VACATION MORE OFTEN

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The Journal of the American Medical Association reported in its September 2019 issue that persons who take vacations may lessen the risk of developing metabolic syndrome, a medical condition that increases the risk of heart disease, stroke, and diabetes.

Researchers noted that 74% of US workers who have paid vacation time only use half of their available vacation days. Would it make a difference in their health if more vacation time were used? The study accounted for vacation factors including location, time off work, stress experienced during vacation, cost, activities, alcohol use, sleep habits and level of disengagement from work and personal worries. Study participants were evaluated by body and blood measurements as well as lifestyle surveys.

The goal of the study was to look for a connection between vacationing and metabolic syndrome — large waist circumference, hypertension, elevated triglyceride levels, low high-density lipoprotein (HDL) cholesterol, and elevated blood glucose. Prior studies have shown that these factors can be controlled by lifestyle changes. For the 12 months of the study, participants took about 5 vacations, used 14 paid vacation days, spent 40% of their vacations at home, considered their vacations to be low-stress, didn’t drink much alcohol and slept well.

The results showed that study members had a 21% incidence of metabolic syndrome compared with 35% in the US population. Each vacation was associated with a 24% reduced risk of metabolic syndrome, and the number of vacations rather than the total number of vacation days used was associated with reduced metabolic symptoms. The probability of meeting the criteria for metabolic syndrome was 47% for those who took no vacations, 16% for those who took the average 5 vacations and 1% for those who took the maximum 15 vacations.

The study’s lead author, Bryce Hruska of Syracuse University, summed things up like this: “People say vacations are relaxing, so the thought is that if you vacation more frequently you’ve got a reduction in stress…that may translate into fewer of these metabolic symptoms.” He also said,” the important part is that you’re using your vacation.”

Can the flu shot cause the flu?

The viruses that cause influenza—the flu—change each year, making it more difficult for our immune systems to recognize and eliminate them. This, in turn, allows the flu to infect millions of people every year, causing pneumonia and other severe complications that can lead to hospitalization and death. Our best defense against the flu is to get the annual vaccination.

The flu vaccine is adjusted each year to adapt to the changes in the virus, which is why we have to get vaccinated every year. No tolerance develops to flu vaccination, so it continues to help every year.

Many patients believe that flu shots can cause the flu. However, patients who get sick after receiving the flu shot were already becoming ill at the time of their flu shot and simply did not know it yet. Controlled trials have proven conclusively that flu shots help prevent the flu and don’t cause it.

THE LOWDOWN ON HIGH CHOLESTEROL

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Cholesterol is a waxy substance that our body uses both to build cells and certain hormones. Too much cholesterol can pose a problem.  

The liver makes enough cholesterol for our needs. Dietary cholesterol, found in meat, poultry and full-fat dairy products, adds to our blood cholesterol levels. These foods also contain saturated and trans fats, which cause the liver to make even more cholesterol.

While cholesterol is circulating in the blood, it can join with other substances to form thick, hard deposits on the inside of arteries. These can narrow the arteries and make them less flexible, resulting in a condition known as arteriosclerosis. If a blood clot should form and block one of these narrowed arteries, a heart attack or stroke can occur. 

Unhealthy behaviors can be the main culprits behind high cholesterol numbers. You can improve your cholesterol levels by eating a healthy diet, increasing physical activity, avoiding smoking and exposure to tobacco smoke and losing excess weight. Heredity can also play a role if you inherit genes from parents and grandparents that cause you to have too much cholesterol. Hereditary high cholesterol can be dangerous because it can lead to early-onset heart disease.

Two types of lipoproteins carry cholesterol in the blood—low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL, the “bad” cholesterol, leads to the development of arteriosclerosis, while HDL, the “good” cholesterol, acts as a scavenger that carries LDL cholesterol from the arteries back to the liver, where it is removed from the body. Think of LDL as a litterbug and HDL as a vacuum cleaner. Triglycerides, the most common fat in the body, store energy from your diet. In combination with high LDL levels, high triglyceride levels can contribute to arteriosclerosis.

Medications can help control high cholesterol levels. While many medicines have been touted to reduce cholesterol levels, statins are clearly the most effective and are the first-line therapy for most patients needing treatment. If you have any of the following conditions, you should consult with your doctor about possibly starting statin therapy:

  • History of heart disease caused by arteriosclerosis

  • LDL cholesterol levels greater than 190

  • Age 40-75 years, with diabetes

  • Age 40-75 years, with LDL cholesterol level of 70-189 with other arteriosclerosis risk factors

There are other options for patients who do not tolerate statins.

It’s easy to get your cholesterol tested. Your doctor can arrange a fasting test (no food or beverages except water for at least 8 hours before the test). To determine your cardiac risk, your doctor will consider your cholesterol results as well as factors including age, sex, family history, smoking, diabetes and high blood pressure. Then you should have a discussion with your physician about any additional testing that may be necessary and if you should begin treatment.

Use this link to calculate your cardiovascular risk: www.cvriskcalculator.com

TOP 10 TAKE-HOME MESSAGES FOR THE PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE

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Cardiovascular disease includes atherosclerotic vascular disease(ASCVD) (hardening of the arteries), heart failure (meaning the heart is not pumping as well as usual), and atrial fibrillation (a heart rhythm problem).
Primary prevention means taking steps to prevent the first occurrence of a condition, in this case, cardiovascular disease.

According to the American College of Cardiology, these are the most important steps to take to prevent the development of cardiac disease:


1. Promote a healthy lifestyle throughout life.


2. Work with your family physician to evaluate the social determinants of health such as stress, early life, work, unemployment, food, addiction, transportation and social exclusion to inform treatment decisions.


3. If you are age 40-75 and you are being evaluated for cardiovascular disease prevention, ask your family physician to calculate the 10-year risk for ASCVD before you start pharmacological therapy.


4. Consume a healthy diet emphasizing vegetables, fruits, nuts, whole grains, lean vegetable and animal protein, and fish. Trans fats, processed meats, refined carbohydrates, and sweetened beverages should be minimized.


5. Engage in a minimum of 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity each week.


6. If you have type 2 diabetes mellitus, adopt lifestyle changes including improving dietary habits and achieving exercise recommendations.


7. Quit using tobacco products. Your family physician can provide resources to help.


8. Avoid routine use of aspirin for primary prevention.


9. Begin statin therapy for first-line treatment for the primary prevention of ASCVD if your low-density lipoprotein level (LDL) is greater than 190, you have diabetes and you are 40-75 years of age, and/or if you are otherwise deemed at risk by your family physician.


10. Make use of non-pharmacological (non-medication) interventions if you have elevated blood pressure. These measures include increasing active exercise, eating a lower-salt diet, losing weight (at least 10 pounds), and avoiding stimulants such as caffeine and pseudoephedrine.

And don’t forget to get enough sleep!

UPDATE ON ASPIRIN

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In an earlier blog, I reviewed the current recommendations for the daily use of aspirin for the prevention of heart disease in patients with known heart disease and, due to the lack of evidence, that aspirin not be used for the primary prevention of heart disease in adults with no history of heart disease.  Aspirin may be recommended by physicians for selected patients at high risk of cardiovascular disease and low risk of bleeding.

Are people really following these guidelines? A new study by Harvard Medical School researchers looked at the prevalence of aspirin use for primary prevention in Americans 40 and older.  29 million adults are taking an aspirin a day in spite of no known history of heart disease, and 6.6 million of them do so without a doctor’s recommendation. Nearly half of people over 70 and without known heart disease—about 10 million—were taking aspirin for prevention without any medical indication to do so. Aspirin use may cause excessive bleeding, allergic reactions, and other side effects. According to the American College of Cardiology, people over 70 who don’t have heart disease—or are younger but at increased risk of bleeding—should avoid daily aspirin for prevention.

If you are not sure about whether or not you should take aspirin, ask your family physician

DEEP VENOUS THROMBOSIS PREVENTION

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Deep Venous Thrombosis (DVT), a blood clot that may develop in a large vein (most commonly in the legs), is a potentially serious medical condition. In some cases, these clots can break away and travel through the bloodstream to vital organs and cause severe medical conditions or even death.

Risk factors for DVT include prolonged physical immobility, blood-clotting disorders, family history, cancer, heart disease, pregnancy, obesity, recent major surgery, and smoking.

With the summer travel season in full swing, flying and bus trips pose increased risks of DVT. Preventive measures while traveling include wearing loose-fitting clothing, regularly changing leg positions, walking, avoiding crossing the legs at the ankles or knees, and wearing compression stockings. Keeping well-hydrated is important.

Simple exercises including turning the ankles in circles, up-and-down foot pumps, knee lifts and knee to chest movements can also help. Since blood return from the legs is in part dependent upon the contraction of thigh and calf muscles any leg movement is beneficial.

For information contact your primary care physician.