Posted by & filed under Noah's Notes.

In addition to movie discounts and joke fodder for my children, my AARP membership sometimes also provides some interesting medical information.

It’s usually pretty reliable and often useful but a recent Facebook posting by AARP caught my eye.  It was entitled “10 Surprising Heart Attack Triggers” and it’s a very interesting list, but before we launch into it it’s important to be clear about the difference between and “association” and “cause and effect”.  Cause and effect means that we know that some factor causes a particular outcome:  smoking and lung cancer or influenza virus and the flu, as examples.  Associations, on the other hand, are observed patterns of relationship between a factor and an outcome and can lead to studies that prove or disprove cause and effect.  Some associations can be misleading (for instance measles vaccine does not cause autism but because it is administered at about the age when autism begins to become apparent many people and some unscrupulous physicians claim cause and effect).

So with that in mind, let’s look at some of these interesting “triggers of heart attack” from the AARP.

  1. Asthma that requires daily medication  Having asthma that is severe enough to require the use of daily medication is associated with a 60% higher risk of a heart attack.  No cause and effect here.  It could be that asthmatics are more likely to ignore symptoms of heart disease, thinking that chest tightness is part of their asthma.  Asthma is also a disease of inflammation, which can also contribute to heart disease.  And perhaps the medications themselves carry some risk.
  2. Taking certain drugs for heartburn  These drugs, called protein pump inhibitors (PPI) include drugs like  Nexium, Prilosec, Prevacid and Protonix, are associated with a 16% to 21% increased risk of heart attack.  Again, no cause and effect has been proven, but PPIs ma reduce blood levels of nitric oxide, which is a chemical which may protect the lining of our arteries.  There are other reasons that it may not be good to stay on PPIs for a long period of time (the subject for another blog) and it is recommended that people regularly try to substitute safer drugs, like ranitidine (Zantac) or cimetidine (Tagamet).
  3. Having migraines with visual changes  This is called a “classic migraine” headache and is typically preceded by visual changes like wavy lines or seeing spots.  Women of middle age and older with this problem in the prior year have a 91% increased risk of heart attack and a 108% increased risk of stroke.  Migraines are not well understood so this association is hard to explain.  But 18% of women fall into this category so it is important.
  4. Skipping the flu shot  Separate from the reduced risk of developing influenza, the flu shot appears to confer protection from heart attack in the ear following administration, a 50% reduction in fact.  Apparently some of the antibodies produced by the bod in response to the vaccine help to protect our blood vessels.  This is compelling and getting a flu shot seems like a “no-brainer” to me.  I know that anti-vaccine types will shudder to read this but really, it is safe and pretty effective.
  5. Weak grip strength  A recent study has found that for every decrease of 11 lb. decrease in grip strength there is an associated 17% increase in risk for heart disease.  This may be due to circulation problems to our muscles in the same group who have coronary artery disease.  This may be a useful tool to screen for risk of heart disease in people who are not having symptoms.  It’s being studied.

If you or a loved one have some of these “risks” it is not cause for panic.  But it might be a good reason to have a discussion with your primary care provider and to limit your risk for heart disease through healthy eating, exercise, blood pressure control and avoiding tobacco use.

Next month we’ll take a look at the other 5 “surprising triggers of heart disease”.


Noah Nesin, MD

Dr. Nesin, Vice President of Medical Affairs for PCHC, is a family doctor with 30 years of experience.

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