Choose Wisely: An EKG?

Should an EKG (electrocardiogram- the heart tracing) be a ROUTINE part of your annual physical? NO- not unless you have risk factors that suggest otherwise! I am blogging this month about the American Academy of Family Physician's recommendations for tests and procedures that patients and doctors should question. The Choosing Wisely campaign is focusing attention across specialties to look at evidence-based recommendations that should be discussed to help make better decisions for patient health & health dollars.

So what about the heart tracing? Well, it turns out that there is little evidence that pure screening EKGs in healthy, low-risk people will pick up silent coronary heart disease and subsequently prevent heart attacks. Instead, what we see is a moderate number of false-positive tests that lead to additional unnecessary and often invasive procedures.

Who SHOULD get EKG's? Risk factors for coronary disease include high blood pressure, high "bad" (LDL) cholesterol or low "good" (HDL) cholesterol, smoking, family history of heart disease, diabetes, males over age 45 & women over 55, and obesity. The more risk factors you have, the higher your risk, and the more likely it is that your doctor will indeed recommend an EKG at your office visit.

Check out the other AAFP Recommendations: Bone Density Test, Sinus Infection treatment, and Back X-rays

BOTTOM LINE: ROUTINE EKGs in healthy, low risk patients are unnecessary and possibly harmful- skip this test unless you & your doctor determine you are at risk for heart disease!

Heart Disease in Women- New AHA Guidelines

The American Heart Association has recently published an update to their Guidelines for the Prevention of Cardiovascular Disease in Women, so I thought I would highlight a few issues that may surprise you. Did you know that women are more likely to have a stroke than a heart attack? My patients with risk factors such as high blood pressure or high cholesterol worry far more about having a heart attack than having a stroke, yet at every age, women truly are more likely to suffer a stroke. (The opposite is true for men.) Sadly, in the United States, one woman dies every minute from cardiovascular disease.

The numbers of young women (aged 35-54) dying from cardiovascular disease is rising, paralleling the rise in obesity in our country. Now 2 of 3 women over the age of 20 are overweight or obese. This is why I spend so much time counseling patients and blogging and talking about weight loss and healthy lifestyle changes!

Women who had any pregnancy related complications such as premature birth, pre-eclampsia or gestional diabetes are now known to have higher risk of future cardiovascular events- possibly doubling their risk- despite blood pressures and sugars returning to normal after childbirth. We need to treat these women more aggressively to reduce their risk factors both with behavior modification and with medications.

BOTTOM LINE: Women, recognize that YOU are at risk for strokes and heart attacks as much, if not more than the men you are worrying about! Schedule a check up with your family doctor today.

More Drug Warnings- This Time, Rosiglitazone

We seem to be constantly bombarded with drug warnings these days. Today, an FDA panel is debating about a diabetes medication that has been on the market since 1991, rosiglitazone (Avandia). Studies have shown that patients taking this medication have a higher rate of "cardiovascular events", though it is not clear whether or not these events lead to a greater death rate.

Why is there any debate? Shouldn't we simply remove it from the market, since there are other diabetes drugs? Well, of course, it's not that simple. Diabetes itself causes an increased risk of cardiovascular events. There are many diabetics who have uncontrolled blood sugars despite being on several other medications. This class of drugs actually has produced significant lowering of high blood sugars for many patients. It's all a balance.

Ultimately, this puts me back on my soap box. Though I have a few (literally less than five) patients with adult-onset diabetes who eat perfectly (tons of fruits and veggies, high fiber, and few sweets), and have normal weight, yet still require medications to control their blood sugars (yes you, "FP"!), the VAST MAJORITY of my adult onset diabetic patients would have completely normal blood sugars if they ate well, exercised, and lost weight.

BOTTOM LINE: NO medication is without risk, so MAXIMIZE your health with proper diet and exercise and MINIMIZE the number of medications you need to take!