New Stroke Guidelines Will Provide Critical Emergency Treatment to More Patients (excerpt)

A committee convened by the American Heart Association and the American Stroke Association created and recently released new guidelines for treating acute ischemic stroke. Find out what these guidelines mean for those who experience a stroke, and why timely response to stroke warning signs is still essential.

Now, thanks to new stroke treatment guidelines released by the American Heart Association and American Stroke Association (AHA/ASA), more people may have the chance for a positive outcome.

The guidelines focus on acute ischemic stroke — the most common type — which occurs when an artery to the brain is blocked by a clot, or blood flow to the brain is reduced or stopped. New evidence-based research prompted the update of the 2013 guidelines, though the AHA/ASA’s scientific statement affirms the “urgent need for continued research on treatment of acute ischemic stroke.”

Released on January 24, 2018 the guidelines include a number of recommendations for clinicians addressing prehospital care, urgent and emergency evaluation and treatments, and secondary prevention measures typically delivered during a hospitalization.

But the two major takeaways in this 2018 edition? According to William J. Powers, MD, the chair of the guideline-writing group and a professor of neurology at the University of North Carolina in Chapel Hill, the new guidelines expand the window on when thrombectomies can be performed, and increase access to alteplase — the only FDA-approved clot-dissolving ischemic stroke IV treatment, also referred to as IV tPA — following acute ischemic stroke.

What was once a six-hour window for administering a mechanical thrombectomy to remove the clot has now been expanded to 24 hours for select patients (advanced testing is required to determine if the patient may benefit from a thrombectomy past the six-hour window).

Eligibility for the clot-dissolving drug alteplase (IV tPA) has been expanded too: New research suggests that patients experiencing a mild stroke may also benefit from receiving alteplase, if it’s given promptly and appropriately.

“We now have the ability to provide treatments that will help prevent disability [related to a stroke],” says Dr. Powers. “But you have to come to the hospital, and the sooner the better,” he adds.


Cholesterol-Lowering Snacks

by Dr Arthur Agatstone

I can’t stop snacking between meals, but I want to try to eat things that will help me lower my cholesterol (instead of raising it!). What would you recommend?

— Steven, Colorado

The good news — or the bad news, depending on what you’re snacking on — is that “bad” low-density lipoprotein (LDL) cholesterol is sensitive to diet, though less sensitive than triglycerides and good high-density lipoprotein (HDL) cholesterol. Fortunately, the same foods that can help lower LDL may also improve HDL and triglycerides. So instead of snacking on chips and doughnuts, consider these healthier options:

Nuts and seeds. Sunflower seeds, pistachios, pumpkin seeds, sesame seeds, pine nuts, flaxseeds, and almonds are particularly high in plant sterols, which can help reduce LDL. But it’s easy to overdo it on nuts and seeds (and they are calorie dense), so I suggest limiting your total intake to about one ounce, or 1/4 cup, a day if you are also trying to lose weight.

Apples. Research shows that eating two apples a day can slow down the oxidation of LDL cholesterol and help prevent plaque buildup. The protective antioxidants are in the apples’ skin, so don’t peel them.

Oat bran. An important source of water-soluble fiber, oats have long been recognized as a potential cholesterol-lowering dietary component. The soluble fiber in oat bran binds with bile acids in the intestine to block the absorption of cholesterol by the body. According to a study conducted at the Jean Mayer USDA Human Nutrition Research Center on Aging in Boston, antioxidant compounds found in oat bran called avenanthramides can also prevent white blood cells from sticking to the artery walls, which is an important step in preventing plaque formation. So why not have a bowl of unsweetened oat cereal as a midmorning or mid-afternoon snack? Not only is it filling, it’s good for your heart.

Grapefruit. Studies show that the phytochemicals called liminoids in pink and red grapefruit make them powerful LDL busters. But this snack is not for everyone. Because grapefruit can interfere with the breakdown of certain medications, including statins and calcium channel blockers, don’t eat a lot of grapefruit or drink the juice as a snack if you’re on these medications.

Tune-Up Your Heart in 30 Days.

The title to this article brought to mind the undeniable truth in the fact that people generally care more for the health of their car than they do for themselves… (Heidi’s opinion above)

By Steven Masley, MD, Special to Everyday Health.

As a resident and then physician, I volunteered in more than fifteen impoverished countries. Most people in the underdeveloped world by necessity had to be fit and to eat unprocessed food. In fact, I was shocked to realize that despite their difficult living conditions, if they weren’t starving, they usually enjoyed better heart health than most of my patients back home. They were trimmer, fitter and had fewer joint problems. They also had better blood sugar, cholesterol, and blood pressure control.

Why are Americans cardiovascular “wrecks” compared to people in other countries? Why does cardiovascular disease remain our No. 1 killer today — accounting for more deaths than all forms of cancer combined? The answer is simple — our lifestyle is killing us! Our diets rich in trans and saturated fats and sugar and low in nutrients and fiber, our lack of exercise, our stressed-out lives that leave little time for rest and reflection all contribute to the cardiovascular disease epidemic in the US.

How Your Heart Ages

The first step to avoiding heart disease is understanding how your heart and arteries age. Here’s why: The factor that causes most heart problems is not cholesterol, but the growth of plaque in your arteries. Newly-formed, soft plaque can coat the lining of the arteries and mound up like pimples. These lesions can pop into the bloodstream. The inflammatory chemicals released from this rupture cause large blood clots to form. These travel to the heart and brain, blocking the supply of oxygen which leads to a heart attack, stroke, or sudden death.

To determine your heart’s true age, we need to look at the growth of plaque. That is simple and safe to do with ultrasound equipment similar to what monitors a fetus. This new carotid intimal-medial thickness testing (carotid IMT) calculates arterial plaque growth. It reliably estimates my patients’ arterial age.

The carotid arteries carry blood from the heart to the brain. Research has shown that more than 90 percent of the time, the carotid and coronary arteries grow plaque at the same rate. The thickness of plaque in the carotid artery reflects growth in the arteries that feed the heart. Carotid IMT is an excellent predictor of risk for future cardiovascular events.

To receive a carotid IMT test, my patient lies on an exam table. I apply warm ultrasound gel on his neck. I gently pass a measuring device from the machine over the skin and take pictures of the carotid arteries, just beneath the surface. I transfer the images to my computer, enlarge them, and use software to measure the plaque thickness accurate to hundredths of millimeters.

Studies in major medical journals have determined average plaque thickness in thousands of men and women. So once I’ve calculated my patient’s score, I use these figures to project his arteries’ average age. A 50-year-old man, for instance, might have the plaque of a 40-, 50-, or 60-year-old . . . or even older

How to Tune Up Your Heart

In my new book, The 30-Day Heart Tune-Up, I explain how to shrink plaque, improve circulation, and strengthen your heartbeat.

Here are your tools to accomplish these goals:

  • Incorporate five heart healing foods into your diet:
    • Fiber: You need 30 grams a day from fruits, veggies, beans and nuts.
    • Healthy fats: Substitute saturated and trans fats with olive and almond oils, avocados, omega-3 eggs. Eat cold water, small-mouth fish 3 times a week (or take a fish oil supplement).
    • Lean protein: Eat free-range grass fed meats and poultry, low mercury seafood, beans, protein powder, tofu, plain nonfat yogurt.
    • Beneficial beverages: Drink green tea, hot cocoa, red wine!
    • Fabulous flavors: Use herbs and spices, garlic, dark chocolate
  • Aerobic and weight-training exercise strengthens your heart and arteries. Exercise not only burns fat, it also improves blood sugar control, lowers inflammation, improves your cholesterol profile, reduces stress and builds stamina.
  • Manage your stress: Stress-induced spasms in coronary arteries can lead to a heart attack, stroke, or sudden death. Reduce stress by:
    • Getting plenty of good quality sleep
    • Engaging in moments of peace and meditation
    • Enjoying loving relationships including sex, if possible
    • Exercising

Follow a customized supplement plan that includes:

  • 400 mg of magnesium
  • 12-15 mg of zinc
  • fiber
  • fish oil.

By taking these steps you can tune up your own heart for a healthier future.


Steven Masley, M.D., F.A.A.F.P., C.N.S., F.A.C.N., C.C.D., is a board- certified and fellow certified physician and nutritionist, a health researcher, speaker, author, and chef. He is the author of the forthcoming book, THE 30-DAY HEART TUNE-UP: A Breakthrough Medical Plan to Prevent and Reverse Heart Disease. Over the past fifteen years, he has won acclaim for helping hundreds of patients reverse Type II diabetes and eliminate the symptoms of cardiovascular disease. Currently, he is the President for the Masley Optimal Health Center, the medical director for the Ten Years Younger ProgramTM, and has a clinical appointment with the University of South Florida

The Anti-Inflammatory Diet: Putting Out the Fire In Your Diet. By Shilpi Agarwal, MD

If you’re feeling more achy, tired, or sluggish than usual, inflammation may be lighting your body up both inside and out. Recent research suggests that persistent inflammation is at the source of many diseases such as arthritis, heart disease, cancer, diabetes, and even Alzheimer’s disease. Generally, inflammation is a defense mechanism in the body that helps stop growth of abnormal cells, promotes healing of injured tissues, and signals cells to fight off viral and bacterial infections. But when inflammation persists, it requires the body to recruit different mediators to protect the cells. And when these mediators are present for prolonged periods of time they can destroy healthy tissue and trigger disease.

Adding anti-inflammatory foods to your diet can promote healing and reduce health hazards in the body. We all know that completely changing your diet overnight is challenging, but adding a few foods that cut down inflammation can go a long way.

The cornerstone of reducing inflammation through diet includes eliminating foods with preservatives and additives and consuming more whole foods, fruits and vegetables. Additionally, spices like turmeric, ginger, and cayenne pepper all have anti-inflammatory properties. Pepper contains capsaicin, a compound that reduces substance P, a pro-inflammatory protein that can be found at the site of swollen tissues, and abnormal cells. Reducing substance P can decrease pain, swelling, and even joint and tissue damage.

Consider adding the following foods into your diet to stomp out inflammation:

White and Green Tea: These teas are full of polyphenols, which are chemicals found in foods and spices that fight off inflammation and reduce oxidative stress.  Try adding two cups to your daily routine.

Olive Oil: Using this type of oil in your cooking adds omega-3 fatty acids, which are known to be inflammation busters. Olive oil also contains oleocanthal which is a natural, and powerful anti-oxidant that works similar to medications like ibuprofen.

Red Wine: Enjoying red wine can improve heart health and diabetes because it contains resveratrol another natural anti-inflammatory. Remember to enjoy in small quantities!

Walnuts: Walnuts are a great source of omega-3 fatty acids, and have been shown to reduce inflammation in the body. These nutritious nuts also contain high levels of protein, magnesium and fiber.

Cocoa: Enjoying cocoa (in moderation!) can increase flavonols in the body. Flavonols help eliminate toxins and are known to reduce the production and effect of pro-inflammatory substances. Dark-chocolate is a great source.

Here’s How Cold Weather Can Trigger a Heart Attack

Cold weather causes blood vessels to constrict. Find out how to protect your heart when the temperature drops.

Chilling fact: Every 40 seconds, someone in the United States has a heart attack, according to the American Heart Association. Although the life-threatening event can seem random, a study presented in August 2017 at the European Society of Cardiology Congress found that the average number of heart attacks per day was significantly higher during colder versus warmer temperatures.

Your heart needs oxygen-rich blood to function. A heart attack happens when a buildup of plaque — a mix of fat, cholesterol, and other substances — in your arteries breaks free. A blood clot forms around the plaque to either completely block or restrict blood flow to your heart. And freezing weather can ignite this painful process.

The Connection Between Your Ticker and Subzero Temps

“Cold weather, especially a very rapid change in the weather, is more likely to cause your blood vessels to constrict. If you have narrowing of the blood vessels already because of underlying heart disease and your blood vessels are constricted further, it restricts the amount of blood that’s getting to vital organs,” says Lawrence Phillips, MD, cardiologist and assistant professor of medicine at NYU Langone Health in New York City. In other words, cold weather can make heart attack more likely to happen.

Instead of triggering a full-blown heart attack, cold weather can also just minimize blood flow to the heart, causing chest pain (angina), which is a symptom of coronary artery disease. This is the main form of heart disease, a disorder of the blood vessels of the heart that can lead to heart attack.

In addition to coronary artery disease, cold weather can put a strain on your heart and circulatory system, affecting other forms of cardiovascular disease, too.

“If you have a diagnosis of heart failure or advanced valve disease, you have to be very careful when the weather changes to the colder side as well,” Dr. Phillips says.

Moreover, research presented in August 2015 at the European Society of Cardiology Congress in London showed that cold weather may also increase the risk of ischemic stroke in patients with atrial fibrillation, a heart rhythm disorder. Ischemic stroke — the most common type of stroke — occurs when ruptured arterial plaque causes a blood clot to block a blood vessel to the brain, cutting off its much needed blood and oxygen supply.

Sudden bouts of energetic activity, such as rushing around to get out of the cold or shoveling snow, in combination with chilly temperatures can put additional strain on the blood vessels that feed your heart or brain. This puts you at greater risk of having a cardiovascular event, especially if you’re usually sedentary.

Symptoms of heart attack include uncomfortable pressure, squeezing, fullness, or pain in your chest (angina) or other areas of your body and shortness of breath.

Stroke symptoms to watch out for include facial drooping, especially on one side, arm weakness, and difficulty speaking.

Cold Weather Cures for Preventing Heart Attack and Stroke

The good news? If you’re an average healthy person, the cold weather won’t increase your risk of a cardiovascular event, such as heart attack, stroke, or angina. Trouble is, you can have underlying coronary artery disease — the clogged arteries (atherosclerosis) that are the underpinnings of a heart attack and stroke — and not even know it. Cardiovascular disease doesn’t always have signs or symptoms. So you might not even know you have it until you have a heart attack or stroke.

Here’s what to do to reduce your risk of heart attack and stroke, especially in cold weather.

Get a checkup. “As you’re gearing up for winter, make sure your health is optimized,” Phillips says. In other words, the start of winter is a good time for a routine physical to make sure your heart can take the cold. If you have a diagnosis of coronary artery disease, heart failure, or advanced valve disease, make sure to get the appropriate treatment and follow-up. You want to make sure your blood cholesterol and blood pressure are under control, too. High cholesterol and high blood pressure can increase the risk of heart attack and stroke.

Cover your mouth. If you have heart disease, heart failure, or advanced valve disease, cover your nose and mouth with a scarf before going outside. “Wearing a scarf allows the air to naturally get warmed before it comes into your body,” Phillips says. “It won’t be such a shock to your body.”

Bundle up. To avoid getting too cold, which may increase the risk of heart attack, don’t forget to wear a hat, gloves, and multiple layers, which can help you stay warm by trapping air and body heat. But don’t overdo it. If you get hot, take off a layer. And remember to stay well hydrated.

Know your body. If you notice heart-related symptoms, such as chest pain, shortness of breath, feeling winded, or fluttering in your chest, see your doctor. “If something feels different than normal, don’t ignore it. Get evaluated,” Phillips says. Similarly, if you’re having chest pain at rest, and it’s a new symptom, you need an immediate evaluation. Call 911. “Never drive yourself to the emergency department,” he says.

Don’t let snow-shoveling kick off your workout. “If you haven’t been exercising regularly, snow shoveling isn’t the best idea,” Phillips says. Because snow can be heavy, shoveling may be a lot more physical activity than you’re used to, which canput a strain on your heart. Anybody with a chronic medical condition, not just heart disease, should talk to their doctor about whether snow shoveling is a good idea. “I tell my patients with underlying heart disease not to shovel snow,” Phillips says. “But they can use a snow blower.”

Get a flu shot. A study published in October 2013 in The Journal of the American Medical Association found that a flu shot was associated with a lower risk of cardiovascular events; getting a flu shot may reduce your risk of heart attack or stroke. Likewise, reduce your chances of getting the flu by staying away from people who are sick, washing your hands with soap and water often, and avoiding touching your eyes, nose, and mouth.