Heart Health Archive

People who take frequent saunas or hot baths may lower their risk of heart problems. But be cautious if you have low blood pressure.

Soaking in a bathtub or basking in a sauna can be a pleasant way to relax. Done on a regular basis, both habits may also help prevent heart attacks and strokes, according to several studies.

"The high temperatures in a warm tub or sauna cause your blood vessels to dilate, which lowers blood pressure," says Dr. Adolph Hutter, professor of medicine at Harvard Medical School. The volume of blood your heart pumps will also rise, especially in a hot tub. That's a result of the pressure of the water on the body, which increases the heart's workload, he explains.

For monitoring conditions that contribute to heart attack and stroke, virtual doctor visits are much more convenient than in-person appointments. Where is this trend headed?

Virtual doctor visits — when you talk to a physician on a video call instead of during an in-person office exam — have been available in certain places for years. But they never really caught on until the pandemic hit earlier this year. Almost overnight, virtual care became an indispensable tool for managing coronavirus infections and other health conditions during the crisis.

In 2019, virtual visits accounted for fewer than 1% of the appointments at Mass General Brigham, a large health care system founded by Harvard-affiliated Brigham and Women's Hospital and Massachusetts General Hospital (MGH). "But during the peak of the coronavirus surge in Boston, 80% of all visits were done virtually," says Dr. Lee Schwamm, director of the Center for TeleHealth at MGH and vice president of virtual care at Mass General Brigham.

Yes, but only under very unusual circumstances. Unless you have a rare inherited heart condition, consider these examples as curiosities rather than cause for concern.

If you take a statin, you've probably noticed the bright yellow sticker on the back of the prescription bottle warning you to avoid grapefruit and grapefruit juice. This tangy citrus fruit contains compounds that interfere with enzymes that break down various medications, including statins. This can boost blood levels of the drug, which could increase the risk of side effects.

It turns out that grapefruit also contains a substance called naringenin that can cause subtle changes in the heart's carefully choreographed timing. It does this by slightly prolonging what's known as the QT interval (see "What is long QT syndrome?"). To be clear, this phenomenon only happened in some volunteers after they drank about four cups of grapefruit juice. But a handful of other substances can have a similar effect, as described in an article about these so-called arrhythmogenic foods in the July 2020 issue of Trends in Cardiovascular Medicine.

Many provide links to published research about these heart -protecting drugs. Others mention personal beliefs about statins, some of which are inaccurate.

Statins are among the most frequently prescribed medications in the United States. These cholesterol-lowering drugs help reduce the risk of heart attacks and strokes, especially for people who've already had one of those life-threatening events. But many people stop taking their statins or don't take them as prescribed, a phenomenon doctors refer to as nonadherence.

Hoping to gain some insight into this trend, researchers analyzed 11,852 posts that mentioned statins on Twitter over a five-year period. About a quarter of Americans use Twitter, which is one of the most popular social media platforms. Although many of the tweets featured ads or financial market information, nearly half were related to health issues associated with statins. Of these, more than a third provided resource information, such as a link to a published study. About 20% included personal beliefs or attitudes about statins, which proved to be quite polarized. Some people described statins as lifesaving, while others referred to them as poisonous or deadly, according to the researchers, whose study was published June 25, 2020, in JAMA Network Open.

More than 10 million adults in the US have hypothyroidism — when the thyroid gland fails to produce enough thyroid hormone to meet the body’s needs — but the vast majority of these cases are considered mild. Whether or not to treat mild hypothyroidism is an ongoing debate. There is a possible link between mild hypothyroidism and coronary artery disease, but researchers found that treating it in older people did not provide any benefit.

Research we're watching

Frail, older people with health problems may live longer if they take the blood pressure medications their doctors prescribe, according to a study published in the August 2020 issue of the journal Hypertension.

Previous research suggests that in general, older people benefit from blood pressure drugs. But trials usually don't include people with multiple medical conditions, because those health problems make longevity findings challenging to interpret.

Research we're watching

Ticagrelor (Brilinta), a drug that helps prevent blood clots, was approved in 2011 for treating people who had experienced a heart attack or acute coronary syndrome (a sudden loss of blood flow to the heart). Now, the drug can be prescribed to a broader group of people. In June 2020, the FDA expanded ticagrelor's approval to reduce the likelihood of first heart attack or stroke among high-risk people with coronary artery disease.

The expansion is based on results from a multiyear study of more than 19,000 people with coronary artery disease and diabetes at high risk for a heart attack. Participants who took aspirin plus ticagrelor were less likely to experience a heart attack, stroke, or death from heart disease compared with those who took aspirin alone.

Research we're watching

People with chronic pain may be more likely to have a heart attack or stroke than those without chronic pain, according to a study published online May 7, 2020, by the journal Pain Medicine.

From 2001 to 2005, researchers identified 17,614 Taiwanese people who had used pain relievers for at least three months. The most common causes of pain were spinal disorders, arthritis, and headaches; the pain relievers included both over-the-counter drugs and prescription opioids. For the comparison group, researchers used 35,228 people without chronic pain who were matched by age and sex to those in the first group.

If you have experienced a heart attack or undergone a heart procedure, don't neglect your mental health during recovery.

Recovery from a heart attack, heart failure, angioplasty, or heart surgery — what doctors call heart events — can be stressful. Depending on your condition, it may also involve cardiac rehabilitation. This medically supervised program focuses on exercise, diet, and lifestyle changes. While the primary focus is to help you physically, you also need to address your mental and emotional health.

"It's normal to have some anxiety and stress after a heart attack or heart surgery," says Dr. Christopher Celano, assistant professor of psychiatry at Harvard-affiliated Massachusetts General Hospital. "But how long these feelings linger, and whether they are also associated with symptoms of depression, can affect your rehab recovery success and potentially increase your risk of future problems."

News briefs

Here's a finding worth toasting if you're partial to a tipple: a study published online June 29, 2020, by JAMA Network Open linked low-to-moderate alcohol drinking in middle age with better cognitive (thinking) skills in older age. Researchers analyzed the health data of about 20,000 adults (average age 61) who took part in cognitive screenings every few years during a nine-year period and reported how much alcohol they drank each week. Men who had fewer than 15 drinks per week, and women who had fewer than eight drinks per week, were considered moderate drinkers. And they're the ones who appeared to have better word recall and vocabulary over time, and slower rates of cognitive decline, compared with people who never drank. The study is observational and doesn't prove that drinking alcohol protects the brain. In fact, the subject is debated: some studies have suggested that moderate alcohol drinking is associated with better cardiovascular health compared with heavy alcohol intake, but other studies have found that drinking any amount of alcohol increases the risk for high blood pressure and stroke. The takeaway: if you're going to raise a glass, do so only in moderation.

Image: © Ridofranz/Getty Images