Photo courtesy of Flickr user Mr. T in DC.
Grab some chocolate, pop an aspirin and wash it all down with red wine. You’re on your way to a heart-healthy life, right? Not so fast.
According to Dr. Steven Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, much of the information Americans use as a guide for heart health is little more than folklore.
“It’s appalling,” he said. “And it’s getting worse. These days, you can conduct an Internet search for any heart condition and get a lot of information. The problem is most of it is wrong. And a lot of the common mythology is wrong, too.”
In a new book, “Heart 411,” Nissen and his colleague, cardiac surgeon Dr. Marc Gillinov, approach some of the more popular rumors “the way a jury would approach a trial”: Is there evidence beyond a reasonable doubt that red wine is good for your heart or that red meat is bad?
On this final day of American Heart Month, Nissen shared some of their verdicts.
Myth 1: Red Wine
“It turns out that there’s no information to suggest that red wine is better than any other form of alcohol for your heart,” Nissen said. “But there is information to show that moderate alcohol intake of any kind — red wine, white wine, beer or hard spirits — benefits patients in preventing heart disease. It does so by raising the good cholesterol, or HDL.
“The myth about red wine came from the so-called French paradox — that the French drink a lot of red wine and they have a relatively low instance of heart disease, despite the fact that they eat a lot of fat. People began to think maybe red wine was protecting them. And there was a little bit of research in animals showing that an element of red wine known as resveratrol seemed to be protective in mice. But what the public didn’t get was that they gave thousands of times more resveratrol to the mice than humans would ever get from drinking red wine, and the research just didn’t hold up in additional studies.
“At the end of the day, we don’t recommend taking up drinking to benefit your heart. But if you do drink a glass or two of alcohol per day, depending on your body mass, it can be a heart-healthy activity.”
Myth 2: Red Meat
“Red meat is a source of saturated fat, and all other things being equal, saturated fat does tend to raise the bad cholesterol, LDL. And so it’s not a good thing,” Nissen said.
“However, we stress the importance of a diet we call, ‘no-fad.’ One of the most disturbing current trends promises that if you eat no meat and virtually no fat, you’ll become ‘heart attack proof.’ Our conclusions from the research out there is that this is just utter nonsense — that there are no ‘heart-attack-proof’ diets, that completely eliminating fat, including meat, does not have a convincing health benefit, and that in fact a balanced diet is best.
“We advocate what is called the Mediterranean diet — one that actually has quite a bit of fat — good fat like olive oil and canola oil, fats that contain polyunsaturated fatty acids and not a lot of trans fats. If someone promises you that a diet will melt away the plaque in your coronary, run as fast away from those diets as you can.
“Eating red meat in moderation is not a problem. It’s not good for your heart, but if you don’t exceed reasonable quantities — small amounts of red meat as part of a balanced diet — it is not something people need to avoid.”
Myth 3: Chocolate
“There is a little bit of evidence — and it’s not very strong — that dark chocolate is probably an OK food for the heart,” Nissen said. “There’s even a small study that seems to indicate that dark chocolate might lower blood pressure a little bit. But the effects are very small, and all chocolate tends to have a fair amount of calories and a lot of sugar.
“And so to call any chocolate a heart-healthy food is a mistake. This is another example, because it’s cutesy, because it’s newsy: Whenever one of these poor-quality studies comes out, they get latched upon by the media. But the truth is there are no randomized control trials of any quality on this subject.
“In our book, we talk about the difference between an observational study and a randomized control trial. Most of the alcohol and chocolate studies do not come from randomized control trials, where you would give half the people these substances for five years and half of them would avoid it altogether and you find out who does better. In fact, they come from observational studies, which are inherently flawed. And so the solidity of the evidence is much more limited when you have only observational data.”
Myth 4: Work-Related Stress
“It’s not a huge factor, but it does appear to play some role in a minority of heart attacks,” Nissen said. “We actually have some pretty good scientific data that extreme levels of stress can cause something called Broken Heart Syndrome, which is caused by a sudden rush of stress.
“The best data comes from some interesting observations that during the Super Bowl, when a person is rooting for his or her team and their stress and anxiety goes up, there appears to be more heart attacks. But even better data comes from places like Israel, during the first Gulf War (and) the Scud missile attacks. When people were under tremendous stress, there was a big bump in the rate of heart attacks.
“All of this shows that stress under some circumstances, particularly when it’s extreme, can trigger a heart attack. But it is also important to note that we are pretty well-adapted as a species to handle stress. Our ancestors had lots of it. When we were swinging from the trees in the jungle, there were predators chasing after us. And so stress is not just a function of modern life. We don’t think chronic stress is good for people. It does seem to raise levels of inflammation in the body. But people should not believe that if they’ve got some stress in their lives, it’s going to make them have a heart attack. Stress is a factor, but it’s certainly not the most important factor in heart disease.”
Myth 5: Sex
“It’s extremely rare, but you can have a heart attack from sex,” Nissen said. “There is some data — and this is perhaps comforting to some spouses in the country — that sex with your regular partner does not raise the heart rate and blood pressure to levels that are strongly associated with having a heart attack.
“However, sex with a non-regular partner, particularly if you’re in an extramarital relationship, does seem to have an association with an increased risk of a heart attack. And I think the reasons that most people have surmised is that there is more excitement involved. There may be a fear of being caught and there’s maybe some guilt. For all of those reasons, heart rate and blood pressure go up and may act as a trigger for a heart attack.
“So it’s one more reason to stay faithful to your spouse. On the opposite end of the spectrum, don’t count on sex as your form of exercise for the day. For most of us, the duration of activity is insufficient to meet the aerobic needs of an exercise program.”
Updated March 1: Here is the second set of myths as explained by Nissen:
Myth 6: Dietary Supplements
“Almost all of our patients come in taking dietary supplements, and they believe that it will help their heart health because it says right on the bottle, ‘Promotes heart health.’ These are products like fish oil, coenzyme Q, and the big rage now, Vitamin D. You know, if you go into the local pharmacy, you can find row after row after row of dietary supplements — many I haven’t even heard of. And none of these claims have been evaluated by the Food and Drug Administration.
“In fact, in a great national tragedy in 1993, Congress passed a law that barred the FDA from regulating dietary supplements. And so we don’t even know whether most of the dietary supplements actually contain the ingredients they claim to contain. At the moment, everybody is taking Vitamin D, and there just isn’t evidence that it protects the heart. More importantly, it diverts patients away from the real therapies that they need.
“Often when we go on a book signing, we will ask the audience how many people take fish oil. And lots of hands go up. And then we ask them, ‘Do you think the fish oil lowers your cholesterol?’ and most of the hands go up. Fish oil actually raises levels of LDL cholesterol — it doesn’t lower it, it raises it. But the problem is those claims cannot be regulated because the FDA is virtually powerless. Sooner or later there will be a major national catastrophe.
“We also warn people that these dietary supplements can even interact with their prescription medications, causing them to become toxic or ineffective. And so there are no dietary supplements that we recommend for patients.”
Myth 7: An Aspirin a Day
“Another long-standing myth is that it’s a good idea to take an aspirin a day for people who are at risk for heart disease. In fact, if you’re at low enough risk — if you’re an otherwise healthy 40- or 50-year-old man or woman — it actually increases your risk of adverse consequences, including bleeding into your brain and into your stomach. That’s because aspirin is an anticoagulant, it prevents clotting of the blood. And that is, of course, a benefit but it’s also a risk.
“In the stomach, it has been found to irritate the lining by affecting something known as the prostaglandins, which are protective in the stomach. When those prostaglandins are altered, the stomach is more vulnerable to the effects of acid, leading to erosion of the stomach and bleeding. And the second mechanism is that because aspirin is an anti-platelet agent, it actually prevents blood clotting. And so the combination of irritation to the gastro-intestinal tract plus the anti-coagulant effect is what leads to an increased risk of gastrointestinal bleeding, which is quite significant.
“As for the brain, people of certain ages have areas of weakness in the blood vessels of the brain, and if you get a little bit of a break in those blood vessels and your blood clots normally, nothing bad may happen. But if you have an anticoagulant on board, you may have a serious cranial bleed. When you add it all up, for people who are otherwise healthy, the risks exceed the benefits of taking an aspirin a day.”
Myth 8: Stress Testing
“This is an often-unnecessary test in which a patient walks on a treadmill and has their electrocardiogram monitored so that the physician can look for changes that may be a consequence of not getting enough blood flow to the heart muscle. It’s a test that’s very commonly done in America millions of times each year, and many people are having them done who shouldn’t. In fact, we strongly discourage it in most cases unless the patient is having chest pain symptoms.
“The problem with it is that there are too many false positives and no evidence that screening people with stress testing actually improves their health. These tests often lead to an angiogram and ultimately, to unnecessary coronary interventions, like a stent. Why is this being done so much? Well I hate to be so cynical, but one of the reasons is that are certainly economic incentives for doctors to over-test. Some people have the test done simply because they tell their doctor they want to start an exercise program and their doctor will say, ‘OK, well let’s do a stress test on you.’ People should push back against those kinds of recommendations if they don’t have any of the symptoms of heart disease.”
Myth 9: Calcium Testing
“This is another test commonly performed and widely advocated that we don’t recommend. People are put in a special kind of CT scan and their doctor looks for calcium in the coronaries of the heart. When you see calcium, it usually means there’s plaque in the coronaries, and physicians can then try to prevent heart disease. The problem is that we should be preventing people with risk factors whether or not they have calcium in their coronaries. And so essentially it doesn’t give us information that we can use productively to prevent people from dying or having a heart attack.
“Even though it may have some predictive value, it also can lead to more testing and some pretty significantly bad consequences. If a minor blockage is found, the temptation is often very high to do an angiography, to do a catheterization, and sometimes, even to put in a stent. There’s no evidence that if you take somebody who doesn’t have symptoms and do a heart catheterization, that anything you find will actually benefit the patient. And so it’s driving up health care costs. America spends more on health care than any other country by a factor of about two, and this is one of the reasons why.”
Myth 10: Women Don’t Feel Chest Pain During Heart Attacks
“This one is just pervasive. After a recent article in JAMA (the Journal of the American Medical Association), this has been covered by the media a lot — that many women who have heart attacks don’t have chest pain. While that may be true for some women, it’s important to understand that the principal symptom of a heart attack in both men and women is chest pain. About 12 percent of women are more likely not to have chest pain during a heart attack, but that’s not a huge difference.
“Women may just have a shortness of breath or dizziness or pass out, but the same is true for a small percentage of men. Men and women are more alike than dissimilar. There are some differences, but they’re not as big as people may think. For heart attacks, the same advices should be given to both genders: If you have chest pain, if you have a sudden onset of severe shortness of breath, if you get dizzy, light-headed and sweaty all of a sudden, take it seriously, call 911 and get to the hospital — whether you’re a man or a woman.”