UPDATE March 20, 2019:  The results of the “Apple Heart Study” were just released at the annual meeting of the American College of Cardiology.  Read my comment at the end of this post for an update.

Today, Apple released its ECG app and irregular heart rhythm notification feature.

The announcement about the technology was made with great fanfare a couple of months ago, when Apple also revealed that the device had received approval by the FDA.  This raised some eyebrows because—according to some—the technology was being approved and released to the public without evidence of effectiveness or harm.

What is so unique and novel about the product is that it claims to be able to detect atrial fibrillation, or “a.fib,” which is a common irregularity of the heart rhythm.  A.fib is not usually fatal but it can be a problem for two reasons.

First, the arrhythmia causes and irregularity and rapidity of the pulse that can provoke palpitations and also impair the pumping capacity of the heart.  This typically causes symptoms, so that people who develop a.fib typically become aware of the problem and seek medical attention relatively promptly.

But not everybody is necessarily aware that they have a.fib.Read more

As readers of the blog may know, I have been a very strong proponent of the coronary calcium scan for many years.  The scan is a great tool to help determine vascular health and make a decision regarding the treatment of high cholesterol.

I have argued in previous blog posts and videos that patients with a coronary calcium score of zero may be able to avoid medications to lower cholesterol.  In the last couple weeks, 2 news items from the cardiology community have bolstered my opinion.Read more

The blood pressure is fickle

We typically think of the blood pressure as a pair of numbers that are measured in the doctor’s office once in a while.  If the numbers are persistently too high, you have “high blood pressure” (also known as hypertension) and that’s a concern for the future.  If untreated, hypertension can lead to serious complications, including heart, kidney and brain damage.

But we know that people can get a little nervous when they’re at the doctor’s office, so the blood pressure may be high there but be normal the rest of the time.  That is called “white coat hypertension,” because the stress of seeing a doctor in a white coat is enough to raise the blood pressure!

And we also know that the opposite can occur: the blood pressure may be deceptively low at he doctor’s office, but much higher during the day when the stress of work or of taking care of the household is in full force.  That is called “masked hypertension,” because the doctor only sees normal blood pressure numbers in the clinic and is unaware that the numbers are actually higher most of the time.

The blood pressure changes all the time, so it’s quite challenging to make a determination about hypertension on a few sets of numbers taken here and there.

A new way to measure BP

A few years ago, medical device manufacturers developed ambulatory blood pressure monitors (ABPMs), which are simple blood pressure machines, the size of a WalkMan tape player (does anyone remember those?!).

The device can be worn over a period of 24 to 48 hours and which automatically obtain a large number of measurements while you’re out and about during the day, and even at night when you sleep!Read more

A gym in our neighborhood has a big sign that challenges the passerby to “Make your body your machine.”  Another one a few blocks away entices potential customers with a poster that says “We don’t use machines.  We build them.”

These are clever and funny points.  There is certainly a sense in which bodies are like machines, with parts that work on each other to accomplish things.  And, for all practical purposes, those parts can be described the same as engine parts:  There is a fuel system (digestion and metabolism), a plumbing system with a pump (the heart and blood vessels), an electrical system (the nerves), a system of pulleys and joints (the muscular system), etc.

But the metaphor can go a little too far.Read more

As some of you may know, a new definition of hypertension (high blood pressure) was recently proposed by the American Heart Association, the American College of Cardiology, and 9 other sponsoring organizations.

According to the new definition, if one’s resting blood pressure (measured properly) is more than 120/80, it should be considered “elevated.”  And if one’s BP is more than 130/80, then the person with that blood pressure should receive a diagnosis of hypertension.

Needless to say, the proposed definition has generated a lot of controversy.  If all doctors adopted the new definition, that would create millions of new patients overnight, and a third of American adults would be considered to have a chronic disease!

What’s more, anyone with a blood pressure over 120/80 would be advised to have close medical follow-ups: repeat visits every 3-6 months, according to the new guidelines.Read more

A recent tweet from JAMA, the journal of the American Medical Association, urged me and other doctors to “include nutrition counseling into the flow of [our] daily practice.”

Along with the tweet came a link to an article that outlines “relatively small” dietary changes, based on the latest Dietary Guidelines for Americans, that can “significantly improve health.”

My response to the tweet was swift and knee-jerk.  I will not do it.  I simply will not.  I refuse to follow dietary guidelines or recommend them to my patients.

“What are you saying?!” “Are you the kind of self-interested doctor who only treats disease and cares nothing about prevention?!”  I imagine my outraged critics erupting in a chorus of disapproval.

Is my reaction unwarranted?  After all, the recommendations themselves seem sensible enough:  Eat fast food less often; drink fewer sugary sodas; consume more fruits and vegetables.  What’s not to like?

Unhealthy guidelines

I don’t know.  Perhaps it’s dietary guideline fatigue.

For more than 40 years, the nutrition experts have instructed us with guideline after guideline, food pyramid after food pyramid.  But what have they got to show for?  The obesity epidemic followed the introduction of dietary recommendations, and some doctors even blame those recommendations for causing the epidemic!

The blame may be far-fetched, but there’s something un-natural and perhaps even unhealthy about dietary guidelines.Read more