Heart Attacks

“Heart attacks 'are worse' if they happen in the morning

People who have a heart attack in the morning tend to fare worse than those who have one at other times of the day and night, experts have discovered.

Heart attacks occurring between 0600 and noon are more likely to create a larger area of damaged heart tissue.

The findings in Heart journal come from a study of over 800 patients in Spain.

Experts say the body's natural sleep-awake cycle could explain the differences seen, but advise more research to confirm the findings.

It is well established that a person's 24-hour body clock can influence heart attack risk.

For example, doctors know that people are more likely to have a heart attack around the time when they are waking up from sleep than at other times, but what is less known is the extent of damage that this leads to.

Regardless of the time of day, the quicker someone having a heart attack is treated, the less the damage they will have”

Judy O'SullivanBritish Heart Foundation

To investigate, Dr Borja Ibanez and colleagues analysed data on 811 patients at their hospital who had suffered a type of heart attack known as an ST elevation myocardial infarction, which occurs when there is a prolonged period of blocked blood supply to the heart muscle.

The researchers split the patients into four groups based on what time segment of the 24-hour clock the heart attack occurred.

They found that one group in particular - the 0600 to midday or "morning" heart attack group - had the most severe heart attacks.

This morning group had much higher levels of an enzyme in their blood that is a marker of dying heart tissue than patients whose heart attack had occurred in the evening (between 6pm and midnight).

Judging by the blood enzyme levels, the researchers estimate that the area of the heart damaged in the morning group was, on average, a fifth larger in comparison.

Judy O'Sullivan, senior cardiac nurse at the British Heart Foundation, said: "This study provides some interesting observations on the association between the time of day a heart attack occurs and the degree of subsequent damage to the heart muscle.

"However further research is needed before we can draw firm conclusions.

"Regardless of the time of day, the quicker someone having a heart attack is treated, the less the damage they will have, which is why it is essential that anyone who experiences heart attack symptoms should call 999 immediately."”

“To Your Health: Heart attacks -- An ounce of prevention…or another ounce of sirloin?

By Dr. Rick Donahue/rickdonahue@personalhealthmd.com

For years as a primary care physician, I felt there was often not enough time in a typical appointment to balance the needs for “disease-treating care” and “health-promoting care.”

Scientific breakthroughs of the past century have focused on the dramatic, sometimes miracle-like treatments of specific diseases, such as caring for someone with a heart attack. For medical students and doctors alike, these life-saving treatments often become more compelling than preventing a heart attack by working to promote a patient’s overall wellness. Of course, once someone is having a heart attack, the doctor and hospital do their best to deliver rapid and intensive care.

But here’s the rub: Some, perhaps many, heart attacks could be prevented from happening if doctors and patients focused more on disease prevention and wellness. Permit me to tell you a personal story as a primary care doctor trying to balance treating serious disease with promoting health.

For 10 years, I was the sole family doctor serving a lobstering island community in Maine. I loved it. As a young doctor, it was satisfying and exciting to care for an entire community. I provided primary care, emergency care, counseling, home visits, school visits -- cradle to grave, so to speak. I saw everyone for everything, sending them off-island for specialists and hospital care as needed.

While working on ambulance runs during my first three years, I noticed a strong pattern. The five to six  people a year having heart attacks were not the same people who were coming in to have annual check-ups, get a cholesterol screening or work on a healthier lifestyle. Instead, many were often smokers, overweight, and ate more red meat and cheese. I began working with our mainland cardiologist, and by using the clot-busting medicine TPA, we developed the fastest pre-hospital heart attack care in New England. We immediately reduced the island’s death rate from heart attacks, and the community noticed.

Seeing firsthand how an unhealthy lifestyle could wake up the genetic risk of having a heart attack, something clicked. Could we really reduce heart attacks through more health promotion and community health? With the local Rotary Club and ladies’ auxiliary, we initiated annual public health screening clinics right in the fire department truck bay. The hot drinks and homemade muffins helped draw people in for screenings of fasting sugar, blood pressure and cholesterol profile. It became a fun community event – everyone helped and supported each other. People started comparing their cholesterol levels and started to eat a little better, walk more and smoke less. The average community blood sugar and cholesterol levels measurably improved, and fewer people were walking around with untreated high blood pressure. Somehow the culture around health shifted a little. More people started coming in for regular check-ups. And there were fewer ambulance runs for chest pain. In fact, eight years later, only one or two people a year were having a heart attack.

I have to admit, the adrenalin rush of treating a heart attack, bringing someone back from that edge of life, was a bit more exciting for a young doctor than running community screening clinics. With time though, I realized that medicine is not about the doctor’s experience, but about the patient’s wellness. For primary care doctors and the most sought-after specialists, it’s not just about treating the disease, but about the art of addressing the concerns of the whole person.

And if we keep sight of the big picture, we realize there are many diseases that can be prevented. The good news is that public health research provides us with many tips for staying healthy and strong. For example, heart health begins with knowing your family’s history for heart attacks and stroke. Reducing red meat and cheese (those sticky bad fats), increasing vegetables and lean proteins, working to get your weight within a healthier range (BMI 23-25) by reducing sugary foods, eliminating smoking, and getting at least 20 minutes of heart-healthy exercise a day goes a long way toward preventing a heart attack. We all know change sounds easier than it is. It’s the art of medicine that helps the patients find a lifestyle plan that they can sustain.

So the next time you see your doctor, ask if you can reduce your risk of a heart attack even further with the use of a baby aspirin or omega-3 fish oil and choose that old adage, “An ounce of prevention is worth a pound of cure.”

Dr. Rick Donahue is a clinical instructor at Harvard Medical School with 20 years of experience delivering complete primary care. His private practice in Back Bay, Personal Health MD (www.PersonalHealthMD.com), is dedicated to providing comprehensive state of the artprimary care. He lives in Brookline. Do you have a health question for Dr Donahue? Ask him at rickdonahue@personalhealthmd.com.

Read more: To Your Health: Heart attacks -- An ounce of prevention…or another ounce of sirloin? - Brookline, Massachusetts - Brookline TAB http://www.wickedlocal.com/...rloin#ixzz1KpeLleP1”