Category: Heart Health

lipid disorders and heart disease
FAQs with Ashley Davila: Lipid Disorders and Heart Disease Prevention
Posted on by Leslie Branon

If you have been diagnosed with a lipid disorder, you are at an increased risk for developing heart disease, which is the leading cause of death worldwide. At Texas Diabetes and Endocrinology, we believe that cardiovascular risk reduction and prevention is one of our most important jobs.

Cardiovascular risk assessments help our patients gain better control of their health by identifying underlying conditions that can cause a heart attack or stroke. We offer advanced lipid and Carotid-Intima-Media Thickness (CIMT) testing and treatments designed to prevent cardiovascular disease.

In this blog, advanced practice provider and clinical lipid specialist Ashley Davila, MSN, ACNS-BC answers some frequently asked questions about lipid disorders and heart disease prevention.

What does it mean to have a lipid disorder?

​A lipid disorder is a broad term that encompasses patients who have abnormalities in their cholesterol or lipoprotein profiles and often these disorders place patients at increased risk for cardiovascular disease.

Who is a candidate for advanced lipid testing?

Advanced lipid testing is very informative for patients with metabolic issues (i.e., diabetes, insulin resistance) as it measures lipoprotein particles instead of just cholesterol. There are often abnormalities in lipoproteins that would not be readily identifiable with just a standard cholesterol panel. Advanced lipid testing is also very useful in patients with significant artery disease or strong family history of significant artery disease.

Who is a candidate for Carotid Intima-Media Thickness (CIMT) testing?

CIMT is a non-invasive test to assess the health of the arteries. It can detect the earliest changes seen in the arteries – thickening in the intima-medial space. CIMT is recommended for younger patients who have significant family histories related to heart disease.

Heart Disease Prevention

By following these preventative measures, you can greatly lower your risk of developing heart disease. 

Exercise regularly

One of the most important things you can do to prevent heart disease is to exercise regularly. Getting your heart rate up and breaking a sweat helps to strengthen your heart and cardiovascular system. Aim for at least thirty minutes of moderate exercise most days of the week. 

Maintain a healthy diet

A diet low in saturated and trans fats, added sugars, and salt can help lower blood pressure and cholesterol, two major risk factors for heart disease. Focus on eating plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats like those found in nuts, seeds, and fish.

Quit smoking

Smoking damages the lining of blood vessels and increases the risk of blood clots. If you smoke, quitting is one of the best things you can do for your heart health. 

Manage stress

Stress can take a toll on your heart health, as chronic stress can lead to high blood pressure and inflammation, both of which increase the risk of heart disease. Take steps to manage your stress levels, such as practicing relaxation techniques like meditation or yoga, getting regular exercise, and getting enough sleep.

Regular check-ups and screenings

Regular check-ups with a doctor can help identify and manage risk factors for heart disease. Your doctor can measure your blood pressure, cholesterol, and blood sugar levels to ensure that they are within healthy ranges. 

Limit alcohol consumption

While moderate alcohol consumption has been linked to a lower risk of heart disease, excessive drinking can have the opposite effect. Drinking too much alcohol can lead to high blood pressure, heart failure, and stroke. 

Lipid Disorder Treatment 

Lipid disorder treatment is determined by a patients’ underlying health conditions, cholesterol levels and age. Lifestyle changes are the first line of defense in fighting lipid disorders. In some cases, medication and supplements for cholesterol management may be recommended. Remember to always consult with your doctor before making any major lifestyle changes or beginning a treatment regimen. 

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Advanced Lipid Tests
Posted on by Katy Farr

Fish Oil (Omega 3 fatty acids has been touted as a having heart and vascular protective effects for many years.  In 2018, a number of large clinical studies including studies in people with diabetes showed that fish oil had little to no effect in reducing cardiovascular events.  This was quite disappointing to doctors and patients alike and many stopped taking fish oil.

 

  • Then in 1/19 a large study called the Reduce-It Trial was published in the New England Journal of Medicine.  It looked at the effect of an Omega 3 fatty which was a specific component of fish oil—EPA or icosapent ethyl in people with known heart disease and/or diabetes.   Let me tell you a bit about the people enrolled in the study.  The study included people who were 45 years of age or older with known heart disease OR who were 50 years of age or older and diabetes mellitus and at least 1 additional heart risk factor.
  • They had to have a fasting triglyceride of 150-499 mg/dl and their cholesterol had to be already well controlled on a statin.  The LDL cholesterol at the start of the study was really very controlled and was in the mid 70’s.
  • The study went on for 5 years.  The remarkable finding was that the icosapent ethyl reduced cardiovascular death, heart attack and stroke considerably.  This was phenomenal news to those of us who every day, treat people with heart disease and heart disease risk.

 

In summary, in the past year, we learned that regular fish oil doesn’t have the heart disease reduction effect that was claimed but that a specific derivation of fish oil, the omega 3 fatty acid icosapent ethyl (only available by prescription) reduces cardiovascular death and heart attacks and strokes in the people described above.

 

We at Texas Diabetes and Endocrinology continually strive to be current and at the forefront of using interventions to reduce heart attack and stroke risk.  We are experts in diabetes and heart risk factor management.  One of our doctors and one of our clinical nurse specialists, Ashley Davila CNS, are boarded in Lipidology.  We are also members of the National Lipid Association.   We perform noninvasive heart disease risk assessments with an easy ultrasound based arterial assessment called Carotid Intimal Medial Thickness (CIMT).  We also obtain “advanced lipid tests” in many individuals to help in their cardiovascular risk reduction/prevention.

 

We have participated in many clinical research studies evaluating a number of medications used to lower cholesterol.  We are soon enrolling a study to evaluate the effect of a medication on lowering Lp(a) also called lipoprotein little a, which is an important indicator of heart attack and stroke risk.  If you or any of your family has been told that you have an elevated Lp(a), please call our office and ask for the research department.

 

Statins & Diabetes
Posted on by Misha Diden

Despite great strides in health care, heart disease remains the number one cause of death in the United States. Individuals with diabetes are three times more likely to develop heart disease, heart attack or stroke than someone without diabetes. We at TDE take this very seriously and work with our patients to reduce their cardiac risk. Of course the best approach to healthcare is prevention: maintaining an optimal weight, engaging in regular exercise and enjoying a healthy diet low in saturated fats. However, when cholesterol can’t be controlled with lifestyle changes alone, statins are an excellent option.

Why statins?
Statins such as Lipitor and Crestor have been researched extensively with studies showing a powerful reduction of LDL (bad) cholesterol (20-60%) and more importantly, a significantly reduced risk of heart attack and stroke. Statins reduce production of LDL cholesterol and triglycerides and can increase HDL (healthy) cholesterol levels. Statins have also been shown to have anti-inflammatory properties and may reverse damage from atherosclerosis in some cases. Further studies have suggested a connection between statin use and a decreased risk of developing some forms of dementia as well as improved outcomes in patients with heart failure and cardiac bypass surgery. The American Diabetes Association recommends statins for individuals with known cardiovascular disease, prior heart attack or stroke, high levels of LDL and those with diabetes between the ages of 40 and 75 years.

What is the impact of statins on blood sugar?
The news recently reported the results of a study linking the use of statins to an increased risk of diabetes. This is of course a concern as the goal of statin therapy is to reduce risk. It is true that statins can cause a mild increase in blood sugars in some individuals and bears watching. However, given the cardiac benefits, the American Diabetes Association issued the following statement, “The clear benefits of statins on cardiovascular disease likely outweigh any potential detrimental effects on glucose metabolism and diabetes risk.” A representative from the Food and Drug Administration stated, “Clearly we think that the heart benefit of statins outweighs this small increased risk.”

What about side effects?
Side effects are an important consideration whenever starting a new medication. Studies have suggested that adverse side effects occur less often with statins than with most other classes of cholesterol lowering medications. The most common side effect is muscle soreness. This can be related to the dose of the statin or vary with the type of statin being used. We also follow liver enzymes in patients taking statins as these markers can rise in some people. Most patients tolerate these medications very well and the American Association for Clinical Endocrinologists continues to recommend statins as the preferred treatment for cholesterol reduction. When starting any medication it is important to discuss the risks and benefits with your health care provider.