Page not found – Apex Heart and Vascular Center (Vein Clinic) https://www.apexheartandvascular.com NJ Interventional Cardiologist Vascular Surgeon PAD Specialist Fri, 08 Mar 2024 21:43:09 +0000 en-US hourly 1 https://www.apexheartandvascular.com/wp-content/uploads/2020/12/favicon-150x150.png Page not found – Apex Heart and Vascular Center (Vein Clinic) https://www.apexheartandvascular.com 32 32 Gender Matters: Heart Disease in Women https://www.apexheartandvascular.com/gender-matters-heart-disease-in-women https://www.apexheartandvascular.com/gender-matters-heart-disease-in-women#respond Fri, 08 Mar 2024 21:20:03 +0000 http://www.apexheartandvascular.com/?p=1943 Continue reading ]]> By: Sarina Sachdev, MD

Although heart disease is sometimes thought of as a man’s disease, almost as many women as men die each year of heart disease in the United States.

This map shows death rates from heart disease in women in the United States. The darker red indicates a higher death rate.

Heart disease hitmap

More than 9 million American women of all ages and ethnicity suffer from CVD. Despite the monumental efforts and great progress made by researchers, scientists, and health professionals in the prevention, identification, and treatment of CVD, more than a half a million women each year continue to die of the disease, while the total number of male deaths continues to decline. Moreover, minority women continue to bear the brunt of the burden of CVD. Health care professionals who speak to women about primary and secondary prevention clearly realize that most women think heart disease belongs “out in the garage” with the power tools. While a recent survey showed that about a third of women identify heart disease as the number one killer, only 7 percent felt they were personally at risk. For women survivors today, in all walks of life, heart disease remains a very difficult issue to air publicly, because it is not generally recognized as a major cause of morbidity and mortality in women. Health care professionals should not forget that motivating women to become better caretakers of themselves and better consumers of health care is only part of a complex equation.

Heart disease model

Campaign by the Heart Research UK challenging the misperception that heart disease is a “man’s disease”.

Women are less likely than men to receive medical treatment for high cholesterol, less likely to get life-saving drugs to prevent complications of a heart attack, and less likely to enter into a cardiac rehabilitation program. The importance of improving women’s access to good risk management care through their gynecologists or primary care physicians cannot be overestimated.

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American Heart Health Month https://www.apexheartandvascular.com/american-heart-health-month https://www.apexheartandvascular.com/american-heart-health-month#respond Wed, 21 Feb 2024 06:52:35 +0000 http://www.apexheartandvascular.com/?p=1878 Continue reading ]]> apex heart month poster
Welcome to American Heart Health Month! At Apex Heart and Vascular Care Vein Clinic, we stand as warriors in the battle against cardiovascular diseases. As February dawns upon us, it’s not just Valentine’s Day when we should focus on the heart; it’s a crucial moment to spotlight the importance of cardiovascular health, raise awareness, and work together in action.

The Urgency of Heart Health:

Heart disease continues to loom as the leading cause of mortality globally, claiming millions of lives each year. In the United States alone, the statistics are alarming.

Heart Disease Death Rates Statistics Graph

 

 

 

 

 

 

 

 

 

 

 

 

 

These numbers aren’t just figures; they represent real individuals, families, and communities impacted by the ravages of cardiovascular illnesses.

Our Noble Cause:

At Apex Heart and Vascular Care, our mission is unwavering: to empower individuals to reclaim control over their heart health through knowledge, prevention, and advanced treatment modalities. We advocate for a comprehensive approach that encompasses lifestyle modifications, early detection, and personalized interventions tailored to each patient’s unique circumstances.

The Foundation:

The bedrock of our approach lies in evidence-based medicine.

Article about Top Cardiac advancements

Campaigns and Collaborations:

February serves as a pivotal juncture to amplify our efforts and engage communities in the fight against heart disease. Join us as we participate in the American Heart Month, a nationwide endeavor dedicated to disseminating heart health awareness and fostering preventive measures. Through a myriad of initiatives, including educational seminars, complimentary screenings, and community outreach programs, we endeavor to reach individuals across diverse demographics and geographical regions.

Beyond the Month of February:

While American Heart Health Month provides a focal point for heightened awareness, our commitment to cardiovascular health transcends temporal confines. We are steadfast in our dedication to forging enduring partnerships with our patients, providing ongoing guidance, monitoring, and access to state-of-the-art treatment modalities.

apex heart month poster

Join the Movement:

Joining hands with esteemed organizations such as the American Heart Association (AHA), the World Heart Federation, and others can amplify our collective impact in the fight against heart disease. By supporting these organizations through donations, volunteering, or participating in their events and campaigns, you can contribute to groundbreaking research, advocacy efforts, and community outreach initiatives aimed at promoting heart health.

Early detection is paramount in the battle against cardiovascular diseases. Regular health screenings, including blood pressure checks, cholesterol tests, and cardiac evaluations, can facilitate timely intervention and prevent the progression of underlying conditions. Remember, knowledge is power, and early detection saves lives.

At Apex Heart and Vascular Care Vein Clinic, we understand the importance of proactive health management. Our state-of-the-art facilities, experienced medical team, and cutting-edge diagnostic technologies are dedicated to delivering comprehensive cardiovascular care. Whether you require preventive services, diagnostic evaluations, or advanced treatment options, we are here to guide you every step of the way.

Don’t wait until it’s too late. Take charge of your heart health today. Schedule a consultation with us at Apex Heart and Vascular Care Vein Clinic by giving us a call at 973-916-0002 and embark on a journey toward optimal cardiovascular wellness. Together, let’s pave the path to a healthier, heart-strong future.

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March is Deep Vein Thrombosis Awareness Month! Navigating the New Era of Pulmonary Embolism and Deep Vein Thrombosis Treatment https://www.apexheartandvascular.com/march-is-deep-vein-thrombosis-awareness-month https://www.apexheartandvascular.com/march-is-deep-vein-thrombosis-awareness-month#respond Wed, 29 Nov 2023 02:58:02 +0000 http://www.apexheartandvascular.com/?p=1833 Continue reading ]]> March Awareness

In the rapidly evolving landscape of cardiovascular medicine, recent breakthroughs in the management of pulmonary embolism (PE) and deep vein thrombosis (DVT) mark a significant leap forward. This detailed blog post explores the intricacies of pivotal clinical trials and their collective impact on shaping modern therapeutic strategies, offering a beacon of hope for patients and clinicians alike.

In recognition of DVT Awareness Month, we delve into critical statistics highlighting the significant impact of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) on public health and the healthcare system. These figures underscore the urgency of awareness, prevention, and timely intervention:

Annual Incidence: Over 1 million Americans are affected by DVT and PE each year, signaling a widespread health concern.

Mortality Rates: PE ranks as the third leading vascular diagnosis causing death, with a notable mortality rate in untreated cases.

Long-term Complications: Approximately half of DVT patients might face post-thrombotic syndrome, affecting their daily lives.

Healthcare Costs: The treatment of acute DVT or PE episodes places a heavy financial burden on the healthcare system, with costs per patient often surpassing $10,000.

Awareness Initiatives: March, designated as DVT Awareness Month, plays a crucial role in educating the public and healthcare professionals about these conditions.

DVT and Pulmonary Embolism Clinical Trials: A Convergence of Innovation

The treatment of pulmonary embolism, a condition fraught with high morbidity and mortality rates, is undergoing a transformative phase, guided by the outcomes of several key clinical trials, including PEERLESS, APEX-AV, PE-TRACT, HI-PEITHO, and STORM-PE.

PEERLESS TRIAL:

The PEERLESS trial is a pivotal study designed to compare the effectiveness of mechanical thrombectomy using the FlowTriever System against catheter-directed thrombolysis (CDT) in treating hemodynamically stable pulmonary embolism (PE). The study plans to enroll 550 patients, who will be randomized to either treatment strategy. The primary outcome focuses on a composite measure that includes all-cause mortality, intracranial hemorrhage, major bleeding, clinical deterioration, and ICU admission, evaluated at hospital discharge or 7 days after the procedure. Secondary outcomes will assess all-cause mortality, readmission rates, and adverse events within 30 days, as well as changes in the right-ventricular/left-ventricular ratio and quality of life assessments.

However, the specific findings of the PEERLESS trial were not provided in the accessed information, indicating that the results might not yet be published or available for review. This study is crucial as it’s set to provide key insights into the most effective interventional approaches for PE patients when advanced therapy is deemed necessary.

To learn more about the study’s design, eligibility criteria, and potential implications, visit the PEERLESS trial’s page on ClinicalTrials.gov.

Peerless
Rationale and Design of the PEERLESS Study

APEX-AV, PE-TRACT, HI-PEITHO, and STORM-PE:

Spearheading PE Treatment Advances

Each of these trials brings a unique perspective to the table, addressing different facets of PE treatment—from anticoagulation strategies and thrombolytic therapy to interventional techniques and the management of high-risk patient groups.

APEX-AV Trial Insights: This study focuses on anticoagulation efficacy and safety in a specific subset of PE patients, potentially reshaping risk stratification and anticoagulation protocols. The trial’s findings could lead to more personalized treatment plans, optimizing therapeutic outcomes while minimizing adverse events.

APEX-AV

PE-TRACT Trial: Zeroing in on catheter-directed thrombolysis (CDT) versus standard care, the PE-TRACT trial offers valuable data on the procedural success, complications, and long-term outcomes of CDT, informing clinical decisions in acute PE management, particularly in hemodynamically stable patients with a high burden of clot.

PE Tract
PE-tract Spotlight

HI-PEITHO Trial: This investigation extends the original PEITHO trial’s scope by exploring the long-term benefits and risks of thrombolytic therapy in intermediate-high–risk PE patients. The outcomes may redefine the utility of thrombolytics, balancing efficacy in reducing PE recurrence and mortality against the risk of major bleeding.

HI-PEITHO
HI-PEITHO

The RESCUE Trial: the study evaluated the Bashir endovascular catheter for pharmacomechanical catheter-directed thrombolysis (PM-CDT) in patients with intermediate-risk acute pulmonary embolism (PE). The study aimed to assess the device’s efficacy in improving right ventricular/left ventricular (RV/LV) diameter ratios and its safety in terms of serious adverse events, including major bleeding.

Involving 109 patients across 18 U.S. sites, the study found a significant 33.3% reduction in the RV/LV diameter ratio and a 35.9% decrease in pulmonary artery obstruction 48 hours post-treatment. The safety profile was favorable, with only a 0.92% incidence of serious adverse events. These results indicate that PM-CDT with the Bashir catheter is an effective and safe treatment for intermediate-risk acute PE, offering significant improvements with minimal complications. The study highlights the potential for broader adoption of this treatment, though it calls for further research to confirm these findings.

Central Illustration

STORM-PE Study: With a focus on mechanical thrombectomy, STORM-PE sheds light on this emerging intervention’s role in managing acute PE. By evaluating procedural success rates, hemodynamic improvements, and patient recovery trajectories, STORM-PE contributes critical insights into the expanding arsenal against PE.

STORM-PE
STORM-PE

Read more about these PE clinical trials here.

Deep Vein Thrombosis: Shifting Paradigms in Treatment

Parallel to advancements in PE management, the approach to deep vein thrombosis (DVT) is being refined and enhanced by recent studies, including groundbreaking work on pharmacomechanical catheter-directed thrombolysis and innovative compression therapy techniques.

Pharmacomechanical Catheter-Directed Thrombolysis:

A New Dawn in DVT Care

The advent of pharmacomechanical catheter-directed thrombolysis (PCDT) represents a significant milestone in DVT treatment, offering a minimally invasive option that combines mechanical clot disruption with targeted drug delivery. This method promises to reduce the clot burden rapidly, alleviate symptoms, and potentially lower the risk of post-thrombotic syndrome (PTS), a debilitating long-term complication of DVT.

Read more about PCDT in DVT treatment here.

Compression Therapy Innovations: The CELEST Trial and Beyond

The CELEST trial challenges existing norms by comparing 25 mm Hg versus 35 mm Hg elastic compression stockings in preventing PTS after DVT. Its findings could lead to a paradigm shift in post-DVT care, optimizing compression therapy to balance efficacy and patient compliance.

Explore the CELEST trial findings here.

The EINSTEIN Clinical Trial Programme: Rivaroxaban at the Forefront

The EINSTEIN clinical trial programme has been instrumental in establishing rivaroxaban, a direct oral anticoagulant (DOAC), as a cornerstone in both DVT and PE management. Its convenience, efficacy, and safety profile offer a compelling alternative to traditional vitamin K antagonists, streamlining anticoagulation therapy and enhancing patient quality of life.

Further insights into the EINSTEIN programme and Rivaroxaban can be found here.

Integrating Innovations: The Path Forward in PE and DVT Treatment

The confluence of findings from these diverse clinical trials heralds a new era in PE and DVT management, emphasizing personalized medicine, multidisciplinary care, and patient-centered approaches. By carefully integrating these innovations, healthcare professionals can significantly improve treatment outcomes, reduce complications, and ultimately transform the lives of those affected by these challenging conditions.

In conclusion, the dynamic field of PE and DVT treatment continues to evolve, driven by relentless research and clinical inquiry. As we delve deeper into the nuances of each study and embrace the collaborative spirit of medical science, the future for patients with these conditions looks brighter than ever.

Joining Forces with Leading Organizations

Several organizations are at the forefront of research, patient advocacy, and education in the realm of thrombosis. Engaging with these entities can offer resources, community support, and opportunities to contribute to the cause.

  • American Society of Hematology (ASH): A leading organization dedicated to furthering the understanding and treatment of hematologic malignancies and disorders, including thrombosis. Visit ASH
  • Thrombosis Research Institute (TRI): TRI is committed to reducing the global burden of thrombosis through scientific research and education. Explore TRI
  • International Society on Thrombosis and Haemostasis (ISTH): ISTH promotes understanding, prevention, diagnosis, and treatment of thrombotic and bleeding disorders. Join ISTH

Advocacy and Awareness Campaigns

Raising awareness is crucial in the fight against DVT and PE. Campaigns like the White Sock Campaign, initiated by the National Blood Clot Alliance, symbolize the struggle of those affected by DVT and aim to spread knowledge about prevention and early detection.

  • White Sock Campaign: An initiative encouraging individuals to wear one white sock to symbolize the often invisible signs of DVT and to stand in solidarity with those affected. Learn more about the White Sock Campaign
White Socks display
White Socks display

Patient Support and Resources

Providing patients and their families with access to reliable information, support networks, and resources is essential for navigating the challenges of DVT and PE.

  • Stop the Clot: A resource by the National Blood Clot Alliance offering patient stories, educational materials, and support for those affected by blood clots. Visit Stop the Clot
  • Pulmonary Embolism Response Team (PERT) Consortium: Dedicated to the advancement of care for patients with PE, providing educational materials, research, and a collaborative network. Explore PERT Consortium
  • Clot Connect: An educational outreach program providing information on the prevention and treatment of blood clots and clotting disorders. Access Clot Connect
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DEBUNKING MYTHS ABOUT PERIPHERAL VASCULAR DISEASE https://www.apexheartandvascular.com/debunking-myths-about-peripheral-vascular-disease https://www.apexheartandvascular.com/debunking-myths-about-peripheral-vascular-disease#respond Wed, 11 Oct 2023 06:50:30 +0000 http://www.apexheartandvascular.com/?p=1508 Continue reading ]]>

THE APEX TEAM HAS ACHIEVED…

diagram of data

“My goal is to eradicate unnecessary amputations, especially in low-income communities of New Jersey.”

“I dedicate much of my practice to shedding light on a disease with a worse prognosis and mortality rate than cancer but with 50 times less awareness in the community.”

Picture of Doctors forming a heart with a stethoscope

OUR VASCULAR DISEASE WARRIORS

Picture of Doctors with clips art of heroes

PVD affects nearly 12 million Americans, and about half of them are undiagnosed. Additionally, an estimated 180,000 of them – disproportionately from minority communities – suffer avoidable amputations every year. By increasing PVD awareness nationally, Apex Heart and Vascular Care Vein Clinic hopes to improve access to PVD screening and treatments, which have been shown to improve quality of life, reduce care costs, and prevent limb loss. No patients should fall through the cracks. We encourage members of the vascular care community to use the tools mentioned above to spread the word about PVD Awareness Month among their colleagues, patients, friends, and communities. Together, we can increase understanding of PVD for all.

DEBUNKING PAD MYTHS IN 2023

Myth #1: PVD has consistent, defined symptoms.

Many people who have PVD exhibit pain in their legs with physical activity, such as cramping in the calves when walking, which gets better at rest. However, peripheral vascular disease symptoms can vary widely—such as changes in the appearance of extremities (color, loss of hair, shiny skin), cold legs and feet, open sores that don’t heal, erectile dysfunction, or no pulse or weak pulse in legs and feet.

Myth #2: PVD is limited to your legs.

While it is true that peripheral vascular disease is more common in the legs, PVD can happen in any blood vessel. Fat deposits also build up in arteries that supply blood to your heart and brain, which causes poor blood circulation to the kidneys, intestines, arms, legs, and feet and can increase your risk for heart conditions.

Myth #3: PVD isn’t life-threatening.

While PVD is treatable, and many people who have it can go on to lead long, healthy, and active lives, it is absolutely a life-threatening condition if ignored, misdiagnosed, or left unchecked. It’s dangerous because any significant blockages that restrict blood flow to your limbs and organs can cause irreparable damage over the long term, including gangrene that leads to amputation. Unfortunately, it is very clear from what the statistics tell us that this disease is claiming the lives of many Americans every year. A disease that is flying completely under the radar of our healthcare system but depleting it of its resources. 60,000 people are losing their lives due to PVD every single year – minorities being the most affected. We must concentrate much of our efforts on reducing these numbers, saving limbs, and saving lives.

Myth #4: PVD is a man’s disease.

This is yet another example of peripheral vascular disease myths that simply aren’t true. In fact, one study showed that women have equal to, if not higher, rates of PVD compared to men despite fewer cardiovascular disease risk factors. In addition, women with peripheral artery disease experience faster functional decline compared to men.
Because women have a longer life expectancy, they will be even more disproportionately affected by PVD as the population ages.

Myth #5: Treatment for PVD is invasive surgery.

In reality, PVD can be successfully treated with simple lifestyle changes and medication when caught early. This includes everything from quitting smoking to maintaining a healthy weight, diet, and exercise. If necessary, your doctor may suggest minimally invasive treatments such as:

– Angioplasty — A balloon system that uses a catheter to open up narrowed or blocked arteries.
– Atherectomy — Advanced laser technology that clears away built-up plaque on large blood vessels.
– Stenting — This involves a small mesh tube to keep closed-off blood vessels open for the long term.

WHAT IS PERIPHERAL VASCULAR DISEASE (PVD)

  1. Peripheral Vascular Disease (PVD) is a significant but often overlooked medical condition: it affects approximately 20 million Americans. The primary risk factors for PVD include smoking, diabetes, age, and family history, among others.
  2. Early detection and treatment are crucial for managing PVD effectively and avoidinga severe complications like gangrene and limb amputation. Diagnostics may include physical examinations, imaging tests, and minimally invasive procedures, while treatment options range from lifestyle changes and medications to surgery.
  3. For those affected by PVD, it’s vital to seek ongoing care from healthcare professionals specializing in vascular issues. This care will include a comprehensive, individualized approach that aims to manage cardiovascular risk factors, improve limb symptoms and functionality, and periodically reassess the patient’s condition for optimal management.

WHAT CAUSES IT >

POOR BLOOD CIRCULATION

(PVD), or PAD is a disease of the leg, arteries, and veins. PVD happens when there is a narrowing of the blood vessels outside of your heart. The cause of PVD is atherosclerosis. This happens when plaque builds up on the walls of the arteries that supply blood to the arms and legs. Plaque is a substance made up of fat and cholesterol. It causes the arteries to narrow or become blocked. This can reduce or stop blood flow, usually to the legs. If severe enough, blocked blood flow can cause tissue death and can sometimes lead to amputation of the foot or leg. The main risk factors for PVD are smoking and diabetes. Other risk factors include older age and diseases like high blood cholesterol, high blood pressure, obesity, sleep apnea, heart disease, stroke, and due to family history. Venous disease can be due to prior pregnancies, blood clots, family history, or jobs with prolonged standing. PVD can increase your risk of heart attack, stroke, and transient ischemic attack.

Doctors diagnose PVD with a physical exam and heart and imaging tests. Treatments include lifestyle changes, medicines, and sometimes surgery. Lifestyle changes include dietary changes, exercise, and efforts to lower high cholesterol levels and high blood pressure. Left untreated, PVD can lead to gangrene and limb amputation.

WHAT IS IT >

HOW DO I KNOW IF MY PATIENT HAS PVD OR SOMETHING ELSE?

For a big portion of those affected by PVD, symptoms will not appear until the issue has significantly progressed and requires more extensive treatments. Patients who smoke, over the age of 50, have diabetes, restlessness, tingling sensations, or numbness should get a screening as soon as possible to reduce the risk and improve blood flow.

DETAIL >

DIAGNOSIS AND LONG-TERM FOLLOW-UP FOR PATIENTS WITH PVD

Leg pain does not always indicate PVD, but older patients, especially those who are at risk, should see a physician. A simple, noninvasive ultrasound and leg BP examination can diagnose PVD and determine its severity. Patients with symptoms of PVD should be referred to a vascular surgeon. Vascular specialists can perform necessary treatments, including medication management, minimally invasive endovascular angioplasty, stent procedures, and bypass surgery if indicated. PVD is a lifelong medical condition, and our clinicians will develop a unique, comprehensive care plan for each patient. This follow-up plan includes regular clinical evaluations by one of our health care professionals with experience in treating PVD. Care for PVD will involve risk reduction with medical therapy and lifestyle changes, optimizing patient function with structured exercise, and revascularization when needed. Continued reevaluation is necessary to assess risk factors, limb symptoms, and functional status.

CLEANING BLOCKAGES FROM 20 YEARS IN 20 MINUTES

PREVENTING AMPUTATIONS ONE REVASCULARIZATION AT A TIME.

Revascularization mainly aims to improve claudication symptoms and quality of life rather than focus on limb salvage. It should be an option for PVD patients still facing functional limits despite comprehensive treatment, including medication and structured exercise. The choice between endovascular methods and surgery depends on symptom severity, prior treatment responses, patient goals, and the prospect of long-lasting relief.

Veins

TECHNIQUES TO TREAT VASCULAR BLOCKAGES AND CLAUDICATION INCLUDE ANGIOPLASTY, STENTS, AND ATHERECTOMY.

Veins

Restless nights and restless legs…

SAY GOODBYE TO TOSSING AND TURNING
Leg pain that disrupts sleep could mean dealing with both Restless Leg Syndrome and Peripheral Arterial Disease. These conditions can overlap, making symptoms more severe and complicating diagnosis and treatment. PAD can trigger or worsen RLS symptoms by causing muscle hypoxia, while RLS can exacerbate PAD symptoms by increasing muscle oxygen demand. Diagnosis typically involves Doppler ultrasound for PAD and neurological exams for RLS, and treatment for one may not be effective for the other. Accurate diagnosis and tailored treatment are crucial for effective relief.

Figure 1.

Case 1: Retrograde access through Anterior tibial artery (ATA).

Picture of a deformed feet

Figure 2.

Case 1: Angiogram showing occluded right Anterior tibial artery and Tibioperoneal trunk

leg x ray

Figure 3.

Case 1: Guidewire going through Anterior tibial artery (ATA).

leg x ray

Figure 4.

Case 1: Final Angiographic Result.

leg x ray
leg x ray

The angiogram results were generally favorable for the major vessels, including the aorto-iliac and common femoral arteries. However, there was a notable 90% stenosis in the tibial peroneal trunk (TPT) and multiple 75% blockages in the posterior tibial artery (PTA). To address these, the team used a combination of antegrade and retrograde techniques. Advanced medical equipment was used to remove the blockages in the patient’s ATA, PTA, and TPT. After clearing the obstructions, the team performed balloon angioplasty with specific measurements: they used a 3.5-x 300-mm Ultraverse BD Bard balloon for the dorsalis pedis artery (DPA), ATA, and PTA, and a 4.0-x 60-mm Lutonix DCB for the TPT. The outcome was considered excellent based on extravascular ultrasound (EVUS) assessments. To ensure hemostasis and further minimize the risk of complications, manual pressure to close the access site securely. The patient responded very well to the treatment; he was able to walk an hour post-procedure and received additional treatments for his severe leg infection. This case highlights the effectiveness of using trans-radial access in patients with complex health conditions. The techniques used included specialized catheters ranging from 5 to 6 Fr and 6 to 7 Fr GSS sheaths. The outcome showcases the potential benefits of alternative access routes and specialized equipment in vascular interventions for high-risk patients.

Case 2: A 67-year-old male with a significant medical history, including hypertension, hyperlipidemia, and type 2 diabetes mellitus, presented with severe claudication in his left lower limb and a nonhealing wound on his left 2nd and 3rd toe. Physical examination revealed a pale left lower extremity with minimal hairs, indicative of reduced blood flow. Arterial Duplex demonstrated a 90% stenosis in the mid-left superficial femoral artery, coupled with monophasic waveforms throughout the left lower extremity below the knee. The ankle-brachial index/pressure-volume recording (ABI/PVR) ratios told a compelling story, with the left side registering an alarming 0.5, compared to a more reassuring 0.8 on the right. Arterial ultrasound findings further supported the diagnosis, affirming monophasic waveforms and the critical 90% stenosis in the mid-left superficial femoral artery. A confirming CT angiography sealed the diagnosis. Faced with these challenging findings, the patient underwent balloon angioplasty of the left superficial femoral artery. The procedure aimed to restore blood flow and alleviate the debilitating claudication symptoms and nonhealing wound on the left foot toe that had significantly impacted the patient’s quality of life. The post-procedure assessment brought about a rapid and remarkable improvement in claudication symptoms. The patient reported a dramatic enhancement in mobility and a significantly reduced reliance on pain medications. The intervention successfully addressed the 90% stenosis, with post-intervention evaluations confirming improved blood flow and a return to normal or near-normal waveforms throughout the left lower extremity. This case exemplifies the transformative potential of minimally invasive vascular interventions. In the face of severe claudication and extensive atherosclerosis, the patient experienced substantial relief and enhanced quality of life through balloon angioplasty. This success underscores the importance of early diagnosis and prompt intervention in the management of peripheral arterial disease, particularly in patients with significant comorbidities. It serves as a testament to the positive impact of cutting-edge vascular procedures on patients’ lives.

Case 2: Figure 1: Angiogram prior to revascularization procedure.

leg x ray

Case 2: Figure 2 showing a balloon going through the Left Superficial Femoral Artery (SFA)

leg x ray

Case 2: Figure 3 showing the final angiographic result.

leg x ray
Deformed Leg
Infographic about sickness

“Nobody cares how much you know until they know how much you care.” – Theodore Roosevelt.

LETTER FROM DR. SHAH TO HEALTHCARE PROVIDERS

Peripheral Arterial Disease is extremely common, and it has a huge impact not only on the quality of life of our patients but also on their family members and overall survival. It saddens my heart when I see a patient wheelchair-bound, living their life in a nursing home because they lost a limb due to a circulation issue, especially when they did not even get a proper opportunity to assess their circulation. Medical science, and especially the field of endovascular procedures, has advanced so much that it’s unfair to our patients if they don’t go through a proper assessment and team effort for limb salvage. It is our moral, ethical, fiscal, and medicolegal responsibility to do everything in our capacity as a team to help people who are threatened with limb loss. Not only this, but we should also have a more comprehensive and holistic approach to assess not just for circulation but to look at their other comorbidities, simultaneous cardiovascular risk, and the challenges these patients face, which are oftentimes a combination of social issues. These are the very people who have poor socioeconomic status, poor access to healthcare, poor understanding of the disease processes, substance abuse and other mental health issues, and a very poor outlook on life. They are not just looking for ‘Experts’ who can open their blockages, but also someone who’s gonna be a true champion advocating for their overall physical, mental, and social health. After all, as Roosevelt had said ‘No one cares how much you know until they know how much you care”. As a vascular and cardiac specialist in some of the most densely populated and low-income areas of New Jersey, I am passionate about treating vascular disease and improving vascular health. Sometimes, people have so many risk factors they don’t understand. Unfortunately, I am seeing an increase in the number of amputations as a result of undetected peripheral vascular disease. Peripheral vascular disease is one of the primary areas that is often missed by healthcare providers. Peripheral vascular disease is more common than you think. Peripheral vascular disease impacts 20 million Americans. Vascular issues like peripheral artery disease or peripheral vascular disease are actually relatively easy to detect, fix, and prevent. At Apex, the staff will be wearing white socks as high as your knee to bring awareness to our community about this silent but deadly disease.

However, we can’t find what we aren’t looking for. That is why I am on a mission to educate healthcare providers and the community at large about the early signs of vascular disease.

Sincerely,

Dr. Shah Dr. Anuj Shah, MD Executive Director Apex Heart & Vascular Care

Wheel Chart

The
Economic Burden Of Peripheral Arterial Disease
PROJECTIONS THROUGH 2035 IN AMERICA

  • The rising prevalence of PAD is set to become an economic and healthcare crisis. Current projections indicate that nearly 21 million Americans could be dealing with PAD by 2035, significantly straining the healthcare system.
  • PAD treatment needs to be as diverse as the communities affected by it. Telemedicine, coordinated care, and cultural competence are crucial in optimizing treatment and reducing healthcare costs. The economic impact is especially devastating in underdiagnosed populations, such as women and low-income areas.
  • PAD is linked to high rates of lower-limb amputations, carrying both emotional and significant economic repercussions. These involve not just the immediate costs of surgical procedures but also the long-term costs of prosthetics, physical therapy, and potential disability benefits. Mortality rates post-amputation also contribute to lost earnings and productivity.

“By 2035, the economic toll of PAD is projected to exceed a staggering $135 billion. Behind these numbers are lives irrevocably changed” — limbs lost, families disrupted, dreams deferred.

The Looming PAD Epidemic
Peripheral Arterial Disease (PAD) has long been the silent player in the arena of cardiovascular diseases, often overshadowed by conditions such as heart disease or stroke. However, the silence masks a burgeoning crisis, both in healthcare and economic terms. A decade ago, PAD affected a small percentage of the American population. Current data, however, shockingly reveals that nearly 21 million Americans could be grappling with PAD by 2035, thereby unraveling a parallel financial catastrophe. This isn’t merely a linear progression but an exponential one, exposing the underpreparedness of the healthcare system to manage this impending avalanche.

Projections – PAD Costs Through 2035 in billions.

Bar Graph
Road and cars

WHEN IT COMES TO GETTING SCREENED… YOU CAN’T GET COLD FEET

PVD is a serious circulatory condition caused by the same fatty deposits and plaques that clog up hearts. These deposits can also build up on the walls of the arteries leading to the limbs, causing pain, numbness, and chilled feet and hands. At Apex Heart & Vascular Center, our physicians specialize in vascular care and can treat vascular issues at the source. Help us bring awareness to this disease affecting over 8 million Americans.

Feet on Ice

PREVENTING AMPUTATIONS TO KEEP YOU IN THE GAME…

From a vascular perspective, amputation represents a point of no return that changes an individual’s life in profound ways. The loss of a limb disrupts not only basic mobility but also impacts circulatory health, potentially exacerbating existing vascular conditions and creating new health challenges. The onus is on multispecialty healthcare providers and patients to work collaboratively to halt the progression towards this severe outcome. With advancements in vascular therapies, early and accurate diagnosis, and community awareness about diseases like PAD, we have the tools at our disposal to make amputations a last resort rather than an inevitable consequence. By working together, we can aim to keep patients whole in every sense of the word.

Old man playing soccer
Doctor Hugging a patient

Gwen Can Dance Again!

For Gwen, walking her usual half a block at a time without being in pain used to be out of the question. Gwen would go to work and do her job, and she would walk to church, but it was never a monumental task when it came to walking, so she did not notice how bad the pain had become. It wasn’t until she decided to go to a party from the local gospel group that she realized she had put herself in a seriously dangerous spot. Her Primary care provider referred her after a complex diagnosis, and this was the beginning of her new life. “I have suffered with PAD for 10 years. I was diagnosed the wrong way because of a spinal problem, but my primary care put me in the arms of an angel that God led me to, to heal my legs.” Gwen said.

What Was Stopping Gwen From Enjoying Her Life Normally?

Upon examination and testing, it was determined that Gwen had a blockage in the arteries of her right leg and a partial blockage in her left leg. She was diagnosed with peripheral artery disease (PAD). Gwen, a 66-year-old female with a past medical history of hypertension, hyperlipidemia, coronary artery disease, and PAD, presented to Apex Heart and Vascular Care Vein Clinic with life-altering claudication in both her right and left lower extremities. First, we successfully completed a PAD intervention on her left leg.

During that intervention, we also discovered a complete occlusion of the right SFA. We couldn’t stop at that point. After two weeks, we made another attempt and succeeded in our second intervention for her right leg. The result was as successful as the first intervention. We had finally done it.

“When I say Severe Pain, God Knows I Mean Severe Pain, Because I Spent Crying Many Days and Many Nights.”

Bone x ray

Figure 3A-C: Pre-intervention angiography showing occlusion of right SFA (A). IVUS of reference vessel – 5 mm (B). Successful revascularization of right SFA using atherectomy and balloon angioplasty.

How Did We Help Gwen Dance Again?

The patient was prepared for the procedure with necessary measures, including anticoagulation using heparin. Utilizing a guidewire, we successfully crossed the proximal cap of the stenosis. Post-crossing, intravascular ultrasound (IVUS) identified a heavily calcified plaque within the reference vessel. Subsequently, we conducted an atherectomy followed by balloon angioplasty, effectively reducing the 100% stenosis to less than 10%.

“I was completely blocked in my legs. I had no feeling in my legs every time I walked.”

ESCAPE THE PAIN

Peripheral Vascular Disease can mean unsightly and unpleasant feelings in the legs. This does not mean patients have to live with pain. At Apex Heart & Vascular Center, our physicians specialize in vascular care and can treat vascular issues at the source. Help us bring awareness to this disease affecting over 8 million Americans.

Legs wrapped in barbed wire
Legs wrapped in barbed wire
LET’S MAKE AMPUTATIONS A THING OF THE PAST…

IT’S CRAZY THAT IN 2023, PEOPLE STILL CONSIDER CUTTING A LEG TO BE A CONSERVATIVE TREATMENT WHILE VIEWING PERIPHERAL ANGIOGRAPHY AS AN AGGRESSIVE APPROACH.

FIGHTING PVD IS A TEAM GAME, AND ALL DIFFERENT SPECIALTIES NEED TO BE A PART OF OUR EARLY DIAGNOSIS CAMPAIGN – PLEASE JOIN US!

As a New Jersey Vascular Specialist, my goal is to empower other New Jersey physicians who work with diabetic patients to reduce diabetic foot complications and amputations. Apex Heart and Vascular wants to collaborate with other physicians who work with diabetic patients throughout the New Jersey region. As NJ vascular specialists, we believe that primary care physicians, internists, podiatrists, endocrinologists, infectious disease and wound care specialists, urgent care center providers, and other specialties play a critical role in the early identification of peripheral vascular disease. Because primary care physicians and podiatrists are the providers of foot exams in the New Jersey community, we work very closely with them to regularly do foot health exams to detect PVD. This disease often has other connotations for the patient, including depression and mental health issues, which inevitably cause them to need a lot of hand-holding. We need to work together to keep these patients engaged and prevent them from falling through the cracks and, ultimately, not receiving the care they need.

How can you join our fight and get involved?

Follow the American Heart Association, SALSAL Foundation, Amputee Coalition, and other organizations bringing awareness.

American Heart Logo
Save a Leg Logo
Amputee Logo
Doctors smiling together
On Wednesdays, WEAR WHITE SOCKS and bring awareness!

The White Sock Campaign is a national campaign to raise awareness of peripheral vascular disease (PVD) and the prevention of amputation. Our staff members wear one white sock to raise awareness in our community about PVD and the importance of preventative care and early screening.

Doctors forming a heart and nurses raising their legs
Join Our Events to Fight PVD!

During PVD Awareness Month, we encourage you to use the tools we have developed to raise awareness of the disease amongst your colleagues, patients, friends, and communities throughout September. These include sample social media posts, a PVD Awareness Month handheld sign, encouraging doctors who are helping patients save their limbs every day to take a photo using CVC’s handheld “I saved a limb today!” sign.

Doctors smiling together

HIGHLIGHTS FROM OUR PAD AWARENESS EVENT FOR 2023

CELEBRATING A MONTH OF AWARENESS: REFLECTING ON OUR UNFORGETTABLE PAD AWARENESS EVENT

(Peripheral Arterial Disease) Awareness Month holds a special place in our hearts here at Apex Heart & Vascular Care Vein Clinic. As the month winds down, we find ourselves reflecting on the criticality of awareness, education, and collective action in battling this pervasive disease and the phenomenal success of our recent PAD Awareness Event.

People Smiling outside the tent
People having a party under a tent
Apex Gift Bags
Man holding a woman by the shoulder

BRIDGING EXPERIENCES: THE PAD SYMPTOM SIMULATOR
A standout feature from the event was the innovative “PAD Symptom Simulator,” a creative and immersive experience designed to help individuals grasp the nuanced and sometimes elusive symptoms that PAD patients encounter.

Legs covered in ice blocks

The PAD Ice Bucket Challenge exposed participants to the chilling limb sensations reported by PAD patients, while the Cinder Block Challenge metaphorically materialized the heavy, dragging sensation in the legs that many experience. Each simulation was crafted based on genuine patient testimonials, aiming to foster empathy and understanding among healthcare providers, caregivers, and the wider community. It was not just an experiment but an eye-opening journey through the untold struggles faced by PAD patients every day.

People dipping their legs in ice
Legs wrapped in barbed wire

Attendees navigated the Barbed Wire Challenge. A simulation that encircled participants with the idea of legs with a constraining, albeit safe, barbed wire, evoking the relentless and sharp pains often described by PAD sufferers. Through this visceral encounter, the simulation forged a palpable connection between spectators and the insidious pain lurking in the shadows of everyday PAD battles, spurring a collective sigh amidst the onlookers.

The Cinder Block Challenge was a real eye-opener at our PAD Awareness Event. Attendees had cinder blocks strapped to their feet and tried to walk. Simple as that. It was a quick and direct way for them to get a glimpse into what some PAD patients describe – a heaviness in their legs that turns a simple walk across the room into a challenge. The echoing drag of the blocks on the floor served as a reminder of the often unnoticed and unseen struggle PAD patients endure. A straightforward but impactful experience, the cinder block walk was a step into the shoes of those fighting against PAD, offering a tangible connection and an enriched understanding of their journey.

Tying shoes

Our Shoe Tie Challenge was a thought-provoking element of the event, prompting participants to tie their shoes while having one leg rendered unavailable. This simulation, although merely a glimpse, provided a stark look into the daily life of individuals who’ve lost a limb due to Peripheral Arterial Disease (PAD) complications. Participants hopped, balanced, and struggled with the seemingly ordinary task, uncovering the hidden battles that amputees often face in executing what many deem a trivial activity.

FORWARD, TOGETHER IN UNCEASING STRIDES AGAINST PAD

As the month draws to a close, our dedication to the continued battle against PAD, amputations, and cardiovascular diseases surges forward undeterred. Your continued engagement and advocacy are not only welcomed but crucial as we persist in our collective crusade against PAD and its pervasive repercussions. Heartfelt thanks to each and every one of you for making this event not merely a gathering but a poignant symphony of shared struggles, unified commitment, and collective resilience against PAD. For those who missed it or wish to relive the moments, stay tuned for an evocative video recap, which will spotlight the key moments, emotional narratives, and collective spirit that defined our PAD Awareness Event this September.

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Peripheral Arterial Disease Awareness Month 2023-2024 Edition. https://www.apexheartandvascular.com/peripheral-arterial-disease-awareness https://www.apexheartandvascular.com/peripheral-arterial-disease-awareness#respond Wed, 28 Sep 2022 21:15:42 +0000 https://www.apexheartandvascular.com/?p=1273 Continue reading ]]>
  1. September is Peripheral Arterial Disease Awareness Month.
    PVD affects an estimated 20 million Americans. Yet, it is widely misunderstood by the public and often goes undiagnosed. PVD is treatable, and with early detection of the disease, millions could avoid serious help concerns related to PVD. Thanks to National PVD Awareness Month, a much-needed spotlight is being cast on the importance of early detection. In September, we come together to provide hope and advocate for awareness.

    Why is it crucial to check for peripheral arterial disease?
    Failure to recognize the signs of PAD will cause a significantly higher risk of cardiovascular disease, which otherwise goes undetected. It is important to identify patients at risk of PAD or cardiovascular disease because everyone should reduce cardiovascular risk factors.

  2. How can you join our fight?
    During PVD Awareness Month, we encourage you to use the tools CVC has developed to raise awareness of the disease amongst your colleagues, patients, friends, and communities throughout September. These include:
    • Social media posts
    • PVD Awareness Month handheld sign—encouraging doctors who are helping patients save their limbs every day to take a photo using a handheld “I saved a limb today!” sign
    • Lawmaker one-pager
    • White Socks Campaign!
    SUBMIT YOUR INFORMATION TO GET INVOLVED
  3. PAD Statistics – A deadly disease flying under the radar
    According to “High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease” 9
    Only 75.8% of PAD patients without lower extremity amputation are alive with both limbs at one year. The mortality rate after 3 years is 43.2%.
    Within one year, 51.7% of PAD patients with a lower extremity amputation will die of myocardial infarction, stroke, or another cause of death.
    When we follow these patients up to three years, 70.9% of them will be dead.

    In a study published by the Atherosclerosis Journal 10, it was found that PAD patients with leg amputations on entry were five times more likely to have a subsequent amputation and had a nearly two times higher increase in rates of cardiovascular death (and all-cause mortality) and an increase in the composite outcome of MI, stroke, cardiovascular death, or hospitalization. The study also found that critical limb ischemia (CLI) is associated with a 1-year mortality rate of 20% and a 1-year limb loss rate of 20%

    PAMPHLET PAD
  4. Diabetes and Amputation: A Silent and Deadly Beast
    PAMPHLET PAD
  5. Critical Limb Ischemia Warriors – No patient can fall through the cracks.
    PAMPHLET PAD
    PAMPHLET PAD
  6. Our Impact Fighting PAD – Join Our Fight
    PAMPHLET PAD
    PAMPHLET PAD
    PAMPHLET PAD
    PAMPHLET PAD
  7. Letter From Dr. Shah To Healthcare Providers
    Peripheral Arterial Disease is extremely common and it has a huge impact on not just the quality of life of our patients but also their family members and their overall survival. It saddens my heart when I see a patient wheelchair-bound living his or her life in the nursing home, because they lost a limb due to a circulation issue, especially when they did not even get a proper opportunity to assess their circulation. Medical science and especially the field of endovascular procedures has advanced so much that it’s unfair to our patients if they don’t go through a proper assessment and team effort for limb salvage. It is our moral, ethical, fiscal, and medicolegal responsibility that together as a team to do everything in our capacity to help people who are threatened with limb loss. Not only this, but we should also have a more comprehensive and holistic approach to assess not just for circulation but look at their other co-morbidities, simultaneous cardiovascular risk, and the challenges these patients face which are often times a combination of social issues. These are the very people, who have poor socioeconomic status, poor access to healthcare, poor understanding of the disease processes, substance abuse, and other mental health issues, and a very poor outlook on life. They are not just looking for ‘Experts’ who can open their blockages but also someone who’s gonna be a true champion advocating for their overall physical, mental and social health. After all, as Roosevelt had said ‘No one cares how much you know until they know how much you care”. As a vascular and PAD specialist in some of the most densely populated and low-income areas of New Jersey, I am passionate about treating vascular disease and improving vascular health. Sometimes people have so many risk factors they don’t understand. Unfortunately, I am seeing an increase in the number of amputations as a result of undetected peripheral vascular disease. Peripheral vascular disease is one of the primary areas that is often missed by health care providers. Peripheral vascular disease is more common than you think. Peripheral vascular disease impacts 20 million Americans. Vascular issues like peripheral artery disease or peripheral vascular disease are actually relatively easy to detect, fix and prevent. Throughout the month of September, the staff will be wearing white socks as high as your knee, to bring awareness to our community about this silent but deadly disease.

    However, we can’t find what we aren’t looking for. That is why I am on a mission to educate health care providers and the community at large about the early signs of vascular disease, Anuj Shah

  8. How do We Treat PAD?

    What are the treatments for peripheral artery disease?
    Dr. Shah devises customized treatment plans and offers a range of effective treatments for PAD, including:

    • Medications
    • Physical rehabilitation
    • Supervised walking therapy
    • Lifestyle changes, such as diet and exercise
    • Minimally invasive procedures to open blockages when necessary

    Dr. Shah first assesses your condition based on your symptoms, medical and family history, and other factors. He typically begins with lifestyle approaches, such as diet and exercise, and utilizes other treatments when needed. A healthy lifestyle with stress-relief, regular exercise, and a nutrient-dense diet can aid in the management and prevention of PAD.

    PAMPHLET PAD
  9. Endovascular Interventions Throughout History – Bypass Surgeries Are A Thing Of The Past.
    PAMPHLET PAD
    PAMPHLET PAD
  10. Minimally Invasive Procedures – Revascularizations Saving Lives
    PAMPHLET PAD
    PAMPHLET PAD
  11. Success Stories From PAD:
    Gawayne Can Dance Again!
    Champion Trainer Gets His Health Back!
  12. How can you get involved?
    PAMPHLET PAD
    SUBMIT YOUR INFORMATION TO GET INVOLVED
  13. PAD & Limb Loss Awareness Video
  14. PAD Misconception #1: Peripheral arterial disease (PAD) must not be common or we would hear about it more in the news.
    As physicians, we sometimes only see the obvious, but do not see what is taking place beneath the surface. PAD is a very common disease, but unfortunately, it does not receive a lot of publicity in consumer-facing media outlets. It certainly receives much less publicity than regular cardiovascular issues because there is a general lack of awareness about what peripheral arterial disease is. It’s also not recognized by many doctors, and the effort to increase public awareness is limited because people don’t truly understand the risk factors associated with PAD, specifically as it pertains to diabetes.

    Although PAD and amputation are not highly publicized medical issues, they are life-threatening and a leading cause of mortality, especially among those with diabetes. When we look at mortality rates, the only thing with a worse mortality rate than amputation over five years is stage 4 lung cancer.

    “Five-year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer” 1 published in the Journal of Foot and Ankle Research.

    PAMPHLET PAD

    According to the National Heart, Lung, and Blood Institute (NLBI) 2, 18 million individuals in the United States are afflicted with some form of peripheral arterial disease (PAD).

    PAD Misconception #2: Peripheral arterial disease only impacts the elderly.
    Peripheral Arterial Disease becomes more apparent as people age, but precursors of atherosclerosis are present from a young age. In the Framingham Heart Study 6 they looked at the top peripheral arterial disease risk factors. They found that every 40-milligram increase in LDL, your odds ratio was 1.2, which means there is a 20% higher risk of getting peripheral arterial disease. For every ten cigarette smokes per day, your risk of PAD went up 40%. For mild diabetes, the odds ratio was 1.5 and for mild hypertension, it was 1.5 moderate hypertension 2.2, and for diabetics it was 2.6.

    A study derived from results of a National Health and Nutrition Examination 3 projected that the prevalence of PAD continues to grow with age. When people are in their 40’s to 60’s, we see about 1 million cases of PAD, but we see around 4 million cases of PAD of people in their 70’s to 80’s and it continues to grow.

    A study by the New England Journal of Medicine in 1999 4, estimated that the number of people with PAD was eight to nine million and projected the number would continue to go up in the next decade with a number coming around 12 million in 2020.

    A study published by Vascular Disease Management in 2016 5 found that we have already significantly surpassed that number and currently PAD prevalence is estimated at 18 million.

    When we look at the independent factors of peripheral arterial disease, diabetes and smoking are the two biggest ones and the odds ratio is around four for diabetes. It’s almost a 400-fold increase in peripheral arterial disease.

    PAD Misconception #3. Peripheral Arterial Disease is only a nuisance. It won’t kill you.
    In the “Reduction of Atherothrombosis for Continued Health Registry” 7 The American College of Cardiology looked at major adverse PAD events, or what we call the major adverse PAD event (MACE), in three different populations: people who had documented coronary artery disease (CAD), people who had Cerebral vascular disease, and people who had peripheral arterial disease. In other words, somebody who already had a heart attack, somebody who already had a stroke, and somebody who had pre-existing peripheral arterial disease.

    When we look at the various cardiovascular risks, cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and stroke combination, or MACE, it’s consistently similar across the board and that’s why vascular specialists say peripheral arterial disease is CAD risk factor equivalent.

    When a patient has PAD, the risk factor of future mortality and morbidity are significantly higher and there is also tremendous overlap. Patients that have coronary artery disease are oftentimes the same patients who have PAD, and they are the same people who end up suffering from a stroke.

    In the study “Ten Year Mortality in Different Peripheral Arterial Disease Stages: A Population Based Observational Study on Outcome” 8 , it was found that over ten years, the all-cause mortality rate for PAD patients was 33.1%. The percent of deaths that were attributed to cardiovascular issues as the main cause of death was 35.6% and 15.8% of deaths cited cardiovascular issues as a contributing factor in the cause of death.

    The study found that the risk of cardiovascular mortality was approximately twice as high for age adjusted PAD patients and the risk increases significantly as the patients progress through the stages of PAD (Asymptomatic PAD, Intermittent Claudication and severe Critical Limb Ischemia).

    The history of peripheral arterial disease is very similar to coronary artery disease (CAD), where a patient has stable CAD and then develops acute coronary syndrome. Similarly, you have stable PAD (claudication), when people have pain when they walk, but it gets better when they stop walking, but the stable PAD later changes into critical limb ischemia (CLI).

    If you look at claudication’s, which are “stable PAD patients,” the risks of non-fatal myocardial infarction (MI) and stroke is around 20%. This is a CAD risk factor equivalent and the death rate is 15 to 30%.

    When people develop critical limb ischemia (CLI), which is a more vigorous form of peripheral arterial disease, the outcomes are abysmal.

    PAD Misconception #4: Detection of Peripheral Arterial Disease is difficult.
    Many patients will come in with symptoms including leg pain, so this is not entirely true. However, patients do often have atypical symptoms of PAD. The classic symptom of peripheral arterial disease is intermittent claudication. Claudication is when you start walking, you get an exertional calf pain, usually related to one muscle group, whether it’s in the gluteal region or the calf and it resolves within ten minutes of rest.

    Unfortunately, less than one third of PAD patients have classic claudication symptoms. A majority of patients will have atypical leg pain symptoms, where the pain is not exertional leg pain, which is not just the calves, but other muscle groups. This pain may not even stop the patient from walking or fail to relieve with rest. There are many clinical variations of PAD symptoms. This is a large part of the problem as to why it becomes so difficult for primary care physicians and podiatrists to detect PAD.

    When we look at the rate of foot exams in primary care offices, from my personal experience, I would estimate that less than 5% of the overall population gets their feet examined. Many cardiologists also routinely fail to get annual foot exams, so as a group we are not much better.

    PAD Misconception #5: PAD does not impact every other organ and system in the body.
    A PAD diagnosis completely changes people’s long-term prognosis. Atherosclerosis causes coronary artery disease and the same atherosclerosis can happen in all other vessels. Essentially, it all stems from the same vascular tree. When it happens in the cerebral system, it causes Transient Ischemic Attack (TIA) and ischemic stroke. In the heart, it causes myocardial infarction and unstable angina. In the kidney arteries, it causes renal artery stenosis, renovascular hypertension, and intestinal ischemia. Mesenteric ischemia comes from PAD. Erectile dysfunction often stems from PAD, either from Leriche syndrome (aortoiliac occlusive disease) or from potential arteries or internal iliac arteries with stenosis. Claudication, critical limb ischemia, gangrene and amputation are all systemic manifestation of atherosclerosis.

    PAD Misconception #6: The health of one limb does not impact the health of the other limb.
    What happens to one limb can directly impact what happens to the other limb. The level of amputation directly relates to the pressure you put on the contralateral limb. Many times, the people who have a transmetatarsal amputation (TMA) are the same people who will get a below-the-knee amputation (BKA) in that leg.

    These are the same patients who will end up getting above knee amputation in their leg and the same people will get a contralateral limb amputation.

    These patients will end up going to nursing homes, they will develop decubitus ulcers and they will catch infections. They will then have decubitus ulcers and will need a Foley catheter. They may also develop a urinary tract infection (UTI).

    This creates a vicious cycle where patients come to the hospital and become susceptible to catching a hospital acquired infection. They then go back and their entire trajectory after one amputation will constantly change and thus the vicious cycle repeats.

    PAD Misconception #7: PAD can only be detected by one type of medical specialist.
    DYK: Less than one third of PAD patients will have classic symptoms?

    I believe in a comprehensive approach to medical treatment that empowers physicians to screen and test for the symptoms of PAD. All doctors and medical professionals have an ethical responsibility to test for and detect PAD because it directly affects mortality and morbidity. As health care providers, we have great power, but great power comes with great responsibility.

    There are medical and legal responsibilities when patients have peripheral arterial disease and it gets missed and unfortunately, somebody will ultimately end up getting an amputation as a result.

    PAD is not difficult to screen for. The problem is that unfortunately, many physicians don’t screen for it at all. Oftentimes, a medical history and physical exam is all it takes. Sometimes, additional testing for PAD is required. We use the ankle-brachial index (ABI), which is one of the easiest ways of detecting peripheral arterial disease in an earlier setting.

    We need to differentiate intermittent claudication or peripheral arterial disease from venous claudication and neurogenic claudication.

    ABOUT DR. ANUJ R. SHAH

    DR. ANUJ R. SHAH

    Dr. Shah is an interventional cardiologist and an endovascular specialist originally trained at Mt. Sinai. He has been in practice for 11 years and is passionate about the improvement of leg circulation and peripheral arterial disease. He is currently the Director of Apex Heart and Vascular and still has privileges at Mount Sinai as an assistant professor. He is a regional authority on peripheral arterial disease and critical limb ischemia and frequently is featured in the media and podcasts on diabetes management.

    AMPUTATION PREVENTION RESOURCES AND ADDITIONAL READING ON PAD:

    1. Five Year Mortality and Direct Costs of Care for People with Diabetic Foot Complications Are Comparable to Cancer
    2. Facts About Peripheral Arterial Disease (PAD)
    3. Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States
    4. Mortality over a Period of 10 Years in Patients with Peripheral Arterial Disease
    5. Reducing Amputation Rates in Critical Limb Ischemia Patients Via a Limb Salvage Program
    6. Framingham Heart Study
    7. Reduction of Atherothrombosis for Continued Health Registry
    8. Ten Year Mortality in Different Peripheral Arterial Disease Stages: A Population Based Observational Study on Outcome
    9. High Mortality Risks After Major Lower Extremity Amputation in Medicare Patients with Peripheral Artery Disease
    10. Fate of Individuals with Ischemic Amputations in the REACH Registry: Three-year Cardiovascular and Limb-related Outcomes
    11. The Costs of Diabetic Foot: The Economic Case for the Limb Salvage Team
    12. A Cost-Utility Analysis of Amputation versus Salvage
    13. Limb Salvage Versus Amputation: A Closer Look At The Evidence, Costs And Long-Term Outcomes
  15. Top rated cardiologist and vascular specialist at apex heart and vascular at locations in
    • 293 Passaic Street, Passaic, NJ 07055
    • 2643 Mt. Prospect Ave., Newark, NJ 07104
    • 143 Palisade Ave, Jersey City, NJ 07306
    • 2 Smalley Terrace, Irvington, NJ 07111
    • 591 Franklin Avenue, Nutley, NJ 07110
    • 91 Main St, Paterson, NJ 07501
    • 606 Broadway, Paterson, NJ 07514
    • 654 Mt. Prospect Ave, Newark, NJ 07104
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Diets For Heart Disease and Diabetes https://www.apexheartandvascular.com/diets-for-heart-disease-and-diabetes https://www.apexheartandvascular.com/diets-for-heart-disease-and-diabetes#respond Tue, 17 Aug 2021 17:55:13 +0000 https://www.apexheartandvascular.com/?p=1235 Continue reading ]]> Best Diet for Heart Health, Heart Disease and Diabetes

Top NJ Cardiologist: A Vegan Diet is good for heart disease patients 

In this article, we will discuss:

  • Is a plant-based diet good for heart disease patients?
  • Do vegans get heart disease?
  • Can plant-based diets reverse clogged arteries?
  • Will a vegan diet reverse heart disease?
  • Do cardiologists recommend a vegan diet?
  • What diet do cardiologists recommend?

UNHEALTHY DIETS FOR HEART DISEASE PATIENTS

  • Diabetic diet: What is a diabetic diet?
  • Diabetes and Heart Disease: What is the best diet for diabetics?
  • Best diet after heart attack and stents

Diet after Heart Attack: Best diet for heart disease and diabetes

Diet plan for someone with heart disease

Try to avoid bad fat, unnecessary fat, unnecessary carbs and sugars. I don’t recommend a no carb diet. Either go with a low sugar, low carb diet or you can go with a low-fat diet.

They both work well and improve your strength, stamina, and energy levels. It improves cholesterol levels as well as weight reduction. Those are the diets that I typically recommend to my cardiovascular patients with a history of heart disease.

Post heart attack diet

  • Avoid having fat, especially saturated fat.
  • Excess of carbs and excess of sugar is bad for everyone.

[READ]: 15 diabetes apps to manage your health

Is the keto diet good for heart disease patients?

The keto diet is something new. The jury is still out on seeing how much long-term benefit we are going to see from this. It is a tough diet to stick to. Many people try it but then they give up on it because it is difficult to stick to.

How much of an effect does exercise have on preventing diet related ailments such as heart disease and type 2 diabetes?

There are multiple studies showing the benefits of exercise in reducing heart disease and type 2 diabetes by up to 30%, but in most of those studies, the subjects who were exercising were also eating ‘healthy.’ Often, exercise alone leads to high energy expenditure and calorie loss, but people can consume a lot of those calories back by eating junk in a brief time span.

For example, a lot of the benefit of 45 minutes of high-intensity exercise is lost with just two sugary sodas.

Whereas studies have shown that a proper diet is more (approximately 75%) responsible for weight-loss compared to exercise, there are certainly other benefits of exercise that outweighs one’s weight. There have been a number of studies looking at ‘Fitness’ vs. “Fatness’ and a recent meta-analysis of all these studies have concluded that compared to normal weight -fit individual, unfit individuals had twice the risk of mortality regardless of their weights (BMI). Overweight and obese-fit individuals had the same risk of mortality as normal weight fit individuals.

As far as cardiac disease and lifespan is compared, it is better to be ‘fat and fit’ than unfit with any weight. 

It’s the combination of ‘good habits’ (preferably – great habits!) including moderate exercise of at least 30 minutes/day, healthy diet (along with reducing stress in life and avoiding smoking) has shown 75-80 percent lower risk of developing any chronic disease, including a 93 percent lower risk of getting type 2 Diabetes, an 81 percent reduced risk of a heart attack, a 50 percent lower risk of a stroke and a 36 percent reduction in all forms of cancer.

Are there diet changes patients can make to decrease their risk of heart disease or stroke?

Change in diet is the key factor along with regular exercise and proper attention to sleep. Mindfulness and meditation are also known to decrease the risk of heart disease and stroke.

Knowing that food is healthy is only one part of being healthy. It first requires a commitment to being healthy. Once you’re committed – you need not only cognitive but emotional mastery over this – so you form healthy habits and associations and take pride in making those choices. This includes regular exercise, avoiding inflammatory, processed food and going for healthier options, especially if you have type two diabetes.

Diets for lowering your cholesterol

Diet is a tricky thing, especially for a heart disease patient. It is one of those controversial subjects because so much has been done and yet so much more needs to be done.

As far as cardiovascular disease goes, there’s only one diet which has shown true improvement in cardiovascular outcomes, which is the Mediterranean diet. It is high in good cholesterol. It has a lot of nuts and olive oil.

Every other type of diet is probably good, but the commonly recommended diets are low fat diet, low cholesterol diet, low sugar diet, keto diet. All of those diets have a lot of proponents of these different types of diets.

Unfortunately, none of them have demonstrated long-term benefits for cardiovascular disease. There is no particular diet except for the Mediterranean diet, which has shown that the future risk of heart attack or stroke is reduced.

There are other benefits that specific heart healthy diets have such as weight reduction. Certain diets will lower your cholesterol, which hopefully will translate into reducing heart attack and stroke. As far as diet goes, we know that it is important to stick to something.

Heart Disease and Inflammation

When working with patients who have heart disease or are at risk for heart disease and stroke, you want to pay close attention to diet. Is inflammation the real cause of heart attacks?

A recent study showed that avoiding inflammatory foods can lower risk for heart disease and stroke.

People with unhealthy dietary habits, including inflammatory food, are at a much higher risk of heart disease and stroke. In clinical practice, we see a pattern. Some people who have not developed healthy habits and have not paid attention to their diet and nutrition.

Unfortunately, these are often the same group of people who also don’t exercise and have poorly controlled blood pressure, cholesterol and diabetes profiles, which puts them at risk of heart disease and stroke.

Poor diet habits compound their risk of heart attack and stroke by not only direct impact on the vascular endothelium (inner lining of blood vessels that get inflamed) but also higher risk of diabetes and cholesterol.

Have you encountered at-risk patients who have changed their diet to eliminate inflammatory foods and have successfully improved their blood profile and cardiac test results?

Once someone (typically an at-risk patient) decides to focus on their health, they can work on changing their diet, reduce inflammatory food etc. This has been shown to improve their blood profile by improving LDL and triglyceride levels (bad lipids) and also by controlling their blood pressure.

Once people choose to have a healthy lifestyle by better (less inflammatory) diet and exercise, we see tremendous results on their cardiac tests showing a reduction in plaque content.

There are many studies that show that a healthy lifestyle causes reduction in atherosclerosis (plaque building) confirmed via Carotid Intima media thickness (CIMT) and coronary calcium score (Coronary CT scan) – which are surrogates for overall atherosclerosis (plaque building) burden.

Which foods are inflammatory?

Processed foods are very inflammatory. Red meat and anything with refined sugar tends to be very inflammatory. A lot of beverages with sugar also tend to be very inflammatory.

Does adding anti-inflammatory foods to the diet help to improve risk levels? 

Adding anti-inflammatory food helps improve risk levels. Antioxidants like berries, green tea are great. There are other sources like chili peppers, turmeric with curcumin and cocoa can be great too. Also, food with long-chain omega-3 fatty acids EPA, DHA like fatty fish can be very healthy. Overall, the Mediterranean diet is considered to be the best cardiovascular diet due to food high in the above content.

PLANT-BASED DIETS

  • Vegan diet heart disease reversal
  • Is a vegan diet good for heart disease?

NJ Cardiologist shares why new study is a myth and the #1 reason you should keep eating plant-based foods

There has been a lot of controversy about what is a better diet – a “vegetarian/vegan diet” vs. a predominantly meat-based diet. Intuitively, most people would think that the plant-based vegetarian diet is better for cardiovascular health, but lately, there have been some publications and news articles talking about how a plant-based diet could lead to a higher risk of stroke.

This comes from one research study that was performed at Oxford University, where they looked at 48,000 patients in an ‘observational’ fashion. They followed these patients and looked at those with vegetarian diets (not plant-based diets) vs. fish and meat-based diets and what they found was that people who had vegetarian diets were ‘associated’ with a significantly lower risk of ischemic heart disease (cardiac blockages) but it was also associated with a higher risk of stroke.

Overall, for every 1,000 patients who followed a vegetarian diet, on average, 10 would have a lower risk of heart attacks, but 3 would have a higher risk of stroke. This information has now been extrapolated into some news media – thinking that ‘vegetarian’ (and later extrapolated to saying ‘plant-based’ diet) is not that safe.

I have several issues with this. When we look at the study, they are talking about ‘hemorrhagic stroke’ (a stroke caused by bleeding in the brain) that is truly driving this higher association; but not stroke related to blockages (ischemic).

When you combine total cardiovascular risks (heart attacks, strokes combined), vegetarian diets were still associated with lower risks. But this is just the tip of the iceberg in terms of flaws with the fundamental extrapolation being made about the diets.

They collected patients for the study between 1993 to 2001 who said they were vegetarian and followed them over 18 years and later published the study in July 2019. It is important to note that the ‘vegetarian’ diet has significantly changed over many years. There are vegetarian diets that are not that healthy.

Second, there are multiple factors that could play a role in the risk of stroke etc., namely high blood pressure, diabetes, high cholesterol etc. and there’s no objective measurement of these other risk factors between the groups in this study, but rather they relied only on subjective information provided by the people in the study.

However, there is no obvious confirmed theory why this would be the case. The only known deficiency most vegetarians may have is vitamin B12, but vitamin B12 deficiency is never proven to increase risks of intracranial bleeding.

This stems from the limitation of an observational study since an observational study can only point towards ‘association’ and not ‘causation’ and we know that ‘association is not causation’.

Time and time again in medicine, we have seen that there are observations showing one thing, but when we look at the purest form of research called randomized controlled trial (RCT), those ‘associations’ don’t stand the test of the RCT’s.

The biggest example of this is ‘Hormone Replacement therapy’ (HRT). In the early 2000s, HRT was routinely recommended in postmenopausal women based on observational study evidence. But in 2002, the results of a randomized controlled trial on more than 1600 women in menopause, assigned to HRT vs. placebo, showed that HRT led to increased risk of coronary disease, mammary tumor, blood clots and strokes.

These discrepancies can be explained considering that several confounding factors like exercise, smoking, education or income – in fact correlated to the outcome – were not included in the observational studies.

Plant Based Diets and Heart Disease

Is a vegan diet good for heart disease?

We know that the Mediterranean diet has the best cardiovascular health benefits. It is the only diet that is what we call randomized control data supporting that it actually helps with it. Everything else has a benefit in terms of weight loss. We know on animal models that the plant-based diet has significant results that cause less atherosclerosis.

A lot of people recommend a vegan diet because of that. Lately, there has been a bit of controversy around it. They looked at in the United Kingdom and there were marginally higher incidences of stroke in people who are vegetarian and vegan, which created a big uproar.

But then you have to look at the results and the statistics and studies and it turned out, it’s what we call association and not causation. It’s just like one of those random statistical outliers that came out. As far as cardiac health is concerned, that diet was better. That’s why diet is one of those things that continues to change.

Does the Mediterranean diet include fish? Or is it mostly just straight vegetarian?

Fish, poultry, beans, eggs are all part of the Mediterranean diet. Whole grains, vegetables, fruits. A moderate portion of dairy products. There are not a lot of dairy products in the Mediterranean diet and a limited intake of red meat.

Should you stop eating plant-based diets?

There is no need to stop eating a plant-based diet. Until a true randomized controlled trial is run comparing various diets, it is not wise to extrapolate the results of the said recent study.  I tell my patients to eat healthy no matter what. There are plenty of benefits of plant-based diets and there is no proven risk of stroke associated with plant-based diets.

As Mark Twain said, “There are three kinds of lies: lies, damned lies, and statistics.”

Whenever I look at statistics and the poor inference for popular media – it reminds me of how important it is to look at data and properly interpret it.

I wouldn’t jump to throw away your plant-based diet for steak quite yet.

Our ever-increasing rate of obesity in the United States continues to increase. Here is how we combat it.  

Obesity leads to many cardiovascular issues because it is an underlying root problem. If you trace that back, there is a large genetic component.

There is a famous saying that genes run in the family. So do recipes! 

People will say, my parents used to be overweight and my grandparents used to be overweight, so I’m overweight too.

Sure. But they also probably made some mistakes.

  • They had a certain kind of diet.
  • They didn’t exercise.
  • They ignored it.

Those are the things you can change. Paying attention to your diet and living a healthy lifestyle with frequent exercise is very important.

PREVENTING HEART DISEASE: CHANGE HAS TO BE MADE

It should be stylish and sexy to eat healthy and be healthy. That should be mainstream conversation.

When we talk about access to health care and the disparities in access to health care, a large portion of that is also access to healthy food. At the government policy level, change has to be made. At the industry level, the food industry has to own up to it. These conversations have to become mainstream.

It’s shocking that even now, if somebody wants to be healthy and have a salad for lunch, it would cost them fifteen dollars to get a salad versus a Mac burger for two dollars. The food industry is playing a big role in the obesity epidemic in the US. 

Diet itself is not a diet. Diet is your culture.

Culturally, you are raised in a particular way. If we want to change people’s diets and the population, first we have to collectively act and change the deep-rooted cultural beliefs around diet, recipes and food. We have to change the way people and families are raised and what family values are specifically as it pertains to diet.

The government and regulation agencies have to come and make a change because healthier food traditionally is more expensive. The fundamental shift has to come in until the food becomes cheaper, the healthier food, the salads, not costing you 15 dollars. You can’t change that. Instead, you can change your mentality and say, “You know what, I am committed to my health, even if it means I’m going to have $15 for lunch every day. That’s okay.” That’s where the integration comes in.

Your belief system has to change. You have to be committed to being healthy.

Can an Unhealthy Diet Catch Up to You If You Work Out? 

Yes. A healthy diet, regular exercise and stress reduction are the three pillars of a more robust, longer life.  Balancing all three are essential for wellness and dare I say, a more fulfilled life. Maintaining fitness is vital and has benefits beyond one’s weight, but having an unhealthy diet can lead to serious issues, even if a person works out regularly.

A diet that is high in sugar and bad fat can lead to plaque building in various arteries in the body and can lead to a chronic inflammatory state. At some point, the damage from this will catch up, leading to reducing one’s ability to exercise and by causing actual physical limitations to exercise.

How much does your diet matter if you exercise often? Can you outrun a poor diet?

Diet does matter and it’s difficult to outrun a bad diet because it’s the combination of exercise and proper diet which has been demonstrated to show all the benefits. A sedentary lifestyle increases chronic inflammation and hence exercise reduces the risks of chronic inflammation, leading to the benefits in cutting premature death rates by 20-30% and adding an additional 3 to 10 years in people’s life spans when compared to a controlled group who didn’t exercise.

The typical American diet high in animal protein, sugar and bad fat can lead to increased production of interleukin (blood chemicals that promote chronic inflammatory state). Therefore, it’s unlikely that one can simply outrun a poor diet.

ZIP CODE HEALTH

“Awareness is important regardless of where you live in America.”

Your zip code determines more than your genetic code. Where you live plays a huge role in your health care treatment. There are certain parts of this country where I think it comes down to everything but access to health care. I have an office in Irvington, New Jersey. These are very urban areas and good luck trying to find a healthy meal if you live there and you want to get a healthy meal.

It’s so difficult to find healthy options versus if you live in the West Village in Manhattan and you want to find a healthy meal there, every corner has seven options. Where you live plays a big role in access to health care and healthy meal choices.

Creating Healthy Habits Through Diet, Discipline, and Exercise

Diet is one of those things that is always changing. What we thought was perfect 20 years ago we cringe at today. People used to think, no carb diet and then no fat diet, and then no sugar diet came and then keto diet became hot. It’s very difficult because what we have to look at is not short term, a lot of things in the short term immediately give tremendous, beautiful, great results, and especially weight loss.

Focus on what is going to build a healthy habit because you can go from zero to 60 to 200 very quickly and lose a lot of weight. Unfortunately, I’ve seen so many people that gain that weight back.

Do not go on a health sprint. Health is not a sprint, it’s a marathon.

Look at something that brings great long-term health results. This is where science is still struggling to find out what was one of the most perfect, greatest diet, and what is something that people can stick with? That requires motivation, but that also requires your palette to be trained.

  • What do you actually believe in?
  • What are your values you believe in?
  • Vegan diet or not?
  • Plant-based diet or not?

Something that is long-term that can give you long-term health benefits.

Creating Healthy Habits Through Diet, Discipline, and Exercise

Everything in moderation

“A filet itself is not bad, it’s the side dishes like the potatoes and the extra butter that will go on that you have to worry about.”

Best Food For Heart Attack Patients:

If somebody is disciplined enough they have their one cheat day. I have a lot of patients with open heart surgery that come to me for follow up and love seeing me because I take a prescription pad I write down, “Cheat day number one in 30 days” and they love it. If you allow them to have a cheat day once a month and I give them a prescription for that. I also give a prescription of smiles and hugs and they just love it.

Heart Heathy Food List & Foods To Avoid With Heart Disease:

If you’re hypertensive, your blood pressure is running high. Your cheat day cannot be like something super salty, like Chinese food. Then your pressure is going to go up.

Cardiac Diet Cheat Day

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Healthy eating. Eat smart. Healthy food for your heart.

Apex can help you with managing your diabetes. Prevent and reverse heart disease. Need a custom plan for a diet to reverse heart disease? We can help you create the best diet for heart disease and diabetes meal plans. If you have Peripheral Artery Disease we can create a custom Heart Healthy Diet for you.

 

RESOURCES:

Plant‐Based Diets Are Associated with a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults

https://www.ahajournals.org/doi/10.1161/JAHA.119.012865

Studies published recently in the Journal of the American Heart Association and JAMA Internal Medicine found that diets high in plant-based foods can decrease your risk of dying of heart attack, stroke, or heart failure by 32 percent, and developing type 2 diabetes by 30 percent.

 

LISTEN: SUGAR BY HALF PODCAST: What is a diabetic foot attack and how do you prevent one?

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