Calcium in Heart Scan Predicts Disease
EBT Scan Most Useful in People at Intermediate Risk of Heart Attack
May 12, 2003 — Roughly half of all heart attacks and other coronary deaths occur in people without symptoms of heart disease. A new and somewhat controversial screening method that measures calcium deposits in the walls of the arteries that cover the heart offers the promise of predicting these events in this group of hard-to-identify patients.
In the largest study ever published assessing electron beam coronary artery calcium scanning as a screening tool for heart disease, researchers concluded that the diagnostic method was remarkably useful for identifying future trouble in people at moderate risk. Compared with men with the lowest levels of the calcium deposits in the coronary arteries, men with the highest levels of calcium scores were twice as likely to have heart attacks and 10 times as likely to need bypass surgery or angioplasty.
“Electron beam tomography (EBT) provided incremental information above the traditional risk factor assessment for this intermediate risk group,” lead researcher George T. Kondos, MD, tells WebMD. “This appears to be much better than the traditional treadmill test for identifying people with asymptomatic disease.”
In this study, Kondos and colleagues at the University of Illinois College of Medicine used EBT to evaluate the risk for coronary events among 5,635 men and women with no symptoms of heart disease. Participants were asked to hold their breath on two occasions for 30 seconds to one minute while lying on a special couch that slid into a hollow computed tomography (CT) scanner. During this time, electron beams create multiple images of the heart, and a computer measures the density of calcium deposits in the artery walls.
Within three-and-a-half years of having the test, 224 of the volunteers developed evidence of heart disease. They either required bypass surgery or angioplasty to open clogged arteries, had heart attacks, or died of coronary-related causes. EBT scanning detected high amounts of calcium deposits in 95% of these participants, but low amounts of calcium were detected in 67% of the participants who did not experience coronary events.
Compared with people with the lowest calcium levels, women with the highest levels were almost four times as likely to need heart bypass surgery or angioplasty during the follow-up, and men were 10 times as likely to require the procedures.
Kondos tells WebMD that EBT probably has little value in predicting future heart disease in people at very low or high risk for heart disease. Those at intermediate risk — including men over 45 and women over 50 with at least one added risk factor, such as diabetes, high blood pressure, high cholesterol, family history, or vascular disease — would benefit from this screening.
“This study reinforces (the idea) that the test is best reserved for individuals at intermediate risk in the population,” American Heart Disease President Robert Bonow, MD, says in a news release.
In an editorial accompanying the study, cardiologist and epidemiologist William Weintraub, MD, wrote that it is clear that the cost of EBT can not be justified for people at high and low risk for heart disease. The 10-minute test can cost from $400 to $1,000 and it is rarely covered by insurance.
The jury is still out, he concludes, on whether the cost is justified in people in the intermediate-risk category. Critics of the scanning method say another new measure of heart disease risk — blood testing for the presence of C-reactive protein — may prove to be just as useful at a fraction of the cost.
Weintraub, who is a professor of medicine at Atlantas Emory University, tells WebMD that he would recommend EBT as a diagnostic test for some, but not all, people in the intermediate-risk category.
“This is a powerful predictor of risk, but we are not quite sure what it adds to the other risk factors that we already measure,” he says. “Within the next five years I do think it will have a bigger place in the diagnosis of coronary artery disease and its position will be better defined.”
Can you really shape up in just minutes a day A quick workout routine – or simple lifestyle changes — may fit your goals.
With work, family, and social obligations competing for our time, it seems were all keeping a frantic pace these days. Its hard to find time for a workout routine – and easy to see the allure of quick workouts that promise fitness in just a few minutes a day.
But can these popular programs really do the trick, or are they just another waste of precious time
Well, say some fitness experts, it all depends on what youre after. Odds are, you wont become an elite athlete or greatly improve the health of your heart if you exercise only in quick workouts. But you might end up a little stronger and a little healthier – and maybe even look a bit better in your bathing suit.
According to online fitness trainer Jorge Cruise, author of the best-selling book 8 Minutes in the Morning: A Simple Way to Burn Fat, short bouts of weight training can help you build muscle mass and boost your metabolism. And that, he says, can help you lose weight.
The quick workout component of Cruises program consists of doing four sets each of two strength-training exercises (things like push-ups and bicep curls), six days a week. After a quick warm-up, you do one set of 12 repetitions of the first of the days exercises, then immediately follow with 12 reps of the second exercise. Repeat the cycle three more times and youre done for the day.
The book specifies two different exercises for each day, working chest and back one day; shoulders and abdominals the next; then triceps and biceps; hamstrings and quadriceps; calves and butt; and inner and outer thighs.
“The program is very specific,” Cruise tells WebMD. “It has been designed to provide short workouts — preferably done in the morning — that will give your metabolism a boost throughout the day.”
The eight minutes a day of strength training should help you lose an average of two pounds a week, says Cruise, who also recommends an eating plan emphasizing portion control and “healthy” fats. But Cruise is quick to emphasize that his program is not designed for overall fitness. “This is exclusively for weight loss,” he says. “If you want to work on anything else, this is not for you.”
Within the fitness industry, Cruise is one of several proponents of short sessions of strength -training exercise. Similar philosophies can be found in the books Power of 10: The Once-a-Week Slow Motion Fitness Revolution by Adam Zickerman and Bill Schley, and Flip the Switch: Discover the Weight-Loss Solution and the Secret of Getting Started by Jim Karas, among others.
Beyond strength training
But while Cruise touts the health benefits of strength training – it keeps your bones strong and your muscles toned – he does not discount the value of other forms of exercise. “If you want to keep your heart and lungs healthy, then you need cardiovascular exercise,” says Cruise, who includes a section on power walking in his book.
Indeed, the Institute of Medicine recommended last fall that most Americans get a minimum of 60 minutes of moderate-intensity exercise each day (other health and medical organizations recommend at least 30 minutes of daily activity). But there is scientific evidence for the benefits of short bursts of exercise — at least when the exercise is the aerobic type.
For example, in a study published in the journal Medicine & Science in Sports & Exercise, researchers found that three brisk, 10-minute walks taken throughout the day can be at least as effective as one 30-minute walk at reducing cardiovascular risk and improving mood.
The study involved 21 sedentary men and women in their mid-40s. Five days a week for a six-week period, the volunteers either took 10-minute walks three times per day, or a brisk walk lasting 30 minutes once a day. Then, after a two-week rest period, the two groups swapped their walking routines and continued for another six weeks. Both groups saw a slight drop in total cholesterol levels and improved their levels of “good” cholesterol and their aerobic ability. Both the long and short walks brought decreases in tension and anxiety.
And James Hill, PhD, director of the Clinical Nutrition Research Unit at the University of Colorado Health Sciences Center, who recently analyzed two national surveys of U.S. eating habits, believes most people can avoid weight gain by simply cutting back 100 calories daily – or by burning 100 extra calories a day. In the Feb. 7 issue of Science, Hill and his colleagues write, “this can be achieved by small changes in behaviour, such as 15 minutes per day of walking.”
When 8 Minutes Is Not Enough
Ken Turley, PhD, assistant professor of kinesiology and director of the Wellness Center at Harding University in Searcy, Ark., says the value of quick workouts depends on what youre aiming for
For instance, he says, if you want to improve your physical performance – say, increase your speed in a 10K race or win a power-lifting contest – working out for a few minutes a day probably wont do you much good.
If youre interested in improving a specific aspect of your fitness, such as strength, endurance, or flexibility, quick workouts might help. But, he says, thats only if it comes on top of any exercise routine youre already following.
“If the eight minutes of exercise is in addition to what youre already doing, excess calories will be burned, and – assuming your caloric intake doesnt change – this deficit will result in better weight management,” he tells WebMD.
Hill adds that only so many calories can be burned in eight minutes, regardless of the intensity or the type of activity. Assuming you burn about 100 calories in each daily eight-minute session, burning a pound of fat (3,500 calories) would take you 35 days.
Even among fitness trainers, theres considerable doubt that eight minutes of exercise a day is really enough for anyone.
“Eight minutes a day, of course, is better than nothing, but the surgeon general and the American College of Sports Medicine are still recommending 20 to 60 minutes of cardiovascular exercise three to five times a week, and strength training two to three times a week on alternating days,” says fitness specialist Kelli Calabrese, MS, ACE, CSCS.
“Those guidelines are proven to reduce the risk of deadly diseases like diabetes, atherosclerosis [hardening of the arteries], and obesity, as well as to improve fitness,” she says.
The benefits of quick workouts, says certified fitness trainer Leigh Crews, are that they simplify a subject many people find confusing; provide step-by-step guidelines to follow; recommend a reduced caloric intake; and set up an easy-to-follow schedule.
“Youre not really meeting the guidelines set forth by the ACSM, but if youre a totally sedentary individual, even training each muscle group once a week is going to show results over no training at all,” says Crews, who specializes in continuing education for fitness professionals.
Get Fit the Sneaky Way
So what should you do if you want to improve your fitness and your health, but cant spare any more time or energy for a workout routine Try sneaking in some exercise, suggest some experts. Research has shown that working activity into your daily life can be as effective as a structured exercise program in improving long-term cardio-respiratory fitness and blood pressure.
Alan Muney, MD, chief medical officer of the Trumbull, Conn.-based Oxford Health Plans Inc., offers these tips:
??? Instead of taking the car for short trips, walk. Walking is a weight-bearing exercise that strengthens the bones and burns substantial calories.
??? Combine a shopping trip with a brisk walk around the mall.
??? Instead of taking the elevator or escalator, use the stairs.
??? Listen to upbeat music while cleaning the house, and sweep to the beat.
??? When travelling for business or pleasure, look for hotels with a gym or a pool. Pack a resistance band in your suitcase to keep arms and legs toned, and bring along an exercise tape if the hotel has a VCR.
??? When youre travelling by car, stop periodically to stretch or take a short walk.
??? Work your neck muscles, shoulders, and back with simple exercises done at your desk.
??? Do abdominal crunches, push-ups, or leg lifts while lying on the floor watching television.
Keep in mind that adding exercise to your schedule, in any way, in any amount, can also improve other aspects of your life.
“Exercise lifts your mood, boosts your self-esteem, and reduces your stress,” says Calabrese. “If you can manage to make exercising a priority, you will be pleasantly surprised at how much better you will be at managing lifes tasks.
“In the long run, the time you invest in exercise, even in small amounts, will come back to you.”
Beware of Untested Weight-Loss Pills
Weve heard about the dangers of popping weight-loss pills. But there are safe ways to drop extra pounds using supplements — yes, even ephedra — and prescriptions.
By? John? Casey
Feature? Reviewed By? Michael ? Smith,? MD
on Friday, March 07, 2003
Seventeen days of taking usnic acid to promote weight loss was all it took for Jennifer Rosenthal of Long Beach, Calif., to go from being a healthy, active 28-year-old to being in a coma on life support. An emergency liver transplant saved her life.
Rosenthals story, though extreme, points to the problem of the many untested and unregulated products sold on the Internet and in some drug and health-food stores.
“This is a young woman who almost lost her life,” said Rosenthals transplant surgeon, Ronald W. Busuttil, MD, in an interview with The New York Times. “Although shes got her life back now, she has to be under lifelong medical care. Her life has been altered forever. The fact that you can get these things over the Internet is mind boggling.”
Usnic acid is an antibacterial substance made from lichens. But online marketers sell it as a weight-loss drug and performance enhancer. Since it falls under the FDA category of a dietary supplement, its sale and use is entirely unregulated.
In that regard, usnic acid is not unlike ephedra, another weight-loss pill that is sold online and in many thousands of neighborhood health-food and drugstores. Ephedra has been implicated in the February death of Baltimore Orioles pitcher Steve Bechler, who succumbed to heat stroke on a Broward County, Fla., practice field after reportedly taking an ephedra-containing weight-loss supplement.
Does all this mean there are no useful, safe weight-loss drugs
Safe Weight-Loss Pills
If youre really serious about taking weight-loss pills, theres a safer way to go about it. First, work with a medical professional to develop a treatment plan that fits your needs.
Theres no reason to go trolling the Internet for weight-loss magic, says Steven Heymsfield, MD, deputy director of the New York Obesity Research Center at St. Lukes-Roosevelt Hospital in New York City. There are safe drugs that can really make a big difference in getting to a healthy weight.
There are three drugs most commonly prescribed for weight loss.
Phentermine, an appetite suppressant, was approved for use in 1959 and is the most commonly prescribed prescription because it costs less than the other major drugs. Some users report it can make them feel jumpy.
Xenical inhibits lipase — an enzyme that breaks down fat in the intestines. Xenical decreases the amount of fat your body absorbs from food by 30%, which results in lower calorie intake. But all that undigested fat can make sudden, unwelcome appearances in the form of diarrhea.
Meridia increases levels of brain chemicals that help reduce appetite. Appetite-suppressants work by increasing serotonin or catecholamine chemicals that alter mood and appetite through means that are not well understood. Since Meridia can raise blood pressure and heart rate, people with any kind of heart disease shouldnt take this drug.
These drugs are all moderately useful and approved for use over various periods of time, says Heymsfield. But increasingly we are seeing these used in combinations or cocktails to decrease side effects and maintain weight loss, which tends to slow over time. Phen-pro is a weight-loss cocktail that combines phentermine with Prozac or other antidepressants. The use of the antidepressant in these cocktails is not to treat depression. No one is quite sure exactly why these combinations appear to improve weight loss. Some doctors also will prescribe combinations of Xenical or Meridia with phentermine.
Along with the cocktails, other drugs are increasingly being used for weight loss, says Heymsfield. Some of these include:
??? Topamax, an antiseizure medication approved for use in the treatment of epilepsy
??? Wellbutrin, an antidepressant
Using prescription drugs that arent officially approved by the FDA for weight loss is commonplace, but the doctor needs to be very, very careful, says Heymsfield. You dont want a truck driver or someone who operates heavy machinery taking an antiseizure medication because fatigue or euphoria can be a side effect.
And medical researchers are pressing very hard to develop new weight-loss pills. One of the most promising drugs in development is Axokine, says Heymsfield. It is in the final phase of testing, and it not only looks like it will be important for weight loss, but it may also help people with type 2 diabetes.
What About Ephedra
Theres no doubt that ephedra can be dangerous when misused, says Heymsfield. Consumers think it is some benign herbal preparation because they can get it at the health-food store, but it is a real drug with potentially dangerous side effects in a very small minority of the people who use it.
But even Heymsfield, who has been a vocal critic of ephedra, says it can be used safely — under a doctors supervision.
Ephedras safety depends on the dosage, frequency of use, and medical condition of the user, says Ray Sahelian, MD, doctor in private practice in Marina Del Rey, Calif., who has written extensively on the safety and efficacy of dietary supplements. A young person with a healthy heart who takes ephedra in reasonable doses, eats a normal meal, drinks plenty of fluids, and is not involved in heavy physical activity in hot weather is not likely to have any serious side effects, he says.
However, a person with a weak heart or with high blood pressure who skips meals, is dehydrated, or works out in hot, humid weather will have an untoward reaction, perhaps even including a fatality.
There is no magic pill for weight loss, says Heymsfield. But an experienced doctor can develop a treatment plan that can result in much better overall health for the patient.
Angry Children at Risk for Heart Disease
Helping Angry Children Become Flexible Is as Important as Diet, Exercise for Preventing Heart Disease
By? Jeanie Lerche? Davis
WebMD Medical News?
Reviewed By? Brunilda ? Nazario,? MD
on Monday, May 19, 2003
May 19, 2003 — We know its true with adults: Frequent anger increases risk of heart disease. Now, a study shows that angry children — as young as age 8 – develop early signs of heart disease.
“Heart disease starts in childhood,” says lead researcher Kristen Salomon, PhD, social/health psychologist at University of South Florida at Tampa. Her study appears in this months Health Psychology.
“We need to worry about obesity, exercise, diet,” she tells WebMD. “Bad habits develop very early in life. But its also important to focus on psychological factors, to find kids who are hostile, and help them deal with it.”
A handful of studies have suggested that heart disease can begin in early childhood, gets worse with age, and that it is closely tied with weight gain and obesity in childhood — the result of poor heath habits. This is perhaps the first study pointing to hostility as an aggravating factor for childrens heart health.
In her study, Salomon focused on 134 children — between 8-to-10 and 15-to-17 years old — all recruited from schools in suburban Pittsburgh. “These were healthy, normal kids. We screened them for psychological problems, so these were not pathologically disturbed children,” she tells WebMD.
They measured the kids cholesterol, blood pressure, insulin levels, and body mass index (BMI) to determine risk for heart disease.
Researchers also tested the kids for hostility, using a questionnaire that “measured their level of cynicism about the world, how they responded to situations when provoked. It measures aggression, how much they tend to feel hostile during the day,” Salomon explains.
They interviewed each child to draw out hostility in very subtle ways, she says. Example: “The kids were asked a question, but before they could finish answering it, but the interviewer would cut them off. That provokes people to act aggressively — make snide remarks, cut off the interviewer in return.”
Three years later, kids had all the same tests again.
The “most compelling finding,” says Salomon, “was that kids who did not show early signs of heart disease at visit 1 — but were hostile — were 22% more likely to have them at visit 2 than kids who werent hostile.”
Hostility, anger, and aggressiveness are complicated reactions with many roots, says John Sargent, MD, child and adolescent psychiatrist at Baylor College of Medicine in Houston. He agreed to discuss the findings with WebMD.
Predatory aggressiveness is one thing: “I want that, and Im going to take it from you.” Reactive aggressiveness is another: “Im a threatened soul in the universe, watching out for whoevers doing stuff to me, and Im going to get em.”
Temperament can predispose some children to anger and hostility, he explains. That behavioral style is largely genetic, yet is affected by environment, he says.
You wont likely see the placid, adaptable kids lash out, Sargent explains. But push a shy child into a new environment, and they might act hostile if theyre having trouble adapting, he says.
Also, a “difficult child” is the misfit, the kid who always has some difficulty interacting with the world. “When kids like that grow up among people who dont know how to deal with them effectively, they become more hostile,” he explains.
Depressed children — and children who have witnessed trauma — can also act with hostility, he tells WebMD. “Kids with a chip on their shoulder, who react intensely to slights or disappointments, can be seen by peers parents teachers as being negative. Sometimes depression and [posttraumatic stress disorder] coincide. Sometimes depression is a response to trauma or adversity.”
Bottom line, he says: Helping angry children will improve the quality of their lives, helping them have more friends and a better self-image. Such positive influences may help children take better care of themselves, offsetting the risk for heart disease.