 | PRx Host : | Welcome to PlanetRx Live Events. Today's guest is Dr. John Cooke, a leader in the field of heart health. Dr. Cooke, associate professor of medicine and director of vascular medicine at Stanford University School of Medicine, developed the innovative HeartBar, a specially fortified medical food product designed to help people with heart disease.
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| Dr. Cooke : | Thank you for having me. Hello, all.
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| PRx Host : | Dr. Cooke, let's begin with a general question. What have you found to be the biggest threat to heart health?
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| Dr. Cooke : | The biggest threats to heart health are the known risk factors: high cholesterol, high blood pressure, diabetes, and tobacco use.
However, there are unknown factors which are currently the subject of research. There are likely genetic factors involved in determining who is going to be more at risk for heart disease.
The good news is that there are many things that you can do to reduce your risk.
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| PRx Host : | Let's turn to some questions from the audience:
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| flika : | I have been diagnosed with high cholesterol and triglycerides for several years. I have tried all the statins and they all give me severe muscle pain. Are you aware of any lowering agents that do not have this side effect? I would add that my diagnosis is familial high cholesterol.
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| Dr. Cooke : | One statin that may produce fewer problems with muscle aches is cerivastatin, also known as Baycol. I have had two patients who had problems with statins who were able to tolerate Baycol. If Baycol doesn't work for you, high-dose niacin, 1.5 to 3 grams daily, may be effective in reducing your cholesterol.
In addition, there are bioacid resins like colestipol that can be used with niacin to further lower cholesterol. Finally, in addition to a low-fat diet, you might want to consider one of the stanol ester products that are on the market, Take Control or Benecol. These are margarines that actually lower your cholesterol. They can be found in the store or in the pharmacy, over the counter.
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| PRx Host : | Here's another question, in two parts:
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| Joanni : | My cousin, in his early 60s, insisted that although he didn't exercise and was overweight, his cholesterol level was OK so he had no need to worry about his heart. It turned out that he had six arteries blocked, and underwent major bypass surgery. What early warning signs are there for possible stroke or heart attack in a situation like this?
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| Dr. Cooke : | Obviously your cousin was incorrect in believing that just because his cholesterol was OK, he didn't need to worry about heart disease. Being sedentary and overweight puts you at risk for heart disease, even if your cholesterol isn't very high. An individual who is sedentary or who is obese is at greater risk than someone who is thin and active.
The early warning signs of heart attack are chest discomfort, particularly with exertion, with emotional stress, or after a heavy meal. Sometimes the chest pain is more of a pressure or a tightness in the chest, often the discomfort can radiate down into the left arm, or even up into the jaw.
Early warning signs of stroke include brief episodes of vision loss, weakness in an arm or leg, and inability to speak or understand speech.
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| Joanni : | He is now being told that he's in better health than he has been for at least 20 years! Assuming he eats sensibly, and exercises regularly, how long can his bypass operation reasonably be expected to remain effective?
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| Dr. Cooke : | Bypass operations involving the use of vein grafts typically last about 10 years. When the bypass is done using the internal memory artery (an artery that runs along the inside of the chest wall), it tends to last for the life of the patient. These bypasses are much more durable than vein grafts.
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| Heartless : | Can one have a second or third bypass operation?
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| Dr. Cooke : | Correct. To prevent the need for another operation, the LDL cholesterol should be under 100. The blood pressure and blood glucose should be controlled, and the individual should be vigorously active.
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| Im45 : | Can you talk briefly about good cholesterol vs. bad cholesterol?
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| Dr. Cooke : | The bad cholesterol is the low-density lipoprotein cholesterol (LDL). The good cholesterol is high-density lipoprotein cholesterol (HDL). It is thought that the LDL delivers cholesterol to the arteries, causing plaque to form. It is also believed that the HDL carries cholesterol away from the arteries and back to the liver, thereby reducing plaque formation.
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| HiC : | We know that high blood pressure can cause heart damage. With exercise and medication, my pressure is now down to 140/80. Can the effects of any damage previously done to my heart be reversed?
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| Dr. Cooke : | Yes. There is evidence that control of blood pressure can reverse some of the bad effects of prolonged high blood pressure. Prolonged high blood pressure causes thickening of the blood vessels and thickening of the wall of the heart. Control of the blood pressure, particularly with certain drugs, can cause the thickening to recede. The drugs that are probably best at causing the thickness to recede are the ACE inhibitors, calcium channel blockers, and beta-blockers. Ask your doctor about these.
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| KathyMillin : | My aunt has type 2 diabetes and is going through menopause right now. Should she be concerned about her cholesterol?
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| Dr. Cooke : | Yes. People with diabetes have a great risk of developing heart disease. If they have other risk factors, their risk of having heart disease multiplies. It's very important to control cholesterol and blood pressure in people with diabetes. In fact, recent studies suggest that it's more important to control blood pressure than it is to control the blood sugar in people with diabetes, in terms of reducing their risk of heart attack.
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| officedays : | With a work day that typically involves long, sedentary hours in front of a computer, can you recommend any exercises that can be performed at one's desk?
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| Dr. Cooke : | It's very difficult to do aerobic exercise sitting at a desk! Push away from your desk, get outside and walk, bike, swim, or jog. The best kind of exercise is an exercise that is low-impact, light-load, and done for 30 minutes daily.
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| healthynut : | What vitamins and minerals affect the heart? Are there any supplements that protect the heart specifically?
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| Dr. Cooke : | This is very interesting, and opens up a huge area of information. There is evidence that antioxidants can improve vessel function, and can slow the progression of heart disease. I think the best way to obtain antioxidants is by eating at least five or six servings of fruits and vegetables daily. Fruits and vegetables are loaded with antioxidants that can beneficially affect your heart.
There is evidence that arginine can be useful in people with heart disease. Arginine is a semi-essential amino acid that is part of our diet. It has been shown in many clinical studies that people with hardening of the arteries, or heart disease, require more arginine than people who are healthy.
The arginine is used in part to make nitric oxide. Nitric oxide is a relaxer of blood vessels, and has been shown to slow the progression of atherosclerosis and even induce regression.
My group at Stanford and others have shown that people with heart disease, given arginine supplementation, can walk farther and feel better. Studies at the Mayo Clinic show up to 150% improvement in coronary blood flow in people with heart disease who are given arginine supplementation.
There are a number of other vitamins and minerals that have important impact on the heart as well, but in the constraints of this format, we don't have time to talk about all of them.
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| zrica : | I'm working hard to reduce the amount of fat in my diet. Will this have any effect on my heart health?
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| Dr. Cooke : | In my opinion, there's been too much emphasis on reducing fat in the diet at the expense of increasing carbohydrates. A low-fat, high-carb diet can cause problems for many people. Read Gerald Reaven's book Syndrome X for a more complete understanding of the adverse effects of a low-fat, high-carbohydrate diet.
My recommendation is for approximately 50% carbohydrates, 30% fat, and 20%-25% protein. The protein should be from nuts and legumes (soy protein is a particularly good source, so tofu is a good choice), fish, and chicken. The skin should be removed from the chicken. The skin contains about half of the saturated fat of the entire chicken.
Fat is not evil. We need fat for our body, our cells, and the membranes of the cells, but the preferable fat is polyunsaturated or monounsaturated fat. Avoid saturated fat found in butter, cream, doughnuts, and French pastry.
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| JoJose : | I smoked for 10 years, but was an active semi-athlete the whole time. I am under 30 and have quit. Do you think I am OK for the future?
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| Dr. Cooke : | Yes. You've done the best thing you can for your health by stopping the use of cigarettes. There may have been some damage to your blood vessels, but with good diet and exercise, and a visit to your doctor to treat any other risk factors, you can have a good chance of being free from heart disease.
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| newmom : | My father died of a heart attack at 53. I've got two small children, ages 2 and 5. Should I be concerned for their heart health? How much of heart health is genetic?
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| Dr. Cooke : | There is certainly a genetic predisposition. When your children are teenagers, it will be worthwhile having them seen by a preventive cardiologist or internist who is particularly interested in prevention of heart disease. Some of the familial risk factors have been discovered (homocysteine and lipoprotein A). They should be checked, and by the time your children are teenagers, there may be some others to look for. There are specific therapies for these familial risk factors that your doctor can tell you about. In the meantime, make sure your children get plenty of exercise and eat a diet that's rich in fruits and vegetables, and low in saturated fat.
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| richard : | Dr. Cooke, I've heard stories of perfectly healthy athletes who have suddenly died of heart attacks. What might cause this?
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| Dr. Cooke : | The causes of sudden death in young athletes are multiple. In some young athletes, there is a problem with their heart that was present at birth: The vessels to the heart may be abnormal, or there may be abnormal thickening of the heart. In other young athletes, the use of drugs, cocaine in particular, puts them at risk.
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| beth : | This may seem an odd question but I have always had very low cholesterol and am told that people on the very low cholesterol end may not develop heart disease but are at greater risk for other diseases -- is this true?
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| Dr. Cooke : | Partly. Sometimes low cholesterol can be an indication of other things. Low cholesterol can be seen in someone who has hyperthyroidism, who is not absorbing their food properly, or who has a tumor. However, if you've always had low cholesterol (for several years at least), and you feel healthy, then you should have nothing to worry about.
My cholesterol is quite low (total cholesterol of 140), with a "bad" cholesterol of 70 and "good" cholesterol of 70. This is in part due to diet and exercise, but since my siblings also have low cholesterol, it may also be partly genetic. People may have the same diet, but may have different cholesterol values, because of the influence of genetics.
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| Carl12 : | When should I get my cholesterol tested? What exactly does this test involve?
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| Dr. Cooke : | If you have no family history of heart disease, then you should probably get your cholesterol checked when you are in your early 20s. If it's low, there's nothing more you need to do. If it's high, your doctor will recommend a program of diet and nutrition. If your cholesterol is low to begin with, I would say to recheck it every five years or so thereafter. If it's high, you need to start a diet and nutrition program and have your cholesterol checked in about eight weeks to determine if the diet and exercise program is working.
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| Francine : | My mother has been taking HRT for about five years and has decided she'd like to wean off it. Are there any non-drug steps she can take to protect herself against heart disease?
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| Dr. Cooke : | Yes, possibly. There is some evidence that phytoestrogens may help protect women from heart disease. Phytoestrogens are plant substances that have estrogen-like properties. People who consume high amounts of phytoestrogens have lower heart disease rates. The best sources of phytoestrogens are soy protein products.
Populations that consume large amounts of soy have less heart attack risk. Women who consume high amounts of soy or soy supplements have healthier bones, fewer menopausal symptoms, and better functioning blood vessels.
However, it has not yet been shown that the administration of soy supplements or soy protein can prevent heart attack, although population studies suggest this might be the case.
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| Dreamer4life : | I am a 32-year-old woman in basically good health, except for chest pains and tightness that have become more frequent over the last few months. Two doctors have diagnosed the problem as stress-related -- one used the term "panic attacks." Other than a central nervous system depressant such as Ativan (which I would like to avoid), are there any other appropriate medications that could be taken safely over the long term?
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| Dr. Cooke : | One has to be convinced that the diagnosis is correct. The treatment may be very different, depending on the diagnosis. There are many things that can cause chest pain in a young woman. Usually, it is stress. Sometimes it can be mitral valve prolapse or costochondritis (inflammation of the rib cage). There are other causes of chest pain in young women, such as pulmonary hypertension, but this is much less likely.
However, if you are not happy with the current diagnosis, you might want to see a cardiologist to get another opinion, because the treatment is going to be very different depending on what is the cause.
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| PRx Host : | Dr. Cooke, can you tell us about HeartBar? What inspired it and how does it work?
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| Dr. Cooke : | The HeartBar was inspired by my work at Stanford. My work has been to understand nitric oxide, a molecule made by the blood vessels. Nitric oxide is a strong relaxer of blood vessels. Three American scientists won the Nobel prize for discovering that blood vessels make nitric oxide.
At Stanford we have shown that nitric oxide also prevents atherosclerosis, in addition to relaxing the blood vessels. Furthermore, we have found that people with heart disease make less nitric oxide. We have demonstrated that one can increase the level of nitric oxide in people with heart disease by giving them arginine, the precursor for nitric oxide. It is a semi-essential amino acid that we get in our diet. People with heart disease require more arginine so that they can make enough nitric oxide to relax their blood vessels.
Studies at Stanford and other medical centers, including the Mayo Clinic, have shown that people with heart disease can feel better and walk farther without pain when given arginine supplementation.
The problem with arginine supplementation is that you have to take 12 to 18 500-mg capsules a day to achieve a beneficial effect. To make it easier for people to get arginine supplementation, we have put it into a medical food bar, which contains arginine as well as other nutrients for the heart, such as vitamins E, C, B-6, B-12, and folic acid, in a soy protein base. We have done several studies now with the HeartBar and have shown that it improves blood flow and relieves pain in people with cardiovascular disease, improves their quality of life, and allows them to exercise longer. The HeartBar is available over the counter at PlanetRx.com.
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| Gonnabeamom : | Should older pregnant women have special concerns about blood pressure and cholesterol?
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| Dr. Cooke : | In terms of pregnancy, the major concern is with blood pressure. A woman with high blood pressure is more likely to have an increase in blood pressure during pregnancy. She should be seeing a doctor who has expertise in the treatment of high blood pressure in pregnancy. High cholesterol is less of a problem during pregnancy. However, for your long-term health, controlling your cholesterol will be important.
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| Quitter : | I know smoking is bad for you, and stopped smoking myself 15 years ago. How exactly does smoking harm the cardiovascular system?
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| Dr. Cooke : | Great question! We're studying this at Stanford. No one knows for sure. We do know that people who smoke have a much greater risk of having a heart attack or a stroke. If they've had a bypass graft, it's more likely to close. If they have an ulcer on their foot, they're more likely to need an amputation. So smoking is very bad for you if you have heart disease.
It's also very bad if you don't have heart disease, because smoking contributes to it. However, the mechanism by which tobacco causes heart disease is not known for certain. We do know tobacco smoke contains a lot of nasty free radicals. These free radicals can damage your blood vessels as well as your lungs.
In addition, work in my laboratory indicates that nicotine can cause plaques and tumors to grow by supplying small blood vessels to the tumor or to the plaque.
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| Jerrianne : | We hear of people living way past 100, and anything from regular consumption of red wine to a daily dollop of yogurt is given credit for their longevity. Does either red wine or yogurt actually contribute to heart health?
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| Dr. Cooke : | There is evidence that alcohol in moderation can reduce your risk of heart disease. Specifically one to two glasses of wine (red or white) or one to two beers or drinks daily can reduce your risk of heart disease. But once you begin to drink more than that (three or more drinks per day), you start to run the risk of increasing your chance of heart disease. Alcoholics often have high blood pressure, for example.
Red wine does have some special antioxidants in it that are at least as potent as vitamin E (these antioxidants are known by the chemical names resveratrol and quercetin). They may contribute to the healthful effects of red wine. But alcohol itself seems to be protective to your blood vessels, probably because it raises your good cholesterol (HDL). So put your feet up tonight and have a glass of wine! I don't know about yogurt.
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| Shannon : | Are there any new technologies that you know of that might make heart surgery more effective or safer, or anything like that?
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| Dr. Cooke : | There are far too many angioplasties and heart surgeries being done in this country. The best approach is to avoid heart surgery and angioplasty by exercise and diet.
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| PRx Host : | Here's a question that I'm sure many would like answered:
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| AndyandAndy : | Can I earn my McDonald's? I mean, will exercise actually keep cholesterol from sticking in my veins?
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| Dr. Cooke : | Probably not, although it has been shown that the administration of antioxidants with McDonald's Happy Meals can reduce the vascular impairment that occurs after eating one.
One study showed that after eating one McDonald's meal, the ability of the blood vessels to relax is impaired for several hours after the meal. Having one McDonald's meal drives down your vascular function (the ability of your blood vessels to relax ) by half. If you're a perfectly healthy person, you will recover after one McDonald's meal. I don't know what would happen after a thousand, or if you weren't perfectly healthy.
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| Patrick : | We hear that low levels of vitamin E, beta-carotene, and vitamin C may put a person at risk for heart disease. Are there any recommended amounts of these vitamins, to offset this risk?
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| Dr. Cooke : | Actually, there is evidence that low doses of beta-carotene can have an adverse impact in smokers. I do not recommend beta-carotene for my patients with heart disease. I do recommend antioxidant therapy for people with heart disease. However, the best source of antioxidants are in fruits and vegetables, which contain vitamins C and E, in addition to many other chemicals that are beneficial antioxidants.
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| PRx Host : | Are there interesting developments on the horizon for heart health?
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| Dr. Cooke : | One very interesting area is angiogenesis, or "biological bypasses." It turns out that the body is able to grow new blood vessels around obstructions. When a blood vessel becomes occluded, the body tries to compensate by growing small threads of vessels around the occlusion. We now understand the growth factors that cause these new vessels to form. These growth factors are now being used in clinical trials to try to improve the blood flow in hearts and limbs of people that have occluded heart vessels or leg vessels.
Another area of great interest, particularly at Stanford, is the detection of genes that may put us at more or less risk of having a heart attack or stroke. Now that the human genome has been mapped, we can begin to understand which of these genes might be playing a role in heart disease.
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| PRx Host : | This has been very informative, Dr. Cooke! Do you have a website where our users might find more information about heart health?
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| Dr. Cooke : | You can go to www.cookepharma.com for more information about heart health, and also to http://cardiology.stanford.edu.
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| PRx Host : | Thanks so much! It's been a pleasure having you!
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| Dr. Cooke : | Thank you!
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