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Each month TheGoodheart.com provides you with Tips to aid you on
your journey towards emotional well-being and a healthy heart.
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Tips for April 2008

A Change of Heart…Can Ending a Relationship Be Good For You?

“Having a close relationship means you’ll have a healthy heart.” “Living alone is not good for your heart.” “Married people are healthier than singles.” “Isolation increases the risk of heart attack.” It’s not quite that simple. Certain conditions must be true for these statements to be true.

A close, but distressed, relationship may end up being detrimental to the heart. There’s a growing body of literature informing us of the dangers of relationships in conflict that offer little in the way of emotional support – two possible outcomes: hypertension and elevated risk of having a cardiac event.

Living alone may not be harmful when life is satisfying, includes good health habits, and is viewed positively – a productive life with time for peaceful solitude versus a life lived in abject loneliness. Alone or with another - purpose, appreciation, engagement, and a fair amount of wisdom may protect the heart, buffering harmful effects of the inevitable disappointments and strain found in every lifetime.

Scores of popular magazines and best-selling books advise the reader on how to “survive” the dissolution of a relationship. Indeed, the emphasis is on survival, reflecting the assumption, “Ending a relationship will be a negative experience”. “Even if you want to end a relationship – it can be devastating.” Is that always the case? Not according to what Gary Lewandowski and Nicole Bizzoco report in their study conducted at Monmouth University in New Jersey (“Addition through subtraction: Growth following the dissolution of a low quality relationship”, 2007)

Relationships are thought to help us be the best we can be as opportunities for growth multiply. However, a relationship without the elements needed for “self-expansion” (the development of knowledge, identities, and capabilities”) may be experienced as “low” in quality. The end of a low quality relationship may not mean a “loss of self”. We’ve learned that separation may open the door to a “rediscovery of the self”, personal growth, and more good feelings.

A potentially painful event – leaving a relationship – with all the frightening “unknowns” - may ultimately bring as many positive changes as anticipated negatives. We’re not encouraging separation but we are interested in broadening the view of what the “right” lifestyle should be when it comes to your health. There isn’t one. Knowing what matters (perspective), examining life enough to know what might be your best “style”, one that suits the person you are (honesty), and being responsible about the way you take care of yourself (conscientious), will allow your heart and mind to flourish (growth).

Austen Hayes, Ph.D.

Statins Lower Blood Pressure?

The University of California San Diego Statin Study, published in the April 14, 2008 issue of the Archives of Internal Medicine, confirms that statins (e.g.Zocor or simvastatin, Pravachol or pravastatin), used to lower cholesterol, also reduce blood pressure a modest amount.

The study, which included almost 1000 participants who did not have heart disease, showed that pravastatin lowered systolic blood pressure (the top number) by 1.5 mm Hg and diastolic blood pressure (the bottom number) by 2.3 mm Hg, and simvastatin lowered systolic blood pressure 2.9 mm Hg and diastolic blood pressure by 3 mm Hg. (A previous study did not show any reductions in blood pressure in people with heart disease.) Although the reductions are small, they translate into a significant decrease in the risk of stroke. The reductions in blood pressure were even greater for the participants who did not have high blood pressure at the start of the study or were not taking antihypertensive medications.

The decrease in blood pressure was noted after one month of taking the medication and the positive effects of the medication were lost within 2 months of stopping.

The bottom line is, if you are taking a statin to lower your cholesterol – you may get an added benefit of a modest decrease in blood pressure, especially if you don’t have heart disease.

Patty Brownstein, RN, MSN

Anxiety May Pose a Risk Equal to Depression

Severely anxious men, without any indication of heart disease at the start of a 12-year investigation, had more heart attacks than their less anxious peers (Shen, et al., 2007). Until recently, most emotion-driven associations to heart disease have focused on Type-A, depression, and hostility with far less said about anxiety. All negative emotional states, especially those considered chronic or severe, will trigger potentially damaging physiological reactions (increased blood pressure, vessel constriction, increased clotting, etc.). The overall discomfort felt by a man or woman suffering with obsessive thinking, irrational compulsions, social introversion, phobias, or somatic complaints (e.g., tension) leaves little doubt that chronic arousal can do so much to chip away at good health. Does that mean the “anxiety-prone” individual will seek treatment that we now know might reduce the possibility of having a heart attack?

Anxious people are “self”-conscious, focusing inward. They often think of themselves as “weak”, “abnormal” or “weird”. They view their symptoms as “strange”, too embarrassing to reveal. So…
…instead of getting help, they may become more avoidant. An obsessive individual can hide intrusive thoughts. A phobic person will avoid a feared object or situation. Socially introverted people learn to turn-down invitations. If you conclude that inner tension is hard for others to detect – relief! The longer symptoms and fears are successfully hidden – the longer the time before help is secured – the longer the problem lasts and the worse it may become.

Prevention depends on your willingness to talk with caregivers about cholesterol, exercise, smoking, diabetes, or unusual or worrisome physical symptoms. Let’s talk about doubts and fears. There’s nothing “strange” about anxiety. There’s little if anything you might reveal to a trained therapist or physician that hasn’t been heard before. The health of your heart is always more important than what others think of you – always.

Austen Hayes, Ph.D.

PAD is Not Only Something to Write On

Peripheral Arterial Disease (P.A.D.) is related to coronary heart disease. Just like fatty deposits (plaque) can build up in the arteries of your heart, fatty deposits can also clog the arteries in your legs. People who have P.A.D. are also at risk for developing coronary artery disease (and vice versa) because many of the same risk factors or habits that can lead to clogged arteries in your legs, can also lead to clogged arteries in your heart.

What are the risk factors for P.A.D.? Your risk increases if you:
- Are over 50 years old
- Currently smoke or used to smoke (smokers or previous smokers have 4X greater risk of developing P.A.D. as someone who never smoked)
- Have diabetes
- Have high blood pressure
- Have coronary heart disease
- Are African American
What are the symptoms of P.A.D.? Most people with P.A.D. do not have symptoms. But if you believe you are at risk, talk with your healthcare provider about being tested and lowering your risk. If symptoms are present, they include:

Fatigue, heaviness, tiredness, or cramping in the leg muscles (buttocks, thigh or calf) that occurs during activities such as walking or stair climbing, and goes away when you stop doing the activity (this is called claudication)
Pain in your legs and/or feet at night while asleep
Sores or wounds on your feet, toes or legs that heal slowly, or do not heal well or at all
Color change in your feet (paleness, blueness)
One leg feels cooler to the touch than the other
Your toenails don’t grow well and there is less hair growth on your toes and legs
If you have any of these symptoms or feel you are at risk for having or developing P.A.D., talk to your doctor.

Based on the input gathered from participants in this study, the characteristics of a truly courageous, “ideal” person are presented as lists of “definitions and descriptions”, “factors”, “behaviors”, and “scales”. The meaning of courage is broadened. Following a heart attack, or bypass surgery, or any challenge to the function or structure of the heart, a fitting definition, easily applied to the heart patient…

How is P.A.D. treated?

Lifestyle changes, such as those you would do to decrease your risk of heart disease, including quitting smoking, decreasing blood pressure and cholesterol, maintaining a healthy weight and exercising (For those with claudication, talk to your healthcare provider about a specific walking program for those with this type of discomfort)
Medications to decrease blood pressure and cholesterol, and to prevent blood clots and decrease claudication pain
Special procedures (angioplasty – like in the heart) and surgeries (bypass surgery – like in the heart) for severe P.A.D. to improve circulation and decrease pain

For more information about P.A.D., check out these websites:

www.aboutpad.org
www.PADCoalition.org (for clinicians as well)
www.nhlbi.nih.gov/health/dci/Diseases/pad/pad_what.html(for clinicians as well)

Patty Brownstein, RN, MSN

We explain a lot of what we do based on how we feel. “I didn’t answer the phone – I wasn’t in the mood” or “I was feeling too down to go to the gym”… relatively small decisions. Unfortunately, when it comes to larger, life-changing decisions about things that matter and dramatically affect lifestyle – we still engage in “emotional reasoning”. How would you feel about a decision that will affect your life if you knew it was processed through a filter of negativity, clouded thinking, and diminished confidence?

For eight years researchers followed late-middle aged individuals (ages 53-58 at the start of the investigation) determining the impact depression would have on decisions about when to retire (Doshi, et al., 2008). Given the choice, depressed men and women were more likely to retire than their non-depressed peers. In fact, with only a few depressive symptoms (“sub-clinical depression”), women were inclined to choose retirement over the workplace.

What does this have to do with heart disease? When retirement is part of a positively anticipated plan, it can be a lively, creative time of life. However, decided at a low point, motivated by a desire to escape - there may be no “plan”. Separating from the work environment may not mean relief, after all. Feeling isolated, without goals or interests, negative symptoms may worsen. Diminished interest in self-care may lead to unhealthy habits (poor diet, lack of exercise, smoking, excessive alcohol consumption), certain to threaten the health of the heart.

If you’re struggling with a major decision and you think you may be depressed, the first most valuable decision you can make is to find the help or support you need to improve the way you’re feeling. Exercise, psychotherapy, medication – or any combination – depending on your psychological and biological makeup - can make an enormous difference in health and quality of life. Whichever method is best for you – most of us benefit from exercise – movement as a reliable antidote to depression! In fact, exercise has been found to lower the likelihood of relapse (relapse rate 9%) more than therapy or therapy and medication in combination (relapse rate 30%) (Blumenthal, et al., 1999).

Retirement isn’t good or bad. But it should be right – for you. The heart flourishes when lives are satisfying, engaging, and give us something to get up for each morning. The office or the garden – decide wisely with a clear mind and an open heart.

Austen Hayes, Ph.D.

Do stress management techniques (e.g. “relaxation response”) and lifestyle modifications (e.g. weight reduction, diet modification, exercise) really work? Do they help change any risk factors for heart disease, and will that change actually help decrease our chance of having a future cardiac event? The answer to that, according to two studies, is yes! In May 2003, in a study published in the Journal of the American Medical Association, Chobanian and colleagues found that just a 5% decrease in systolic blood pressure (the top number), decreases mortality by 7% and the risk of having a stroke by 30%.

A recent study, published in the March issue of the Journal of Alternative and Complementary Medicine, compared two groups of patients over the age of 55, who had systolic blood pressures between 140-159, with a normal diastolic blood pressure (the bottom number) of below 90. All were taking at least 2 anti-hypertensive medications. The first group received training in the relaxation response and information on coping strategies. The second group received information primarily on life style modifications. At the end of the study period, both groups decreased their systolic blood pressure by an average of 9 mm Hg.

It is nice to keep getting verification that our hard work is paying off. By practicing good coping strategies, by exercising, changing our diet and stopping smoking, we are definitely improving our chances for a longer and healthier life. Keep up the good work!

Patty Brownstein, RN, MSN

Courage for Us All…
It’s unlikely that the experiences of any two cardiac patients will be exactly alike. Unique perceptions of what might be considered the same “event” will foster unlimited combinations of feelings and behaviors. Still, there are common human themes in strength of character or virtue that help us to “endure tough situations” (Rate, et al., 2007). Courage is one of those virtues and if we take notice, we see it expressed by both the fearful and the confident, over and over again.

We have one heart. We depend on this heart to beat continuously, hour after hour, for decades. There is no back-up muscle. There is no left or right heart. Only one. If you’ve been diagnosed with heart disease, the “reality” of what has happened may be a bit of a shock. With such reality some respond with fear and self-doubt, focusing on the unfamiliar, unpredictable nature of heart disease...some feel more confident than ever, determined to reestablish personal control. Others respond with anger, regret, frustration…and on and on - all resulting from individual differences in the ways we “see” the same situation. No matter how many and wide the contradictions, when it comes to heart disease, all are courageous.

Most of us think of courage as that moment when an individual selflessly puts their life on the line to save another – even a stranger. Someone coming forth willingly at great personal risk to reveal a truth for the good of others might easily be labeled “courageous”.

Based on the input gathered from participants in this study, the characteristics of a truly courageous, “ideal” person are presented as lists of “definitions and descriptions”, “factors”, “behaviors”, and “scales”. The meaning of courage is broadened. Following a heart attack, or bypass surgery, or any challenge to the function or structure of the heart, a fitting definition, easily applied to the heart patient…

“Courage, also called fortitude or bravery, is the ability to endure what is necessary to achieve a good end; even in the face of great obstacles.” (Cavanagh & Moberg, 1999)…and behaviors easily applied to what the heart patient does…
- Can handle tough situations.
- Perseveres in the face of obstacles.
- Remains composed in dangerous situations.
- Perseveres under pressure.
- Does not quit when “the going gets tough”.

A short time ago, the goodheart.com weekly tips discussed the positive results of a study showing that CPR using chest compressions only was better than performing mouth-to-mouth breathing and chest compressions, for witnessed cardiac arrest. (See www.thegoodheart.com previous tips.)

On March 31, 2008, the American Heart Association published a scientific advisory statement on-line in Circulation saying that using either “compression only” (“hands-only”) CPR or the traditional CPR are of equal benefit. According to heartwire, the Heart Association advisory states that if an adult is observed to collapse suddenly, first call 911, and then a bystander who witnessed the collapse can perform chest compression only CPR if:
- they are not trained in CPR, or
- they are trained but are not confident that they can perform the traditional CPR adequately.
If a bystander is trained in the mouth-to mouth-breathing and chest compression traditional CPR, and is confident they can perform it adequately, then the person can choose to do either that CPR or the chest compression only type.

The American Heart Association has thought this was important information to get out to the public since they decided to amend their last guidelines (released in 2005), rather than wait to include this information when their new updated guidelines are released in 2010.

One of the barriers to perform conventional CPR is that the person may feel it’s too complicated and they will not remember all the different steps. Another is that some people are afraid of performing mouth-to-mouth breathing for fear of infection. By taking away that fear and by simplifying the process, it is hopeful that more people will perform CPR when needed. People will be taught that if they witness an adult collapsing suddenly, is non-responsive and is not breathing, that doing chest compressions only (without mouth-to-mouth breathing) can save their life. Wouldn’t you do it?

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