Prevention
Heart disease is the number one cause of death in the United States.
Fortunately, we now know ways to reduce our risks. Use this
information to help you lead a healthier and longer life.
Risk Factors
The following table lists primary risk factors for developing heart
disease.
Count your total risk factors:
_ Male 45 years or older
_ Female 55 years or older
_ Female under age 55 with premature menopause not treated with
estrogen replacement therapy
_ Smoker
_ High Blood Pressure
_ Diabetes mellitus
_ Family history of heart disease (a parent or sibling under 55 if
male, or under 65 if female)
_ High total blood cholesterol
_ Low HDL (good) blood cholesterol (you can subtract one risk factor
if HDL is higher than 60)
_ High LDL (bad) blood cholesterol
_ High triglyceride blood level
_ Obesity - 30% or more overweight
_ Sedentary lifestyle
_ History of vascular disease
Total risk factors
Unfortunately, certain risk factors such as family history and gender
cannot be changed. However, by modifying other risk factors, the odds
of having a heart attack can be substantially reduced. For individuals
with heart disease, the lowering of the LDL cholesterol below 100
mg/dl (milligrams per deciliter of blood) can stabilize coronary
disease or even promote regression of coronary disease.
Below is a brief discussion of various risk factors and preventive
measures that can be taken. More detailed explanations are available
at
www.americanheart.org and
www.acc.org.
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Lipids: Cholesterol and Triglyceride
The fat and fat-like
substances in the blood are called lipids and include both cholesterol
and triglycerides. Cholesterol is present in every cell of your body.
It is used to form cell membranes and part of some hormones. The body
manufactures the majority of required cholesterol, mostly in the
liver; therefore, excessive dietary cholesterol intake is unnecessary
and may be harmful. Animal foods such as meats, poultry, fish,
seafood, egg yolks, and dairy products are rich in cholesterol. Plant
foods such as fruits, nuts, seeds, vegetables and grains do not
contain cholesterol.
Cholesterol will not dissolve in the bloodstream; it is transported to
and from cells by special carriers called lipoproteins. The low
density lipoprotein (LDL) is the major cholesterol carrier in the
blood and contributes to plaque formation in the arteries. When clots
form at the site of plaques, blood flow is interrupted, leading to
heart attacks or strokes. Thus LDL cholesterol is known as the bad
cholesterol.
The high density lipoprotein (HDL) is mostly made by the liver.
It is thought to carry cholesterol away from the arteries and away
from plaques back to the liver where it is eliminated. Thus high
levels of HDL cholesterol are good; likewise, low levels increase the
risk of heart attacks. HDL levels are difficult to raise. Exercise
appears to help; less clear is the role of alcohol. Two drinks of
alcohol per day may help raise HDL; more than two can contribute to
high blood pressure, high triglycerides, liver disease, and weakening
of the heart muscle.
Triglycerides are blood fats derived from food and manufactured
in the liver. Although less of a risk factor than high cholesterol,
elevated triglyceride levels are associated with heart disease. Levels
less than 200 mg/dl are considered normal. Levels between 200 and 400
mg/dl increase risk of heart attacks, and higher levels (400 to over
1000 mg/dl) add risks of pancreatitis (inflammation of the pancreas)
and diabetes.
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Know the Numbers!
Lipid levels should be
measured on fasting blood samples. Based on multiple studies, the
following guidelines for blood lipid levels are recommended by the
National Cholesterol Education Program:
A more sophisticated subtype analysis of lipid levels is now
commercially available and should be discussed with your physician for
unusual clinical circumstances.
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Basic Diet Information
Dietary modification is the first step in controlling cholesterol.
A healthy diet should limit total cholesterol intake to no more than
300 milligrams per day. Total fat intake of less than 40 grams per day
will aid in weight loss and lipid management. Different types of fats
exert different effects on cholesterol levels.
Saturated fatty acids in the diet raise cholesterol. Animal
foods high in saturated fatty acids include red meat, poultry skin,
and dairy products. Plant foods high in saturated fatty acids include
coconut oil, tropical oil, and cocoa butter. Saturated fatty acids
should be less than 10 percent of total calories each day.
Polyunsaturated and monounsaturated fatty acids may help reduce
cholesterol levels when substituted for saturated fatty acids. They
should be less than 10 and 15 percent of your daily calories
respectively. Oils high in polyunsaturated fats include vegetable
cooking oils, such as corn, safflower, sunflower, and soybean. Better
choices are found in monounsaturated oils such as olive and canola
oils.
Unfortunately, changes in diet will not always provide the necessary
response in blood lipid levels; genetic factors also exert an
influence. During the last several years, major advances in drug
therapy have helped lead to substantial reductions in lipid levels.
Consultation should be made with your doctor to choose the appropriate
therapy.
Omega 3 Fish oil has antioxidant properties and may help to reduce cholesterol when taken at 1,000 to 6,000mg per day.
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Stop Smoking
Cigarette smoking is arguably the greatest threat to a healthy
heart. Cigars are also linked to higher incidences of heart disease.
Your primary care physician can provide suggestions about the current
therapies and drugs that help you stop smoking.
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Control Diabetes
Diabetes is associated with premature atherosclerosis and small
vessel disease. Tighter control of blood sugar levels is thought to
reduce complications secondary to diabetes. Appropriate weight loss in
Type II diabetes reduces the risk of cardiac disease.
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Exercise
Aerobic exercise helps protect against heart disease. The greatest
benefit is achieved with at least three 30-minute exercise sessions
per week. Activities do not need to be strenuous. Walking, swimming or
bike riding are some of the easier habits to adopt.
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Aspirin a Day
Aspirin is an effective blood thinner. Patients with heart disease
should take one aspirin per day to lessen the risk of heart attacks.
The usual dosage is one adult aspirin (325 mg). Coated aspirin is
recommended to reduce gastric irritation and a baby aspirin (81 mg)
can be used for individuals unable to tolerate full strength. Patients
with allergies to aspirin should discuss alternatives with their
physicians and in most cases aspirin should be avoided in patients on
Coumadin.
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What is Homocysteine?
Homocysteine is an amino acid found in the blood. Elevated levels
are associated with increased risk of heart and vascular disease.
Unfortunately accurate measurement of homocysteine levels is not yet
readily available for all cardiac patients. Diets high in folic acids
and B vitamins lower homocysteine levels, but no controlled studies
have directly shown that dietary supplements lower the risk of heart
disease. With that caveat, a balanced diet and a multivitamin with
folic acid and B vitamins may be beneficial.
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Vascular Disease: Neck and Leg
Blocked arteries in the neck, the carotid arteries, can lead to
stroke when sufficiently narrowed. Stethoscope examination of the neck
can detect sounds called bruits which often indicate carotid artery
blockage. The severity can be estimated by carotid ultrasound and
doppler evaluation and appropriate treatment can be instituted.
Claudication is the name of the leg pain usually first noticed with
blocked leg arteries. It typically occurs with walking a specific
distance and is relieved by rest. Palpation of the leg pulses and
doppler evaluation of the legs can help guide treatment.
Carotid artery disease and vascular disease of the extremities is
strongly correlated with coronary artery disease. If you have vascular
disease, you should discuss appropriate screening tests for heart
disease with your physician.
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High Blood Pressure
High blood pressure, called hypertension, is directly related to
coronary artery disease and thickening of the heart muscle. The
majority of high blood pressure is called essential hypertension and
is readily treatable. Typically the goal is a pressure below 120/70
(systolic/diastolic) with a target blood pressure of 135/85. Proper diets including low sodium diets,
exercise, and appropriate weight loss all help in controlling blood
pressure. There is a wide range of medications available for blood
pressure control.
Less common causes of hypertension include kidney disease, vascular
disease, or rare tumors. Consult your physician for proper evaluation.
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