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 INTERVIEW WITH
DR. ISADORE ROSENFELD
Rossi Distinguished Professor of Clinical Medicine/Cardiology, Weill Medical College, Cornell University
CBS CARES: Do you recommend diet and exercise first to reduce high cholesterol or would you generally prescribe an anti-cholesterol drug to do the job?
DR. ROSENFELD: I usually prescribe diet and exercise first, but for a short period of time. In my experience, people don't follow a diet as vigorously as they should in order to make a difference. And anti-cholesterol drugs, also called statins, are extremely well tolerated. There's a chapter in my new book called "The Miracle Statins." I list all of the good things that statins do.
CBS CARES: Why are African-Americans at a greater risk of developing heart disease?
DR. ROSENFELD: They have more hypertension. For socioeconomic reasons, I don't think the African-American diet is as apt to be healthy as that of Caucasians.
CBS CARES: What about women in the South? Why do they have an increased risk?
DR. ROSENFELD: Again, I think it's their diet. It's not as healthy.
CBS CARES: Does caffeine increase the risk of heart attacks?
DR. ROSENFELD: It increases the heart rate, but I do not believe that caffeine increases the risk of heart attacks. However, a recent report suggests that even one cup of coffee promotes inflammation and may increase the heart attack risk in genetically vulnerable people.
CBS CARES: Do depression, loneliness and anger contribute to heart disease?
DR. ROSENFELD: Yes, they certainly do. The aggressive, hostile, angry and depressed, as a rule, have a higher incidence of heart disease.
CBS CARES: Is this because anger and hostility cause inflammation?
DR. ROSENFELD: All of these things stimulate the production of adrenaline and enzymes. And these enzymes promote inflammation, which is a key factor in heart disease.
CBS CARES: If inflammation increases the risk of heart attacks, why do recent studies suggest that prescription anti-inflammatories such as Vioxx and Bextra may increase rather than decrease heart attack risks?
DR. ROSENFELD: Inflammation is one significant risk factor for a heart attack, but there are others. The Cox-2 drugs to which you refer and non-steroid anti-inflammatories can increase heart attack risks, because their anti-inflammatory benefits cannot override the other problems that they may cause.
CBS CARES: Is the mechanism by which these anti-inflammatory drugs may increase heart attack risks known?
DR. ROSENFELD: The exact mechanism is not yet known. A factor may be that these anti-inflammatories affect the coagulability (clotting tendency) of the blood.
CBS CARES: Would a menopausal woman's risk factors for heart disease affect whether you would prescribe hormone therapy for her menopausal symptoms?
DR. ROSENFELD: The risk of developing heart disease on hormone therapy is low. However, it is increased somewhat. Some doctors don't prescribe hormone therapy because of this. But, unless the woman has additional risks of heart disease, I continue to approve hormone replacement when a menopausal woman is suffering from symptoms that are making her life miserable.
CBS CARES: Are you saying that hormone therapy for menopausal women is basically safe?
DR. ROSENFELD: Yes, if you take the lowest effective dose for the shortest period of time, because these menopausal symptoms usually clear up in a couple of years. The danger of hormone therapy is the longer it's used and the higher the dose, the higher the risk, notably of breast and ovarian cancer. Certainly the risk of heart disease is very low, but it exists and women need to be informed, so they and their doctor can make a proper evaluation of benefits and risks.
CBS CARES: If younger women have more estrogen and less risk of heart attack, why would estrogen therapy for menopausal and post-menopausal women, increase rather than decrease their risk of heart attack?
DR. ROSENFELD: Very good question. For generations doctors have been giving estrogen in order to perpetuate its protective qualities. And all I can say is that nature in her wisdom stopped making it at menopause. So I don't know the answer to that. We were so sold on estrogen that we used to give men estrogen to prevent them from developing heart attacks. And it did not.
CBS CARES: What should pre-menopausal women be doing in terms of lifestyle and diagnostic screening?
DR. ROSENFELD: An adult woman should not be smoking, should have her blood pressure checked and should have her cholesterol level checked. She should also be on an exercise program and not be overweight. If she is diabetic, she should have her diabetes under control.
CBS CARES: What is a stress test and what are the various ways to perform it?
DR. ROSENFELD: Basically, you're stressing the heart to test it. There are several ways to do a stress test. An exercise test on a treadmill, or a stress echo in which you exercise the patient, get an electrocardiogram and then look at an echocardiogram to see the movement of the heart. When there's not enough blood supply to the area of the heart muscle you can see a difference in the way that the muscle contracts. The most sophisticated one is the nuclear stress test, which is more expensive.
CBS CARES: What other diagnostic tests do you use to detect heart disease?
DR. ROSENFELD: In someone with high risk I do a procedure that can be done in ten minutes and it's non-invasive. The patient lies on the table and it's called an ultra fast CT scan of the chest. It detects coronary artery calcifications and determines how many arteries are calcified. It's not a precise thing, but based on the number of arteries and the degree of calcification, you can access a patient's risk. It's not widely used and it is not very expensive.
CBS CARES: Can doctors detect heart disease from a mammogram?
DR. ROSENFELD: Coincidentally, the mammogram may reveal calcification of the coronary arteries. Doctors should be alerted to this because it's not a normal finding. But, you wouldn't take a mammogram in order to find out if you have calcification in the coronary arteries.
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