By Mike DuBose with Blake DuBose and Surb Guram, MD
Heart disease has become an American epidemic. Approximately one-third of the US population (more than 80 million people) is afflicted with a cardiovascular disease, which kills 800,000 people every year—the most common cause of death in America. Cardiovascular disease also accounts for $1 out of every $6 spent on healthcare.
According to the Centers for Disease Control (CDC), the major causes of heart disease include: diabetes, being overweight or obese, poor diet, physical inactivity, excessive alcohol consumption, smoking, long-term stress, high blood pressure, elevated cholesterol, genetics, and inflammation in the blood. Currently, approximately 50% of Americans exhibit at least one of these eleven risk factors.
American Heart Association president Gordon Tomasselli called high blood pressure “the most significant risk factor for heart disease” in a 2012 USA Today article. Having high blood pressure “means that the blood running through your arteries flows with too much force and puts pressure on your arteries, stretching them past their healthy limit and causing microscopic tears,” according to the American Heart Association. The arteries can then become blocked by the scar tissue that forms as those tears heal.
The Heart and its Functions
To truly understand heart disease and its risk factors, it’s important to know how the heart works. It is a fascinating miracle about the size of an adult fist, weighing in at about 10 ounces (although men’s hearts are larger than women’s). Like a home, the heart has plumbing, electricity, doors, and walls. Cells locatedin the heart generate electrical activity, which causes the heart to pump at a rate of about 72 beats per minute—more than 100,000 times per day. This pushes blood through a network of blood vessels called the circulatory system, allowing the lungs to saturate blood with the oxygen needed by the brain, kidneys, and other vital organs. Each day, the heart pumps up to 2,000 gallons of blood through the body.
Because of the heart’s vital importance to overall health, malfunctions in the organ can cause serious concerns. An electrical problem could lead to an irregular heartbeat, which can be difficult to detect since it can occur briefly and then disappear. One common form of irregularity is atrial fibrillation.A plumbing issue might arise with the arteries, which are tubes through which the blood flows to the body. A healthy artery, with its flexible walls and smooth inner lining, allows free movement of the blood. When the lining is damaged (usually due to smoking, high blood pressure, and/or excess cholesterol), the artery walls become stiff and blood flow is restricted or blocked.
If an artery becomes partially blocked and cannot supply enough blood to the heart, the heart muscle cramps, causing chest pain or angina. It’s a warning sign, but many people (particularly men) ignore it or fail to seek medical attention. When an artery is completely blocked and no blood or oxygen can reach the heart muscle, the artery begins to die, resulting in a heart attack. Whether the person dies or is able to recover depends on the severity of the heart attack and how soon medical attention is obtained.
Symptoms of a Heart Attack
Men usually experience the classical symptoms, such as chest and arm pains and shortness of breath, whereas women may have nausea, jaw or back pain, vomiting, or heavy fatigue, according to Suzanne Steinbaum, director of the New York’s Heart and Vascular Institute, who spoke to USA Today in September 2013.
One of the deadliest facets of heart disease is sudden cardiac arrest, which strikes 360,000 individuals each year. Less than ten percent live! Victims include actor James Gandolfini and TV journalist Tim Russert, who both died in their fifties of sudden cardiac arrest. In a USA Today article, Dr. Sumeet Chunh, a cardiologist at the Cedars-Sinai Heart Institute who has researched sudden death, called cardiac arrest “the ultimate heart problem.” Chunh said, “You’ll die within ten minutes unless you are lucky enough to get medical assistance quickly.” According to the American Heart Association, there are warning signs as much as four weeks in advance: chest pain, dizziness, faintness, and/or heart palpitations.
Preventing and Treating Cardiovascular Disease
In a 2013 USA Today article, Nanci Hellmich reports that 200,000 of the lives lost to heart disease each year could be prevented through some simple lifestyle changes. No matter how old you are, you can still take steps toward reducing your risk of death by heart attack. While more study is needed, here are some tips on preventing heart disease that are based on strong, well-researched evidence:
Schedule regular medical physicals: Search for an excellent physician who listens to you, doesn’t rush, and makes you feel comfortable. An internist (or a cardiologist, if you’re at increased risk for heart disease) is preferable because they receive advanced training in diagnosing medical abnormalities. See this doctor at least once per year.
Before your visit, make a list of any medicines you take, their dosages, and any unusual issues or symptoms you are experiencing. Don’t ignore patterns, even those that just seem minor (like pains, shortness of breath, dizziness, fatigue, or nausea). They may be major warning signs—our bodies often try to warn us when something is wrong. The more details you can tell your doctor, like the timing and frequency of the symptoms, the more likely it is that he or she can correctly diagnose and treat the problem.
Other problem signs can go undetected without skilled medical assessments, so take any tests that your doctor recommends just to be safe. Once, I had no symptoms, but Dr. Guram detected an abnormality when I went in for my annual physical examination. More extensive testing revealed that my heart’s aorta was abnormally dilated and that I had an aneurysm. My genes had handed me a potential time bomb!
Once your doctor has completed your physical, LISTEN to him or her and take action to correct any issues. Keep copies of your blood work and other test results in a file to track any growing problems.
Study your genes: Review your family tree, including grandparents, parents, and siblings, for history of diseases. Some health problems can travel through families, so knowing your relatives’ health histories can point physicians in the right direction when they are treating you. A family history of heart disease doesn’t necessarily mean that you will inherit it, but it does place you at a higher risk. Most scientists believe that genes are roughly 25% responsible for your health. As surgeon Dr. Mehmet Oz, MD, said, “Your genetics load the gun. Your lifestyle pulls the trigger.”
Learn about your diseases and their treatment: Ideally, you want to take as few medications as possible to avoid potential side effects, but you should ultimately follow your doctor’s orders. Ensure that all your doctors know the medications you are taking since some combinations can cause serious problems. Websites like drugs.com allow you to enter all of your drugs at once to discover interactions.
Research your medical disorder and all medications that you are taking using reputable and research-filled websites like webMD.com, drugs.com, CDC.gov, mayoclinic.com, NIH.gov, and clevelandclinic.org. Also, consult your pharmacist and read all the material that your pharmacy provides about your medications. Don’t be alarmed by lists of potential side effects or negative reviews, as they may not apply to you. If one medication, such as a cholesterol-lowering statin drug, causes problems, there may be alternatives that you can tolerate.
Maintain a list of any unusual changes in memory, emotions, sleep, pain, digestive system, thoughts, behaviors, etc., and when and how often they occur, as they may be side effects of your medications. Keep a list of your medications in a computer file so you can easily print them out for doctor visits and update them afterward.
The body takes time to adjust to some heart medications, so don’t write off those that don’t seem to work immediately. If you are doing well with such things as losing weight, exercising, and lowering your cholesterol, you could ask your doctor if it is possible to lower the dosage or eliminate some drugs.Because I stepped up my exercise and lost weight, I was able to adjust my statin dose. Never stop taking your medications without consulting your doctor, since this can cause serious side effects.
Exercise: According to a December 2013 USA Today article, exercise may be the best medicine one can get: “Studies show that exercise reduces the risk of early death, helps control weight and lowers the risk of heart disease, stroke, type 2 diabetes, depression, some types of cancer, anxiety disorders, cognitive decline and hip fractures. It can help improve sleep, memory, concentration and mood.” Timothy Church, a physician and director of preventive medicine research at the Pennington Biomedical Research Center, noted, “Exercise strengthens the entire human machine—the heart, the brain, the blood vessels, the bones, the muscles. The most important thing you can do for your long-term health is lead an active life.”
Don’t smoke: Any level of tobacco intake is bad for you. According to the CDC, cigarette smoking causes more than 440,000 deaths annually, and it can seriously harm every organ in the body and all parts of the circulatory system. Smoking increases your odds of coronary heart disease and stroke by 400%. It causes the blood vessels to thicken and restrict, which makes the heart beat faster and increases blood pressure, often causing dangerous clots. There are various methods and medications that your doctor can suggest to help you kick the habit, as well as more nontraditional methods such as hypnotism. I witnessed Dr. Fredrick Mau of Watermark Hypnosis break a smoker’s addiction in one hypnosis session!
Reduce stress: TheJanuary 2014 Harvard Heart Letter reports that 70% of people with heart disease are affected by emotional stress. Exactly howthis stress relates to heart problems is unclear, but the consequences are very real. “Emotional and mental stress work the same way as inadequate blood flow caused by physical stress—and may be just as likely to trigger a heart attack,” the newsletter notes. In other words, stress can shorten your life. Thus, carefully examine stressors in your life and their causes and then take actions to fix them. This can mean a job change, avoiding negative people, seeking professional counseling, meditating, exercising, or taking medications to reduce anxiety and depression.
Lose weight: “Overweight and obese people could slash their increased risk of heart disease by half and their increased risk of stroke by three quarters by controlling their blood pressure, cholesterol and blood sugar, a big new international study suggests,” writes Kim Painter in a 2013 USA Today article. Numerous similar studies have proven that being overweight or obese can cause many health problems, including high blood pressure, diabetes, heart disease, joint problems, high levels of blood inflammation, sleep apnea, cancer, and elevated cholesterol, that are linked to heart disease. Losing weight can be difficult, but the chance it offers to lower your risk of heart disease is worth the effort. The CDC shares many weight loss tips at its website, www.cdc.gov, and our article “How I Lost 35 Pounds…While Still Eating Fried Chicken” contains additional information and can be read at www.mikedubose.com.
Control diabetes: According to the National Institutes of Health (NIH), there are about 26 million diabetics in the US, 30% of whom do not know they have the disease. In addition, nearly 80 million individuals are pre-diabetics. The NIH also says that 68% of diabetics die of heart disease or stroke. High blood sugars caused by the inability of the pancreas to secrete insulin lead to a host of complications that can affect every part of the body, including the heart and blood vessels, eyes, kidneys, nerves, gums, and teeth. Diabetes creates high blood sugar, which thickens the blood, restricting its flow through the body’s plumbing system. An annual medical physical will detect pre- or existing diabetes so it can be treated. The objective is to keep blood sugar within a normal range with diet, exercise, weight loss, and if needed, insulin or other medications. If you are a diabetic, your physician can run an A1c blood test that will indicate how well you are controlling your blood sugar.
Eat healthy: Most research today suggests that exercising, eating a well-balanced, healthy diet, and losing weight can reduce the need for medications and supplements. A good rule of thumb is to limit fast foods or those made in commercial plants. Read food labels and avoid the “bad fats”— saturated and trans fats, or “STs,”—which are located in fatty meats, whole milk cheeses, fried foods, ice cream, snack foods, French fries, packaged baked goods, and most margarines. STs increase cholesterol and fat in the blood. Instead, consume polyunsaturated and monounsaturated fats, or “PMs” (the “good fats” found in nuts, seeds, olive oil, and fish). Limit your high-fat dairy and meat products (especially red meat), and focus more on vegetables, beans, fruits, fiber, low-fat foods, and grains. If you are eating right, your plate should be full of colorful foods like berries and leafy greens. In fact, a recent study of 93,600 women led by Dr. Eric Rimm, associate professor at the Harvard School of Public Health and Harvard Medical School,showed that those who ate more than three servings of strawberries or blueberries each week had a 34% lower risk of heart attack than those who rarely ate the berries.
Sodium, a major factor in high blood pressure, is used for flavoring or as a preservative. Foods—particularly processed foods, restaurant meals, and fast foods—often contain startlingly high amounts of sodium. The Mayo Clinic notes that your body needs some sodium to function properly because it helps maintain the right balance of fluids in your body, assists in transmittingnerve impulses, and influences the contraction and relaxation of muscles. Generally, your kidneys will naturally balance the amount of sodium stored in your body, holding onto it when the amount is low and excreting the excess when levels are too high. If for some reason your kidneys can't eliminate enough sodium, it starts to build up in your blood. Because sodium attracts and holds water, your blood volume increases, which makes your heart work harder and increases pressure in your arteries. Diseases such as congestive heart failure, cirrhosis, and chronic kidney disease can make it hard for your kidneys to keep sodium levels balanced.
Guidelines for acceptable sodium consumption vary depending on the source and other factors. The American Heart Association recommends ingesting no more than 1,500 MG of sodium per day. The US government’s Dietary Guidelines for Americans recommend limiting sodium to less than 2,300 mg a day—or 1,500 mg if you're age 51 or older, are black, or have high blood pressure, diabetes or chronic kidney disease.
Most Americans—90%, by the CDC’s estimation—eat much more that the recommended amount of sodium. According to Nanci Hellmich’s article, many Americans consume 3,600 MG (or more) every day. It can be difficult to track salt consumption, and it all adds up quickly. To give you an idea of sodium levels in common foods, a half teaspoon of salt (a few dashes of the salt shaker) contains 1,200 MG of sodium. Two slices of one type of whole wheat bread contain 250 MG!
One way to reduce sodium intake is to substitute fresh herbs or seasonings like Mrs. Dash products in place of salt when cooking. If eating out, ask the waiter to place any sauces on the side. Always remember to taste your food before reaching for the salt shaker, and read food labels carefully for any unexpected sources of sodium.
Lower your blood pressure: High blood pressureaffects 78 million American adults and can have many causes, including: smoking, caffeine, genetics, being overweight, not exercising, too much sodium, excessive alcohol use, stress, older age, kidney disease, thyroid disorder, prescribed and over-the-counter medications, pregnancy, bad diet, and sleep apnea, to name a few. Lowering your blood pressure through strategies like losing weight or eating a healthy diet can help reduce your risk of stroke, heart failure, and heart disease. If fighting high blood pressure the “natural” way doesn’t help, you may need medication, so work with your doctor to determine the best protocol.
Recently, some guidelines have sparked controversy by recommending that people aged 60 or older keep their blood pressure at 150/90 or less. The more generally accepted limit, however, is 140/90 (for individuals of all ages). It’s possible to test your own blood pressure periodically using a monitoring device such as the Omron, which is recommended by Consumer Reports.
When taking your own blood pressure, note any differences in readings between arms. According to Sheldon Sheps, MD, a hypertension expert at the Mayo Clinic, in general, “a small difference in blood pressure readings between arms isn't a health concern.” However, a difference of more than 20 for systolic pressure (the top number) or more than 10 for diastolic pressure (the bottom number) between arms “may be a sign of an underlying problem—such as narrowing of the main arteries to that arm.” A consistent 10-15 difference in the top number “is a risk marker for vascular disease and for a greater risk of developing cardiovascular disease and related complications during the next 10 years,” Sheps said. Thus, inform your doctor if your blood pressure readings yield any abnormal results.
Reduce inflammation: According to a Wall Street Journal article by Laura Landro, heart disease, diabetes, Alzheimer’s, stroke and cancer share a common bond: “Scientists have linked each of these to a condition known as chronic inflammation, and they are studying how high-fat foods and excess body weight may increase the risk for fatal disorders.” The body’s immune system naturally produces inflammation when it is threatened by an injury or irritant; however, if it stays “under attack” for long periods of time, health problems—such as heart valve damage, brain cell damage, stroke, cancer—can result. Landro lists “high-fat foods, too much body fat and smoking” as examples of factors that can provoke and extend inflammation. To assess your inflammation levels, ask your doctor to run the hs-CRP blood test, which measures C-reactive protein.
Fortunately, there are several ways to reduce inflammation, such as eating a diet rich in omega-3 fatty acids (found in foods like salmon), high in fiber, and containing three daily servings of low-fat dairy products. You should also brush your teeth several times a day and floss daily to reduce inflammation in the mouth, which can affect the heart. Because being sick with the flu dangerously elevates inflammation levels, getting one’s flu shot can also help reduce the risk of heart attack.
Consume alcohol in moderation: Excessive drinking can cause a host of health problems, notably high blood pressure. According to the CDC, acceptable ranges of alcohol consumption are one drink per day for women and two for men. New research indicates that moderate alcohol consumption may even be good for your heart, although more long-term studies are needed. As the Mayo Clinic reported, “the alcohol and certain substances in red wine called antioxidants may help prevent heart disease by increasing levels of ‘good’ cholesterol and protecting against artery damage.” Non-drinkers may order the supplement resveratrol to obtain these antioxidants without consuming wine.
Monitor your sleep habits: According to the CDC,sleep disorders are increasingly recognized as a serious public health threat and are often linked to traffic accidents, industrial disasters, and medical errors. Persons experiencing sleep insufficiency are also more likely to suffer from chronic diseases such as hypertension, diabetes, depression, and obesity, as well as cancer and increased mortality. The NIH suggests that school-aged children need 10 hours of sleep daily, teens 9-10 hours, and adults 8 hours.
Some people get insufficient rest due to sleep disorders, which affect an estimated 50-70 million US citizens. One such disorder is sleep apnea, a very serious problem often associated with adults who snore. A person with sleep apnea may quit breathing for up to a minute because their throat passageway is blocked; this can happen over a hundred times per night. When it realizes that oxygen is cut off, the brain wakes the person up enough to regain breathing. Thus, people with sleep apnea usually feel fatigued the next morning and often suffer headaches, lower mental functioning, and irritability. Untreated sleep apnea can lead to depression, increased blood pressure, irregular heartbeats, and an increased risk of heart attacks and sudden death syndrome. If you or a loved one is experiencing any of these symptoms, ask your doctor for a referral to a physician trained in sleep disorders to conduct a study.
Lower cholesterol: Cholesterol is a fat (often called a lipid) that is carried through the bloodstream by triglycerides. The body needs triglycerides for energy; however, high triglyceride levels may also be linked to heart disease.The exact role that triglycerides play remains controversial, but lowering your triglycerides may be beneficial. What is known is that lowering LDL, or “bad” cholesterol, is directly linked to a reduction in heart disease risk. High HDL, or “good” cholesterol, is considered protective for heart disease, although there is controversy over whether raising HDL levels with medication is good or bad. Saturated and trans fats raise LDL; polyunsaturated and monounsaturated fats promote HDL.
High cholesterol has no symptoms, and only a fasting blood test called a lipoprotein profile will provide information about the different components. Past guidelines suggested that patients at risk for coronary disease stay under 200 mg/dl total cholesterol, with less than 100 for LDL, more than 40 for HDL, and less than 150 for triglycerides. In November 2013, the American Heart Association and the American College of Cardiology issued new standards for monitoring cholesterol that urge doctors to consider a patient’s ten-year risk index along with their LDL, HDL, and triglyceride information. The risk index takes family history, body weight, blood pressure, and tobacco habits into account along with the cholesterol numbers.
Usually, overall cholesterol can be improved by losing weight, ceasing tobacco use, eating a healthier diet, and exercising briskly most days a week. According to the Mayo Clinic, the top five types of food that can lower cholesterol are: (1) oatmeal, oat bran, and high-fiber foods; (2) fish and omega-3 fatty acid-rich foods; (3) nuts, such as walnuts and almonds (in moderation); (4) olive oil; and (5) other foods rich in plant sterols and stanols that block cholesterol absorption (many fruits, vegetables, vegetable oils, nuts, seeds, cereals and legumes). Many doctors recommend the Mediterranean diet for heart-healthy nutrition.
Whether due to genetics, other diseases, or medication side effects, some individuals cannot control their cholesterol by diet and exercise alone. In these cases, your doctor may prescribe a statin drug such as Lipitor or Crestor. There are various types of statin medications that act on different organs to reduce cholesterol. If you cannot control your cholesterol using statin medications (or if you suffer side effects like joint pain), speak to your physician about other methods of lowering your cholesterol.
The bottom line: Many Americans are living a lifestyle that will result in premature disability or death. However, based on our extensive research, we have concluded that it’s never too late to start a new, healthier lifestyle. Remember: 25% or more of heart disease cases can be prevented. If we look at the British Journal of Medicine’s Whitehall Study of 19,000 men, research-based evidence documents that those who didn’t smoke, have high blood pressure, or have high cholesterol lived ten years longer than the study participants who did. The facts speak for themselves: make just a few life changes and you could extend your lifespan and improve the quality of your later years!
About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, experience, success, research, and mistakes.
Mike DuBose has been in business since 1981, authored The Art of Building a Great Business, and is a field instructor with USC’s graduate school. He is the owner of three debt-free corporations, including Columbia Conference Center, Research Associates, and The Evaluation Group. Visit his nonprofit website www.mikedubose.com.
Blake DuBose graduated from Newberry College School of Business and is president of DuBose Web Group. View our published articles at www.duboseweb.com.
Dr. Surb Guram, MD is a board-certified internist and is a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.
Katie Beck serves as Director of Communications for the DuBose family of companies. She graduated from the USC School of Journalism and Honors College.
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