Sleeping With Any Light Raises Risk of Obesity  Diabetes and More

Even dim light can disrupt sleep, raising the risk of serious health issues in older adults, a new study found. Dogs and cats who share their human’s bed tend to have a “higher trust level and a tighter bond with the humans that are in their lives. It’s a big display of trust on their part,” Varble said.

Sleep myths that may be keeping you from a good night’s rest. “Exposure to any amount of light during the sleep period was correlated with the higher prevalence of diabetes, obesity and hypertension in both older men and women,” senior author Phyllis Zee, chief of sleep medicine at Northwestern University Feinberg School of Medicine in Chicago, told CNN.

“People should do their best to avoid or minimize the amount of light they are exposed to during sleep,” she added. A study published earlier this year by Zee and her team examined the role of light in sleep for healthy adults in their 20s. Sleeping for only one night with a dim light, such as a TV set with the sound off, raised the blood sugar and heart rate of the young people during the sleep lab experiment.

An elevated heart rate at night has been shown in prior studies to be a risk factor for future heart disease and early death, while higher blood sugar levels are a sign of insulin resistance, which can ultimately lead to type 2 diabetes. The dim light entered the eyelids and disrupted sleep in the young adults despite the fact that participants slept with their eyes closed, Zee said. Yet even that tiny amount of light created a deficit of slow wave and rapid eye movement sleep, the stages of slumber in which most cellular renewal occurs, she said.

Objective Measurements

The new study, published Wednesday in the journal Sleep, focused on seniors who “already are at higher risk for diabetes and cardiovascular disease,” said coauthor Dr. Minjee Kim, an assistant professor of neurology at Northwestern University Feinberg School of Medicine, in a statement. “We wanted to see if there was a difference in frequencies of these diseases related to light exposure at night,” Kim said. Instead of pulling people into a sleep lab, the new study used a real-world setting.

Researchers gave 552 men and women between the ages of 63 and 84 an actigraph, a small device worn like a wristwatch that measures sleep cycles, average movement and light exposure. We’re actually measuring the amount of light the person is exposed to with a sensor on their body and comparing that to their sleep and wake activity over a 24-hour period,” Zee said. “What I think is different and notable in our study is that we have really objective data with this method.”

Fewer than half of the adults in the study got five hours of darkness at night. Zee and her team said they were surprised to find that fewer than half of the men and women in the study consistently slept in darkness for at least five hours each day. “More than 53% or so had some light during the night in the room,” she said. “In a secondary analysis, we found those who had higher amounts of light at night were also the most likely to have diabetes, obesity or hypertension.” In addition, Zee said, people who slept with higher levels of light were more likely to go to bed later and get up later, and “we know late sleepers tend to also have a higher risk for cardiovascular and metabolic disorders.”

What to do

Strategies for reducing light levels at night include positioning your bed away from windows or using light-blocking window shades. Don’t charge laptops and cellphones in your bedroom where melatonin-altering blue light can disrupt your sleep. If low levels of light persist, try a sleep mask to shelter your eyes. Using melatonin for sleep is on the rise, study says, despite potential health harms. If you have to get up, don’t turn on lights if you don’t have to, Zee advised. If you do, keep them as dim as possible and illuminated only for brief periods of time.

Older adults often have to get up at night to visit the bathroom, due to health issues or side effects from medications, Zee said, so advising that age group to turn out all lights might put them at risk of falling. In that case, consider using nightlights positioned very low to the ground, and choose lights with an amber or red color. That spectrum of light has a longer wavelength, and is less intrusive and disruptive to our circadian rhythm, or body clock, than shorter wavelengths such as blue light.

Source: Sleeping with any light raises risk of obesity, diabetes and more, study finds – CNN

Heart rate increases in light room, and body can’t rest properly 

We showed your heart rate increases when you sleep in a moderately lit room,” said Daniela Grimaldi, MD, PhD, co-first author of the study and a research assistant professor of Neurology in the Division of Sleep Medicine. “Even though you are asleep, your autonomic nervous system is activated. That’s bad. Usually, your heart rate together with other cardiovascular parameters are lower at night and higher during the day.”

There are sympathetic and parasympathetic nervous systems that regulate our physiology during the day and night. Sympathetic takes charge during the day and parasympathetic is supposed to control physiology at night, when it conveys restoration to the entire body.

How nighttime light during sleep can lead to diabetes and obesity

Investigators found insulin resistance occurred the morning after people slept in a light room. Insulin resistance is when cells in your muscles, fat and liver don’t respond well to insulin and can’t use glucose from your blood for energy. To make up for it, your pancreas makes more insulin. Over time, your blood sugar goes up. An earlier study published in JAMA Internal Medicine looked at a large population of healthy people who had exposure to light during sleep. They were more overweight and obese, Zee said.

“Now we are showing a mechanism that might be fundamental to explain why this happens. We show it’s affecting your ability to regulate glucose,” Zee said. The participants in the study weren’t aware of the biological changes in their bodies at night. “But the brain senses it,” Grimaldi said. “It acts like the brain of somebody whose sleep is light and fragmented. The sleep physiology is not resting the way it’s supposed to.”

Exposure to artificial light at night during sleep is common

Exposure to artificial light at night during sleep is common, either from indoor light emitting devices or from sources outside the home, particularly in large urban areas. A significant proportion of individuals (up to 40 percent) sleep with a bedside lamp on or with a light on in the bedroom, or keep a television on.

Light and its relationship to health is double edged.

“In addition to sleep, nutrition and exercise, light exposure during the daytime is an important factor for health, but during the night we show that even modest intensity of light can impair measures of heart and endocrine health,” Zee said. The study tested the effect of sleeping with 100 lux (moderate light) compared to 3 lux (dim light) in participants over a single night. The investigators discovered that moderate light exposure caused the body to go into a higher alert state.

In this state, the heart rate increases as well as the force with which the heart contracts and the rate of how fast the blood is conducted to your blood vessels for oxygenated blood flow.

Zee’s top tips for reducing light during sleep

  1. Don’t turn lights on. If you need to have a light on (which older adults may want for safety), make it a dim light that is closer to the floor.
  2. Color is important. Amber or a red or orange light is less stimulating for the brain. Don’t use white or blue light and keep it far away from the sleeping person.
  3. Blackout shades or eye masks are good if you can’t control the outdoor light. Move your bed so the outdoor light isn’t shining on your face.

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6 clever tips for a great night’s sleep NewsNet5, Ohio

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Shortness of Breath Could Signal Heart Attack With Worst Survival Rate Study

Shortness of breath may be a sign of heart attack and lead to less survival than those with typical symptoms of chest pain, according to a study.

The researchers from Braga Hospital in Portugal, showed that just 76 per cent of heart attack patients with dyspnoea or fatigue as their main symptom are alive at one year compared to 94 per cent of those with chest pain as the predominant feature.

“Patients presenting with shortness of breath or fatigue had a worse prognosis than those with chest pain. They were less likely to be alive one year after their heart attack and also less likely to stay out of hospital for heart problems during that 12-month period,” said Dr. Paulo Medeiros from the Hospital.

“Dyspnoea and extreme tiredness were more common heart attack symptoms in women, older people and patients with other conditions such as high blood pressure, diabetes, kidney disease and lung disease,” Medeiros added.

Chest pain is the hallmark presentation of myocardial infarction but other complaints such as shortness of breath, upper abdominal or neck pain, or transient loss of consciousness (blackouts) may be the reason to attend the emergency department.

The study focused on non-ST-elevation myocardial infarction (NSTEMI), a type of heart attack in which an artery supplying blood to the heart becomes partially blocked.

The study included 4,726 patients aged 18 years and older admitted with NSTEMI between October 2010 and September 2019.

Patients were divided into three groups according to their main symptom at presentation. Chest pain was the most common presenting symptom (4,313 patients; 91 per cent), followed by dyspnoea/fatigue (332 patients; 7 per cent) and syncope (81 patients; 2 per cent). Syncope is a temporary loss of consciousness caused by a fall in blood pressure.

Patients with dyspnoea/fatigue were significantly older than those in the other two groups, with an average age of 75 years compared with 68 years in the chest pain group and 74 years in the syncope group.

Those with dyspnoea/fatigue were also more commonly women (42 per cent) compared to patients with chest pain as the main symptom (29 per cent women) or syncope (37 per cent women).

Compared to the other two groups, patients with dyspnoea/fatigue as their main symptom were more likely to also have high blood pressure, diabetes, chronic kidney disease and chronic obstructive pulmonary disease (COPD).

“This study highlights the need to consider a diagnosis of myocardial infarction even when the primary complaint is not chest pain. In addition to the classic heart attack symptom of chest pain, pressure, or heaviness radiating to one or both arms, the neck or jaw, people should seek urgent medical help if they experience prolonged shortness of breath,” Medeiros said.

Source: Shortness of breath could signal heart attack with worst survival rate Study

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Covid Year Three Will Be Better, Experts Agree, Unless Rich Countries Ignore The Pandemic Elsewhere

It was March 2020 when the reality of the Covid-19 pandemic hit home in the U.S. When the NBA suspended its season, it seemed to give permission for other closures and stay-at-home orders, and they quickly followed. At that point, there had only been around 3,000 confirmed cases of the disease and about 60 confirmed Covid deaths.

Fast-forward two years, and the numbers are staggering. According to estimates from Johns Hopkins University, as of Wednesday there have been over 79 million confirmed Covid cases and over 960,000 deaths. Several million have been hospitalized and millions more have reported symptoms that linger for weeks or even months, with unknown consequences moving into the future.

“It’s massively higher than I thought,” says Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco. “Particularly when in November 2020 the announcement came out that we had a vaccine that was 95% effective.”

Amanda Castel, a professor of epidemiology at George Washington University’s Milken Institute School of Public Health, said in an email that she’s also surprised that the pandemic is still going, compared to her initial expectation. “In retrospect, I think I was hopeful that it would be more self-limited, like the SARS pandemic.”

The worst of the pandemic is behind us, experts told Forbes, in part because the first two years provided valuable tools for the continued fight against both Covid and future disease epidemics. Ignoring the pandemic in lower-income countries, they say, could mean new variants making their way back to the U.S.

One lesson the experts didn’t expect to learn was how polarizing the response to the pandemic could be, especially as time went on. “I was surprised and alarmed to see how politically polarized Covid-19 responses have become, with some U.S. states (most recently Florida) promoting public health policies that directly oppose the science (and common sense),” Steffanie Strathdee, associate dean of global health sciences at the University of California, San Diego, said in an email.

The depth and intensity of political anger against public health officials was also jarring, says Castel. “To think that many public health leaders at the local, state and national level received death threats and lawsuits because of the evidence-based guidance they issued is appalling.”

“It’s tragic, because the outcomes of that were that hundreds of thousands of people died, who would not have died, if the response had been less political and more governed by the best science,” Wachter adds.

Wachter also says it’s hard to fathom the size of anti-vaccine sentiment based on what things looked like before the pandemic. “The anti-vax movement was previously pretty small and fringe,” he says. “And it was as likely to come from the left as the right—maybe even more likely to come from the left.”

The worst of the pandemic is (probably) behind us

“Years three and four will, hopefully, see a transition of Covid-19 from an emergent condition to an ongoing public health challenge with significantly less morbidity and mortality,” Anand Parekh, chief medical advisor for the Bipartisan Policy Center, says in an email. But not if it’s left to itself, he’s quick to add. “This would require easy access to prevention, testing and treatment.”

“I think the likeliest path will be a version of where we are now,” says Wachter. “With small surges that will not be overwhelming and be regional, partly related to seasonality, maybe partly related to vaccine status in different regions.”

The biggest unknown about this prediction, of course, is whether a new Covid variant emerges, which Strathdee warns is an increased risk if high-income countries choose to ignore the pandemic in the rest of the world. “If we don’t ensure that new medical advances such as vaccines and therapeutics reach the lower- and middle-income countries, new variants will emerge that threaten us all.”

Long Covid will have a potentially long impact

A potentially bigger challenge than surges of new infections in pandemic year three, says Wachter, are the still mostly unknown impacts of long Covid. If it turns out that, as some preliminary estimates suggest, as many as 10% to 20% of people experience lingering symptoms, “that’s tens of millions of people, and that’ll have an impact on the workforce and that’ll have an impact on economic performance.”

Long Covid will take a potential toll on the healthcare system as well, adds Castel. “Until we learn more about how to prevent and treat long Covid, we can anticipate a large burden on the healthcare system for the near future.”

“The high prevalence of long Covid stands to cause significant disability,” Strathdee says. “which affects both mental and physical health, including quality of life. I don’t think we’ve got a good handle yet on how big this problem may be.”

One major concern, says Wachter, is that unlike most respiratory diseases, early studies are warning that Covid may cause long-term health problems. A recent study said that people with even mild Covid showed more incidents of brain damage compared with those uninfected. Another finding: People infected with Covid have higher rates of heart attack and strokes. “If that turns out to be real, you’re talking about a new risk factor in almost 40% of the population,” he says. “A risk factor that may be as potent, as if people have high blood pressure or if they smoke. And that’s a very big deal.”

The tool kit for the next disease surge

Health experts agree that Covid-19 is likely to be around for a long time, and it’s also not going to be the last pandemic. The past two years, they say, have provided a lot of insight into what needs to be done to prepare for the next deadly disease surge.

When it comes to respiratory viruses like Covid, “We need to keep good-fitting N95 face masks, HEPA filters and good old soap and water,” says Strathdee.

“Masks should have been consistently recommended early on in the pandemic, as other countries did,” Parekh agrees. Castel concurs. “Masks are simple to use, relatively easy to obtain, and have proven to be effective in both protecting the wearer and those around them.”

Another key tool for combating future epidemics is testing, Wachter says. “We clearly made a terrible error early on in not working hard to get good tests out there more quickly,” he says. “And particularly, I think we were very late on home testing, both developing them and distributing them.”

One crucial factor that emerged to combat Covid, says Esther Krofah, executive director of FasterCures and the Center for Public Health at the Milken Institute, was research collaboration between scientists, companies and governments to produce vaccines and therapeutics quickly. That’s something she hopes doesn’t go away. “We need to ensure we build sustainable infrastructure to continue such collaboration,” she says, “and move forward efforts to change the culture in medical research to align with the urgent needs of patients.”

Experts do suggest rethinking one of the most contentious aspects of the pandemic response: school closures. “One of the real lessons learned is the negative impact of school closures on kids,” says Wachter. “And I think it will influence our response the next time.”

“Virtual schooling, while necessary intermittently, will need to be more closely considered in the future taking into account the virus’ epidemiology, risk to students and staff, and considerations for childcare/parental workforce,” says Parekh.

Hospitals need to be better prepared for future surges

Covid-19 hit hospitals extremely hard, overworking doctors and nurses to the point of burnout during pandemic surges, as intensive care units and other departments were pushed to capacity and beyond. This means that hospitals will need to work on building their surge capacity, experts say.

“Stockpiling and distributing critical medical material, deploying surge medical staff and ensuring that healthcare systems through federal grants are exercising their response plans are all critical,” Parekh says.

A major challenge for hospitals, says Wachter, will be getting extra capacity in place without breaking the bank. “Nobody’s going to be able to afford to keep a lot of excess bed capacity available, or a lot of excess nursing and doctor capacity,” he says. However, what hospitals can do is better stockpile equipment and protective clothing for healthcare workers. “The things that are not wildly expensive but you do want to have in the basement.”

In addition to better preparing for surges, hospitals also need to be better at identifying threats early so public health measures can be put in place, says Strathdee. “Public health departments and hospitals need to be better equipped to conduct surveillance, which includes systems for timely reporting.”

Castel encourages closer communication between hospitals and public health officials. “Hospitals are often sentinel sites and the first place that persons infected with these illnesses seek care, therefore they must have the capacity to work closely with public health to assist in the timely detection of emerging infectious diseases.”

Rebuilding trust and fighting apathy is critical

“An effective response to a pandemic requires three things: political leadership, national unity and timely resources,” says Parekh. Those first two have been hard to come by since 2020, with one expert confiding to Forbes their concern that political polarization “has significantly impaired the ability of public health authorities to enact countermeasures in the future.”

Another challenge that health experts have seen during the course of the pandemic isn’t just politics but also apathy. “On May 24, 2020, the New York Times covered its whole front page with a story headlined: ‘U.S. Deaths Near 100,000, An Incalculable Loss.’ It listed names of the dead, as the paper did after 9/11. In December 2020, shortly before vaccines became available, we approached 300,000 dead, though the Times did not (and still has not) run a similar story,” Krofah says. “I’m afraid we have become numb to these numbers.”

Wachter notes that if a new surge of Covid comes in the next few months, it may be hard to galvanize a public response. “Everybody is so cognitively over this,” he says. “And the idea that you would have to hunker down again? It’s going to be awfully hard to convince people to do that.”

Other experts agree that separating politics from public health is going to be essential in order to move forward in combating future epidemics. A crucial aspect of that is rebuilding trust in institutions, repaid in kind with clear communication rooted in science. But it’s also, several say, something that has to happen between people’s everyday interactions with each other.

For Castel, what’s needed is that sense of community seen early in the pandemic when “neighbors volunteered to help older, more vulnerable people get groceries, or to make masks, or to donate food to overworked medical personnel,” she says. “Without this sense of community, we would not be where we are today and I can only hope that if faced with another pandemic, that we would all come together again in a united effort to protect and support each other. “

I’m a senior editor at Forbes covering healthcare, science, and cutting edge technology. 

Source: Covid Year Three Will Be Better, Experts Agree, Unless Rich Countries Ignore The Pandemic Elsewhere

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Is Walking Enough Exercise? A Cardiologist Answers

There are seasons in life when a 15-minute walk is the most you can commit to your exercise routine—and, hey, that’s 100 percent okay. Maybe your job is more of a nine to nine than a nine to five right now, or childcare is monopolizing your free moments. Whatever the case, we asked a cardiologist to answer the age-old question is walking enough exercise? And the first thing you need to know is that the simple answer is yes.

According to Michael Weinrauch, MD, a New Jersey-based cardiologist, the bottom line is that even the smallest neighborhood loop can have an immense impact on your health and well-being. “The take home point here is that even 15 minutes a day of walking, without stopping, provides benefit with regards to cardiovascular morbidity and mortality,” he says.

Morbidity refers to illness or disease, while mortality refers to death. Research has associated 15 minutes of activity with a 22 percent lower risk of death (mortality), and walking with a 43 percent reduced risk in stroke and reduction the risk factors of heart attack (morbidity), regardless of how fast your heart is beating. “Keep in mind, most of the research that has been done on the benefits of walking have been done without monitoring heart rates during physical activity.

Remember, the Fitbit and smart watch apps are still actually a relatively new phenomenon,” adds Dr. Weinrauch. Long story, short: The morbidity and mortality benefits of walking seem to occur regardless of your heart’s beats per minute (BPMs). 

“The take home point here is that even 15 minutes a day of walking, without stopping, provides benefit with regards to cardiovascular morbidity and mortality.” – Michael Weinrauch, MD, cardiologist

With that being said, you can increase your cardiovascular fitness by increasing your heart rate and going longer distances—and that may offer even more benefits when it come to morbidity and mortality. “Cardiovascular fitness or aerobic fitness can be defined as a measurement of the body’s ability to deliver oxygen to its muscles,” explains Dr. Weinrauch.

VO2 Max, which is the maximum rate that oxygen can be consumed during exercise that increases in intensity, is the gold standard for measurement of fitness.” However, it’s really up to you how “fit” you want to be. If you’re someone who wants to build up your VO2 max so you can run a marathon, fantastic. And if you’re someone who’s content with a brisk walk to your favorite coffee store, that’s also great.

“The bottom line is, if you are walking to improve your health, do not worry about how high to raise your heart rate. If you are interested improving your cardiovascular fitness in addition to improving your health, then more vigorous exercise training will likely be necessary,” Dr. Weinrauch says.

It’s the choose your own adventure of fitness. And regardless of your choice, you’re still collecting those morbidity and mortality benefits as long as you clock your 15 minutes each day.

Make sure to stretch after you walk! 

Kells McPhillips

By: Kells McPhillips

Source: Is Walking Enough Exercise? A Cardiologist Answers | Well+Good

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Critics:

Brisk walking, like any form of exercise, will cause your heart to beat faster. As a general rule, the faster you move, the more your heart rate will increase. For example, running will typically cause a faster heart rate than walking at a leisurely pace. A stronger heart is just one of the many benefits associated with brisk walking and other forms of aerobic or cardiovascular exercise.

The heart just like any other muscle gains strength from exercise. A stronger heart can effortlessly pump more blood with each beat. The resting heart rate of people who regularly exercise tends to be lower because the heart doesn’t have to struggle to pump blood, People who regularly engage in cardiovascular activities like brisk walking have a 45 percent lower risk of developing heart disease than people who don’t maintain an active lifestyle, explains University of Maryland Medical Center.

Brisk walking can help lower “bad” or LDL cholesterol while raising “good “or HDL level. Walking or jogging 12 miles a week has been shown to significantly boost good cholesterol. You need to log at least 20 miles per week or about three miles per day to put a notable dent in LDL levels, explains University of Maryland Medical Center. Walking can also manage blood-pressure levels and lower the risk of type 2 diabetes.

By increasing your speed to a 4.5 mph power walk, at 13 minutes per mile, you can also increase the calories burned per mile. A 125-pound walker burns 77 calories, while a 155-pound person burns 96 calories and a 185-pound walker burns 115 calories per mile.

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Planning For Surgery? You Might Not Need All Those Tests Beforehand

Let’s say you’re scheduled for a common and relatively low-risk operation, like a cataract removal, hernia repair or a hip or knee replacement. It’s normal to feel anxious about any upcoming surgery.

But what if one of the presurgical tests your doctor orders — for example, a chest X-ray or cardiac stress test — turns up something unexpected, like a suspicious nodule or a mild heart abnormality? Now you have even more reason to worry, and your surgery will likely be delayed until further tests assure the doctor it would be safe to operate.

Experts say that presurgical testing is often unjustified for many common operations. Many of these tests are a waste of time and money, a growing body of research shows, and the tests themselves can sometimes result in complications.

For more than two decades, experts in various medical specialties, including cardiology, ophthalmology and anesthesiology, have issued guidelines directed at reducing preoperative tests that rarely provide findings relevant to a patient’s surgical risk. Yet practicing doctors often do not follow this advice.

Guidelines published in 2002, for example, from the American College of Cardiology, the American Heart Association and the American Society of Anesthesiologists resulted in almost no change in doctors’ presurgical orders nearly a decade later, according to a report in JAMA Internal Medicine. The only exception was a decline in the use of electrocardiograms, or EKGs, a noninvasive test that checks heart function at rest.

Sometimes a preoperative test of questionable value results in unanticipated complications, as happened to a man in his 50s scheduled for repair of a very painful hernia. Two Colorado doctors reported in 2014 that the man’s lab tests and physical exam were normal. But a chest X-ray, ordered because he had a history of mild asthma, suggested he had a nodule on a lung.

Doctors delayed the surgery until he got a CT scan, which did not confirm a lung nodule but did find one on an adrenal gland. Again, doctors postponed surgery to allow for further work-up of the adrenal nodule, which was ultimately found to be benign. The man finally had his hernia repaired after six additional months of debilitating pain and repeated anxiety over incidental test findings suggesting he could have cancer.

However, doctors are making some headway. In 2019 in JAMA Internal Medicine, Dr. John N. Mafi, an internist at the David Geffen School of Medicine at the University of California, Los Angeles, and his colleagues described an effort to reduce “low-value preoperative care” for patients about to have cataract surgery. New guidelines were issued, and a specially trained quality improvement nurse advised the surgeons about the new recommended protocol.

The result, as assessed in a controlled clinical trial of 1,054 patients, was a dramatic decline in preoperative testing, a significant projected cost saving after the first year and “no measurable adverse effects” on the patients’ surgery, he said.

Perhaps most problematic among common preoperative procedures is a cardiac stress test, which assesses blood flow to the heart while patients exercise. Dr. Alana E. Sigmund, an internal medicine physician at the Hospital for Special Surgery in New York who has studied physicians’ responses to preoperative guidelines, said in an interview, “Cardiac stress testing is over-ordered. If there’s no indication of a heart problem, like shortness of breath, there’s no reason to do this test prior to surgery.”

The latest guidelines, which the American College of Cardiology and American Heart Association issued in 2014, advise that a cardiac stress test before surgery is generally not recommended for patients lacking symptoms suggestive of heart disease. The guidelines leave the decision to test up to the doctor, and you might think it’s better to rule out a possible heart problem before surgery.

But existing evidence shows no health or lifesaving benefit from a preoperative stress test when the patient lacks cardiac symptoms or has fewer than two major risk factors for having a heart attack, like high blood pressure and smoking, especially when the prospective surgery itself is low-risk.

Yet despite these guidelines and a national campaign called Choosing Wisely, aimed at curbing unnecessary tests and procedures, a recent study by Dr. Daniel S. Rubin and his colleagues at the University of Chicago found that many doctors persist in ordering preoperative stress tests among patients at very low risk for cardiac complications. The study, published in JAMA Cardiology in January, looked at more than 800,000 patients having a hip or knee replaced, which is usually considered a low-risk surgery.

It found that nearly half the patients who were given a preoperative stress test had no cardiac risk factors that might justify its use. Furthermore, the stress test did not lessen the risk of suffering a heart attack or cardiac arrest during or immediately after surgery, even among patients with one or more cardiac risk factors.

In fact, the stress test might have been counterproductive. For reasons Dr. Rubin could not explain, patients without risk factors who were given a cardiac stress test had double the surgical complication rate experienced by comparable patients who did not have one.

Whatever the explanation for that finding, testing itself is not free of risk, as noted by Dr. Ravi Chopra, a resident in neurology at Washington University School of Medicine. In JAMA Internal Medicine in October, Dr. Chopra and his colleagues described a 72-year-old patient with no known cardiovascular disease or cardiac symptoms who was given a stress test before a hip replacement. The test showed a mild heart abnormality, prompting a catheterization that resulted in damage to two blood vessels that then had to be surgically repaired.

“Testing can cause harm,” Dr. Chopra said. “We need to think hard about whom we’re testing. There should be a really good reason.”

Experts suggest you’d be wise to ask whether the prescribed tests would reveal anything relevant to your surgical risk that the doctor could not determine by asking you a few questions during a routine physical. For example, answering a simple question like, “Do you get out of breath climbing a flight of stairs or walking four city blocks?” might provide a quick assessment of whether you might be having heart symptoms.

Dr. Mafi added that “it’s hard to change physician behavior with guidelines,” especially when doctors fear being sued if something goes wrong that might have been prevented by a presurgical test. He suggested that patients can help by questioning what a particular test might show and whether it’s really needed. Also helpful, he said, is to choose a doctor “who’s thoughtful, takes time to listen and is judicious about testing. You don’t have to order 100 tests if just one test will do.”

Portrait of Jane E. Brody

 

Jane E. Brody is the Personal Health columnist for The New York Times, a position she has held since 1976. Ms. Brody’s widely read and quoted column, which appears in The Times’s Science Times section and in scores of other newspapers around the country, earned her the title of “High Priestess of Health” from Time magazine.

Source: Planning for Surgery? You Might Not Need All Those Tests Beforehand. – The New York Times

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