Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What should I do to prevent heart attacks and strokes?
Losing excess weight,
exercising regularly, controlling diabetes and high
blood pressure, lowering the bad LDL
cholesterol, and
stopping cigarette smoking
are crucial steps in preventing heart attacks and strokes. The association
between homocysteine levels and atherosclerosis is generally weaker compared to
the known risk factors of diabetes, high blood pressure (hypertension), high
cholesterol level, and cigarette smoking.
It is recommended that healthy adults eat more fresh fruits and vegetable,
eat less saturated fat and cholesterol, and take one multivitamin daily. One
multivitamin will supply 400 mcg (microgram or one-one thousandth of a gram)/day
of folic acid in addition to vitamins B6, B12, and other important vitamins.
Who should undergo testing for homocysteine blood levels?
Some doctors screen for elevated homocysteine levels in patients with early
onset of blood clot formation, heart attacks, strokes, or other symptoms related
to atherosclerosis, especially if these patients do not have typical risk
factors, such as smoking cigarettes, diabetes, high blood pressure, or high LDL
cholesterol levels.
Currently, there are no official recommendations as to who should undergo
testing for homocysteine blood levels. Before more scientific data become
available from the currently ongoing studies, many experts do not recommend
a screening test for blood homocysteine levels, even in patients with unexplained
blood clot formation. In addition, the consensus recommendation is against
treating elevated homocysteine levels with vitamins to prevent heart disease.
There is also no consensus as to the optimal dose of folic acid and other B
vitamins for the treatment of elevated blood homocysteine levels. (For example,
treatment of patients with high homocysteine levels may require higher doses of
folic acid and other B vitamins than the amounts contained in a multivitamin.)
Therefore, a decision regarding testing should be individualized after
consulting with your doctor.
References:
1. Ray, JG. Meta-analysis of hyperhomocysteinemia as a risk factor for
venous thromboembolic disease. Arch Intern Med 1998; 158:2101.
2. den Heijer, M, Rosendaal, FR, Blom, HJ, et al. Hyperhomocysteinemia and
venous thrombosis: a meta-analysis. Thromb Haemost 1998; 80:874.
3. Vermeulen, EG, Stehouwer, CD, Twisk, JW, et al. Effect of
homocysteine-lowering treatment with folic acid plus vitamin B6 on progression
of subclinical atherosclerosis: a randomised, placebo- controlled trial. Lancet
2000; 355:517.
4. Eikelboom, JW, Lonn, E, Genest, J Jr, et al. Homocyst(e)ine and
cardiovascular disease: a critical review of the epidemiologic evidence. Ann
Intern Med 1999; 131:363
5. Robinson, K, Arheart, K, Refsum, H, et al. for the European COMCAC Group.
Low circulating folate and vitamin B6 concentrations. Risk factors for stroke, peripheral vascular disease, and coronary artery disease. Circulation 1998;
97:437.
6. He, K, Merchant, A, Rimm, EB, et al. Folate, vitamin B6, and B12 intakes
in relation to risk of stroke among men. Stroke 2004; 35:169.
7. McNulty, H, Dowey le, RC, Strain, JJ, et al. Riboflavin lowers
homocysteine in individuals homozygous for the MTHFR 677C->T polymorphism.
Circulation 2006; 113:74.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
A pulmonary embolism occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate.
Deep vein thrombosis (DVT) is a blood clot in a vein located deep in the muscles of the legs, thighs, pelvis (lower torso), or arms. The most common symptoms of a deep vein thrombosis are swelling and pain in the leg that has the blood clot. A DVT is difficult to diagnose without specific tests in which the deep vein system can be examined.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Vitamins are organic substances that are essential for the proper growth and functioning of the body. Calcium is a mineral essential for healthy bones and is also important for muscle contraction, heart action, and normal blood clotting.
Heart attacks are the major causes of unexpected, sudden death among men and women. A heart attack is also a significant cause of heart failure. Learn the risk factors for heart attack such as high blood pressure, diabetes, and other heart conditions. Lowering your risk factor, lifestyle changes, and in some cases medication are the most effective way of preventing a heart attack.
A heart attack is a layperson's term for a sudden blockage of a coronary artery. This photo essay inlcudes graphics, pictures, and illustrations of diseased heart tissue and the mechanisms that lead to coronary artery disease, and possible heart attack.
Cholesterol occurs naturally in the body. High blood cholesterol levels increase a person's risk of developing heart disease, heart attacks, strokes, TIAs, and more. In addition to medication (fibrates, statins, bile acid sequestrants, and niacin), lifestyle changes can be made to lower blood cholesterol levels
Vitamins and exercise can lower your risk for heart attack and heart disease. Folic acid, vitamins, and homocysteine levels are interconnected and affect your risk for heart disease or heart attack. Antioxidants and exercise also play a key role in heart attack and heart disease prevention. Lower your risk factors for heart disease and heart attack by lowering cholesterol, lowering blood pressure, diabetes prevention, and smoking cesssation.
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