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Posts Tagged ‘Dr. Nina Radford’

Nutrition Consultation at Cooper Clinic

August 11, 2014 Leave a comment

In this year’s Medscape survey, 50 percent of primary care respondents said they spent 16 minutes or less with patients. Cooper Clinic physicians spend up to two hours with every patient. We’re rounding out the blog series that broke down each of the six components of the comprehensive preventive exam at Cooper Clinic. If you haven’t followed along, read about the first five (of six) components to get caught up.

  1. Medical Exam & Counseling
  2. Laboratory Analysis
  3. Cardiovascular Screening
  4. Multidetector Computed Tomography (MDCT) Scan
  5. Skin Cancer Screening
  6. Nutrition Consultation

One-on-one consultations with a registered dietitian nutritionist (RDN) are designed to help patients gain the knowledge and skills needed to achieve a healthy lifestyle. This consultation includes nutrition coaching, a personalized action plan with diet recommendations and a computer analysis of a Three-Day Food Record to calculate the nutrients in your diet.

If eating well were easy, we would all be healthier and weigh less. But the bottom line is that staying faithful to mindful nutrition is hard. We may know what foods to choose, but just cannot find the strategy to make good choices. Or we may think we know the right food choices to make, only to find that a “healthy” bran muffin has as much fat and calories as a gooey cinnamon roll. Some of us would not know how to recognize a good fat from a bad fat if our life depended on it (which in some ways is kind of does).

Our RDNs can take the complex concepts of nutrition and translate them in simple terms as they apply to your individual dietary habits. Are there specific foods you love that need to be modified to be more nutrient dense? If your cholesterol is a tad high and you want to increase fiber in your diet for cholesterol lowering? An RDN can show you how to make simple changes in your food choices to make that happen. Are you on the go and prone to missing lunch? Our RDNs can tell you which of the meal bar substitutes (and there are a zillion out there) make the most sense for your nutritional needs, taste preferences and weight goals.

There is so much information online and in the news that it can be difficult to separate fact from fiction. Is it good to take calcium supplements to protect the bones or bad to take calcium supplements because of risk to the heart? Do I get enough calcium in my diet so I don’t even have to worry about supplements?

With a one-on-one consultation, your specific needs can be addressed. Are you a vegetarian worried about protein intake? Are you pre-diabetic and wonder which food choices will help you lower your blood sugar? Do you entertain clients at restaurants and need to find a way to eat a healthy meal from the menu without being a wet blanket? Surely nothing kills a party faster than having the host order a chicken breast with kale and a side of water.

Just as important as helping you make a road map for your nutrition journey, our dietitians are with you every step of the way. They are there for you if you need to come in to the clinic for a visit to brainstorm about roadblocks or you can schedule a phone consultation as frequently as would like to keep you headed in the right direction. The nutrition train is definitely one you want to get on board.

To learn more about Cooper Clinic’s preventive exam, click here or call us at 866.906.2667 (COOP).

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Does Sitting Too Much Affect Your Heart Health?

There is a new area of science looking specifically at the harms of physical inactivity or sedentary behavior, which is not necessarily the inverse of benefits of physical activity, according to Nina Radford, MD, Cardiologist and Director of Clinical Research at Cooper Clinic.

Most of the data suggests that if you spend too much time sitting, you’re more likely to develop risk factors for heart disease and diabetes. The more time you spend sitting, the more weight you gain, the more your waist circumference increases, your blood sugar rises and cholesterol profile worsens.

Improve Your Heart Health
There are several conventional recommendations to people who sit long periods of time each day. Some of these suggestions include:

  • Get up once an hour and take a walk.
  • Stand while on the phone or opening mail.
  • Rather than emailing a colleague who works down the hall, walk down the hall to speak to them instead.
  • At lunch, take some time to walk around your building or around the block.

While these suggestions can’t hurt, there’s a bigger picture we have to look at, says Dr. Radford. Being sedentary isn’t only about sitting at your desk at work. It’s a sedentary lifestyle that is truly dangerous. People who are sedentary get less moderate physical activity and may have worse diet patterns.

New research shows that someone who is physically fit and makes regular exercise a priority, but who has a desk job, has fewer risk factors for heart disease than someone who has a desk job and is not physically fit.

“There is a new idea that if you sit at your desk all day, going to the gym at night won’t help, but that is not necessarily the case,” says Dr. Radford.

Researchers at The Cooper Institute have found that the adverse effects of time spent sitting are less pronounced the more fit you are.

“The notion that you can’t undo the ravages of a sedentary lifestyle by exercising every day is a bad public health message and the data doesn’t convincingly demonstrate that,” says Dr. Radford

So what does Dr. Radford recommend? Be generally active and get an annual physcial exam. Make it a priority to get 150 minutes of moderate physical activity every week. If you do have to sit long periods of time, get up and move around as much as possible, but the real emphasis is on living an otherwise active lifestyle.

Podcast: Does Calcium Consumption Make Sense? Dr. Nina Radford Weighs In

Dr. Nina Radford, Cooper Clinic

Dr. Nina Radford, Cooper Clinic

Nina Radford, MD, Director of Clinical Research and a cardiologist at Cooper Clinic, talks with Vitamin Expert Todd Whitthorne, about research reported in February 2013 by BMJ that calcium supplements are linked to significantly increased heart attack risk. Dr. Radford, board certified in Internal Medicine and Cardiovascular Disease, gives her opinions about calcium consumption (in both food and supplements) for women who are concerned about both bone health and heart health.

Click here to listen to the interview.

The Utility of General Health Checks in Adults Takes a Beating

November 27, 2012 Leave a comment

By Nina Radford, MD, Director of Clinic Research at Cooper Clinic

In a Cochrane systematic review and meta-analysis of 14 trials (involving 182,880 participants) recently published in the British Medical Journal, the authors from the Nordic Cochrane Center conclude that general health checks, defined as “a contact between a person and a health care professional to identify signs, symptoms or risk factors for disease that were previously unrecognized,” do not improve the health of patients. Specifically, the authors report that health checks do not reduce cardiovascular deaths or cancer deaths (in an analysis of data from 8 of the 14 trials).

So based on this review, does this mean you ought to cancel your upcoming doctor’s appointment for your annual examination and wait until you detect a problem with your health to make an appointment with your doctor? Absolutely not. 

If you take a careful look at the framework from which these authors made their conclusions as well as the studies included in their review, I think you will agree.

The authors set the stage for this review by challenging the notion that early detection of disease in a general health check leads to improved patient outcomes or reduction of disease or death. In their words, “Theoretically, there are many possible benefits of general health checks, through apparently intuitive mechanisms.” In other words, we think there are benefits of general health checks because that makes sense to us (so called intuition) but there is no rigorously proven scientific evidence. Furthermore, they go on to say that the detection of risk factors such as hypertension of hypercholesterolemia “may” lead to reductions in morbidity and mortality through preventive treatment.

You may be thinking that this is a crazy statement because we know that treating hypertension and hyperlipidemia in a primary prevention does reduce heart attacks and death from cardiovascular disease. Well, we know this is true if you are enrolled in a clinical trial, but do we know it is true if your hypertension or high cholesterol is detected by your primary care provider? Technically, we do not have clinical trials data to prove this, but why should we? The whole point of clinical trials is to prove that therapies are effective so they can be brought into clinical practice.

Let’s take a look at the eight studies included in the analysis of the impact of health checks on cardiovascular mortality and cancer death. Here are some features of these trials as a group:

  1. Seven of the eight trials were started between 1963 and 1971; one started in 1989. Many therapies that we know save lives were not available at the time of these trials. For example, the first statin was released for marketing 1987.
  2. Only three of the eight trials offered lifestyle interventions. Without effective drug therapies, education about healthy lifestyles is critical.
  3. The number of health checks ranged from just one (in three trials) to three. We know it is hard to change a health behavior in just one visit.
  4. The average follow up ranged from four to 22 years.

To give you a feel for what these studies were like, let me describe one. The authors included data from one study performed in Stockholm of 3,064 men and women ages 18 to 65 who underwent one health check in 1969 compared to 29,122 men and women who did not undergo a health check in 1969 and then ascertained the death status on all participants 22 years later.

Frankly, I am not surprised to find that people who had one health check in 1969 did not have a reduced risk of dying from heart disease or cancer more than two decades later compared to people who did not have one health check because there are so many potential confounders concerning how all those people lived (who smoked, who didn’t, etc.) and were treated (who had a regular doctor, who took medications) during the intervening 22 years. But I certainly do not see this as an indictment of routine health checks in 2012.

The authors of this study conclude that “our results do not support the use of general health checks aimed at a general adult population…” which is the tag line I am sure you will see on the 5:00 news.

However, the authors go on to say that physicians should not stop “clinically motivated testing and preventive activities” and that their results “do not imply that all individual components of health check are ineffective.…”

So, keep that doctor’s appointment, take your medications, watch what you eat and get some exercise. You’ll be glad you did.

Dr. Nina Radford is Director of Clinical Research and a cardiologist at Cooper Clinic. She received a Bachelor of Arts from Cornell University and a Medical Degree from Mount Sinai School of Medicine. She completed her internal medicine internship, residency and a clinical and research fellowship in cardiology at The University of Texas Southwestern Medical School Affiliated Hospitals. Dr. Radford also completed a fellowship at the American Heart Association Bugher Foundation Centers for Molecular Biology in the Cardiovascular System. She is certified in internal medicine with a subspecialty certification in cardiovascular disease by the American Board of Internal Medicine. She also is certified by the American Society of Hypertension and the Board of Nuclear Cardiology and is a Testamur of the National Board of Echocardiography. She serves on the Board of Directors of the Discovery Foundation and The Cooper Institute.

Interview with Cooper Clinic Head of Cardiology Dr. Nina Radford about Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events

September 18, 2012 2 comments

Dr. Nina Radford, Cooper Clinic

Todd Whitthorne talked with Dr. Nina Radford, about the systematic review and meta-analysis Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events published in the JAMA September 12, 2012, Vol 308, No 10 issue. Click here if you would prefer to listen to the interview.

Todd:  Hello once again this is Todd Whitthorne with another healthy living podcast and I’m joined today by Dr. Nina Radford, the Head of Cardiology for the Cooper Clinic and we’re going to talk about a recent article in JAMA that discussed a meta-analysis of omega-3 as it relates to the cardiovascular benefits.  So Dr. Radford, this can be a rather complicated topic because we’re talking about statistics and scientific research, but I do know we have a very educated and inquisitive listening audience, so let’s walk through this paper because the headlines we’ve seen in the newspapers or heard on the radio basically came out and said that “omega-3, or fish oil, did not show benefit for cardiovascular health.” Can we dig a little deeper and explain really what this paper was investigating, and what the results showed?

Dr. Radford: Absolutely! I’m just delighted to discuss this with you because as we both know, sometimes these very important papers get condensed into a single, simple sentence or headline that may peak an individual’s attention but doesn’t always tell the whole story…, and this paper I think is a good example of that.

So this paper is a meta-analysis, and what that means is it is combining information from multiple studies, and why would you want to do that? Well, if you combine studies together your population will grow, so for example in this meta-analysis they combined the data from 20 studies so it included almost 69,000 patients.  When you have a larger patient population, it’s easier to see small effects that may occur that may be statistically significant. The problem with combining studies is that all studies are a little bit different… the ages of the patient may be different; the formulation of the omega-3 being used may be different; they time they use the omega-3 may be very different; it may be in a different country where native foods are very different for example, from the United States. So, one of the problems is that when you combine studies that are very different, and you reach conclusions from them, your house is sort of built of rickety wood, so you have to be careful in terms of how you interpret it. That being said, what we have are this combination of 20 studies. The median age is 68, and I’ll remind you median means that 50% or below that age, and 50% are above, and in these studies the age range was 49 to 70. In these studies, the median dose of omega-3 was about a gram, and that’s probably less than most people consider taking daily today.

Todd:  I’m sorry. That’s a gram of EPA plus DHA, not a gram of fish oil, correct?

Dr. Radford: That’s correct. And the range was from .53, so half a gram, which most of us would consider on the lower side, to 1.8 grams per day. The treatment duration was about two years and spanned from one to six, and the important thing about these studies is that 13 of the 20 were secondary prevention studies.  What that means is those participants had already been diagnosed with heart disease. They had heart attack, bypass, heart failure, sudden death, stents, but they were not people who were taking it to prevent the first event. Rather, these were people who were put on fish oil to prevent a second cardiovascular event or death. Four of the studies were mixed primary secondary, you couldn’t really sort out which was which, and three of the studies had to do with preventing sudden death in people who had implantable cardiac defibrillators (those are the internal defibrillators that shock you if you have a potentially life-threatening heart rhythm abnormality). So again, these are patients who are older, they have known heart disease, and they’re taking EPA plus DHA at a median of a gram for about two years.

Now, one of the things that we have to remember in all of this is that there’s pretty good reason to think that fish oil may help when we look at basic science. There have been studies that suggest it lowers blood pressure, lowers triglycerides, may stabilize heart rhythms, may reduce the stickiness of the blood to form to form blood clots, so there’s some good rationale from which these studies were conducted, and that’s always sort of reassuring to know there’s some basic science that underlies these. So in this analysis, they looked at five major outcomes  – all cause mortality (that’s the risk of dying of anything); cardiac death (dying of heart attack); they looked at sudden death (which is a heart rhythm abnormality); rather than having a heart attack and then having heart failure, for example; having a nonfatal heart attack; or stroke.

When we look at whether or not a result is statistically significant, we look at something called the P value, and the P value helps us decide if this result that could happen by chance, or is this the result that can withstand rigorous statistical testing? And we rely on that P value as readers of medical science, to let us know yes, that’s statistically significant, or no it’s not.  We don’t just rely on the number that we see, we have to rely on the statistics to back it up, so in this population is that meaningful.

Now, in most studies that I read, a P value of significance is a P value less than 0.05. When you know that the P value is less than that, you know it’s statistically significant. And when we look at that range of P value in this study, there was actually a demonstrated benefit in terms of reducing cardiac death. It reduced it by about 9 percent. Now, what’s made this somewhat controversial is these authors have decided to make a much more limited P value of .0063, and that’s rather usual, and that requires that the effect be more robust if you will, in order to prove that it’s present.

And when we look at studies – for example you may remember testing hormone replacement, and did hormone replacement reduce the risk of death for example? In all of those studies the P value is 0.05. If you look at whether statin medications reduce the risk of dying from heart disease, the P value is 05. So the use of this very, very small P value, is a little unusual and not everybody is accepting it when we look at this study. So certainly, what I would conclude from this study, based on a P value I think is reasonable, is that there is likely a small reduction in cardiac death in the studies of patients who are older and already had advanced heart disease.

One of the things I think is very interesting in this paper is that they provide sort of a chronologic history. They start with studies done in the mid- 1995’s and they go through the studies that were published more recently in 2012.  And what’s interesting is in the studies that were published in the in the mid-to-late 90s until 2005, there was a benefit of omega-3 in terms of all cause mortality. But when you look at the most recent studies that were published in 2010 or 2012 you did not see that effect. So does that mean that the studies that were done early on were wrong? Absolutely not!  What we see is an effect of improving medical science and improving technology. Compared to 1995, patients who are treated after a heart attack today are treated with much more sophisticated medications. Their lipids are much more aggressively lowered compared to patients in 1995, so if I add a therapy like omega-3 fatty acids, which have a small benefit compared to those other therapies, it may be hard to see that benefit unless you have an extraordinarily large number of patients in the trial. And so, I don’t see this as being a call to throw away all your fish oil.  Rather, I see this as a recommendation that there is likely is benefit, but it’s small, compared to the other known therapies that we have for patients treated after a heart attack.  Now let me be very clear that this has no bearing on patients who haven’t heart disease yet; who haven’t had their first heart attack yet. Maybe they have high cholesterol.  Maybe they have a strong family history of developing heart disease and they want to prevent their first event.  This paper doesn’t address population all.

Todd:  Clearly, what’s interesting about omega-3, is that there are literally thousands of studies that have been done looking at the various and assorted benefits and in a variety of areas, but in particular cardiovascular disease.  So for someone healthy, someone that is just looking to improve their overall cardiovascular risk profile, omega-3 still make sense from your perspective as a cardiologist?

Dr. Radford: I think that they definitely ought to be offered to patients. I think that they definitely may have some benefits in terms of reducing death from cardiovascular disease. I think compared to their other therapies, like statin medications or low dose daily aspirin, that effects may be small, but every little bit helps if we’re talking about reducing your risk of dying of heart disease.

Todd:  And that main benefit as we hear so much about inflammation, that seems to be the benefit of omega-3, as an anti-inflammatory?

Dr. Radford: And there may be benefits well beyond that, that we simply don’t have enough knowledge about.

Todd:  Very good. Well Dr. Radford, as always I appreciate your insight.  It’s like going to Paul Harvey for the rest of the story, to break it down and simplify something that is very, very complex, so we appreciate it.

Folks, if you want more information, you can sign up for The Cooperized Newsletter. As always, we’ll keep you updated with whatever we can here on the podcast and on the website. Until next time, this is Todd Whitthorne. Have a great day. Be healthy.

Interview with Cooper Clinic head of cardiology Dr. Nina Radford about HDL Cholesterol

August 27, 2012 3 comments

Todd Whitthorne recently sat down with Dr. Nina Radford, and discussed HDL Cholesterol. Click here if you would prefer to listen to the interview.

Todd:  Hello, and welcome to another Healthy Living podcast from Cooper Aerobics Center. This is Todd Whitthorne, and I’m joined today by Dr. Nina Radford the head of cardiology at the Cooper Clinic, and Dr. Radford we have a topic today that I think is going to interest a lot of our listeners. Generally when it comes to health, we like to distill things down to takeaways, and when it comes to cholesterol we have a tendency to think that LDL is lousy and the HDL is healthy. There’s a recent study published in May of 2012 in the Lancet that says, well maybe raising HDL is not all that beneficial.  What do we need to know about that?

Dr. Radford: Well Todd, that’s a great question. Historically, when we talk about cholesterol parameters, as you described, we look at LDL, and when it’s high it’s bad for us – it increases the risk of heart attack…, and when we look at HDL, if it’s too low, it increases our risk of heart attack. And those are associations – if we look at a group of people who’ve had heart attacks versus a group of people who haven’t, and you find that high LDL is associated with heart attacks and low HDL is associated with heart attack, but that doesn’t necessarily prove causation.

Now with LDL cholesterol, there have been a number of studies that have gone on from “association” to proving “causation,” and how do we do that? Well first we say “Gosh, if high LDL is associated with heart attack, if we lower it with drugs does that lower the risk?”, and in fact there have been many, many studies showing if you lower LDL cholesterol with diet or medication, you reduce the risk of subsequent heart attacks.

They can also look at from another angle, and that is the genetic angle. There are some people who are actually born with genes that cause their LDL to be low. So, they look in those families who have those genes that cause low LDL, and they ask the question “In those families, is there a reduced risk of having a heart attack?”, and in fact there is. So, whether or not your LDL is low because you take medicine, or you follow specific lifestyles, or it’s low because low LDL happens to run in your family…, either way, both of those situations are associated with a lower risk of heart attack. So you make the transition from “association” to “cause.”

Now investigators are trying to do the same thing with HDL. So we say “Gosh, having a low HDL is associated with heart attacks – having a high HDL must be good for you then!” So we look at studies: If I give you a drug that causes your HDL to increase – something like niacin, for example, will that reduce the risk of having heart? And in fact, there was a recent trial called the Aim-High Trial that took patients who already had a low LDL (so that is they were already on medicine to lower their LDL because they have heart disease), but their HDL was low. Researchers treated patients with a drug that causes the HDL to go and see if it would lower their risk of having another heart event even more! The study did not demonstrate any benefit from increasing the HDL with the medication. So, then all of a sudden, people started to wonder if raising HDL is a good thing, “Is high HDL really protective?” because we didn’t see it in this study. So, what these investigators did in the Lancet study was they looked at people who have a genetic cause of having high HDL – they had genes that ran in their family that actually blessed them with very HDL levels.

Todd:  Dr. Cooper calls that the Methuselah factor. I’ve heard him say that many times.

Dr. Radford: They’re just lucky they were born with a high HDL. Investigators looked at 21,000 people in one study and 12,000 people in another group, so they combined those groups and were looking at over 30,000 individuals who had this gene, and they predicted that the risk of having a heart attack should be lower in these people because they have HDL, and in fact they did not see that the risk was lower.

So here we have this Genetic Study, right on the heels of this Drug Trial, and all a sudden people are saying “Hey, I thought having a high HDL was good for you! What’s going on here?” Well, you have to be careful about dismissing decades of historical data based on a couple of studies.

For example, in this study where they gave a drug to increase the HDL to see if it would reduce risk, well we know that LDL, the bad cholesterol, is a bigger driver of risk than HDL. So if I lower your LDL and get it super low with a drug, plus you’re on an aspirin, and an ACE inhibitor, and fish oil, and you’re meditating, and you’re doing all the right things…, and on top of all those really good things, I add another good thing, it may be that the effect is not big enough that you can see it. Because you’re doing six other good things, and when you add the seventh the benefit isn’t big enough. And so, that may be part of.

But then when you look at this Genetics Study, and you add it to the Drug Study, what’s the story? Well, the story is this: It may be that having a high HDL is a marker for some other thing that you’re doing that’s good. So, for example, we know that if you want to increase your HDL and you exercise, you can do it. But what if exercise causes another thing to happen? So, and I’m going to make it up….. Let’s say exercise increases your “Todd” factor. So, if you’re a regular exerciser, your “Todd” factor goes sky high. Now, your HDL also goes sky high, and we can measure the HDL, but we don’t know how to measure the “Todd” factor.

Todd:  At least not yet!

Dr. Radford: So, it may be that HDL is kind of going along for the ride and the real benefit of exercise is the “Todd” factor that we’re not smart enough to measure yet. So, that’s what we’re not clear about.

Now, should you stop doing things we know will raise HDL? Like being at your ideal body weight, taking some fish oil, exercising regularly? Absolutely not! But whether or not you should take medications to raise your HDL, beyond the other good heart healthy things that you’re doing, is not clear, and what most physicians are doing is taking it on a case-by-case basis.

If you’re taking a medication to raise your HDL don’t stop it, because we’ve only got that one Trial that’s raised some questions…, but it’s a good thing to ask your doctor when you see them next. You’re reviewing all your meds – it’s a good thing to do every year – and say you’re taking this for your blood pressure, taking this for cholesterol, this for prostate, this to make your hair shiny, etc. Every year you’ll want to look at all those meds and talk with your doctor and say “Do I need to take each of these (medications)?” And, if you happen to be on a drug for raising HDL, it’s a good time to review (taking it) and decide if you still need it.

Todd:  So, where are we from your perspective – historically, it’s the question that comes up all the time – “Is at HDL? Is it LDL? Is it the combination, that atherogenic index, of total cholesterol divided by HDL?” Dr. Nina Radford, head of cardiology at the Cooper Clinic, what you think is the most important component? Or, is there a magic number we need to be thinking about, as the average patient?

Dr. Radford: Well, that is a great question! It depends a little bit on what your other risk factors are; what your age is; and what your gender is. So, for example, compared to men, HDL is probably a bigger driver of risk in women. But that has to do with probably differences in our hormones. LDL is still a driver of risk in women – it doesn’t mean you can willy-nilly have your LDL be high and super size your fries, but it looks like some studies suggest in women before they’re had their first heart attack or heart disease HDL is a big driver of risk.

In men, LDL appears to be a bigger driver. When you talk about patients who already had their first heart attack; had a stent; have heart disease…, LDL is a very big driver of risk, and needs to be very specifically controlled.

Todd:  In both men and women?

Dr. Radford: Absolutely! In both genders! So it depends a little bit on the age and the clinical background in terms of which factors I’ll be more concerned about.

Todd:  So the takeaway is case-by-case, patient-by-patient, one size does not fit all?

Dr. Radford: Absolutely.

Todd:  Very good. Dr. Nina Radford, the head of cardiology at Cooper Clinic, great information as always! We appreciate your time Dr. Radford.

Folks, if you want more information, you can always sign up for the Get Cooperized Newsletter. We’ll have more podcasts in the very near future. Stay with us. We’ll see you soon.