller R Fla.-1 Walt Minnick D Idaho-1 Harry E. Mitchell D Ariz.-5 Jerry Moran R Kan.-1 Tim Murphy R Pa.-18 Sue Myrick R N.C.-9 Randy Neugebauer R Tex.-19 Devin Nunes R Calif.-21 Glenn Nye D Va.-2 Pete Olson R Tex.-22 Ron Paul R Tex.-14 Erik Paulsen R Minn.-3 Mike Pence R Ind.-6 Tom Petri R Wis.-6 Joe Pitts R Pa.-16 Todd R. Platts R Pa.-19 Ted Poe R Tex.-2 Bill Posey R Fla.-15 Tom Price R Ga.-6 Adam H. Putnam R Fla.-12 George P. Radanovich R Calif.-19 Denny Rehberg R Mont.-1 Dave Reichert R Wash.-8 Phil Roe R Tenn.-1 Harold Rogers R Ky.-5 Mike Rogers R Mich.-8 Mike D. Rogers R Ala.-3 Dana Rohrabacher R Calif.-46 Tom Rooney R Fla.-16 Ileana Ros-Lehtinen R Fla.-18 Peter Roskam R Ill.-6 Mike Ross D Ark.-4 Ed Royce R Calif.-40 Paul D. Ryan R Wis.-1 Steve Scalise R La.-1 Jean Schmidt R Ohio-2 Aaron Schock R Ill.-18 F. James Sensenbrenner R Wis.-5 Pete Sessions R Tex.-32 John Shadegg R Ariz.-3 John Shimkus R Ill.-19 Heath Shuler D N.C.-11 Bill Shuster R Pa.-9 Mike Simpson R Idaho-2 Ike Skelton D Mo.-4 Adrian Smith R Neb.-3 Christopher H. Smith R N.J.-4 Lamar Smith R Tex.-21 Mark Souder R Ind.-3 Zack Space D Ohio-18 Cliff Stearns R Fla.-6 John Sullivan R Okla.-1 Gene Taylor D Miss.-4 Lee Terry R Neb.-2 Glenn Thompson R Pa.-5 William M. Thornberry R Tex.-13 Todd Tiahrt R Kan.-4 Pat Tiberi R Ohio-12 Michael R. Turner R Ohio-3 Fred Upton R Mich.-6 Greg Walden R Ore.-2 Zach Wamp R Tenn.-3 Lynn Westmoreland R Ga.-3 Edward Whitfield R Ky.-1 Joe Wilson R S.C.-2 Robert J. Wittman R Va.-1 Frank R. Wolf R Va.-10 C. W. Bill Young R Fla.-10 Don Young R Alaska-1 Did Not Vote (0) Member Party Dist. Nancy Pelosi D Calif.-8 Present (0) Member Party Dist. From New York Times

Geographic Primary-Stroke-Center Placement

I've noticed several comments from heart attack and/or stroke survivors lately regarding the lack of available facilities where they reside.  The article below (courtesy of International Media News Group http://egmnblog.wordpress.com ) peaked my interest; heck, there is a map included which would explain exactly why survivors are expressing frustration about lack of facilities.  Look at all of the gaping white spaces on the map pictured below - I'm very thankful to the writer, Mitchel Zoler, for making this information available:

The Uncoordinated U.S. Primary Stroke Centers

From the International Stroke Conference in San Antonio

The good news for U.S. stroke patients is that in March 2010, 685 certified primary stroke centers existed in America. The bad news is that no one makes sure they’re optimally placed to maximize coverage of the U.S. population.

The Joint Commission, a U.S. hospital accreditation organization, began certifying primary stroke centers in December 2003. The idea was that these centers would specialize in state-of-the-art stroke care and become the prime locations for acute stroke patients to receive care.

The concept has certainly taken root. According to Dr. Karen C. Albright, a neurologist at the University of California, San Diego, 524 certified American primary stroke centers existed by November 2008, and another 102 came on board during the following year, through late September, 2009. The pace for new center certifications has held steady, with another 59 centers added to the list during a little more than another 5 months.

Stroke patients who live in the white areas have a greater than 60 minute trip to their nearest primary stroke center (photo by Mitchel Zoler).

But according to Dr. Albright, many of the new centers added during Nov. 2008-Sept. 2009 were “in proximity to existing centers.” No person or group controls where new stroke centers open, and they’ve left big gaps of uncovered population. Based on the centers that existed last September, Dr. Albright estimated that roughly 63 million to 135 million Americans lived more than 60 minutes away from the closest primary stroke center (see map). The upper end number, 135 million, applied if all emergency stroke transport was by ambulance. The number fell to 63 million if all centers had helicopter transport available, but that’s a big if because in reality many centers don’t use air transport.

Some excellent models exist for better emergency-care coordination, most notably the way trauma care is integrated and delivered across the U.S., particularly by regional systems like the Southeast Texas Trauma Regional Advisory Council.  Recently, SETTRAC set up regional coordination of emergency stroke care in the Houston area.

Now all that has to happen is for this approach to spread through the rest of Texas, and then the rest of the United States.

—Mitchel Zoler

Are You Properly Storing Vitamins & Supplements?

I'm guilty! Vitamins and prescriptions that I take on a daily basis have been in a basket on a kitchen counter (I don't have children in my home). Fortunately, I had already moved items everyone hopes to avoid anyway - you've got bigger problems if you need any of these - (cough drops, tablets, cold medicine tablets) used on a non-regular basis into a hallway storage area. That was the germ freak in me in action. Who knows that happened to the germ freak who didn't worry about the daily vitamins and prescriptions and all that takes place in the kitchen, go figure!

Kitchens, Bathrooms No Place for Vitamins

By Jennifer Warner
WebMD Health News

Reviewed by Laura J. Martin, MD

Humidity in Kitchens and Bathrooms Degrades Shelf Life of Vitamins, Study Finds

March 4, 2010 -- The kitchen or bathroom may be the worst place in the house to store your vitamins.

A new study shows high humidity and temperatures, such as those found in the bathroom and kitchen, can quickly degrade the potency of vitamin C and shorten the shelf life of vitamin supplements -- even if the bottle cap is on tightly.

Researchers found the most common types of vitamin C used in vitamin supplements and other fortified products are prone to a process called deliquescence, in which humidity causes a water-soluble substance to dissolve.

"Opening and closing a package will change the atmosphere in it. If you open and close a package in a bathroom, you add a little bit of humidity and moisture each time," researcher Lisa Mauer, associate professor of food science at Purdue University, says in a news release. "The humidity in your kitchen or bathroom can cycle up quite high, depending on how long of a shower you take, for example, and can get higher than 98%."

"If you get some moisture present or ingredients dissolve, they'll decrease the quality and shelf life of the product and decrease the nutrient delivery," Mauer says. "Within a very short time -- in a week -- you can get complete loss of vitamin C in some products that have deliquesced."

Humidity and Vitamin C Don't Mix

Powdered vitamin C is a popular ingredient for food fortification and is one of the most commonly added nutrients to vitamin supplements. Researchers say because vitamin C is very unstable and its content must be declared on nutrient labels, it is commonly used as an indication of the shelf life of foods and supplements.

For example, monitoring deterioration of vitamin C until it no longer meets its declared label value is one way to determine a product's shelf life.

Researchers say temperature and water are the two most frequently cited factors affecting shelf life. But information on deterioration and shelf life of vitamin C is based on models in which temperature and relative humidity were varied at the same time.

In contrast, this study looked at how various changes in relative humidity and temperature, such as those found in a bathroom or kitchen, affect the deterioration of two common forms of powdered vitamin C, ascorbic acid and sodium ascorbate.

The results, published in the Journal of Agricultural and Food Chemistry, showed relative humidity had the largest impact on vitamin C degradation, and this effect was magnified at elevated storage temperatures.

The study showed that at room temperature, sodium ascorbate and ascorbic acid deliquesce at 86% and 98% humidity, respectively. Once the humidity or temperature level was brought back down, the product will solidify again, but researchers say the damage has already been done.

"Any chemical changes or degradation that have occurred before resolidification don't reverse. You don't regain a vitamin C content after the product resolidifies or is moved to a lower humidity," Mauer says. "The chemical changes we've observed are not reversible."

They say keeping vitamin supplements away from warm, humid environments is the first step to maintaining their effectiveness.

The first signs of nutrient degradation are usually brown spots, especially on children's vitamins. Maurer recommends discarding any vitamin supplement that is showing signs of moisture in the container or browning.

"They're not necessarily unsafe, but why give a vitamin to a kid if it doesn't have the vitamin content you're hoping to give them?" Mauer says. "You're just giving them candy at that point with a high sugar content."

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

As a Patient, Advocate for Yourself!

Posted on Tue, Feb. 09, 2010

Cardiologist's advice about No. 1 killer of women

BY TERESA MEARStmears@mindspring.com

The leading killer of women isn't breast cancer or any other kind of cancer, but heart disease, which kills nearly twice as many women each year as die from all forms of cancer combined. During February, which is American Heart Month, many groups focus on women's heart health with screenings and the American Heart Association's ``Go Red'' movement to raise awareness. There was a time when women didn't respond well to treatment such as heart bypasses and stents, but that is changing, says Dr. Stratego ``Stacey'' Castanes, an interventional cardiologist who has been active in Miami-Dade heart health awareness events. ``One of the reasons we're doing better is patient education, women being advocates for themselves,'' says Castanes, who is in private practice and is also associated with the South Miami Heart Center. We talked to Castanes about women and heart disease. Her answers have been edited for space. Q: How is heart disease different in women than in men? A: The biggest difference is the symptoms, especially of heart attacks. The things that we classically describe to patients -- chest discomfort like an elephant sitting on the chest, radiation to the jaw and down the arm -- aren't quite the symptoms women feel. We still don't know how to describe the classic symptoms women feel. I've had women who were having a massive heart attack and they just felt as if all they needed to do was burp and it would get better. It fools everyone. My recommendation to women is if you're feeling bad enough to think that something's wrong and it's persistent and it continues to make you feel worse -- women still feel some kind of chest discomfort and some type of shortness of breath -- you should go to the emergency room. Q: What is the most important thing women can do to protect their hearts? A: The most important thing is exercise. Exercise can decrease your risk for breast cancer, treat depression, prevent heart attacks and strokes, control blood pressure, prevent adult-onset diabetes. The other important thing is having the same due diligence that women have for seeing their ob-gyn to seeing a cardiologist to determine their risk. Q: What are the risk factors for women? A: Smoking brings on heart disease, 10 to 20 years earlier. Strong family history of heart disease is a risk factor. Post-menopausal for women is a strong risk factor. Diabetes. High blood pressure. High cholesterol. The risk factors are basically the same for men. Q: Who needs cholesterol-lowering medication? A: There was an interesting study done in 2007 where they used criteria to determine if someone was low risk, intermediate risk or high risk for heart disease. Then they looked at patients who had reported a heart attack or stroke. The scariest part of the study was that 80 percent of the people, before their event, were considered low risk. Cholesterol is one of those things where there is no such thing as normal. Depending on the risk factors, you have to make the decision of whether to treat cholesterol. A cholesterol of 130 might be OK for one person but for another person who has a family risk of heart disease and is a smoker, that's not OK and that cholesterol needs to be treated. Q: Should women take a daily aspirin to lower their risk of heart disease? A: We have gone back and forth and been very confused throughout the years about what to recommend. For men it's very clear-cut. If you're in your 40s you should be on aspirin to prevent heart attack and stroke. Women tend to get heart disease later in life and there's an increased risk of bleeding with the aspirin. We initially didn't have clear-cut guidelines. Now the guidelines say if you're above 60 with one risk factor for coronary disease you should consider aspirin. If you have two risk factors, you should definitely be on aspirin. Q: What is the link between diabetes and heart disease? A: Basically we consider diabetes equivalent to heart disease. Diabetics are three to five times more likely to have coronary disease than their counterparts with all the same problems but not diabetes. Blood pressure needs to be very tightly controlled, even tighter than usual. Cholesterol needs to be tightly controlled. It seems that a lot of heart disease is linked to an inflammatory process. Diabetes is a constant inflammatory process. The endothelium, the tissue in the lining of the arteries, needs to work a certain way for the heart to function normally. Inflammatory states such as diabetes cause dysfunction of that endothelium, which results in coronary artery disease. Q: Why is blood pressure important? A: Blood pressure is important because it's so closely linked to increased risk of heart attack or stroke. On a very basic level, the endothelium gets pounded with these high blood pressures all day, which results in inflammation and damage to the endothelium. Q: What's your advice about diet? A: Physicians are always asked about diet, and the sad thing is we take less of a month of it in medical school. Nutritionists know this much better. One of the simplest things is that you should have as much color on your plate as possible. Yellow all over the plate -- pasta, corn, potatoes -- is not good.

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© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com