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'Trying to make people better consumers'
May 2010
PORTLAND, OR - Kaiser Health News noted workers at a steel mill here soon will be able to pick a new insurance type that offers free care for some ills, such as diabetes or depression, but requires hefty extra fees for treatments seen overused, including knee replacements, hysterectomies, and heart bypass surgery.
The plan, to be offered by five Oregon insurers, is the most far-reaching and potentially controversial step in a plan by U.S. employers to rein in medical costsd by redesigning health benefits.
"We’re trying to make people better consumers," says John Worcester, head of benefits at Evraz Oregon Steel, the sole employer to sign up since the plans went on the market earlier this year.
Workers who choose the option over a more traditional plan next year could see their costs drop sharply if they have one of six chronic woes but might pay much more in deductibles and co-payments if they need a hip replacement or heart stent.
The policies are among the first to apply financial incentives on both sides of a factor driving up the healthcare tab: underuse of proven treatments and overuse of some surgeries and diagnostic tests that may be less valuable.
MEMPHIS - MedPage Today stated intensive blood pressure and lipid control does little for high cardiovascular risk in diabetes, suggests the ACCORD study. Using a blood pressure target of 120mm Hg versus the general standard of 140 didn’t cut the primary outcome of nonfatal MI, nonfatal stroke, and death from cardiovascular causes (1.87% versus 2.09% per year), reported Dr. William Cushman, of the VA Medical Center in Memphis. Likewise, adding fenofibrate to standard statin therapy didn’t cut the major adverse cardiovascular events (2.24% versus 2.41% per year), said Dr. Henry Ginsberg, of Columbia University in New York. Both studies, part of the complex Action to Control Cardiovascular Risk in Diabetes trial, were offered at the American College of Cardiology meeting and online at the New England Journal of Medicine. The intensive glucose lowering part of the trial was halted in 2008 due to 22% excess mortality with a near normal blood glucose target of 6% hemoglobin A1c.
ATLANTA - The Wall Street Journal reported pneumonia and sepsis, infections which often are preventable with tight hospital infection controls, killed 48,000 patients and added $8.1 billion to healthcare costs in 2006, a study in the Archives of Internal Medicine found. Scientists studied 69 million hospital discharge records in 40 states 1998-2006; the length of stay and mortality rates for the infections didn’t change substantially over time, the study noted, and high infection rates persist. The news, principal investigator Ramanan Laxminarayan told the Health Blog, is the study for the first time links about half of all infection deaths directly to infections acquired in the hospital in the course of care. While the U.S. Centers for Disease Control and Prevention (CDC) estimates there are 1.7 million hospital infections and 99,000 associated deaths yearly, Laxminarayan says, those numbers don’t calculate deaths caused by, rather than merely tied to infections patients get in the hospital. The CDC figures also are based on voluntary reports by hospitals, while this study is based on data about patient diagnosis, hospital treatment, and exposure to infections prior to hospital admission.
BIRMINGHAM, AL - African-Americans 65 and younger are more than twice as likely to have a stroke versus Caucasians in any region. Those in the South with a stroke are more likely to die than elsewhere, scientists at the University of Alabama/Birmingham School of Public Health found. Findings are from UAB's Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, one of the largest ongoing health studies. This report is among the first to show major regional and racial disparities in stroke rates. It underscores the need for targeted stroke prevention and care strategies in those at greatest risk, said Virginia Howard, Ph.D., a UAB associate professor of epidemiology and a REGARDS investigator. "This is the first study to take national data and really lay it out on the table," Howard said. "We found in the 45-54 group that blacks have a 2.5-fold greater stroke rate compared to whites, which is startling." The study shows a stroke rate greater than 12% higher in eight states known as the Stroke Belt - Alabama, Arkansas, Georgia, Louisiana, Mississippi, North and South Carolina, and Tennessee - with the highest stroke rate in Georgia, North and South Carolina.
BUFFALO, NY - Smokers who have Multiple Sclerosis (MS) may be at higher risk of brain shrinkage and more brain lesions related to MS, notes a study in the journal Neurology. Smoking is linked to a greater risk of MS. Scientists studied 368 people in New York with an average age of 44 with MS for an average of 12 years. They underwent brain scans and were asked about their smoking history. Of the group, 240 were non-smokers, 96 current smokers, and 32 past smokers. Current smokers were people who smoked more than 10 cigarettes daily in the three months prior to the study; past smokers smoked for at least six months sometime before the start of the study. The study found smokers with MS had a greater breakdown of the barrier between the brain and blood and had nearly 17% more brain lesions on their scans versus non-smokers with MS. Smokers with MS had 13% larger ventricles and a smaller brain size versus non-smokers with MS. "These results show smoking appears to quite literally injure the brain in a person with (MS) and increases the risk of disease severity and progression," said study author Dr. Robert Zivadinov, associate professor with State University of New York School of Medicine.
DALLAS - Taking the most commonly-prescribed anti-diabetic drug, Metformin, cuts the risk of getting pancreatic cancer by 62%, states a study from the University of Texas’ M. D. Anderson Cancer Center in the journal Gastroenterology. "This is the first epidemiological study of Metformin in the cancer population, and it offers an exciting direction for chemoprevention research for a disease greatly in need of treatment and prevention strategies," said Dr. Donghui Li, professor in the Dept. of Gastrointestinal Medical Oncology. An oral drug, Metformin is used for type 2 diabetes. Li says more than 35 million prescriptions for the drug are filled annually, and it's most often given to type 2 diabetics who are obese and/or have insulin resistance. "Metformin works by increasing the cellular sensitivity to insulin and decreasing its level circulating in diabetics. Insulin also seems to have a growth-promoting effect in cancer," said Li, the study's senior author.
SAN DIEGO - HealthDay News noted heavy drinking can alter ability to recognize other people's facial emotions, a study found. Scientists used functional MRI to monitor brain activity in 15 abstinent long-term alcoholics while they looked at images of faces with positive or negative emotional expressions. The brain scans revealed lower activation in the amygdala and hippocampus, brain regions used for processing facial emotions. The inability to judge emotional expressions "can result in miscommunication during emotionally-charged situations and lead to unnecessary conflicts and difficulties in interpersonal relationships. Negative repercussions can contribute to increased drinking," study author Ksenija Marinkovic, assistant professor in the radiology department at the University of California said. A news release from Alcoholism: Clinical & Experimental Research published the findings.
SEATTLE - The Health Behavior News Service noted a study found doctors, like most people who responded, subconsciously prefer whites to blacks, which can affect their ability to provide equal healthcare to minority patients. "The biggest take home is doctors’ unconscious stereotypes may affect quality of care, and greater self-awareness may be a way to address any effects unconscious attitudes may have on behaviors that lead to healthcare disparities," said lead author Janice Sabin. She’s acting assistant professor, Dept. of Medical Education /Biomedical Informatics at the University of Washington. The Institute of Medicine found minorities still get lower quality of care, and doctors’ biases and this study suggest inferior care and stereotypes might be related. In the study in the Journal of Health Care for the Poor and Underserved, Sabin and her team used data from 404,277 people who took a test online that measured race attitudes 2004-2006. Of the test-takers, 2,535 were medical doctors of both sexes and diverse racial groups. Researchers found the majority of doctors showed implicit preference for white Americans versus black Americans. Black doctors were the exception because they, on average, didn’t favor either group.
NAPLES, ITALY - MedPage Today noted the Mediterranean diet - rich in nuts, whole grains, fruits, and veggies - cuts the likelihood patients recently diagnosed with type 2 diabetes will need antihyperglycemic drugs. A study funded by the Second University of Naples found among diabetics who ate a Mediterranean-style diet, only 44% needed antihyperglycemic drugs versus 70% of patients who ate a standard low-fat diet. The report in the Archives of Internal Medicine stated patients on the Mediterranean diet lost more weight and had greater gains in blood sugar control and coronary risk measures than those on the low-fat diet. "A Mediterranean diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly-diagnosed type 2 diabetes," Dr. Dario Giugliano, of Second University, and his team. Despite these findings, authors suggested drug therapy would still be a primary weapon in the battle against type 2 diabetes as the number of cases grows to 380 million cases worldwide by 2025, estimates cited in the paper project.
JACKSONVILLE, FLA. - Mayo Clinic scientists and their global team found a single gene promotes essential tremor in some patients, Parkinson's disease in others. These are common but distinct neurological disorders. Notably, patients with essential tremor shake when they move, Parkinson's patients shake when they’re at rest. In Parkinsonism & Related Disorders, scientists report a variant in LINGO1, a gene involved in neuronal survival, is the first proven evidence of a common genetic component in developing both disorders. Based on the findings, mutations in this gene are potentially responsible for 5% of patients with Parkinson's, and 5% of patients with essential tremor, says study lead investigator, Dr. Carles Vilariño-Güell, of Mayo Clinic. "There is a mutation in the gene that must be causing/contributing to Parkinson's in some people and essential tremor in others," he says. That doesn’t mean, however, that people who have essential tremor have a higher risk of Parkinson's. Essential tremor is the most common movement disorder, affecting 4% of the population over 40, or about five million people in the U.S. Parkinson's is seen in 2% of people over 65, and more than 500,000 patients in the U.S. have it.
NORWICH, ENGLAND - HealthDay News disclosed fruit may have more beneficial antioxidants than previously thought. A study done on apples, peaches, and nectarines found these fruits hold up to five times more polyphenols, chemical substances believed to yield disease-fighting properties, than scientists thought. Institute of Food Research scientists studied previously-ignored nonextractable polyphenols, ones in fruit cells which can’t be broken down and measured as easily as the "extractable polyphenols" scientists usually study. "These polyphenols need to be treated with acid to extract them from the cell walls of fruit in the lab," said Sara Arranz, of the Spanish Council for Scientific Research in Madrid. "If non-extractable polyphenols aren’t considered, the levels of beneficial polyphenols such as proanthocyanidins, ellagic acid, and catechin are substantially underestimated." This study was online at the Journal of Agricultural and Food Chemistry.
CHAPEL HILL, NC - In laying down the developing brain‘s neural circuitry, billions of neurons must go to their correct destinations and form complex synaptic connections with their new neighbors. ScienceDaily disclosed that when the process goes awry, neurodevelopmental disorders such as mental retardation, dyslexia, or Autism may result. University of North Carolina/Chapel Hill School of Medicine scientists found that establishing the neural wiring needed to function normally depends on the ability of neurons to make finger-like projections of their membrane called filopodia. The finding in the journal Cell, indicates the current notion as to how cells change shape, migrate, or differentiate needs revision.
LOS ANGELES - Medical News Today noted scientists at Cedars-Sinai Medical Center's Maxine Dunitz Neurosurgical Institute isolated stem-like cells in benign (pituitary) tumors and used these "mother" cells to generate new tumors in lab mice. Targeting cells of origin is seen as a possible strategy in the fight against malignant and benign tumors. Scientists from Cedars-Sinai's departments of Neurosurgery, Pathology and Laboratory Medicine, and Surgery participated in the studies, funded partly by the U.S. National Institutes of Health and the Italian Association for Neurological Research. Cells generated from the pituitary tumor cells had the same genetic makeup and characteristics as the original tumors and were capable of generating new tumors, states an article in the British Journal of Cancer. Normal stem cells are able to self-renew and the potential to "differentiate" into any of several types of cells. Tumor stem-like cells seem to have the same self-renewing and multipotent properties, but instead of producing healthy cells, they propagate tumor cells.
BOSTON - MedPage Today noted cancer patients surviving at least five years are substantially more likely to show signs of serious psychological distress than other people, scientists found. Serious distress was seen 40% more frequently among long-term survivors versus people never diagnosed with cancer, said Dr. Karen Hoffman, of Brigham and Women's Hospital, and colleagues. "Prompt diagnosis and treatment of mental distress can have a positive impact on functioning, quality of life, and overall well-being of survivors," they wrote in Archives of Internal Medicine. "The increased risk of serious psychosocial distress and the need to screen for [it] should be communicated to primary care physicians and other care providers," they added. Findings came from an analysis of answers of nearly 127,000 participants in the National Health Interview Survey, done 2002-2006 by the U.S. Census Bureau.
NEW YORK - Prevention Magazine resident cardiologist Dr. Arthur Agatston says the first query for patients when they enter his office is: "How’s traffic?" Being stuck in traffic lifts blood pressure and triples heart attack risk. If a patient had a tough trip and BP is up, he’ll recheck later. Other situations/times when risk jumps: It soars 40% in the a.m., Harvard scientists figure. Your body secretes adrenaline, other stress hormones, raising BP and demand for oxygen. Your blood is thicker, harder to pump due to lack of fluid. Wake up slowly, exercise after thorough warm-up. On Monday a.m. especially, 21% more heart attacks occur probably due to stress/depression about return to work. Relax Sunday, but don’t sleep in. Getting up early Monday after sleeping late Saturday and Sunday can raise BP even more because your body is fatigued and its natural rhythms are out of whack. A five-course, calories-be-damned dinner can have an immediate impact on your heart health. If you must indulge, keep portion sizes reasonable. A daily aspirin will help prevent blood "stickiness."
MEMPHIS - MedPage Today stated intensive blood pressure and lipid control does little for high cardiovascular risk in diabetes, suggests the ACCORD study. Using a blood pressure target of 120mm Hg versus the general standard of 140 didn’t cut the primary outcome of nonfatal MI, nonfatal stroke, and death from cardiovascular causes (1.87% versus 2.09% per year), reported Dr. William Cushman, of the VA Medical Center in Memphis. Likewise, adding fenofibrate to standard statin therapy didn’t cut the major adverse cardiovascular events (2.24% versus 2.41% per year), said Dr. Henry Ginsberg, of Columbia University in New York. Both studies, part of the complex Action to Control Cardiovascular Risk in Diabetes trial, were offered at the American College of Cardiology meeting and online at the New England Journal of Medicine. The intensive glucose lowering part of the trial was halted in 2008 due to 22% excess mortality with a near normal blood glucose target of 6% hemoglobin A1c.
ATLANTA - The Wall Street Journal reported pneumonia and sepsis, infections which often are preventable with tight hospital infection controls, killed 48,000 patients and added $8.1 billion to healthcare costs in 2006, a study in the Archives of Internal Medicine found. Scientists studied 69 million hospital discharge records in 40 states 1998-2006; the length of stay and mortality rates for the infections didn’t change substantially over time, the study noted, and high infection rates persist. The news, principal investigator Ramanan Laxminarayan told the Health Blog, is the study for the first time links about half of all infection deaths directly to infections acquired in the hospital in the course of care. While the U.S. Centers for Disease Control and Prevention (CDC) estimates there are 1.7 million hospital infections and 99,000 associated deaths yearly, Laxminarayan says, those numbers don’t calculate deaths caused by, rather than merely tied to infections patients get in the hospital. The CDC figures also are based on voluntary reports by hospitals, while this study is based on data about patient diagnosis, hospital treatment, and exposure to infections prior to hospital admission.
BIRMINGHAM, AL - African-Americans 65 and younger are more than twice as likely to have a stroke versus Caucasians in any region. Those in the South with a stroke are more likely to die than elsewhere, scientists at the University of Alabama/Birmingham School of Public Health found. Findings are from UAB's Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, one of the largest ongoing health studies. This report is among the first to show major regional and racial disparities in stroke rates. It underscores the need for targeted stroke prevention and care strategies in those at greatest risk, said Virginia Howard, Ph.D., a UAB associate professor of epidemiology and a REGARDS investigator. "This is the first study to take national data and really lay it out on the table," Howard said. "We found in the 45-54 group that blacks have a 2.5-fold greater stroke rate compared to whites, which is startling." The study shows a stroke rate greater than 12% higher in eight states known as the Stroke Belt - Alabama, Arkansas, Georgia, Louisiana, Mississippi, North and South Carolina, and Tennessee - with the highest stroke rate in Georgia, North and South Carolina.
BUFFALO, NY - Smokers who have Multiple Sclerosis (MS) may be at higher risk of brain shrinkage and more brain lesions related to MS, notes a study in the journal Neurology. Smoking is linked to a greater risk of MS. Scientists studied 368 people in New York with an average age of 44 with MS for an average of 12 years. They underwent brain scans and were asked about their smoking history. Of the group, 240 were non-smokers, 96 current smokers, and 32 past smokers. Current smokers were people who smoked more than 10 cigarettes daily in the three months prior to the study; past smokers smoked for at least six months sometime before the start of the study. The study found smokers with MS had a greater breakdown of the barrier between the brain and blood and had nearly 17% more brain lesions on their scans versus non-smokers with MS. Smokers with MS had 13% larger ventricles and a smaller brain size versus non-smokers with MS. "These results show smoking appears to quite literally injure the brain in a person with (MS) and increases the risk of disease severity and progression," said study author Dr. Robert Zivadinov, associate professor with State University of New York School of Medicine.
DALLAS - Taking the most commonly-prescribed anti-diabetic drug, Metformin, cuts the risk of getting pancreatic cancer by 62%, states a study from the University of Texas’ M. D. Anderson Cancer Center in the journal Gastroenterology. "This is the first epidemiological study of Metformin in the cancer population, and it offers an exciting direction for chemoprevention research for a disease greatly in need of treatment and prevention strategies," said Dr. Donghui Li, professor in the Dept. of Gastrointestinal Medical Oncology. An oral drug, Metformin is used for type 2 diabetes. Li says more than 35 million prescriptions for the drug are filled annually, and it's most often given to type 2 diabetics who are obese and/or have insulin resistance. "Metformin works by increasing the cellular sensitivity to insulin and decreasing its level circulating in diabetics. Insulin also seems to have a growth-promoting effect in cancer," said Li, the study's senior author.
SAN DIEGO - HealthDay News noted heavy drinking can alter ability to recognize other people's facial emotions, a study found. Scientists used functional MRI to monitor brain activity in 15 abstinent long-term alcoholics while they looked at images of faces with positive or negative emotional expressions. The brain scans revealed lower activation in the amygdala and hippocampus, brain regions used for processing facial emotions. The inability to judge emotional expressions "can result in miscommunication during emotionally-charged situations and lead to unnecessary conflicts and difficulties in interpersonal relationships. Negative repercussions can contribute to increased drinking," study author Ksenija Marinkovic, assistant professor in the radiology department at the University of California said. A news release from Alcoholism: Clinical & Experimental Research published the findings.
SEATTLE - The Health Behavior News Service noted a study found doctors, like most people who responded, subconsciously prefer whites to blacks, which can affect their ability to provide equal healthcare to minority patients. "The biggest take home is doctors’ unconscious stereotypes may affect quality of care, and greater self-awareness may be a way to address any effects unconscious attitudes may have on behaviors that lead to healthcare disparities," said lead author Janice Sabin. She’s acting assistant professor, Dept. of Medical Education /Biomedical Informatics at the University of Washington. The Institute of Medicine found minorities still get lower quality of care, and doctors’ biases and this study suggest inferior care and stereotypes might be related. In the study in the Journal of Health Care for the Poor and Underserved, Sabin and her team used data from 404,277 people who took a test online that measured race attitudes 2004-2006. Of the test-takers, 2,535 were medical doctors of both sexes and diverse racial groups. Researchers found the majority of doctors showed implicit preference for white Americans versus black Americans. Black doctors were the exception because they, on average, didn’t favor either group.
NAPLES, ITALY - MedPage Today noted the Mediterranean diet - rich in nuts, whole grains, fruits, and veggies - cuts the likelihood patients recently diagnosed with type 2 diabetes will need antihyperglycemic drugs. A study funded by the Second University of Naples found among diabetics who ate a Mediterranean-style diet, only 44% needed antihyperglycemic drugs versus 70% of patients who ate a standard low-fat diet. The report in the Archives of Internal Medicine stated patients on the Mediterranean diet lost more weight and had greater gains in blood sugar control and coronary risk measures than those on the low-fat diet. "A Mediterranean diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly-diagnosed type 2 diabetes," Dr. Dario Giugliano, of Second University, and his team. Despite these findings, authors suggested drug therapy would still be a primary weapon in the battle against type 2 diabetes as the number of cases grows to 380 million cases worldwide by 2025, estimates cited in the paper project.
JACKSONVILLE, FLA. - Mayo Clinic scientists and their global team found a single gene promotes essential tremor in some patients, Parkinson's disease in others. These are common but distinct neurological disorders. Notably, patients with essential tremor shake when they move, Parkinson's patients shake when they’re at rest. In Parkinsonism & Related Disorders, scientists report a variant in LINGO1, a gene involved in neuronal survival, is the first proven evidence of a common genetic component in developing both disorders. Based on the findings, mutations in this gene are potentially responsible for 5% of patients with Parkinson's, and 5% of patients with essential tremor, says study lead investigator, Dr. Carles Vilariño-Güell, of Mayo Clinic. "There is a mutation in the gene that must be causing/contributing to Parkinson's in some people and essential tremor in others," he says. That doesn’t mean, however, that people who have essential tremor have a higher risk of Parkinson's. Essential tremor is the most common movement disorder, affecting 4% of the population over 40, or about five million people in the U.S. Parkinson's is seen in 2% of people over 65, and more than 500,000 patients in the U.S. have it.
NORWICH, ENGLAND - HealthDay News disclosed fruit may have more beneficial antioxidants than previously thought. A study done on apples, peaches, and nectarines found these fruits hold up to five times more polyphenols, chemical substances believed to yield disease-fighting properties, than scientists thought. Institute of Food Research scientists studied previously-ignored nonextractable polyphenols, ones in fruit cells which can’t be broken down and measured as easily as the "extractable polyphenols" scientists usually study. "These polyphenols need to be treated with acid to extract them from the cell walls of fruit in the lab," said Sara Arranz, of the Spanish Council for Scientific Research in Madrid. "If non-extractable polyphenols aren’t considered, the levels of beneficial polyphenols such as proanthocyanidins, ellagic acid, and catechin are substantially underestimated." This study was online at the Journal of Agricultural and Food Chemistry.
CHAPEL HILL, NC - In laying down the developing brain‘s neural circuitry, billions of neurons must go to their correct destinations and form complex synaptic connections with their new neighbors. ScienceDaily disclosed that when the process goes awry, neurodevelopmental disorders such as mental retardation, dyslexia, or Autism may result. University of North Carolina/Chapel Hill School of Medicine scientists found that establishing the neural wiring needed to function normally depends on the ability of neurons to make finger-like projections of their membrane called filopodia. The finding in the journal Cell, indicates the current notion as to how cells change shape, migrate, or differentiate needs revision.
LOS ANGELES - Medical News Today noted scientists at Cedars-Sinai Medical Center's Maxine Dunitz Neurosurgical Institute isolated stem-like cells in benign (pituitary) tumors and used these "mother" cells to generate new tumors in lab mice. Targeting cells of origin is seen as a possible strategy in the fight against malignant and benign tumors. Scientists from Cedars-Sinai's departments of Neurosurgery, Pathology and Laboratory Medicine, and Surgery participated in the studies, funded partly by the U.S. National Institutes of Health and the Italian Association for Neurological Research. Cells generated from the pituitary tumor cells had the same genetic makeup and characteristics as the original tumors and were capable of generating new tumors, states an article in the British Journal of Cancer. Normal stem cells are able to self-renew and the potential to "differentiate" into any of several types of cells. Tumor stem-like cells seem to have the same self-renewing and multipotent properties, but instead of producing healthy cells, they propagate tumor cells.
BOSTON - MedPage Today noted cancer patients surviving at least five years are substantially more likely to show signs of serious psychological distress than other people, scientists found. Serious distress was seen 40% more frequently among long-term survivors versus people never diagnosed with cancer, said Dr. Karen Hoffman, of Brigham and Women's Hospital, and colleagues. "Prompt diagnosis and treatment of mental distress can have a positive impact on functioning, quality of life, and overall well-being of survivors," they wrote in Archives of Internal Medicine. "The increased risk of serious psychosocial distress and the need to screen for [it] should be communicated to primary care physicians and other care providers," they added. Findings came from an analysis of answers of nearly 127,000 participants in the National Health Interview Survey, done 2002-2006 by the U.S. Census Bureau.
NEW YORK - Prevention Magazine resident cardiologist Dr. Arthur Agatston says the first query for patients when they enter his office is: "How’s traffic?" Being stuck in traffic lifts blood pressure and triples heart attack risk. If a patient had a tough trip and BP is up, he’ll recheck later. Other situations/times when risk jumps: It soars 40% in the a.m., Harvard scientists figure. Your body secretes adrenaline, other stress hormones, raising BP and demand for oxygen. Your blood is thicker, harder to pump due to lack of fluid. Wake up slowly, exercise after thorough warm-up. On Monday a.m. especially, 21% more heart attacks occur probably due to stress/depression about return to work. Relax Sunday, but don’t sleep in. Getting up early Monday after sleeping late Saturday and Sunday can raise BP even more because your body is fatigued and its natural rhythms are out of whack. A five-course, calories-be-damned dinner can have an immediate impact on your heart health. If you must indulge, keep portion sizes reasonable. A daily aspirin will help prevent blood "stickiness."