Heart Health

How does sugar increase the risk of heart disease?

DEAR DOCTOR K: I've read that sugar increases the risk of heart disease. How does it do that? Also, any advice for those of us with a sweet tooth?

DEAR READER: So far as we know, sugar doesn't directly harm the heart. But it sure indirectly harms the heart, by promoting the following cardiac risk factors -- problems that lead to heart disease: OBESITY: Excess calories contribute to obesity. Added sugar is a major source of excess (and empty) calories. Overweight and obese people are at greater risk for heart problems. Today, we're discovering that the cells containing fat make hormones that travel in the blood and have many harmful effects on the heart.

Is it possible to go off blood pressure medication through diet and exercise?

DEAR DOCTOR K: Is it possible to get off blood pressure-lowering medication through diet and exercise?

DEAR READER: Yes, it is. I've seen many patients commit to lifestyle changes and get off blood-pressure medicines entirely. More often, I've seen that a commitment to a healthier lifestyle allows people to greatly reduce how much medication they take, even though they still need some medicines to control their blood pressure. While many people, myself included, would like to not have to take medicines at all, being able to reduce the dose is a big deal. Many of the side effects of medicines are reduced or eliminated by reducing the dose.

What is sick sinus syndrome?

DEAR DOCTOR K: My doctor says I have "sick sinus syndrome." What is it?

DEAR READER:Your question reminded me of something that happened many years ago. A new patient came to my office. She told me that a colleague of mine had been her doctor, but she had stopped seeing him because "he didn't know what he was talking about." When I asked her to explain, she said that she had been weak and had almost fainted several times. At other times, her heart suddenly seemed to be beating too fast.

When is it safe to have sex after a heart attack?

DEAR DOCTOR K: I'm a man in my 60s. I had a heart attack a few months ago, and now I'm afraid to have sex. Is it too strenuous for my heart?

DEAR READER: Your question is a common one. Many of my patients who've had a heart attack wonder if and when it will be safe to resume sexual activity. I can understand why. Physical exertion causes the heart to work harder, and if you've had a heart attack, your heart has been injured.

Does my high HDL cancel out concerns about my high LDL cholesterol?

DEAR DOCTOR K: I am 71 years old. My LDL cholesterol is 160, but my HDL is 122. Does my high HDL cancel out concerns about my high LDL cholesterol?

DEAR READER: I can't give you a definite answer for a simple reason: There are very few people like you. Therefore, there are few studies of people like you. Here's what we know. For the vast majority of people, the higher your LDL ("bad") cholesterol, the greater your risk of heart disease. In contrast, the higher your HDL ("good") cholesterol, the lower your risk.

What’s the link between diabetes and heart disease?

DEAR DOCTOR K: When I was diagnosed with diabetes, my doctor said I am now also at increased risk for heart disease. What's the connection?

DEAR READER: The link between diabetes and cardiovascular disease is stronger than many people realize: About two-thirds of people with diabetes die of heart disease or stroke. I spoke to my colleague Dr. Benjamin Scirica, a cardiologist at Harvard-affiliated Brigham and Women's Hospital, about the link between the two conditions. He explained that diabetes harms the heart in several ways.

Are treatments for peripheral artery disease and coronary artery disease similar?

DEAR DOCTOR K: I have PAD. It sounds like coronary artery disease of the legs. Is the treatment similar too?

DEAR READER: You're right: It's the same disease -- atherosclerosis -- in different arteries. In atherosclerosis, cholesterol-filled growths, called plaques, grow inside the artery. They block the flow of blood through blood vessels. In coronary artery disease (CAD), atherosclerosis blocks blood flow to the heart. In peripheral artery disease (PAD), plaque builds up in the arteries of the legs and feet, restricting blood flow to those areas.

Do I really need to be on statins?

DEAR DOCTOR K: I had bypass surgery last year, and I've been on two different statins. But I had severe muscle and joint pain. Do I really need to be on a statin? The side effects are awful for me.

DEAR READER: Statins are the most widely prescribed cholesterol-lowering drugs. They significantly lower levels of harmful LDL cholesterol in the body. And they've been shown to reduce death, heart attack and stroke risk by up to 30 percent in people at high risk.

How is a pacemaker inserted?

DEAR DOCTOR K: I'm scheduled to have a pacemaker inserted in a couple of weeks. Can you tell me what will happen during the procedure?

DEAR READER: A pacemaker is a little box that is placed beneath the skin of your chest. It has wires that run into your heart, attaching to its inner surface. A pacemaker regulates your heartbeat electronically.

What is a list superfoods that support heart health?

DEAR DOCTOR K: You've written about "superfoods" that deliver a lot of nutritional bang for their buck. Do you have a list of superfoods for heart health?

DEAR READER: Many foods -- from the everyday to the exotic -- are rich in nutrients that help keep heart disease at bay. That's good news, and it's been documented in many scientific studies. My colleagues in nutrition science at the Harvard School of Public Health and Harvard Medical School have published the following list of heart-healthy superfoods. They and I use the word "superfoods" advisedly. Obviously, no food offers anything like perfect protection against any illness.