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Home > Health Information

Heart Health: What Smart Women Need to Know - Questions and Answers

Answers to questions asked at the February 20, 2008 Heart Symposium

Questions Answered by Dr. Devries

Question: Are any cardio exercises better than others?
Answer: The best cardio exercise is the one you will actually do! That is, do the one (or better yet- several) that you enjoy and will be most likely to stick with.

Question: What about Coenzyme Q10- Is it good or bad?
Answer: Coenzyme Q10 (CoQ10) is needed by the body for energy production. Statin medications, among others, lower the level of Coenzyme Q10. Some reports indicate fewer side-effects from statins in those taking Coenzyme Q10 supplements. Other reports indicate possible benefits for some with heart failure. We definitely need to learn more about this supplement. Ask your doctor before starting any supplement.

Question: Is one statin better for women than another? Is one statin better for different body types?
Answer: Each of the statins has different chemical properties including: potency for lowering the bad LDL cholesterol, effect on the good HDL cholesterol and length of time they stay in your system. There is no one statin better for an individual body type. However, some people tolerate one statin better than another; this requires individual adjustment and does not follow a predictable rule.

Question: Which cancers are most preventable by following a Mediterranean diet?
Answer: The Mediterranean style diet has been linked to lower rates of breast cancer, as well as cancers of the digestive and urinary tract.

Question: Describe health touch therapy-who does this?
Answer: Healing touch therapy is a technique that assumes that energy surrounds a person and can be manipulated to lower stress and improve symptoms. There is a certification process which assures that the practioner has had significant training and supervision You can learn more about this at www.healingtouchinternational.org.

Question: Since many of the supplements did not have 1000 EPA/DHA, is there a particular brand (i.e. GNC), which you would recommend?
Answer: I generally use Nordic Naturals and Carlson brands, but there are other good brands. Use the content listing on the back of bottle to make sure you are getting the dose that your doctor recommends. Ask your doctor before taking any supplement.

Question: Does fish oil help lower LDL as well as cholesterol?
Answer: Fish oil can lower triglycerides but does not lower total cholesterol or LDL-cholesterol.

Question: What are the benefits (in percentages) of a combined approach to cholesterol reduction, with the use of statins and the adoption of a Mediterranean diet?
Answer: Great question- but we don’t have the data yet. I believe that this combined approach will prove to be particularly potent for those at highest risk.

Question: What are you thoughts on using policosanol to lower cholesterol/LDL levels?
Answer: Policosanol, derived from either sugar cane or beeswax, is not effective at lowering cholesterol. Early reports that indicated benefit have not been replicated. I do not use policosanol in my practice.

Question: Can you take plant sterols and stanols in addition to a statin?
Answer: Yes- sterols/stanols can be combined with statins for additional LDL lowering. Always check with your doctor before starting any supplement.

Question: I was started on 100mg Niacin, 18 day, for an increased lipoprotein (a) - (over 200) after about 6 months if dropped to 49. I have been taking it for 2 years. Is this a life long regimen, or can I slowly wean down, or stop?
Answer: Lipoprotein (a) is an inherited fat that can increase your risk of heart disease. As your experience demonstrates, niacin is effective in lowering levels. Unfortunately, the levels will quickly rise once niacin is stopped so long term treatment is required to keep levels in check.

Question: What recommendations do you have for the intake of whole grains if you are gluten intolerant or if you have celiac disease?
Answer: I am not an expert in gluten sensitivities so I can not make a recommendation for best grains in this circumstance. Nevertheless, your health will be improved by minimizing intake of foods that contained processed grains.

Question: Over the years, hasn’t the acceptable cholesterol “range” been reduced, causing more people to now fall outside of the acceptable range?
Answer: As we learn more about cholesterol, the desirable range for some people-those at higher risk-has dropped. Factors that enter into determining the desirable range of cholesterol (broken down into the bad LDL and good HDL) include age, family history, lifestyle factors and past medical problems.

Question: Where do arrhythmias fit into the picture?
Answer: This is a tough question to answer because arrhythmias (heart beat problems) span the range from minor annoyances to life threatening disasters. The appropriate options depend on where in this range a given situation falls- a determination that can only be made by your doctor.

Question: Do you use the newer medication, Zetia, to lower cholesterol? Per the ads, it works in the gut… Any success with it?
Answer: I do use Zetia- a medicine that lowers the absorption of cholesterol from the digestive tract. This can be used by itself-or combined with statin medicines (in addition to lifestyle changes) to lower cholesterol. When Zetia is used with statin medicines, a lower dose of the statin is required than would be needed with a statin alone to achieve the same cholesterol level. I often find this combination useful for people who have had difficulties on higher doses of statins.

Question: Can you comment on the benefit of using flax seed in your diet?
Answer: Flax seed contains the healthy omega-3 fatty acids. Fish has a form of omega-3 that is more easily used by the body and is generally recommended over flax unless you are a vegetarian. If you do choose flax, best to grind it fresh for maximum benefit.

Questions answered by Dr. Wenger

Question: What are the risk factors after terminating Hormone Replacement Therapy (HRT)?
Answer: A 3-year follow-up study after completion of the estrogen/progestin arm of the Women’s Health Initiative showed a persisting increased risk for breast and other cancers, no persisting risk for cardiovascular disease, coronary disease, stroke, or venous thromboembolism, but a subsidence of the benefits for bone health.

Question: Does the use of hormone therapy for birth control have similar risk of breast cancer as hormone therapy for menopause?
Answer: Oral contraceptives have not been associated with an increased risk for breast cancer.

Question: What about high risk factors as they apply to Black women?
Answer: Black women often have lesser abnormalities of cholesterol, but far more serious abnormalities of hypertension, overweight, and sedentary lifestyle, as well as diabetes. Major attention is warranted to the control of hypertension in black women.

Question: Is cognitive impairment reversible if the suspected cause is Menopausal Hormone Therapy (MHT)?
Answer: It is not known whether cognitive impairment is reversible, as there was no follow up to the Women’s Health Initiative Memory Study – just the initial questionnaire.

Question: What is congestive heart failure and why can someone have it for years before dying?
Answer: Heart failure is failure of the heart to pump adequately. It is characteristically treated with medications which can control the problem for many, many years.

Question: Should everyone take a low does of aspirin everyday?
Answer: Low-dose aspirin is recommended for all men older than 40 years of age to prevent heart attack, without benefit for stroke. For younger women there is prevention of stroke, but not prevention of heart attack; and in women older than 65 years of age, there is modest prevention of heart attack and stroke, but an almost equal increased risk of bleeding.

Question: We all must die of something. How can that fact be considered when calculating statistics and warning “younger” people about health issues?
Answer: Young people should want to lead as healthy a life as possible – it is not just mortality but the illness and impairment of quality of life that occur with disregard of health issues by younger people.

Question: What is omega-3 fatty acid? Is it a component of fish oil?
Answer: Omega-3 fatty acid is a component of fish oil – but the concentration in the various fish oil preparations varies.

Question: What is the difference between salmon oil and fish oil?
Answer: Salmon oil is one type of fish oil – but the specific omega-3 fatty acid composition of each preparation must be ascertained.

Question: If total cholesterol is less >200 but LDL is low, is there anything to be concerned about?
Answer: Do not worry about a low LDL – it is associated with good health.

Question: What is tachycardia and what is its causes? Can it lead to a heart attack?
Answer: Tachycardia is simply an increase in heart rate. There are many causes, some of which may be anxiety, fright, anemia, thyroid disease – in and of itself, it does not predispose to heart attack.

Question: What is the recommended health care for mitral valve prolapse?
Answer: Mitral valve prolapse does not require specific medication or interventions other than a generally healthy lifestyle.