Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
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.
Homocysteine is metabolized (chemically transformed) into methionine and
cysteine with the help of the B vitamins; folic acid, B12, and B6 (pyridoxine).
Therefore, insufficient amounts of these B vitamins in the body can
theoretically hamper the metabolic breakdown of homocysteine, and hence increase
its blood levels. High levels of homocysteine in the blood
(hyperhomocysteinemia) can damage the inner surface of blood vessels, promote
blood clotting, and accelerate atherosclerosis.
The current state of knowledge regarding folic acid, homocysteine, and
heart
attacks is as follows:
The level of blood folate is an important determinant
of the blood homocysteine level. Low blood folate levels are associated with
high blood levels of homocysteine.
Low blood folate is common among individuals who do
not take multivitamins, but unusual among those who do.
The consumption of folic acid supplements or folic
acid fortified cereals can increase blood folate levels and decrease blood
homocysteine levels.
In a
large population study involving women, those who had the highest consumption of
folic acid (usually in the form of multivitamins) had fewer heart attacks than
those who consumed the least amount of folic acid.
Even though current
scientific evidence suggests that taking folic acid and vitamin B supplements to
lower homocysteine levels should help prevent atherosclerosis and heart attacks,
conclusive proof is still lacking because:
There are no conclusive controlled studies (discussed
at the beginning of this article) demonstrating that increasing folic acid
intake actually prevents atherosclerosis and heart attacks.
There is no clinical study demonstrating that lowering blood levels
of homocysteine actually prevents atherosclerosis and heart attacks.
There is
also no official recommendation as to who should be tested for
hyperhomocysteinemia. The optimal doses of the B vitamins, folic acid, B12, and
B6, required to prevent and treat hyperhomocysteinemia are also uncertain. For
folic acid, a daily dose of 0.8-1.0 mg is probably adequate.
What about antioxidants for heart attack prevention?
Antioxidants are food supplements that have been promoted as preventing heart
disease and stroke. An important early event in the development of a cholesterol
plaque in atherosclerosis is the oxidative modification of LDL cholesterol (low
density lipoprotein) particles in the blood and the subsequent interaction of
this modified LDL with the wall of the coronary artery. This process initiates
the formation of the cholesterol plaque.
Antioxidants that block the oxidative modification of LDL have been shown to
slow the progression of atherosclerosis in animal experiments. Examples of
antioxidants include vitamin E and beta carotene. In humans, observational
studies (studies that observe the frequency of related conditions) have found a
relationship between the dietary intake of vitamin E and lower rates of heart
attacks.
Observational studies provide only circumstantial evidence, however, and
credible evidence is obtained only by way of controlled trials (discussed at the
beginning of this article). Several controlled trials performed to date have
yielded conflicting results on the benefits of antioxidant therapy. These
results may possibly be due to the low doses of vitamin E used, the small number
of patients in the study, or the limited duration of treatment.
The Heart Outcomes Prevention Evaluation study used a high dose
(400 IU per day) of vitamin E over a span of five years in patients with
significant risk factors for heart disease or stroke. This study found no
difference in the occurrence of heart attack or stroke in the group treated with
vitamin E versus those given the placebo. This study demonstrated that
antioxidant therapy does not have any benefit in persons who have or are at high
risk for having atherosclerosis.
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.
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
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.
There are many causes of scalp hair loss. This featured article covers the common ones such as patchy hair loss (alopecia areata, trichotillomania, and tinea capitis), telogen effluvium, and androgenetic alopecia (male-pattern baldness, female-pattern baldness).
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
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.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include: intermittent claudication, rest pain, numbness in the extremities, and more. Treatment for peripheral artery disease include: lifestyle measures, medication, angioplasty, and 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.
Osteopenia is a bone condition characterized by bone loss that is not as severe as in osteoporosis. Bone fracture is the typical symptom of osteopenia, though the condition may be present without symptoms. Treatment involves lifestyle modifications (quitting smoking, not drinking in excess) and ensuring an adequate intake of vitamin D and calcium.
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.
Smoker's lung photo essay is a collection of pictures and microscopic slides of lung disease caused by cigarette smoking. Smoker's lung refers to the diseases and structural abnormalities in the lung caused by cigarette smoking.
Vitamin D deficiency has been linked with rickets, cancer, cardiovascular disease, severe asthma in children and cognitive impairment in older adults. Causes include not ingesting enough of the vitamin over time, having limited exposure to sunlight, having dark skin, and obesity. Symptoms include bone pain and muscle weakness. Treatment for vitamin D deficiency involves obtaining more vitamin D through supplements, diet, or exposure to sunlight.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
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.
The heart is a very important organ in the body. It is responsible for continuously pumping oxygen and nutrient-rich blood throughout your body to sustain life. It is a fist-sized muscle that beats (expands and contracts) 100,000 times per day, pumping a total of five or six quarts of blood each minute, or about 2,000 gallons per day.
The importance of a healthy lifestyle in disease prevention is widely understood and most people know that lifestyle changes and choices can be critical to good health. Yet, few practice healthy behaviors that constitute healthy living.
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.
Setting a good example for your children when it comes to diet and exercise will help them to make healthy decisions about nutrition and fitness. Eating calcium-rich foods and performing weight-bearing exercise will help your children prevent osteoporosis and fractures later in life.
A heart attack (also known as a myocardial infarction) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen,causing injury to the heart muscle. Injury to the heart muscle causes chest pain
and chest pressure sensation. If blood flow is not restored to the heart muscle within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to
die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is eventually replaced by scar tissue.
Approximately one million Americans suffer a heart attack each year. Four hundred thousand of them die as a result of their heart attack.
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