Heart Health

Did cancer treatment increase my heart disease risk?

DEAR DOCTOR K: I survived cancer, only to be told that the treatments that saved my life may have increased my risk for cardiovascular disease. What are the risks? And can I minimize them?

DEAR READER: As more people are living longer after a cancer diagnosis, more people are coping with the long-term effects of cancer treatment. Many cancer-suppressing treatments can have undesirable effects, for example, on the heart and blood vessels.

Are heart palpitations dangerous?

DEAR DOCTOR K: I often experience heart palpitations -- almost every time I'm excited, angry or scared. Is this dangerous to my health?

DEAR READER: The word "palpitations" is used differently by different people. To me, palpitations are simply an awareness of your heart beating. People aren't usually aware of their heart beating. But when it beats unusually forcefully, irregularly or rapidly, you notice the heartbeat.

Does hormone replacement therapy increase heart disease risk or not?

DEAR DOCTOR K: I'm in my third year of menopause, and my doctor won't prescribe hormone therapy. He says it increases the risk of heart disease. I think I recall that you told another reader that this is not true. Is my doctor right, or are you?

DEAR READER: You won't be surprised to learn that I think I'm right. But in the previous column you refer to, I didn't say exactly what you remember. I said that the effect of hormone therapy (HT) on heart disease depends on a woman's age and how recently she entered menopause. In younger women, in their first six to 10 years after menopause, HT protects against heart disease. In contrast, in older women, HT increases the risk of heart disease. It's called the "age effect."

Do I need to see a cardiologist?

DEAR DOCTOR K: I have high cholesterol and high blood pressure, so I know I'm at increased risk for heart disease. Should I see a cardiologist?

DEAR READER: For many people, a primary care physician (PCP) can effectively manage standard risk factors for heart disease. Your PCP also will know when you need to see a cardiologist, and can refer you to a particular one.

Why does my doctor think I don’t need an angioplasty and stent?

DEAR DOCTOR K: A test showed a 50 percent blockage in one of my coronary arteries. That sounds pretty bad to me. But the cardiologist said I didn't need an angioplasty and stent. Why?

DEAR READER: Coronary arteries send needed blood to the heart muscle. That blood flow can be blocked by cholesterol-rich plaques of atherosclerosis. When the blockage seriously reduces blood flow, it increases your risk of a heart attack. An angioplasty and stents can be helpful for restoring blood flow, but the procedure is not risk-free.

I’ve been eating more salmon for its omega-3 fats. Does it matter if the salmon is farmed or wild-caught?

DEAR DOCTOR K: You've written that fatty fish like salmon are a good source of omega-3 fats. Does it matter whether the salmon is farmed or wild?

DEAR READER: Salmon and other fatty fish certainly are an excellent dietary source of omega-3 fatty acids, which lower the risk of heart disease. Many supermarkets offer both farmed and wild-caught salmon. The two types have noticeably different tastes and textures. Wild-caught also tends to be more expensive.

Is red wine good for heart health?

DEAR DOCTOR K: I've heard that drinking red wine, or any alcoholic beverage, in moderation is "heart-healthy." Is it true, and is red wine any healthier than other alcoholic beverages?

DEAR READER: There are many studies of the two questions you ask. As for the first question, most studies have found that moderate drinkers are less likely to develop Type 2 diabetes and heart disease. That's when moderate drinkers are compared either to non-drinkers or to heavy drinkers.

I have a heart condition. What do I need to know before I get pregnant?

DEAR DOCTOR K: I have a heart condition. What do I need to know before I get pregnant?

DEAR READER: When a woman is pregnant, her heart is working for two. Blood passes through her placenta to her baby. This places additional demands on her body's circulatory system, particularly the heart. Among other changes, her heart pumps a much higher volume of blood each minute. As a woman with a heart condition, it's particularly important for you to understand what this added workload might mean to your health, and to your baby's.

Has the SPRINT trial led to a change in blood pressure goals?

DEAR DOCTOR K: A few months ago, I read that results from a big trial were going to change blood pressure treatment goals. Where do things stand now?

DEAR READER: I'll bet you're referring to SPRINT. In September 2015, the National Institutes of Health (which funded the study) reported that the study had been stopped earlier than planned because its results were clear. Recently, the complete report of the study (called SPRINT) and its results was published in The New England Journal of Medicine.

Is it safe to take ibuprofen after an angioplasty?

DEAR DOCTOR K: I had angioplasty with a stent recently. I need to take aspirin and Plavix every day. I used to take ibuprofen for pain, but a neighbor said I shouldn't take it if I'm on aspirin and Plavix. Is that right?

DEAR READER: Taking aspirin and Plavix after angioplasty and stent placement is standard care. Both aspirin and clopidogrel (Plavix) attach to blood cells called platelets to make them less sticky. You need these drugs to prevent the formation of a blood clot inside the stent. If a clot forms in the stent, it can suddenly cut off the blood supply and cause a major heart attack.