Heart health self-care

Heart health self-care

Heart health self-care

A heart attack, also known as a ‘myocardial infarction’ or ‘coronary’, is when the blood supply to part of your heart muscle is blocked, causing damage to your heart. The blockage is usually caused by a blood clot forming in one of the coronary arteries (major blood vessels ) that supply blood to your heart. This is more ly to happen if your arteries have become narrowed.

The narrowing of the arteries develops over many years and is caused by fatty deposits, or plaque, building up on your artery walls. This is called atherosclerosis or coronary artery disease.

Exactly what causes the plaque build-up in the arteries is not fully understood. However, there are risk factors which increase your chances of developing coronary artery disease and having a heart attack.

Heart disease risk factors

  • increasing age
  • being male
  • a previous history of heart disease
  • a family history of heart disease
  • smoking
  • obesity
  • poor diet
  • raised blood cholesterol or triglycerides
  • raised blood pressure
  • diabetes
  • low levels of exercise
  • stress

Heart risk assessments

Your health professional can estimate your risk of having a heart attack or stroke in the next 5 years. This assessment includes measuring your blood cholesterol levels and blood pressure.

These results can help you and your health professional to plan any necessary lifestyle changes, medications and ongoing monitoring to reduce your level of heart risk. If the results show you may be at moderate or higher risk, a more detailed examination might be recommended.

In general, a risk assessment is a good idea if you are:

  • a man older than 45 years
  • a woman older than 55 years

But you should have a risk assessment at a younger age (a man older than 35 years, a woman older than 45 years) if you:

  • smoke
  • are overweight
  • have high cholesterol, triglycerides or blood pressure
  • have a family history of cardiovascular disease or diabetes

See Your Pharmacist or Medical Professional

  • if you have symptoms such as chest pain; you should seek medical help immediately by calling 000
  • if you think you would benefit from a heart risk assessment

Tips for a healthy heart:

  • eat a healthy diet high in fruit, vegetables and fibre, and low in fat, sugar and salt; increase your consumption of fish as this has a protective effect on the heart
  • bake, grill, poach, steam or stir fry foods instead of shallow or deep frying
  • maintain a healthy bodyweight
  • drink plenty of water
  • gradually increase your level of physical activity to 30 minutes of moderate intensity exercise on most, if not all days of the week (if very overweight, discuss with your doctor the best exercise options for you)
  • stop smoking
  • limit your alcohol intake (and aim to have at least 2 alcohol-free days each week)
  • make time to relax

Medicines to reduce risk of blood clots and heart attack

[GENERAL SALE]
e.g. aspirin (Astrix, Cardiprin 100, Cartia, DBL Aspirin, Solprin, Disprin, Spren)

  • aspirin can be taken daily (75 to 150 mg) to help prevent heart attacks and some types of strokes. Some of the above products (e.g. Solprin and Disprin) would need to be cut in half for this dose.
  • aspirin works by thinning your blood, and reducing the chance of blood clots forming in your arteries
  • this treatment is often referred to as ‘low-dose aspirin’ because the doses used are much lower than those for treating pain or fever
  • taking low-dose aspirin on a long-term basis is not suitable for everyone; you should discuss this with your pharmacist or GP, especially if you have an allergy to aspirin or NSAIDs, or have aspirin-sensitive asthma
  • side effects of aspirin can include stomach irritation and ulcers

Medicines to reduce cholesterol and triglyceride levels

[PHARMACIST ONLY]
e.g. nicotinic acid (Nicotinic Acid)

  • only nicotinic acid is available from a pharmacist; all the other cholesterol and triglyceride-lowering medications are currently only available on prescription
  • should be taken with food to reduce stomach upset
  • flush and stomach upset should stop after 2-6 weeks of treatment
  • seek medical advice promptly if muscle pain, tenderness or weakness occurs

[PRESCRIPTION ONLY]
e.g. simvastatin (Lipex, Simvar, Simvastatin Winthrop, Simvastatin-Spirit, Simvasyn, Zocor),

ezetimibe and and simvastatin (Vytorin),

pravastatin (Lipostat, Pravachol, Pravastatin, Pravastatin Winthrop),

atorvastatin (Atorvachol, Caduet, Lipitor, Lorstat, Torvastat, Trovas),

fluvastatin (Lescol XL Tablets),

rosuvastatin (Cavstat, Crestor, Crosuva, Rostor),

ezetimibe (Ezetrol, Ezemichol, Zient),

cholestyramine (Questran Lite),

colestipol (Colestid Granules for Oral Suspension),

fenofibrate (Lipidil),

gemfibrozil (Ausgem, Gemhexal, Lipigem)

  • medicines to reduce cholesterol or triglycerides may be needed if diet and lifestyle changes are not enough on their own
  • treatment is often life-long
  • some of these medications may cause muscle pain; always discuss this with your doctor
  • it is important to take prescribed medications for cholesterol or triglycerides every day, even if you are not aware of any symptoms from your high cholesterol levels

[GENERAL SALE]
e.g. Benefiber, Metamucil (sugar-free available), Fybogel, Nucolox, Normafibre

  • these products are fibre supplements and known as bulk-forming laxatives
  • they can help reduce cholesterol levels, in combination with a low-fat diet
  • they are not absorbed by your body and do not interact with other medicines
  • drink plenty of water when taking fibre supplements
  • do not lie down immediately after taking a dose
  • if you have diabetes, check with your pharmacist for an appropriate product, as most contain sugar
  • if you are considering taking fibre supplements to reduce your cholesterol level, you should discuss this with your pharmacist or GP first

Medicines to reduce high blood pressure

[PRESCRIPTION ONLY]
e.g. beta blockers such as atenolol (Tenormin, Tensig), diuretics such as hydrochlorothiazide (Accuretic, Dithiazide), ACE inhibitors such as perindopril (Coversyl)

  • many people will need more than one type of blood pressure medication to reduce their blood pressure to a sufficiently low level
  • treatment is often life-long
  • it is important to take prescribed medications for blood pressure every day, even if you aren’t aware of any symptoms from your high blood pressure
  • do not stop taking blood pressure medicines unless your doctor advises you to.
  • it would be helpful to monitor your blood pressure at home in order to give daily readings to your pharmacist or doctor

Complementary products

  • fish oils containing omega-3 fatty acids may have a beneficial effect on triglyceride levels; eating fish in moderate quantities may achieve the same effect as taking fish oil supplements
  • plant sterol spreads have been shown to reduce cholesterol levels when used in recommended amounts
  • garlic (Allium sativum) is claimed to help lower cholesterol levels and reduce the chance of blood clots forming, but there is not a lot of scientific evidence to support its use
  • garlic can cause increased bleeding when used with aspirin or warfarin

More Information

For more information see the link at Related Health Information below.

Availability of medicines

  • GENERAL SALE available through pharmacies and possibly other retail outlets.
  • PHARMACY ONLY available for sale through pharmacies only.
  • PHARMACIST ONLY may only be sold by a pharmacist.
  • PRESCRIPTION ONLY available only with a prescription from your doctor or other health professional.

Search myDr for Consumer Medicine Information

References

1. Pharmaceutical Society of Australia. Fat and Cholesterol 2019. Available from: https://psa.org.au/kiosk/item.php?id=30&from=s&name=heart%20disease. 2. Australian Medicines Handbook. Aspirin 2019. Available from: https://amhonline.amh.net.au/chapters/blood-electrolytes/antiplatelet-drugs/other-antiplatelet-drugs/aspirin-antiplatelet. 3.

Australian Medicines Handbook. Nicotinic Acid 2019. Available from: https://amhonline.amh.net.au/chapters/cardiovascular-drugs/drugs-dyslipidaemia/other-drugs-dyslipidaemia/nicotinic-acid.

4. Australian Medicines Handbook. Statins 2019. Available from: https://amhonline.amh.net.

au/chapters/cardiovascular-drugs/drugs-dyslipidaemia/statins?menu=vertical.

Source: https://www.mydr.com.au/pharmacy-care/heart-health-self-care

Self-care: 4 ways to nourish body and soul

Heart health self-care

There’s a lot of talk about self-care these days, but what is it really? Self-care means paying attention to and supporting one’s own physical and mental health. It is also a big part of treatment for many physical and mental health disorders.

It’s so, so important.

But, it’s also one of the first things to fall by the wayside in times of stress, especially for those who are primary caregivers. This includes parents, people caring for elderly relatives, healthcare providers, and first responders. These are the people who often put the well-being of others above themselves.

This is a big problem.

Why is self-care important?

Well, we can’t function very well if we aren’t very well. If it is important to us to be able to take care of others, then we must pay attention to our own well-being.

My favorite analogy for this is clichéd, but accurate. When you get on an airplane and the flight attendant gives that safety spiel, when they get to the part about the oxygen masks, the first thing they tell you is: “If you’re traveling with children or others who need assistance, put your oxygen mask on first.”

Think about it. Let’s say you don’t do that and you fall unconscious due to lack of oxygen, then no one gets the help they need. Lose/lose situation there. It’s the same deal in everyday life. When we don’t take care of ourselves, no one wins.

And yet there is a pervasive cultural pressure to keep pushing ourselves, to ignore the physical needs of our bodies and the emotional needs of our souls, which invariably leads to chronic stress, burnout, depression. Data show that burned-out healthcare providers provide crappy service, depressed parents can’t effectively parent, and the list goes on.

When I talk with my patients about self-care, I often hear things “But I don’t have time!” or “I’ll feel I’m being selfish!”

As one of two working parents with two small children, I can empathize greatly with these patients. So, the advice I give is the same advice that I follow.

I know that it can be difficult to fit in self-care when time is at a premium and demands on you are high, but here are four easy things you can consider.

4 things to help revive and nourish body and soul

Be physically active. Exercise busts stress, boosts the mood, and elevates our energy level, not to mention the heart health benefits. Believe it or not, you can exercise just about anywhere, anytime. It doesn’t have to be at the gym. It doesn’t have to be a scheduled class. And it doesn’t have to be more than a few minutes a day. All activity counts.

I encourage patients to think of an activity that they enjoy. Anything. Think about how that enjoyable activity can fit into your life: maybe you can ride your bike to work, or take your kids on an easy hike, or get the whole family to rake leaves with you.

Let’s brainstorm about activities that will fit into your life: Maybe make your next meeting a walking one, or take a brisk walk at lunchtime. Try a few minutes on the exercise bike in the kitchen, or dancing around your living room in your socks. On my very busy days, I make sure I take the stairs whenever I have the option. I park farther away than I need to and walk a little more.

If I’m going to the grocery store and I only need a few things, I use a hand basket instead of a cart. It. All. Counts. And the more, the better.

Eat well. That means eat healthy. The mountain of studies supporting a whole-foods, plant-based diet for our health is almost as large as the exercise one. Stay away from inflammatory, sugar-spiking, insulin-releasing foods processed carbohydrates (think all added sugars and anything made with flour). Aim for things that grew on plants or trees.

The more colorful the fruits or vegetables, the more vitamins, minerals, and antioxidants they have and the healthier they are. Vitamin pills and other supplements just don’t work as well. Not going vegetarian to save your life? Got it. Just get colorful fruits and veggies into your diet wherever you can.

We don’t have to be perfect, but the more plant-based our diets are, the better.

Calm your mind. We all have stressors in our lives. What varies is how much we let the stressors stress us. What can we do? Yes, meditation works. The relaxation response works. Yoga works. But for those patients who stare at me blankly when I mention these, I talk about other calming activities. This can mean knitting, baking, walking, swimming.

Anything quiet and peaceful, when one can take deep breaths and be calmly, enjoyably focused. Me? I try to do a few favorite yoga stretches at the end of the day, right before bed. This is usually after the kids fall asleep, and I can’t even be bothered to find my yoga mat.

I just get right to it on the carpet in my daughter’s room: downward dog, plank, cobra, and then some of my own moves, to stretch out my back.

Sleep well. Aim for a refreshing amount of sleep. While this will differ for everyone, generally it’s about eight hours.

It’s tempting to stay up late to cram in those last household chores or answer email, but really, the world won’t end if the laundry is dirty for another day, or the dishes are piled up in the sink.

Sleep deprivation causes irritability, poor cognition, impaired reflexes and response time (think: car accidents!), and chronic sleep deprivation can contribute to depression and anxiety. Create a short, easy bedtime routine.

Stretching or yoga, prayer, or reading a book can be relaxing. But stay away from your smartphone, tablet, or laptop, as the light interferes and interrupts the natural sleep onset. Alcohol near bedtime also interferes with sleep, and is a common cause of nighttime or early-morning awakening.

The bottom line

Maybe we can’t do all these things every day. But if we make self-care a goal, and try to address all of these factors regularly, then we will feel and function better. The better we feel and function, the more we can do for the people and things we care about. And that is a win-win.

Source: https://www.health.harvard.edu/blog/self-care-4-ways-nourish-body-soul-2017111612736

Self-care in heart failure patients

Heart health self-care

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10 Ways to Take Charge of Your Heart Health

Heart health self-care

Use the following tips – 10 Ways to Take Charge of Your Heart Health – to embark on a heart-healthy lifestyle to fight heart disease.

1. Schedule a Yearly Checkup 

Your heart is in your hands. Each year on your birthday, schedule a checkup to have your blood pressure, cholesterol and glucose levels checked, and ask your doctor to help you reach or maintain a healthy weight. Be sure to follow your healthcare professional's recommendations, including taking prescribed medications as directed.

2. Get Physical

Step, march or jog in place for at least 15 minutes a day while watching your favorite TV shows. Increase your activity by five minutes each week until you're getting a minimum of 30 minutes most days of the week.

If exercise and diet do not get you to your goal, ask your doctor about adding medication.

Keep your numbers in check: Get Physical

3. Drink More Water

Take a water bottle with you wherever you go. It'll keep you hydrated and the bottle's weight will strengthen your arms.

4. Eat Healthy

Keep packages of unhealthy food hidden. Put raw veggies and fruits in front in the refrigerator and healthy snacks in the front of the pantry, so that's what you see first. If you grab healthy foods for a minimum of 21 times, healthy choices will become a habit.

Also, look for the American Heart Association red and white heart-check mark. This easy, reliable grocery shopping tool helps you identify foods that can be part of a sensible eating plan.

Keep your numbers in check: Diet and Nutrition

5. Control Cholesterol

Eating foods high in saturated fat, trans fat or cholesterol can lead to high blood cholesterol. To help keep your cholesterol levels down, eat foods low in saturated fat and trans fat, such as lean chicken or turkey (roasted or baked, with skin removed), fruits and veggies, low-fat or fat-free dairy products and whole grains. Look for cookbooks that focus on heart health in your local bookstore and check out the American Heart Association's recipe section at www.heart.org

6. Cut Down on Salt

To help lower high blood pressure, watch your salt intake. It may be disguised in food labels as sodium alginate, sodium sulfite, sodium caseinate, disodium phosphate, sodium benzoate, sodium hydroxide, monosodium glutamate (MSG), or sodium citrate.

7. Quit Smoking

Try this four-step way to kick your habit:

  • On Day 1, cut the number of cigarettes you smoke by half
  • On Day 3, cut the number of cigarettes you smoke in half again
  • And on Day 5, cut your smoking in half again
  • On your Quit Day… quit!

Keep your numbers in check: Quitting Smoking

8. Maintain a Healthy Weight

Excess weight increases your risk of heart disease, stroke and diabetes. To achieve steady, painless weight loss, take it easy. Each day, if you eat 200-300 calories less than you would normally consume, and exercise at least 30 minutes on most or all days of the week, you'll get closer to your goal and be able to achieve weight loss that's steady and painless.

9. Stay Positive

If you get off your exercise schedule, have a cigarette, or eat a fattening meal, immediately get back on track toward re-establishing a healthy lifestyle.

10. Give Yourself Credit

To maintain momentum with exercising, losing weight, or quitting smoking, keep track of your achievements and reward yourself by doing something you enjoy.

Source: https://www.uwhealth.org/go-red/10-ways-to-take-charge-of-your-heart-health/10543

Treat yourself well: The importance of practicing self-care for yourself and your heart

Heart health self-care

How regularly do you show your heart some love? Your heart works hard for you, 24-7, without any conscious effort on your part (thank goodness). But you can — and should — put conscious thought into caring for your heart so it keeps on taking care of you. That’s true self-care.

While many health conditions, including high blood pressure, high cholesterol, type 2 diabetes and obstructive sleep apnea, can increase the risk of heart disease, our lifestyle — the sum total of our daily habits — also influences our personal risk. That includes the choices we make about whether to smoke, how much alcohol to drink, when to go to bed, how to handle stress, what to eat and how active to be.

Let’s start with food. A heart-healthy diet includes lots of plants — vegetables, fruits, whole grains, pulses (beans and lentils), nuts and seeds — which offer vitamins and minerals, fiber and phytochemicals. Phytochemicals are compounds in plants that benefit us in a variety of ways, including some that may directly benefit cardiovascular health.

What about fat? Research is unequivocal that trans fats (commonly known as partially hydrogenated oils) are associated with increased risk of cardiovascular disease, but the findings are more ambiguous about other types of fat. Generally speaking, the type of fats you find in nuts, seeds, avocados, olive oil, canola oil and oily fish are heart-healthy ones.

To show your heart you care:

  • Eat more vegetables. Aim for 4 cups per day, paying special attention to deeply colored vegetables, as these tend to be richer in phytochemicals.
  • Eat fish at least twice a week. That’s about 8 ounces total. Prioritize oily fish salmon, herring, sardines, Atlantic mackerel (not king mackerel) and anchovies, which are rich in heart-healthy omega-3 fats.
  • Swap refined grains for whole grains most of the time. For example, brown rice instead of white rice, whole-wheat flour instead of white flour. If you oatmeal, go for regular or thick-cut oats, or the steel-cut variety, instead of instant.
  • Choose lean cuts of meat. If you eat meat, go for leaner cuts of beef (sirloin or round) and pork (tenderloin or chop), and trim off visible fat.
  • Cut back on foods and beverages that contain added sugars. If you consume soda or other beverages sweetened with sugar in any of its guises — including sucrose, high-fructose corn syrup, dextrose and maltose — that’s a good place to pare back. If you tend to choose sweets for snacks, or mindlessly eat them, that’s a habit worth changing. However, this isn’t about never having dessert!

Speaking of mindlessness, practices of mindfulness such as meditation and yoga have been shown to benefit health in numerous ways. In fact, a 2017 statement from the American Heart Association said meditation appears to reduce the risk of heart disease, although we need more research to clarify the connection. In the meantime, peace out!

Now, what about physical activity? According to a 2019 statement from the American College of Sports Medicine, meeting the Physical Activity Guidelines for Americans significantly reduces the risk of heart disease and death from heart disease. Those guidelines recommend 150 to 300 minutes (2.

5 to 5 hours) per week of moderate-intensity physical activity, such as brisk walking, or 75 to 150 minutes of vigorous activity, such as running.

If that sounds daunting because your activity levels are currently low, take heart: The statement said the benefits of physical activity start building at lower levels of activity — as little as an hour per week of moderate activity — and that any exercise is better than none.

Source: https://www.seattletimes.com/life/wellness/the-importance-of-practicing-self-care-for-yourself-and-your-heart/

Managing Heart Disease

Heart health self-care

Cost: The cost varies by organization, but rarely is more than $50.
Format: This course is offered as an in-person workshop.

About the Program

The Chronic Disease Self-Management Program is an interactive workshop for people with all types of chronic conditions. Stanford University developed this course to help people with one or more chronic conditions learn the strategies to manage their condition and have the confidence to carry them out.

Program Details

This interactive workshop meets for 2.5 hours per week for 6 weeks in convenient community locations. The instructors are trained leaders, at least one of whom has a chronic condition. This workshop is known by a variety of different names, including Living Well.

The program is also available in Spanish.

Subjects covered include:

  • Techniques to deal with problems such as frustration, fatigue, pain, and isolation.
  • Appropriate exercise for maintaining and improving strength, flexibility, and endurance.
  • Appropriate use of medications.
  • Communicating effectively with family, friends, and health professionals.
  • Managing depression.
  • Better breathing techniques.
  • Relaxation techniques.
  • Healthy eating habits.
  • Making good decisions about your health.
  • How to evaluate new treatments.

Visit the Self-Management Resource Center website to learn more about the Chronic Disease Self-Management Program.External

Locate organizations licensed to offer the program in your area on the Evidence-Based Leadership CouncilExternal website.

Chronic Disease Self-Management Program: Tool Kit for Active Living

Cost: $43.96.
Format: Self-study toolkit.

About the Program

The Chronic Disease Self-Management Program Tool Kit for Active Living provides much of the same information as the Chronic Disease Self-Management Program (CDSMP) in a self-study format that you can receive by mail.

Program Details

The tool kit helps you construct your own self-management plan to deal with your chronic condition(s) through exercise, and strategies to reduce stress, fatigue, pain and other symptoms. It encourages goal setting, action planning, and thinking and acting proactively. You can work through the toolkit at your own pace, focusing on areas most important to you.

The program is also available in Spanish.

The self-study kit includes:

  • The workbook Living a Healthy Life with Chronic Conditions.
  • Information Sheets briefly describing common problems and helpful solutions.
  • A self-test that helps you identify elements and set priorities for a personal self-management plan.
  • Action Plan description with instruction and examples for developing unique plan.
  • Exercise Action Plan with hints and instruction on use of the other exercise and activity materials, Relaxation CD and Exercise CD.

Visit the Self-Management Resource Center website to learn more about the Chronic Disease Self-Management Program: Tool Kit for Active Living.ExternalExternal

Tomando Control de su Salud

Cost: The cost varies by organization, but rarely is more than $50.
Format: This course is offered as an in-person workshop.

About the Program

This course, developed by Stanford University, is an interactive workshop for Spanish speaking adults with all types of chronic conditions. If you have one or more chronic condition, this program can help you learn the strategies and skills to manage your health and your condition(s) more effectively and live your everyday life.

Program Details

All the workshop sessions are held in Spanish. It is very similar to the Chronic Disease Self-Management Program (CDSMP), but was developed to be culturally appropriate for Spanish speaking adults. Workshop sessions last for 2.5 hours per week for 6 weeks at convenient community locations.

Topics include:

  • Techniques to deal with problems such as frustration, fatigue, pain, and isolation.
  • Appropriate exercise for maintaining and improving strength, flexibility, and endurance.
  • Managing depression.
  • Appropriate use of medications.
  • Communicating effectively with family, friends, and health professionals.
  • Healthy eating habits.
  • Better breathing techniques.
  • Relaxation techniques.
  • Appropriate use of the health care system.
  • Making good decisions about your health.
  • How to evaluate new treatments.

Visit the Self-Management Resource Center website to learn more about Tomando Control de su Salud.External

Locate organizations licensed to offer the program in your area on the Evidence-Based Leadership CouncilExternal website.

Source: https://www.cdc.gov/learnmorefeelbetter/programs/heart.htm

Self-Care for Heart Health

Heart health self-care

Self-Care for Heart Health

Mary Barna Bridgeman, PharmD, BCPS, CGP, and Rupal Patel Mansukhani, PharmD

Case 1: Vitamin E Supplementation LR is a 58-year-old female who comes to the pharmacy enquiring about vitamins that can reduce her risk of heart disease. She has no symptoms or significant cardiac history, except that her mother has atrial fibrillation and her father has high cholesterol, hypertension, and heart failure. She would to start taking a once-daily vitamin E supplement since she remembers hearing a few years ago that vitamin E is particularly good for promoting heart health. She has no known allergies to medications and reports taking a daily women’s multivitamin, omeprazole 40 mg once daily for gastroesophageal reflux disease, and ibuprofen as needed for headaches and pains. What recommendations can you give LR on the use of vitamin E for heart health?

Answer: 

It is well-recognized that Americans spend billions of dollars annually on vitamins, dietary supplements, and nutritional aids on the premise of promoting good health and preventing disease. Most recently, an expert panel of the US Preventative Services Task force concluded that there is insufficient evidence to support use of single or paired vitamin and/or mineral supplementation to reduce the risk of cancer or heart disease.1 Specifically, this committee identified that there is insufficient evidence to determine whether vitamins and minerals alone or in combination can reduce the risk of cardiovascular disease or cancer, with the exception of beta-carotene (vitamin A) and vitamin E, for which clinical data indicate they are either not effective (vitamin E) or potentially harmful (vitamin A) in preventing heart disease or cancer, respectively.1 In the case of LR, considering she is already taking a daily multivitamin, reiterate the importance of adhering to the recommended dietary allowances of nutrients listed on the label and remind her that increasing supplementation of a specific nutrient doesn’t always equate to better health. Further, remind her that the best way to achieve the health benefits of vitamins and nutrients is through consumption of a well-balanced diet that is low in fat and sodium and high in fiber.

Case 2: Omega-3 Fatty Acid Supplementation 

TJ is a 45-year-old male who is seeking information on omega-3 fatty acids. He’s heard and seen a lot of news extolling the benefits of the omega-3s for heart health is and wondering if supplementation is a natural way for him to lower his cholesterol without medications. TJ has a sulfa allergy and is currently taking atorvastatin 40 mg once daily for dyslipidemia, lisinopril 40 mg daily and chlorthalidone 50 mg daily for hypertension, and escitalopram 10 mg daily for depression. What can you recommend for TJ? What information can you give him about the benefits of dietary intake and supplementation with omega-3 fatty acids?

Answer: 

Omega-3 fatty acids have received much attention in the press and been the subject of several large-scale clinical research studies on heart health and cholesterol reduction in recent years. The major dietary forms of this type of fatty acid include docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and alpha-linolenic acid (ALA). DHA and EPA are primarily found in animal products, particularly from dietary seafood sources (oily fish and shellfish) and from fish oil capsules. ALA is more often derived from vegetable oils and dietary sources such as flax seeds, walnuts, and dairy products. Omega-3 fatty acids may reduce triglycerides and blood pressure and improve immune function, among many other potential health benefits. Consuming 1 or 2 servings of fish per week may additionally reduce the risk of heart disease, particularly sudden cardiac death. 

Much the use of vitamin and mineral supplements for promoting health and wellness, it is generally recognized that dietary intake of the omega-3 fatty acids has been shown to have a benefit in promoting cardiac wellness, while the benefits of omega-3 supplements to the diet remain less certain. The Dietary Guidelines for Americans, 2010, has been updated to include a recommendation that most American adults should consume 8 or more ounces of seafood per week to ensure adequate intake of these heart-healthy nutrients; pregnant women and children usually require less than this amount.2 A recent study published in 2012 found that supplementing EPA and DHA may not have the same protective effect on heart function as food sources of these nutrients.3 For TJ, counsel him on the importance of dietary consumption and on foods rich in omega-3s for heart health promotion.

Case 3: Smoking Cessation

SA is a 57-year-old businessman who comes to the pharmacy seeking a recommendation for smoking cessation. Last month, he had a myocardial infarction (MI) and received extensive counseling prior to discharge from the hospital on the need to quit smoking to reduce his risk of a subsequent MI. He is interested in purchasing an OTC smoking cessation aid as instructed by his physician; however, he would a recommendation for a specific dosage form to purchase. He reports smoking approximately half a pack of cigarettes per day. He smokes throughout the day, most often on breaks at work, in the evening when out with friends, and while traveling. He smokes his first cigarette of the day after his coffee, approximately 30 minutes after waking. He has no known medication allergies but is taking multiple new medications, including aspirin, clopidogrel, metoprolol, atorvastatin, and ramipril. He would prefer to not have to take another medication by mouth. What OTC remedy or remedies can you recommend to SA to aid his quit attempt?

Answer: 

Smoking cessation is a critical intervention for reducing the risk of heart disease, stroke, and MI, particularly in a patient who recently experienced a heart attack. his smoking habits, patterns of nicotine use, number of cigarettes smoked per day (approximately 10) and coexisting medical problems, SA is clearly a candidate for nicotine replacement therapy. Therapies approved for smoking cessation include OTC nicotine gums, lozenges, and transdermal patches, along with prescription-only nicotine inhalers, nasal sprays, varenicline, and bupropion; SA is most ly to prefer using transdermal patches over other dosage forms.4 his nicotine use, consider recommending a 14-mg/day patch to start, with a plan to taper to 7 mg after 6 weeks of use.4

Counsel SA on the appropriate use of the transdermal patch and the potential for side effects, most notably abnormal dreams, headache, or insomnia.

If these become bothersome, removing the patch at bedtime and replacing it first thing in the morning may be preferred.

4 Further, recommend he follow up with local counseling services or use a toll-free service (1-800-QUIT-NOW), if interested, to improve his success.

Case 4: Weight-Loss Medication

KD is a 63-year-old obese female who is requesting advice on an OTC weight-loss medication. KD has recently been diagnosed with high blood pressure and started on medications to try to control it. the advice of her physician, she would to try to lose weight in an attempt to improve her cardiac health. She enrolled herself in a diet/lifestyle modification program; however, she’s seen commercials for drugs that she believes may help augment her attempted dietary modification. She has no known allergies to medication and reports taking hydrochlorothiazide 25 mg daily and amlodipine 10 mg daily. What OTC product and self-care advice can you give KD?

Answer:

Obesity and coronary heart disease go hand in hand, as increased body mass can influence blood pressure, blood glucose control, and cholesterol. Weight loss is not a condition for self-treatment that results in an instantaneous fix, but rather a condition that requires a multifaceted life-long approach to maintaining a healthy weight and lifestyle. In KD’s case, her decision to join a weight-loss and dietary modification support group is a prudent, but sometimes costly, approach and initial step to help her achieve her weight-loss goals. Dietary modification, including reducing daily caloric intake, using fat or sugar substitutes, and altering the frequency of meals, are part of an effective weight-loss strategy.5 Further, as long as medically cleared for participation, incorporation of routine physical exercise may further help with weight reduction.

Although numerous herbal products have been touted for weight loss, the use of most of these products is not supported by validated claims for this indication and may increase the risk of adverse cardiac outcomes.

If KD remains motivated to try and OTC agent, recommend that she consider the use of orlistat (Alli), an agent that may reduce dietary fat absorption and that has been associated with a modest weight loss. This medication is taken at a dose of 60 mg 3 times daily before meals containing fat.

Side effects may include reduced fat-soluble vitamin absorption and gastrointestinal effects, including flatulence, loose stools, and fecal incontinence.5

If KD remains motivated to pursue a pharmacologic agent to support her weight loss, encourage her to speak with her primary care provider for additional information on prescription-only products. Dr. Bridgeman is an internal medicine clinical pharmacist in New Brunswick, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University. Dr. Mansukhani is a clinical pharmacist in South Plainfield, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University.
References

  1. Fortmann SP, Burda BU, Senger CA, Lim JS, Whitlock EP. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: an updated systematic evidence review for the US Preventive Services Task Force [published online November 12, 2013]. Ann Intern Med. doi:10.7326/0003-4819-159-12-201312170-00729.
  2. US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Government Printing Office; December 2010. www.cnpp.usda.gov/dgas2010-policydocument.htm. Accessed November 18, 2013.
  3. Kwak SM, Myung SK, Lee YJ, Seo HG. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials. Arch Intern Med. 2012;172:686-694.
  4. Hudmon KS, Kroon LA, Corelli RL. Smoking cessation. In: Krinsky DL, Berardi RR, Ferreri SP, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 17th ed. Washington, DC: American Pharmacists Association; 2011.
  5. Miller SJ, Bartels CL. Overweight and obesity. In: Krinsky DL, Berardi RR, Ferreri SP, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 17th ed. Washington, DC: American Pharmacists Association; 2011.

Source: https://www.pharmacytimes.com/publications/issue/2013/december2013/self-care-for-heart-health

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