Heredity

We certainly can't change heredity. We have no control over who brought us into this world. But we certainly need to realize that if our parents had heart disease at an early age, we are much more likely to develop coronary artery disease. We also have to realize that families pass on more than genes. A recent study indicated that people with a family history of coronary artery disease have two times the risk of having a significant elevation in cholesterol. The types of food, exercise habits, and exposure to smoking also run in families. But it does not mean that we just sit back and do nothing. If we have heart disease "in our family" we need to do everything to reduce our other risk factors - we should eat right, exercise, don't smoke, control our blood pressure and diabetes, and decrease stress levels.

Gender

Males have a higher incidence of heart disease at an earlier age. This is the predominant reason that there are four times as many women over the age of 80 than men. However, after the onset of menopause, the incidence of cardiovascular disease in women more closely approximates that of men. Generally, this means that women tend to develop problems with heart disease 10 years later than men.

As more women enter the work force and assume the lifestyle habits of their counterparts (increased smoking, stressful work place, etc.,), the incidence of heart disease in younger women has increased.

The fact that menopause coincides with when women begin to catch up to men in the area of incidence of heart disease has led to a great deal of research. The question is asked - Can we preserve the lower risk for women for a longer time? This has led to much research on the effect of estrogen replacement (hormonal) therapy and heart disease. It is certainly worth discussing the pros and cons with your doctors.

Age

Even though the risk of heart disease increases with age, it does not mean you can't do anything about it. A change in lifestyle with modification of risk factors has been shown in many studies to be helpful at any age. In fact, one study suggested that discontinuing smoking after age 60 may add 5-7 years to our life.

Risk factors that can be controlled or modified:

Smoking

Smoking is the leading cause of preventable illness and death in the United States. That's right, this is enemy #1 on the list of things that lead to poor health and decreased life span. In fact, 20% of all deaths in this country are attributable to smoking. The good news is that the number of people smoking has decreased.

The bad news is that this decrease is not fast enough and more and more young people are picking up this addictive habit. If you want to know why you should quit smoking or hopefully never start, look at the table below:

Questions remain over smoking:

1. Is it worth quitting?
   After you quit, the risk of heart disease decreases dramatically within two years.
   If you quit after 50, the chance of dying is reduced in half over the next 15 years.
   If you quit after 60, you add 5-7 years to your life span.
2. Can I quit?
   Yes you can! It won't be easy because nicotine is an addictive substance. But thousands of people do it every day. Get help! Ask your doctor, nurses, and pharmacists. Find out about resources to help you.
3. I have tried and I failed before! Why should I try again?
   Less than a quarter of people who quit smoking are able to do it on their first try. Most take 3-4 tries.
4. What about the cravings?
   Most cravings last less than 20 minutes. Try to have a plan on what to do until the urge goes away.
5. I can't stand the irritability, lack of concentration, and frustration.
   Consider quitting on a vacation or at least make less demands on yourself. Give yourself a break.
6. But I will gain weight!
   Studies show that one-third of ex-smokers gain weight, one-third lose weight, and one-third stay the same weight. Of the group that gains weight, only 10% keep the increased weight. However, it will take will power to keep from substituting food for cigarettes. An exercise program could help.
7. What if I can't sleep?
   Avoid naps during the day and only go to bed when tired. Avoid caffeine and exercise at night. If you don't fall asleep within 30 minutes, get up for a while and read a book.

High Blood Cholesterol

Unfortunately, a significant number of people in this country have elevated cholesterol levels. This is one of the reasons why heart disease is by far the leading cause of death in the United States. Recent large studies indicate that a 1% increase in cholesterol leads to a 2% increase in the risk of heart disease. And we have answered the question of whether reducing cholesterol is worthwhile for us. Several large studies in Europe indicate that reducing cholesterol to target levels (LDL < 100 in people with known heart disease and <130 in people with high risk for heart disease) leads to nearly one-third less deaths, heart attacks, angioplasty (balloon) procedures, and heart bypass surgery.

Controlling cholesterol levels may require changes in diet and may even involve drug treatment. The following "Heart Smart" hints from the Willis-Knighton Heart Institute may help:

• Have plenty of fresh fruits and vegetables available.
• Serve whole grain bread and cereals.
• Use low-fat milk and low-fat yogurt. Choose cheeses that are lower in fat.
• Include starchy foods like potatoes, rice and pasta often.
• Skip toppings like butter, margarine, gravy, and sour cream that add extra fat and calories. Try using grated Parmesan cheese, herbed cottage cheeses or low-fat yogurt toppings instead.
• Select lean meats like chicken, turkey, fish, lean beef cuts (top round, eye of round, top loin & sirloin, lean hamburger) and lean pork cuts (tenderloin, loin chops, and ham). Trim off all visible fat and remove skin from poultry.
• Choose margarine and vegetable oils like canola, corn, sunflower, soybean and olive oils.
• Try angel food cake, frozen fruit bars, or low-fat frozen yogurt in place of rich creamy desserts.
• Use non-stick vegetable sprays to reduce added fat when cooking.
• Use fat-free cooking methods like baking, broiling, grilling, poaching, or steaming when preparing meat, poultry and fish.
• Serve vegetable- and broth-based soups. Or, use low-fat milk when making cream soups.

There are many drugs that are relatively safe to use to lower cholesterol. Many people are unable to reduce their cholesterol to desirable levels despite a good diet. This is not failure on your part. It is because our body makes too much cholesterol internally and our cholesterol increase is not totally dependent on our diet. This is where medication such as HMG Co-A Reductase Inhibitors, Cholestyramine, Niacin, and Lopid become useful. You need to ask your doctor about these drugs if necessary.

High Blood Pressure

High blood pressure can have a negative effect on your vital organs. The elevation of blood pressure especially affects your heart, brain, and kidneys. It makes the heart work harder and leads to increased risk of heart attack, stroke, and kidney failure. It is ideal to keep your top number (systolic pressure) < 140 and bottom number (diastolic pressure) < 90. However, these goals cannot always be reached as we get older and will be balanced against symptoms of overly aggressive lowering of the blood pressure. We also realize the blood pressure can be elevated as a result of the stress of a doctor visit. This "white coat" hypertension often leads physicians to have your blood pressure recorded outside of this stressful environment.

Obesity

Being overweight (especially > 30% above our ideal body weight) leads to an increased incidence of heart disease. This is because of the added work load to our heart as well as increase in high blood pressure, diabetes, and elevated cholesterol. Just losing weight can "cure" high blood pressure, diabetes, and elevated cholesterol in some people.

Physical Inactivity

Physicians have become more convinced that regular exercise is important in the prevention of heart disease. Recent studies show a 30% reduction in coronary artery disease in those who exercise regularly in comparison to those people with a sedentary lifestyle. Examples of aerobic activity include walking, jogging, cycling, swimming, rowing, cross-country skiing, stair climbing, and dancing. At the least, we should strive to do aerobic exercise for 20-30 minutes 3-5 times a week. Walking 10-20 miles per week will accomplish our goal. And it is important to realize that we don't have to run marathons to get benefit. Any exercise is better than no exercise at all. We should not get discouraged when we don't reach our goals immediately.

Stress and Behavior

Research has shown that people that respond with anger and impatience are at an increased risk of heart attack. "Hot reactors" respond with intense constriction of blood vessels and high blood pressure. Changing behavior is important and there are many helpful resources in the bookstore and library, as well as counseling and pharmacological management. Personally we would recommend Steven Covey's bestseller, "Seven Habits of Highly Effective People" as a place to start.