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How To Keep Your Heart Healthy

Sixty-two-year-old Jack Andre says having a heart attack in March 2010 was like getting hit in the head with a baseball bat. "It brought a lot of things to my attention that I never thought about before," he says. He was overweight, didn't exercise, and often ate high-fat foods. But he never connected his lifestyle to his heart.

"Six months before the heart attack, my doctor told me I had borderline high cholesterol and high blood pressure," says Andre, of Rockville, Md. "But I didn't think much of it."

That all changed after he experienced heart attack symptoms--extreme fatigue, dizziness, and back pain. Tests revealed that Andre had three clogged coronary arteries. "Now I walk every day at lunch, eat smaller portions, and I'm a food label reader," he says.

Bonnie Brown, 50, of Baltimore, says she also didn't change her life until she had a heart attack in 2007. "I used to smoke, ate cold-cut subs for breakfast, and had lots of fried foods, all the time, any time," Brown says. But her heart attack--which she initially mistook for a bad case of indigestion--led her to give up cigarettes, improve her diet, and sign up for weekly water aerobics and line dancing classes.

"There's nothing that motivates people like having a heart attack or bypass surgery," says Christopher Cates, M.D., director of vascular intervention at the Emory Heart Center in Atlanta. "I've found that people think that heart disease always happens to someone else, until it happens to them." Experts say that until Americans change their way of thinking from one of damage control to one of proactive prevention, heart disease will remain the No.1 killer of men and women in the United States.

"In many ways, I think we've become insulated by high-tech care," Cates says. "As physicians, we are partners in the health care of our patients, which means we need to educate them about their risk factors for heart disease. And they need to have some sense of ownership about what they can control. They can't simply look to their doctors or to the FDA or to Medicine, and say, 'Cure me, but I'm going to eat fatty foods, smoke, and be sedentary.'"

One of the reasons that some people may shrug off the possibility of developing heart disease is that it's a gradual, lifelong process that people can't see or feel. About the size of a fist, the heart muscle relies on oxygen and nutrients to continually pump blood through the circulatory system. In coronary artery disease, the most common type of heart disease, plaque builds up in the coronary arteries, the vessels that bring oxygen and nutrients to the heart muscle. As the walls of the arteries get clogged, the space through which blood flows narrows. This decreases or cuts off the supply of oxygen and nutrients, which can result in chest pain or a heart attack. Damage can result when the supply is cut off for more than a few minutes. It's called a heart attack when prolonged chest pain or symptoms (20 minutes or more) are associated with permanent damage to the heart muscle.

Every year, more than 1 million people have heart attacks, according to the National Heart, Lung, and Blood Institute (NHLBI). About 13 million Americans have coronary heart disease, and about half a million people die from it each year.

What's Your Risk Profile?

Risk factors for heart disease are typically labeled "uncontrollable" or "controllable." The main uncontrollable risk factors are age, gender, and a family history of heart disease, especially at an early age.

The risk of heart disease rises as people age, and men tend to develop it earlier. Specifically, men ages 45 and older are at increased risk of heart disease, while women 55 and older are at increased risk. A woman's natural hormones give some level of protection from heart disease before menopause.

"Heart disease presents in women an average of seven to 10 years later than in men," says Patrice Desvigne-Nickens, M.D., leader of cardiovascular medicine at the NHLBI. "But after menopause, women develop heart disease as often as men, and women who have a heart attack don't fare as well as men." Women are more likely than men to die from a heart attack.

Though heart disease is the leading cause of death for both men and women in this country, surveys have shown that many women don't know it, and that they are more worried about cancer, especially breast cancer. "We want women to know that heart disease is not a man's disease. Rather, heart disease is the leading cause of death for women, and heart disease is preventable and treatable," says Desvigne-Nickens.

The NHLBI defines having a family history of early heart disease this way: A father or brother who had heart disease before 55, or a mother or sister who had heart disease before 65. Be sure to tell your doctor if any of your family members have had heart disease. Andre says it was only after he had a heart attack that he learned that he had four uncles who had been diagnosed with coronary artery disease.

Even if you have uncontrollable risk factors for heart disease, it doesn't mean that you can't take steps to limit your risk. Researchers say that controllable risk factors--physical inactivity, smoking, overweight or obesity, high blood pressure, high blood cholesterol, and diabetes--are all major influences on the development and severity of heart disease.

According to Cynthia Tracy, M.D., chief of cardiology at Georgetown University Hospital in Washington, D.C., the best way to combat heart disease is to know the risk factors, "own" the risk factors that apply to you, and address the ones that are controllable. "I think many people can rattle off risk factors, but then they don't internalize them to say: 'That's a risk factor for me. I am at risk for heart disease. And now I'm going to do something about it,'" Tracy says.

Taking Charge of Your Health

Because of advances in medicine and technology, people with heart disease are living longer, more productive lives than ever before. But prevention is still the best weapon in the fight against heart disease. As with anything in life, there are no guarantees. You could do all the right things and still develop heart disease because there are so many factors involved. But by living a healthier life, you could delay heart disease for years or minimize its damage. Whether you are already healthy, are at high risk for heart disease, or have survived a heart attack, the advice to protect your heart is the same.

Get moving and maintain a healthy weight. Exercise improves heart function, lowers blood pressure and blood cholesterol, and boosts energy. And being overweight forces the heart to work harder. But about 1 in 4 U.S. adults are sedentary.

The general recommendation from the NHLBI is to get at least 30 minutes of moderate physical activity on most, and preferably all, days of the week. And you don't need to run a marathon or buy an expensive gym club membership to do it. The 30 minutes also don't have to be done all at once, but can be broken up into 10-minute intervals throughout your day.

"Exercising is like taking the pennies from under the couch cushions and putting them into your piggybank," says Ann Bolger, M.D., a spokeswoman for the American Heart Association (AHA) and a cardiologist in San Francisco. "Every little bit counts."

Vigorous exercise like running or doing aerobics brings more health benefits than lighter intensity activities, but walking is a great form of exercise. Brisk walking can get your heart rate up and give you a solid workout. Walking at a comfortable pace can work well for many people, too. "The best exercise is the one you feel good about and can do over and over again," Bolger says. And it's easier to work exercise into your everyday routine than you might think.

For example, Bolger suggests parking farther away when you go to the grocery store or to your office to create a longer walk, taking the stairs, walking all the way around a mall the next time you go shopping, and walking around your neighborhood. Getting support from a walking buddy or a walking group can be a good way to keep you motivated.

Talk with your doctor about what form of exercise is best for you. Those with severe heart disease, for example, are advised against strenuous exercise.

Desvigne-Nickens suggests that you teach your children early that exercise is fun and good for them. Families can walk together, ride bikes, and chase after balls in a park. "But we have to show them," she says. "Our children are exercising their thumbs with computers and video games, and obesity in childhood is epidemic."

Stick to a nutritious, well-balanced diet. This advice might make you groan if your usual lunch consists of cheeseburgers with french fries or pizza slices topped with sausage. But the good news is that diet isn't an all-or-nothing affair.

A heart-healthy diet means a diet that's low in fat, cholesterol, and salt, and high in fruits, vegetables, grains, and fiber. "But it doesn't mean that you can never have pizza or ice cream again," Bolger says. You could start by telling yourself that you will eat a big leafy green salad first, and then you will have one slice of cheese pizza, not three slices with sausage. "Or if you must have a burger, don't get your usual order of french fries," Bolger suggests. "That alone cuts hundreds of calories."

Experts point out that a heart-healthy diet should be the routine. That way, when you have high-fat food every now and then, you're still on track. Making a high-fat diet the routine is asking for trouble.

Bolger teaches people about the AHA's Simple Solutions program, which helps women--often the ones who do the cooking and grocery shopping--adopt simple ways to improve eating habits for the whole family. For example, it's wise to make a grocery list so that you can carefully plan your meals. "You have to make a conscious decision to make your snack a bag of grapes instead of a candy bar or cookies," Bolger says.
Bolger also asks her patients to tell her the food or food group that gets them into trouble. If you pin that down you can start to make healthy substitutions. Tell Bolger that overloading on ice cream is your downfall and she'll tell you about her recipe for a berry dessert: Use nonfat yogurt, sweeten it up as much as you want with a sugar substitute, add a drop of vanilla extract, microwave frozen strawberries briefly to soften them up, add the berries, stir it all around, and enjoy.

Like exercise, good eating habits need to start early. "Teaching your children to eat well is one of the most loving things you can do for them," Bolger says. Your children tend to follow your lead, eat what you eat, and eat what you put in front of them. It's up to you how often you put a banana in front of them instead of high-fat cookies.

Look at the Nutrition Facts label on the foods you buy for guidance. The general rule of thumb is that foods that provide 5 percent of the daily value (DV) of fat or less are low in fat, and foods that are labeled as providing 20 percent or more of the daily value are high in fat.

Control your blood pressure. About 50 million American adults have high blood pressure, also called hypertension. The top number of a blood pressure reading, called the systolic pressure, represents the force of blood in the arteries as the heart beats. The bottom number, called diastolic pressure, is the force of blood in the arteries as the heart relaxes between beats. High blood pressure makes the heart work extra hard and hardens artery walls, increasing the risk of heart disease and stroke.

A blood pressure level of 140 over 90 mm Hg (millimeters of mercury) or higher is considered high. The NHLBI recently set a new "prehypertension" level of any reading above 120 over 80 mm Hg.

Poor eating habits and physical inactivity both contribute to high blood pressure. According to the NHLBI, table salt increases average levels of blood pressure, and this effect is greater in some people than in others.

The National Institutes of Health's DASH diet (Dietary Approaches to Stop Hypertension) is rich in fruits, vegetables, and low-fat dairy foods, and low in total and saturated fat. The DASH diet also reduces red meat, sweets, and sugary drinks, and it's rich in potassium, calcium, magnesium, fiber, and protein.

It's important to keep on top of your blood pressure levels through regular doctor visits. High blood pressure disproportionately affects racial and ethnic minority groups, including blacks, Hispanics, and American Indians/Alaska Natives. The condition is known as a silent killer because there are no symptoms. If lifestyle changes alone don't bring your blood pressure within the normal range, medications may also be needed.

Recent NHLBI research has shown that older, less costly diuretics work better than newer medicines to treat high blood pressure. These findings, part of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), were published in the Dec. 18, 2002, issue of the Journal of the American Medical Association.

Control blood cholesterol. Cholesterol is a fat-like substance in the blood. High levels of triglycerides, another form of fat in the blood, can also indicate heart disease risk.

As with blood pressure, eating a low-fat, low-cholesterol diet and engaging in physical activity can lower cholesterol levels. Your body turns saturated fats into cholesterol. And the higher your cholesterol level, the more likely it is that the substance will build up and stick to artery walls.

The only way to find out your cholesterol levels is to go to a doctor and have a blood test after fasting for nine to 12 hours. A lipoprotein profile will reveal your total cholesterol, which is measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. Total cholesterol less than 200 mg/dL is desirable, 200-239 mg/dL is borderline high, and 240 mg/dL or more is high.

Low-density lipoprotein (LDL), also known as "bad cholesterol," should be less than 100 mg/dL. A level of 100-129 mg/dL is near optimal/above optimal, 130-159 mg/dL is borderline high, 160-189 mg/dL is high, and 190 mg/dL and above is very high.

High-density lipoprotein (HDL), also known as "good cholesterol," protects the arteries from bad cholesterol buildup, so the higher the HDL, the better. HDL levels of 60 mg/dL or more help lower heart disease risk, and an HDL level of less than 40 mg/dL is considered low.

People ages 20 and older should have cholesterol measured at least once every five years. If lifestyle changes alone don't adequately budge cholesterol levels, medications may be needed.

Experts say the drug class known as "statins" marks a significant advance in preventing heart disease. These drugs work by partially blocking the synthesis of cholesterol in the liver, which helps remove cholesterol from the blood. Along with lowering cholesterol, statins help stabilize blood vessel membranes. Examples include Lescol (fluvastatin), Pravachol (pravastatin), Zocor (simvastatin), and Lipitor (atorvastatin). The most recent addition to this class, AstraZeneca Pharmaceuticals' Crestor (rosuvastatin), was approved by the Food and Drug Administration in August 2003. Even with drug treatment, a cholesterol-lowering diet and exercise are still recommended.

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