VOLUME 26 NUMBER 2

Heartburn and your heart

INSIDE

Proton-pump inhibitors offer welcome relief for people with chronic

heartburn. Heres what you need to know to use them wisely.

eartburn didnt get its name by accident.

Although the problem stems from excess stomach acid rather than heart-related
issues, it provokes searing pain focused directly behind the breastbone. Of the over
eight million emergency room visits for chest
pain each year, severe heartburn, also known
as gastroesophageal reflux disease (GERD),
accounts for over half the cases in which actual heart problems are ruled out.
The advent of a class of drugs called
proton-pump inhibitors (PPIs) has been a
godsend for people plagued by acid reflux.
According to the FDA, about one in 14 people in the United States currently takes or has
taken a PPI drug (see Proton-pump inhibitors for heartburn, page 7).

PPIs are far more effective for suppressing

stomach acid production than earlier classes
of drugs. For people who are subject to bleeding in their intestinal tract, they can also lower that risk, says Dr. Michelle ODonoghue,
cardiovascular specialist at Harvard-affiliated Brigham and Womens Hospital.

Perils of PPIs?

But no drug is completely safe. Proton-pump

inhibitors may cause allergic reactions (such
as a rash) or diarrhea. Although the data are
not conclusive, some studies have linked
their use to osteoporosis (weakening of the
bones) and an increased risk of pneumonia
among people admitted to the hospital. Some

Image: Thinkstock

Ask the Doctor . . . . . . . . . . . 2

Low LDL: Is it safe?
Pacemakers and cellphones
How to eat more produce. . . 3
Accuracy of the
new statin guidelines. . . . . . 4
Exercise to avoid
heart failure . . . . . . . . . . . . . 5
What is an AAA? . . . . . . . . . 6
Painkillers and the heart . . . 7
Research briefs . . . . . . . . . . 8
Secondhand smoke and stroke
Low-dose aspirin advice
Better fitness lowers afib symptoms
NEWLY RELEASED:

Pain Relief: Alternative remedies

without drugs or surgery
www.health.harvard.edu/NoPain

continued on p. 7

Heartburn or heart attack?

Dont ignore the possibility that chest pain may mean a heart attack instead
of heartburn. Symptoms associated with GERD can mimic the pain of a heart
attack or angina (chest pain caused by insufficient blood flow to the heart),
especially when the sensation is squeezing rather than burning in nature.
It can be dangerous to assume that your chest pain is caused by reflux.
In particular, people with GERD should always seek medical attention if
they experience chest discomfort brought on by exercise, which is more
characteristic of a heart-related problem. Above all, see a doctor if you have
any symptoms you are unsure about, and head to the emergency room if you
have chest tightness, break into a sweat, turn pale, become very weak, or faint.

Symptoms of ANGINA or a HEART ATTACK

Symptoms of HEARTBURN (GERD)

Tightness, pressure, squeezing, stabbing, or

dull pain, most often in the center of the chest

Pain that spreads to the shoulders, neck, or arms
Irregular or rapid heartbeat
Cold sweat or clammy skin
Lightheadedness, weakness, or dizziness
Shortness of breath
Nausea, indigestion, and sometimes vomiting
The appearance of symptoms with physical
exertion or extreme stress

OCTOBER 2015

Burning chest pain that begins at the breastbone

Pain that moves up toward your throat but doesnt
typically radiate to your shoulders, neck, or arms
Sensation that food is coming back into your
mouth
Bitter or acidic taste at the back of your throat
Pain that worsens when you lie down or
bend over
The appearance of symptoms after a large
or spicy meal

FIVE THINGS TO
DO THIS MONTH

Learn the difference

between heartburn and
heart attack. But if you have
chest discomfort and arent sure
about the cause, seek medical
help ASAP. (page 1)

2
3

Eat more fruits and

vegetables. These eight simple
suggestions may help. (page 3)

Calculate your 10-year risk

for a heart attack. This value
can help you talk with your doctor
to see if you should be taking a
statin. (page 4)

Commit to an exercise
routine. Doing so can help
stave off heart failure and lessen
afib symptoms. (pages 5 and 8)

Use painkillers wisely. These

widely used drugs are riskier
for your heart than once thought.
(page 7)

This Harvard Health Publication was prepared exclusively for Frank Talamantes - Purchased at http://www.health.harvard.edu

ASK THE DOCTOR

by DEEPAK L. BHATT, M.D., M.P.H., Editor in Chief

Can LDL be too low?

Editor in Chief Deepak L. Bhatt, MD, MPH

Executive Editor Julie Corliss
Associate Editor Stephanie Slon

Editorial Board
Board members are associated with Harvard Medical School
and affiliated institutions.

Heart Paula A. Johnson, MD, Peter Zimetbaum, MD

Bone Disease Scott Martin, MD, Donald T. Reilly, MD, PhD
Cancer Marc Garnick, MD
Dermatology Kenneth Arndt, MD, Suzanne Olbricht, MD
Endocrinology Alan Malabanan, MD
Exercise/Lifestyle I-Min Lee, MD, ScD, JoAnn E. Manson, MD, DrPH
Gastroenterology Jacqueline Lee Wolf, MD
Geriatrics Suzanne E. Salamon, MD
Neurology Gad Marshall, MD
Nutrition Eric B. Rimm, ScD
Psychiatry Ann R. Epstein, MD, Michael Miller, MD,
Ronald Schouten, MD, JD
Urology William C. DeWolf, MD
Womens Health Karen Carlson, MD, Martha K. Richardson, MD,
Isaac Schiff, MD


Customer Service
Call 877-649-9457 (toll-free)

Q
A

After a year of taking a statin, my LDL cholesterol

measurement is 50 mg/dL, which seems awfully
low. Is there any downside to a very low LDL?
Based on what we currently know, a low-density
lipoprotein (LDL) level of 50 mg/dL appears to
be reasonably safe, especially when attained naturally.
Studies of people whove already had a heart attack suggest that lowering LDL to about 50 mg/dL provides further protection against recurrent cardiovascular events
versus reaching a level of around 70 mg/dL. In studies
lasting up to seven years or so, these lower LDL levels appeared to be well tolerated.
Several ongoing trials are now testing a new class of cholesterol-lowering drugs
known as PCSK9 inhibitors to see if LDL levels lower than 40 mg/dL provide even
greater protection against heart attacks and dying from cardiovascular disease.
These studies will also examine the safety of having a very low cholesterol level,
including a careful evaluation of any subtle effects on brain function.
Although the Internet is full of claims that cholesterol-lowering drugs cause
memory problems, there is no good scientific evidence to date that supports a link
between cholesterol-reducing drugs and memory loss or other cognitive problems.

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Editor in Chief Gregory D. Curfman, MD
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In association with
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The goal of the Harvard Heart Letter is to interpret medical
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fashion. Its contents are not intended to provide personal medical
advice, which should be obtained directly from a physician.

Cellphone safety with a pacemaker

Q
A

Ive heard that my smartphone might interfere with my

pacemaker. What exactly can happen?
The possible riskwhich is very lowis that an implanted
device might misinterpret the electromagnetic signal from
a nearby cellphone. Both pacemakers and implantable cardioverter-defibrillators (ICDs) may be vulnerable.
With a pacemaker (which helps start or regulate a slow
heartbeat), interference from the smartphone might be mis- Keep your cellphone at
taken for a signal from the heart, causing the pacemaker to least five inches away
from your pacemaker or
temporarily stop working. That might cause you to faint.
ICD.
ICDs are usually implanted in people who are at risk of
abnormal rhythms in the hearts lower chambers, known as ventricular arrhythmias.
If the device detects a life-threatening arrhythmia, it delivers a high-energy shock
to jolt the heart back into a normal rhythm. But if a smartphone signal mimics a
dangerous arrhythmia, the ICD might deliver an unnecessary shock.
The FDA recommends that people keep their cellphones at least five to seven
inches away from a pacemaker or ICD. This warning was based on devices available
a decade ago. Even so, a recent European study confirmed that the recommended
safety distance may still be relevant with newer-model smartphones, networks,
and cardiac devices.
To be on the safe side, avoid storing your phone in your shirt pocket. And when
making calls, hold the phone to the ear opposite the side of your pacemaker.

Visit the Harvard Health Blog online:

www.health.harvard.edu/blog

2015

Harvard University (ISSN 1051-5313)

Proceeds support research efforts of Harvard Medical School.

Send us a question for Ask the Doctor

By mail: Harvard Heart Letter
10 Shattuck St., 2nd Floor, Boston, MA 02115
By email: heart_letter@hms.harvard.edu
(Please write Ask the doctor in the subject line.)

Because of the volume of correspondence we receive, we cant answer every question, nor can we provide personal medical advice.

2 | Harvard Heart Letter | October 2015

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8 ways to eat more fruits and

vegetables
Theyre full of the nutrients you need for a healthy heart.

hat familiar refrain Eat your vegetables! still hasnt sunk in. Only
about one in 10 adults in the United
States eats the amount recommended
by the current federal dietary guidelines. And were not doing much better
when it comes to fruit, according to a
recent report from the CDC (see How
much should you be eating?).
These dismal data dont bode well
for the nations health, because eating
plenty of produce can help people reach
(or stay) at a healthy weight. And fruits
and vegetables contain nutrients such
as fiber, minerals, and vitamins that
may prevent heart disease.

Here are eight suggestions to put

more produce on your plate.

Take stock of how many fruits

and veggies you eat now. Note the two
exceptions for counting your daily tally: For raw leafy salad greens, two cups
equals a cup of vegetables. For dried
fruit, a half-cup equals one cup. A cup
of 100% juice can count as one of your
daily cups. But youre better off eating
whole fruits or vegetables, which contain heart-protecting fiber, so go easy
on that option.

How much should you be eating?

Image: Thinkstock

Too much takeout

Lack of time is one reason people dont

eat more vegetables, says Linda Delahanty, director of nutrition and behavioral research at the Diabetes Center
at Harvard-affiliated Massachusetts
General Hospital. Buying and preparing vegetables takes time. Many
people eat on the go and pick up takeout foods. They order a main dish, but
not always a side salad or vegetable,
says Delahanty.
Also, people often stick with whats
familiar and eat the same old corn,
peas, and potatoes. Most dont experiment with different types of vegetables
or new ways to prepare them, says
Delahanty.

A better bargain than you think

Finally, many people perceive fruits and

vegetables as pricey. But the latest figures from the U.S. Department of Agriculture show that the average price for
a one-cup serving of fruit or vegetables
is only about 50 cents. Compared with
a small bag of chips, a can of soda, or
another nutrient-poor snack, produce
is a real bargain.
www.health.harvard.edu

Keep track and make a plan.

helps avoid spoilage that can occur with

fresh produce, which can be useful for
people who have unpredictable schedules or who travel frequently.
Stay in season. Fresh fruit and
4 vegetables tend to be less expensive when theyre in season. For the
freshest selection, seek out a farmers
market, or pick your own fruit and vegetables at an orchard or a farm.
out. Try eating at least
5 Branch
one new fruit or vegetable every week. Challenge yourself to eat a
rainbow by adding as many differentcolored fruits and vegetables as you can
to your diet: red peppers, oranges, butternut squash, spinach, blueberries, and
purple cabbage.
on extra flavor. Make your
6 Add
steamed vegetables more flavor-

Vegetables
Fruit

Recommended
daily amount

Percentage of
U.S. adults who
meet that goal

2 to 3 cups

9%

1.5 to 2 cups

13%

Source: Centers for Disease Control and Prevention.

Go for convenience. If peeling,

chopping, and cleaning up feels

like too much work, take advantage
of pre-cut, pre-washed fresh fruit and
vegetables, such as cubed melon or
pineapple, baby carrots, celery sticks,
and bagged salad greens. Supermarket
salad bars often offer a wide variety of
veggies and fruits. Or pick up cooked
vegetables from a restaurant.
Focus on frozen. Nutrition-wise,
3 frozen vegetables are similar
toperhaps even better thanfresh.
Theyre picked at the peak of ripeness
and immediately flash-frozen, which
helps retain their vitamins and phytochemicals, the naturally occurring
substances in plants thought to lower
heart disease risk. Also, buying frozen

ful by topping with one or more of

these:
olive, nut, or sesame oil
chopped, toasted nuts
Parmesan or feta cheese
fresh, minced herbs or a dried herb
and spice blend.
dips and spreads. Dunk cut7 Try
up broccoli, peppers, or carrots
into hummus, guacamole, or your favorite salad dressing. Slather nut butter
on apple or banana slices. Dip orange
slices or strawberries into melted dark
chocolate.
Sip soups. Vegetable-rich stews
8 and soups are an easy way to eat
a variety of vegetables. In the summer,
try cold soups like gazpacho or fruit
soups made with berries or melons.
October 2015 | Harvard Heart Letter

This Harvard Health Publication was prepared exclusively for Frank Talamantes - Purchased at http://www.health.harvard.edu

|3

New studies support statin guidelines

Whats
your risk?

But if you are healthy, deciding if these commonly

prescribed drugs are right for you is a personal choice.

To estimate your odds of

having a heart attack or stroke
over the next decade, see
www.health.harvard.edu/heartrisk.
Youll need to know your total
and HDL cholesterol values
and blood pressure
reading.

4 | Harvard Heart Letter | October 2015

Should you take a statin?

If all this has you wondering if you

should be taking a statin, heres another
way to think about the decision. Statins
lower the risk of a heart attack by about
20%. If youre in a low-risk group, say
5%, taking a statin reduces your risk to
4%, explains Dr. Gaziano. Some people in that group might decide its not
worth the hassle of taking a drug every
day for a very small benefit. But others might want to do everything they
possibly can to lower their risk, he says.
Thats why its so important to have a
discussion with your doctor about your
own situation and preferences.
But dont neglect the other important
ways to lower your risk of heart disease.
Healthy lifestyle habits like avoiding tobacco, getting regular exercise, and eating a good diet can help your heart as
well as your overall health.

THE OTHER STATIN GUIDELINES

In addition to recommending statins
for people with a 7.5% or higher risk
of cardiovascular disease in the next
10 years, the new guidelines also
recommend statins for people in these
risk categories:

anyone who has cardiovascular

disease, including angina (chest
pain with exercise or stress), a
previous heart attack or stroke, or
related conditions

anyone with a very high level LDL

(generally 190 mg/dL or above)

anyone with diabetes who is 40 to 75

www.health.harvard.edu

This Harvard Health Publication was prepared exclusively for Frank Talamantes - Purchased at http://www.health.harvard.edu

Image: Thinkstock

or many years, the main deciding numbers of heart attacks, strokes, and
factor for taking a statin was how deaths from cardiovascular disease in
much harmful low-density lipopro- both groups over a nearly 10-year peritein (LDL) cholesterol was circulating od. The rates in both groups were nearthough your bloodstream. That all ly the same (just over 6%), suggesting
changed about two years ago, when that the new guidelines wouldnt put
leading cardiology organizations is- too many people on the drugs unnecsued new guidelines that shifted away essarily. And when they looked at the
from targeting LDL. The biggest change people who werent eligible for a statin
was for people ages 40 to 75 who have under the new guidelines, just 1% had
a 7.5% or higher risk of having a heart a heart attack or stroke. Under the old
attack or stroke over the next 10 years ones, 2.4% did. That suggests that the
(see Whats your risk?).
new guidelines provide a more accurate
Yet some doctors chalassessment of who would
lenged the recommendabenefit from a statin and
tions, arguing that many
who wouldnt.
healthy adults would end
The other JAMA study
up taking a statin but get
relied on a computer modlittle benefit from the
el that projected the costs
drug while running the
for a hypothetical group
risk of developing side
of Americans ages 40 to
effects such as muscle
75 who would take a statin
pain and diabetes. Now,
based on the new guidetwo new studies suggest
lines. These costs include
that the new guidelines
the expense of cholesterol
appear to be more actesting, medications, and
curate and cost-effective Discuss your own situation
lab and doctor visits, as
and preferences with your
than the old ones.
well as the cost of treating
doctor when deciding whether
Were moving the to take a statin.
heart attacks and strokes,
dial toward a more accusays senior author Dr.
rate prediction of heart disease risk and Thomas A. Gaziano, cardiologist at
its relevance to statin therapy, says Dr. Brigham and Womens Hospital. The
Christopher ODonnell, associate pro- downsides of taking a statin, including
fessor at Harvard Medical School and the inconvenience of taking a daily pill
co-author of one of the studies, both and a slightly higher risk of diabetes
published July 14 in the Journal of the related to statin use, were also part of
American Medical Association (JAMA). the equation.
Another key factor in the model
Clarifying the benefits
was a measure known as the qualityOne of the studies included 2,435 peo- adjusted life-year, which measures the
ple from the long-running Framing- burden of a disease in terms of both
ham Heart study who were not taking the quality and quantity of life lived.
a statin. Researchers determined that The model showed that the new guide39% of these people would have been lineswhich would put almost half of
eligible to take a statin under the new adults ages 40 to 75 on a statinwould
guidelines, versus 14% under the older be cost-effective, at least based on the
guidelines. They then looked at the overall expense to society as a whole.

The journey toward heart disease

tion. Although everyday chores such

as gardening and housework help you
Exercise and lifestyle changes can thwart heart failure
burn calories, they arent a substitute
for a more structured exercise regimen.
down the road.
Ideally, you should aim for
ymptoms of heart failurefatigue, who walked at a brisker
30 minutes of exercise at
shortness of breath, and swelling in pace and burned at least
least five times a week. A
your legs and feetmay creep up slow- 845 calories each week in
thorough workout would
ly or appear dramatically. Years of toil leisure activities (see How
include five or 10 minutes
against high blood pressure, plaque- many calories are you
of warm-up to raise your
clogged arteries, and excess body fat burning?) cut their risk of
heart rate, at least 30 mingradually erode your hearts capacity heart failure by a quarter.
utes of brisker activity, and
to move blood through the body effec- This finding makes a lot of
a few minutes of cooling
tively. The condition often germinates sense on the cellular level,
down to allow your heart
from the seeds of lifestyle choices plant- say the study authors. As
to return to its resting pace.
ed much earlier in life.
cell damage progresses be- Breaking up your daily
Resistance exercises
Cardiovascular disease can remain cause of inflammation and exercise into three
activities that build your
silent for decades, but even in its covert other destructive processes, 10-minute bursts can be
musclescan increase
as
effective
as
30
minutes
phase there are things you can do to your metabolism changes,
your strength, improve
of continuous activity.
slow or halt the destructive process, you gain fat, and you lose
your flexibility, and help
says Dr. Mandeep Mehra, medical di- muscle mass. Exercise protects your you avoid falls. But stick to lighter
rector of the Heart and Vascular Cen- heart health by reversing these process- weights and milder activities so as not
ter at Harvard-affiliated Brigham and es, thereby helping you avoid the haz- to strain your heart.
Womens Hospital.
ards of high blood pressure, diabetes,
and obesity. In fact, the study partici- Check with your doctor
A life cycle snapshot
pants who maintained a healthier body If you dont have particular medical
An article in the July issue of JACC: mass index also fared better.
concerns, a program of moderate walkHeart Failure explored the role of key
Even if you have a long history of not ing and strength training is a safe way
health factors in the progression of exercising, its still possible to create a to go. If you have arthritis, other musheart disease in 4,500 older adults, in- safe, healthy exercise routine suited to culoskeletal issues, or heart disease, talk
cluding those with risk factors such as your abilities. To begin, take a close to your doctor before you start. And
high blood pressure and diabetes. Their look at your current level of activity. dont be deterred from making lifestyle
average age was 72. Researchers focused Build activity into your day by taking changes now, even if youve lagged over
on how the participants current behav- the stairs versus the elevator and park- the years. The choices you make today
iors (such as diet, exercise, smoking, ing a short distance from your destina- still matter to your overall outlook.
alcohol use, and body weight) affected
their chances of developing heart failHow many calories are you burning?
ure during a six-year period.
Leisure activity
Calories burned per hour
Those who engaged in positive health
125-pound
155-pound
185-pound
habitsespecially regular exercise
person
person
person
were 45% less likely to develop heart
Bowling
90
112
133
failure compared with those with lessDancing:
slow,
waltz,
foxtrot
90
112
133
healthy habits. When you look at peoGolf: using cart
105
130
155
ple older than 65, you see the collective
Tai chi
120
149
178
influence of health habits across the life
cycle and the tipping point when ongoWalking: 3.5 mph (17 minutes per mile)
120
149
178
ing silent disease converts into clinical
Playing with kids: moderate effort
120
149
178
heart failure symptoms, says Dr. Mehra.
Gardening: general
135
167
200

Image: Thinkstock

Walk it off

While its hardly news that exercising

is good for you, the people in this study
www.health.harvard.edu

Swimming: general
Tennis: general
Bicycling: 12 to 14 mph

180
210
240

223
260
298

266
311
355

October 2015 | Harvard Heart Letter

This Harvard Health Publication was prepared exclusively for Frank Talamantes - Purchased at http://www.health.harvard.edu

|5

Abdominal aortic aneurysms:

What you need to know
Targeted screening and improved repair techniques may
minimize the danger of this uncommon condition.
Abdominal aortic aneurysm (AAA)

But most aneurysms occur in

the aorta, the main artery that
comes out of the heart and
supplies blood to the lower half
of the body. About 75% of aortic
aneurysms form in middle of the
body and are known as abdominal aortic aneurysms or AAAs.

Monitoring and treatment

Abdominal
aorta
Aneurysm
Kidney

ith a diameter roughly the size

of a garden hose, the aorta is
the bodys largest artery. It curves out
of the heart through the chest, passing
straight down the center of the body before dividing into the arteries that serve
the legs (see illustration).
Like other blood vessels in the body,
the aorta can develop atherosclerosis.
Harmful LDL cholesterol lodges in the
vessel wall, creating plaque buildup and
damaging the artery wall. The constant stress of blood flowing through
the aortaexacerbated by high blood
pressurecan cause the arterys wall
to bulge where there is a weak spot.
This bulge is most likely to form in the
abdominal area and is known as an
abdominal aortic aneurysm, AAA, or
triple A.
Most AAAs grow very slowly and
dont cause any symptoms. But an undiscovered large one can rupture without warning, causing massive bleeding
inside the abdomen. When that happens, the odds of survival are less than
20%, says Dr. Christopher Kwolek, a
vascular surgeon at Harvard-affiliated

6 | Harvard Heart Letter | October 2015

Massachusetts General Hospital. Even

if someone gets to the hospital in time
to undergo emergency surgery, the
heart, kidneys, or lungs may fail in the
intensive care unit following the operation, he says. But if an AAA is discovered early, monitored, and repaired if it
grows dangerously large, the survival
rate is greater than 95%.

Screening for AAAs

Most AAAs are found by chance during

an imaging test performed for another
reason, such as an ultrasound to examine the gallbladder or an MRI to evaluate a spinal problem, says Dr. Kwolek.
Rarely, AAAs cause symptoms such as
a deep pain or a throbbing sensation in
the back or the side of the abdomen.
Those at greatest risk for an AAA
include older male smokers and people
with a family history of the condition. Men ages 65 to 75 who have ever
smoked should undergo a one-time
ultrasound screening for an AAA, as
recommended by current guidelines.
Even minimal smokingany amount
over 100 cigarettes over a lifetimeis

A bulge that is one-and-a-half times the

vessels normal diameter or greater is
considered an aneurysm. These smaller
AAAs are monitored with annual ultrasound tests. Most grow very slowly over
the course of years or decades. However, if the aneurysm grows quickly, the
vessel should be repaired. One option
is open repair, which involves a large
incision in the abdomen or side of the
body. After a week in the hospital, a full
recovery could take months. Today, 70%
to 80% of AAAs are treated with a minimally invasive procedure known as endovascular repair. The surgeon passes a
catheter through a small incision in the
leg and threads it into the aorta to reach
the AAA. A fabric-coated metal cage, or
stent, is then put in place to reinforce the
bulging aorta, which seals around the
stent. After a night or two in the hospital, the person goes home and, in general, recovers fully in two weeks or less.
While the first-generation catheters
used to repair AAAs were about as wide
as your thumb, the current ones are closer to the diameter of a pencil and more
flexible, says Dr. Kwolek. These advances
have made it easier to treat women (who
tend to have smaller arteries than men)
with the endovascular technique.

AAA prevention

To avoid an AAA, the same advice for

preventing heart disease applies: dont
smoke, eat a healthy diet, exercise regularly, and keep your blood pressure and
cholesterol in a healthy range. These
habits are also vital if you have an AAA,
as youll want to be as healthy as possible if you end up needing a repair.
www.health.harvard.edu

This Harvard Health Publication was prepared exclusively for Frank Talamantes - Purchased at http://www.health.harvard.edu

Illustration by Scott Leighton

An aneurysm is a weakened
and ballooning area in an artery.
These dangerous bulges can
occur in arteries throughout the
body, including those in the brain,
the back of the knee, the intestines, and the spleen.

enough to raise your risk. Because the

risk in women is lower, screening isnt
advised unless they have a family history of AAA, says Dr. Kwolek. In fact,
Medicare pays for a one-time screening within six months of enrollment
for both men and women with a family
history of AAA, as well as for men who
have ever smoked.

Stronger heart risk warning

for popular painkillers

Image: Thinkstock

NSAID users: Take the lowest effective dose

for the shortest possible time.

attack from taking NSAIDs because

their baseline risk is higher. But the
drugs also raise risk among people
without heart disease risk factors. Just
how much varies, depending on the
drug and the dose.

he tiny print on your bottle of

over-the-counter ibuprofen (Advil,
Motrin) includes this warning: The
risk of heart attack or stroke may go up
if you use more than directed or longer
than directed. A similar warning appears on the label for naproxen (Aleve,
Naprosyn). Both drugs are nonsteroidal
anti-inflammatory drugs, or NSAIDs
popular painkillers used to treat arthritis, muscle strains, headaches, and
other painful conditions. In July, the
FDA announced plans to strengthen
these heart risk warnings on both overthe-counter and prescription NSAIDs.
Until recently, only long-term
NSAID useover many months or
yearswas considered dangerous in
terms of heart attack risk. But the new
evidence suggests that the harm from
NSAIDs can occur with short-term use,
during the first couple of weeks of taking the drugs, says Harvard professor

Dr. Elliott Antman, a

Use with caution
cardiologist at Brigham
If you have heart disand Womens Hospiease, taking an NSAID
tal and lead author of
for the occasional headguidelines on NSAID
ache is probably okay,
use from the American Current data suggest that
says Dr. Antman. But
naproxen may be the safest NSAID.
Heart Association.
he always recommends
naproxen rather than ibuprofen. While
How NSAIDs may harm the heart the evidence is not definitive, some data
NSAIDs pose a two-pronged risk to the suggest that naproxen may be less risky
cardiovascular system. First, NSAIDs than other NSAIDs.
encourage the body to retain more salt
Dont make the mistake of some
and water, which can raise blood pres- weekend athletes, who routinely take
sure. Second, they may change levels NSAIDs to prevent or treat minor musof substances in the blood in ways that cles aches or sprains. Too often, such
might make clots more likely to form. use becomes a habit, says Dr. Antman.
These clots can block an artery feeding Those with chronic conditions like arthe heart or brain, triggering a heart at- thritis, who may need long-term pain
tack or stroke.
relief, should work with their doctors to
People with heart disease or its risk find the safest options. Follow Dr. Antfactors (such as high blood pressure, mans mantra: Take the safest drug at
high cholesterol, or a family history) the lowest dose for the shortest possible
have a greater chance of having a heart period of time.

Heartburn and your heart from p. 1

Proton-pump inhibitors for heartburn

Drugs in red are available only by prescription;

PPIs increase a persons risk of heart

disease, and I wouldnt advise people
to stop taking PPIs because of worries
about heart attack risk alone, says Dr.
ODonoghue. Nonetheless, its a good
idea to periodically re-evaluate with
your doctor any medication you use.

reports have suggested that PPIs may the others are sold over the counter.
interfere with the effectiveness of the Generic name
Brand name
heart drug clopidogrel (Plavix).
dexlansoprazole*
Dexilant
Now, theres a new concern. Research esomeprazole
Nexium
published in the online journal PLOS lansoprazole
Prevacid
ONE in June reports that the PPIs may omeprazole slow release Prilosec
increase the risk of a heart attack. HowTapering off
immediate
Zegerid
ever, Dr. ODonoghue says these results
If you have mild GERD with no other
release
should be viewed with caution. Observa- pantoprazole
complicating medical conditions, you
Protonix
tional studies like this one cant account rabeprazole
may be able to cut back on your PPI
Aciphex
for every possible factor that might * All except this one are available as generics.
use. But check with your doctor first.
skew the results, she says. For example,
You may need to continue on the drug
some of the people in the study who were taking PPIs to treat if you regularly take aspirin, blood thinners, or nonsteroidal
acid reflux may have been doing so incorrectly because they anti-inflammatory drugs (see above story) or if you have a
were actually experiencing symptoms of heart disease. Also, condition such as stomach ulcers or Barretts esophagus.
people who were being treated with PPIs may have been suf- Lifestyle changes such as losing weight, sleeping with the
fering from other illnesses that may have increased their risk head of your bed slightly elevated, and avoiding eating before
of heart attack. At this point, there is no clear evidence that bed can all help calm stomach acid.
www.health.harvard.edu

October 2015 | Harvard Heart Letter

This Harvard Health Publication was prepared exclusively for Frank Talamantes - Purchased at http://www.health.harvard.edu

|7

RESEARCH WERE WATCHING

Secondhand smoke boosts stroke risk

eing near a smoker forces you

to breathe what that person exhales as well as what wafts from the
burning end of the cigarette. This
so-called secondhand smoke has been
linked to a host of health problems,
including lung cancer, heart attack,
and stroke. Now, a large study further validates
earlier research about the risk of stroke caused by
secondhand smoke.
The study, published online June 16 by the
American Journal of Preventive Medicine, included nearly 22,000 people ages 45 and older.

Almost a quarter of the participants

reported secondhand smoke exposure, which was defined as more
than one hour per week in close
contact with a smoker. After adjustment for other stroke risk factors,
there was a 30 percent increase in
the overall risk of stroke among people exposed
to secondhand smoke.
The good news is that 28 states and the District
of Columbia have passed comprehensive laws prohibiting smoking in all public places and workplaces, including restaurants and bars.

Low-dose aspirin for people with heart disease

f you have heart disease, national guidelines

recommend that you take a low-dose (81-mg)
aspirin every day. Its an inexpensive and effective
way to lower your risk of a heart attack or stroke.
According to a report in the July 17 Morbidity and
Mortality Weekly Report, about seven in 10 adults
with heart disease follow this advice.
The study relied on telephone surveys done by
the CDC about health behaviors. It included data
from more than 17,900 adults from 20 states and
the District of Columbia.
Nearly 94% of people with heart disease who

regularly take low-dose aspirin reported that they

do so to prevent a heart attack, although many
also cited stroke prevention as a reason. Men,
people ages 65 and older, whites, and those with
at least two heart risk factors were more likely to
use aspirin than those in other groups.
If you have heart disease and youre not taking a daily low-dose aspirin, ask your doctor if you
should start. Note that for people without heart
disease, the possible risk of gastrointestinal bleeding associated with aspirin use may outweigh the
benefits to your cardiovascular system.

oosting your fitness level may help decrease

the symptoms of the most common heart
rhythm disorder, according to a study published
online June 22 by the Journal of the American
College of Cardiology. The disorderatrial fibrillation, or afibcauses an irregular, rapid
heartbeat that can lead to shortness of breath,
dizziness, and fainting.
The study included 308 people with afib who
were also overweight or obese, a condition that
raises the risk of afib. The participants answered
questions about their afib symptoms and underwent tests to determine their fitness levels, which
were described in metabolic equivalents, or METs.

Whats coming up:

8 | Harvard Heart Letter | October 2015

(METs measure your level of

exertion and are based on how
much oxygen your body uses
during activities; sitting still is
1 MET, and brisk walking is 3.)
Researchers prescribed exercise programs for
the volunteers that were tailored to their age and
fitness level and which gradually increased in intensity. The participants also received weight-loss
counseling. After four years, people who increased
their fitness levels by 2 or more METs were more
likely to have reduced or eliminated their afib
symptoms than those whose fitness improved by
less than 2 METs.

Healthy options for your Thanksgiving table

The dangers of deep dips in blood pressure
Who should seek cardiac rehabilitation?
Marching orders: How to start a walking program

www.health.harvard.edu

This Harvard Health Publication was prepared exclusively for Frank Talamantes - Purchased at http://www.health.harvard.edu

Images: Thinkstock

Getting in shape may improve afib symptoms

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