On a Statin -- get your HbA1C checked

The FDA has approved safety label changes for statins, which include eliminating the requirement for routine monitoring of liver enzymes from the drug labels and adding information about the potential for generally non-serious and reversible cognitive side effects and reports of increased blood sugar and HbA1c levels.

Fit and Fat?

Changes in Fitness and Fatness on the Development of Cardiovascular Disease Risk Factors

Hypertension, Metabolic Syndrome, and Hypercholesterolemia

Duck-chul Lee, PhD^_*,_*, Xuemei Sui, MD^_*,Timothy S. Church, MD, Carl J. Lavie, MD,Andrew S. Jackson, PED^|| and Steven N. Blair, PED^_*,

^_* Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
 Department of Preventive Medicine Research, Pennington Biomedical Research Center, Baton Rouge, Louisiana
 Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School–University of Queensland School of Medicine, New Orleans, Louisiana
^|| Department of Health and Human Performance, University of Houston, Houston, Texas

Manuscript received September 12, 2011; revised manuscript received November 7, 2011, accepted November 12, 2011.

^_* Reprint requests and correspondence: Dr. Duck-chul Lee, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, South Carolina 29208 (Email: lee23@mailbox.sc.edu).

Objectives: This study sought examine the independent and combined associations of changes in fitness and fatness with the subsequent incidence of the cardiovascular disease (CVD) risk factors of hypertension, metabolic syndrome, and hypercholesterolemia.

Background: The relative and combined contributions of fitness and fatness to health are controversial, and few studies are available on the associations of changes in fitness and fatness with the development of CVD risk factors.

Methods: We followed up 3,148 healthy adults who received at least 3 medical examinations. Fitness was determined by using a maximal treadmill test. Fatness was expressed by percent body fat and body mass index. Changes in fitness and fatness between the first and second examinations were categorized into loss, stable, or gain groups.

Results: During the 6-year follow-up after the second examination, 752, 426, and 597 adults developed hypertension, metabolic syndrome, and hypercholesterolemia, respectively. Maintaining or improving fitness was associated with lower risk of developing each outcome, whereas increasing fatness was associated with higher risk of developing each outcome, after adjusting for possible confounders and fatness or fitness for each other (all p for trend <0.05). In the joint analyses, the increased risks associated with fat gain appeared to be attenuated, although not completely eliminated, when fitness was maintained or improved. In addition, the increased risks associated with fitness loss were also somewhat attenuated when fatness was reduced.

Conclusions: Both maintaining or improving fitness and preventing fat gain are important to reduce the risk of developing CVD risk factors in healthy adults.

Key Words: body fatness • cardiorespiratory fitness • hypercholesterolemia • hypertension • metabolic syndrome

J Am Coll Cardiol, 2012; 59:665-672, doi:10.1016/j.jacc.2011.11.013
© 2012 by the American College of Cardiology Foundation

Painless Heart Attacks in Women

Association of Age and Sex With Myocardial Infarction Symptom Presentation and In-Hospital Mortality

1. John G. Canto, MD, MSPH; 
2. William J. Rogers, MD; 
3. Robert J. Goldberg, PhD;
4. Eric D. Peterson, MD, MPH; 
5. Nanette K. Wenger, MD; 
6. Viola Vaccarino, MD, PhD; 
7. Catarina I. Kiefe, MD, PhD; 
8. Paul D. Frederick, MPH, MBA; 
9. George Sopko, MD, MPH; 
10. Zhi-Jie Zheng, MD, PhD 
11. for the NRMI Investigators

[+] Author Affiliations

1. Author Affiliations: Watson Clinic and Lakeland Regional Medical Center, Lakeland, Florida (Dr Canto); University of Alabama Medical Center, Birmingham (Dr Rogers); Department of Quantitative Health Sciences, University of Massachusetts Medical Center, Worcester (Drs Goldberg and Kiefe); Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina (Dr Peterson); Department of Medicine, Division of Cardiology, Emory School of Medicine (Drs Wenger and Vaccarino), and the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Vaccarino); ICON Late Phase & Outcomes Research, San Francisco, California (Dr Frederick); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (Dr Sopko); and the School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Dr Zheng).

ABSTRACT

Context Women are generally older than men at hospitalization for myocardial infarction (MI) and also present less frequently with chest pain/discomfort. However, few studies have taken age into account when examining sex differences in clinical presentation and mortality.

Objective To examine the relationship between sex and symptom presentation and between sex, symptom presentation, and hospital mortality, before and after accounting for age in patients hospitalized with MI.

Design, Setting, and Patients Observational study from the National Registry of Myocardial Infarction, 1994-2006, of 1 143 513 registry patients (481 581 women and 661 932 men).

Main Outcome Measures We examined predictors of MI presentation without chest pain and the relationship between age, sex, and hospital mortality.

Results The proportion of MI patients who presented without chest pain was significantly higher for women than men (42.0% [95% CI, 41.8%-42.1%] vs 30.7% [95% CI, 30.6%-30.8%]; P < .001). There was a significant interaction between age and sex with chest pain at presentation, with a larger sex difference in younger than older patients, which became attenuated with advancing age. Multivariable adjusted age-specific odds ratios (ORs) for lack of chest pain for women (referent, men) were younger than 45 years, 1.30 (95% CI, 1.23-1.36); 45 to 54 years, 1.26 (95% CI, 1.22-1.30); 55 to 64 years, 1.24 (95% CI, 1.21-1.27); 65 to 74 years, 1.13 (95% CI, 1.11-1.15); and 75 years or older, 1.03 (95% CI, 1.02-1.04). Two-way interaction (sex and age) on MI presentation without chest pain was significant (P < .001). The in-hospital mortality rate was 14.6% for women and 10.3% for men. Younger women presenting without chest pain had greater hospital mortality than younger men without chest pain, and these sex differences decreased or even reversed with advancing age, with adjusted OR for age younger than 45 years, 1.18 (95% CI, 1.00-1.39); 45 to 54 years, 1.13 (95% CI, 1.02-1.26); 55 to 64 years, 1.02 (95% CI, 0.96-1.09); 65 to 74 years, 0.91 (95% CI, 0.88-0.95); and 75 years or older, 0.81 (95% CI, 0.79-0.83). The 3-way interaction (sex, age, and chest pain) on mortality was significant (P < .001).

Conclusion In this registry of patients hospitalized with MI, women were more likely than men to present without chest pain and had higher mortality than men within the same age group, but sex differences in clinical presentation without chest pain and in mortality were attenuated with increasing age.

High Blood Pressure, What is the Big Deal?

As your blood pressure goes up, the risk of stroke goes up. Even when the top number (systolic) number goes from 100 to 130. Also, even if your blood pressure is ok -- in the 130 to 150 range -- the risk of stroke goes up when you start to add other medical conditions, such as diabetes or smoking. The left of the graph is the risk of stroke over 10 years and the bottom is blood pressure and associated conditions. 

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Nitro Under Tongue or Spray for Chest Pain?

Nitro works well for chest pain. For those that do not like the pill, try the spray under the tongue. No need for the tablet to dissolve, it gets right into your system. 

Need a new cardiologist in New Milford, CT?

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