When Does High Cholesterol Start "Counting"?

Calcium and heart disease are staying together in the news. Yesterday, I talked about calcium supplements. Today, I want to tell you about another study- the "CARDIA" study (Coronary Artery Risk Development in Young Adults). Basically, this study looked at young people who began the trial at age 18-30 in the early 1980's. Their blood cholesterol levels were measured at baseline, and then followed periodically for twenty years. At the endpoint, coronary calcium scores were evaluated. (These scores are from a CT scan that looks at calcium deposits in the coronary arteries- the ones that if clogged, cause a heart attack.) The question was whether or not high lipid (cholesterol) levels in your youth led to these deposits in your middle age. The answer: a resounding YES.

As always, there is a catch. This time, the tricky part is that although high calcium deposit scores are definitely associated with heart disease, it is not the same objective evidence as whether or not people with early high cholesterol levels will actually have more heart attacks. I believe, however, that the take-home message is this: we do indeed pay for "the sins of our youth"- high cholesterol levels that are UNTREATED in young people are going to lead to problems down the road.

What should we do? The jury is still out on whether or not we should be starting younger patients on lipid-lowering medications, despite numerous studies trying to evaluate this issue. We DO know that improving diets and increasing aerobic activity reduces heart disease, with NO negative side effects.

BOTTOM LINE: Don't wait till you are 40 to check your cholesterol levels- find out EARLY and make lifestyle and dietary changes to improve your numbers NOW so you can decrease your heart disease risk LATER!

Hearts a-flutter

Have you ever had the sensation that your heart was jumping around, skipping beats or "fluttering"? Doctors use the word "palpitations" to describe this feeling. Patients experiencing palpitations are often very worried that they are going to have a heart attack. The good news is that the vast majority of the time, early or skipped heart beats cause nothing more than the simple sensation of a heart "hiccup". They are not dangerous, and do NOT lead to additional problems. (Of course, you need to check with your doctor about your symptoms to be sure you are not in the percentage that has a truly concerning arrhythmia, but be reassured this is uncommon.) Now, if your "heart hiccups" are also associated with increasing shortness of breath or trouble exercising- that's a different ball game, so head to your doctor now to be checked out.
Heart attack symptoms, on the other hand, rarely involve any type of flipping sensations- instead, think more about escalating pressure and squeezing chest discomfort, as well as nausea, sweating, and shortness of breath. Palpitations, on the other hand, most often occur without any other types of discomfort, and may occur in healthy young people as well as those medically challenged.
There are numerous triggers for palpitations. The most common ones I see in my practice are decongestants and caffeine. Alcohol overindulgence is another frequent cause. Once we identify the trigger, avoidance is the simple treatment. For patients who develop persistent palpitations, there are medications available to reduce the symptoms (and therefore the patient's anxiety from the symptoms) but they are not typically necessary.
BOTTOM LINE: If your heart is flip-flopping, reduce stimulants such as caffeine and decongestants, and head to your doctor to get checked out- but don't worry that this is leading up to a heart attack.