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Published on February 23, 2016

14 heart health myths debunked, clarified and otherwise set straight

By Mackenzie Clark, Lawrence Journal World reporter 

as published in 2/23/2016 Lawrence Journal World 

There are a lot of health myths out there, and because cardiovascular disease is the No. 1 cause of death in America — accounting for 1 in 4 deaths— a lot of those myths have to do with heart health.

Dr. Michael Zabel is medical director of Cardiovascular Specialists of Lawrence, a Lawrence Memorial Hospital affiliate. He received his medical degree from Washington University in St. Louis and completed his residency and fellowship at Duke University Medicine Center, both of which consistently rank in the top 10 medical schools in the United States.

Dr. Michael Zabel, medical director of Cardiovascular Specialists of Lawrence, an affiliate of Lawrence Memorial Hospital

Dr. Michael Zabel, medical director of Cardiovascular Specialists of Lawrence, an affiliate of Lawrence Memorial Hospital

Here are Zabel’s professional opinions on 14 of the top cardiovascular health myths.

Heart Health 101

1. If I have high blood pressure or high cholesterol, I’ll know it.

Definitely no on both accounts, Zabel said. High cholesterol almost never gives symptoms; high blood pressure sometimes presents with headaches and blurred vision, but that’s pretty rare.

2. But I’ll definitely know if I’m having a heart attack.

“Unfortunately, that’s not true, either,” Zabel said. “About a third of all heart attacks are what we call silent, which means what it sounds like it means. It means that people are not aware of it.”

It’s fairly rare, Zabel said, but it is possible to have a heart attack with no symptoms at all. However, it’s more common for people to think they’re experiencing something else, such as indigestion or a gallbladder attack, when they’re actually having a heart attack.

Likely signs of a heart attack

• Cardiologists used to say “chest pain” is a sign, but that may not be the most apt description. Dr. Zabel said he’s often heard from patients that it’s a squeezing, heaviness, or constricting pressure, better described as “chest discomfort” — not generally a sharp, stabbing pain.

• Discomfort or pain in the jaw, shoulders, arms (particularly the left arm) or back may be a sign.

• Nausea that seems unusual, especially along with other symptoms, such as sweating or shortness of breath.

“I always tell people, ‘Look, you’ve lived in your body. You know what your body’s like,’” Zabel said. If you feel nauseated in a way that concerns you, it may be best to seek medical treatment.

Are we what we eat?

3. Taking baby aspirin each day will lower my risk of heart attack.

That’s true, Zabel said, with caveats. Baby aspirin decreases the risk of heart attacks and strokes, but also increases the risk of certain bleeding abnormalities.

“I would stop short of a blanket recommendation for everybody to take a baby aspirin a day. I think that has to be an individual decision; people need to seek advice from (their primary care physician),” he said.

It’s best to take baby aspirin with a meal. It’s long-lasting, so it doesn’t really matter what time of day you take it, Zabel said.

4. “Drinking red wine every day is good for my heart health.”

An ounce of alcohol a day, or roughly one serving, does raise good cholesterol a little bit and possibly even lowers blood pressure, Zabel said — and that’s not limited to red wine. Any more than that one serving, however — which means any more than 5 ounces of wine, 1 ounce of hard liquor, or 12 ounces of beer — does “all kinds of bad things.”

“I personally never recommend alcohol — it’s just too much of a two-edged sword for me to feel comfortable recommending it,” Zabel said.

5. “Sodium is evil and should be avoided.”

“Most of us need to eat less sodium than we currently do,” Zabel said. The average American gets about three times the amount of sodium they should.

6. “Eggs: 'incredible and edible,' or heart attacks waiting to happen?”

Some are OK — even for people with heart or cholesterol issues — but more than three or four eggs a week might be too much for anyone, Zabel said. However, you can “knock yourself out” with egg whites. They’re pure protein, Zabel added.

Yolks, on the other hand, are basically pure fat, which is problematic.

Fats are very calorie-dense, so it’s easy to gain weight if you’re eating lots of them. They also have a direct negative effect on cholesterol metabolism, Zabel said.

The one type of fat to avoid completely is trans fat. Trans fats don’t exist in nature, so the human body does not have the enzymes needed to break them down.

“There is no such thing as moderation with trans fat,” Zabel said. “Half a gram of trans fat is half a gram too much. Trans fats are basically poison to our cardiovascular system.”

Manufacturers are using a lot less trans fats in recent years, Zabel said, but it’s important to check labels to be safe.

7. “Caffeine will raise my heart rate and be detrimental to my overall heart health.”

Yes, it will raise your heart rate temporarily, Zabel said, but not to a dangerous level for most people. It does not increase cardiovascular risk. However, he said he doesn’t believe caffeine will improve overall health, as some studies say.

Studies: What to believe?

Dr. Zabel said you can find a study to support just about anything you want to say. In cardiology, however, there has been research over 100 years — and much of that research is in studies that follow tens of thousands of patients for long periods of time.

Many studies that emerge focus on small groups of patients over shorter time spans, and they may lead to recommendations that are quickly disproven.

“Wise physicians and wise patients need to cast a skeptical eye on all recommendations, really,” he said. “If it doesn’t make sense, they should be asking their physicians, ‘Well, what’s that based on?’”

On the topic of beverages, the best thing we can drink is water, Zabel said.

“Unfortunately, even juice is not healthy. A lot of people think that it is, because it’s natural,” he said.

8. “Garlic is good for my heart.”

Probably not, Zabel said. Studies on garlic have been “underwhelming at best.”

In fact, Zabel said there are few exceptions of supplements that have held up under rigorous scientific testing — one of those being melatonin, to help with sleep. But he has had patients who take upwards of 20 supplements each day, and they show no interest in stopping.

“We in the medical profession bear some of the responsibility for that, because over the years we’ve recommended various supplements,” Zabel said, noting that at various times, cardiologists have believed in strong cardiovascular benefits of supplements such as Vitamin A, Vitamin E and omega-3, or fish oil — all of which have been disproven. “When the medical profession can’t get it straight, it’s hard to expect our patients to get it straight.”

Lifestyle choices

9. “As long as I eat healthy, I don’t need to exercise — or vice versa.”

“Unfortunately, that’s not true,” Zabel said. “You really need to do both.”

If you exercise frequently and burn lots of calories, you can eat more, but it still should be healthy foods, he said.

10. “All exercise is created equal, and whatever I do will be equally beneficial to my heart.”

When it comes to aerobic exercise, that’s pretty much true, Zabel said — repetitive exercise that increases the heart rate and breathing rate, such as biking, running, swimming, calisthenics, and so on. Those provide benefits of lowering blood pressure, lowering bad cholesterol, raising good cholesterol, and improving insulin sensitivity, which is a protector against diabetes.

For those with knee trouble, a stationary bike may be a good choice. For those with hip problems or other lower-body restrictions, a rowing machine could be a good option — it primarily works the upper body.

Strength training has benefits in weight loss, protection from diabetes and decreasing fall risk, Zabel said, but it doesn’t give the same cardiovascular benefits as aerobics. They’re complementary.

11. “Our metaphorical hearts — emotional and mental health — have no effect on our real hearts.”

Definitely not true, Zabel said. People who report themselves as happily married are at one-third less risk of suffering a heart attack or being hospitalized for heart failure, he said, and studies show that people who own pets also face a lower risk of heart disease.

“People that are happier, and people that are engaged with life — and particularly if that involves other people in their lives, whether it’s a spouse, or children, or just good friends — those people are at demonstrably lower risk for having problems,” Zabel said. “I think it’s pretty clear we’re designed to be social animals — we just work better that way.”

When to worry

12. “I’m still young — I don’t need to worry about my heart.”

If you think you've had or are having a heart attack:

Call an ambulance or go to the emergency room, Dr. Zabel said — at Lawrence Memorial Hospital, the staff can run an electrocardiogram test quickly to determine if a patient has had a heart attack.

Zabel said he understands that people don’t like to go to the ER and may be embarrassed if it turns out to be something less serious, but “I’d rather have you come in 10 times for something that wasn’t your heart than sit at home and wait out a heart attack and come in with bad heart failure or cardiac arrest,” he said.

Coughing won’t necessarily help during a heart attack, but Zabel said he thinks it’s fine to take an aspirin while waiting for an ambulance — they'd give you one in the ambulance anyway.

Generally, if symptoms dissipate within 30 minutes it may not have been a full-blown heart attack, but could be what cardiologists call an unstable angina, which is basically one step below one, and it's best to seek treatment immediately.

Youth is a wonderful protector, Zabel said, but a family history of heart disease, particularly in first-degree family members (parents, siblings, etc.) does increase risk, no matter your age.

He also said no smokers are low-risk, even at young ages, but the risk of having a heart attack or a stroke drops within the first two weeks of quitting smoking.

“It’s never too late to make healthy changes,” Zabel said.

13. “A severe toothache may be a sign of heart disease.”

An aching jaw could actually be due to the heart, Zabel said, particularly for people who have no history of dental problems and those who have other symptoms with it, such as nausea or sweating. There’s usually some chest discomfort with it, but not always.

14. “My family has a history of heart disease, so I’m doomed.”

Not necessarily. Family history makes up about 20 percent of cardiovascular risk, Zabel said.

The cold, hard, scary truth about heart attacks

The technical term for a heart attack is a myocardial infarction, which literally means death of the heart muscle.

That can be as little as 1 percent of the heart muscle; Zabel has seen a patient survive an infarction of almost two-thirds of the heart muscle (although it’s very rare to survive when 50 percent or more of the heart muscle dies). It causes permanent damage and nothing can be done to reverse it.

Sometimes the discomfort or pain that a heart attack causes seems to go away after a few hours — that’s because as the muscle dies, the nerves die, too.

Zabel said he can do the most to help patients who haven’t yet had that permanent damage, which is why it’s important to seek treatment if you’re concerned.

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