My Adventures with Heart Failure

Ladies Home Journal had a short blurb, which I can't find amongst my clippings right now, about how and why blood thinners help reduce the chances of SCD from atrial fibrillation. I don't remember the details of how it does that, but I do remember the statistics they cited in the column: if you are at risk of atrial fibrillation, and you don't take any blood thinners, you have a 1 in 20 chance of having an incident that could kill you, each year. [Note, my own EP says it's one in 17, not one in 20; I suppose they were rounding off.] If you take low-dose aspirin as a blood thinner, that lowers your risk to 1 in 40 - only half the chance. And if you take coumadin, it lowers your risk to a 1 in 70 chance each year.

So, even if you don't need blood thinners because of clotting risks, apparently you should take them because of fibrillation risks. While taking a strong blood thinner such as coumadin can carry its own risks - I ride a motorcycle, so I'd never take a prescription strength blood thinner, since it could make even a mild accident fatal - taking "baby aspirin" has far fewer risks and apparently accomplishes a lot. And, according to my cardiologist, if you take a proton pump inhibitor, such as Prilosec (available over the counter), it reduced the chances that aspirin will give you stomach ulcers. On the other hand - and isn't there always an other hand? - proton pump inhibitors such as Prilosec and Protonix (one of the newest prescription ones) are in one of the classes of drugs that can lead to increased risk of arrhythmia (see post about 9 posts down from this one). So it sounds like we've come full circle, hasn't it!! Apparently, if possible, to reduce your fibrillation risk in an optimum manner, you should take the low-dose aspirin without the proton-pump inhibitor, if possible.

It gets more complicated all the time.

This week's article:

Common painkillers may raise risk of heart failure

May 23 (Reuters Health) - Patients who use non-steroidal anti-inflammatory drugs (NSAIDs), which include over-the-counter analgesics such as ibuprofen or naproxen, have a small increased risk of experiencing a first hospitalization for heart failure, researchers from Spain report. They also found that for patients with pre-existing heart failure, NSAIDs may worsen the condition, triggering the need for hospital admission. ...

With current NSAID use, the overall risk of a first hospitalization for heart failure was increased by 30 percent after accounting for major heart failure risk factors, report Huerta and colleagues from Centro Espanol de Investigacion Farmacoepidemiologica in Madrid.

The increased risk of heart failure hospitalization associated with individual NSAIDs ranged from 10 percent with diclofenac to more than threefold with indomethacin. The dose and duration of use of the drugs had no apparent effects.

Heart failure hospitalization was also associated with known risk factors including high blood pressure, diabetes, kidney failure, other heart disease and anemia. Obesity, smoking, alcohol use, and recent hospitalizations and specialists' visits -- two indicators of other illness -- were also associated with an increased risk of hospitalization.

However, a prior diagnosis of heart failure was the main risk factor triggering a first hospitalization for heart failure, increasing the risk by more than sevenfold.

The investigators point out that their results are compatible with the findings of other published studies indicating that NSAIDs exacerbate heart failure symptoms, leading to hospitalization among susceptible patients, such as those with a history of cardiovascular disease and, in particular, previous heart failure.

The new study adds the finding that NSAIDs trigger the risk of hospitalization for heart failure in patients without a history of heart failure, the researchers conclude.

SOURCE: Heart, May 2006.

Science News has a short blurb mentioning that they've found out exactly what it is that makes it a bad idea to eat grapefruit or drink grapefruit juice when taking certain medications. Lipitor, for example, and the other statins, which most of us with almost any heart problem seem to be taking. So anyway, it turns out to be certain compounds called furanocoumarins, which are in grapefruit juice but not in other citrus juices, that are the metabolism-interfering compounds. Since the furanocoumarins can be filtered out of grapefruit juice, this may mean that in the not too distant future, those of us on medication can start drinking grapefruit juice for breakfast again! Whee! Don't know as there's any way to do that with fresh grapefruit, though; I guess we'll have to keep on eating those high-in-potassium canteloupe halves instead of grapefruit halves. Oh well.

More ICD news

Boston Sci finds battery problem in some devices

May 16 (Reuters) - Boston Scientific Corp. on Monday said it had notified doctors that some of its implantable cardiac devices, which it acquired as part of its purchase of Guidant Corp. last month, could be at risk for early battery depletion.
Boston Scientific, whose shares fell 1 percent, said the problem occurred in a single lot of 996 implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillator devices that had been implanted in patients globally. No deaths or injuries were reported.

Implantable cardiac devices, or ICDs, are used to jolt a dangerously racing heartbeat back to a normal rhythm. Several models of the life-saving devices have been the subject of recalls or safety alerts by Guidant and other manufacturers in recent years.

Boston Scientific said 30 of its Guidant devices had been returned by May 8, and it had received an additional 46 reports of devices that remained implanted but showed signs of premature battery depletion.

The devices, which contain a faulty component from the single manufacturing batch, are in the Vitality DS, Vitality AVT and Vitality 2 ICD lines and the Contak Renewal 3, Contak Renewal 4 and Contak Renewal 4AVF lines of CRT-Ds.

In information posted on its Web site, Boston Scientific advised doctors to schedule follow-up appointments as soon as possible with patients who had received the devices and contact the company for instructions to determine remaining battery life of the devices.

The battery problem came to light after an overall review of Guidant's product lines, Boston Scientific said.

Boston Scientific swooped in to buy Guidant for about $27 billion after Guidant initiated a series of device recalls and was stung by criticism over its failure to promptly notify physicians and the public about life-threatening defects.

"We understand and acknowledge we have to do a better job of communicating, and this is a step in that direction," Boston Scientific spokesman Paul Donovan said.

Boston Scientific also advised doctors of two device malfunctions linked with implantation of Guidant defibrillators in an unusual position.

Planting one of these devices below the chest muscle, rather than below the skin, can result in mechanical stress to an area of the titanium case that can cause the product to malfunction, the company said. The uncommon technique could affect devices in the Renewal 3, Renewal 4 and Vitality HE product lines.

The two patients whose devices malfunctioned underwent successful replacement procedures, Boston Scientific said.

Morgan Stanley analyst Glenn Reicin said the product notifications stem from an approach adopted by Guidant last year to update physicians regularly about performance issues.

"Investors should view these communications as normal course of business," Reicin said in a note to clients.

Boston Scientific is currently working to resolve a warning letter from the U.S. Food and Drug Administration over quality control issues. The Guidant division also faces its own FDA warning letter over its ICDs.

Here's a relatively low-sodium macaroni and cheese recipe. Please note that this recipe is NOT low-fat; I don't know of any way to make mac-n-cheese that is low-fat, low-sodium, and tasty all at once; at most, you can get two of those together. This one is low-sodium and tasty. There are footnotes telling you where some of the ingredients are available.

Macaroni Quattro Formaggio
Cook 12 ounces of elbow macaroni or other small-to-medium pasta (tiny shells, rotini, radiatore, etc.) according to directions on package.
Grate an 8 ounce bar of low-sodium cheddar cheese⁽¹⁾. Dice up 4 ounces of FRESH mozzarella cheese⁽²⁾. (If you have an ounce or so of leftover swiss⁽³⁾ (gruyere, emmenthaler) cheese, you can grate that and add it too.) Mix these cheeses with the macaroni, and place in a casserole dish. Over the top of the macaroni, sprinkle about 2 ounces of grated Parmesan and Romano cheese⁽⁴⁾, then on top of that, about 2 ounces (1/4 cup) of low-sodium seasoned dry bread crumbs⁽⁵⁾, spreading the Parmesan/Romano and the crumbs as evenly as possibly across the whole top of the casserole. Then slice up 2 tablespoons of unsalted butter, and dot the top of the casserole with little chunks of butter. Over the whole thing, pour a can of evaporated milk - depending on where you live, that's somewhere around 8 to 12 liquid ounces; the exact amount isn't critical as long as it's at least 1 cup and not more than about a cup and a half. Place the dish, uncovered, in a 350°F oven, for 25 minutes, then switch the oven to BROIL and 400°F for 3 minutes, to brown the crumbs on top. Let the dish cool for about 5 minutes before serving.Serves 4 to 6 people as a main course, depending on the people.

To fancy it up some, drain a can of no-salt-added diced stewed tomatoes, and add them in when you are first mixing the macaroni with the cheddar and mozzarella.

The leftovers are extremely tasty cold, too; it can be served as slices, along with a salad.

(1) Heluva Good makes low-sodium cheddar; if you can't get your local supermarket to order some, you can order directly from the company. You'd better like cheese though, since it's a minimum of 4 bars.
(2) Most larger supermarkets will carry a national brand of fresh mozzarella, such as Bel Giorno, which has about 70 mg of sodium per ounce. Fresh mozzarella comes in round balls floating in liquid, by the way. If you can find some from a local dairy, though, those fresh mozzarellas often have as little as 15 mg of sodium per ounce. High-end markets such as Whole Foods, Central Market, etc. will usually have local-dairy mozzarella in their cheese assortments.
(3) Swiss cheeses vary greatly in their sodium, so you have to check the labels, but there are quite a few brands that run only 50-75 mg of sodium per ounce, including the house brand from Giant, and the commonly available Alpine Lace brand.
(4) Parmesan and Romano, or any grated cheese intended for spaghetti, can vary widely in sodium, too. This will be the highest in sodium of the cheeses in this recipe. But you can find one that has 75-100 mg of sodium per serving compared to others that have 150-180 mg of sodium per serving, and that's what to look for.
(5) Healthy Heart Market, see the link at right, carries low-so bread crumbs. They also have the canned no-salt added tomatoes, if you decide to add those.

This week's article:

How exercise helps heart failure patients
May 04 (HealthCentersOnline) - A small study may help explain why aerobic training helps to reverse the abnormal heart patterns that appear in patients after experiencing heart failure.
Heart failure is chronic condition in which at least one chamber of the heart is not pumping well enough to meet the body's needs. This leads to congestion in the lungs or pulmonary blood vessels and may cause fluid to back up in the lungs, legs and ankles.

Previous research has demonstrated that aerobic exercise can help a person with heart failure feel and function better. Now, new research suggests that this response works by suppressing certain neurohormones that cause many of the severe symptoms of heart failure.

Following certain cardiac events (e.g., heart attack), the body works to protect itself in the short term by increasing its production of certain types of B-type natriuretic peptides (BNP). These neurohormones constrict blood vessels and help heart cells to retain sodium, which allows the heart to continue to pump blood effectively.

However, over a period of time an imbalance of the BNP neurohormones can become detrimental, leading to irregular heart rhythms, tissue buildup and the accumulation of fluid in the heart.

Researchers from Italy have found that aerobic exercise helps to improve the effects of heart failure by lowering some types of BNP. The researchers studied 47 heart failure patients who had entered a nine-month aerobic training program. The 44 patients who completed the program reported an improvement in their quality of life significantly greater than a similar control group (that did not include heart failure patients). Testing also revealed the heart failure patients had lowered levels of three types of BNP.

"Reversing neurohormonal activation by physical training adds to the current clinical practice a novel non-pharmacological aid. Out of 85 patients who completed the protocol, only the 44 randomized to the training program improved functional capacity, systolic function, and quality of life, in contrast to the controls. These beneficial effects were associated with a decrease in plasma level of BNP, NT-proBNP, and norepinephrine, only in the training group," explained Claudio Passino, M.D. from the CNR Institute of Clinical Physiology in Italy, in a recent press release.

The results of the study appear in the May issue of the Journal of the American College of Cardiology.