It happens to the best of us. We have great hopes and expectations for our exercise program, swearing that we will hit the gym daily but ultimately feeling dejected at what we consider a failure of motivation leading back to the couch. If this describes the past several years of your life, you are most certainly not alone. Starting an exercise program after months or even years of sitting on the sidelines can be daunting, mainly because it’s the most challenging right at the beginning when you must push yourself and feel a little pain to get the gain. This might be further complicated by any heart health issues, which may scare you into believing that exercise will cause your heart to overload or somehow shut down.
There are several apparent symptoms of coronary artery disease that virtually all of us understand and should not be ignored. Chief among them is angina or chest pain, often a warning sign of an impending heart attack – caused by the blockage of arteries that feed the heart. However, many patients experience a phenomenon known as peripheral artery disease, or PAD, a far less known condition that involves partial occlusion of the arteries in the extremities – the hands and the legs.
Peripheral artery disease comes in several stages, the first being relatively mild. Patients often don’t experience significant problems but may feel pain in their legs or arms during exercise. This is because as the blood flow to the extremities increases, the arteries can’t deliver enough blood (due to blockage), leading to an oxygen deficiency. In the later stages of PAD, more significant symptoms may occur. This can include cold, shiny skin, loss of hair in the extremity, pain in the extremities, even at rest, and more.
These days, heart health has become a loosely used term. And while the theory behind heart, healthy foods, drinks, and activities are important to understand, how can one practice a healthy heart lifestyle in “real” life? In other words, with all the temptations around us, what can we do to prolong our heart health and, frankly, our lives?
The most important thing to understand about heart health is that it is not a zero-sum game. If you have been following lax dietary and exercise habits and experiencing high cholesterol, hypertension, diabetes, or other metabolic concerns, it’s important to remember that these did not develop overnight and will not be fixed immediately. Getting back to a heart-healthy lifestyle is a continuum that will start with minor improvements that eventually lead to more considerable successes—being heart-healthy means changing habits for the better but doing so sustainably.
Plenty of data supports the concept of incremental improvements leading to long-term overall success. These improvements may seem small, but as we stack one on the other, we slowly but surely reach our goals.
If you’ve been following the news lately, you’ve probably seen much coverage on using OzempicTM, a diabetes drug approved in 2017 by the FDA, and WegovyTM (with the same active ingredient), approved in 2022 for certain obese patients. These drugs, and others like MounjaroTM and RybelsusTM, have been in such high demand that we are experiencing the effects of production shortfalls. Notably, while Ozempic and Mounjaro are diabetes drugs, they can still be prescribed “off-label” by qualified physicians and clinicians.
Let’s discuss whether these drugs make sense for a patient concerned about heart disease, and in doing so, we will focus on the two drugs (both Semaglutides) that have garnered the most headlines – Ozempic and Wegovy. Ozempic has apparent positive effects on type-2 diabetes by reducing blood sugar levels through improved insulin sensitivity in type two diabetics. While taking the drug, most patients ate less and lost weight, leading the developer to seek FDA approval for a new higher-dose indication as a weight loss therapy – Wegovy was brought to market last year.
Erectile Dysfunction, or ED, is right up there alongside heart disease, striking fear into the hearts of men everywhere. In fact, ED affects more people each year as our population gets older and our diets and lifestyles get decidedly less healthy. But let’s talk about ED and how it can possibly be a warning sign of future coronary artery disease.
To start, we must understand more about the blood vessels in the body. The blood transport mechanism is an unbelievably complex series of progressively smaller blood vessels that deliver critical oxygen to every cell in the body. You can imagine, therefore, that when blood flow is slowed or interrupted, the result is not good. When we talk about ED, we now know that the problem is primarily vascular in middle-aged and older men, and the mental health concerns that we once blamed it on don’t seem to play as big a role as we once thought. In fact, it’s widely accepted that if patients experience erectile dysfunction in their middle age or older, they are likely to have a cardiovascular concern or, at the very least, a heightened risk for future heart problems.
Starting a new exercise regimen can sometimes be nerve-racking if you’ve been diagnosed with heart (cardiovascular) disease. You know you have to do it, but one can’t help but wonder how it will affect your heart and if it will trigger a cardiovascular event. To be sure, any new exercise program should be discussed with your cardiologist to ensure maximum safety. But there are a few tried and true exercise programs that virtually everyone can pursue. One such program is known as zone 2 training or base training. When you think about training programs, you are often pushed toward HIIT, which involves bursts of high-intensity exercise. To be sure, there is a place for this kind of training, and with proper oversight from your medical team and exercise physiologist, it can be very successful. However, HIIT, typically higher zone training, does not create that base level of endurance and cardiovascular function that zone 2 can.
When we talk about peripheral artery disease or PAD, we often focus on one of the most common causes of atherosclerosis, cholesterol. After all, excess fat in the bloodstream caused by high blood cholesterol is why plaque begins to form on the walls of the arteries. However, focusing only on cholesterol misses other serious concerns that may increase the risk of PAD, including type 2 diabetes, also known as adult-onset diabetes. Diabetes is a significant concern in the United States and worldwide. In fact, according to the WHO, the incidence of diabetes worldwide almost quadrupled between 1980 and 2014.
If you’ve been following our blog, you know there is much to learn about peripheral artery disease or PAD. The condition is insidious in that its symptoms are not always obvious. When they do become apparent, a patient may have already progressed to a more severe stage requiring significant intervention and ultimately leading to a higher potential for disability.
When we talk about PAD, we usually discuss its detection and treatment. This makes sense because it is estimated that two out of every three PAD patients don’t know they have it. Getting the word out and educating patients about their risks is essential.
However, once we have started treating PAD, many patients rightly want to understand more about how the treatment is going and whether it has been successful. There are a couple of ways to do that.
In what could only be described as shocking research, a recent study of 22 children has found that electronic video games can cause dangerous ventricular arrhythmias in kids, with those having congenital and/or proarrhythmic heart issues being the most at risk. Of those 22 kids, six experienced cardiac arrests, and four died. Ten kids had been previously diagnosed with catecholaminergic polymorphic ventricular tachycardia, four had long QT syndrome, and two underwent prior congenital heart surgery. These children seemed to have the highest risk of syncope – unexplained fainting – or even death after playing certain electronic games.
We have known that athletic kids with congenital heart problems can develop arrhythmias, some life-threatening, due to the exertion on the heart. But this was the first review to delve into electronic games, especially those not requiring physical activity. One would assume that playing a game would not have a similar effect on the heart as vigorous physical exertion, but that seems not to be the case.
There has been quite a bit of debate in the medical and diet community about a recent study entitled Calorie Restriction with or without Time-Restricted Eating in Weight Loss which showed, in essence, that intermittent fasting was no more successful in providing weight loss than caloric restriction.
First, let’s talk about how this study was misinterpreted. Many media outlets interpreted this study as saying intermittent fasting was ineffective. However, other studies have shown this not to be the case. Some thoughts: