High blood pressure causes brain lesions later in life

High blood pressure causes brain lesions later in life


Your heart and brain health are connected

How high blood pressure causes brain lesions later in life

Your heart and brain health are connected. Two studies regarding memory loss in seniors indicate that instead of being a sign of simply aging, short-term memory loss could be a symptom of the effects of hypertension or high blood pressure.

Controlling your blood pressure younger in life will have an impact on your memory later in life. Researchers from University College London in the U.K. studied high blood pressure in men from 36 to 43 years old led to smaller brain volume at 69 to 71. What they recently reported was that high and rising blood pressure in middle age was associated with brain function later in life. The American Heart Association defines high blood pressure (HBP or hypertension) when your blood pressure, the force of blood flowing through your blood vessels, is consistently too high. It’s been a known risk factor for heart disease, heart failure, heart attack, stroke, and cardiovascular disease. The new study exploring uncontrolled HBP as a risk factor for dementia connected brain and heart health.

“This has been a real game-changer for us in the past few months,” says Dr. Robert Benton, Director of Clinical Research at Capital Cardiology Associates. With around 15–20% of our blood going to the brain, physicians have long understood the importance of blood flow and reducing blockages or flow to the body’s most essential organ. In the UK study, doctors found white matter brain lesions, a sign of blood vessel damage in the brain, an indicator of aging, and a risk factor for cognitive decline. Dr. Benton acknowledged that showing adults the damage uncontrolled blood pressure is doing to their brain would be an effective awareness tool. “I wish we had a brain CT score as we do for heart patients,” he said. Cardiac CT for Calcium Scoring is a scan that uses an x-ray focused on the functions of your heart. The images show cardiologists the amount of plaque in the arteries of the heart that has calcified or hardened. This can blockage or narrowing of the arteries is an indicator of atherosclerosis or coronary artery disease (CAD). People with a higher content of calcium (score) of calcium have an increased risk of heart attack or cardiac events. “In just a few seconds, we could get a better picture of spots on the brain associated with HBP. That’s one of the things on my wish lists for tests! I think this would really get the message across. ‘This tiny bit of scar on your brain could let to forgetting where your keys are, or worse,” added Dr. Benton.

In the SPRINT MIND trial published in January, investigators from the Wake Forest School of Medicine in Winston-Salem, looked into whether aggressively lowering blood pressure could protect the heart, kidney, and brain over five years. Aggressively lowering blood pressure in hypertensive older adults did not significantly reduce dementia risk, SPRINT MIND investigators reported. “The real question becomes when you frequently decrease blood pressure through medication, sometimes in older people, dizziness or disorientation can be a negative side effect,” Dr. Benton commented. This is a challenge that physicians face when prescribing treatment. “You have a symptom and sign that is very clear and distressing. What do people complain about when they get older? Forgetfulness. Now there is evidence linking that lack of controlled blood pressure with objective evidence of damage to the brain. This has led me to be more aggressive in the last several months in presenting this issue with patients: you could lose memory due to uncontrolled high blood pressure. Your health today affects how you will live in the future. No one wants to lose their independence over hypertension and high blood pressure,” said Dr. Benton.

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates
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.

Connecting with youth on their vascular health

Connecting with youth on their vascular health


Connecting with young people
on their vascular health to
build healthy communities

How the one-day. “V-Healthy Program”
is changing the Capital Region and the world

Heart disease is the leading cause of death in the United States. This is something that more than half of Americans are worried about, yet in a recent study, we know our bank balance better than our blood pressure. The good news is most adults, can identify the modifiable risk factors for heart disease (cigarette smoking, indulging in alcohol, poor diet, lack of activity/exercise). We understand that everyday lifestyle choices affect our health. The challenge for physicians has been arming patients with basic health knowledge, like the link between diabetes and heart disease, so that they can take better control of their heart health. This paradox can be especially frustrating for a new surgeon, fresh out of medical school training, who cannot understand how people are more interested in their finances than their cardiovascular health.

Fifteen years ago, Dr. Manish Mehta was that young vascular surgeon, who wanted to do more than inform his patients on vascular health — he wanted to create community awareness. “When I talk to patients every day, I’m trying to teach them about their vascular health and vascular disease and how this impacts all of us as we get older,” he said. He quickly realized how difficult it is to explain the complexities of vascular health. The biology of blood flow through veins. The function of arteries and science of genetics and other risk factors that can cause blockages in our blood vessels. On top of being something that occurs inside our body, vascular disease is a process that develops over time with long-term implications. Dr. Mehta compares vascular disease to morning traffic. “Picture a highway or freeway system with three open lanes and traffic is flowing. Everyone is doing 65/70 miles an hour while they could be safe and doing 55 mph. Now, imagine there’s a car accident in the right lane. All the right lane traffic slows down, which causes the middle lane to slow down, as well. Everyone tries to move over to the left lane, and that causes a backup. When this event happens in an artery, and stagnant flow happens, blood starts to clot. The danger is when a clot travels to a vital organ. In the case of the brain, that can then cause a stroke. In the case of a lower extremity, you can cause ulcers and lack of blood supply.”

In 2004, Dr. Mehta founded the Center for Vascular Awareness (CVA), a non-profit organization. Their goal is “to educate the general public regarding the field of vascular medicine and to educate the underserved to help them help their doctor.” In the summer of 2016, the CVA launched the V-Healthy program to reach high school students. Their goal was to bridge the gap in vascular health and science that often fails to connect with young people. “It’s impossible for a 15-year-old to look forward in time and say what’s going to happen when he’s 55, or she’s 62. At the end of the day, we wanted to create a program that empowers children to take their vascular disease in their hands,” said Mehta.

That program is “V-Healthy Day.” Dr. Mehta’s team found an exciting way to connect young minds with complex vascular disease topics like hypertension, Peripheral Arterial Disease, stroke, and Deep Vein Thrombosis. The first V-Healthy Day happened in 2017 with 20 physicians and health care providers at Shenendehowa High School. The next year, the program jumped to include 10 area high schools, reaching over 3,000 students. The V-Healthy™ program consists of a 45-minute curriculum that is hands-on, literally. Mehta shared his secret, “We bought hundreds of blood pressure cuffs and taught students how to measure blood pressure.” Brilliant! What engaged the kids was the take-home assignment. “The big message is, we talk about how they like their parents on the outside and the inside. We empower them to go home and measure blood pressure on their parents for one week.” The students also participate in a survey on the program which Dr. Mehta uses to measure success rates. “Seventy percent of kids had a much better understanding of hypertension, diabetes, smoking, and lifestyle decisions. Eighty percent of kids want to share this with their parents. Ninety percent of kids said that they personally want to learn more about vascular health.”

Connecting with young people, bringing a health message home, that may seem like a win, but for Dr. Mehta, he is still looking at impacting our community. “This is a movement that has to be grassroots at a level where kids are empowered to influence change. There’s really no other way around this the way I see it. I have been reached out to by the American Heart Association, we’ve had numerous conversations on this program. The Center for Disease Control has contacted me, as well as large organizations within the society of vascular surgery, on how we can bring this program to teach doctors and healthcare providers in different parts of the world on how to create the change that we’re making here in the Capital Region. This is all happening right now as we speak.”

Almost 20 area high school are on board for the next V-Healthy Day. The CVA will announce the next date and list of participating schools in November. You can learn more about the program by clicking here.

Eating Fresh and Healthy for your Heart

Eating Fresh and Healthy for your Heart


Eating Fresh
and Healthy
for your Heart

How to sneak “good foods” into your daily meals

Eat right. Get exercise. Live healthy. Whether you are watching the morning talk shows, talking with friends, visiting family, or scrolling through your newsfeed; at some point in the day, you come across a new diet, “superfood,” or way of eating that enhances your health and happiness. Why? Nearly 90% of Americans fall below the fruit and vegetable consumption recommendations — we all struggle to find creative ways to make healthy choices every day.

Super foods

Every season, there is a new “superfood” that catches media attention and appears in everything from salads, smoothies, to side dishes. Blueberries, salmon, kale, and acai are just a few examples of foods that have garnered the superfood label. Most nutrition experts disagree with the definition of a superfood, calling it a marketing term. Catrina is the owner of Catrina K Fitness. As a NASM Certified Personal Trainer and Corrective Exercise Specialist with a specialization in Nutrition, she explained how companies created the term to market their products through media hype. “I think if you look at it this way if you ever go to a dietician and ask them, ‘what superfoods do you recommend?’ They will tell you there is no such thing as a superfood. If you go to your doctor and ask, ‘what superfood should I take for heart disease?’ They are never going to tell you that goji berries are the way to go.”

What is essential is to do your research when you come across a new food that has nutritional or health benefits. Blueberries, kale, and sweet potatoes, for example, often get more attention because of the research given to them versus other berries, leafy greens, or squash. Most of the exciting superfoods fit into the exotic category, like acai berry, that might be healthy but are not more nutritional on their own over less exciting or expensive fruits. Another tip is to check the nutrition labels of drinks or products made from superfruits – the added sugar may be the reason you prefer the taste.

Catrina also pointed out that “too much of a good thing is a good thing” when trying to maximize the benefits of superfoods. She advises adding them to snacks and meals instead of making them the primary serving. “Make sure you’re not telling yourself, ‘this is going to cure my illnesses.’ It’s a treat just like anything else, and moderation is key. No one food will cure you, and none of them are superior to other foods. Fruits and vegetables are great and healthy for you, but there is no superfood.”

Healthy foods and picky eaters

“Children aren’t the only picky eaters at the dinner table. There is a fair share of adults who push fruits and veggies to the side in favor of mac and cheese. Some of these adults are even us. If you are trying to change your diet plan, Catrina advises getting ideas on how to sneak healthy foods into some of your favorite dishes. “Let’s say your husband is a huge mac and cheese fan, throw in some broccoli or chop up some peppers and onions and see if they even notice.” The key to successfully eating healthy is to start slow with incremental changes, especially when dealing with picky eaters. “I’m also not a big believer in forcing children to finish the plate. Don’t tell them they have to eat their vegetables to earn dessert. These actions put negative connotations with healthy foods. I’m a big believer in the “test and try method”; put the food on their plate and wait to see what they eat. Alternatively, encourage them to try or taste it. With a little help, your picky eater will soon make good choices on their own,” Catrina said.

The tough part for home cooks is getting new ideas for old dishes. Catrina’s suggestion may come from a surprising source. “I always get ideas from restaurants,” she revealed. “If you get grilled asparagus from somewhere and you really like it then start grilling it at home!” There are a couple of ways to bring that restaurant dish taste to your home kitchen. One, is browsing for healthy copycat takeout recipes online. Love that grab-and-go breakfast burrito? There’s a quick and healthy way to make it that doesn’t require pulling up to the drive-thru window! A change you will notice in “healthy home dishes” is a noticeable reduction for salt, fat, and sugar in the recipes. These ingredients are added to dishes by chefs for flavor, seasoning, or as a preservative. Many store-bought frozen foods, canned, or pre-packaged foods are high in sodium so try to use fresh ingredients when possible.

“Another big tip is seasoning,” adds Catrina. “The reason you like dishes in a restaurant and not at home is because you’re just heating a vegetable and throwing it on a plate. There are other ways to cook vegetables besides microwaving them, like grilling or oven-roasting them. Once you learn how to season, roast, and add olive oil or dressing to your veggies, you will taste the difference. Try different flavors to see if they encourage everyone in the house to eat it or if it makes you want to make it more.”

Healthy eating for the whole family

The goal for every busy home cook is to make one meal that everyone can enjoy. A simple tip to encourage interest in meals is inviting your children to help make them. Studies show that children are more excited about eating healthy foods when they are involved. Give them age-appropriate tasks and keep a step-stool handy. Not only does prepping one meal saves time in the kitchen, but it also saves money for the household. The average American household spends over $4,350 on food every year. When you add dining out, we pay another $3,000 at restaurants, take-out/delivery, and quick-service vendors.

The other challenge with healthy eating is that eating healthy is often more expensive. Catrina acknowledged the difficult choice parents make when trying to balance their time, budget, and nutrition needs. “This is a difficult socio-economic topic. It is hard to tell a family that is not making much money, ‘you need to cook everything at home.’ Unfortunately, in our society, fast food or convenience foods are the less expensive alternative. This is a fact that no one fully addresses. However, it is just about managing your time, managing your money, finding what your family likes, maybe learning how to bulk shop for those items, and also not demonizing food. If you can only afford a few cans of tuna for your protein that week, or less expensive cuts of meat, that’s fine. Make the smart choices that are best for your family’s health and get creative in making healthy dishes. Eggs are a great source of protein. Serving them with breakfast, let’s children know that there are other foods on the plate, not just the sugary, sweet, or carb options.”

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates
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.

Pacemakers and Implantable Devices

Pacemakers and Implantable Devices


What’s the difference between a pacemaker and a defibrillator?

“I tell people if pacemakers are like cruise control, defibrillators are like the airbag in your car.”

The concept of using pacemakers and implantable device to manage irregular heart rhythm patterns (arrhythmias) and heart failure started over 50 years ago. Since then, we have seen these devices improve patient outcomes from atrial fibrillation, arrhythmias, and heart failure. An estimated 1.5 million Americans have a pacemaker today. As a new generation of heart patients seek implanted devices to aid in the regulation and monitoring of the electrical system of the heart, some question having a small piece of technology implanted inside their chest.

Maryellen King is an Advanced Practice Nurse who specializes in cardiac device management and electrophysiology. As Manager of the Remote Monitoring Clinic at Capital Cardiology, she is an expert on how implanted technology continues to evolve to meet the needs of future heart patients. Maryellen has been working with patients who have had a pacemaker or defibrillator implanted for the past ten years. She often starts her visits by explaining the difference between the two devices.

What is a pacemaker?

Pacemakers allow most heart patients to participate in life fully. “Pacemakers are like cruise control on a car,” King explained. The device works on demand to regulate through electrical pulses that aid the heart to beat a normal rate. “They are meant for low or slow heart rates. People who have conditions where their heart rate is consistently low, or it’s likely to drop too slow or slow suddenly. They may be candidates for a pacemaker.” The device helps patients have a normal resting heart rate between 60-100 bpm.

The first pacemaker was implanted in 1958; it fired for three hours. About 400,000 pacemakers are implanted in the U.S. each year. Today’s devices have a lithium battery that can last 8-10 years, “maybe a few years more or less depending on usage,” King added. In size, pacemakers are small and relatively light. They are about the size of a half-dollar or smaller than pop-socket on a smartphone. Newer models weigh between 1 and 2 ounces. While there may be a slight bulge under the skin where the device is implanted, most patients have no problem wearing jewelry or clothing. Most patients don’t feel the pacemaker working. “Sometimes, during testing, when we’re trying to check some settings someone’s aware that we might be doing something, they can feel thumping. On an overall basis, no, people forget they have them.”

What is a defibrillator?

“A defibrillator is a life-saving device,” said King. Known as implantable cardioverter defibrillator or ICD’s, “they were developed in the 1980s. The reason people get defibrillators is that they’re at risk for life-threatening heart rhythm. Not just a slow heart rate, but a heart rhythm that could cause their heart to stop pumping blood suddenly,” she added. ICD’s work differently than a pacemaker, in that, they monitor heart rhythms and delivers electrical shocks to the heart known as defibrillation. The ICD current allows the heart to reset its electrical state and return to a regular beat where your heart pumps blood effectively. If you have a dangerously fast or rapid heartbeat, you would be a candidate for an ICD. “I tell people if pacemakers are like cruise control, defibrillators are like the airbag in your car. If you know you’re at risk for an accident and you’re driving a car you want the safety features, you want the airbag.”

As technology gets smaller, faster, and smarter, it also has added a layer of care for heart patients at home. Maryellen King also manages the Remote Monitoring Clinic at Capital Cardiology Associates. Her team oversees data collected from hundreds of patients with implanted devices that transmit patient data in real-time. “The remote technology that’s available now is usually a little monitor the size of a book, that transmits while the patient is sleeping,” King shared. Her team of nurses and remote monitoring technicians scan for alerts or urgent issues that require immediate attention. They can check for the device battery, usage of the pacemaker or ICD, along with changes in the heart rhythm. “When there are irregularities in their reports, we work with patients to see they are on the correct medications or anti-coagulation. In some cases, we will call the patient to follow up or send them to the hospital, depending on what is the most appropriate direction.”

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates
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.

Palliative Care

Palliative Care

Palliative Care
offers an extra
level of care to
patients and
their families


Palliative care focuses on relief from pain, the symptoms and the stress of serious illness to improve quality of life for patients and their families. It is a team-based approach, involving specialty-trained doctors, nurses, and social workers who work with the patient’s other health care providers to offer an extra layer of support.

While its beginnings trace back with the hospice movement of the 1960s, palliative care is not end of life care and can be delivered alongside curative treatment. “Palliative care is a combination of specialty of care providers, just like in cardiology and pulmonary and cancer specialists, it’s also a service and certain skill set,” explained Dr. George Giokas, chief medical officer of St. Peter’s Health Partners (SPHP) palliative care service line. “Essentially, it’s an extra layer of support for patients and their families that have a serious illness, working with your doctors. We aim to provide the best possible care.”

Palliative Care Team

The palliative care team is assembled depending on the patient’s needs, location, and situation. “The beautiful thing about palliative care is that it is not just one staff person or provider. It’s the amazing coupling of a nurse practitioner, physicians assistant, or registered nurse and also a social worker,” noted Catherine Markey, Social Worker. In the Capital District, Dr. Giokas and his team are embedded in local hospitals and physicians offices. Their goal is to be present when they are most needed: at the beginning of treatment. “We are involved in supporting patients at any stage of their disease trajectory but frequently at the onset, the first moment you are diagnosed with stroke, heart failure, or heart attack. That moment is optimally appropriate to introduce palliative care,” said Dr. Giokas.

For those outside the medical community, not much is known about this service to patients and their families. One area is long-term care. “Most illness that palliative care works with, and honestly, most illness that people have are not sudden events that you have, heal from, and then it’s all over with. That might happen with a car accident, but for most people with heart failure or emphysema, or most cancers, people were living with it for decades at some time,” Dr. Giokas outlined. He also outlined the “healing” process, noting that in the physical sense, healing is a role for physical therapists and their staff. A palliative team looks beyond the diagnosis to help patients live their best life while living with their disease. “People don’t get better by themselves; they are usually in a community our family that supports the healing process.”

According to the CDC, approximately 53 million Americans are currently serving as informal caregivers for patients with a variety of illnesses. The other aspect of palliative care is providing support to caretakers and family members by explaining the medical treatment and discussing stress areas. The daily demands of administering medications, accompanying the patient to physician visits, and preparing prescribed meals can lead to stress for family members and spouses, especially when they are trying to raise a family or care for themselves. Dr. Giokas acknowledges that part of the challenge is offering advanced care for a growing, aging population that has a wide spectrum of health problems. “It’s rare for us to treat just one condition, like heart disease. Patients often have a mild element of emphysema, COPD, diabetes, or arthritis. As a team, we work with the provider to treat all of the patient’s problems.”

The role of women as caregivers

Heart disease is the leading killer for men and women in the United States. Assitance and care will typically fall onto family members and spouses — most of whom are women. Studies show that more than 50% of women in America will care for a family member at some point during their adult lives. In a recent survey among California residents, 16% were serving as caregivers; of these, an estimated 59% to 75% were women, most of whom were married. Their average age: 51 years old. The strain of caring for a heart disease patient has recently been identified as an independent risk factor, putting the caregiver at almost 2-fold higher risk of coronary artery disease. “We can explore the ways to cope with that stress, whether it’s bringing in more resources from the community, additional family members to help, or working on long-term coping strategies that deal with the hard emotions of dealing with heart failure in your life,” Markey added.

In recent years, many states have created these cross-disciplinary task forces and passed legislation to educate providers and the public. For example, Vermont requires health care providers to demonstrate competency in identifying and engaging patients who could benefit from palliative care. In our area, very few patients ask for palliative care. Most referrals come from physicians when they discuss the role of a caretaker with family members. “I often hear from patients and their families how much time we spend with them. On average, it’s about an hour per visit. Our follow-up visits can potentially be just as long. We get to know them and ask questions on topics that they are not used to discussing in the medical setting. I often hear people saying that they don’t feel alone anymore when dealing with their illness; they feel like they have someone walking with them,” Markey shared.

For more information on palliative care options, please ask your doctor or health care provider at your next appointment.

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates
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.