Tag Archives: Coronary artery disease

Heart Disease is Preventable


The simple answer: Coronary artery narrowing is a silent disease that develops over many years from untreated risk factors that are unknown or not addressed.

People don’t realize they have heart disease until something bad happens, such as a heart attack or sudden death. They don’t realize subtle symptoms such as mild shortness of breath, upset stomach and fatigue are signs of heart disease. Women tend to complain less and are more often not diagnosed when they do see a physician.

Narrowed coronary arteries restrict blood flow to the heart muscle and begin causing symptoms that resolve with rest. When arteries become blocked, the pain persists. A part of theArtery heart dies because the muscle is starved of blood and oxygen. Sweating, weakness, discomfort in the chest, jaw, neck, arm and sometimes the back are common with a heart attack. This is a medical emergency and 911 should be called for immediate medical care. If the artery can be opened with angioplasty and stents soon enough, heart damage is decreased. Fifty percent of people who have heart attacks die before reaching a hospital.

Coronary artery disease is preventable, but unhealthy lifestyles and food choices are difficult to change. We live in a fast food environment. The number of people smoking has decreased and some people are making healthier food choices through education, but heart disease is still the leading cause of death. Obesity has increased to epidemic proportions, even in the young, so we have a long way to go to become a healthier nation.

50% of US citizens have either high blood pressure, high cholesterol or smoke
2/3 of adults are overweight or obese
1/3 of children are overweight or obese
Overweight 5-year-olds show evidence of early heart disease

Take control of your health and reduce heart disease risks with healthy actions. See a physician to monitor health and measure glucose, thyroid, cholesterol, vitamin D, blood count and inflammatory markers such as C-reactive protein.
♥ Stop tobacco use
♥ Control high blood pressure
♥ Treat abnormal cholesterol levels with dietary modification and medication
♥ Obesity and Diabetes: normalize weight and glucose
♥ Exercise daily with your doctor’s recommendation
♥ Limit alcohol consumption
♥ Consider heredity factors and obtain early testing/treatment

You can counteract good genes by making bad life choices. You can offset bad genes by making healthy choices. The choice is yours to make.


Heart disease, osteoporosis and dementia increase with age.
New information supports prescribing estrogen to reduce these risks.

Few doctors will prescribe a hormone replacement following menopause because the Women’s Health Initiative (WHI) showed the risks of use far outweighed its benefits. According to the study, prescribing hormone replacements to block hot flashes put women at risk of breast cancer, uterine cancer, strokes and blood clots.

Hormone supplementation is complex. There are many pros and cons, but the WHI conclusion made it easy for doctors to just say no.

However, new research may reverse that practice. It might be time to once reconsider the use of hormone replacement for some woman.

Loss of ovarian hormone effects after menopause (or surgical ovarian removal) results in reduced bone density, leading to osteoporosis and broken bones. Many other symptoms such as skin wrinkling, hair changes and reduced libido are non-life threatening, but are irritating. In addition, serious health problems evolve over years and impact long term health.

Heart shapped brain♥ Heart diseasebrain skeleton



Heart disease is the #1 cause of death in women.
There was a time when we were told estrogen had no effect on cholesterol, but a recent study showed reduced estrogen resulted in decreased function and effectiveness of HDL. HDL is High Density Lipoprotein, the good cholesterol. We want this number to be high.

♥ In a Danish study, women who took estrogen after menopause had a significant reduction in heart attack, heart failure and mortality (with no increase in cancer, clots or stroke).
♥ A Japanese study on menopausal women reported similar favorable heart findings and, in addition, showed improved bone density.

Osteoporosis results in more than 1.5 million fractures each year.
Fifty percent of all women over the age of 50 will suffer an osteoporosis-related fracture. Estrogen aids in calcium metabolism and is a key component of bone mass. Loss of estrogen with menopause contributes to weak bones and fractures in aging women. Poor diet and lack of exercise during adolescence reduce bone strength in later years. Proper exercise, vitamin D and adequate calcium intake are beneficial for bone health.

Alzheimer’s disease is the 6th leading cause of death in the US – 2/3rds of these are women. At this time, Alzheimer’s is the only cause of death in the top ten that cannot be prevented or cured. The good news is, a recent preliminary study of the brain showed positive estrogen effects on the hippocampus (memory area) in women taking estrogen. Hormone replacement may reduce dementia in women. (See: Estrogen is back in the news. www.lipsticklogic.com)

As the population ages, dementia, osteoporosis and heart disease are becoming more prevalent. It is important to re-examine what can be done to reduce these debilitating illnesses. Estrogen replacement may once again be appropriate in some women.

Note: Why some women cannot take estrogen supplements.
There are 230,000 new cases of Breast Cancer each year and, annually, 40,000 women die from the disease.

There are many types of breast cancer. Some breast cancers result from genetic mutations, but 85% of breast cancers occur in women with no family history.

In some types of breast cancer, hormone replacement supports abnormal cell growth, helping the cancer cells grow and spread. These cancer cells have surface markers for estrogen and/or progesterone. This means hormone supplements should not be prescribed. A personal history of breast cancer or uterine/ovarian cancer also precludes the use of replacement therapy.

In the Women’s Health Initiative, the highest risk for breast cancer was associated with hormone replacement when both estrogen and progestin were prescribed. Women who have had a hysterectomy do not require progestin.

For additional information on similar topic see our other women’s health blog:www.lipsticklogic.com

CT Scan Your Heart

Did you know heart CT scans can identify narrowed coronary arteries better than a stress test?

Stress Tests
Treadmill testFor many years, the standard medical evaluation to look for heart disease has been a stress test. Walking on a treadmill, with continuous heart monitoring and periodic blood pressure checks, is still considered useful, and provides a functional heart evaluation.

The determination is based on stressing the heart with exercise and evaluating the cardiac response by electrical changes on the ECG. With patients suspected of having microvascular disease – when large coronary arteries mayEcho_heart be normal but tiny arterioles are stiff and narrowed – the stress test is done with usual monitoring, followed by an immediate heart echocardiogram to further evaluate heart function under physical stress.

Nuclear Stress Tests
nuclear stress testIn addition to the treadmill evaluation, a nuclear dye may be injected into a vein and the heart is scanned to evaluate blood flow, comparing the heart at rest with blood flow through the heart muscle with exercise. These comparisons evaluate differences in blood flow and identify possible coronary artery narrowing.

Invasive Coronary Arteriogram – Coronary Angiogram
The gold standard for evaluating narrowed coronary arteries is the invasive coronary Coronary angioangiogram. In that procedure, a catheter is placed in an artery, threaded to the heart and dye visible under fluoroscopy X-rays is used to outline the inside of the arteries supplying the heart muscle with blood and oxygen. If an artery is dangerously narrowed, the blockage can be dilated and stented to keep it open and prevent a heart attack. So, this test can be both diagnostic and therapeutic.

CT Coronary Angiogram (CT = Computed Tomographic Angiogram of the coronary arteries of the heart)

ct-heartJohns Hopkins researchers recently published their research comparing the noninvasive cardiac CT scan with stress tests and coronary angiograms. The CT angiograms showed a 91% accuracy in detecting or ruling out an artery blockage. Stress tests measured out at 69% accuracy.

Both heart CT scans and invasive angiograms are more expensive than stress tests. Stress tests provide information, but the CT scan is better. If the CT looks good, further medical follow-up will still be required, but you avoid complications, higher radiation exposure, and higher cost of the invasive procedure.

No evaluation carries 100% accuracy. The American Heart Association and the American College of Cardiology recommend stress tests as a first line screening tool. These guidelines may change because of this study showing the increased accuracy of the CT angiogram.

For more information on heart CT scans and the calcium score check out: https://www.nlm.nih.gov/medlineplus/ency/article/007344.htm

Betty Kuffel, MD

Statin Treatment for Cardiovascular Disease

Primary Prevention and Treatment in Women

More women die of heart disease than of breast cancer.
Women are also more likely to die from a heart attack than men.

vitruvian-woman-sm1.jpgIf you have risk factors for, or have already had, a cardiovascular event such as a heart attack or stroke, taking a statin medication to alter abnormal cholesterol can be life-saving.

Common Risk Factors:
High blood pressure
High LDL cholesterol
High triglycerides
Low HDL cholesterol
Family history of early heart disease
Sedentary life style

Lowering LDL cholesterol with statins can prevent cardiovascular disease.

A recent study analyzed the effects of 27 trials including 174,000 people and found women gain the same benefits from statins as men. Prior to this study the value of treating healthy women with risk factors to prevent heart disease was not clear.

We have known lowering cholesterol after a heart attack or stroke is beneficial in both men and women, but this new study confirms statin drugs are also valuable in preventing cardiovascular disease in women. Statin treatment improves overall survival by reducing the liver’s production of cholesterol.

Men develop heart disease at a younger age than women, likely because estrogen in women is protective. Following menopause, risk for heart disease in women climbs especially in those who smoke.

People with diabetes have an increased risk for cardiovascular disease affecting the coronary arteries in the heart, arteries in the brain, and small arteries in the eyes and kidneys. Last summer, another study important to women showed diabetic women had a 30% reduction in the risk of dying of heart attack or stroke when treated with another cholesterol modifying drug, fenofibrate.

Many scientific studies over decades have shown the benefit of lowering low-density lipoprotein LDL cholesterol to prevent heart attacks and strokes. LDL is the “bad” cholesterol, (think “L” for Lard as a way to remember LDL as the bad cholesterol) and that you want it Low. This is the cholesterol that clogs arteries similar to the way lard solidifies if poured down a drain.

Triglycerides, another form of cholesterol often elevated in diabetics, obesity, and as a familial disorder, contribute to heart and vascular disease. This must also be lowered to reduce risk.

The high-density lipoprotein (HDL) is the transport molecule that moves LDL out of the arteries. The HDL is the “good” cholesterol you want High.

Assess and lower risks for heart disease:
• See your doctor. Discuss risk factors and how to modify them.
• Have blood tests: lipid panel and hemoglobin A1c (check for diabetes)
• Assess your cholesterol levels and discuss treatment needs and options
• Reduce saturated fat intake, fried foods – no more than 35% of your daily calories should come from fat
• Attain ideal weight
• Exercise at least thirty minutes a day – If you’re healthy but not physically active, starting an aerobic exercise program could increase your good cholesterol by 5% in the first two months. Regular exercise also lowers bad cholesterol.

Remember, high cholesterol does not cause symptoms. It is a silent disease that slowly narrows arteries throughout your body.

For more information on modifying risk factors read additional posts on this site. At www.lipsticklogic.com you will also find articles on women’s health.

Best wishes for good health in 2015.

Betty Kuffel, MD and Bev Erickson


If you are a fast food junkie or frequently eat in restaurants, healthier options are becoming available but it is still up to you to make the choice. Forget the bread; choose baked or grilled options and a salad with low fat dressing.

Guidelines for heart health and weight reduction are everywhere but take a look at shopper’s grocery carts. How many of them are filled with fresh fruits and vegetables? Not many.

Some processed foods may be healthy, but you must read labels carefully and then decide. I WmSonoma hot chocolaterecently wanted to purchase a hot chocolate mix to serve during winter holiday activities. Many products on the shelves contained many ingredients I couldn’t identify as safe, even after years of studying chemistry. I left without making a purchase. Most mixes contained unpronounceable chemicals, plus significant fat and sugar.

 Later I found a hot chocolate powder at Williams-Sonoma made with bittersweet chocolate, sugar and peppermint oil that looked a bit healthier. But, if it’s that difficult to buy a hot chocolate mix, it may take you all day to read all packaged food labels of the items you want to purchase. On the other hand, if you avoid the center isles of the grocery and purchase fresh and frozen products, you will save time and money and have a better chance of improving your health.

Fast Healthy Choices to Consider:

Fat Free Yogurt, raw oatmeal with flax seed is quick and heart healthy

Fresh fruits and vegetables require little preparation – many can be eaten raw.

Fresh meats – wash, season and grill – avoid frying or adding gravy or sauces

Fresh or frozen cold water fish like salmon, cod or trout – marinade and grill in minutes

Avoid sweets, fats and breads (except hearty whole wheat or multi-grains)

Limit your portions


Choose unprocessed grains: oatmeal, steel cut oats, rice, wild rice, barley, whole grain breads. Avoid sugar-rich granola, sugary cereals and white breads.

Choose fresh fruits and vegetables: you’ll save money by purchasing whole or bulk fruits and Saladveggies like bags of potatoes, apples, full sized carrots, heads of lettuce, celery, cauliflower and broccoli – wash and cut them as you need them.

Choose fish and lean meat; boil/bake/broil – no frying. Avoid all fried foods for a healthier heart and weight.

 Med.FoodExercise a minimum of 30 minutes three times a week.


cropped-vitruvian-heart-woman1.jpgSome of my friends believe they can make better choices to attain maximum health and yet I see them regularly exercising and eating wisely. These are two very important actions in the scheme of health and living longer. After seeing parents and relatives die young from smoking, heart disease, diabetes and obesity, they vowed to make personal choices that correlate with better health.

 Other people I know do not exercise and eat wantonly. A common breakfast choice by one particular person is a bacon/sausage omelet with a side of pancakes. This person is more than 100 pounds overweight, has high blood pressure, out-of-control diabetes and has had a heart attack. His choices and health issues provide a view of factors seen in many who contribute to current world statistics placing heart disease as the leading cause of death in women and men.

Coronary artery disease, also called atherosclerosis is a disease in which arteries narrow because of metabolic abnormalities related to lifestyle choices. In the United States, 18% of all deaths are from coronary artery disease. Inflammation is a large component of this disease in conjunction with the accumulation of LDL-cholesterol fat inside blood vessels. Increasing weight leads to Type 2 diabetes and diabetes contributes to the disease process.

You have probably read or heard this scenario so many times you find it boring. Some people say they have tried everything and can’t lose weight. Losing weight is not magical. It doesn’t matter what time of day you eat, whether you drink water before, during or after meals. It doesn’t matter whether your largest meal is in the evening, whether you graze all day, or eat one meal per day. What matters is how much you eat and what you eat. In other words, it is important to balance your food intake with your energy output.

We all need to eat for energy. Without proper food, our body processes are impaired. But when we eat more food than we burn off each day, the body stores that extra food as fat. If the stored fat isn’t burned, it continues to accumulate — that is how the body evolved to survive during times of sparse food.

 Consider these examples:

If you eat one scoop of ice cream (about 400 calories) in addition to your daily calorie needs, you must walk one hour just to burn off that extra 400 calories. If you don’t exercise to burn the extra fuel, your body will store the calories as fat.

Even eating one extra little banana per day (about 100 calories) can add up. In one month you will have consumed 3100 more calories than you needed to maintain your energy needs. At the end of one year, your scale will show you are up by 10 pounds.

One weekly meal that includes a bacon cheeseburger, fries and a shake (about 1500 calories) can put you on the road to obesity. Over a year, without significant additional exercise, that daily fast food meal alone can add up to a 20 pound weight gain per year.

The first step in taking control of your health is to learn how. Making a healthy lifestyle change is within your power. By making healthy changes in your diet and adding exercise to your daily routine, you will begin the road to better health and possibly even extend your life. Just like adults, obese children show signs of early heart disease. Teaching kids to eat right and exercise can also reverse the negative effects of their overeating.

Your Heart is a health guide. Scientific studies over many years support healthy food choices like the Mediterranean diet and vegetarian eating, too. Choose to eat healthy.

Make 2014 the year for better health choices for you and your family. Don’t smoke. Avoid sweets and all fried and fatty foods. Eat fresh fruits and vegetables and add exercise to your day.

Beginning today Your Heart is available at a reduced price in both paperback and Kindle through December 24th. To purchase, click on Kindle Heart book or Paperback Heart book

Happy Holidays

Holiday Sale: Heart Health Guide

Tis the Season of Good Cheer

This year give a gift that will last all year and maybe save a life.

winter holidayIf you know anyone with health issues that might benefit from a paperback science-based health guide, consider giving them:

Your Heart – Prevent and Reverse Heart Disease in Women, Men and Children.

The book is available free as a Kindle e-book through December 15th Your Heart E-book but for those who are not e-readers, Your Heart is also for sale through Amazon at the reduced price of $9.99 through December 24thBuy Your Heart the paperback


Cardiac arrest

Are there warning signs before the heart stops?

A study reported at the American Heart Association’s Scientific Sessions this month showed sudden death isn’t so sudden after all. Fifty-six percent of the men in an Oregon study had chest pain and didn’t report it. Others had: dizziness, fainting, palpitations and shortness of breath. These may be unrecognized heart symptoms in women, too.

Nearly 400,000 people have cardiac arrests each year and 88% of the events occur at home. Unless medics are called and CPR is started immediately survival is low. Fewer than 10% of those suffering a cardiac arrest survive.

 What can you do?

Learn the symptoms and seek attention before a heart attack or cardiac arrest occurs.

Chest pain is not always the first symptom of coronary artery blockage. More than 50% of people having heart attacks die before reaching the hospital. To improve your chances for survival, pay attention to possible symptoms of reduced heart blood flow. These vary and in women are often subtle.

            Possible heart symptoms: May be mildchest-pain

            ♥ Indigestion, nausea

            ♥ Upper back or abdominal discomfort

            ♥ Aching in neck, jaw, or either arm

            ♥ Short of breath or weak with activity

            ♥ Weakness with mild activity

            ♥ Chest discomfort or pressure

What causes the heart to stop?

Heart disease develops over a lifetime. The slow narrowing within heart arteries is silent — no symptoms. When the blood flow is decreased to the point when symptoms are recognized, the actual blood flow may be restricted by more than 90%. When increased oxygen is needed such as with exercise or stress, the heart beats faster but cannot supply enough blood and the heart muscle suffers. Sometimes sudden death is caused by abnormal fatal rhythms generated by the irritable oxygen-starved conduction system. In a heart attack, the vessel has closed, stopping all blood flow to a portion of the muscle and the heart stops beating.

What are common factors increasing risk for heart disease and sudden death?

Untreated High Blood pressure

Smoking: All tobacco use & second hand smokecigarette smoking quitting

Obesity and high fat diet


High LDL cholesterol

Low HDL cholesterol


Illicit drug use

Excess alcohol



Hands-Only® CPR instructional video recommended for adults since 2008


The American Heart Association is a terrific source for up-to-date information for heart health. Heart disease is the leading cause of death in adults and most people don’t know they have it. More than 60% of women who died suddenly had not complained of heart symptoms. This is true for many sudden death male victims, too. The problem is so common, you are likely to be nearby when someone collapses. Do you know what to do?Chest Compression

An instruction video produced by the AHA will only take a couple minutes to watch. I encourage you to do it. You may save a life.   http://tinyurl.com/oneminuteCPR

If you have trouble with the link. Go directly to the AHA.

Dr. Betty


Diabetes Health in your handsType 2 diabetes is preventable, treatable and partially reversible in many people. If you have prediabetes or borderline blood glucose without aggressive treatment including weight loss, you will likely progress to full blown diabetes within ten years. With proper medical care, exercise and healthful food choices, you can take control and improve your health.

 Until the epidemic of obesity around the world occurred, Type 2 diabetes was a disease of older people, not teenagers. We are now seeing overweight adolescents with Type 2 diabetes. Of grave concern is evidence of heart disease present in overweight 5-year-olds.obesity

Bad food choices and lack of exercise contribute to Type 2 diabetes & heart disease.

Even if heart disease runs in your family you have the ability to reduce hereditary risks and live longer. Interventions need to begin in childhood and continued throughout life, but it’s never too late to start. The American Heart Association recommends children should have a blood lipid panel before age twenty to help determine risks and begin treatment when appropriate. Do you know your lipid numbers?

You can offset “bad cholesterol genes” by making healthy choices.

 When vessels become narrowed with inflammatory cholesterol plaques, symptoms can be intense with crushing chest pain radiating into the neck and down the arms, weakness, sweating and collapse. However, that is not always the case. In fact, arteries may be more than 90% closed and generate no symptoms. Just because you have no chest pain, it doesn’t mean you don’t have cardiovascular disease.

 Major risk factors for coronary artery disease include: tobacco use, uncontrolled high blood pressure, cholesterol abnormalities, obesity, diabetes, low activity, alcohol and other drugs, high levels of calcium supplements (over 1200mg/day) and hereditary factors. In addition, microvascular dysfunction, a form of coronary artery disease in small vessels is common in women. This is because women more often develop autoimmune disorders such as rheumatoid arthritis, MS and lupus. In addition, anemia, polycystic ovary disease, hormone changes and Type 2 diabetes all contribute to the metabolic mix.

Even if you have been diagnosed with Type 2 diabetes, coronary artery disease, peripheralMed.Food vascular disease, or have had a heart attack, stents or a stroke, there is hope for improvement. Exercise and normalizing weight, blood pressure and blood glucose, in addition to a medication regimen to improve lipids — all contribute to lowering risks and reducing the closure of arteries and stents. Taking a statin to lower your cholesterol is not a ticket to eating fried foods, bacon cheeseburgers or eggs. Good dietary practices are essential to long term health.