VOLUME 27 NUMBER 12 AUGUST 2017

Does diet soda raise stroke risk? INSIDE

Ask the Doctor. . . . . . . . . . . 2
Some studies suggest a possible link. But dont switch to regular Heart failure with a normal

sugary sodastry infused water instead. ejection fraction

Ways to learn CPR. . . . . . . . 3

F or diet soda fans, re-

cent news reports link-
ing these popular drinks to
drinking diet soda, says Dr.
Kathryn Rexrode, an assoc
iate professor of medicine at
Torn neck arteries: Causes
and consequences. . . . . . . . 4
Marijuanas effects
a higher risk of stroke may Harvard-affiliated Brigham
on the heart. . . . . . . . . . . . . 5
have been alarming. A closer and Womens Hospital who
look at the study behind the co-authored an earlier, larger Is there enough effort
in your exercise? . . . . . . . . . 6
headlines suggests theres no study looking at soda con-
klenova | Thinkstock

need to panic. But beverages sumption and stroke risk. Research briefs. . . . . . . . . . 8
Heart attack risk from
naturally low in calories are
painrelievers
probably a healthier option Stroke risk from Alcohol: Maybe not so good
than artificially sweetened allsodas? foryour heart?
drinks. That 2012 studywhich fol- Exercise therapy for blocked
For starters, observa- lowed more than 127,000 leg arteries
tional studies like this one Quench your thirst with infused people for more than two
NEWLY RELEASED
(see Diet soda and the water instead of soda. decadesdetected a slightly
A Guide to Cognitive Fitness:
brain: The latest findings) higher risk of stroke in peo- 6 Steps to optimizing brain function
cannot prove cause and effect. Also, only ple who drank more than one soda per day, and improving brain health
97 people had strokes during the 10-year regardless of whether it contained sugar or an www.health.harvard.edu/cogfit
follow-up, which means only two or three of artificial sweetener.
those strokes could possibly be attributed to continued on p.7 FIVE THINGS TO
DO THIS MONTH

Diet soda and the brain: The latest findings 1 Sign up for a CPR class.
Fewer than one in five people
know how to do this simple,
A study in the April 20, 2017, issue of Stroke examined how soft drink choices might affect the lifesaving technique. (page 3)
brain. Heres a summary:
Who: 2,888 people ages 45 and older and
1,484 people ages 60 and older from the
How: Participants filled out diet questionnaires
up to three times over a seven-year period and
2 Learn why you should be
nice to your neck. A torn
artery in the neck can trigger a
tongpatong | Thinkstock

long-running Framingham Heart Study. were followed over the next decade.
Why: To see whether drinking either artificially
sweetened or sugar-sweetened soft drinks
influenced the risk of stroke and dementia.
What happened: During the follow-up,
3%of the participants had a stroke, and
5%developed dementia.
Key findings: People who reported drinking
stroke. (page 4)
3 Check if youre exercising
hard enough to help your
heart. Rating your perceived
exertion can help. (page 6 )
4 Swap diet soda for infused
water. Fruit, cucumber, or
mint can enhance the flavor of
plain or sparkling water. (page 7)

5
at least one artificially sweetened soda a day Be cautious when taking
compared with less than one a week were ap- pain pills. Common over-the-
proximately twice as likely to have a stroke. counter drugs may raise heart
attack risk. (page 8)
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 ASK THE DOCTOR
by DEEPAK L. BHATT, M.D., M.P.H., Editor in Chief

When the heart pumps normally but struggles

Editor in Chief Deepak L. Bhatt, MD, MPH
Executive Editor Julie Corliss
Q I was recently admitted to the hospital with heart fail-
ure and received a heart ultrasound. The test report
stated that my hearts pumping ability is normal. I dont
Contributor Stephanie Slon
understand. Was my diagnosis wrong, or is the test wrong?

A If you were diagnosed with heart failure in the hospital,

Editorial Board

Board members are associated with Harvard Medical School
and affiliated institutions. Im presuming that you were admitted with symptoms
Heart Paula A. Johnson, MD, Peter Zimetbaum, MD such as shortness of breath, fatigue, and difficulty doing ev-
Bone Disease Scott Martin, MD, Donald T. Reilly, MD, PhD
eryday activities. Other common symptoms include swell-
Cancer Marc Garnick, MD
Dermatology Kenneth Arndt, MD, Suzanne Olbricht, MD
ing in your legs and feet and trouble breathing at night.
Endocrinology Alan Malabanan, MD Heart failure means that the heart cannot pump well
Exercise/Lifestyle I-Min Lee, MD, ScD, JoAnn E. Manson, MD, DrPH enough to meet the bodys need for blood. To diagnose the condition, doctors rely
Gastroenterology Jacqueline Lee Wolf, MD on several tests, including blood tests, an electrocardiogram (ECG), and a chest x-ray.
Geriatrics Suzanne E. Salamon, MD
Neurology Gad Marshall, MD
An ultrasound of the heart (echocardiogram) shows how well the heart can pump.
Nutrition Eric B. Rimm, ScD A measurement known as the ejection fraction, or EF, refers to the amount of blood
Psychiatry Ann R. Epstein, MD, Michael Miller, MD, pushed out (ejected) with each heartbeat. A normal EF is 50% to 70%.
Ronald Schouten, MD, JD
An EF in the range of 41% to 49% is considered borderline low. An EF of 40% or
Urology William C. DeWolf, MD
Womens Health Karen Carlson, MD, Martha K. Richardson, MD, lower suggests heart failure with reduced ejection fraction. This type of heart failure,
Isaac Schiff, MD which used to be called systolic heart failure, happens because the heart muscle
doesnt contract effectively. It can occur after a heart attack, but there are many other
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Email harvardHH@strategicfulfillment.com However, about half of people with chronic
Online www.health.harvard.edu/customer-service heart failure have a normal EF. Formerly known
Letters Harvard Heart Letter as diastolic heart failure, this condition is now
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mally. This type of heart failure is more com-
Editorial Correspondence mon in older people, especially women, as well
Email heart_letter@hms.harvard.edu A heart ultrasound (echocardiogram) as people who have high blood pressure or the
Letters Harvard Heart Letter reveals the hearts pumping ability.
Harvard Health Publications
irregular heart rhythm called atrial fibrillation.
Harvard Institutes of Medicine, 4th Floor People with either type of heart failure usually need to take blood pressure drugs
4 Blackfan Circle
Boston, MA 02115 known as diuretics (sometimes called water pills) to eliminate excess fluid from the
Permissions body. Common examples include chlorothiazide (Diuril), chlorthalidone (Hygroton),
Online www.health.harvard.edu/permissions and furosemide (Lasix). However, people like you who have a preserved ejection
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diuretic dose is too high. While other blood pressure drugs such as ACE inhibitors
seem to help people with reduced ejection fraction, thats not the case for those with
Published monthly by Harvard Health Publications, preserved ejection fraction. But a number of clinical trials studying new therapies for
a division of Harvard Medical School
heart failure with preserved ejection fraction are currently under way.
Editor in Chief Gregory D. Curfman, MD
A healthy, low-salt diet appears to be important for people with heart failure. Los-
In association with
ing weight (if needed) and avoiding alcohol can also help improve your symptoms. Its
Belvoir Media Group, LLC, 535 Connecticut Avenue,
Norwalk, CT 06854. Robert Englander, Chairman and also a good idea to engage in regular physical activity, but ask your doctor for advice
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2 | Harvard Heart Letter | August 2017 www.health.harvard.edu

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 The push you need to learn CPR is recommended for vicitims of drown-
ing or drug overdose.
After calling 911, do you know what to do if a person is You can learn CPR basics from a one-
unresponsive and not breathing? minute AHA video at www.heart.org/
HandsOnlyCPR. But theres no substi-

E ach year, an estimated

600,000 Americans
suffer a cardiac arrest, dur-
tute for hands-on practice to give you a
sense of the correct pressure and rate of
compressions, says Dr. Pozner. Another
ing which the heart sud- place to practice is at one of the training
denly and unexpectedly kiosks that are currently located at six
Rawpixel Ltd | Thinkstock

stops beating. If someone airports in the United States: Dallas/Fort

nearby immediately be- Worth, Chicago OHare, Indianapolis,
gins cardiopulmonary Las Vegas McCarran, Hartsfield-Jack-
resuscitation (CPR), the son Atlanta, and Baltimore-Washington
chest compressions can Thurgood Marshall.
keep blood flowing to the
persons brain and other vi- Dont hesitate to help
tal organsand more than To perform hands-only CPR, you push hard and fast on a Less than one-third of people who expe-
double the odds of survival. persons chest. No mouth breathing is required. rience sudden cardiac arrest receive CPR
About 70% of cardiac from a bystander. While increased CPR
arrests happen at home. If this happened Red Cross. Youll practice hands-only training rates will likely help, another
to your spouse or loved one, wouldnt it CPRpushing hard and fast on the cen- possible barrier is the fear of doing
be awful if you didnt know what to do? ter of the cheston a rubber torso. The incorrect or unneeded CPR, according
says Dr. Charles Pozner, associate pro- action can keep blood circulating until to Dr. Pozner. We used to train people
fessor of emergency medicine at Har- the persons heart can be shocked back to spend time checking for breathing
vard-affiliated Brigham and Womens into a normal rhythm with a defibrillator. and a pulse. But if you cant easily find
Hospital. But only 18% of adults in the Emergency personnel will bring and use a pulse and the person isnt breathing
United States have been trained in CPR this device. But airports, malls, casinos, normally, assume that he or she is in
within the past two years, according to sports arenas, and many office buildings cardiac arrest. A quick response is more
a recent nationwide survey of 9,022 peo- also have automatic external defibrilla- important, he says.
ple, published in the May 24, 2017, Jour- tors (AEDs). So if you witness a cardiac If youre not sure if someone needs
nal of the American Heart Association. arrest in a public place, ask a bystander CPR, err on the side of caution. Its bet-
There was some encouraging news, to find one. AEDs use voice prompts, ter do CPR on someone who doesnt
however: 65% of the survey respondents lights, and text messages to guide users need it rather than not do it on someone
said theyd been trained at some point through the needed steps. Most CPR who does, Dr. Pozner says. Yes, properly
previously. People who are required classes also include defibrillator training; done CPR can break a persons ribs, but
to know CPR for their jobs need to be some also teach CPR with breaths, which thats very unlikely to be fatal.
recertified every one to two years. For
everyone else, that frequency probably
isnt realistic. But all adults should take CPR coaching from your phone or virtual assistant
an in-person CPR class at least once, About half of the 911 operators in the United States are trained to pro-
milindri | Thinkstock

says Dr. Pozner. In many states, learn- vide verbal cues for CPR, according to the American Heart Association
ing CPR is mandatory to graduate from (AHA). If you reach a trained operator, put your phone on speaker to
high school, which may explain why hear the instructions; he or she will count out loud to help you adminis-
younger people are more likely to have ter compression at the correct rate (about 100 beats per minute).
CPR training than older people are. You can also get CPR coaching and other science-based information from the AHA
from an Amazon Echo, a so-called virtual assistant device that you control with
CPR training: A vital step your voice. More than eight million people in the United States have these devices,
If youve never taken a CPR class (or its which respond to the name Alexa. To use it, you need to enable the skill in the Alexa
been many years since you have), you can app or by saying, Alexa, enable American Heart Association. Then, in an emergency,
find one through the American Heart you would say: Alexa, ask American Heart how do I perform CPR?
Association (AHA) or the American
www.health.harvard.edu August 2017 | Harvard Heart Letter |3
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When a pain in the neck is serious
A tear in one of the main arteries of the neck
is a rare cause of stroke.
Y ou probably dont give much
thought to your neck, unless some-
thing goes wrong and it starts to hurt.
This underappreciated body part has
to be strong enough to support a heavy
weight (your head) yet still allow you to
tilt, turn, and nod your head easily.
Most of the time, neck pain
doesnt signal a serious medical
problem. But its worth learning
about one of the rare exceptions:
a tear in one of the arteries of the
neck, known as a cervical artery
dissection (see What is a cervical
artery dissection?). Although these
occur in only about two in 100,000
people per year, they are one of the
most common causes of stroke in
people under age 50.
Over the past two decades,
awareness of cervical artery dissec-
tion has grown tremendously, says
Dr. Natalia Rost, associate professor
of neurology at Harvard-affiliated
Massachusetts General Hospital.
This may stem in part from the rec-
ognition that stroke rates seem to
be rising among younger people,
despite an overall downward trend
in deaths caused by stroke.
More common before
age50
Cervical artery dissections are seen
more often in younger adults for
two main reasons. First, a small
percentage of people have under-
lying inherited connective tis-
sue disorders that make their arteries
more likely to tear. For these people,
an artery tear is more likely to mani-
fest at a younger age, explains Dr. Rost.
In older people, other types of strokes
(such as those associated with brain
arteries narrowed by fatty plaque) are
more common. But dissections can still
happen in older people. A recent study
4 | Harvard Heart Letter | August 2017 www.health.harvard.edu
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in the journal Neurology found that one
in 14 people diagnosed with a cervical
artery dissection was age 60 or older.
The second (and perhaps bigger rea-
son) artery dissections are more com-
mon before age 50? Younger adults are
What is a cervical artery
dissection?
Cervical arteries
Vertebral
arteries
Carotid
arteries
Two pairs of blood vessels in the neck
the carotid and vertebral arteries, known
collectively as the cervical arteriescarry
blood to the brain.
A tear in the lining of one of these vessels is
called a cervical artery dissection.
Blood leaks between the layers of the artery
wall and forms a clot. The clot may completely
block blood flow through the artery, or break
off and lodge in an artery in the brain. If either
happens, the result is a stroke.
more likely to engage in exercise that in-
volves neck movements that can precip-
itate a tear. Dr. Rost has seen a number
of artery tears in people who do high-
intensity fitness programs that combine
elements from several sports and types
of exercise. Dissections have also been
reported after strenuous weight lifting,
head-flinging dance moves, and even
yoga. If not done properly, certain posi-
tions such as a shoulder stand can cause
hyperextension of the neck.
Hairdresser and
chiropractorcautions
You can also hyperextend your neck
while tipping your head back to have
your hair washed at a salon sink. Even
though there are only a dozen or so such
cases described in the medical literature,
theres a name for this phenomenon:
Image courtesy of N. Rost, MD, Massachusetts General Hospital
beauty parlor stroke syndrome. To
play it safe, do as Dr. Rost does. Ask
your hairdresser for a neck exten-
sion, which is a little cushion that
props up your head so you dont feel
any strain on your neck, she advises.
Not surprisingly, whiplash sus-
tained during a car accident can
also cause a cervical artery dissec-
tion. And in rare cases, so can the
quick, thrusting neck movements
some chiropractors and other health
care professionals use to treat neck
pain, known as cervical manipula-
tive therapy or adjustment. How-
ever, its not clear whether the neck
therapy itself causes the tear, or
whether the pain from an existing
tear might prompt people to seek
out such treatment. Still, the Ameri-
can Heart Association warns people
to be extra cautious about getting
cervical manipulative therapy.
Unusual, persistent pain
With a cervical artery dissection,
the pain is unusual, persistent, and
often accompanied by a severe
headache, says Dr. Rost. The pain
from a carotid artery tear often
spreads along the side of the neck
and up toward the outer corner of the
eye. A vertebral artery tear may feel like
something sharp is stuck in the base
of your skull. If you experience such
painespecially if you also have stroke
symptoms such as dizziness, double
vision, jerky eye movements, unsteadi-
ness while walking, or slurred speech
call 911 immediately.
 Marijuana and heart health:
What you need to know
Access to marijuana is growing, but its risks and benefits
have not been carefully studied.
I n 28 states in this country, you can
legally use marijuana for a range of
health problems, including chronic pain,
anxiety, and nausea. Smoking is the fast-
est way to feel the effects of marijuana,
UrosPoteko | Thinkstock
which is derived from the Cannabis sa-
tiva plant. Yet marijuana smoke contains
many of the same toxins, irritants, and
carcinogens found in cigarette smoke
a known contributor to heart disease as
well as cancer.
Marijuana cultivation and use dates
back some 6,000 years. However, the
cardiovascular and other health effects of
cannabis arent well studied. Thats partly
because under federal law, cannabis is
a Schedule I substance, meaning it has
no currently accepted medical use and
a high potential for abuse. That designa-
tion places numerous restrictions on re-
searchers, making it difficult to carry out
rigorous research on marijuana.
As a result, everything were told
about what marijuana does or doesnt do
should be viewed with a certain amount
of caution. This holds equally true for
the risks as well as the benefits, says Dr.
Kenneth Mukamal, associate professor
of medicine at Harvard-affiliated Beth
Israel Deaconess Medical Center.
Pot and pain
Some of the strongest evidence sup-
porting the medical use of marijuana
is for managing chronic pain. Cannabi-
noid compounds (see Cannabis 101)
CreativeFire | Thinkstock
interact with receptors in nerve cells to
slow down pain impulses and ease dis-
comfort. Cannabinoids also have been
shown to be effective in quelling nausea
and vomiting. In addition, marijuana is a
powerful appetite inducer. The combina-
tion of these attributes makes marijuana
a therapeutic option for people coping
with the side effects of chemotherapy
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with lung diseases should not smoke it.
As is true for other legal but unregulated herbal
products, the potential benefits and risks of
medical marijuana are not well studied.
and others who are in danger of unin-
tended weight loss. However, in condi-
tions where gaining extra weight might
exacerbate existing health problems,
such as diabetes, appetite stimulation
would be counterproductive.
Cardiovascular effects
One of the few things scientists know
for sure about marijuana and cardio-
vascular health is that people with estab-
lished heart disease who are under stress
develop chest pain more quickly if they
have been smoking marijuana than they
would have otherwise. This is because
of complex effects cannabinoids have
on the cardiovascular system, including
raising resting heart rate, dilating blood
vessels, and making the heart pump
harder. Research suggests that the risk
of heart attack is several times higher in
the hour after smoking marijuana than
it would be normally. While this does
not pose a significant threat to people
who have minimal cardiovascular risk,
it should be a red flag for anyone
with a history of heart disease.
Although the evidence is weaker,
there are also links to a higher risk
of atrial fibrillation or ischemic
stroke immediately following mar-
ijuana use. Consistent with these
links, studies by Dr. Mukamal and
colleagues also suggest that marijuana
smoking may increase the long-term
death rate among heart attack survivors.
Questions remain
Most of the evidence linking marijuana
to heart attack and stroke is based on
reports from people who smoked it. So
its hard to separate the effects of can-
nabinoid compounds on the cardiovas-
cular system from the hazards posed by
the irritants and carcinogens contained
in the smoke. Because cannabis smoke
is known to cause airway inflammation,
wheezing, and chest tightness, people
Other people who should just say no to
marijuana include those who may be
vulnerable to developing schizophrenia
or addiction.
Cannabis 101
The cannabis plant contains more than
100 unique chemical components clas-
sified as cannabinoids. These are the
active ingredients that bind to specific
receptors in the brain and other parts
of the body. The two most prevalent
types are tetrahydrocannabinol (THC),
which is primarily responsible for the
mind-altering properties sought out
by recreational users, and cannabidiol
(CBD), which has no psychoactive effect.
Cannabidiol may actually work to offset
the psychoactive properties of THC.
The magnitude of marijuanas psycho-
active effect depends on the THC level
in the particular strain of plant, which
parts of the plant are used, and the
route through which the drug enters
the body. Legalization in some states
has led to the breeding of strains that
are three to seven times more potent
than those available three decades ago.
The impact of smoked or
inhaled marijuana is gener-
ally felt within a few minutes
and lasts two to four hours.
Marijuana ingested in food
or beverages kicks in more
slowly and lasts longer.
|5
Prescribing the best medicine
Are you exercising enough to prevent heart disease?
I t can help you lose weight; decrease
your blood pressure, cholesterol, and
blood sugar; and reduce your stress.
But wait, theres more: it also lowers
your odds of a heart attack or other
cardiovascular event and may even
extend your life.
This wonder drug isnt a drug at all,
of courseits exercise. Yet only about
half of all American adults do enough
physical activity to benefit their health.
And exercise is especially vital for peo-
ple who are at risk for heart disease or
already have it.
Doctors are good at prescribing
statins and aspirin, but were not very
good at prescribing one of the most
powerful therapies available, which is
exercise, says Dr. Hicham Skali, a car-
diologist at Harvard-affiliated Brigham
and Womens Hospital.
Expert advice
One issue is that doctors arent always
sure how to offer specific exercise
advice to people with different heart-
related conditions and risk factors. In
the future, a new computer program
developed by European cardiac rehabil-
itation experts may help. Called Exer-
cise Prescription in Everyday Practice
and Rehabilitative Training (EXPERT),
the program prompts a clinician to
enter information such as the persons
age, weight, and resting heart rate,
along with any health conditions and
medications. The program then gen-
erates a tailored exercise routine that
includes the type of exercise, intensity,
frequency, and duration, along with
any safety precautions.
For physicians, using this program
could be a good way to get a conver-
sation started, says Dr. Skali. But since
most doctors dont have the tool (it still
needs to be validated in a study), where
does that leave you? During most office
visits, doctors often dont have time for
6 | Harvard Heart Letter | August 2017 www.health.harvard.edu
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lemsespecially diabetes and obesity
that contribute to heart disease. So be
sure you know how much and how hard
you should be exercisingand how to
address any barriers that are keeping
you from doing it, says Dr. Skali.
Enough exertion?
For people without heart disease, the
American Heart Association recom-
Wavebreakmedia | Thinkstock
mends at least 150 minutes per week
of moderate exercise or 75 minutes per
week of vigorous exercise (or a com-
bination of the two). Walking is often
championed as a great way to get exer-
cise, but check that youre actually walk-
ing briskly enough to raise your heart
rate. People will tell me, Well, I dont
go the gym, but Im pretty activeI do
yard work and walk my dog every day,
Talking while walking: says Dr. Skali. But as people get older,
Assessing your effort their dogs tend to get smaller, and the
Use this rate of perceived exertion (RPE) outing ends up being more of a stroll
scale to gauge whether you are exercising than a brisk walk, he notes.
intensely enough. Wearable fitness trackers have made
Scale Intensity Breathing/ heart rate tracking popular in recent
speaking pattern years. But you dont really need to mea-
1 Extremely Restful breathing; sure your heart rate to know if youre
easy able to sing exercising hard enough. Instead, Dr.
2 Very Can easily speak in Skali recommends paying attention
easy completesentences to your rate of perceived exertion, or
3 Easy RPE (see Talking while walking: As-
sessing your effort). Aim for an exer-
4 Easy to Speech becomes
moderate broken tion level around 5 or 6about halfway
between sitting still and exercising as
5 Moderate Breathing becomes
heavier hard as you possibly can. Start slowly
and build up to 30 minutes a day, five
6 Talking is difficult
days a week. As your fitness level im-
7 Moderate Deep, forceful proves, you may be able to save time
to breathing, butstill
vigorous sustainable by adding short bouts of more vigorous
activity. As a general rule of thumb, one
8 Vigorous Labored breathing;
cannot talk
minute of vigorous-intensity activity
counts about as much as two minutes
9 Very labored
of moderate-intensityactivity.
breathing; borderline
breathless Focusing on RPE also makes sense
if you take a beta blocker, which helps
10 Very Gasping for air
vigorous lower blood pressure and slows the
heart rate. Common examples include
a detailed discussion about exercise. If metoprolol (Lopressor, Toprol) and
you have specific exercise-related con- atenolol (Tenormin). People often no-
cerns, however, bring them up. Regular tice that their heart rate does not rise
exercise improves many of the prob- continued on the bottom of p.7
 Diet soda and strokefrom p. 1
However, the new study found
no higher stroke risk from drinking
sugar-sweetened soft drinks or other
sugary beverages, says Dr. Rexrode.
That certainly doesnt suggest theyre a
better choice than diet sodas, though.
Many studies have already shown that
drinking sugary beverages on a regular
VeliborZitarevic | Thinkstock
basis can lead to weight gain, diabetes,
heart disease, and stroke, she notes.
Possible explanations
In fact, one possible explanation why
sugary beverages werent linked to
stroke in the recent study might be a
phenomenon known as survival bias. In
this case, that would mean that people
who drank a lot of sugar-sweetened
beverages may have died earlier from
other illnesses such as heart disease.
Conversely, diet beverages may have
shown a link to stroke because of a
different issue, called reverse causation.
In an attempt to be healthier, people
who are overweight or have diabetes
may be more likely to choose diet drinks
over sugary ones. Their heightened
stroke risk may result from their health
problems rather than their beverage
choice. We might just be measuring the
residual impact of obesity and diabetes,
says Dr. Rexrode.
Artificial sweeteners:
Othershortcomings
Another conundrum: researchers dont
have any plausible explanation for why
artificial sweeteners might increase
stroke risk. Still, there may be other
reasons to ditch them.
Exercise effortfrom p. 6
as high during exercise after they start
taking these drugs and may wonder if
theyre exercising at the right intensity.
Its fine to go by how you feel rather
than trying to reach a certain target
heart rate, says Dr. Skali.
www.health.harvard.edu August 2017 | Harvard Heart Letter
This Harvard Health Publication was prepared exclusively for Lars Ekstroem - Purchased at http://www.health.harvard.edu
Plain water too boring? Try these options
Looking for an alternative to diet sodas, but still want something
lowcalorie? Try flavored water, which you can buy in cans or bottles
inmany flavors, in both sparkling and flat varieties. Or, just make your
own at home.
If youre on the go a lot, you might want to purchase a fruit infuser water
bottle, which features a special inner chamber to hold pieces of fruit
(orother flavor boosters such as mint or cucumber slices) to enhance
the taste. Here are some other ideas to liven up your beverage choices.
SWEET: Add frozen fruit to ice water, such as strawberries, blueberries,
or pineapple, or use the juice from a slice of orange to sweeten
sparkling water.
REFRESHING: Add a few sprigs of fresh mint to ice water.
ROBUST: Drink unsweetened black tea or coffee (decaffeinated
orregular) over ice.
FLAVORFUL: Try chilled herbal teas. They come in many flavors
andvarieties, such as pear, peach, raspberry, licorice, and mint.
POWERFUL: Drink vegetable juice blends, such as tomato, cucumber, and celery.
You can make your own using a blender or juicer. If you buy prepackaged vegetable
juice, choose a low-sodium variety.
SPICY: Add a few drops of honey to hot water, then sprinkle a dash of your favorite
spice, such as cinnamon or cayenne pepper, then pour over ice.
If you use artificial sweeteners to on the many heart-protecting nutrients
control your weight, you should know found in fresh, natural foods.
that the support for that strategy is But Dr. Rexrode isnt a stickler when
pretty shaky. Some evidence suggests it comes to diet soda. I encourage my
that artificial sweeteners make people patients to eliminate regular soda and
crave sugary, high-calorie foods, thereby other sugar-sweetened drinks to avoid
negating the sweeteners potential to cut empty calories, she says. But if some-
your overall calorie intake. one says they cant do without a Coke in
Also, some experts believe that the morning to wake up, Ill encourage
people who use these high-intensity them to switch to coffee or diet Coke.
sweeteners (which are hundreds of Water is an even better choice, how-
times sweeter than sugar) may come to ever. There are a lot of ways to make it
find naturally sweet foods, such as fruit, more appealing, both visually and taste-
less appealing and less-sweet foods, such wise, such as using an infusion water
as vegetables, downright unpalatable. If bottle, she adds. (See Plain water too
so, those people might be missing out boring? Try these options).
Alternatives to walking peripheral artery disease (PAD). How-
For people who have low back pain or ever, walking is as effective asand less
creaky knees or hips, walking may be risky thangetting a leg artery stent, a
difficult. Swimming, doing water aero- tiny mesh tube to open up the artery.
bics, or using a recumbent bike may Even if your calves hurt after walking
be better options. Walking may also just one block, take a rest, recover, and
be painful for people with narrowed repeat. Eventually, youll be able to walk
arteries in the legs, a problem known as farther without pain.
|7
 RESEARCH WERE WATCHING

Pain relievers and heart attack risk

H eart attack risk may rise within a week of
taking daily high doses of certain over-the-
counter pain relievers, according to a new study.
than 1,200 milligrams (mg) of ibuprofen (Motrin,
Advil) and more than 750 mg of naproxen (Aleve,
Naprosyn) per day. Compared with people who
Previous research has linked didnt take NSAIDs, those who
the use of pain relievers known as did had 20% to 50% higher odds
nonsteroidal anti-inflammatory of having a heart attack while

drugs (NSAIDs) to a heightened
risk of heart attack. The new
report, published in the May 9,
2017, issue of The BMJ, analyzed
data from nearly half a million people, of whom
about 61,000 had heart attacks.
Researchers found that the risk began to
increase within the first week of taking an NSAID.
The most harmful doses appeared to be more
FinStock | Thinkstock
taking the drugs.
For healthy people, whose
baseline risk of heart attack is
very low, that level of added risk
is minimal. But for older people, especially those
with high blood pressure or a previous heart attack,
its more worrisome. Dont use these drugs unless
you really need them, and then at the lowest pos-
sible dose for the least amount of time.

Alcohols heart advantages under scrutiny

C onventional wisdom holds that a drink or two What might explain the findings? Older

a day protects against heart disease. But this
assumption may be wishful thinking,
a new analysis suggests.
For the paper, researchers scruti-
nized findings from 45 studies that
involved a total of nearly three million
people. Current moderate drinkers (up
to two drinks a day) were less likely
than nondrinkers to die of heart disease. But studies
that looked at drinking over the lifespan suggest a
different conclusion. These studies, as well as those
that accounted for peoples baseline heart health,
found no benefit from moderate drinking.
i_frontier | Thinkstock
people who avoid alcohol may be less healthy
than moderate drinkersbut not
because they never drank alcohol.
Rather, they may have quit drinking
because their health problems
require them to take medications
that can interact with alcohol. In
contrast, seniors who drink arent
healthy because of that habit. Instead, their good
health means they arent taking medications, so
they have no reason to avoid alcohol. The study
appears in the May 2017 issue of the Journal of
Studies on Alcohol andDrugs.

Medicare now covers exercise training for blocked leg arteries

A bout 8.5 million Americans have peripheral
artery disease, or PAD, in which fatty plaque
clogs arteries outside of the heart, most commonly
in the legs. The hallmark symptom is calf or thigh
pain while walking that goes away when you rest.
The safest, most effective treatment for PAD is
supervised exercise training, in which youre mon-
itored while walking on a treadmill. Few people
participate, however, partly because of the expense
of the regimen. It involves up to 36 sessions of 30
to 60 minutes each over a period of three months.
But in late May, Medicare announced that it will
now cover supervised exercise therapy for PAD,
which means other insurers will likely follow suit.
Under the new policy, you will need to see a doctor
for a referral and receive information about other
ways to lower your risk of PAD. These include
stopping smoking and losing weight (if needed)
and controlling your blood pressure, blood sugar,
and cholesterol levels.

How food industry trends might affect your heart health

Whats coming up: Thelatest on the genetics of cardiovascular disease
Why too little sleep may be bad for your heart
Ways to manage side effects from blood pressure drugs

8 | Harvard Heart Letter | August 2017 www.health.harvard.edu

This Harvard Health Publication was prepared exclusively for Lars Ekstroem - Purchased at http://www.health.harvard.edu