Lee Kirksey, MD  
Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Your Waist Size Predicts Heart Attack Risk

Apr 25, 2009 - 7 comments



Weight gain


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Thyroid problem


Polycystic Ovarian syndrome


insulin resistance

I was reviewing a recent paper on the associations of BMI, waist size and hip to waist ration as predictors of heart attack risk. It turns out that your hip size may have the closest correlation. Currently in the US, 70% of men and 65% of women are obese (BMI) >25.5. As we look to give people simpler ways of self-assessing their heart attack and stroke risk, waist circumference is one simple way to do this. Read on to learn why abdominal fat is a bad thing. As it turns out, those love handles may be cute...but they may also be deadly

According to several recent studies, both waist size and the waist to hip ratio may be better indicators of heart disease risk than the traditional Body Mass Index (BMI).

The American Heart Association (AHA) recommends that people aim for a BMI of between 18.5 and 24.9 however most Americans have a BMI well above this range. Approximately 70% of American men and 60% of American women have a BMI greater than 25 and around 35% of Americans have a BMI greater than 30 (these individuals fall into the obese category). The proportion of Americans with a BMI over 25 has more than doubled over the last 30 years.

The major drawback of BMI is that it does not take into account a persons body composition. An athlete or body builder for example may have little body fat and yet have a BMI well over 25 due to the large amount of muscle they carry.

Waist size on the other hand gives a good indication of the amount of fat a person is carrying, particularly around the stomach area. Abdominal fat is considered an important risk factor for cardiovascular diseases such as coronary heart disease and stroke. Abdominal fat is also a risk factor for diabetes because it leads to a reduction in the body’s response to insulin which results in larger amounts of insulin needing to be secreted by the pancreas to control blood sugar levels. This eventually leads to insulin resistance and the onset of type-2 diabetes.

Most doctors recommend a waist size of under 37 inches (84 cm) for men and 32 inches (81 cm) for women. As of 2008, the average American man has a waist size of around 40 inches, an increase of 5 inches compared to 40 years ago. The average American woman has a waist size of 37 inches, an increase of 7 inches over the last 40 years.

One study, presented at the annual conference of the American College of Cardiology in Atlanta, found that a 14 cm increase in waist size correlated to around a 30% increase in heart disease risk. The data was collected from over 160,000 individuals in 63 countries and represents one of the largest studies on the effects of waist size on heart disease.

A study of post-menopausal women conducted at the Washington University School of Medicine also found that the correlation between waist size and three different heart disease risk factors: insulin sensitivity, HDL-cholesterol, and triglyceride levels was stronger than the correlation between BMI and the three risk factors. The authors of the study concluded that waist circumference was a better measure of heart disease risk than BMI in middle aged and older women.

Recently, it has been suggested that the waist to hip ratio is a better predictor of heart disease than either BMI or waist size alone. The waist to hip ratio is calculated by dividing the circumference of the waist at its smallest point by the circumference of the hips at their widest point. An optimal waist to hip ratio is less than 0.8 in women and 0.9 in men.

A study, published in the American Journal of Epidemiology in 1998, found the waist to hip ratio to be a far better predictor of heart disease than BMI.

Red Meat- A Heart Attack Waiting!!

Apr 09, 2009 - 20 comments

heart attack risk



The findings appear in Monday's Archives of Internal Medicine.

Over 10 years, eating the equivalent of a quarter-pound hamburger daily gave men in the study a 22 percent higher risk of dying of cancer and a 27 percent higher risk of dying of heart disease. That's compared to those who ate the least red meat, just 5 ounces per week.

A recently published study in the Archives of Internal Medicine confirmed what an increasing number of studies show.
Individuals who eat a diet high in animal fats like hamburger and processed meats like cold cuts, hot dogs and bacon have a greater risk of heart attack. It is not rocket science to suggest that if one eats a large amount of cholesterol-the body cannot rid itself of all of that fat. As a person who grew up in the midwest on meat and potatoes- I understand that this information may not be welcome news.  However, I think despite what the powerful meat industry tells us, the writing is on the wall. Eat meat in moderation and ones chance of living longer is increased.

Here are some exerpts from the study

Women who ate large amounts of red meat had a 20 percent higher risk of dying of cancer and a 50 percent higher risk of dying of heart disease than women who ate less.

For processed meats, the increased risks for large quantities were slightly lower overall than for red meat. The researchers compared deaths in the people with the highest intakes to deaths in people with the lowest to calculate the increased risk.

People whose diets contained more white meat like chicken and fish had lower risks of death.

The researchers surveyed more than 545,000 people, ages 50 to 71 years old, on their eating habits, then followed them for 10 years. There were more than 70,000 deaths during that time.

So put down the steak and grab yourself a chicken breast or fresh water salmon. Your heart will thank you later


DVT Awareness Month

Mar 07, 2009 - 14 comments



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March is DVT (Deep Venous Thromboses) awareness month. A time to educate and inform the public about the risk factors, prevention, identification and treatment of this preventable and potentially fatal process. DVT, simply put, is a blood clot that develops in a deep vein of the body. The most harmful consequence of the development of DVT is that pieces of the clot can break off and migrate to the heart or lungs causing acute difficulty breathing and overwhelming stress on the heart. The following lists some of the commonly asked questions

What is Deep Vein Thrombosis (DVT)?

Deep vein thrombosis, commonly referred to as "DVT", occurs when a blood clot, or thrombus, develops in the large veins of the legs or pelvic area. Some DVT’s may cause no pain, whereas others can be quite painful. With prompt diagnosis and treatment, the majority of DVT’s are not life threatening. However, a blood clot that forms in the invisible "deep veins" can be an immediate threat to your life, as compared to a clot that forms in the visible "superficial" veins, the ones beneath your skin. A clot that forms in the large, deep veins is more likely to break free and travel through the vein. It is then called an embolus. When an embolus travels from the legs or pelvic areas and lodges in a lung artery, the condition is known as a "pulmonary embolism," or PE, a potentially fatal condition if not immediately diagnosed and treated.

What are the causes of DVT?
Generally, a DVT is caused by a combination of two or three underlying conditions:

slow or sluggish blood flow through a deep vein
a tendency for a person’s blood to clot quickly
irritation or inflammation of the inner lining of the vein.
There are a variety of settings in which this clotting process can occur. First, individuals on bed rest (such as during or after a surgical procedure or medical illness, such as heart attack or stroke), or confined and unable to walk (such as during prolonged air or car travel) are common settings. It can occur in certain families in whom there is a history of parents or siblings who have suffered from prior blood clots. It can also occur in individuals whom active cancer or its treatment may predispose the blood to clotting.

Having a recent major surgical procedure, especially a hip and knee orthopedic surgeries or those requiring prolonged bed rest, predispose the blood to clotting. Irritation or inflammation occurs when a leg vein is injured by a major accident or medical procedure.

Also, there are specific medical conditions that may increase your risk of developing a DVT via these three mechanisms, such as congestive heart failure, severe obesity, chronic respiratory failure, a history of smoking, varicose veins, pregnancy and estrogen treatment. If you are concerned that you may be at risk due to any of these conditions, please consult with your physician.

Helpful Ways to Avoid Medical Errors

Feb 20, 2009 - 20 comments

medical errors


Heart Attack




medication errors


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university of pennsylvania

I sit on an advisory board for our state that focuses on medical errors. Medical errors can occur in many forms including  prescribing medications in people with allergies, wrong dosages, wrong site surgery and many others. Most of the problems occur do to systems errors more so than do to the incompetence of a single individuals.

I recently had surgery on my ankle and I was quite concerned with this issue. I thought it might be helpful to post some ways that a patient or family member of a patient might be able to minimize the chance of a medical error occuring

What Can You Do? Be Involved in Your Health Care

1.   The single most important way you can help to prevent errors is to be an active member of your health care team.
That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Some specific tips, based on the latest scientific evidence about what works best, follow.

2.   Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.
At least once a year, bring all of your medicines and supplements with you to your doctor. "Brown bagging" your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.

3.   Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
This can help you avoid getting a medicine that can harm you.

4.   When your doctor writes you a prescription, make sure you can read it.
If you can't read your doctor's handwriting, your pharmacist might not be able to either.

5.   Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.
What is the medicine for?
How am I supposed to take it, and for how long?
What side effects are likely? What do I do if they occur?
Is this medicine safe to take with other medicines or dietary supplements I am taking?
What food, drink, or activities should I avoid while taking this medicine?

6.   When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?
A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.

7.   If you have any questions about the directions on your medicine labels, ask.
Medicine labels can be hard to understand. For example, ask if "four doses daily" means taking a dose every 6 hours around the clock or just during regular waking hours.

8.   Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you're not sure how to use it.
Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.

9.   Ask for written information about the side effects your medicine could cause.
If you know what might happen, you will be better prepared if it does—or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.

Hospital Stays
10.   If you have a choice, choose a hospital at which many patients have the procedure or surgery you need.
Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.

11.   If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands.
Handwashing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A recent study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.

12.   When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home.
This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.

13.   If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done.
Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.

Other Steps You Can Take
14.   Speak up if you have questions or concerns.
You have a right to question anyone who is involved with your care.

15.   Make sure that someone, such as your personal doctor, is in charge of your care.
This is especially important if you have many health problems or are in a hospital.

16.   Make sure that all health professionals involved in your care have important health information about you.
Do not assume that everyone knows everything they need to.

17.   Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can't).
Even if you think you don't need help now, you might need it later.

18.   Know that "more" is not always better.
It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.

19.   If you have a test, don't assume that no news is good news.
Ask about the results.

20.   Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.