Heart Attack
Heart-healthy nutrition, daily physical activity, eliminating tobacco, controlling diabetes and a commitment to follow your healthcare professional’s recommendations (including for cholesterol and high blood pressure) are all part of reducing your risk for heart disease, heart attack and stroke.
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Heart disease is the number-one killer of women. Women who die suddenly from heart disease, 63 percent had no previous signs of disease.
Heart Disease Risks
Smoking
Smoking is the biggest risk factor for heart attacks in women, according to the American Heart Association?.
Physical inactivity
Being active reduces the risk of heart disease. There are several, easy, small, practical ways women can increase their activity level.
High blood pressure and cholesterol
Unhealthy blood pressure and/or blood cholesterol levels can lead to serious heart problems, such as heart attack and stroke. Make sure you have your blood pressure and cholesterol levels checked at your next doctor visit. If your numbers are high, talk to your doctor about how to lower them—and how frequently you need to have them checked.
Alcohol
If you drink alcohol, drink in moderation. Try to consume no more than two drinks a day for men and one drink a day for women. Drinking more can increase the dangers of high blood pressure and obesity, which in turn can boost the threat of heart disease.
Obesity
According to the American Heart Association, people who have excess body fat are more likely to develop heart disease, even if they have no other risk factors. Excess weight increases the strain on the heart and influences blood pressure and blood cholesterol. Shedding as little as 10 to 20 pounds can help lower your heart disease risk.
Diet
In addition to staying trim, make sure you eat the right foods. A heart-healthy diet low in saturated fats and cholesterol can reduce your risk for a heart attack. Adding a fiber supplement also may help lower cholesterol when it’s part of a diet low in saturated fat and cholesterol.
Stress
Try to take steps to reduce your stress level. Studies have shown that stress and how people deal with it can influence the likelihood of heart disease. When faced with stress, people tend to overeat, smoke, or drink more—escalating risk factors.
Then, in July 1977, I found out how wrong I had been. For the second time in a week, I was sitting in the office of Dr. John Nagle, a prominent cardiologist in Tacoma, Washington. I’d gone to see my family physician, Dr. James Early, five days earlier because I’d been experiencing shortness of breath and a low-grade but nagging chest pain as I warmed up to play tennis. The pain was dull, more like a feeling of fullness, and it would usually disappear by the end of the warm-up. But one day it stayed with me through two hours of play, so I called Dr. Early. “I’ve got a problem in my lungs, probably a touch
of bronchitis,” I told him. He asked me to come in right away. I had seen him just four months earlier for my annual physical, and the results were excellent, so I wasn’t expecting anything more than a quick visit and perhaps a prescription.
This time, however, my electrocardiogram indicated an obstruction of a coronary artery.
Dr. Early said there was no evidence of a heart attack, but he wanted me to see a cardiologist that same afternoon. Three hours later, I found myself undergoing a thorough cardiac examination with
Dr. Nagle. I was given an exercise stress test, which indicated that the cardiac muscle wasn’t getting enough blood, but it would take an X-ray to determine the extent of the problem. A thin plastic tube was inserted into an artery in my leg and threaded into my heart. Then a dye was injected into the tube, and Dr. Nagle traced its progress through my coronary arteries.
Now we were ready to review the results. Dr. Nagle began speaking. He told me that my chest pain was caused by three arterial blockages, ranging from 50% to 95%. “This is called coronary heart disease,” he said. “Buildups of fat and cholesterol are interfering with blood flow to your heart. The largest blockage is badly located. A blood clot could seal off the opening and trigger a fatal heart attack. I recommend immediate coronary bypass surgery . . .” There was more, but those words hit me like a hard slap in the face. Just get up and leave, I told myself. You’re not supposed to be here.
Like most people, I knew something about the workings of the heart and the coronary arteries, but the information was chiefly of the Biology 101 variety. Some decent information was out there, but what
did it have to do with me, a young guy in the prime of his life? Unknowingly, I had succumbed to the “what I don’t know won’t hurt me” syndrome. In reality, however, what I didn’t know could not only
hurt me, it could kill me.
Facing Reality
As the diagnosis sank in on that July afternoon, my own age of innocence and ignorance came to an end. My initial reaction was the typical “Why me?” response. Bernie and I had not yet celebrated our 10th wedding anniversary. Our daughter was six; our son was just four. I was in the midst of building a career and contributing to my community. Then I remembered reading a comment by President John F. Kennedy reflecting the fact that life was basically unfair—that unfairness was part of its nature. The randomness of death existed for everyone. All at once, I understood. Why not me?
I was gripped by pure, stomach-churning fear. Old age was something I had always looked forward to sharing with Bernie and my kids. Now I had to face the fact that death not only could happen in the near
future, but probably would happen as a result of the time bomb inside my chest. As we talked that day, Dr. Nagle calmly and deliberately explained the many facets of my situation. Soon the late afternoon shadows began to turn into evening twilight, and I was suddenly aware of the importance of time.
Less than a week later, Dr. Kari Vitikainen, a gifted cardiac surgeon, performed a five-hour operation in which a piece of vein was taken from my left leg and used to create a new arterial channel. The new channel literally bypassed the blocked area, allowing blood to again flow freely to my heart.
Ten days after surgery, I went home to recover, happy to be alive but very concerned about my future. Bypass had not “cured” me. Dr. Early put it in perspective: “You had heart disease the day before
surgery, you had heart disease the day after surgery, and you have it today as well. The surgery took away the pain and the threat of an imminent heart attack. But it did not remove the disease. Only a change in your lifestyle can reduce your future heart attack risk.”
This knowledge was complicated by the prediction of another doctor, a well-known lipids specialist at a national university. I saw him after the surgery for advice on how to manage my cholesterol.
“Shouldn’t I change my diet?” I asked.
“Don’t bother,” he said. “You have an aggressive form of coronary heart disease at a very early age. I’m not sure what you can do to help yourself. Frankly, I’d be surprised if you live to be forty.”
Now, for the first time, I was mad! He’s wrong, I thought. I’m going to find a way to beat this disease. My anger and determination became the twin foundations of a resolve to eat a better diet and live a healthier life. Finally, I had reached a point in time when I was ready to listen and learn. Once again, I turned to Dr. Nagle. “My advice is for you to focus on making healthy lifestyle changes,” he said. “You need to find a new diet pattern that meets your physical and emotional needs, fits your way of life and can be sustained for the long term. And you have to make it work in the real world. Only you and Bernie can do that.”
And so, in the midst of much confusion, we began.
The Mediterranean-Style Diet
When I started to collect information, to simply figure out what to do, the connection between diet and heart health was still controversial. One cardiologist who saw the importance of diet was Dr. John Farquhar of Stanford University Medical School.
I met Dr. Farquhar at a cardiac conference where he delivered a lecture called “The American Diet May Be Hazardous to Your Health.” I had listened to a number of speakers at this conference and had yet to learn anything that helped with daily living—that answered the basic question What can I eat today? That question was addressed in Dr. Farquhar’s discussion of the late Dr. Ancel Keys, a pioneer in cardiac research. In the early 1950s, Dr. Keys went to Italy to observe a curious dichotomy. Italians ate much more fat in their diet than Americans did, yet heart disease was virtually unheard of in their country. While Americans were feasting on steak and potatoes, white bread and butter, and whole milk, Italians ate very few animal foods and favored fruits, vegetables, whole grains, olive oil and wine. Could there be a link between diet and health?
Compelled to learn the answer, Dr. Keys instituted the Seven Countries Study, in which diet, blood cholesterol and frequency of heart attack were measured in communities in Finland, Greece, Italy, Japan, the Netherlands, the United States and Yugoslavia. In all, some 12,000 men in the 40-to-49 age range were tested and observed. The study illustrated that cultures in which saturated fat made up a significant
percentage of total caloric intake demonstrated elevated cholesterol levels and a higher incidence of coronary heart disease than cultures with a lower percentage. Thus the Finns, who ate 20% of their calories
as saturated fat, had cholesterol levels that averaged 265. The Japanese ate only 5% of their calories as saturated fat and had correspondingly lower cholesterol levels, averaging just 165. A most important point was that the heart attack rate for middle-aged Finnish men was six times greater than for Japanese men of the same age. American men in the study had a heart disease rate twice that of Italian men and four times that of Greek men. Dr. Keys’ conclusion: “Saturated fat in the diet leads to high blood cholesterol and then to heart attacks.”
As Dr. Farquhar clearly connected the dots between diet, cholesterol and heart disease, he provided a realistic vision of how to eat. His recommendation was the same as that of Dr. Keys: a Mediterranean diet emulating the traditional eating habits of southern Europe (Italy, Spain, Portugal and southern France), parts of North Africa (especially Morocco and Tunisia), parts of Turkey and parts of the Middle East (especially Lebanon and Syria). This diet emphasizes food from plant sources, such as whole grains, fruit, vegetables, nuts and olive oil. It also includes moderate amounts of poultry and fish while restricting meat, processed foods and refined grains.
The Mediterranean approach made…
A study suggests that researchers will have to find a better way to identify who is more likely to develop heart disease.
This is the VOA Special English Health Report.
Cardiovascular disease is the world’s leading cause of death. It includes heart attack, stroke and high blood pressure.
Over the years, researchers have identified several substances in the blood that can serve as what they call cardiac biomarkers. These are used to measure the presence and development of cardiovascular disease.
Researchers have increasingly tried to use these biomarkers to identify people who are at high risk of developing heart disease. But a new study has found that they offer little help in this way.
A team from Massachusetts General Hospital and Sweden’s Lund University studied how effective the biomarkers are as predictors. Thomas Wang at the Mass General Heart Center was the senior author of the study.
THOMAS WANG: “What we found is that, in fact, even after measuring those additional biomarkers that there wasn’t a great deal of benefit in terms of understanding who was more likely to develop heart disease.”
Doctor Wang says they did identify some combinations of biomarkers that improved predictions of heart attacks and strokes. But, he says, there is not enough evidence to justify measuring these in everybody.
THOMAS WANG: “It’s still possible that in certain patients, measuring these biomarkers would be helpful. There are some patients for whom physicians are really on the fence about whether to give one therapy or another. And in those cases having the biomarker which adds a little bit of information may be helpful in terms of decision making. But for the majority of patients, having the information of the biomarker probably wouldn’t make a difference.”
Doctor Wang hopes future research will discover biomarkers that are better able to predict the risk of cardiovascular disease. But for now, he says, doctors should depend on traditional risk factors. These include a history of high blood pressure, high cholesterol, tobacco use, diabetes, obesity, physical inactivity or poor nutrition.
A separate study found no support for a theory that a biomarker called C-reactive protein causes heart disease. Earlier research suggested that the more of the protein in people’s blood, the more likely they are to develop heart disease. The new study confirmed a link, but did not find evidence that the C-reactive protein causes the disease.
Both studies appeared in the July 1st issue of Journal of the American Medical Association.
The World Health Organization estimates that cardiovascular disease killed seventeen and a half million people in 2005. That was 30 percent of all deaths. Eight out of ten happened in low and middle income countries. At current growth rates, the W.H.O. expects the number to reach 20 million by 2015.
And that’s the VOA Special English Health Report, written by June Simms. I’m Steve Ember
What’s the link between smoking and heart disease?
What should I do if I have risk factors for coronary artery disease?
What’s the link between smoking and heart disease?
What should I do if I have risk factors for coronary artery disease?
A blood test that may identify those with heart disease is being tested by researchers at Duke University (North Carolina). Based on a set of genetic markers that indicate both the presence and the level of artery blockages, researchers are hopeful that this test will one day replace more expensive and time consuming preliminary testing, such as echocardiogram and exercise stress tests.
If a person having chest pain could be assessed for the presence and degree of coronary artery disease (CAD) based on a blood test, they could proceed directly on to catheterization and either stenting or bypass surgery. This kind of test could be very useful to assess a person acutely having chest pain who presents to the emergency room, or to streamline the assessment of a person at risk for heart disease who presents to their health care provider with symptoms suggesting heart disease.
Currently individuals who are suspected to have CAD undergo other tests first, because they are less invasive and less costly than going directly to catheterization. These tests also limit exposure to x-ray radiation. Insurance companies often require these preliminary tests to “prove” the presence of CAD before proceeding to the cath lab. Unfortunately these tests don’t always determine the presence or absence of CAD, resulting in cardiac catheterization anyway. This process is both time consuming for the patient, expensive to our health care system, and allows time for an untoward event to happen.
The researchers report that the current study, published in the journal Circulation: Cardiovascular Genetics, is based on a small number of participants and will need to be verified in a larger number of people before the blood test is approved for use. It is currently undergoing additional trials at 28 sites around the US, with a wide variety of study recipients.
Commenting on the study results, Dr. Sidney Smith, a UNC-Chapel Hill cardiologist, noted, “If these findings hold for this broad group of population, the test could prove to be a valuable supplement in our management and treatment of patients with coronary heart disease.”
Dr. Joe Falsone, an invasive cardiologist at Wake Heart & Vascular Associates, called the discovery “potentially exciting news,” and said “we could probably use this as a screening tool for patients we thought were at high risk.”
For more information about participating in clinical trials at Duke please see “Research at Duke Medicine.” ClinicalTrials.gov is a registry of federally and privately supported clinical trials conducted in the United States and around the world.
Take care.
Laurie
Oct. 7, 2009 — When it comes to seeking treatment for chest pain, education doesn’t always mean people do the right thing.
In a new study, heart patients who received counseling about heart attack symptoms and when to get treatment were no more likely to get immediate care than those who had not received counseling. This is disappointing because patients who receive care within 90 minutes after the onset of heart attack symptoms fare much better.
