World No Tobacco Day 2022

World No Tobacco Day 2022


World No Tobacco Day is May 31, 2022:
The fight for your life and

fresh air for all New Yorkers

Meet Harlan Juster, the doctor who is advancing

public health policies to tackle big tobaccO IN

New York STATE

According to the Centers for Disease Control, tobacco is the leading cause of preventable disease disability and death in both the United States and in New York State. In New York, tobacco use is responsible for more than 28,000 deaths every year — that’s more than alcohol, auto accidents, and shootings. Since 1964, the Surgeon General’s Warning has appeared on all tobacco products sold in the United States. Additionally, May 31st is World No Tobacco Day, intended to encourage 24 hours of abstinence from all forms of tobacco consumption around the globe. This year, I spoke with Dr. Harlan Juster, Director of the Bureau of Tobacco Control New York State Department of Health on the many coordinated efforts New York State offers to help New Yorkers quit smoking. After reading a few of his tweets, I was encouraged and excited to meet a health care professional who is taking big tobacco head-on, advocating public health policies.

It’s a fact that smoking increases the risk of severe health problems, many diseases, and death – not just for the smoker but also in the community. “We have 2 million smokers still in New York state, that’s about 14% of our adult population. Which is quite low, compared to other states,” noted Dr. Juster. America’s Health Rankings, published by the United Health Foundation, a not-for-profit, private foundation dedicated to improving health and health care, reported that Utah is the healthiest State with just 8.9% of the population smoking; West Virginia was least-healthiest at 26%. It’s estimated that just over 17% of the total U.S. population smokes. The target is to reduce the national prevalence of cigarette smoking among adults to 12% by 2020.

There are cost benefits to citizens, communities, and the health care system to having fewer smokers in the population. “The cost of tobacco-related health care in New York State annually alone is about $10 billion,” stated Dr. Juster. The CDC reports that smoking-related diseases cost the United States more than $300 billion a year, including nearly $170 billion in direct health care costs and more than $156 billion in lost productivity. The challenge in addressing the dangers and risk of smoking is that smoking is a very personal decision. Dr. Juster recognized the difference in taking a message he would share with a patient in his private practice versus a population of 2 million smokers across New York State. However, he also sees a unique opportunity to connect on an individual basis. “We know that 80% of smokers will see a health care provider every year, and that’s a perfect opportunity for that provider to step in and offer evidence-based tobacco treatment. That usually consists of counseling on the risks of smoking, but also to write prescriptions for treatment,” said Dr. Juster. Up to 70% of smokers want to quit and expect their physician will talk to them about it. Smokers who are advised by their doctor to stop smoking are nearly twice as likely to do so than those who are not. “From a public policy side, we want strong policies that keep youth from starting to smoke, like raising the cost of tobacco, removing the sale of tobacco products from pharmacies, maybe getting rid of some the flavors,” he concluded.

“Tobacco control is really one of the great public health success stories in this country.”

Dr. Harlan Juster

Director of the Bureau of Tobacco Control, New York State Department of Health

Resources to help you quit

From 2012-2013, the first quit smoking campaign aired, urging smokers to call 1-800-QUIT-NOW. At least 400,000 smokers quit due to those messages. In 2014, the CDC ran a second wave of that campaign when an estimated 104,000 Americans quit smoking for good. Dr. Juster’s Bureau of Tobacco Control has been funding the New York State Smokers’ Quitline since 2003. “It’s an outstanding service! Any smoker in New York State or someone who knows a smoker in New York State can call to get advice. They can talk with Quit Coaches to help plan to quit. Often they will receive two, three, or four weeks of free nicotine replacement therapy with to help with their quit attempt. The NYS Quitline is just as effective as other State’s programs but is much more efficient.”

Controversial advertising

Lately, the New York State Department of Health has come under fire from its graphic new ads urging citizens to quit smoking. Ironically, most of us are unaware of the over $1 million that the tobacco industry spends each hour on cigarette advertising and promotion. In the beginning, the ads were light, focused on creating a positive culture change. “We’ve done extensive research on what ad messages work and which do not,” said Dr. Juster. “We know that ads with humor or with soft messages like why you should quit did not work well. They did not compel people to make behavioral changes.” Below is an example of one of the State’s first commercials from 1984.

By 2000, the messaging evolved into ads that show the consequences of smoking or the emotional impact smoking has on smokers and their families. While the critics argued over the shock value, the ads worked driving calls to the Quitline. “As we have had success over the past twenty years, we have learned that smoking is not spread evenly across the population, it’s actually concentrated in certain areas. Individuals that are at low-income or less educated, those with substance abuse or mental illness, those with physical disabilities all tend to smoke at higher rates than the rest of the community. We are working on ways to reach them better. We currently rank in the top performing states with tobacco control. California, Massachusetts, Minnesota, New York, and Florida, these are states that are working together on tobacco control,” Dr. Juster shared.

Some European countries have taken notice of American success, taking extreme steps in their advertising campaigns or with new warning labels on tobacco products. Cigarette packs in Germany now display images of rotten teeth and blackened lungs. Certain cigarette manufacturers in the U.K. had to switch to plain packaging, without brands or imagery. Also, the top European court upheld a 2014 European Commission directive that banned flavored cigarettes, mandated that 65 percent of the surface of packs must be covered with health warnings and imposed restrictions on how much nicotine could be taken in through vaping e-cigarettes.

A 2016 study published in the American Journal of Preventative Medicine found that even current smokers believed e-cigarettes to be equally or more harmful than traditional cigarettes, a misperception that could dissuade many of them from switching to less dangerous e-cigarette products.

The next challenge

“Since the year 2000, the amount of youth smoking combustible cigarettes has steadily declined; in 2016 only 4% of high school age youth smoked cigarettes,” noted Dr. Juster. It’s frustrating to learn that over twenty years when the public health policy is turning the tide in the fight to reduce tobacco usage a new product enters the market, aimed at the most vulnerable targets: smokers who want to quit and young people. The challenge this time is e-cigarettes or electronic cigarettes, devices that allow users to inhale “vapors” rather than traditional cigarette smoke.

The other side of the coin is that young people are vaping at incredibly high rates. In 2015, the U.S. surgeon general reported that e-cigarette use among high school students had increased by 900 percent, and 40 percent of young e-cigarette users had never smoked regular tobacco. “We are starting to focus on vaping now,” declared Dr. Juster. “In our new budget from the Governor passed by the Legislation, two new laws will go into effect in New York State this year. One requires that anyone selling the [e-cig] liquids will have to register through the State’s Department of Tax and Finance. Step two is that they will also have to collect a 20% tax on the sale of the products. Raise the cost, who is the most price-sensitive consumers on vaping products? Young people. Vaping is a unique problem in that predatory practices are being conducted by some of the manufacturers, like Juul, who offer flavors that appeal to young people. Vaping has also been added to the Comprehensive Clear Air Act in New York State that forbids vaping in all places where cigarette smoking is banned indoors. If adults want to use these products, the most we can do is educate them on the dangers of dual-use – smoking cigarettes and electronic devices.”

One truth about the anti-tobacco fight is: there is always something new. “There are also new products on the horizon, beyond electronic cigarettes, like IQOS (I Quit Ordinary Smoking), a product of Philip Morris. Instead of a liquid being heated and aerosolized, it uses ground up tobacco. They claim because it’s not combusted or burned, it’s safer than a cigarette. Yet another device to sell their products,” said Dr. Juster.

Written by: Michael Arce, Marketing Coordinator 
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

Employee Health and Fitness

Employee Health and Fitness


A Healthier Workforce

The push to improve the health and
fitness levels in America’s workforce

To say that Diane Hart has dedicated her life to health and fitness is an understatement. In 1981, she launched Hart to Heart Fitness, her personal training business in Albany County. Her career path extended to launching corporate wellness and resilience programs for area businesses. Diane’s leadership skills and passion for helping people change their health and lifestyle led to her current role as President and Executive Director of the National Association for Health and Fitness (NAHF). She brought her signature “high energy” personality to a recent episode of HeartTalk, presented by Capital Cardiology Associates, to discuss workplace health and fitness.

Advocating for healthier communities

Moments before our program, Diane had just finished a phone call with Senator Chuck Schumer. She shared the details of their conversation, Diane was lobbying for consideration of legislation to be included in the Senate’s next Stimulus Package. “We have attempted to pass this for six years, it’s the Personal Health Investment Today (PHIT) Act. This has tremendous bipartisan support,” she added. PHIT would make any expense exclusively intended to be physically active, eligible for FSA/HSA reimbursement. This would cover sporting equipment, health club memberships, youth camps, pay to play sports fees, tournaments, and fitness tracking devices for health conditions (like heart disease). “This act promotes a healthy culture. When you look at healthcare costs today, 3.3 trillion expenditures go towards people with chronic and mental health conditions, which we know physical activity can improve. We also hope this will relieve some of the comorbidity factors Americans face due to COVID.”

Diane Hart accepting the 2016 President’s Council on Fitness, Sports & Nutrition Lifetime Achievement Award

Advocating for legislation that improves American communities’ health is just a part of the NAHF’s mission. The Association’s members are also leaders in developing change-behavior programs, like Global Employee Health and Fitness Month (GEHFM). This event, traditionally, was a workplace-focused health awareness month held during May. It’s active in 38 states, with almost 7,000 companies and organizations participating. However, Hart noted that following the impact of the pandemic, 2020’s edition would need to be updated. “We realized the need to move it virtually when the world moved to work from home and exited office buildings.”

The state of health in the American workforce

A 2018 Kaiser Family Foundation survey reports that 82% of large firms and 53% of small employers across the country offer some form of a wellness program. There are two reasons why: many employers believe that improving their workers’ health and their family members can improve morale and productivity and reduce health care costs. The CDC reported the systematic review of 56 published studies of worksite health programs which showed that well-implemented workplace health programs can lead to 25% savings each on absenteeism, health care costs, and workers’ compensation and disability management claims costs. The CDC added that productivity losses related to personal and family health problems cost U.S. employers $1,685 per employee per year or $225.8 billion annually. Healthy workers are more productive workers, and that helps the company’s bottom line.

Today’s job seekers are also looking for employee benefits that extend past competitive compensation, medical/dental/vision coverage, and time-off. Employers who consistently rank as a “Top Workplace” has noticed that Americans working full-time spend more than one-third of their day, five days per week at the workplace. Applicants are pursuing happiness — an offering that includes work/life balance and positive workplace culture. Firms with an on-site gym or those that offer gym memberships as perks are highly sought by savvy job hunters. While these amenities may not be possible for all business owners, Hart pointed out examples of company fitness opportunities like participating in 5K runs or healthy eating demonstrations, creating healthy moments where individuals can bring these good habits home. “The excitement from participating in these projects needs to expand to help families and children.”

The recent push to offer health incentives has not moved the needle on the state health for the American workforce. “I’m sad about that,” Hart said as she took a deep breath. “We are actually 35th in the world, mostly because our workforce is over-worked.” Last year, Spain surpassed Italy on the Bloomberg Healthiest Country Index, which ranks 169 economies according to factors that contribute to overall health. According to the University of Washington’s Institute for Health Metrics and Evaluation, by 2040, Spain is forecasted to have the highest lifespan at almost 86 years. The country has seen a decline in cardiovascular diseases and deaths from cancer. Experts note that their eating habits, particularly following the Mediterranean diet, have reduced Spain’s obesity rate. That is not the case in America.

Type 2 Diabetes and Obesity are the two main causes of heart disease. According to an article from Corporate Wellness Magazine, more than 50% of health care costs in the United States are due to unhealthy lifestyle habits, such as smoking, inactivity, and weight gain. Healthy workplace activities and programs reduce the development of chronic disease risk factors like alcohol/tobacco use, raised blood pressure, and high blood sugar or cholesterol levels — all by-products of unhealthy diets and sedentary lifestyles. “When I look at the chronic diseases in America, six out of ten of us as adults have a chronic disease or condition,” noted Hart. “Sadly, we know that most heart disease cases, heart attack, stroke, and cancer can be prevented through good lifestyle choices and regular health screenings.”

Written by Michael Arce, host of HeartTalk presented by Capital Cardiology Associates

Candid Physician Electronic Medical Records and Blood Work

Candid Physician Electronic Medical Records and Blood Work


Candid Physician: Medical Records and Testing

Would it surprise you if your doctor shares
some of your healthcare system frustrations?

Stop me if you have thought or heard any of these common healthcare complaints.

There are too many medical record systems. It’s too difficult to make sense of information in an after-visit summary. Why does every health care provider request the same blood work? It feels like my doctor spends more time looking at my charts than talking to me. The way patients are billed is confusing.

Those are five of the most common complaints about the healthcare system. Here is the shocking part: your doctor most likely feels the same way you do when it comes to improving your care quality and the inefficiencies in the healthcare system.

On a recent episode of HeartTalk presented by Capital Cardiology Associates, I had a candid conversation with Dr. Connor Healey, a board-certified cardiologist on the challenges healthcare providers face. I was surprised to learn that a physician shares many of the frustrations of his patients. He was also open to sharing his thoughts and feedback on how we can improve the system. Our talk opened with the after-visit summary (AVS), a paper or electronic document, given to patients after an appointment. As one study found, “the AVS is nearly universal in the United State. However, patients infrequently reference or even retain their AVS, suggesting currently designed documents do not meeting patients’ needs.” The main goal of the AVS was to create a basic report of your doctor’s visit, enabling patients to make better lifestyle choices, while also providing transparency in the care orders. Instead of a standard report that could be freely shared between the patient and their providers, “most of these summaries are inadequate and speak to the inefficient system we have,” stated Dr. Healey. “There is too much medical jargon or information that patients don’t understand, like billing or coding.

There are too many medical record systems

It should be noted that one driving factor behind why every healthcare provider in the United States is pushing to provide an AVS is to meet a standard in the Health Information Technology for Economic and Clinical Health (HITECH) Act. This unlocks financial incentives from the Centers for Medicare and Medicaid Services (CMS). The AVS information is also useful for providers and healthcare teams when they are collecting data before a visit or procedure. The AVS is part of the electronic health records (EHR) system outlined in HITECH. “Most patients would know an EHR as a ‘patient portal,'” Dr. Healey pointed out. This component was initially one of the most challenging goals to reach due to the lack of a national medical records system. “More than 50% of affluent countries have a national health records system, according to the World Health Organization (WHO). The United States is not one of them.”

The reason why you must fill out a separate medical records information form at every health provider is due to the fact that there is not an industry-standard EHR. “Number one, there are way too many different EHRs out there. Your primary doctor may use one; we use a different one at Captial Cardiology Associates (CCA), your rheumatologist may use another. None of them are the same as what is used where you receive your hospital care,” added Dr. Healey. According to the National Electronic Health Records Survey of 2017, nearly 9 in 10 (86%) of office-based physicians had adopted an EHR. “None of these systems talk to each other, that is my biggest complaint.”

Blood work and testing

Whether you visit your doctor for your annual physical once a year or have a roster of health care specialist appointments during the year, chances are you have your blood tested. Blood work and testing are two examples of services that could be difficult to understand on an AVS. “What do the results mean,” is a common question asked by patients. The other is, “why do I have to get my blood checked by every doctor?” As we have learned, since most healthcare providers do not have access to the same patient records, this is an inefficiency in the system. Or as Dr. Healey stated, “blood work is probably the number one example of lack of communication between healthcare providers. Ask any patient the number of times they get blood drawn in a year, it’s ridiculous.” In most cases, the tests that are order are the same test. As part of your routine physical, your primary care provider typically checks your kidney functions, electrolytes, vitamin D levels, cholesterol, and other areas depending on your medical history. “When you come to the cardiology office, that’s a lot of what I’m looking at too. I may look at a troponin, which is a blood test for heart damage. I may look at BNP, a blood test that indicates how much MI stretch there is and acts as a surrogate for, ‘hey, do you have too much fluid circulating in your body?’ While most of it is redundant, there are specialty tests that do get ordered, which is why you will need more than one blood test a year. Having said that, there is so much waste on the redundancy of the standard blood tests that the country would save, literally, tens of millions of dollars if we had a better capability of sharing results.”

A better system

As we have transitioned from hand-written notes to electronic records, there are still improvements necessary to upgrade the American healthcare system. A valid point on a Twitter thread stated that EHR’s should be more intuitive. As one doctor tweeted, “As a millennial doc, I still wonder how my older colleagues managed to learn and use. Then read a recent study that EHR is one of the top reasons for physician burnout… and it all makes sense.”

“The goal is to improve the system so that physicians can deliver the highest quality of care at the lowest cost. This starts with a standardized AVS and better connected EMR,” Dr. Healey suggested. Healey visualizes a digital document designed as a standard medical record file, delivering a simple visit summary to the patient, and pertinent information. “Ideally, the solution would be that every patient has a single chart that is unique to them but would accessible by all providers.”

Patient Summary example from Modern Healthcare

A standard patient records system would also improve patient visits. A study released in February of approximately 100 million patient encounters with about 155,000 physicians from 417 health systems, showed that providers spend an average of 16 minutes and 14 seconds per encounter using EHRs. That’s almost a patient visit to review charts, documents, and order tests. Dr. Healey detailed, preparing for a typical patient appointment. “I will get a note that is eight pages long for a single encounter. I have to parse through all of this garbage to find vital signs, physical exam, what was discussed, and the concern or reason why I am seeing this patient. And that’s just one visit! I’m also getting messages from their oncologist, their lung doctor, and in some ways, this is more time consuming that when we used paper charts where we had more control of things.”

Written by Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates

What To Expect When You Visit Your Doctor This Summer

What To Expect When You Visit Your Doctor This Summer

What To Expect When You Visit Your Doctor This Summer

“Be prepared to be screened, to wear a mask, and aim to arrive a little earlier than you normally would.”



Call ahead up to 24 hours before your visit.


You can wait in your car.


ONE visitor per patient.


Try to keep 6 feet between people.


A mask or face covering must be worn at all times.

As New York State reopens, there is a backlog of patients waiting for elective surgeries and office visits. If you haven’t visited a medical facility since the virus outbreak, your experience will be very different due to safety guidelines. Dr. Lance Sullenberger, a board-certified cardiologist at Capital Cardiology Associates and member of the Albany COVID-19 Task Force, shares insight in what to expect when you visit your doctor or an area hospital this summer.

“One of the things I am most proud of at CCA is that we have never closed our doors during the pandemic. Our team adapted on initially a daily basis, now its more like a weekly basis, in terms of providing the highest level of safety for our patients and staff in this environment,” stated Sullenberger. Currently, at all Capital Cardiology Associates locations, patients and their guest are required to passing a temperature check along with providing satisfactory answers to COVID-19 guideline screening questions before being admitted into the building. We also require all patients and their guest to wear a mask or face covering, at all times, during their visit. “We are wearing masks and ask that you do the entire time you are in the building.”

At our Corporate Woods location, patients are allowed to bring one visitor per visit. Due to restrictions at our Troy office in the Samaritan Medical Arts Building, only patients are allowed in the facility. “If you are visiting a facility, what you can do as a patient, please aim to arrive a little earlier than before to allow for the screening and extra time to check-in,” Sullenberger added. Our team is diligent in keeping our schedule on time. Still, Dr. Sullenberger has noticed that patient visits have tended to run over their booked time due to additional questions on the virus or discussions on a patient’s treatment or medications during the outbreak. “I am spending more time digging into the lifestyle changes that could have led to a change in heart health.”

What your doctor will ask you

There were several lifestyle changes that could have impacted your heart health during the shutdown. The World Health Organization (WHO) specifically warned about alcohol use during the COVID-19 pandemic.

Alcohol distributors reported a 50% increase in the sales of alcohol from one week in March of the coronavirus compared to a week the same year ago. Home delivery of liquor increased dramatically, and one report noted a 300% increase in alcohol sales in March compared to January. “I’m seeing that more people are coming in with extra weight due to increased alcohol use or eating more processed or canned food during the pandemic,” Sullenberger commented. Increased alcohol consumption is one of the four modifiable risk-factors for heart disease. “Very few patients are coming in with normal blood pressures. There is a low level of anxiety in our population as well, combine that with increased sodium intake, this condition requires attention and adjustment on medications.”

Fewer heart cases

Emergency Room

Another concern we reported during the outbreak was the drop in hospital visits. Hospital visits declined 33-62% from March to mid-April, according to a report. Some of the drop was attributed to the cancellation of elective procedures due to hosptials needed staff, resources, and room for COVID patients. The sentiment in the medical community was that heart patients were missing from hospitals. “I am finding is that more people had symptoms that they lived with, ignored, or didn’t give attention to, over fear from going to a hospital for treatment,” said Sullenberger. Cardiologists around the world united to share the immediate message that heart disease, heart attacks, and stroke due not take time off during health epidemics. “I want to reassure people that the medical community is doing all we can to mitigate risks as much as possible. If you have been sitting at home, waiting on having your symptoms addressed, you are not doing yourself any favors. If you have chest pain or shortness of breath, now is the time to get the visit done! It is safe to seek attention for your medical needs.”

Healthcare returning to normal operations

Albany, Rensselaer, and Schenectady Counties are now eligible to resume elective surgeries. Governor Cuomo announced that New York State will allow elective outpatient treatments to resume in counties and hospitals without significant risk of COVID-19 surge in the near term. “The elective procedures that have been put on hold have been joint replacement, knee surgeries, hip surgeries, and some ear, nose, and throat,” Sullenberger clarified. A total of 47 counties can now resume these procedures. “We are still waiting for some guidance from the State Department of Health and from the hospitals on what it will take to perform these procedures. Pre-operative (pre-op) steps will require meeting with your surgeon and getting a date scheduled. The major issue is that patients will have to be tested for COVID infection. That is a nasal swab, three days before the procedure. Then the patient must self-quarantine after the surgery. I think we all want to avoid a patient unknowingly who may be asymptotic, bringing infection into a hospital setting.”

Some cardiologists do interventional procedures such as stenting, but they do not perform surgery. Dr. Sullenberger outlined his role in patient pre-op evaluations. “The cardiologist’s responsibility is to make sure that a patient who has any surgical procedure is not at risk of having a heart attack or cardiovascular compilations. We provide an assessment of that risk. As you can imagine, there are people in their 30’s and 40’s who have no cardiac risk factors which don’t need to see a cardiologist and won’t be referred. Likewise, some older people may have a history of diabetes or have high-risk factors, like high blood pressure or heart disease, that require attention. Our role is to see these patients in pre-op visits, to speak with the patients, and sometimes conduct an echocardiogram or stress test to evaluate and gauge any risk.”

The new normal

As far as this “new normal” of temperature checks, health question screenings, and safety guidelines for healthcare providers, Sullenberger has spotted a silver lining in a post-shutdown system. “The handling of the COVID pandemic here from a medical standpoint taught me a lot. In our office, we had an organized team that worked on operating under the guidelines on a daily basis. In the hospital, the setting was different; it was how to take care of patients from a cardiovascular perspective who have active COVID infections. This virus does have multiple manifestations, and it does involve heart-related symptoms and illness. We need to be cognizant of that if we see a second wave in the local population. My key takeaways are that we are going to be in masks for awhile. I don’t know what a while is, I’m not Dr. Faucci, but I would expect at least a year. I also recognized that I have a great group of colleagues. These are dedicated people who work in our offices and hospitals, who are passionate when caring for patients.”

COVID team

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates

COVID-19: Do I Need to Stop or Change My Meds?

COVID-19: Do I Need to Stop or Change My Meds?


Ask a Pharmacist

Do I Need to Stop or Change My Meds?

COVID-19 is a very new virus, and there is a lot that we still do not know about it. There have been some recent claims or speculation about how certain drugs may interact with the COVID-19 infection, but nothing yet has been proven. Some of the medications discussed throughout media sources recently include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and non-steroidal anti-inflammatory drugs (NSAIDs), all of which are very common among CCA patients.

There is a protein, ACE2, in our bodies that the COVID-19 virus binds to and thereby enters targeted cells. An early concern was that patients on medications like ACE inhibitors, ARBs, or NSAIDs that also work on ACE2, may be at an increased risk of getting COVID-19 or having worse outcomes. However, this has not been proven, and in fact, there are recent suggestions that the opposite occurs with ACE inhibitors and ARBs, and that being on one of these medications may be beneficial in the setting of COVID-19.

Below, we aim to help you understand your risks and the best plan of action in these uncertain times. As always, it is highly recommended that you speak to your healthcare provider before changing any of your medications.

ACE inhibitors and ARBs

What are ACE inhibitors and angiotensin receptor blockers (ARBs)?
ACE inhibitors and ARBs are medications commonly used to treat high blood pressure or heart failure and include lisinopril, enalapril, losartan, irbesartan, and valsartan.

Should I continue to take my ACE inhibitor or ARB?

To date, there is no data to support this hypothetical concern. The American College of Cardiology (ACC) and American Heart Association (AHA) both recommend continuing to take ACE inhibitors or ARBs as directed by your healthcare provider. Recently there has been one small study published that provided encouraging data for continuing the use of ACE inhibitors and ARBs. While this evidence is preliminary, it is promising that the benefit of these medications in cardiovascular health may outweigh the risk in COVID-19. Overall, the use of guideline-directed medical therapy is key in controlling blood pressure, and stopping them could lead to a heart attack or stroke.

In conclusion, the FDA, WHO, and CDC are currently unaware of any scientific literature connecting the use of NSAIDs, ACE inhibitors, or ARBs and worsening or causing COVID-19 infections. The information being reported is mainly from purely observational studies, and not based on scientific data. New studies are planned, and we will continue to keep you updated as any new information emerges.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

What are NSAIDs?
NSAIDs include medications you may know more commonly as ibuprofen (Motrin, Advil), naproxen (Aleve), celecoxib (Celebrex), and aspirin. They are commonly used to reduce fevers and relieve mild pain.

Is it safe to continue taking NSAIDs?

There are currently no studies that suggest taking NSAIDs increase your risk of getting COVID-19 or worsening outcomes with COVID-19 infection. The European Society of Cardiology (ESC) and the Food and Drug Administration (FDA) are both unaware of any scientific data to support the worsening of COVID-19 infection associated with NSAID use. The concern to avoid the use of these medications is theoretical, and at this time, patients can continue to use them safely and as directed. The National Institute for Health (NIH) suggests using the lowest dose of NSAIDs, for the shortest period of time, to provide relief of pain and fever, and this is especially important for those with cardiac conditions and kidney issues.

Is there an alternative medication I can take for fever or pain?

If you are looking for a medication to help with pain and fever reduction that is not an NSAID, Tylenol (acetaminophen) is an option! The CDC currently states that acetaminophen (Tylenol) is an appropriate choice to help reduce pain and fever related to COVID-19 infection. Over-the-counter (OTC) products are safe and effective when you follow the directions on the label and use them as directed by your healthcare provider. The maximum daily recommended dose of acetaminophen (Tylenol) is 3,000 mg per day.

Is it safe to take my ‘baby’ Aspirin?

Yes! A low or “baby” dose, 81 mg, aspirin is commonly taken for heart health. The findings of “aspirin worsening COVID-19” are unfounded. It is very important to continue aspirin therapy as it has significant benefits, especially after a heart attack, a coronary stent, or stroke. Aspirin works by a different mechanism of action than other NSAIDs, and thus the cardio-protective effect and the reduction in risk of cardiovascular events outweigh any theoretical risk of aggravation of COVID-19 symptoms.

Please call Capital Cardiology Associates or the Clinical Pharmacy Team at Capital Cardiology Associates for more information, questions, or concerns.

Stay well and wash your hands!

Written by Emily Kronau Pharm Intern, Dylan Carmody Pharm Intern, Emily Plumadore PharmD, Kate Cabral PharmD, BCCP

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