Making Sense of Medicine

A new campaign, named “Million Hearts”, has been launched by the US Department of Health and Human Services to try to prevent one million heart attacks and strokes over the next five years. It uses the four letters “ABCS” to help us all remember key ways to safeguard our blood vessels, particularly the blood vessels that feed our hearts and brains.

“A” is for Aspirin. Million Hearts urges all those at high risk for a heart attack or stroke to take some amount of aspirin – usually a “baby aspirin”, which is 81 milligrams. The tricky thing is to figure out who is at high risk, though there are ways to calculate this if you know your blood pressure and cholesterol levels. If your 10-year risk of heart attack is over 10 percent, aspirin is recommended. The American Heart Association has a calculator you can do online at: https://www.heart.org/gglRisk/locale/en_US/index.html?gtype=health

“B” is for Blood Pressure. Many people are walking around with high blood pressure. This is risky for their blood vessels, which are stressed with each heart beat when the pressure within them is high. People may know they have high blood pressure (also known as “hypertension”), but their medicines aren’t working well, or maybe they aren’t taking them. Many more folks don’t know their blood pressure is high – they’ve never been diagnosed. What are the numbers to shoot for? The top number – systolic – should be below 140, and the bottom number – diastolic – should be below 90.

“C” is for Cholesterol. When I check my patients’ “cholesterol” level, I’m actually checking for several lipids (total, HDL, LDL-C, and triglycerides). The Million Hearts campaign is focusing on the LDL-C level, which is what I call the “really bad cholesterol”. (Hey, I try to make things understandable to my patients!) Everyone should have an LDL-C level below 160, and people at high risk for a heart attack or a stroke should keep it below 100. If eating well (low fat diet) doesn’t get a person to these levels, then cholesterol-lowering medications are necessary.

“S” is for Smoking. Regular readers of my blog know that I harp on the value of stopping smoking. If you’re a smoker, the number one Healthiest Thing you can do is stop smoking. I saw a patient this week who was very anxious – almost frantic, really – about the possibility that he might have cancer. He smokes. I said, “There’s a disconnect here. If you’re so worried about getting cancer, why are you still smoking?” He said he would try to quit. I sighed. I hope he does it. He won’t just be decreasing his risk for cancer, but also his risk for heart attack or stroke. 

May the Million Hearts campaign be successful!

It’s a given that smokers should stop smoking. Everyone knows the link between cigarettes and lung cancer (though younger folks often discount this, thinking, “that’s way too far in the future for me to worry about.”) But far more common than cancer are the lung diseases we call emphysema and chronic bronchitis. Doctors lump these into the acronym “COPD” which stands for Chronic Obstructive Lung Disease.

Our delicate web of lung tissue really hates cigarette smoke. The smoke attacks the airways and they become inflamed and thickened and it soon takes a deeper breath to breathe in the same amount of air. People with COPD typically cough, produce sputum, and are short of breath. They definitely have a lower quality of life.

Bad news, right? So I know now that all of my readers who smoke are collectively ripping up their few remaining cigarettes and vowing never to smoke again. Good job!

Okay, now that we are all non-smokers, I have a bit more bad news to share. It’s possible to be a never-smoker and still get COPD. In fact, a recent study in the medical journal Chest looked at statistics representing 10,000 people from 14 countries. Over 20 percent of the people with COPD had never smoked in their lives. Being a woman, being older, and having a history of asthma all made it more likely to be diagnosed with COPD, despite never smoking.  

I know the government needs our tax money to pave roads, educate children, and provide for the common defense (and maybe a few other things), but, in general, I’m not an enthusiastic tax payer.

Yet here’s a tax I’m in support of, and wish it was even higher: cigarette excise tax. When I read about this in the MMWR (see yesterday’s blog), I had to look up “excise”. It means, “a tax on goods for domestic market”. So that’s a tax that the state or federal government puts on some item which is then sold in the U.S.

The average state excise tax has been steadily increasing, from $.42 a pack in 2000 to $1.44 a pack in 2010. Combining the state with the federal excise tax added $2.21 to each pack of cigarettes in 2009. 

To that I say, “Yes!” (Happy dance).

Every time the cost of cigarettes goes up, a percentage of my patients quit smoking. I urge them to stop smoking, also, but sometimes they need the pain in the pocketbook to take the step.

And now I will officially go on record: I wish the tax was $10 a pack.

Stopping smoking is tough. Very tough. But there are things that can make it easier. One of those things is understanding the reasons a person smokes, and another of those things is getting encouraging support during the quitting process. 

For many years, I’ve recommended my patients who smoke to call 1-800-QUIT-NOW (1-800-784-8669). It a free – completely free – service to provide a “Quit Coach” who helps a person think through the reasons he or she smokes and to plan a quit date, and then to encourage the quitting process. Getting this coaching has helped many of my patients quit smoking, and I appreciate this service.

Many studies have shown that people who are helped by “Quit-lines” are more successful at quitting than people who try it on their own. But was it just because people were already nearly ready to quit on their own when they called? What about those people who hear from their doctors that they should call, and they make that first call reluctantly. Are they able to quit more successfully?

It turns out they are. A study published in the June 10, 2011 Journal of the National Cancer Institute shows that Quit-lines, regardless of how people found out about the service, help more folks stop smoking than would have stopped on their own. 

So call 1-800-QUIT-NOW if you think you maybe, might someday want to quit. It just may be the help you need. If reading helpful material on the internet is more your style, find out your state’s website to stop-smoking resources with the interactive map at:  http://map.naquitline.org .

Finally, make use of the massive amount of helpful information at www.smokefree.gov  .

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