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Health
Tips from Cougars
Heart
 Fatty
Fish Cuts Risk of Death From Heart Attack in Elderly
Older
individuals are less likely to die from a heart attack if they eat
at least one serving of fatty fish per week, according to a study
presented today at the American Heart Association’s 41st Annual
Conference on Cardiovascular Disease Epidemiology and Prevention.
Eating fatty fish at least once per week was associated with a 44
percent lower risk of dying from a heart attack among a group of
older adults, average age 72. In contrast, eating fried fish “which
is typically lean“ was not associated with a lower risk of dying
from a heart attack. Examples of fatty fish are tuna, salmon and
mackerel; examples of lean fish are cod, catfish and snapper. “Our
findings are consistent with results of prior studies done in predominantly
middle-aged adults,” says Dariush Mozaffarian, M.D., lead author
of the study and fellow in cardiology and health services research
at the University of Washington/Seattle Veterans Affairs Medical
Center. Fish is thought to protect against death from heart attack
because it contains good fats called omega-3 (or n-3) polyunsaturated
fatty acids (PUFAs). “Fatty fish are more abundant in omega-3 fatty
acids, while fried fish are typically lean fish without significant
omega-3 fatty acids. Because these omega-3 fatty acids may protect
against dying from a heart attack, eating fatty fish may be of greater
benefit than eating fried fish,” says Mozaffarian. The researchers
found that individuals with a higher intake of fatty fish had higher
plasma levels of omega-3 PUFAs. There was no correlation between
intake of fried fish and plasma levels of omega-3 PUFAs. Many deaths
from heart disease are due to cardiac arrhythmias, or heart rhythm
disturbances, and omega-3 fatty acids may reduce the risk of arrhythmias,
he says. “The study suggests that modest consumption of fatty fish
at any age may be beneficial,” says David S. Siscovick, M.D., professor
of medicine and epidemiology, and co-director of the University
of Washington Cardiovascular Health Research Unit, and a co-author
of the study. “When encouraging people to eat a healthy diet, it
may be important to differentiate which types of fish are good sources
of omega-3 fatty acids,” he says. Researchers analyzed the relationship
between eating fatty fish, eating fried fish and the risk of fatal
heart attack and coronary heart disease deaths among nearly 4,000
men and women older than age 65 involved in the National Heart,
Lung and Blood Institute’s Cardiovascular Health Study, launched
in 1988 to assess the determinants of heart disease and strokes
among older adults. At the beginning of the study, all participants
were free of known cardiovascular disease. Mozaffarian and his colleagues
used a detailed food questionnaire to assess the participants’ usual
diet. Participants were followed for an average of 6.8 years. The
researchers did not determine which specific types of fatty fish
were consumed, therefore it is not possible to recommend one type
of fatty fish, tuna or salmon, for example, over another.
Pump
Up for Your Heart
Sure, cardiovascular exercise strengthens the heart, but
did you know that lifting weights also helps keep your heart pumping
strong? Yes, making more muscles can also improve your ticker. According
to a study from Northern Illinois University, lifting weights or
doing other resistance exercises as seldom as twice per week can
lower your risk of cardiovascular disease. Researchers studied men
and women who started lifting weights on a weekly basis. All participants
lowered their blood pressures by at least 2%--which may sound modest,
but is significant enough to reduce the likelihood of developing
heart disease. Lifting weights for 10 minutes just 3 times per week
can make you as much as 2 years younger.
Aspirin
Heart Warning
Taking aspirin to ward off heart disease could be harmful for people
at low risk, say researchers. They analyzed the pooled results of
four major international clinical trials covering 48,000 people,
of which more than half were treated with aspirin. Aspirin is well
known to reduce the risk of heart attacks and stroke in those who
have already suffered these problems. The results showed that the
painkiller cut the risk of first heart attacks by almost a third.
But it also increased the risk of bleeding complications by almost
70%. The researchers, led by Professor Larry Ramsay, of the Royal
Hallamshire Hospital, Sheffield, concluded that it was important
to identify how likely a person is to have a heart attack before
deciding whether they should take aspirin. If the risk of a heart
attack is calculated as being moderately high - a 15% chance over
10 years - then they say that taking 75mg of aspirin once a day
is a good idea. Except in people with ulcers or high blood pressure
that is not being treated, the chance of preventing a heart attack
far outweighs any possible harm. And in people at moderate risk
- between 5% and 15% - the benefits and disadvantages cancel each
other out, so taking aspirin is probably worthwhile. However, they
conclude that people whose chance of having a heart attack in the
next 10 years is less than 5% should not take aspirin. For these
people the side effects - such as bleeding from the stomach - are
likely to outweigh any benefit. The difficulty is that people do
not often know their true level of heart disease risk - and may
simply decide to treat themselves. This risk can only be calculated
using a set of specially devised tables, taking into account all
the possible risk factors, such as smoking, family history, and
cholesterol levels. "Aspirin lowers the risk of having a heart attack,
but is not recommended as a preventative measure for people who
have a low risk of getting heart disease. "Instead these people
should concentrate on not smoking, doing regular physical activity
- 30 minutes on five days a week - and eating a high fruit and vegetable,
low fat diet."
The research is published in the journal Heart.
Warning
on Heart Disease Wonder Drugs
Drugs to lower cholesterol are overprescribed, with people wasting
millions of dollars, health experts have warned. Australia spent
more than $500m on the drugs last year, with taxpayers subsidizing
most of the cost through the Pharmaceutical Benefits Scheme, the
scheme's figures reveal. But the "wonder drugs", credited with revolutionizing
the treatment of heart disease, are also being prescribed to thousands
of people who may derive limited benefits or are failing to make
key lifestyle changes to help themselves. The former head of Australia's
Pharmaceutical Benefits Scheme, Professor Don Birkett of Flinders
University, warned yesterday the drugs now accounted for almost
15 per cent of the scheme's $3.8 billion total spending. "The issue
is targeting them to the right patients and I have some concerns
that they are not being properly targeted," he said. Heart disease
is the biggest cause of premature death in Australians under 70.
Almost half of all men and women over 40 have elevated cholesterol.
In 1999-2000, the PBS spent $473 million subsidizing lipid reducing
drugs. Total spending on the drugs was $545 million in the year
when the amount paid directly by patients is added to the subsidy.
This was an increase of $110 million on the previous year's total.
At an average cost of $56, an additional 1.8 million prescriptions
were filled last year, bringing the total number of prescriptions
to 9.6 million. Lipid-lowering drugs, or statins, work by partly
blocking the enzyme found in the liver that turns some food into
cholesterol. Professor Phillip Barter, a cardiologist and chairman
of the National Heart Foundation's research committee, warned that
patients should not regard the drugs as a quick-fix. "There is this
almost hysteria about prescribing these drugs, that if you've got
high cholesterol, give the patient statins." But Professor Leon
Simons, director of the lipid department at St Vincent's Hospital
in Sydney, said critics of the drugs had to prove their case. "The
growth is enormous ... but I say it's money well spent," Professor
Simons said. Professor John Marley, who specializes in general practice
at Adelaide University, called for greater research. "There is a
big industry around lowering cholesterol," he said.
Study:
Exercise Boosts Clot-Dissolving Protein
A half hour of minimal exercise can give people with hardening of
the arteries in their legs or arms a boost in protection from a
heart attack or stroke, a study finds. The study found walking boosted
levels of a natural clot-dissolving chemical called tissue plasminogen
activator, known as TPA. The body makes TPA, and genetically engineered
versions are used as drugs to treat heart attack and stroke. The
study examined people with peripheral arterial disease, a condition
similar to the narrowed vessels in coronary artery disease. In either
case, blood clots can develop in the constricted arteries. If a
clot travels to the heart, the result is a heart attack. If it travels
to the brain, the result is a stroke.
The study, which was published in the February issue of the American
College of Sports Medicine journal, Medicine and Science in Sports
and Exercise.
The study done at the University of Maryland looked at eight men
and one woman with an average age of 70. The condition is more common
as people get older, and more common among men than women, said
lead author Christopher J. Womack, now at Michigan State University.
All nine hurt if they walked too far. The disease reduces blood
flow to the legs, leading to cramping and fatigue, although their
symptoms subsided with rest. No patient had been an exerciser before
taking part in the study. The researchers had the nine walk for
30 minutes each, not including any rest breaks. The pace would have
been gentle for a healthy person, but it was tough for the patients
because of the pain it generated, Womack said. The scientists measured
changes in TPA and another chemical, plasminogen activator inhibitor,
PAI-1, which binds to TPA and neutralizes it. The balance between
TPA and PAI-1 helps to regulate the ability to clot. Before exercise,
the patients had only 80 percent of normal TPA levels, so their
ability to dissolve clots was reduced, Womack said. After exercise,
however, TPA levels were about the same as those in a non-exercising
person of the same age with peripheral arterial disease, the study
found. Levels of PAI-1 fell at the same time. And the changes in
both remained significant for at least an hour after the walk, the
report said. "An increase in TPA is good for you, and a decrease
in PAI-1 is good for you," commented researcher Anna Carter of the
University of Leeds in England, who was not a part of the study.
"High levels of PAI-1 have been related to heart disease, and low
levels of TPA have been related to heart disease." The changes were
strong enough potentially to reduce the risk of an artery blockage,
and the findings add to evidence that should encourage people with
peripheral arterial disease to be physically active, Womack said.
Other studies have shown that aerobic activity improves the ability
of patients to perform activities of daily life, and trains them
to go farther without feeling pain. There is a risk that exercise
can jar loose a clot -- causing what the exercise program was aimed
at preventing, Womack conceded. But the risk of this is very small,
and the benefits of exercise are large, so the benefits generally
outweigh the risk, he said.
CORONARY
ARTERY DISEASE WHAT IS IT?
Your heart is your hardest-working muscle. Every day it beats about
100,000 times, pumping nearly 2,000 gallons of blood through more
than 50,000 miles of blood vessels. Like any muscle, it needs plenty
of oxygen. And the harder it works, the more oxygen it needs. The
heart gets oxygen from blood supplied by vessels called coronary
arteries. When deposits, called plaque, narrow these blood vessels,
blood and oxygen can't get to the heart easily: Then you have coronary
artery disease. When your heart needs more blood than it can get-as
you walk up stairs, for instance-it may complain with a squeezing
chest pain called angina pectoris. But about one person in three
with clogged arteries has no warning chest pain. For them, the first
sign of trouble is a heart attack. The good news: You can take steps
to prevent coronary artery disease by making smart choices about
such things as your diet and exercise habits. Even if your arteries
are clogged, you and your doctor can begin to treat the problem
and even reverse it. If you've already had a heart attack, you may
be able to prevent a second one.
(CORONARY ARTERY DISEASE) WHAT IS HAPPENING?
At their widest, the coronary arteries are about as big around as
soda straws. Healthy arteries are smooth inside, so blood flows
through them easily. They become diseased when cholesterol, a fatlike
substance carried in the blood, begins to streak their walls. These
streaks invade the wall and gradually thicken. Your body tries to
protect itself from this buildup by covering it with special cells-in
effect, scar tissue. Over time, the streaks and scarring thicken
and harden into plaque, like rust in a pipe. This slow clogging
is called atherosclerosis. It may begin in childhood and continue
to worsen for years. But symptoms such as chest pains or shortness
of breath don't show up until arteries are already badly narrowed.
Angina is a sign you're in danger of a heart attack. A heart attack
happens when plaque breaks off in a narrowed coronary artery and
blocks blood flow, or when a blood clot forms, usually where an
artery wall is damaged by plaque. In either case, part of the heart
loses its blood supply, and cells there begin to die. Fast treatment
is vital: Many people suffer little or no long-term damage from
a heart attack if blood flow is restored quickly, especially within
the first hour-what doctors call "the golden hour."
(CORONARY ARTERY DISEASE) WHAT CAUSES IT?
Some things that can increase your risk for coronary artery disease
are outside your control. These include your gender, age, and family
background. But you can do plenty about other risk factors.
THINGS YOU CAN'T CHANGE
Gender
Many people think only men have to worry about clogged arteries.
In fact, a woman does have a lower risk than a man until she reaches
menopause. Before then, the female hormone estrogen helps protect
against heart disease. But estrogen levels drop after menopause,
and a woman's risk rises quickly to that of a man.
Age
The older you are, the greater your risk. That's because it may
take many years for plaque to build up in an artery. About four
in five people-male and female-who die from heart attacks are over
65.
Family history
Heart disease runs in families. If your mother or father has coronary
artery disease, you likely have a higher risk than someone from
a family in which no one has heart problems. Having a grandparent,
aunt, or uncle with heart trouble also raises your risk, but not
as much.
Diabetes
You're more likely to develop coronary artery disease if you have
diabetes. The reasons are complex, but experts think diabetes tends
to promote the buildup of plaque on artery walls.
THINGS YOU CAN CHANGE
Smoking
Smoking is one of the worst things you can do to your body. The
nicotine and chemicals in smoke damage the insides of your blood
vessels, and raise cholesterol and blood pressure levels, increasing
your risk of clogged arteries. A man who smokes a pack a day has
twice the risk of heart disease as a man who doesn't smoke. If you're
a woman, smoking is even more dangerous-a pack a day raises your
risk five to ten times. And of course, your risk for lung cancer
also shoots way up if you smoke.
High blood pressure
Blood pressure is the force of blood pushing against your artery
walls as it flows. The pressure rises and falls throughout the day
with changes in your activities and moods, but if it remains higher
than normal most of the time, your heart has to work too hard. High
blood pressure also hurts the artery walls. This makes it easier
for plaque to form and clog arteries. Your risk for problems begins
to rise as your blood pressure goes up. Some experts think that
even if your blood pressure is in the normal range, the lower it
is, the better.
Too much fat and cholesterol
The more fat and cholesterol in your diet, the faster your arteries
are likely to narrow. Meat, eggs, and whole dairy products are examples
of foods that are high in fat and cholesterol.
Too much alcohol
Heavy drinking enlarges the heart muscle and makes it flabby, so
it can no longer pump well. Alcohol also raises blood pressure,
and can cause irregular heartbeat and stroke.
Being overweight
Too much weight puts constant strain on your heart and raises blood
pressure and cholesterol levels. For instance, a 10 percent gain
in body fat raises your chances of a heart attack by about 25 percent,
and your risk continues to rise as your weight goes up. Extra pounds
around the waist (apple shape) seem to be very bad for your heart;
fat around the thighs or hips (pear shape) is less harmful.
Lack of exercise
The less active you are, the more you tend to put on weight. Lack
of exercise also raises your blood pressure and cholesterol levels.
As you get into better shape, your heart gets healthier.
(CORONARY ARTERY DISEASE) WHAT YOU CAN DO
FOR YOURSELF
You can do a lot to keep your heart healthy. If your arteries are
already narrowed-and even if you've already had a heart attack-making
healthy choices can still help.
Eat the right stuff
A low-fat, low-cholesterol diet can help prevent and even reverse
coronary artery disease. You do need some fat and cholesterol to
stay healthy. They provide energy, maintain cell walls, and help
your body make hormones, including sex hormones such as testosterone
and estrogen. And some oils contain substances that may help protect
the arteries. But when you eat extra fat, especially the wrong kinds
of fat, or when you eat extra cholesterol, your body stores some
of these substances as body fat, and some of them end up clogging
your arteries. If you have high blood pressure, then the fat and
cholesterol in your food can turn into an even bigger problem. That's
because high blood pressure roughens artery walls, so plaque-fatty
lumps that can grow and harden over time-is more likely to stick
to the artery walls and build up. Cholesterol is a waxy substance
found only in foods from animals. Your liver makes all you need.
Eating extra cholesterol is one cause of artery disease. But it
isn't the only cause, or even the main one-fat is. While all fats
are fattening, some are worse for your arteries and heart than others.
Saturated fats come from animals and some plants, including palms
and coconuts. These fats are solid at room temperature. They raise
cholesterol levels in your blood and clog your arteries. Hydrogenated
vegetable oils are oils that food manufacturers have turned into
saturated fats. They're found in margarine, vegetable shortening,
and many packaged foods. They clog your arteries just as saturated
fats do. Hydrogenated vegetable oils also contain a form of fat
called trans fatty acid, which appears to raise the level of low-density
lipoprotein (LDL), the so-called bad cholesterol that clogs arteries,
and lower the level of high-density lipoprotein (HDL), the good
kind. Unsaturated fats come from plants and fish, and are liquid
at room temperature. They come in two types: polyunsaturated and
monounsaturated. Most vegetable oils are a mix of the two. Olive
and canola oils are mostly monounsaturated fat. They slightly lower
LDL and slightly raise HDL. Sunflower, safflower, and soybean oils
are mostly polyunsaturated fat. They lower LDL, but appear to slightly
lower HDL as well. Fish oils and flax seed oil contain a special
type of fat, Omega-3s, which appears to prevent blood clots and
lower the risk of heart attack. If you use fat in cooking, use liquid
vegetable oils as much as possible, but remember that too much of
any type of fat is fattening. Here are some simple things you can
do to cut fat and cholesterol in your diet.
>> Read food labels to know what you're getting. The important
things to look for are calories, calories from fat, total fat, saturated
fat, and cholesterol. Also, note if "hydrogenated" or "partially
hydrogenated" vegetable oil is on the list of ingredients and try
to steer clear of foods that contain it. The American Heart Association
advises keeping your fat intake under 30 percent of your total calories
each day. That could mean only 750 calories a day, or even fewer,
from fat. (Just one tablespoon of butter has about 100 calories.)
Not everyone agrees with the 30 percent recommendation, however.
Some experts think you should go for 20 percent or less, while others
say if you're trim and lean, you can be healthy if you get as much
as 40 percent of your daily calories from fat, as long as most of
this fat is the unsaturated kind.
>> Build your meals around fruits, vegetables, and grains.
They have little fat and no cholesterol and are loaded with vitamins,
minerals, and fiber. Fiber is important. It lowers cholesterol and
blood pressure and helps keep your arteries open. Foods rich in
fiber include apples, oranges, potatoes, squash, peas, carrots,
soybeans and other beans, oats, and barley.
>> If you eat red meat, make it a once-in-a-while treat, not
a regular item, and keep it lean. Look for cuts graded "select,"
which means they have the least fat. Other low-fat cuts include
pork loin, lean center-cut ham, venison, veal chops or roast, and
lamb flank. Before cooking chicken, remove the skin and fat. Don't
use chicken injected with salt and fat-read the package label to
make sure it isn't. Eat no more than six ounces of meat, poultry,
or fish a day. Keep servings to three ounces-a cut of meat about
the size of a deck of cards, half a skinless chicken breast or leg,
or three-fourths cup of flaked fish.
>> Some studies suggest that eating fish two or three times
a week can lower your risk of heart attack. While fish may be important,
the way you cook it is even more so. Broil instead of frying or
sauteing in butter or oil.
>>Don't fry foods. Bake, broil, steam, or saute with water
or vegetable broth in a nonstick pan.
>>If you eat dairy foods, go for low- or nonfat versions such
as skim or 1 percent milk, and choose nonfat yogurt, ice milk, or
sherbet instead of ice cream.
>> Egg yolks contain a lot of cholesterol. Eat no more than
three or four a week, including eggs in baked goods. In recipes,
replace one whole egg with two egg whites or use an egg substitute.
>> For salads, try an oil-free dressing. If you use oil, choose
one that is high in unsaturated fats, such as olive, canola, safflower,
or sunflower.
>> Read the labels on frozen dinners and other convenience
foods to see how much fat they contain. Aim for meals that have
less than 10 grams of fat per serving.
Think about making some other diet changes...
>> Use less salt. The body needs only about 200 milligrams
of sodium a day, but most of us get much more than even the very
generous 2,400 mg recommended by most health experts (the amount
in about one teaspoon of salt). Too much sodium makes your body
hold water and other fluids. If you already have high blood pressure,
extra fluid may raise it even higher. But people react to salt differently.
Some can eat salty foods with no effect on their blood pressure.
For others, eating the same foods will make their blood pressure
shoot up. If you have high blood pressure and you know salt is a
problem for you, watch out for canned and prepackaged foods. Many
are loaded with salt-much more, in fact, than the amounts people
usually sprinkle on food at the table. Also steer clear of potato
chips, pizza, fast foods, frozen dinners, and processed meats. And
don't put extra salt on your food. Season with herbs instead.
>> Get plenty of vitamins B-6, B-12, C and E, and folic acid,
as well as the minerals calcium, magnesium, and potassium; they're
necessary for a healthy heart and arteries. A varied diet provides
all you need, but if you want to be sure, take a daily multivitamin
that contains recommended amounts.
>> Get enough calcium and potassium. People who get plenty
of calcium and potassium from their foods tend to have lower blood
pressures than those who don't get enough of either. Aim for at
least 1,000 milligrams of calcium every day (or 1,200 mg if you're
over 50). Good calcium sources include dairy products, green leafy
vegetables, tofu, soybeans, and canned sardines and salmon. If your
diet is typical, you'll probably need a calcium supplement. It's
best to take small doses of less than 500 mg with meals. Calcium
carbonate, as found in Tums or Rolaids, is a good choice. Experts
suggest getting at least 3,500 mg of potassium a day. You'll get
plenty if you stick to a well-balanced diet with lots of fruits
and vegetables. Good sources of potassium include avocados, bananas,
oranges, dried apricots, prunes, spinach, potatoes, milk, and lentils.
If you're concerned about getting enough, though, consider potassium
supplements: one 500 mg pill in the morning and another 500 mg at
night.
Be careful with alcohol Studies show that moderate drinking
may help cut the risk of heart disease slightly. On the other hand,
too much alcohol can raise your blood pressure and cause heart problems.
If you drink, don't drink much. A rule of thumb for men is to have
no more than two drinks a day; for women, no more than one. A drink
is one bottle of beer (12 ounces), one glass of wine (5 ounces),
or one shot of hard liquor (1.5 ounces).
Exercise Regular exercise helps prevent coronary artery disease.
If you already have heart disease, exercise speeds your recovery
and makes a heart attack less likely. Like any muscle, your heart
gets stronger with regular extra work. A strong heart pumps blood
with less effort than a weaker one. Exercise also helps open up
clogged arteries, lower blood pressure, and reduce stress. It can
even help your body get rid of sodium, and increases the levels
of "good" HDL cholesterol in your blood. And exercise makes clots
less likely to form in narrowed arteries, cutting your risk of heart
attack and stroke even more.
The idea of exercising may be a little scary if you haven't been
active over the years, or if you've been told you have a heart problem,
but exercise may be most important then. Here are some tips to make
it safe and easy:
>> Talk to your doctor before beginning an exercise program.
>> Start by being a bit more active each day. Any activity
will help; even brief workouts will lower your blood pressure and
cholesterol. Take the stairs instead of the elevator. Walk the dog
for 15 minutes each evening; your pooch and your blood vessels will
thank you.
>> When you're used to being active, add some activities that
are more aerobic to your routine. These should make you breathe
harder, sweat a bit, and get your heart pumping. Brisk walking,
running, biking, and swimming are all ideal. Take a couple of months
to work up to 20 to 30 minutes at a time most days of the week.
>> Almost any exercise is better than none, but if you have
high blood pressure, until it's under control avoid activities that
make you push and strain, like weight lifting. If you do move on
to lifting weights, don't hold your breath as you lift.
>> Find something you enjoy-it's easier to keep exercising
when you like to do it.
>> If you have symptoms of angina or a heart attack while
exercising, stop and call 911 right away.
Don't smoke
While your risk for many serious health problems shoots up with
the first puff, there's good news: As soon as you've taken your
last puff, your body begins to recover. For instance, within a year,
your risk for heart disease drops to half that of a smoker. And
15 years after stopping, your risk is the same as that of a person
who never smoked.
Control your weight
Start dropping any extra weight. This will help improve blood flow
and lower blood pressure. Don't go on a "crash" diet, though-most
crash dieters gain back any weight they've lost. The best approach?
Combine smart eating with exercise. Extra calories-those you don't
use for energy right away-pack on the pounds. Exercise burns them
off. To lose a pound of fat, you need to use 3,500 more calories
than you take in. That's because one pound of fat has 3,500 calories.
(A typical fast-food lunch of a burger, fries, and a shake is loaded
with about 1,700 calories; by contrast, an apple has only 80.)
Taking off weight may sound daunting, but it doesn't have to be.
Here are some tips for a program that works...
>> Check with your doctor to find out how much you ought to
weigh.
>> Take your time. When you lose weight slowly-no more than
1 percent of your body weight each week-it's easier to keep it off.
>> Be realistic. Don't aim for a weight you can't reach and
maintain. Even a little weight loss will help lower your risk of
heart problems, even if you never reach your ideal weight.
>> Keep an eye on your total calories and cut down on fats.
Follow the dietary guidelines under "Eat the Right Stuff."
>> Keep in mind that "fat-free" and "low-fat" foods can be
a trap. They may not have the fat, but many of them make up for
it with sugar, so they're still high in calories.
>> Stay as active as you can.
Don't stress out
Too much stress can harm your health, and it can be very hard on
your heart and arteries. Your natural response to a demanding or
high-pressure event-a problem at work, a wedding, even getting ready
for a vacation-causes changes in your body. Your heart starts to
beat faster, and your body releases a number of "fight or flight"
chemicals that provide quick energy. Your blood pressure also shoots
up, and that can be bad if it's already too high. Brief bouts of
stress aren't harmful, but a lot of stress day after day can take
a toll. Built-up stress raises your risk of heart and artery disease,
as well as your risk of a number of other health problems, including
depression and headaches.
Here are some tips for staying on an even keel, even in those stressful
times:
>> Exercise. People who exercise often feel less anxious and
more relaxed.
>> Laugh more. Studies show that laughter releases stress-busting
hormones.
>> Don't be a perfectionist. Set reasonable goals and question
whether everything you do has to be the best.
>> Control your anger. When you're angry, ask yourself three
questions: Is this problem important? Is my anger justified? Can
I do anything to fix the problem? If the answer to any of the three
is no, take a few deep breaths and tell yourself to calm down. If
any answer is yes, don't seethe silently; figure out something you
can do to change the situation.
>> Take breaks during a hectic day to calm down. It doesn't
matter what you do-walk around, chat with someone, water some plants-as
long as it's a time-out. Aim for at least 20 minutes a couple of
times a day.
>> Keep a pet. They may shed and slobber, but studies show
their owners have fewer health problems than people without pets.
>> Relax through yoga, deep breathing, stretching exercises,
or meditation.
Lower your blood pressure
Blood pressure is measured with a device that records two numbers,
written one above the other. The top number is systolic pressure,
the peak pressure when your heart squeezes blood out to the rest
of the body. The bottom number is diastolic pressure, the pressure
when your heart relaxes between beats and refills with blood. Doctors
divide blood pressure into levels of risk. They define normal blood
pressure as less than 130/85, but some experts think your risk for
problems begins to go up even when your blood pressure is still
"normal" but above the ideal, 110/70. The higher it is, the higher
your risk for disease, and the harder it is to bring it down to
healthier levels. When your blood pressure reaches Stage 1 (140/90)
or goes higher, then you have what doctors call high blood pressure.
They strongly urge lifestyle changes and perhaps treatment to bring
it down. If you have high blood pressure (hypertension), follow
the guidelines under "What You Can Do for Yourself" for diet, exercise,
weight loss, and stress reduction. If your doctor prescribes medications
for high blood pressure, be sure to take them. You may not be able
to get it down to the ideal, but bringing it down even a little
lower than it is now will help.
Manage your diabetes
If you have diabetes, you can't change that fact. But you can reduce
your risk of coronary artery disease, heart attack, and stroke by
working with your doctor to manage your diabetes with exercise,
the right foods, and medications.
Stay involved
Friendships can do wonders for your health. Studies show that frequent
contact with others cuts your risk for many kinds of disease. Volunteer,
join community groups, take classes, and visit your friends. If
you've had a heart attack, join a support group. You'll learn more
about recovery and treatments, and make new friends.
(CORONARY ARTERY DISEASE) WHAT YOUR DOCTOR
CAN DO FOR YOU You and your doctor have several goals in
treating your coronary artery disease-to restore proper blood flow
to your heart, to prevent angina and heart attack, and to help your
heart and arteries recover. Several medications can help in the
treatment of coronary artery disease.
Nitroglycerin This is the usual drug for angina. It relaxes
and widens your arteries, so more blood and oxygen get through to
the heart. You dissolve a nitroglycerin tablet under your tongue
as soon as pains begin, or just before doing something likely to
cause pains. Nitroglycerin also comes as a time-release pill you
swallow, as a mouth spray, and in a patch that lets you absorb it
through your skin.
Pro: Easy to take-pill, spray, or patch.
Not habit-forming.
Con: May give you a headache or make
you dizzy, lightheaded, faint, or sick to your stomach. Tablets
lose their strength quickly, so you'll have to get new ones every
six months or so.
Beta blockers This prevent angina by slowing the heart rate
so it needs less oxygen. These drugs also help lower blood pressure.
Pro: Can reduce the risk of a second
heart attack.
Con: May worsen asthma and bronchitis.
May lower levels of "good" HDL cholesterol. Side effects may include
depression, fatigue, and impotence.
Calcium channel blockers This group of drugs prevents angina
by relaxing and widening coronary arteries, so more blood flows
through. Calcium channel blockers should not be used immediately
after a heart attack.
Pro: Usually no side effects. Taken
only once a day.
Con: In some people, may cause a rapid
or slow heartbeat, constipation, headache, dizziness, or swollen
legs and ankles.
Anticoagulants help prevent blood clots from developing in
arteries affected by atherosclerosis.
Pro: May help prevent heart attack
and stroke.
Con: May cause dizziness, headache,
nausea, stomach cramps, diarrhea, and vomiting.
Aspirin helps keep blood from clotting and reduces your chances
of having a heart attack. If you do have a heart attack, it's likely
to be less severe if you've been taking aspirin. Aspirin also lowers
the risk of stroke. Experts recommend a half or whole (325 mg) aspirin
tablet every day if you're a man age 50 or older or a woman past
menopause with at least one additional risk factor for heart disease,
such as high blood pressure or high cholesterol. But aspirin isn't
for everyone; don't start taking it without talking to your doctor
first.
Pro: Inexpensive.
Con: Can cause stomach upset. Your
doctor may suggest an enteric-coated brand that delays release of
the drug until it has passed through your stomach. Can worsen liver
or kidney disease, an ulcer, high blood pressure, asthma, or bleeding
problems such as hemophilia. Can increase bleeding. Stop taking
aspirin about five days before any surgery, including oral surgery.
But talk to your doctor before quitting if you know you have artery
problems. Can trigger asthma attacks in 5 to 10 percent of people
with asthma.
ACE inhibitors lower blood pressure by helping keep blood
vessels from narrowing, so blood flows more easily.
Pro: Fewer side effects than diuretics
and beta blockers.
Con: May cause a dry cough. May not
work as well for African Americans.
Angiotensin II inhibitors This new class of drugs works the
way ACE inhibitors do, blocking a potent hormone called angiotensin
II that narrows arteries and makes the kidneys retain sodium and
water.
Pro: Few side effects in most people.
Taken only once a day.
Con: May cause dizziness or a dry cough.
Diuretics These drugs can lower blood pressure by reducing
the volume of fluid in the blood vessels. They do this by causing
the body to get rid of sodium, thus making it get rid of water.
Diuretics also help open up small arteries.
Pro: Few side effects in most people.
Taken only once a day.
Con: Don't always work by themselves
for hypertension Stages 3 and 4 or in younger people. Side effects
of high doses may include weakness, fatigue, headaches, higher cholesterol,
higher blood sugar levels, gout, and impotence.
Angioplasty is the most common surgery for coronary artery
disease. A thin, hollow, flexible wire called a catheter is threaded
to the heart and into a clogged artery. A tiny balloon at the end
of the catheter inflates inside the artery. Pressure from the balloon
flattens plaque and fatty deposits against the wall, opening the
artery so blood can flow through more easily. Sometimes, a wire
mesh tube called a stent is inserted into the artery and left in
place after the balloon is removed. It helps keep plaque from reclogging
the artery. Scientists are also experimenting with brief doses of
radiation, applied to an artery following angioplasty, to prevent
a new buildup of plaque. Angioplasty may help prevent a heart attack
if your arteries are clogged. If you've already had a heart attack,
it may help prevent a second one. And some doctors are now using
angioplasty as the first treatment to help patients who are having
a heart attack.
Pro: About 90 percent get relief from
their chest pains.
Con: About one-third need it again
within six months to reopen the same artery.
In some cases, surgery may be recommended to treat coronary artery
disease...
Coronary bypass surgery If medications and angioplasty don't
work, coronary bypass surgery may help. A surgeon removes a section
of blood vessel from the leg or chest and sews it to the clogged
artery to carry blood around the blocked section, like a freeway
detour.
Pro: Completely relieves angina symptoms
in about 70 percent of patients and partially relieves them in another
20 percent.
Con: Invasive: The chest is often cut
open to expose the heart; so recovery from surgery can take several
months. A new technique, "port access" surgery, requires only small
cuts or "ports" between the ribs. The surgeon uses special tools
and a tiny camera and light to operate. Patients walk out of the
hospital a day or two after surgery and are back at work-or play-within
about three weeks. This type of surgery doesn't provide access to
the entire heart, however; if a vessel in an area that can't be
reached is blocked, then regular surgery may be necessary.
(CORONARY ARTERY) DISEASE SOME WORDS YOU MAY
HEAR
Angina pectoris: chest pain from a shortage of oxygen to
some part of the heart.
Angiocardiography: X-ray exam of the blood vessels or heart
chambers that traces the course of a special fluid injected into
the blood. Angiogram: picture produced during angiocardiography.
Arteriosclerosis: often called hardening of the arteries.
Includes many conditions that thicken and stiffen artery walls.
Atherosclerosis: type of arteriosclerosis marked by fatty
deposits inside artery walls.
Atrium (plural, atria): either of the heart's two upper chambers,
which collect blood coming from the veins and pump it to the ventricles.
Cardiac catheterization: a test that finds blockages in the
arteries.
CAT (computed axial tomogram) scan: an X-ray that shows a
3-D image.
Cholesterol: fatty substance needed to produce certain hormones.
Too much can cause coronary artery disease.
Coronary angioplasty: technique used to open a clogged coronary
artery.
Coronary artery bypass surgery: surgery to route blood flow
around a blocked coronary artery.
Diastolic blood pressure: pressure in arteries between heartbeats,
when the heart rests and refills with blood to pump again. Diastolic
pressure is the bottom number in a fraction like 110/70. (See systolic
blood pressure.)
Echocardiogram: test that uses sound waves to show parts
of the heart.
Edema: buildup of fluid in body tissues, causing swelling.
Electrocardiogram
(ECG, EKG): test that records electrical activity of the
heart.
Embolus: blood clot or fragment of loose plaque that forms
in one blood vessel and travels to another.
High-density lipoprotein (HDL): "good" cholesterol. Helps
remove extra fatty material from the blood vessels. Infarct: area
of tissue in the heart or brain killed when blood flow is suddenly
blocked.
Low-density lipoprotein (LDL): "bad" cholesterol. Promotes
buildup of plaque on blood vessel walls.
MRI (magnetic resonance imaging): a procedure that uses magnets
and radio waves to take a picture of the heart. Myocardial infarction:
heart attack. Stress test: measures heart function during exercise.
Systolic blood pressure: pressure in arteries generated by
each heartbeat when blood is forced from the heart to the body.
Systolic pressure is the top number in a fraction like 110/70. (See
diastolic blood pressure.)
Ventricle: one of the heart's two lower pumping chambers.
The right ventricle pumps blood to the lungs. The left ventricle
pumps blood, returned from the lungs, to the rest of the body.
(CORONARY ARTERY DISEASE)
BURNING CALORIES TEN EASY WAYS
The more you move around, the more calories you use. And the more
vigorously you move around, the better-you'll use up more calories
in less time. Here are the calories burned while doing ten everyday
activities. The figures are for a 132-pound woman and a 176-pound
man burning calories over a 10-minute period. In any given activity,
a lighter person burns fewer calories than a heavier person.
Walking fast
Women: 45
Men: 60
Weeding
Women: 45
Men: 60
Passionate sex
Women: 45
Men: 60
Playing tag with a child
Women: 50
Men: 67
Mowing the lawn
Women: 55
Men: 73
Biking to work
Women: 60
Men: 80
Shoveling snow
Women: 60
Men: 80
Walking up stairs
Women: 70
Men: 93
Backpacking
Women: 80
Men: 106
Running to catch a plane
Women: 115
Men: 153
(CORONARY ARTERY DISEASE) BLOOD PRESSURE AND
YOUR RISK
When your blood pressure stays above 139/89, you're in one of the
stages of rising risk for illness.
Best: below 110/below 70
Normal: below 130/below 85
Borderline: 130-139/85-89
Hypertension occurs at different levels, or "stages."
Stage 1: 140-159/90-99
2: 160-179/100-109
3: 180-209/110-119
4: 210+/120+
(CORONARY ARTERY DISEASE) GET YOUR FRUITS
AND VEGETABLES
Do your best to eat five or more servings of vegetables or fruits
each day. One serving equals one-half cup of chopped raw or cooked
vegetables; one cup of leafy vegetables; three-fourths cup of vegetable
juice; one whole fruit the size of an apple, orange, or pear; one-half
cup of canned fruit; or a quarter cup of dried fruit.
(CORONARY ARTERY DISEASE) BLOOD CHOLESTEROL-WHAT'S
NORMAL?
TOTAL CHOLESTEROL
Normal: below 200 mg/dl.
High: above 240 mg/dl.
LOW-DENSITY LIPOPROTEIN (LDL)
Normal: below 130 mg/dl.
High: above 160 mg/dl.
HIGH-DENSITY LIPOPROTEIN (HDL)
Normal: above 35 mg/dl.
Best: 60 mg/dl
Bad cholesterol: For people of all ages and both sexes, risk for
artery disease rises as total cholesterol and LDL levels rise. The
higher your levels of these two, the higher your risk.
Good cholesterol: To guard against artery disease, your HDL level
should be at least 25 percent of your total cholesterol.
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