Heart Attacks and Healthcare reform- What truly causes them and can we prevent either??

February 28, 2010

Institute For Medical Wellness Healthy Living Report


Heart Attacks and Healthcare reform- What truly causes them and can we prevent either??

This will be the first in a series about cardiovascular disease testing.

Today will focus on total cholesterol measurements and what it really means.

When I first meet a patient, I generally spend a good deal of time reviewing their medical history. This generally accounts for about 20 minutes of our first visit. And what makes the Institute For Medical Wellness distinct from other offices, is that it is I, Dr. Horvitz, that takes the history. I do not rely on paperwork, assistants, or prior records. It is extremely important to get to know each patient, and the initial medical history is the most important step in that process.

What I always find amusing about the initial history, is when I question about previous testing.

Can you guess what testing patient's almost always bring up first?

It is none other than one of my favorite topics, cholesterol!!!

I have had patient's come in to my office scared because they were told their cholesterol was over 200. I have had patient's smile proudly and announce that their cholesterol levels were under 200. I always ask why that is important, and the routine response is, "Well isn't cholesterol bad for me, and shouldn't I try to lower it?"

Many still believe that they need to lower their Total Cholesterol below 200 to reduce their risks of heart attacks, strokes, and other vascular disease. Now, what would you say if I told you that:

Of all people who suffer heart attacks, 50%, that means half, have Total Cholesterol levels above 200 !!!

Sounds pretty ominous ????

OK, then let me take it one step further, by asking what about the other 50% who suffer heart attacks?

Of all people who suffer heart attacks, 50%, that means half, have Total Cholesterol levels below 200 !!!

So how accurate is a Total Cholesterol level in calculating your risk for a heart attack?

It is as accurate as guessing heads or tails when flipping a coin !!!!

I will continue with cardiovascular disease testing in a future newsletter. I hope to show what truly predicts your future risk and what does not!!

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Healthcare Reform Update:

The healthcare summit is over. For those of you who watched it, What did you think?

I'll tell you what I think, but first go back to my previous newsletter with my prediction about the summit. As of now, most of my predictions have come true. Everyone had their talking points, with the president, as usual, speaking the most. But he has that right, because, if I can quote him, "I am the President".

Unfortunately, the two political spectrums are diametrically and philosophically opposed to each other in respect to healthcare.

The democrats want government to exert more power and control over the system.
The republicans want the government to set up rules that would allow individuals and businesses greater leverage when purchasing health insurance and healthcare.

The democrats want a system where politicians and bureaucrats will have the ultimate decision making authority about what type of health insurance is available to you, which leads in the future to what type of treatments will be available.

The republicans want a system left open to the free market, with less political mandates from Washington and state governments. This would allow insurance companies to develop insurance plans that better meet the needs of its subscribers, and lowering the costs.

There is more but I prefer to sum it up this way.

The president wants a plan with heavy, heavy control of your healthcare choices residing in Washington. The president believes that government knows better what you need, and will make better choices for you, than if you could make them yourself. The president wants a healthcare plan where you need to rely on Washington and all of its politics.

The republicans do not want a big reform plan. They want small incremental changes that would allow the power of healthcare decision making to remain with individuals. They want reforms that promote true competition for your healthcare dollar, thereby lowering your costs and improving innovations in treatment. The republicans want a healthcare plan where you rely on yourself and your community, not on Washington politics!

Now to be fair, everything does not always work out exactly as feared or planned.

But it is "intentions", that affect our behavior and beliefs.

It is my view that the president's intentions are to set the stage for a future full government takeover of the healthcare system. It may not occur during his presidency, but he wants to start pushing the car without brakes down the hill towards a full government system. The problem I have, is that once the car starts moving downhill, it becomes very, very hard to stop!

If you did not watch the summit, or the follow-up media highlights, I urge you to watch the following video. Dr. Tom Coburn, a republican senator and physician, gave a republican address concerning the aftermath of the summit. It can be viewed here.

As a disclaimer. I do not like any politician or political group that puts themselves or their party ahead of the constituents they are meant to represent. That is why I am a registered as neither a republican or a democrat, but as an independent.

My views on healthcare has not changed. Please read a newsletter from two years ago, prior to today's healthcare debate.

If you are against the present reforms, click here to sign one of the many petitions seeking a total fresh restart of the reform debate.

No matter what your views on healthcare reform, speak up and contact your political representatives!!

To Good Health!

Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311
www.drhorvitz.com

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Aspirin Does Not Prevent Heart Attacks in High-Risk Patients

SOURCE: University of Dundee

DUNDEE, United Kingdom -- October 17, 2008 -- Taking regular aspirin and antioxidant supplements does not prevent heart attacks in high-risk groups with diabetes and asymptomatic arterial disease, according to a study published today in the online issue of the [BMJ].

Although there is considerable evidence showing no protective benefit of aspirin in high-risk patients without heart disease, guidelines are inconsistent and aspirin is commonly prescribed for the primary prevention of heart disease in patients with diabetes and with peripheral arterial disease.

Jill Belch, University of Dundee, Dundee, United Kingdom, and colleagues investigated whether aspirin and antioxidants given together or separately can reduce heart attacks and death in patients with diabetes and arterial disease.

The study included 1,276 patients aged over 40 years with diabetes and evidence of artery disease. Patients were randomized to receive either aspirin or placebo, an antioxidant or placebo, aspirin and antioxidant, or double placebo. Patients were followed over 8 years.

Overall, the researchers found no benefit from either aspirin or antioxidant treatment in the prevention of heart attacks or death. Patients in the aspirin groups had 116 primary events compared with 117 in the placebo group. No significant difference in events was seen between the antioxidant group and the placebo group.

The authors concluded by voicing their concern at the widespread prescribing of aspirin despite the lack of evidence to support its use in the primary prevention of heart attacks and death in people with diabetes and in view of its possible side effects.

In an accompanying editorial, William Hiatt, Colorado Prevention Center, Denver, Colorado, said: "These findings show that unlike statins and drugs for reducing hypertension, which have a benefit in all risk groups including those with and without heart disease, only patients with a history of clinical or symptomatic heart disease or stroke disease benefit from taking aspirin."

SOURCE: University of Dundee

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Interesting study! We have long thought that aspirin was beneficial for prevention of first and future heart attacks, especially for diabetics who have a higher risk of heart and vascular disease. The question is now:

But why not take an aspirin a day? It can't hurt me, can it ???

All medicines may cause side effects, even aspirin. The most common side effects from aspirin include heartburn, nausea and upset stomach. However other reactions can occur and you should seek medical attention right away if any of these SEVERE side effects occur when using aspirin, including:

• rashes
• hives
• itching
• difficulty breathing
• tightness in the chest
• swelling of the mouth, face, lips, or tongue
• black or bloody stools
• confusion
• diarrhea
• dizziness
• drowsiness
• hearing loss and/or ringing in the ears
• severe or persistent stomach pain
• unusual bruising
• vomiting.

This study concludes that "only patients with a history of clinical or symptomatic heart disease or stroke disease benefit from taking aspirin." In other words, regular use of aspirin for prevention of heart disease or stroke in low risk individuals is not helpful and could actually be harmful.

The study also suggests that the use of the cholesterol lowering drugs known as statins benefits all risk groups. I have disagreed with this notion for many years. More info on the cholesterol issue can be found in these past newsletters:

• The side effects of statins: Heart healthy and head harmful?
  
• Cholesterol may help build muscle

Bottom Line:

If you have diabetes and presently have a low risk of vascular disease, and take aspirin only for prevention, you may consider stopping. Whether this advice holds up for individuals without diabetes will hopefully be in a future study.

We all try to do what is healthy. However what we hear is healthy today, we may hear to be harmful tomorrow. That is why you need a doctor who will take the time keep up with the latest medical information, and weed out the truth from the fiction.

To get a truer overall picture of your health, including reviewing and modifying your individual risk factors, you should schedule a yearly preventive physical.

As Benjamin Franklin once said:

"An ounce of prevention is worth a pound of cure"

Just 1 in 4 know heart attack signs

February 23, 2008 - This article from Yahoo news is brought to you as a service from Dr Steven Horvitz and The Institute for Medical Wellness.

Just 1 in 4 know heart attack signs

By MIKE STOBBE, AP Medical WriterThu Feb 21, 9:02 PM ET

Only about 1 in 4 Americans know the warning signs of a heart attack and what to do first, according to a new government report. That's a decline in knowledge since the last survey in 2001, which showed nearly 1 in 3 to be well informed.

The study's lead author, Dr. Jing Fang, called public awareness in the new survey "alarmingly low." Fang is with the Centers for Disease Control and Prevention, which surveyed residents of 13 states and the District of Columbia.

Heart attack warning signs can include one or more of the following five symptoms: shortness of breath; pain or discomfort in the chest; discomfort in the arms or shoulder; a feeling of weakness or lightheadedness; and discomfort in the jaw, neck or back.

Chest pain is the most common symptom. Women are more likely than men to experience some of the other symptoms, particularly shortness of breath and back or jaw pain, according to the American Heart Association.

Anyone experiencing these symptoms should call 911, the heart association advises.

The groups best informed of heart attack warning signs and what to do about them tended to be white, highly educated, and women. Also scoring well were residents of West Virginia, which has some of the nation's highest heart attack death rates.

Each year more than 900,000 Americans suffer a heart attack, and about 157,000 of them are fatal. About half the deaths occur within an hour of symptoms occurring, experts say.

Because different people experience different symptoms, it's important to be aware of all of them, doctors say.

"It's not always massive chest pain," said Wayne Rosamond, a University of North Carolina epidemiology professor and expert on heart disease statistics.

Of course, knowing is not the same as doing: Although most of those who got the heart attack symptoms right said they would call 911, other studies show that only about half of heart attack victims go to a hospital by ambulance, Rosamond noted.

Patients' concerns about lack of health insurance status or other matters may explain why so few go to a hospital, said Rosamond, who was not involved in the new study.

The CDC's findings were based on a random-digit-dial telephone survey of about 72,000 people in 2005.

In West Virginia, more than 35 percent of respondents from that state knew all five warning signs and that they should call 911, compared with 27 percent in the overall study population.

Iowa and Minnesota also were at the top of the list. The gap between West Virginia and the two other states was not statistically significant.
West Virginia consistently ranks among the states with the highest heart attack deaths rates, and also is a leader in smoking, obesity, high cholesterol and other heart disease risk factors. But it's not clear whether personal experience was the reason the state's residents were so well informed. Public health education campaigns or other factors may also explain the result, experts said.


It is very important to know the warning signs of a heart attack. But heart attacks are only one cause of medical illness. My first job as your physician is not to treat you for your heart attack but to teach you how to prevent it and many other medical illnesses. This is different from alot of the medical community today, the majority of which are geared towards treating your lab values, and then giving you more and more medications to make your numbers look just right. They do not always take into account that treating numbers is not the same as treating disease.

Case in point. People with total cholesterol levels above 200 are responsible for 50% of the heart attacks yearly. What does that mean? It means people with total cholesterol levels below 200 are responsible for the other 50% of heart attacks. So where do you want your total cholesterol to be?

One of my goals for 2008 is to help my patients with prevention and wellness. Patients enrolled in my wellness or retainer programs will be shown many different ways to prevent illness. I will use lab numbers as an indicator of risks, but I prefer to help my patients with lifestyle adjustments as opposed to just using medications. For example, if we lower our risks through proper diet and exercise, and be proactive on other personal risk factors revealed through a comprehensive wellness program, then I feel I am doing my job correctly.

Steven Horvitz, D.O.
Founder of the Institute for Medical Wellness