Read an Excerpt
CHAPTER 1
What You Need to Know and Why You Should Care
TWENTY-FOUR HOURS a day, seven days a week, every thirty seconds in the United States, someone will die of a heart attack — the number one killer and the most important health risk that all of us, men and women, face today.
We fear cancer, and rightly so, but heart disease takes a far greater toll. Cardiovascular disease (CVD) kills more than 750,000 Americans each year. That's nearly 200,000 more people than die from cancer, our next most common killer. For simplicity's sake, the terms CVD (which includes heart attacks, strokes, heart failure, hypertension, and other diseases related to the heart and blood vessels) and heart disease will be used interchangeably throughout this book.
In addition to its human toll, heart disease is a tremendous financial drain. The American Heart Association estimated that its cost to the U.S. economy in 2010, including treatment, maintenance, disability, and loss of work productivity, was over $300 billion. If we continue on our current track, health-care costs related to CVD are expected to triple by 2030, seriously straining our already struggling economy.
PREVENTION: IT'S A PERSONAL THING
It doesn't have to be this way. Imagine a revolutionary medical breakthrough that could reduce the chances of having a heart attack by 60 to 75 percent.
This new therapy is guaranteed to boost your mood; make you appear more attractive; help you lose weight; liven up your sex life; lower your chances of developing other diseases, such as diabetes and certain forms of cancer; and reduce your risk of dementia and stroke. Moreover, it's all natural, nearly 100 percent safe, and basically free.
Who would refuse such an amazing treatment that would transform health care and save billions of dollars every year? The answer: most people in this country and maybe even you.
I'm not talking about complicated laboratory science or another fruitless search for the fabled fountain of youth. The secret to combating heart disease is available right now. It's called prevention. And the key is your lifestyle.
Cardiovascular disease starts its silent assault on the arteries of the heart and other organs decades before it shows up as a heart attack or stroke. Atherosclerosis, or buildup of cholesterol plaques in the arteries, begins as early as childhood. Small cholesterol plaques in the coronary arteries, which feed the heart its vital blood supply, can be found in more than 15 percent of "normal" American teenagers and in 85 percent of people over the age of 50.
A heart attack occurs when one or more of these arteries get blocked and blood can't reach the heart muscle. The blockage is usually due to an unstable cholesterol plaque within a heart artery that ruptures or cracks. The body treats this as an injury and sends blood platelets to the damaged area to seal it off. This process results in a blood clot forming inside the artery, abruptly blocking blood flow. Without blood and oxygen, the heart tissue literally begins to die and can no longer function normally.
A heart attack generally occurs in a segment of the heart artery that is already damaged by years of slow, progressive cholesterol buildup. In most cases, a heart attack does not just "happen" at age 45, 60, or 75. It is a process, and it has been building for many years.
CALCULATING THE ROLE AND RISKS OF LIFESTYLE
A healthy lifestyle, including a heart-friendly diet, daily exercise, not smoking, and maintaining an optimum weight, will reduce your cardiovascular risk by more than 70 percent and extend your life span by nearly fifteen years.
We know more about heart disease prevention than ever before, but the lifestyles Americans choose are increasingly toxic. Less than one in six, regardless of gender, choose to practice a healthful way of life.
Most people in this country are overweight, and more than one in three is obese. Since the 1960s, the prevalence of obesity has nearly tripled. As a major contributor to high blood pressure, high cholesterol, and diabetes, weight is far more than a cosmetic issue. Sadly, men and women all too often sacrifice their health and financial well-being for fast food and sedentary entertainment.
Smoking virtually guarantees that our lives will be shorter and our health- care costs greater. Despite the well-known dangers of tobacco, it continues to ensnare nearly 21 percent of men and 18 percent of women in the United States, dramatically increasing their chances of heart disease, stroke, cancer, and a myriad of other miseries, and stealing health and vitality.
INHERITED RISK AND LIFESAVING MEDICINES
Whereas heart disease is often preventable with lifestyle alone, many of the risk factors that lead to heart disease are impacted by inherited conditions. I have learned in my practice as a cardiologist that bad luck is an unfortunate fact of life, and high cholesterol, high blood pressure, diabetes, and other serious health problems can develop in people who are absolutely committed to a healthy way of life. These conditions become more prevalent as we age, despite our best efforts.
We are fortunate to live in a time in which a wide array of lifesaving medications is available to help treat these and so many other problems. By starting medical therapy early, we can often prevent heart disease and other long-term complications such as kidney failure and stroke. Most of the drugs commonly used are unlikely to cause serious side effects, although careful monitoring and regular follow-up are important. Although taking pills and going for checkups may seem a bit cumbersome, when you add necessary medical therapy to a healthy lifestyle, you may reduce your cardiovascular risk by as much as 85 percent.
CLEARING THE WAY: EXPOSING THE DANGEROUS MYTHS OF HEART DISEASE
Your road to heart power begins with blowing the roof off some of the most common heart disease myths, half-truths, and fallacies.
MYTH NO. 1: HEART DISEASE IS A MAN'S PROBLEM.
FACT: Heart disease is far and away the leading cause of death of American women. Although women tend to develop it about ten years later in life than do men, two out of every five women will die of disease of the cardiovascular system. Too many others will suffer serious disability or a lower quality of life.
MYTH NO. 2: HEART DISEASE IS FOR OLD PEOPLE.
FACT: Heart disease is not an old-age malady. Fully 45 percent of all heart attacks occur before the age of 65, and each year, more than twenty-five thousand American men and eight thousand American women under the age of 45 will die from a heart attack. Medical science has made tremendous progress, and heart attacks are not always the death sentence they once were. But although death rates from heart disease are declining overall, they are on the rise for women under 45. At the same time, we are seeing a slower decline in death rates for younger men, when compared to those for older folks, likely due to dangerously unhealthy lifestyle choices.
MYTH NO. 3: HEART DISEASE SYMPTOMS ARE THE SAME FOR WOMEN AND MEN.
FACT: Women's symptoms may be very different. When a heart attack strikes, women younger than 50 are more than twice as likely to die as are men of the same age, in large part because they ignore their symptoms until it's too late.
The classic, textbook warning signs of heart disease can occur in both men and women: chest pain that sometimes radiates to the left arm or neck, clamminess, nausea, and shortness of breath. Usually the pain, known as angina, is brought on by exertion or stress, and relieved in five to ten minutes with rest.
In the month leading up to a heart attack, many people will experience angina, but all too often the pain is ignored or brushed off as indigestion. Women are more likely to notice extreme fatigue, insomnia, back pain, and shortness of breath, without chest pain. Whatever the symptom, anything that comes on with physical (or emotional) stress and resolves with rest deserves an urgent evaluation.
During a heart attack, men will typically feel severe chest pain, but not everyone will experience heart pain the same way. Forty percent of women suffering from a heart attack report no chest pain at all. Women are more likely than men to complain of nausea, fatigue, neck and jaw pain, shoulder pain, and back pain, and are less likely to break out in a cold sweat. Shortness of breath and a sense of overwhelming weakness are also more common in women. However, men may also experience symptoms of this nature. Whatever form they may take, the symptoms of a heart attack may wax and wane, but are generally relentless. Immediate medical attention is critical, as we are often able to prevent or minimize any permanent damage if we can treat the problem in time.
These are not complicated differences, but you can't ignore the less- than-classic symptoms just because they are not what you might consider typical.
MYTH NO. 4: HEART DISEASE IS USUALLY INHERITED.
FACT: Up to 85 percent of heart attacks are preventable. Obesity, smoking, lack of exercise, poor eating habits, and other unhealthy choices are major, but preventable, risk factors.
It's easy to blame your parents for our health woes, but the truth is that though your genes may interact with other risk factors, only about 15 percent of heart disease can be blamed on genetics alone. You might inherit high blood pressure or high cholesterol, or a susceptibility to diabetes, but those are problems that can be managed with a combination of a healthy diet, regular exercise, and, when needed, medication. On the other hand, it's important to know your family history. If your mom had a heart attack before age 65, or your dad before 55, then your risk may be up to two times greater than the average person's. In that case, it's especially important to choose a heart-smart lifestyle and to get regular medical checkups.
THE AMERICAN HEART ASSOCIATION'S GUIDELINES
THE AMERICAN HEART ASSOCIATION (AHA) has issued guidelines help physicians make appropriate recommendations for every individual, regardless of gender, age, or risk profile. You will learn about the ways that these principles can transform your life for the better in later chapters of this book, and I will explain what these terms mean in language that you can understand. To get a jump start, here are the basic best practices to ensure a healthy heart:
* Get 30 minutes of exercise most days of the week.
* Limit dietary saturated fat to less than 10% of daily calories.
* Limit trans fats to less than 1% of total calories.
* Consume less than 300 mg of cholesterol daily.
* Increase omega-3 fatty acids, especially if you are at high risk for cardiac disease.
* Follow a heart-healthy diet high in fruits, vegetables, grains, low-fat dairy, fish, and legumes.
* Maintain a body mass index between 18.5 and 24.9.
* Keep a waist circumference of less than 35 inches.
* Strive for a blood pressure of less than 120/80.
* Set a goal of LDL cholesterol less than 100, and HDL greater than 50.
* Do not smoke or use any form of tobacco, and avoid secondhand smoke.
These straightforward guidelines will help you understand the profound effects of the many simple choices you make every day. Understanding is the first step to achieving balance and control of your own health and well-being. The more you know, the more power you hold in your own hands. Through Best Practices for a Healthy Heart, you will discover the tools of prevention and learn how you can alter the course of your own life, regardless of where you stand on the heart disease continuum.
A DAY IN THE LIFE OF HEART DISEASE
As a cardiologist, I see the results of an unhealthy lifestyle and untreated risk factors each day. We are fortunate to live in an era of sophisticated cardiac interventions and surgeries, but despite all our modern technology and lifesaving skills, the responsibility for prevention is yours.
To illustrate how prevention can save your life and the path that poor lifestyle habits can take you down, let me share with you a typical day in my life as a cardiologist.
At 7:15 AM I begin my rounds with 57-year-old Jim, who was hospitalized the night before with a severe heart attack in progress. Fortunately, Jim got to the hospital in time, and my on-call partner opened up a critical blockage in one of his major coronary arteries before any permanent damage was done. Jim smokes two packs of cigarettes a day, doesn't exercise, and could stand to lose about 30 pounds.
Jim's father died of a heart attack at the age of 58, but Jim says he never thought it could happen to him. What he doesn't yet realize is that the process of atherosclerosis has been underway for the past thirty-five years, churning along as a consequence of innumerable unhealthy daily choices, combined with his unfortunate genetic makeup.
My next patient is a 48-year-old woman whose weathered face betrays her years of smoking. Sherry rides her bike regularly with her boyfriend, but recently noticed more shortness of breath and a strange ache in her back and arms. She tried not to worry, but when her symptoms got worse, she headed to the hospital for a checkup. Unfortunately, Sherry has already suffered a heart attack, probably a few days before she came to the hospital. Her heart muscle is working at about half its normal capacity. She swears to me that she will never smoke again. That's good, because another heart attack would probably kill her. She will need open-heart surgery before she leaves the hospital.
Later in the day, I see a 39-year-old gentleman who weighs more than 300 pounds. Jesse, an insurance broker, is diabetic, has high blood pressure and high cholesterol, and worries about the breathlessness he feels when he climbs the stairs to his third-floor apartment. We will schedule a stress test and hope that the results are good. However, I fear that Jesse is already well on his way to developing heart disease. Even if the stress test is normal, I will urge him to work on prevention, and he will certainly need medication. Jesse expresses qualms about the cost and possible side effects of these prescriptions. While I am sympathetic, the fact remains that, if his conditions are left untreated, he is likely to suffer irreversible damage to his heart, brain, kidneys, and other vital organs. I explain to Jesse that his high blood pressure, high cholesterol, and diabetes may even disappear if he loses weight, improves his diet, and commits to exercising regularly.
In the office, Hank, one of my favorite patients, arrives for a routine visit. He is a charming 85-year-old gentleman who has endured two bypass operations and the loss of his beloved wife. With the help of a careful selection of medications and an active and optimistic outlook, he lives life to its fullest. In fact, his exercise stress test time is better than those of many seemingly healthy people half his age.
Carmella comes to see me about her blood pressure. She is 35 years old, pregnant with her third child, and never lost the 60 pounds she gained with her first two pregnancies. We have worked hard to control her hypertension, but she needs two drugs to keep it down and is seeing a high-risk obstetric specialist to help her and her baby get through the pregnancy safely.
The last patient of the day is 30-year-old Kharim, who has seen the ravages of heart disease in his own family. Prompted by the recent death of his father at the age of 53, Kharim has started working out regularly. When I first met him, his cholesterol was dangerously high — too high to treat with diet and exercise alone. Kharim has responded beautifully to a low dose of cholesterol-lowering medicine and a heart-smart diet.
Just one day brings a wide array of opportunities for preventive care to make a tangible difference in so many lives.
HERE'S THE GREAT NEWS
Eighty-five percent of heart disease is preventable. That means living a heart-smart lifestyle and seeking medical care for the risk factors that you cannot control. You have the power to make the difference in your own life and in the life of those you love. The choices you make and the chances you take each day are what give you the power to live a longer, stronger, healthier, and happier life.
CHAPTER 2
Overweight: What's the Big Deal?
WEIGHT LOSS IS a $40 billion industry, but just how people become overweight is no great mystery. If your dietary intake and your energy output are not in balance, you will gain weight. It's as simple as that. Nutrition and exercise are the keys to your heart, your mind, and your well- being. Although it is possible to be overweight and physically fit, there is no question that excessive weight will literally drag you down, affecting your health, your job, and your relationships.
Like many people, you may notice your scale creeping up a pound or two every few months. Perhaps you shrug it off, hoping the weight will leave as mysteriously as it came. Unfortunately, time has a way of growing those few unwanted extra pounds into a serious health problem.
(Continues…)
Excerpted from "Best Practices for a Healthy Heart"
by .
Copyright © 2011 Sarah Samaan, MD, FACC.
Excerpted by permission of The Experiment Publishing.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
