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HOUSE CALL WITH DR. SANJAY GUPTA
Looking at Heart Disease
Aired November 19, 2005 - 08:31 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
SANJAY GUPTA, HOST: Good morning and welcome to HOUSECALL. I'm Dr. Sanjay Gupta.
This morning, we're looking at heart disease, from cutting edge treatments to closing the gender gap, and even how your dog might be able to help your heart.
We'll start with the treatment that some are calling drive- through surgery.
SANJAY GUPTA, HOST (voice-over): A couple of nights in the hospital after a heart procedure? That sounds pretty normal, right? But what if you could go home the very same day? Canadian researchers are perfecting a shortcut method for angioplasty that could have you saying home sweet home a lot sooner.
Generally in an angioplasty, doctors thread a catheter through the femoral artery. That's near the groin up to the heart. Then they inflate a small balloon inside a blood vessel to unclog it.
After such an invasive procedure, an overnight stay is required, meaning additional costs and sometimes unwanted anxiety. In the so- called drive-through angioplasty, the catheter goes into the wrist artery. Patients take a drug to curtail any bleeding and usually go home within four to six hours.
NIECA GOLDBERG, DR., AMERICAN HEART ASSOCIATION: The sooner we can get our heart patients back into the comforts of their own home and their community, then we can start to act on the risk factors that actually cause them to have the procedure.
GUPTA: A new study finds that the shorter procedure also yields less bleeding. And it's just as safe as the traditional method.
UNIDENTIFIED MALE: Just jump right up on in here.
GUPTA: And there's another tradition cardiologists are trying to put behind us, the gender gap.
GOLDBERG: For a long time, I guess the last 21 years, more women have died of heart disease than men. Yet when I went to medical school, we were taught that heart disease was largely a man's disease.
UNIDENTIFIED MALE: You're doing terrific. GUPTA: A new study adds to mounting evidence that female heart patients are under diagnosed and under treated for heart disease. Kaiser Permanente researchers found that although women with high cholesterol levels benefit as much from lipid-lowering statin drugs as men, only 58 percent of women who need it are treated with them, compared to 67 percent of men.
The keys to narrowing the gap, women should begin thinking about heart health early in their 20s and continue to have it assessed throughout their lives.
Doctors look for symptoms associated with women's' cardiac problems, like shortness of breath, unusual fatigue, and lower chest discomfort, and recognize that women are as much at risk as men.
And from the cutting edge of heart research comes the promise of regeneration. Scientists are developing methods to strengthen damaged heart tissue with infusions of the patient's own bone marrow cells, which is act like stem cells.
Initial studies show heart attack survivors nearly doubled their pumping ability. Researchers say the technique will take several more years to ultimately be used in the fight against heart disease.
GUPTA: Really interesting stuff. And all these studies that we're talking about today came out in the American Heart Association Scientific Meeting which was held this week.
Our guest, Dr. Timothy Gardner, was the chair of all the scientific sessions at the meeting. He's also a cardio thoracic surgeon at Christiana Care Health Services in Delaware.
Doctor, you read all the studies. You were at the meeting.
TIMOTHY GARDNER, DR., AMERICAN HEART ASSOCIATION: Sure.
GUPTA: Pretty interesting stuff. What was some of the most amazing stuff that you saw?
GARDNER: Well, we had a session on CPR and the way to enhance recovery from CPR. The session was called "What's Hot and Cold in Cardiopulmonary Resuscitation." And it was a great session, emphasized the importance of managing the patients after a successful resuscitation. And cooling is a component of that.
GUPTA: Actually cooling the body down.
GARDNER: Cooling the body gently to a level that allows the brain to recover more completely, as well as the heart after sudden cardiac arrest.
GUPTA: All right, we're going to dive into some of these studies, because a lot of this stuff's very interesting. A lot of people think about heart disease. You just saw the piece about the drive-through angioplasties.
GUPTA: You know, they put it through a wrist artery.
GUPTA: Is this something that we're going to see more of? Is this safe? Should people be asking their doctors about it?
GARDNER: Well, the point of the study is that it is safe, not for everybody. It doesn't apply to everybody, but it is both safe and allows for a much quicker procedure, patients out of the hospital more quickly.
GUPTA: And should everyone be getting this done who needs the angioplasty?
GARDNER: Well, not everyone. There are definite exclusion criteria. But for many patients, this does appear to be an option that we have not used much as yet.
The standard, of course, is to use the femoral artery in the groin. And that requires that the patient stay in bed with compression or some sort of an anti-bleeding technique. This is much easier to control. And as it was shown in the study, which incidentally was called the easy trial, they did in fact demonstrate that you could get the patient through the procedure.
GUPTA: It's good news. Very good news for patients who worry about having some blockages in their arteries.
Lots of e-mail questions coming in on this topic.
GUPTA: A question from Kathleen in Florida who writes this. "I'm really interested in stem cell therapy for heart damage due to heart attacks. My husband currently has a greatly reduced function of his heart. Is this going to be an option soon?"
And doctor, again, we talked a little about this in the piece. Stem cells, people think of that as being far off in the future. Are we going to start seeing that?
GARDNER: Well, this study that was presented from Germany, 100 patients received their own bone marrow stem cells. That is progenerative cells. And there was a definite, positive effect in the majority of those patients.
GUPTA: And when you say positive effect, you mean the hearts got stronger?
GARDNER: The hearts got stronger. There was less damage especially in those patients whose degree of injury was extensive. GUPTA: And it's a really important study, because you point out that someone has a heart attack, it's long been thought that they just never regain any of that function. So this is some of the first times we're talking about actually being able to get some of that function back?
GARDNER: Exactly. We have good treatments for heart failure, but we don't have a treatment yet that regenerates the heart.
GUPTA: OK. Well, you know, one of the most preventable causes you know of heart disease is smoking. And more help may be on the way for those that are trying to stop.
A new study found an experimental drug worked better than the smoking cessation drug Zyban by working differently. You deal with smokers all the time, doctor.
GUPTA: How important is this study?
GARDNER: Oh, it's extremely important in the sense that this is probably the most preventable risk factor for heart disease. But as you know, lots of patients, lots of people are addicted to nicotine. And despite many attempts and behavioral treatment and so on, the addiction is just very difficult to deal with.
This drug blocked the nicotine receptor. So it fooled the body into thinking that the nicotine was occurring. There was even some nicotine-like effect. So it's a new action, a new type of drug. And it has a lot of promise.
GUPTA: And a lot of people out there, smokers, are saying when are we going get it? Do you have any sense of that?
GARDNER: Well, phase 3 trial is in Europe right now. The results that were presented at the American Heart Association are very encouraging.
GARDNER: And I think it's in the pipeline, as they say.
GUPTA: Boy, we really need an anti-smoking drug for sure. Now we're talking with Dr. Timothy Gardner. More of your heart questions coming up after the break.
UNIDENTIFIED FEMALE: Could your coffee be hurting your heart? A new study has a surprising answer.
And dogs show they really are man's best friend. We'll explain.
First, take today's quiz. At what age should you start getting checked for cardiovascular disease? A, 20; B, 30; C, 40? That answer, coming up.
UNIDENTIFIED FEMALE: Checking the quiz, we asked at what age should you start getting checked for cardiovascular disease? A, 20; B, 30; C, 40? The answer, A. Even healthy adults should begin checking their risk at age 20.
GUPTA: I think you've heard it before, but it bears repeating. To help yourself prevent heart disease, know your numbers. That's your weight, your blood pressure, which should be below 120 over 80, and your total cholesterol, which should be below around 200.
We're talking with Dr. Timothy Gardner this morning. He was the head of the scientific sessions at this week's Heart Association meeting.
That means, doctor, you know all the latest research, obviously, that came out of this meeting.
GUPTA: There was an interesting study that I read about, about the two top-selling cholesterol-lowering drugs. There's Lipitor...
GUPTA: ...and Zocor. It was a surprising study to some people out there. What happened there?
GARDNER: Well, it was called the ideal trial. And you know, they use these names for these trials to try to emphasize perhaps the points that they're trying to make.
What is the ideal way to treat cholesterol elevation? So this was a standard dose, one-medication versus the high dose second, newer medication. And in fact, the higher dose worked. It brought the cholesterol down more effectively and without any side effects or problems for the patients.
GUPTA: Is one drug better than the other?
GARDNER: The drugs are probably equivalent in terms of mechanism of action. I think it was the dose that was important here.
GUPTA: So actually going up maybe on the dose of some of these statin medications.
GARDNER: Yes. And you know, some of the idea, the lower the LDL, the bad cholesterol, the better. I think that was the point of this study. And if you can do it safely with a higher dose, probably all the better.
GUPTA: People talk all about these statin medications. And one doctor told me they should be putting the stuff in the drinking water. That seems to really -- you're not quite that big a fan of it, but it does appear that the higher doses at least appear to be better. GARDNER: They also had a study at the Heart Association from Japan, which they used low-dose statin drugs in relatively low-risk populations and showed a benefit in terms of reducing cardiovascular events in that population as well. And that was a population of almost 70 percent women.
GUPTA: Wow. And we are talking about statin drugs. Those are cholesterol lowering drugs. You know, I want to talk about a study that caused some consternation around my office, a study about coffee. We've been told obviously for some time to watch out how much caffeine we drink.
Now a study comes out saying decaffeinated coffee may be harmful to our hearts by raising fatty acids in our blood. Is it time to kibosh coffee all together, doctor?
GARDNER: I don't think so. And even with caffeinated coffee, coffee in moderation is fine. There are some physiological effects from coffee. It can raise your heart rate and so on.
Decaf coffee in this particular study just happened to show a mild elevation in fatty acids. So I think that, again, two cups a day, three cups a day maybe tops shouldn't be a problem. And I don't really think there's...
GUPTA: All right.
GARDNER: I think this is sort of a soft finding as you might say.
GUPTA: You just made a lot of people very happy.
GARDNER: Yes. Right.
GUPTA: Dr. Timothy Gardner is our guest. When HOUSECALL returns, we're going to talk about the gender gap in heart care. Are women getting short changed?
UNIDENTIFIED FEMALE: From the drugs they take. to testing for heart disease, what women need to know about getting the right heart care.
Plus, want to prevent future heart disease? Try pushing yourself a little harder at the gym. But first, more of this week's medical news in "The Pulse".
ELIZABETH COHEN, CNN CORRESPONDENT (voice-over): A new study in The Annals of Internal Medicine warns pregnant and post-partum women of an increased risk of blood clots. Using a 30 years of data, researchers found these women had four times more blood clot problems than non-pregnant women. The studies suggest high-risk women may need special care.
And help for some seniors paying for costly prescription drugs has arrived in the form of a Medicare prescription plan. It depends on what state you live in and how many medicines you take, but most seniors will be able to choose from at least 30 different plans.
This week was the first time seniors could begin signing up for the new benefit, but choosing which plan works may take time, as many seniors say it's confusing. The benefits start January 1st, but seniors have until May 15th to sign up for 2006.
Elizabeth Cohen, CNN.
GUPTA: All right, we're back. We're talking about the latest news in heart disease. Cardiovascular disease is the number one killer of men and women. Yet surveys show while 46 percent of women know it's their biggest risk of death, only 13 percent feel that personal risk of heart disease. That's a major disconnect.
Add that to recent studies showing a clear gender gap in diagnosis, in treatment, and in prognosis. So here to help us close that gap is Dr. Timothy Gardner. He's a cardio thoracic surgeon. He's also medical director of the Center for Heart and Vascular Health at Christiana Care Health Services in Delaware.
Doctor, this is a little bit of a bugaboo of mine, because you know, we talk a lot about heart disease. And a lot of women, even doctors out there, don't realize that it's the number one killer of men and women both.
We talk specifically about the statin drugs. They work as well for women as they do for men. Why aren't women getting them? And what should -- you're a doctor who takes care of this sort of problem. What's your advice to women to make sure they get the care that they deserve?
GARDNER: I think it's an awareness problem, both for women and for doctors. And it's a major issue for the American Heart Association now. A major initiative.
I'm wearing this little red dress. We have a "go red for women" which is our attempt to really heighten the awareness of people that women are at heart health risk.
GUPTA: You know, it's remarkable. And I'll just point this out. breast cancer is something that a lot of women cite as possibly the biggest risk factor. Yet heart disease kills maybe ten times as many as that as breast cancer does.
So the numbers are really -- let's drill down this issue a bit through some e-mails. Diagnosing women can be difficult, which has Paula in Illinois concerned. She asks this question, "What specific test should a woman have to ensure her heart is healthy?" And doctor, are there different tests for women versus men? GARDNER: No, there aren't. Women face the same profile of tests and risk factors in general. So the tests that are usually done for determining your cholesterol, your blood pressure, your C reactive protein level in some instances, things like that, those are the tests that the women should have, just as men.
GUPTA: And let's keep going here. Let's keep on theme of question from Rebecca in Connecticut who writes this. "What are the differences between heart disease risk factors for women and for men?"
GARDNER: There are really no differences. Women, however, have a -- are more likely to develop heart disease, coronary heart disease later in life.
There's about a ten-year gap in terms of the occurrence and incidents of the disease. The risk factors are the same, basically.
GUPTA: If a woman goes into the emergency room with chest pain, and she fits the risk factors, she should get worked up for heart disease?
GUPTA: All right.
GARDNER: And - but we're having to educate ourselves. And also that sometimes the presenting symptoms are not as classic as they appear, you know, traditionally, the elephant on the chest type of thing.
GARDNER: So we're trying to really focus on this as a real public health issue.
GUPTA: All right. Timothy Gardner - Dr. Timothy Gardner is our guest, talking about a very important topic, the gender gap and heart disease in general.
Think you're too young for heart disease? Well, think again. We're going to look at kids and heart disease after the break.
UNIDENTIFIED FEMALE: Kids and heart disease. New studies show some kids are already showing signs of heart disease risk factors. Steps to cut those risks when HOUSECALL continues.
GUPTA: All right, we've been talking about adults and heart disease, but doctors say they're seeing younger and younger patients. Experts believe these patients started developing risk factors at a remarkably early age.
How early? Well, a new study looked at kids in grades 2 to 11 and found 40 percent of students surveyed had at least one blood fat abnormality. Remember that age. Very young. Researchers then investigated how these kids ate. 20 percent dined out four or more times a week. And while those kids weren't any more overweight than the kids who ate at home, their blood tests were disturbing.
They had higher blood pressure, lower levels of good cholesterol, and lower insulin sensitivity as well. That can be an early sign of Type 2 diabetes.
We're talking with Dr. Timothy Gardner of the American Heart Association. Doctor, these are concerning numbers, obviously. And people say that eating out, they're quick to blame eating out is the culprit here. What did you find in the study?
GARDNER: Well, I think that that was the smoking gun in that study. But the fact is you can eat out and eat healthy, too.
And what we need to do is to create a culture of an understanding of what healthy eating is all about. Childhood obesity is a tremendous problem. And I know that you have a particular interest in it. And the Heart Association is partnering with the Clinton Foundation. Former President Bill Clinton...
GARDNER: ...is involved in this initiative. Very important because we know that children who have -- are obese and have these risk factors start are much more likely to present with significant heart disease as adults.
GUPTA: You're a heart surgeon. You're a heart specialist.
GUPTA: Is this a solvable problem?
GARDNER: Well, it's a societal problem. And it's a cultural problem, as well as a medical problem. And we have to focus on the health of our kids.
GUPTA: All right. Let's talk about some specific, good things that we could possibly do. Fish oil is something that a lot of people talk about. Something we know is beneficial for adults. Now we hear that overweight children may benefit from it as well. Is that true?
GARDNER: Yes, it is true. The beneficial effect of fish oil appears to be both in terms of affecting the lipid profile and the cholesterol profile, but also it seems to have some sort of direct, anti inflammatory or may have a direct anti inflammatory effect on the arteries.
But I don't think that we're -- we really need to think about fish oil replacement. You know, everybody taking a spoonful of cod liver oil. I think it's fish in the diet twice a week is the important message.
GARDNER: A balanced diet.
GUPTA: A good message. And the cod liver oil doesn't taste so good either.
Coming up on HOUSECALL, how much and how hard is enough when it comes to exercising your heart? And could your dog help your heart? We'll explain.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: Well, I'm encouraging you, you've been maintaining that level of exercise.
CAROL COSTELLO, CNN CORRESPONDENT (voice-over): Want to get the maximum heart benefits from your workouts? A Harvard study profiled in the December issue of "Men's Health" reveals some interesting findings.
KEN MCGRATH, DR., ATLANTA CARDIOLOGY GROUP: In this study from the Harvard School of Public Health, they showed us that as you increase intensity, you definitely benefit with greater risk reduction for heart disease. Men, who exercise vigorously, such as running six miles an hour for one hour or more per week had a 42 percent risk reduction. That's significant.
COSTELLO: They also found that walking for an hour at least once a week helped lower the risk of heart disease by 18 percent. The 12 year study included 44,000 men. Dr. McGrath says the same applies for women. And he has a take home prescription.
MCGRATH: If you gradually increase that level of intensity up to vigorous exercise, you'll get greater and greater risk reduction for cardiovascular disease.
COSTELLO: By pushing yourself a little harder when you workout, you may help ensure a healthy heart.
Carol Costello, CNN, New York.
GUPTA: All right, thanks, Carol.
To find out more about the studies we've been talking about today, go to the American Heart Association's website. That's at http://americanheart.org.
Another good resource is the Mayo Clinic's Heart Center at www.mayoclinic.com. Just click on heart disease in the lower left corner.
Now to man's best friend. A new study shows a mere 12 minute visit with a dog helped hospitalized heart failure patients lower their pressures and ease some of the stress hormones. Dr. Timothy Gardner's been our guest from the American Heart Association. You have a couple of dogs.
GUPTA: Should you be taking them on rounds?
GARDNER: Well, not quite yet. But this was a very interesting study. And it showed that these patients who are chronically hospitalized, chronically ill, depressed react very favorably to contact with animals. And obviously, the animal handler was there as well. So you know, these are sort of perfect scenarios.
We're not ready for dogs on rounds, but the importance of interaction, patient and animals, patients and dogs, is very interesting.
GUPTA: I know - I have a dog. And the dog calms me down all the time. Thank you so much for being our guest.
GUPTA: Bringing us up to date on all this very important heart health information, Dr. Timothy Gardner.
Also want to thank everyone at home as well for your e-mail questions. Make sure to tune in next week for another edition of HOUSECALL. That's at 8:30 Eastern on Saturday and Sunday. Thanks for watching.
I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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