When you hear “diabetes” what comes to mind?

When you hear “diabetes” what comes to mind? Most people think high blood sugar along with images of obesity, cookies, and desserts. Elevated blood sugar is indeed a prominent and obvious part of diabetes.  Patients see it for themselves as they check their blood sugar; they also experience first hand symptoms of out- of- control blood sugar like excessive urination, unquenchable thirst and even coma that sends them to the intensive care unit.

However, diabetes is more than just high blood sugar, it’s a disease of the arteries. Seven out of ten diabetic deaths are due to heart attacks and strokes, not elevated blood sugar. Diabetes makes all our arteries, large and small, much more sensitive to normal wear and tear. Artery damage due to smoking, high blood pressure, and high cholesterol is more susceptible as well.  Merely controlling blood sugar level and keeping A1c at no more than 7%, although necessary, is hardly enough to protect diabetics from the most feared complications of their disease.

So, what can diabetic patients do to get maximum protection of their arteries? Consistently practice a healthy lifestyle (NO smoking cigarettes, keep a healthy diet, and near-daily exercise) AND keep blood pressure low AND take statins AND, possibly, a low-dose (81 mg) aspirin (provided that there are no stomach or serious bleeding problems). Medications like lisinopril or losartan are also important in protecting the kidneys which can commonly fail in diabetes.  Additionally, some new non-statin cholesterol-lowering medications (Praluent and Repatha) are available but at a cost of approximately ten thousand dollars (US) per year of treatment.

Artery testing, especially testing of the heart arteries, is another element of good diabetic care. Within diabetes the nerves that signal heart pain do not work properly, so it’s not unusual for a diabetic patient to have significant clogging of the heart arteries without experiencing any chest pain. Due to this, the doctor may recommend a stress test from time to time. Diabetic patients need to create a partnership with their physicians in order to reap the full benefits of diabetes education and disease prevention.

Anthony Pothoulakis, MD, FACC

Do you know what Statins are? If not, you should ….

Statins: the Pros and Cons of a Heavyweight

Statins are life saving medications, literally. In the fight against heart disease, they are credited with reversing the tide of rising heart attacks. Of course, the decline in smoking and better use of blood pressure medications has helped with the reduced rate of heart attacks. The good news is that, since 1996, for the first time in over a century, we have seen a decline in heart attacks by 40-percent.

Statins are a group of medications that lower the bad (LDL) cholesterol and reduce inflammation in our arteries. They help stabilize cholesterol plaques that frequently (and permanently) reside in our heart and brain arteries. Statins keep the blood flowing and reduce heart attacks and strokes by 30 to 40 percent.

Since statins are a true heavyweight champion of modern medicine, they are among the most widely prescribed medications in the US (almost 20 million patients use them). Although they generally have a very good safety track record, statins also have a dark side.

The greatest problem with statins is that they are not muscle friendly. About one in five statin users develops muscle aches, pains or stiffness that, although not life-threatening, can cause discomfort and suffering. To many affected statin users, these symptoms make the expected benefits not worthwhile. Other negative aspects of statin use are much more rare and include severe liver damage (one in a million), kidney failure (one in ten thousand), or type 2 diabetes (one in a thousand).

For some individuals healthy choices may include statins, on top of a  healthy lifestyle. The decision to start statins (and continue them for the rest of your life) should be based on your particular risk for developing heart attack or stroke. Individuals with the highest risk include (but are not limited to) those who have:

• already suffered a heart attack, a stroke or mini stroke
• undergone bypass surgery or stent placement
• either type 1 or type 2 diabetes
• an LDL cholesterol above 190 mg/dl.

As you discuss with your doctor whether statins are right for you, you need to weigh the good and the bad when it comes to the side effects of statins. You must consider how statins can help your arteries and prevent life-threatening conditions that may be points of no return, like heart attacks and strokes.

Keep in mind that doctors routinely check (through a simple blood test) for severe liver or muscle damage. They may also recommend over the counter supplements (like Coenzyme Q-10 or Vitamin D) that can protect against muscle aches. Doctors also warn their patients that, in case of severe muscle aches or dark-color urine, they should promptly stop taking statins.

The list of the currently available statin medications includes:

• Crestor (rosuvastatin)
• Lescol (fluvastatin)
• Lipitor (atorvastatin)
• Livalo (pitavastatin)
• Mevacor (lovastatin)
• Pravachol (pravastatin)
• Zocor (simvastatin).
• Advicor (lovastatin/niacin extended-release)
• Simcor (simvastatin/niacin extended-release)
• Vytorin (simvastatin/ezetimibe).

Good health to you!

Anthony Pothoulakis, MD, FACC

Are you self-monitoring your blood pressure?

You are as old as your arteries, even if you think you are only as old as you feel or look. And blood pressure is one of the key factors that determine your artery health. For this reason, knowing your true blood pressure is important to both you and your doctor. Many people suffer from “white coat syndrome” where they are nervous at the doctor’s office. This may result in a blood pressure measurement that is higher than your true blood pressure, whereas your home numbers are likely to be more accurate. Monitoring your blood pressure at home and on a regular basis is the best way to know your true blood pressure. This way, you will give your physician a fuller picture of your blood pressure fluctuations over an extended period of time. Also you will be an important participant to your own health care, a true partner to your doctor.

A blood pressure reading has a top number (systolic) and bottom number (diastolic). To fall into the normal range, your blood pressure should be less than 120 over 80. Prehypertension, which is borderline high blood pressure is 120-139 over 80-89. (Stage one) Mildly elevated high blood pressure is 140-159 over 90-99; and (stage two or) severely elevated high blood pressure is a reading of 160 and above over 100 and above.

Both diabetes and chronic kidney disease make your arteries more sensitive to the bad effects of high blood pressure. Many doctors believe that for these patients the blood pressure should be kept at less than 130 over 80. On the other side, for people over the age of 60, some medical professionals suggest that a top number up to 150 is acceptable. Be aware that as we age the elasticity of our aorta (the largest artery highway that starts at the heart and divides to branches that distribute the blood all over the body) declines. This declining elasticity of the aorta is frequently responsible for a low bottom number (diastolic blood pressure) observed in older individuals.

Blood pressure fluctuates all the time. It is generally higher early in the morning (its highest value is actually one to two hours before we even wake up) and between six and nine in the evening. If the blood pressure between your two arms differs by more than 10 points (mm Hg), record the higher number of the two. There are also specific factors that may cause your blood pressure to temporarily rise. For example, blood pressure rises as a result of:

• Stress
• Exercise or even ordinary physical activity at home or at work
• Caffeine
• Certain medicines
• Smoking
• Cold temperatures

Avoiding as many of these factors as you can when taking your blood pressure will help improve the accuracy of your overall numbers. Depending on the situation, your doctor may want you to check your blood pressure several times during the day to determine how wide the fluctuations are.

Before Checking Your Blood Pressure find a relatively quiet place. Make sure that you are relaxed and comfortably seated. Be sure to have recently emptied your bladder since a full bladder may affect the reading. Remove any tight-sleeved clothing or roll up the sleeve on your arm (if you are using a blood pressure cuff that fits your elbow). How and where you sit is important in an accurate reading. Before taking your blood pressure, rest in a chair next to a table for 5 minutes. Your arm should comfortably rest at heart level. Sit up straight with your back against the chair, legs uncrossed. Rest your forearm on the table with your palm facing up. If your are using a blood pressure cuff that fits your wrist, keep your wrist at the level of your heart.

Is Skinny Really Healthy?

The obesity epidemic is real and has been for the last twenty-five years. Now it is spreading well outside the boundaries of developed nations. It brings along health concerns: type 2 diabetes, heart disease, stroke, and destroyed knee joints. There have been strong and concerted attempts to cure this epidemic and promote the image of a healthy, non-obese human body. But is becoming skinny at all costs the right answer?

Skinny or normal weight individuals who workout almost daily and eat right can also be suffering poor health. It is not unusual for normal or low to normal weight individuals, to have a very high LDL (the bad cholesterol) or high blood pressure. These conditions depend on heredity and aging as much as they do on lifestyle. Unfortunately, a great body is easier to see and detect than high LDL or high blood pressure. If one or both of those conditions has been a problem for years and goes undetected, it could destroy arteries and hearts beyond repair. Furthermore, many health conscious individuals who are thin, fit and eat healthy, have strong convictions against taking anything that is not natural; they are among the hardest to persuade that a pill might be medically necessary for them.

Muscular individuals may not appear skinny but are certainly healthy. If their muscle comes without belly fat, they are doubly healthy. First, they are spared of the toxic effects of belly fat. Second, muscle is metabolically wonderful. It will burn calories even when we are asleep and suck in excess fatty acids and blood sugar. Third, muscle is essential for exercise and later in life, for simply staying functional and able to walk. One caveat: lifting very heavy weights may raise the blood pressure to unsafe high levels and can destroy our aorta and heart, thus it is not recommended.

There are several conditions that can be even more destructive to our health than obesity.

Smoking is number one. The use of tobacco products, in any way or form, can destroy our arteries and cause heart attacks, stroke, heart failure and an assortment of cancers. Smoking can cause you to stop breathing, due to emphysema. This is irreversible. Since smoking reduces appetite, it is not unusual for smokers to have great figures. If these smokers could only see their insides. The ragged terrain of their arteries and their cancer cells in the making are not a trade off for a shapely body!

Trying to become skinny is not the “end all be all”. We know there are negative health consequences of anorexia and an extremely low body weight (a BMI below 18.5 or a waist circumference below 29 inches for men or 25 for women). In an all- out- war against the obesity epidemic and the ravages that come with it, we should see optimal body weight in the right perspective: desirable. Skinny is neither an absolute guarantee of health nor a goal in itself to be conquered at any cost or through any means. To your Health!

Taking something as “harmless” as…

Motrin (ibuprofen) Aleve (naproxen) Celebrex (celecoxib) or Voltaren (diclofenac) could actually be HARMFUL to you…These all are powerful medications known as “NSAIDs”.

These medications are some of the most commonly used medicines in adults and have been used for a long time, over half a century, and are used for many reasons. They help reduce swelling and inflammation caused by injury or arthritis and relieve fever. For women they help ease cramping, and control heavy menstrual bleeding. They are easy to obtain since you can buy them without a doctor’s prescription. However, these very effective medications can also cause serious, even life threatening, side effects.

Beyond simple skin rashes or mild stomach aches, all NSAIDs have been known to cause heart attacks, stroke, heart or kidney failure, high blood pressure, elevated potassium, stomach ulcers and stomach or intestinal bleeding. This is even more of a risk if they are taken at high doses and on a daily basis for prolonged periods of time.

If you suffer from diabetes, kidney or liver disease, high blood pressure, or have a history of heart attacks, stroke or heart failure you are most at risk of these side effects.  Those taking diuretics, certain blood pressure medications (“ACE-inhibitors” or “ARBs”), smokers over the age of 45, and anyone over the age of 65 are especially vulnerable.  Also in a higher risk category are pregnant women, those with Crohn’s disease, ulcerative colitis, stomach ulcer or history of intestinal bleeding, those who easily bruise, and those taking aspirin or other blood thinners.

Ask your doctor whether NSAIDs are right for you. If your doctor approves of the use of NSAIDs, ask how long you should take them and at what doses should they be taken. You may want to consider alternatives, such as acetaminophen (Tylenol) or other pain medicines.

Although aspirin is technically a NSAID, in low doses it helps prevent heart attacks and stroke and it is an unlikely cause of kidney or heart failure. It can, however, cause stomach problems such as ulcers or (intestinal) bleeding.  Aspirin could also cause allergies and even asthma in susceptible individuals.  As with all medication, best to check with your doctor first.