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Proton-pump inhibitors are among the most-prescribed medications, but is long-term use safe?

Proton-pump inhibitors reduce stomach acid, which helps to treat symptoms of acid reflux.
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Proton-pump inhibitors (PPIs), which are used to treat a variety of gastrointestinal problems, are among the most popular drugs in the United States. In fact, the FDA estimates about one in 14 Americans has used a PPI.

About one in six strokes can be traced to atrial fibrillation. Doctors now have newer and better options to lessen this risk.

Close to one in 10 people ages 65 or older have atrial fibrillation (afib), the most common heart rhythm disorder. During a bout of afib, the usually rhythmic contractions of the heart's upper chambers (the atria) are replaced by an ineffectual quiver. While the symptoms, which include a racing heartbeat, dizziness, and shortness of breath, are troublesome for some people, the real threat lies in the increased risk of stroke that accompanies the condition.

When the heart takes on the afib rhythm, blood does not completely move out of the atria. Instead, it tends to pool and clot in a pouchlike extension in the upper left quadrant of the heart, called the left atrial appendage. If these clots break loose, they may travel to the brain and cause a blockage. This is known as an ischemic stroke.

Q. Last year, I was diagnosed with atrial fibrillation and started taking an anti-clotting drug to lower my stroke risk. But my heart is now back in a normal rhythm. Why is my cardiologist keeping me on the drug?

A. During a bout of atrial fibrillation, or afib, the heart's upper chambers (atria) quiver erratically instead of making normal, steady contractions. This common heart rhythm disorder takes many different forms. While some people seem to have a single, isolated episode of afib, others have persistent afib, which lasts longer than a week. Common symptoms include a rapid, irregular heartbeat; a fluttering or "thumping" sensation in the chest; and feeling weak, dizzy, breathless, or fatigued.

A negative attitude about aging appears to be associated with a higher likelihood of Alzheimer's disease.

A study in the journal Psychology and Aging examined healthy, dementia-free subjects from the Baltimore Longitudinal Study of Aging, the nation's longest-running scientific study of aging.

Heart palpitations can be alarming, but are they dangerous?

Do you ever feel that your heart is pounding, skipping, or racing so fast that you're certain it will explode from your chest at any moment? That's how many people describe the experience of heart palpitations. In the most literal sense, palpitations are simply an awareness of your heart beating, says Dr. William Stevenson, professor of medicine at Harvard-affiliated Brigham and Women's Hospital. The most familiar trigger for palpitations is heavy exercise, such as when you pedal extra hard to summit the last computerized hill in your indoor cycling class.

Skipping a beat

Although common, palpitations alarm many people, in part because they tend to come on unexpectedly. Isolated palpitations typically occur when a small rush of adrenaline courses through your body, causing your heart to beat more forcefully than usual. These surges can be generated by a strong emotion such as excitement, fear, or anger. They also can come on after consuming a stimulant such as caffeine.

Ask the Doctor

Q. My primary care doctor referred me to a cardiologist, and I just found out that I have a bicuspid aortic valve. What does that mean for me?

A. The aortic valve sits between the heart and the aorta, the main artery from the heart that distributes oxygen-rich blood throughout the body. A normal aortic valve has three leaflets, or flaps, that open and close tightly to regulate the flow of blood. But between 1% and 2% of people are born with an aortic valve that has only two flaps, known as a bicuspid valve. This defect is twice as common in males as in females and often runs in families.

Even the newer, targeted cancer therapies may harm the heart.

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About 14 million people in the United States are living with cancer, a number that reflects the steady rise in cancer survivorship in recent decades. In 1980, only about half of people with cancer lived five years after diagnosis. Today, five-year cancer survival rates are greater than 70%.

Unfortunately, many cancer-suppressing treatments can have undesirable effects on the heart and blood vessels. The increasing awareness of these effects鈥攃oupled with the surge of older people being diagnosed with and surviving cancer鈥攈as spurred a new specialty known as cardio-oncology. Experts in this burgeoning field focus on promoting heart health in people with cancer, both during and after their treatment.

Ask the doctor

Q: I have developed numerous small, thin veins over my legs. I would like to get rid of them. What is the most effective treatment?

A: Dilated superficial veins, known as reticular or "spider" veins, are a common problem as men get older. The preferred treatment is sclerotherapy, but laser therapy is gaining popularity. Sclerotherapy involves injecting fluid into the veins with a small needle. This liquid causes irritation and inflammation of the vein, leading to its collapse. Laser therapy uses intense pulsed light to cause heat-related damage to the veins. Both treatments involve some discomfort. Wearing compression stockings afterwards appears to help improve outcome.

Men are more likely than women to develop atrial fibrillation (afib)鈥攁 rapid, erratic beat in which the heart's upper chamber doesn't contract forcefully, allowing blood to pool and increasing the risk of clotting. However, some鈥攂ut not all鈥攕tudies have indicated that afib poses a greater stroke risk in women than in men. To settle the question, an international team of researchers looked at 30 studies with 4.4 million participants. They found that compared with men who have afib, women with afib have a 12% higher risk of death from all causes and almost double the risk of having a stroke or dying from one. The results were published online Jan. 20, 2016, by the journal BMJ.

Women notoriously neglect the symptoms of afib鈥攆eeling weak, breathless, or unusually fatigued. If you have afib symptoms, get medical attention, even if you think it's only a virus. There are several successful treatments for afib as well as for preventing stroke in women who have afib.

Mosquitoes can transmit many viruses, such as, Zika, West Nile, dengue, and yellow fever.
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Ask the Doctor

Q. Why is it that we suddenly have epidemics of things like Zika virus that we've never heard about, and that we have no treatments or vaccines for? It feels like we should be better prepared than we apparently are. This worries me more than terrorism.