Cardiovascular

Good Carbs v. Bad Carbs

02/05/2010 , 3:30 PM by Joseph Pepe, Jr.

Good_Carbs__Bad_Carbs_by_saturninenights

I was enjoying lunch with a friend a few weeks ago when he took a swig of his soda, read the nutrition facts and said in a puzzled manner “37 grams of carbohydrates. That seems like a lot. What exactly are carbs?”

“The enemy,” I quipped.

Now, this was merely a split-second, subconscious response that needs clarification. So by all means, I beg your pardon. Carbohydrates are not necessarily our adversary, and can in fact be our friend, but only if we understand the difference between “good carbs” and “bad carbs.” Let me explain.

Carbohydrates are essentially sugars or starches that provide energy for our bodies. Sounds good right? Not so fast! “Bad carbs” are high in glucose and, when consumed, cause a quick spike in our blood-sugar levels. This causes our pancreas to pump out insulin to deal with the excess blood sugar. The insulin then disperses the glucose and our blood sugar levels fall, causing us to be hungry again! I’m sure you’ve experienced this without even knowing it. Remember last week when you ripped through that bag of Cool Ranch Doritos, like Sasquatch attacking Jack Link’s Beef Jerky? Or how about when you had the urge to eat that Rocky Road ice cream with a shovel? Excuse my hyperbole, but these cravings are a result of the quick rise and fall of our sugar levels. Bad carbohydrates are very high in sugar and white flour and include: candy, baked foods, ice cream, white pasta, breads, and sodas. These carbohydrates, while tasty, can often lead to obesity, heart disease and diabetes.

Good carbohydrates, however have a low glycemic index and are generally high in fiber, and rich in vitamins, minerals, and nutrients. These carbs raise our blood glucose levels in a much slower and sustained manner, avoiding the spike that leads to more cravings. These carbs, especially those high in fiber, are essential to our everyday diet. They supply our bodies with energy and help to lower our cholesterol. We want our bodies to take energy from carbs because if no carbs are consumed, our protein intake will be unnecessarily used for energy, diminishing their benefits for muscle growth. Good carbohydrates include: fruits, vegetables, sweet potatoes, brown rice, beans, nuts, whole grain cereals and oat meal.

Now you may still crave that pint of ice cream, but it will be less intense and instead of grabbing the shovel, you’ll just take out a spoon. Consciously replace “bad carbs” with “good carbs,” and you’ll decrease your cravings and feel more energy. Oh, and those jeans will fit again!

About Our Celebrity Blogger. Joseph Pepe, Jr. serves as the Director of Project Development for Planet Fitness.  He oversees the Personal Training and Nutrition Department for 14 locations throughout CT.  He is also the Managing Director for the Lose It! Weight Loss System (www.loseitweightloss.com).  Joe received his B.A. in Economics from Wesleyan University. And since he’s our health and fitness guru, lets give him a plug as a athlete in his younger years as an All-NESCAC and Academic All-NESCAC Football Selection at Wesleyan. Go Cardinals!!

Cholesterol Drugs for Kids: New AAP Recommendations

07/08/2008 , 10:40 AM by Alex Sicre

I’m sure you have seen this blog by Tara Parker Pope by now or read about it from another news source, but I am a little slow coming back from vacation.

Cholesterol drugs for kids? I think this is a little ridiculous. When I was in grade school in the 80s, we had this thing called the President’s Fitness Challenge (or Test?) – where all the students had to take this fitness test to see how you fared against the national average. That was only 25 years ago.

Do they still use this in schools? I agree testing for cholesterol is important, but how about diet and exercise instead of medicating children. We are so quick to medicate children for everything – can’t concentrate, drug em, too fat, drug ‘em. Shouldn’t parents be a little more responsible in regards to their children’s health?

I was diagnosed with high triglycerides and high cholesterol 14 months ago, and have been taking Tricor, and now Niaspan to lower my levels, and I have changed my diet. I am about 5 points from getting off the medications, luckiy, or the next step would have been a stain. From what I heave heard though, I wouldn’t want to wish a statin on anyone, let alone a child.

This is a brief reporting on the AAP recommendation for cholesterol drugs for children from FirstWord by Bryan DeBusk:

The American Academy of Pediatrics on Monday announced new guidelines recommending cholesterol screening and treatment options for children. According to the new policy, patients over 8 years of age with high LDL concentrations should be considered for cholesterol-lowering drug therapy.

The organisation recommended that children and adolescents undergo cholesterol screening if they have a family history of high cholesterol or heart disease, an unknown family history, or risk factors such as obesity, high blood pressure or diabetes. Screening should occur between the ages of two and 10 years.

According to the new policy, patients over 8 years of age with high LDL concentrations should be considered for cholesterol-lowering drug therapy. Children under age 8 with high cholesterol should focus on exercise, nutrition and weight reduction, according to the AAP.

Stephen Daniels, a member of the AAP’s nutrition committee, said the guidelines are based in part on recent research demonstrating the safety of cholesterol-lowering drugs in children, and predicted that the new guidelines will result in long-term health benefits. “If we are more aggressive about this in childhood, I think we can have an impact on what happens later in life…and avoid some of these heart attacks and strokes in adulthood,” Daniels suggested.

Previous recommendations from the AAP stated that cholesterol drugs should only be considered in children older than 10 years if they have not been able to lose weight.

CVD Literature Review and Some Stats from the AHA

01/15/2008 , 9:35 AM by Alex Sicre

This is a literature review of noncompliance in… well the title tells the tale. I will post some comments on the end. This was found on Envirovaluation.org, but I am pretty sure the paper is from a conference on hypertension from 2006 in Spain.

The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review

Summary:
Objectives: To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions.

Methods: English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively.

Results: Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified.

Conclusions: Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue.

COMMENTS:
Yes, we have repeatedly seen that increase medication adherence leads to increase medication costs. This is a given, just like any consumption increase. With diseases that have nor apparent symptoms, other than a heart attack, it is hard to argue the case that in the long run, spending more on your medication will lower your overall healthcare costs. Event hough it is the truth and I believe it, it is sometimes hard to argue because in three years, there will be someone else to pick-up the bill. Whether it is a different employers, healthcare plan or the government, people want to shift the cost to the next person.

I was reading the AHA’s new report on CVD, and I knew that the numbers were pretty high, but a person dies every 37 seconds from CVD, totaling 2400 Americans a day. In 2008, 770,000 Americans with have a new coronary attack, with 430,000 expected to have a recurrent attack. Every 40 seconds someone dies from a stroke – that is one in seventeen deaths in the US. In 2004, heart failure was mentioned in 1 in 8 deaths. 80,700,000 Americans have 1 or more types of CVD.

These numbers are crazy. We are a sick nation that needs to be healed. Starting at childhood with diet and exercise, these numbers can be decreased, probably not in my lifetime, but hopefully my son’s. My father had a mild heart attack last year, and it was a real wakeup call for him at 63. Now he is on more medication and he is adherent.

Sorry for the rant, but it has been on my mind today.

My Health

12/06/2007 , 11:40 AM by Alex Sicre

In February of this year, I was diagnosed with high Triglycerides and high Cholesterol. Mostly hereditary – have you seen the Vytorin ads? – and somewhat my diet. My doctor put me on Tricor, and I have been pretty adherent. In July, I stopped taking it for two weeks while I awaited a new script but otherwise everyday.

My new doctor (my old MD went back to research) didn’t know if Tricor was the right drug, so he sent me for blood work.

He gave me the results today.

The good news is that all my levels went down: Total 247, LDL 149, HDL 38 and Triglycerides 301. The bad news is my HDL went down 10 points (very bad considering this is the “good” cholesterol and 40 or higher is recommended). The LDL went down 50 points (very good 130 is recommended), and my total is only 47 points out of the top part of the spectrum. So I am feeling pretty good about myself. I still need to eat better, lose more weight and exercise more effeciently – but who doesn’t?

The point to all of this – other than letting you all know about my health, which is top of mind in your lives – is that within two minutes of questioning, my MD asked if I had been taking Tricor regularly. I said yes, except for that two week period, and he said “Everyday?” And I said, “Yes, everyday.” I was going to tell him that I am the Director of Corporate Development for a healthcare technology company that focuses on enabling medication adherence and that a get daily text, voice and email reminders, but I didn’t need to get into it.

It then occured to me that if I said I was taking the Tricor (see White Coat Adherence) and was not, that all of his diagnosees would be off. If he thought the Tricor wasn’t working (technically it would not be working because I would not be taking it), and prescribed something else – it could really mess up my system. I never really thought about medication adherence this way, only that by not taking your meds, your condition gets worse.

My MD was happy to see my numbers and my weight go down and he gave me a choice: keep losing weight, eat better and exercise and see what happens in three months, or do all of that and take another medication in conjunction with the Tricor. He wanted to make sure I would stay adherent to another medication. Putting me on Niacin would increase my pills to 4 a day (I am on another med in the morning and bedtime). 32 million people are on 3 or more medications. Plus, he gave me an antibiotic to take for 10 days to knock a sinus infection out which I have had for two weeks.

So now, my total pill count is at 5 pills, 4 medications.

The better news is the rare blood disease he was worried about only needs to be checked every three months. So there is more time at the lab for me. If I stay adherent to the Tricor and the Niacin, and loose more weight (he said 10 lbs), and eat better (I do have the occational french fry, and ice cream) – I should have all my levels in the right range and not have to take any medications.

This would be optimal.

So, I will set up more reminders for myself, get into the routine of taking a new drug and everything should be right as rain.

As long as there are not any horrible side effects – he mentioned hot flashes – and the drugs fall into my formulary. By my son’s 1st birthday, I will be a new man!

A Different Approach to Medication Adherence

11/07/2007 , 11:33 AM by Alex Sicre

I found this tidbit from the US News and World Report website – just a press release. A different approach to staying adherent to medications and dealing with side effects:

From Health Day News
Spirituality helps older black American women with high blood pressure stick to the drug regimens that keep the condition under control, new research suggests.

Older black Americans tend to have poorer anti-hypertensive medication adherence than either younger blacks or white patients, even though adherence helps reduce hypertension-related health problems and deaths, noted a team from the University of Pennsylvania School of Nursing.

This study included 21 black women, average age 73, who were members of a Program of All Inclusive Care for the Elderly. The women had been diagnosed with hypertension for an average of 16.7 years, and they were taking an average of 3.3 prescriptions to battle the condition.

All the women said they used their spirituality to manage their medication adherence. As part of this process, identified as “Partnering with God to Manage My Medications,” the women accepted personal responsibility for adhering to their medication regimen and used their spirituality as a resource to make decisions to remain adherent, to cope with medication side effects, and to increase their ability to deal with barriers that kept them from sticking with their medicines.

The findings suggest that incorporating patients’ beliefs into hypertension treatment may help them draw on inner resources to improve medication adherence, the researchers concluded.

The study was to be presented Wednesday at the American Heart Association annual meeting in Orlando, Fla.

Half of Hypertensive CA Adults Take Drugs for Blood Pressure

10/04/2007 , 11:22 AM by Alex Sicre

This is a press release from the American Heart Association. I have been at a conference this week, but wanted to post this information. My comments will come at a later date.

About half of California adults diagnosed with high blood pressure, or hypertension, do not take medication to lower it, researchers reported today at the American Heart Association’s 61st Annual Fall Conference of the Council for High Blood Pressure Research.

Of those who do, regularly seeing a doctor makes a big difference in their medication adherence.

In a study of California adults, of 42,044 respondents, 11,467 of them said a doctor had told them they had high blood pressure. When adjusted for age, this yielded a prevalence rate of 24.5 percent.

Researchers also found, on an age-adjusted basis, that 49.4 percent of those diagnosed with hypertension, a potentially life-threatening disease, were not taking drugs to lower it. People who had seen a physician during the prior year were more than five times more likely to be on medication than were those who had not.

“That was informative,” said David J. Reynen, M.P.P.A., M.P.H., lead author of the study. “It really underscores the importance of having routine care.”

High blood pressure is a major risk factor for heart attacks and strokes, and it increases a person’s risk of heart failure, kidney disease and blindness.

Doctors recommend drug treatment when a person’s blood pressure consistently measures 140/90 millimeters of mercury (mm Hg) or higher.

Reynen and his colleagues at the California Department of Public Health’s Heart Disease and Stroke Prevention Program in Sacramento wanted a clearer picture of high blood pressure in their state. They proposed a series of questions to be included in the California Health Interview Survey, which is conducted by telephone every two years, and then analyzed the results.

“Unfortunately, the data are collected in such a way that we don’t know to what degree the individual respondents have hypertension,” Reynen said. “One in four adults in California, including one in three African Americans, is hypertensive,” he said. “We talk about people needing to know their numbers. That means not just whether your blood pressure is high or low, but your actual numbers. This study reinforces that.”

The researchers used age-adjustment to standardize the survey results so they could more accurately compare various groups.

Among those surveyed with high blood pressure, the analysis showed that the age-adjusted odds of a person taking drugs to lower blood pressure are:

5.23 times higher for people who saw a physician within the past year compared to those who did not;
2.47 times higher for those with diabetes than those without the disease;
2.05 times higher for those who had health insurance than those who did not;
1.71 times higher for African Americans than for whites (the racial/ethnic groups, respectively, with the highest and lowest high blood pressure rate);
1.46 times higher for people who described their health as poor or fair compared to those in good health;
1.40 times higher for patients diagnosed with heart disease than those without it;
1.38 times higher for smokers than nonsmokers;
1.27 times higher for U.S.-born individuals than foreign-born;
1.21 times higher for people with some form of formal education after graduating high school than those with less formal education.

“Understanding these factors may allow us to develop better strategies to increase the use of blood-pressure-lowering drugs among those with high blood pressure,” Reynen said.

The age-adjusted prevalence of high blood pressure and drug treatment sometimes varied considerably among the various groups surveyed:

African Americans had the highest prevalence of high blood pressure (35 percent), followed by American Indians (29.8 percent), Pacific Islanders (27.2 percent), those of other race/ethnicity (25.9 percent), Latinos (25.0 percent), Asians (24.5 percent) and whites (23.1 percent).

African Americans had the highest rate of drug use to control their high blood pressure (56.6 percent), followed by American Indians (53.1 percent), Asians (52.1 percent), Pacific Islanders (52 percent), whites (49 percent), Latinos (45.8 percent) and those of other race/ethnicity (44.4 percent).

“Physicians should be mindful of these kinds of associated factors when developing treatment plans, and public health officials should be mindful of them when developing public health interventions,” Reynen said. “Knowing someone’s racial/ethnic group may be helpful to us when we try to target messages to this population to tell them they need to see a physician if they have high blood pressure.”

Quotes from Heart and Soul Researcher

09/24/2007 , 10:42 AM by Alex Sicre

Here is a little follow-up to my post on 9.17.07 regarding the Heart and Soul Study. Here are some quotes from the researcher Dr Anil K Gehi from Emory University School of Medicine, Atlanta, GA. These quotes are from an article on the website theheart.com by Lisa Nainggolan 9.24.07:

“We’ve shown that simply asking the patient whether they were adherent to their medication is a pretty decent way to identify those patients we might need to focus on,” Gehi told heartwire.

“The bottom line is that medication nonadherence is a big predictor of adverse cardiovascular outcomes, and we found that the risk associated with nonadherence was equivalent to that associated with diabetes or smoking. Nonadherence is really a big deal that a lot of physicians don’t look at carefully, and it’s not a difficult thing to find out.”

“We have shown that it’s not a difficult thing to find out about adherence, but this is something that perhaps physicians overlook. Our study helps emphasize how important it is; then, something can be done about addressing the specific issues relating to adherence with that patient.”

Those who are found to be nonadherent can be targeted with a number of approaches; Gehi suggests such strategies as pillboxes, getting family involved in medication, and arranging more frequent follow-up visits.

“Also, sometimes simply explaining to a patient what a pill is for and the importance of that medication can make a big difference.”.

COMMENTS:
Uh, duh? I am greatful that this study was done to show how important medication non-adherence is to the world (also highlighted in the NCPIE study, and the WHO Study, countless articles, and this blog). But again, come on, if you don’t take your pills you are not going to be healthy. Plain and Simple.

Heart and Soul Study

09/17/2007 , 10:46 AM by Alex Sicre

Below is the Abstract from the Heart and Soul Study I found in The Archives of Internal Medicine current issue. Unfortunately I do not have a subscription, but I can see flaws in this study just looking at the methodology. I support studies like this in finding the root and causes of medication non-adherence, but self reporting has never been an acurate measure. See my comments below.

Background
Nonadherence to physician treatment recommendations is an increasingly recognized cause of adverse outcomes and increased health care costs, particularly among patients with cardiovascular disease. Whether patient self-report can provide an accurate assessment of medication adherence in outpatients with stable coronary heart disease is unknown.

Methods
We prospectively evaluated the risk of cardiovascular events associated with self-reported medication nonadherence in 1015 outpatients with established coronary heart disease from the Heart and Soul Study. We asked participants a single question: “In the past month, how often did you take your medications as the doctor prescribed?” Nonadherence was defined as taking medications as prescribed 75% of the time or less. Cardiovascular events (coronary heart disease death, myocardial infarction, or stroke) were identified by review of medical records during 3.9 years of follow-up. We used Cox proportional hazards analysis to determine the risk of adverse cardiovascular events associated with self-reported medication nonadherence.

Results
Of the 1015 participants, 83 (8.2%) reported nonadherence to their medications, and 146 (14.4%) developed cardiovascular events. Nonadherent participants were more likely than adherent participants to develop cardiovascular events during 3.9 years of follow-up (22.9% vs 13.8%, P = .03). Self-reported nonadherence remained independently predictive of adverse cardiovascular events after adjusting for baseline cardiac disease severity, traditional risk factors, and depressive symptoms (hazards ratio, 2.3; 95% confidence interval, 1.3-4.3; P = .006).

Conclusions
In outpatients with stable coronary heart disease, self-reported medication nonadherence is associated with a greater than 2-fold increased rate of subsequent cardiovascular events. A single question about medication adherence may be a simple and effective method to identify patients at higher risk for adverse cardiovascular events.

MY COMMENTS
I don’t really like the number 75% as being a proper number for adherence. It should be 100%. Diabetics need to take their pills everyday or suffer problmes with their blood sugar. What if they only chose to take those pills five days a week and skip the weekend? Does that 75% sound OK to you?

Here’s a surprising fact: if you do not take your medication, you are more than likely to have a heart attack. The national average for non-adherence is over 50% – it is astounding how they found the minority as the basis for their study. As far as I know, self reporting has never been an acurate gauge for a study.

Everyone feels guilty and will lie regarding non-adherent behavior regarding everything from flossing to diet to heart medication. Here, take these, they will save your life – oh jeez, yeah I know I was supposed to take them, but, you know, I forgot, so now I am in the hospital – but I did tell you I took them.

Patient education is an important factor, as well as side effects and financial costs when dealing with medication non-adherence. But most often, people forget and it is not in their behavior (especially with a new script) to be adherent to medication – although in this case I like compliant because if you do not take that medication, you will return the hospital and die.