It's Heart Month, which confronts the leading killer in the U.S.; here are five ways to keep your heart healthy or make it healthier.

University of Florida illustration

Kentucky Health News

February is American Heart Month, which focuses on the fact that heart disease is the leading cause of death in the U.S., and ways to lower your risk for heart disease. Here are five ways to boost your heart health, from the Centers for Disease Control and Prevention:

Exercise regularly. Maintaining a healthy weight is an important part of heart disease prevention, and regular exercise is one way to achieve this. The surgeon general recommends that adults get two and a half hours of moderate physical activity like walking or biking weekly. Children and adolescents should aim for an hour of physical activity every day.

Eat healthy. Establishing healthy eating habits is another way to maintain a healthy weight. Avoid foods that are high in saturated fat and trans fat. Opt for foods that are high in fiber and low in saturated fat, trans fat and cholesterol to help prevent high cholesterol. Foods with lower sodium can help lower your blood pressure, and consuming foods with less sugar can help keep your blood sugar under control.

Set limits. Limiting your alcohol intake and avoiding smoking can also help you prevent heart disease. Knowing your limits and setting boundaries can help you stay disciplined, which is another vital part of lowering your risk for heart disease.

Monitor health conditions. If you struggle with high blood pressure or high cholesterol or have diabetes, managing these conditions is a key part of preventing and lowering your risk for heart disease. Consult with doctors and other members of your health team to see what their recommendations are for managing existing medical conditions. They may prescribe medicines to help manage your blood pressure, cholesterol or blood sugar, along with lifestyle changes to help.

Work with a team. It's important to work with your health care team if any of your conditions change, if your family has a history of any of these medical conditions or if you suspect you might be at risk for them. Consult your doctor if you’ve already had a heart attack or if you struggle with mental-health issues. Create a treatment plan that works for you and discuss it regularly, making adjustments when necessary. Don’t stop taking any prescribed medicines before talking to your doctor.

Prioritizing heart health is critical for preventing and lowering your risk for heart disease. For more tips to boost heart health, visit cdc.gov/heartdisease/prevention.htm.

Some decongestants spike blood pressure; alternatives available

Photo by September 15, iStock/Getty Images Plus

By Dr. Vincent Sorrell

University of Kentucky

It’s the season for respiratory viruses and the cough, congestion and sore throats they bring. There are many options for over-the-counter (OTC) remedies and relief, but if you have high blood pressure, you may want to take a closer look at the label. Some may contain warnings that advise against taking if you have high blood pressure. Others contain high levels of sodium, which can also increase blood pressure.

Some OTC decongestants contain pseudoephedrine, a drug that works by constricting the blood vessels to reduce nasal swelling. But with those blood vessels narrowed, blood pressure increases. For the 122 million Americans with hypertension, decongestants can raise an already elevated blood pressure to dangerous levels and increase the chance of heart attack and stroke.

Many OTC cold and flu medicines now have a version formulated specifically for those with high blood pressure. Allergy medicines can also relieve stuffy or runny noses without adverse side effects, just as cough medicines and expectorants to help clear mucus.

If you need relief from cold and sinus congestion without medication, try these at-home remedies:

• Use a saline rinse to move saltwater through the nasal passages to clear out mucus.
• Drink extra fluids to help thin the mucus.
• Use a humidifier to moisten the air in your home and help clear your sinuses.
• Get plenty of rest.

If your symptoms persist, and you’re concerned about which decongestant is the best for you, talk to your doctor.

Vincent Sorrell, M.D., is chief of cardiology at UK HealthCare’s Gill Heart & Vascular Institute.

More than 1/3 of Kentuckians are enrolled in Medicaid. How many in your county? How many kids? What are their big health issues?

Screenshot of health portion of Cabinet for Health and Family Services report on Clay County

By Al Cross

Kentucky Health News

Most Kentuckians probably don't know much about Medicaid, but for more than one in three people in the state, it is a lifeline. In some counties, more than half the residents are Medicaid beneficiaries. But Medicaid runs somewhat under the radar, because many Kentuckians frown on the receipt of public assistance -- even though Medicaid benefits come only with demonstrated medical need.

Medicaid is a combined federal-and-state program, created in 1965 by the law that created Medicare. Originally it was for the very poor, the disabled and the pregnant, but in 2014 expanded to households with incomes up to 138 percent of the federal poverty level because then-Gov. Steve Beshear embraced the 2010 Patient Protection and Affordable Care Act, better known as Obamacare.

The federal government pays 90 percent of the cost for people covered by the expansion, and about 72 percent of others' costs. The state pays the rest, which means Kentucky taxpayers put billions of dollars a year into it. It's not the sort of program that needs to run under the radar; if we are paying the freight, we need to know what's in the haul, and it helps to know it at the local level.

That's easier now that the state Cabinet for Health and Family Services, which runs Medicaid in Kentucky, has posted monthly Medicaid enrollment reports on its website.

These county-by-county reports are more useful than the annual reports that the cabinet circulates more more to show the local impact of its programs. The Medicaid figure on those reports is the number of people in the county who received Medicaid benefits at any time during the program's fiscal year (April to March). That number overstates the rolls at any particular time, because many people go on and off Medicaid each month.

For example, the Fiscal 2022 report for Clay County, one of the nation's poorest, shows 15,922 total beneficiaries in the year, but only 12,815 in the month of June. That is still 62.6 percent of the county's estimated population of 20,484.

That said, the annual reports provide much more information about Medicaid than the monthly reports; among other things, they:

• Break down Medicaid enrollment into types of enrollees: traditional, expansion, children in foster care, and "presumptive eligibility," people who have been enrolled during the pandemic without all the usual checks for eligibility, under legislation passed by Congress. Starting April 1, states will have to start running all the usual checks, and many people will no longer be eligible. In Clay County, for example, 2,842 presumptive eligibles were on the rolls in fiscal 2022, or 18% of the total enrollment.
• Give the number of children who were beneficiaries at any time during the year; in Clay County, 4,612 kids were helped by Medicaid in fiscal 2022. 
• Give the top five diagnoses for adults and children on Medicaid, which can vary widely from year to year. In another poor county, Clinton, the top five diagnoses for adults in fiscal 2021 were chronic obstructive pulmonary disease, hypertension, unspecified illness, opioid dependence and diabetes, in that order. In fiscal 2022, they were hypertension, Covid-19, contact with and suspected exposure to Covid, myopia (nearsightedness) and "other fatigue."
• Give the top five procedures performed on beneficiaries and the top five medications prescribed for beneficiaries. In both Clay and Clinton counties in the last two fiscal years, the most-prescribed drug was naloxone, which reverses the effect of a drug overdose.
• Show the number of health-care providers who served residents of the county and the total they were paid. For example, in Clinton County in fiscal 2022, residents were served by 48 providers who were paid $33 million; $14.3 million of that went to local providers.
• Show the number of newborn screenings and other figures on programs for children, including the percentages of foster children who had an official goal of adoption, and the number with other official goals, such as reunification with their birth families.

The annual reports give much information on programs other than Medicaid, such as the Supplemental Nutrition Assistance Program (once known as food stamps), behavioral-health services (including syringe exchanges), other services by local health departments, health-insurance assistance, child-care assistance, child-support enforcement, social services (such as meals, home care and other services to seniors), and funding of Family Resource and Youth Service Centers, which serve public-school students and their families. The reports also list the number of cabinet employees working in each county.

Dollar General plans to open 1,000 stores in 2020; some worry they contribute to poor nutrition in rural areas

Dollar General Corp., one of the fastest-growing retailers in the country, has announced it will open 1,000 new stores in 2020, just as it did last year. That's on top of the more than 16,000 stores it already has (dozens of which are in Kentucky). "Dollar General's growth is nearly unrivaled in the industry at a time in which many brick-and-mortar retailers are closing stores or folding," Nathaniel Meyersohn reports for CNN."Walmart, which swept into new towns for decades with massive superstores, has essentially stopped opening new ones. By contrast, Dollar General is entering new cities and towns with small stores and opening up in areas where it has already gained hold."

One reason dollar stores are so popular: despite the low unemployment rate, "wages for a vast number of Americans have grown only modestly," Meyersohn reports. "Americans living paycheck-to-paycheck have been a boon to Dollar General, and wages for a vast number of them have grown only modestly. The chains have also reached higher-income shoppers seeking discounts." And Dollar General appeals to convenience, offering many of the same goods as Walmart with a shorter drive.

The chain's growing presence has hurt some small-town retailers. Small, full-service groceries in some towns have been put out of business by Dollar General Markets, which sell fresh produce and meat, though usually not with as wide a selection as the grocery they dislodged.

Most Dollar Generals sell only prepackaged food, which worries nutritionists concerned about rural health. Barry Popkin, a nutrition professor at the University of North Carolina at Chapel Hill, has been a long-time critic of dollar stores. "At a time when poor diets are linked to nearly 900 deaths a day in this country, Popkin says to look at what Dollar Stores sell: rows and rows of sugary drinks, candies, and processed foods high in salt and fat," Allison Aubrey of NPR reports for CBS News. Dollar Generals are frequently located in "food deserts," where residents have little access to fresh food and are often obliged to buy the pre-packaged food Popkin warns against.

For example: in Dekalb County, Georgia, which includes part of Atlanta, there are 68 dollar stores (a mix of Dollar General, Family Dollar, and Dollar Tree, the latter two with the same owner). County Commissioner Lorraine Cochran-Johnson told Aubrey that a quarter of the county's residents live in food deserts, and that dollar stores target such areas. "When you look at the trends and you look at the pattern of growth of the dollar store as well as the areas that have the highest levels of obesity, hypertension, high blood pressure, there is a direct correlation," Cochran-Johnson said.

Food-desert concerns have led some cities and towns to pass laws limiting dollar-store expansion. "Advocates of tighter controls on dollar stores claim the big chains intentionally cluster multiple stores in low-income areas, a strategy that strategy discourages supermarkets from opening and threatens existing mom-and-pop grocers, critics say," Meyersohn reports. "Opponents also express concerns that most dollar stores don't offer fresh produce."

Dollar General spokesperson Crystal Ghassemi objected to the perception that dollar stores contribute to poor eating habits, and told Aubrey that even their regular stores have plain vegetables and chicken in the frozen-foods section. Only about 3 percent of Dollar General outlets sell fresh produce.

Study suggests kids with hypertension more likely to have heart disease as adults; Ky. teens 3rd in U.S. in top risk factor, obesity

Parents.com photo

By Melissa Patrick
Kentucky Health News

Just like adults, children can have high blood pressure. The only way to know is to check for it, and it's important because children with hypertension are more likely to grow up to be adults with heart disease -- the number one killer of adults in Kentucky. And in the biggest risk factor for heart disease, obesity, Kentucky high-school students are the third most likely in the U.S. to be obese.

"Children don't have a lot of symptoms with high blood pressure, so we don't know they have it until we check," said Dr. Donna Grigsby, chief of general pediatrics at UK HealthCare. " If they don't get it under control when they are young it's likely to persist into adulthood. . . . There are a lot of long-lasting consequences to living with high blood pressure that is not well-managed."

Untreated hypertension in adults can lead to heart disease, heart failure, vision loss, stroke and kidney disease.

Grigsby noted that the American Academy of Pediatrics issued new blood-pressure guidelines for children in 2017, and that diagnosing hypertension in children is a little trickier than diagnosing it in adults because it varies by a child's age, height and gender. She stressed that health-care providers have to do more than just take a child's blood pressure; they also have to interpret it.

A recent study in the American Heart Association journal Hypertension suggests kids with hypertension are at a higher risk of heart disease as adults.

Using data from nearly 4,000 children who were followed for 36 years, the study found that the newer guidelines classified 11% of children as having hypertension; the old guidelines classified 7%.

It also found that 19% of the children with high blood pressure according to the new guidelines had an enlarged heart (left ventricular hypertrophy, or LVH) as adults. Under the old guidelines, it was only 12%.

Sperling's Best Places map

A possible pitfall in the study was that all of the children in this study come from one community: Bogalusa, Louisiana, just across the Pearl River from Mississippi, a town of 12,000 with a 57% white and 41% population. Also, the study used no information about actual heart attacks and stroke.

Overall, the study found that 8% of the children who were reclassified to having high blood pressure under the new guidelines were more likely than those without hypertension to develop heart disease as adults; and the children who were reclassified to the lower blood-pressure categories with the new guidelines had similar results as those who had never been diagnosed with hypertension.

"Children who were reclassified to higher blood pressure categories based on 2017 guidelines were at increased risk of hypertension, metabolic syndrome and LVH in later life," the report says.

Metabolic syndrome is a group of risk factors that raises a person's risk for heart disease, stroke and diabetes. They include high blood pressure, excess fat around the waist, high blood-sugar levels, high triglyceride levels and low levels of good cholesterol, or HDL. Having any three of these risk factors produces a diagnosis of metabolic syndrome.

Grigsby said all children should start having their blood pressure checked at age 3, and children who are considered at higher risk of developing high blood pressure should have it done sooner, including those who were born prematurely or who have kidney or heart disease.

The Centers for Disease Control and Prevention reports that an estimated 1.3 million youth between the ages of 12 and 19 have hypertension under the new guidelines, which is about 4% of the population. For example, the CDC says that in a classroom of 30, one would have high blood pressure and about three more would have "elevated blood pressure," once called "prehypertension."

Kentucky-specific data were not available, but the primary risk factor for high blood pressure in children is obesity, and that's a real problem in Kentucky. According to the State of Obesity report, one in five, or 20.2%, of the state's high-school students are obese, the third highest in the country.

"The children that we worry about are the children who are overweight and obese because we know that is a big risk factor for having high blood pressure," Grigsby said.

She said high blood pressure in children is primarily treated with lifestyle changes, like decreasing screen time, increasing activity, and improving diets -- and these changes are most successful when the whole family makes them.

"Instead of diet and weight loss, we talk a lot about healthy lifestyles because this is a change that they are going to have to be able to sustain," she said.

The Kentucky Department for Public Health suggests the 5-2-1-0 prescription to significantly reduce childhood obesity, which says to eat five or more servings of fruits and vegetables each day; limit screen time to no more than two hours a day; be physically active for at least one hour a day; and drink zero sweetened beverages. The website offers free resources to help meet these goals.

Ky. ranks next to last in exercise, which should include both aerobics and strength training; 'closest thing to a wonder drug'

By Melissa Patrick
Kentucky Health News

Kentucky adults rank next to last for getting the recommended amount of exercise, followed only by Mississippi, according to a recently released Centers for Disease Control and Prevention study, based on CDC polling that asks people about their exercise habits and health.

The poll found that only 14.6 percent of Kentucky adults reported getting the amount of exercise that experts say is needed, well below the national figure of 22.9 percent.

Among Kentucky men, 17.9 percent reported getting that amount of  exercise; the national figure for men is 27.2 percent.

Among Kentucky women, 11.4 percent reported getting enough exercise; nationally, 18.7 percent of women said they did.

Using data from the 2010-2015 National Health Interview Survey, the researchers looked at the percentage of adults between the ages of 18 and 64 who met the federal guidelines for both aerobic and muscle-strengthening activities during their free time. The polling did not consider any exercise done while on the job or during a commute.

The 2008 activity guidelines call for muscle-strengthening activities at least twice a week, with either moderate aerobic exercise for at least 150 minutes per week or vigorous aerobic exercise for at least 75 minutes per week, or an equivalent combination. 

Meeting the moderate exercise requirement involves about 20 minutes a day of activities like walking briskly, water aerobics, bicycling slower than 10 miles per hour, doubles tennis or general gardening. The vigorous aerobic requirement hurdle requires about 11 minutes a day of things like race-walking, jogging or running, swimming laps, singles tennis or jumping rope. And add to that two days of muscle-strengthening" exercises, like lifting weights, yoga, push-ups or sit-ups.

Exercise is known to reduce the risk of heart disease, high blood pressure, Type 2 diabetes and certain cancers -- all conditions in which Kentucky ranks in the top 10 states. It can also improve mental health, and Kentucky adults consistently report more poor mental health days than the rest of the nation: averaging 4.6 in the 30 days before they were polled, compared to 3.8 days nationally.

"Physical activity is the closest thing to a wonder drug," then-CDC director Thomas Frieden, told Kentuckians at the 2016 Shaping Our Appalachian Region Innovation Summit in Pikeville.

In general, the study found that adults residing in the Southeast were much less likely than adults in other regions to meet the activity guidelines; states in the West were consistently more likely to have a "significantly higher" rate of activity.

The bottom five states in percentage of adults who met the standard, were Arkansas: 15.7 percent; Indiana: 15.1; South Carolina: 14.8;  Kentucky: 14.6; and Mississippi: 13.5. The top five were Colorado, 32.5 percent;  Idaho,  31.4; New Hampshire, 30.7; Washington, D.C., 30.7; Vermont, 29.5; and Massachusetts: 29.5.

This is Heart Month, and it's still winter, so here's a reminder of the need to be physically active for cardiovascular health

February is American Heart Month, so the state Department for Public Health is encouraging Kentuckians to increase their physical activity to reduce the risk of heart disease and stroke. It is promoting the hashtag #MoveWithHeart on social media to connect with others and get information about exercise, physical activity and improving cardiovascular health.

"Heart disease is the second leading cause of death among Kentuckians, with more than 10,000 people dying each year from heart disease," the department said in a news release. "A major risk factor for heart disease is physical inactivity. Research shows that being physically active can help lower the risk of heart disease and stroke. When we protect our hearts, we care for our cardiovascular health. During the cold months, physical activity can be even more challenging. It’s important that Kentuckians make an effort to move more throughout the day. "

Federal guidelines suggest physical activity that gets our hearts beating faster and leaves us a little breathless for at least 2.5 hours each week. "You can break up that activity into small manageable chunks: 10 minutes here, 20 minutes there, it all adds up," the health department says. "In addition to physical activity, these healthy changes can help Kentuckians lower their risk of developing heart disease:" 

• Watch your weight.
• Quit smoking and stay away from secondhand smoke.
• Control your cholesterol and blood pressure.
• If you drink alcohol, drink only in moderation.
• Get active and eat healthy.

Bonita Bobo, the health department's coordinator for heart disease and stroke prevention, said “All Kentucky children, women and men should try to build activity into your day by taking the stairs, parking farther away from your destination, and stepping away from that computer screen.”

Study: Combination of a low-salt and heart-healthy diet is as good as drug therapy for many adults with high blood pressure

A new study finds that cutting back on salt and following the heart-healthy DASH diet can lower blood pressure, a disease that affects almost two out of every five Kentuckians.

“Our results add to the evidence that dietary interventions are as effective as—or more effective than—anti-hypertensive drugs in those at highest risk for high blood pressure, and should be a routine first-line treatment option for such individuals,” Dr. Stephen Juraschek, a study co-author, said in a news release. Juraschek is an instructor of medicine at Harvard Medical School and an adjunct assistant professor at Johns Hopkins University School of Medicine.

Previous guidelines defined high blood pressure as 140/90 milligrams of mercury (mm/Hg) or higher, but guidelines released this year have re-defined it as 130/80 mm/Hg or higher. High blood pressure increases the risk of stroke, kidney disease, heart attacks and heart failure.

The four-week study, published in the Journal of the American College of Cardiology, included 412 adults between the ages of 23 and 76 who had high blood pressure or were at risk of having it. They were asked to either stay on a "regular" diet or to switch to the Dietary Approaches to Stop Hypertension, or DASH, diet. DASH limits foods high in saturated fat and sugar, and is high in fruits, vegetables, whole grains, low or fat-free dairy, fish, poultry, beans, seeds and nuts.

They were also divided into three groups that received varying amounts of salt. One was allowed about a half a teaspoon per day, another was allowed about a teaspoon per day and the third group was allowed about 1.5 teaspoons a day. To reduce the risk of heart disease and stroke, the U.S. Food and Drug Administration recommends a maximum of about 2,300 mg of sodium per day, which is nearly one teaspoon of salt.

None of the study participants took blood-pressure medicines. Their baseline systolic blood pressures (the top number) ranged from 120 to 159 and their diastolic blood pressure (the bottom number) was between 80 and 95.

The participants were sorted into four groups: 120–129 mm Hg, 130–139 mm Hg, 140–149 mm Hg, and 150 mm Hg or greater.

The results varied based on which regimen the participants followed.

Those who followed the DASH diet with high sodium and had a systolic pressure of 150 or greater, had an 11-point average drop in systolic pressure. The effect was much less, a 4-point drop, among those whose beginning systolic pressure was less than 130.

The effect was even greater for those who were on the low-sodium DASH diet. Those who started with a systolic pressure of less than 130 had a 5-point drop in pressure; those who started between 130 and 139 had a 7-point drop; and those who began between 140 and 149 had a 10-point reduction.

The biggest impact was among those who followed the low-sodium DASH diet and started out with a systolic blood pressure of 150 or greater. They had an average drop of 21 points.

Juraschek called the findings "huge" and said they suggest that those at highest risk for serious hypertension achieve the greatest benefit from the combination diet.

The researchers said further research is needed to determine how the combination diet affects people with systolic blood pressure of 160 or greater or in persons with prior heart disease or diabetes.

Be careful in cold weather, which makes heart attacks, strokes and blood clots more likely; also, watch out for holiday stress

Heart attacks are 30 percent more likely during winter because of the weather, but there are precautions you can take to reduce your risk.

“The winter months can put even a healthy person at risk for a heart attack or other heart health problems,” said Dr. Suresh Sharma of KentuckyOne Health Cardiology Associates in Lexington. “To help protect yourself and those around you, be aware of the warning signs of heart attack, which include pressure, tightness or pain in the chest or arms, nausea, shortness of breath, cold sweat, lightheadedness and fatigue.”

Very cold weather can increase heart rate and blood pressure, and cause blood vessels to narrow, requiring more pressure to force blood through narrowed veins and arteries, increasing your risk of having a heart attack or stroke.

Shoveling snow can be risky.

Shoveling snow or exercising in the cold can also cause blood vessels to narrow and raise blood pressure. "Your heart also has to work much harder to keep your body warm in the cold," a KentuckyOne news release says. "With heart rate and blood pressure already elevated due to the low temperatures, this can cause blood clots to form and provoke coronary artery spasms. . . . When shoveling snow or exercising outdoors, remember to dress warmly to keep your blood flowing, and warm up your muscles prior to doing physical activity. Do not drink alcohol before or immediately after shoveling snow, as this can increase your risk for heart attack."

Stress related to the holidays "can also lead to heart problems," the release says. "People who display symptoms of heart-related illnesses might delay getting treatment because they don’t want to disrupt holiday festivities. Or, holiday travelers might take longer to find medical care away from home, which heightens the risk.

"Overindulgence during the holidays can also put your heart in danger. At family gatherings and holiday parties, people tend to consume alcohol and eat more than usual, including unhealthy foods that are high in sodium. Busy schedules due to holiday engagements cause people to neglect their exercise routines, which can put even more strain on the heart."

Sharma says, “Many people let their health take a backseat during the winter, but it’s actually even more important to ensure your heart is healthy during the colder months. Try to maintain a healthy lifestyle throughout the holiday season, and talk to your primary care provider about ways to protect your heart during the colder months.”

The release says, "If you or someone near you is presenting symptoms of a heart attack, call 911 immediately. Then, if you are able, perform hands-only CPR by placing your hands on the victim’s chest and administering compressions hard and fast, 100 times per minute, in the center of the chest. Don’t stop until help arrives." For more about heart-disease risk factors, or to take a heart-health risk assessment, visit www.kentuckyonehealth.org/heart-disease-risk-factors.

Study finds a genetic marker determines a love for salty foods; says they should be considered a treat, like dessert

Heart-disease death rate for Kentuckians over 35 in 2012-14 (CDC map)

A person's desire for salty foods may be determined by their genes, and that could spell trouble for their heart, according to a recent study at the University of Kentucky.

The College of Nursing study found that individuals with a certain "taste perception genotype" were more likely to eat more than the recommended amount of daily sodium than people without the genotype, says a UK news release.

This matters because too much salt in your bloodstream can cause high blood pressure, or hypertension, one of the major risk factors for heart disease. And heart disease is the leading cause of death in the United States, killing about 610,000 Americans a year, or one in every four deaths, according to the federal Centers for Disease Control and Prevention.

Kentucky leads the nation in both heart disease and hypertension rates. Its death rate from heart disease is 394 per 100,000 people; the national rate is 328. Kentucky ranks sixth in the number of people diagnosed with hypertension, at 39 percent, according to the State of Obesity report. The report also projects that about 1.3 million Kentuckians will be diagnosed with heart disease by 2030.

Sources of salt you may not have thought about

The release notes that the study paves the way toward future prevention opportunities, and that future research will help develop targeted approaches to reduce salt intake by people who are genetically predisposed to salty foods.

The American Heart Association recommends that most people eat no more than 2,300 milligrams of sodium per day (that's one teaspoon of salt) and ideally no more than 1,500 mg. The AHA says about 77 percent of a person's salt intake comes from prepared, packaged and restaurant foods.

An AHA graphic of "The Salty Six" shows six popular foods to pay attention to if you are watching your salt intake because they can add high levels of salt to your diet, including cold cuts and cured meats, pizza, soup, breads and rolls, chicken and burritos and tacos.

The UK release also offers some tips on how to reduce your sodium intake:

• Keep a journal of your salt intake (1/4 teaspoon salt = 575 mg sodium; 1/2 teaspoon salt = 1,150 mg sodium)
• Cook with minimal amounts of added salt, using herbs and spices instead. 
• Read food labels.
• Opt for home-cooked meals so that you can control salt amounts
• Consider salty foods a treat, much like you would consider sugary treats

The AHA adds: "One estimate suggested that if the U.S. population moved to an average intake of 1,500 mg/day sodium from its current level, it could result in a 25.6 percent overall decrease in blood pressure and an estimated $26.2 billion in health care savings. Another estimate projected that achieving this goal would reduce deaths from cardiovascular disease by anywhere from 500,000 to nearly 1.2 million over the next 10 years."

CDC boss Tom Frieden, at SOAR, gives examples of how communities can improve health, such as smoking bans

By Al Cross
Kentucky Health News

PIKEVILLE, Ky. -- Speaking to a region with some of the nation's poorest health, the top federal public-health official gave examples of how individual communities and states have made themselves healthier.

"Health is not just about health, it's about society," Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, told more than 1,000 people at the Shaping Our Applalachian Region Innovation Summit in Pikeville. "Healthy societies are more productive, and productive societies are more healthy."

Referring to Kentucky's high rates of disease and factors that cause them, Frieden said bringing Eastern Kentucky's health statistics up to the national average would save more than 1,000 lives a year.

Frieden cited six communities that have tackled specific health issues, such as obesity, lack of physical activity, heart health, smoking and teen pregnancy.

Obesity is one of SOAR's three main health targets, but it's not an easy one, Frieden said. He said Somerville, Mass., reduced obesity in children under 6 by 21 percent by making it a community issue, with creation of farmers' markets for local produce, construction of walking paths and the mayor leading community walks.

"Physical activity is the closest thing to a wonder drug," Frieden said, because it helps prevent heart disease, strokes, diabetes and cancer, improved mood and lengthens life.

The leading preventable cause of death is smoking, Frieden said, calling for ordinances and laws making workplaces smoke-free. "Nobody should have to risk getting cancer to come to their job," he said.

Heart disease is the most preventable major cause of death, Frieden said, explaining how Minnesota and Grace Community Health Centers in Knox, Clay, Leslie and Bell counties have improved heart health by improving treatment of high blood pressure, or hypertension. "It's the single most important thing" to do for heart health, and it's simple, Frieden said, because the medicine is inexpensive and taken once a day with few if any side effects.

Frieden said the CDC thinks a lot about teen pregnancy because "Teen pregnancy perpetuates a cycle of poverty." He said Spartanburg, S.C., reduced teen pregnancy by 61 percent from 2001 to 2014 partly because South Carolina's Medicaid program paid for long-acting, reversible contraception immediately after delivery, and was the first state to give full reimbursement for post-partum insertion of intrauterine devices for birth control. Kentucky Medicaid doesn't cover such services.

Study of preventive health status finds Kentucky is in the middle of the pack generally, but has several good and bad aspects

A study that looked at preventive health services among states in three categories found that Kentucky fell near the middle of the pack for most of the measures, but was in the top 10 for adult flu vaccinations and top five for prevention of high blood pressure, but in the bottom 10 for human papilloma virus vaccinations for males.

The America's Health Rankings' Spotlight: Prevention study, released in partnership with the American College of Preventive Medicine, took an in-depth look at three categories of preventive services: access to health care, immunizations and chronic disease prevention, to "drive awareness and understanding" of the importance of preventive services and interventions.

The report notes that prevention is a "meaningful part of the solution" as the American healthcare system "sharpens its focus on quality, affordability and overall value." (Chart: Each state is a green dot, national average is a gray diamond and Kentucky is a blue diamond; click on image for larger version)

Access to health care was examined by looking at health care coverage, dedicated health care providers and annual dental visits.

"Access to health care is a key part of disease prevention," says the report. "Individuals without health insurance often have more difficulty accessing the health care system, are less likely to participate in preventive care programs, and have more unmet health needs than those with health insurance."

The report found that 90 percent of Kentuckians reported they have some kind of health insurance, above the national average of 87.6 percent.

Since the implementation of the Patient Protection and Affordable Care Act and the expansion of Medicaid to those whose incomes are up to 138 percent of the federal poverty level, the uninsured rate for Kentuckians aged 18 to 64 has dropped from 25 percent in 2013 to 13 percent in 2015, according to a recent Kentucky Health Issues Poll. Another Foundation for a Healthy Kentucky study reports that thousands of newly insured Kentuckians have used their preventive health services, including dental services, which are free under health reform.

Overall, 79.4 percent of Kentuckians said they had a regular health care provider. The national average is 76.7 percent. Hispanics (47.5 percent) fell below this rate as did Kentuckians between the ages of 18 and 44 years of age (66.5 percent).

Only 61 percent of Kentuckians said they had had a dental visit in the past year, which is lower than the national average of 65.3 percent. Income and education were the greatest barriers to getting dental care in the state, with only 41.2 percent of those who made $25,000 or less seeing a dentist and only 35.7 percent of Kentuckians with less than a high school education seeing a dentist.

A recent study on oral health found that 100,000 more Medicaid-eligible Kentuckians got an oral health service in 2014 than in 2013, prompting the project director for the study to say in an interview, "Kentucky's support for an adult dental benefit is huge."

Immunizations were examined through four different immunization measures that included children, teens and adults.

Overall, 72.3 percent of Kentucky's children had the recommended series of childhood immunizations, 85.5 percent of adolescents had the recommended Tdap (tetanus, diphtheria and pertussis) immunization, and 78.2 percent of adolescents got the recommended meningitis vaccine. All of these were close to the national averages of 71.6 percent, 87.6 percent and 79.3 percent respectively.

However, while 37.4 percent of Kentucky's adolescent females got the recommended HPV vaccine only 13.3 percent of the state's adolescent boys did, placing the state in the bottom 10 states for this measure. National averages were 39.7 percent and 21.6 percent respectively.

Kentucky, with 43.9 percent of its adults vaccinated for the flu, was in the top 10 states for this measure; and 67.7 percent of Kentuckians older than 65 reported being vaccinated for pneumonia. National rates were 40.4 percent and 68.5 percent respectively.

"Vaccines are among the most cost-effective clinical preventive services and one of the best tools for preventing infectious diseases," says the report. "Vaccinations have led to a 95 percent decrease in vaccine-preventable diseases over the last 50 years, and yet VPDs remain a major cause of U.S. morbidity and mortality with thousands of cases of illness and deaths each year."

The chronic disease prevention category was examined through three measures: adult awareness of high blood pressure, cholesterol check and colorectal cancer screening.

"Heart disease and cancer are the top two causes of deaths in the United States, accounting for 46 percent of all deaths in 2013, "says the report. "Routine screening can lead to early detection and treatment of chronic disease risk factors, including high cholesterol and high blood pressure, reducing heart disease and cancer mortality."

The report found that 39.1 percent of Kentuckians have been told they have high blood pressure, which places Kentucky in the bottom five states for this condition. Nationally, 31.4 percent of adults have high blood pressure, although many have it, but aren't aware of their condition, says the report.

Overall, the report found that 77 percent of Kentuckians have been tested for cholesterol in the past five years and 67 percent of Kentuckians aged 50 to 74 have had a colorectal cancer screening. Nationally 76.4 have had a cholesterol check and 66.4 percent have had a colorectal cancer screening.

"According to the Centers for Disease Control and Prevention, Americans use clinical preventive services at half the recommended rate, leading to tens of millions of individuals missing out on basic preventive care. Past research from the Institute of Medicine has also estimated that in one year, the United States spent $55 billion due to missed preventive opportunities," says the report.

One of every three U.S. adults have a combination of risk factors that increase their risk for heart disease and diabetes

More than one-third of adults in the U.S. have a combination of health conditions that put them at higher risk of heart disease and diabetes, and this condition affects nearly half of adults aged 60 and older, according to a new study recently published in the Journal of the American Medical Association.

Image: healthyanswers.com

This combination of health conditions, when found in one person, is called metabolic syndrome. It includes abdominal obesity, high blood pressure, increased fasting glucose levels and abnormal cholesterol levels.

The study collected data gathered by the federal Centers for Disease Control and Prevention from adults 20 and older from 2003 to 2012. It found that about a third had a metabolic symdrome in 2011-12, and nearly half of those 60 and older did. Among those 20 to 39, the rate was 18 percent.

The study report says these were "concerning observations" because of the country's aging population. Hispanics, at 39 percent, were found to have the highest prevalence of metabolic syndrome among ethnic groups. Women had a higher prevalence than men in all age groups.

The American Heart Association says the best way to control the risk factors contributing to metabolic syndrome are to lose weight and increase physical activity. It also encourages patients to routinely monitor their weight, blood glucose, cholesterol and blood pressure and treat these risk factors according to established guidelines.

Researchers discover why common blood-pressure medicine doesn't work for some people: your kidneys don't want to lose salt

Each year, more than 120 million prescriptions are written around the world for thiazide drugs, which lower salt to treat high blood pressure. High blood pressure affects 28 percent of Kentucky adults, according to the state Department for Public Health. Thiazide drugs often save lives but are ineffective in some patients and only work for a time in others. A study by University of Maryland School of Medicine researchers has found a key reason for the failure.

Thiazides prevent salt from moving through the kidney, causing it to expel salt and water. However, the researchers found that the kidney seems to know "that it's losing too much salt and activates mechanisms to retain salt in other ways," said Paul Welling, a professor of physiology at the University of Maryland.

The researchers studied an animal model designed to prevent salt retention, which imitated the thiazides' effects. They discovered almost 400 genes that alter their activity to assist regulation of the kidney's salt control. Eventually, it might be possible to make drugs that affect the body's mechanisms that control how the body interacts with thiazides.

Welling and his colleagues also may have discovered a "biomarker" that could allow doctors to easily find out in which patients thiazides will not work. When the kidney is working against the thiazides, a certain molecule increases in the urine. "Now that we know more about these novel pathways and processes, we can begin to find new ways to help patients with high blood pressure," said Dean E. Albert Reece, vice president for medical affairs at the University of Maryland.

Study shows that removing a clot that causes a stroke leaves victims with higher functional independence

In Kentucky, strokes cause about 5 percent of deaths, and the state had the 11th highest stroke mortality rate in 2009, according to data from the Kentucky Cabinet for Health and Family Services. Fewer than 40 percent of severe stroke victims regain functional independence if they get only the standard drug intervention, but a study has found that also removing the clot both helps restore blood flow to the brain and can lead to more favorable long term outcomes.

"The outcomes are the difference between patients being able to care for themselves after stroke and being dependent," said Demetrius Lopes, surgical director of the comprehensive stroke center at Rush University Medical Center.

The traditional treatment for ischemic stroke—a stroke that involves clots in vessels bringing blood to the brain—is intravenous tissue plasminogen activator (tPA), a medication to dissolve the clot. However, doctors can also perform thrombectomy, a minimally invasive procedure to remove the clot that is allowed only in clinical trials.

In the study, patients with severe ischemic strokes were split into two groups. One group received only tPA, while the other group received tPA as well as thrombectomy. After 90 days, those who received both treatments had less disability and had a functional independence rate of 60 percent, compared to 35.5 percent of those who received only tPA. Also, patients who received thrombectomy had better blood flow rates in the brain.

"Ethically, we can't deny patients a treatment when we have such strong evidence it's better for them," Lopes said. Now thrombectomy is a standard treatment for severe strokes at Rush and some other locations. The study is published in the online edition of the New England Journal of Medicine.

Another study suggests that lack of walking and other physical activity damages blood vessels and causes many health issues

If you are looking for a reason to commit to daily exercise in 2015, here are two: The U.S. surgeon general says most of us only exercise about half the recommended amount to be healthy, and a new study shows that this lack of activity damages our blood vessels, which contributes to much of what ails us.

Research at the University of Missouri School of Medicine, published in Medicine and Science in Sports and Exercise, found that going from high (10,000 steps a day) to low levels of daily physical activity (5,000 steps a day) for just five days decreases the function of the inner lining of the blood vessels in the legs, according to a news release from the university.

“The impairment we saw in just five days was quite striking,” Paul Fadel, associate professor of medical pharmacology and physiology at the university, said in the release. “It shows just how susceptible the vascular system is to physical inactivity.” Previous studies have found that a decrease in blood-vessel function is linked to early cardiovascular death and hypertension.

Kentucky is the ninth most inactive state, with almost one-third (30.2 percent) of Kentuckians reporting in a national survey that they did not engage in physical activity or exercise during the previous 30 days other than doing their regular jobs, according to the State of Obesity report.

A collective New Year's resolution by Kentuckians to increase their physical activity, if kept, would help improve almost every health issue that plagues our state: obesity, diabetes, high blood pressure, heart disease. Kentucky ranks fifth in obesity, 17th in diabetes and fifth in hypertension, and is projected to have more than 1 million cases of heart disease by 2010, the report says.

“Inactivity is typically going to lead to people being overweight and obese,” Fadel said. “The next step after that is insulin resistance, which leads to Type 2 diabetes and cardiovascular disease.”

So, how much activity do we need to keep our blood vessels healthy? 10,000 steps every day, says the surgeon general. But the reality is that most of us only take 5,000 steps a day, which is considered a low activity level. The research for this study is based on 30 minutes of moderate activity a day.

“We need to teach and explain to people about the physiology of their bodies and the physiology of the disease process and help them understand that inactivity plays a foundational role in the disease process,” John Thyfault, associate professor of nutrition and exercise physiology at the university, said.

“Then we give them behavioral tools, like pedometers, to monitor and help them achieve higher physical activity so they start to see and feel health improvements. These studies are proof we need to get people to understand their activity every day plays a role in their health, and that their health is not simply a matter of body weight and how they look in the mirror.”

Study concludes that fasting can reduce cholesterol levels for people in danger of developing diabetes

New research suggests that occasional fasting can help pre-diabetics from developing diabetes, which is more common in Kentucky than most states.

After 10 to 12 hours of fasting, the body looks for other energy sources to sustain itself, so it removes LDL (bad) cholesterol from fat cells and converts it into energyaccording to researchers at the Intermountain Heart Institute at Intermountain Medical Center in Murray, Utah.

"Fasting has the potential to become an important diabetes intervention," in addition to lifestyle changes and weight loss, said Benjamin Home, the lead researcher.

The study focused on prediabetics between the ages of 30 to 69 with at least three of the following metabolic risk factors: a large waistline, a high triglyceride (type of fat in the blood) level, a low HDL (good) cholesterol level, high blood pressure and high blood sugar after fasting.

"Over a six-week period cholesterol levels decreased by about 12 percent in addition to the weight loss," Home said. "Because we expect that the cholesterol was used for energy during the fasting episodes and likely came from fat cells, this leads us to believe fasting may be an effective diabetes intervention."

The removal of LDL cholesterol from the fat cells for energy use should help stop insulin resistance, which happens when the pancreas keeps producing more and more insulin until it can't make enough for the body, and the blood sugar rises. "The fat cells themselves are a major contributor to insulin resistance, which can lead to diabetes," he said. "Because fasting may help to eliminate and break down fat cells, insulin resistance may be frustrated by fasting."

Home noted that although fasting might be effective for protecting against diabetes, the results were not immediate. "How long and how often people should fast for health benefits are additional questions we're just beginning to examine." (Read more)

Study says obese children (Kentucky's a leader in that) may have quadruple the risk of having high blood pressure as adults

By Molly Burchett
Kentucky Health News

A new study shows that being obese in childhood may quadruple the risk of having high blood pressure risk as an adult, highlighting the need for Kentucky to curb its high rate of childhood obesity.

Eighteen percent of Kentucky high schoolers are obese, tying Mississippi for the highest percentage among the states, says a report by Kentucky's Task Force on Childhood Obesity. In the age range of 10 to 17, Kentucky trails several other states but remains a national leader.

One in three U.S. children and teens are overweight or obese, meaning their body mass index is at least the 85th percentile or at least the 95th percentile for their age and gender, respectively, says the American Heart Association. And, even more children are at-risk of becoming obese adults by the year 2030, says new report from Trust for America’s Health and the Robert Wood Johnson Foundation.

This study adds to concern about the long term impact of childhood obesity by linking it with increased risk for high blood pressure. High blood pressure, if left untreated, can damage the heart and coronary arteries that can ultimately lead to a heart attack, heart disease or congestive heart failure, says the AHA.

The findings, which were presented at the American Heart Association High Blood Pressure Research Scientific Sessions 2013, are also part of the growing body of evidence that heart disease may start in childhood, said Dr. Sara E. Watson, study author and a pediatric endocrinology fellow at Riley Hospital for Children at Indiana University in Indianapolis.

Study researchers tracked the growth and blood pressure of 1,117 healthy adolescents from Indianapolis for 27 years, starting in 1986, finding that 6 percent of normal weight children and 26 percent of obese children had high blood pressure as adults.

“It is important that pediatricians counsel patients on the risk of high blood pressure associated with overweight and obesity, and stress that a healthy diet, including reducing salt intake and exercise, may help reduce this risk,” Watson said. “Interventions to prevent and treat obesity will play an important role in decreasing the significant burden of high blood pressure in adulthood.”

Small steps can prevent Kentucky's No. 1 killer, heart disease

It is now February, which is American Heart Month and a perfect time to remind people that small steps can reduce their risk of heart disease, Kentucky's No. 1 killer.

You may be surprised to hear that almost 80 percent of heart disease is preventable and there are daily things that can be done to keep hearts healthy, according Dr. Martha Grogan, medical editor-in-chief of Mayo Clinic Healthy Heart for Life.

For example, try to move 10 extra minutes each day, Recent research shows a sedentary lifestyle may increase your risk of heart attack almost as much as smoking, said Grogan.

Each day, make an effort to get up from your desk to go talk to a colleague instead of sending an email, or walk around the house as you are talking on the phone, she recommends: “Moving even 10 minutes a day for someone who’s been sedentary may reduce the risk for heart disease by 50 percent.”

Hearts are also hurt when you deprive yourself of sleep, which is a necessity like food and water, said Virend Somers, a Mayo cardiologist and sleep expert. Chronic sleep deprivation can increase the risk of obesity, high blood pressure, heart attack, diabetes and depression.

Healthy habits can reduce a majority of risks for heart attack. "A 53-year-old male smoker with high blood pressure has a 20 percent chance of having a heart attack over the next 10 years. If he stops smoking, his risk drops to 10 percent; if he takes high blood pressure medicine, it falls to 5 percent," says preventive cardiologist Randal Thomas, M.D.

These healthy habits and changes like quitting smoking and taking blood pressure medicine can make a difference in life and death. For more from the Mayo Clinic, click here; for a American Heart Month information from the federal Centers for Disease Control and Prevention, go here.

Georgia doctor prescribes pills to help in school -- whether or not the ADHD shoe fits -- to level the playing field for the poor

Amanda Rocafort and her son, Quintn,
who takes Adderall for his ADHD.
(NYT photo by Bryan Meltz)

In light of last week's news that the number of poor children on Medicaid in Kentucky are being prescribed anti-psychotic drugs at alarming rates for such diagnoses as attention-deficit and hyperactivity disorder and depression, the New York Times reports that some doctors are making "no excuses" for prescribing psychostimulants in other locales for children of the poor.  Dr. Michael Anderson, a pediatrician in a poor county north of Atlanta, Ga., said he thinks ADHD is "made up" and "an excuse" to prescribe pills to treat what he "considers the children’s true ill -- poor academic performance in inadequate schools." Still, "I don’t have a whole lot of choice,' said Anderson. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.'"

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining some ground: Prescribe drugs to struggling students in schools not to treat ADHD, necessarily, but to boost their focus and impulse control.  Alan Schwarz reports that Anderson figures that he is arming them with the only tool he has because these children can't afford family therapy or tutoring or behavior-based counseling or any of those other tools that other children might have at their disposal to help them learn.

Of course, Anderson is not without his critics. Many doctors, writes Schwarz, warn of the dangers of exposing children to the unwarranted physical and psychological risks of powerful drugs on everything from mood to blood pressure to the suppression of growth. (Read more)