Heart Disease

Source: Adapted from Looking After Your Body: An Owner’s Guide to Successful Aging, Reader’s Digest

What is heart disease?

The basic mechanism of heart disease is a build-up of cholesterol-laden plaque (a fatty deposit) inside the coronary arteries, the blood vessels that carry oxygen-rich blood to the heart. Plaque narrows the inner channel of the vessels and makes them less flexible. This process is called atherosclerosis, or hardening of the arteries. As normal blood flow to your heart is restricted, you may experience angina (chest pain). If a clot forms or lodges inside a narrowed artery, it can completely cut off blood flow and cause a heart attack. Heart disease is often "silent"’producing no symptoms’until it causes a heart attack.

Who is at risk for heart disease?

Both your genes and your lifestyle habits contribute to heart disease. To calculate your risk, give yourself 1 point for each of the following risk factors:

What you can’t control

• Age. Over age 55 for women.
• Gender. Men are more vulnerable to heart disease than women.
• Post-menopausal status. Women’s risk increases sharply after menopause.
• Family history of heart disease.
• Personal history of a heart attack.
• Ethnicity ‘ people of African, Latin American, or Asian descent.

What you can control

• Smoking or regular exposure to second-hand smoke.
• Low-density lipoprotein, or LDL ("bad" cholesterol), above 4.2 mmol/L.
• High-density lipoprotein, or HDL, below 0.9 mmol/L.
• High blood pressure (over 140/90 mmHg).
• High triglyceride level (over 5.2 mmol/L).
• Diabetes.
• Chronic stress or depression.
• Physical inactivity.
• Obesity.
• High intake of saturated fat.
• Low intake of heart-smart foods.

Subtract 1 point if you have high levels of HDL cholesterol (over 0.9 mmol/L). Then add up your total score. A score of 0 to 2 points puts you at low to moderate risk of heart disease. A score of 3 or more points means you’re at high risk. See your doctor now for an evaluation. And start making some lifestyle changes.

Treatment for heart disease

Many people can control early-stage heart disease by making lifestyle changes and taking certain drugs. Sometimes surgery is necessary.

A diagnosis of heart disease is usually based on your symptoms, medical history, and the presence of risk factors. Your doctor may also want you to have certain tests:

• Electrocardiography (ECG) records your heart’s electrical activity and shows any abnormalities, such as disturbances in your heart rate or heart rhythm. An ECG can also help determine if your heart is getting enough blood and oxygen. And it can reveal thin or absent heart muscle tissue’a sign that a heart attack may have occurred.
• An exercise tolerance test (stress test) records how well your heart functions while you exercise (walking on a treadmill) to help detect any abnormal changes that occur when your heart is pumping hard.
• Coronary angiography may be used if your doctor suspects narrowing or blockage of your coronary arteries. In angiography, a dye that shows up on X-rays is injected into the bloodstream, usually through a thin tube threaded up through an artery in the arm or groin. X-ray pictures are taken after the dye travels to the coronary arteries. If any of the arteries are blocked or narrowed, the flow of dye-treated blood will be visibly blocked or restricted.

Medications for heart disease

To lower your cholesterol, a class of prescription drugs called statins may help. Statins can cut blood levels of cholesterol by up to 60 points and lower your risk of heart attack by one-third. They work by blocking an enzyme your body needs to manufacture cholesterol. The most commonly prescribed statins are simvastatin (Zocor), pravastatin (Pravachol), atorvastatin (Lipitor), fluvastatin (Lescol), and lovastatin (Mevacor).

For angina symptoms, three different classes of prescription drugs can alleviate pain. They can be used alone or in combination. Beta-blockers such as atenolol (Tenormin) and metoprolol (Lopresor) lower your heart rate and blood pressure to decrease your heart’s workload. Nitrates (nitroglycerin) open up your blood vessels, increasing blood flow to the heart. Calcium channel blockers such as diltiazem (Tiazac) and verapamil (Chronovera) also dilate blood vessels and lower blood pressure.

After a heart attack, you’ll receive clot-dissolving drugs or undergo immediate surgery.

Lifestyle Changes

• Work your heart. The best preventive medicine for your heart is aerobic exercise. It reduces high blood pressure and atherosclerosis by widening the blood vessels. Plus, it raises ‘good’ cholesterol levels. Choose an activity that works the large muscles of your legs and buttocks (like brisk walking or bicycling), and strive to reach your target heart rate for at least 15 to 20 minutes, three or four times a week.
• An (up)lifting idea. An American Heart Association (AHA) survey found that lifting weights a few times a week can improve heart health in some people. That’s because stronger muscles can lower your heart rate and blood pressure. Having more muscle tissue also raises your metabolism, which helps control your weight. But don’t skip the brisk walk. The AHA recommends pumping iron in addition to aerobic exercise (and the Heart and Stroke Foundation of Canada concurs).
• Be flexible. Flexibility exercises like yoga not only help keep your joints limber but also help cut the production of stress hormones that can contribute to heart disease.
• An Aspirin a day? People with existing heart disease may benefit from low-dose acetylsalicylic acid (ASA) therapy, which may prevent heart attacks. The dosage ranges from part of an ASA tablet such as Aspirin (80 mg) to one tablet (325 mg) daily. Ask your doctor what’s right for you.
• Depressurize. High blood pressure can lead to heart disease. If diet and exercise can’t control it, blood-pressure medication can help.
• Deal with diabetes. People with diabetes, most of whom are adults with the Type 2 form of the disease, are two to four times more likely to have heart disease or stroke. Controlling the disease is often just a matter of losing extra pounds, exercising regularly, and following a heart-healthy diet.
• Don’t ignore depression. One study found that depressed people were 1.7 times more likely to develop heart disease and that depressed men were nearly three times as likely to die from it. See your doctor for help.

Related Procedures for Heart Disease

In coronary bypass surgery, a healthy blood vessel’usually from your leg’is removed and stitched into place to bypass the diseased artery (or arteries) in your heart. In coronary angioplasty, a catheter (a thin, flexible tube) with a tiny balloon on its tip is inserted into an artery and guided toward the blocked artery near your heart. The balloon is inflated to stretch open the blood vessel and is then removed. In some forms of angioplasty, a stent (a wire mesh device) is placed inside your artery to keep it open after surgery.

Prevention of heart disease

• People who eat a traditional Mediterranean or Asian diet appear to have lower rates of heart disease than those who eat a typical Canadian diet. Incorporate elements of these diets into your healthy eating plan.
• Eat heart-smart foods. Choose foods that can reduce cholesterol and improve heart health, such as fruits (apples, avocados, dried fruits, grapefruit, oranges, strawberries), vegetables (broccoli, carrots, corn, lima beans, onions), seafood (clams, mussels, oysters), fish containing omega-3 fatty acids (salmon and bluefish), soy, nuts, and whole-grain breads and cereals.
• Cut the fat. To keep your cholesterol level down, limit the amount of fat you eat, especially saturated fat. Your total fat intake should be no more than 30 percent of your daily calories. Focus on low-fat alternatives to red meat, such as fish or skinless chicken or turkey. Eating fish several times a week can cut your risk of heart attack by as much as half. Lower your intake of dairy fats by switching to low-fat or skim varieties. Or try soy milk’soy protein can lower cholesterol.
• Spice it up. If you have high blood pressure, cut your sodium intake. In fact, researchers now think that even people whose blood pressure is within normal range should cut back on sodium. Avoid processed foods, which contain a lot of sodium, and ease up on salt at mealtime. But don’t settle for bland fare. Add flavor with salsa, curry, peppers, or garlic. Eating one to three cloves of garlic a day has been shown to reduce blood pressure and possibly lower cholesterol.
• Add rough stuff. Soluble fibre, plentiful in fresh fruits, vegetables, legumes, and whole grains, prevents plaque buildup in your arteries. Studies show that eating three or more servings of fruits and vegetables daily can lower the risk of heart attack and stroke by 25 percent or more. In one study, eating cooked dried beans daily lowered ‘bad’ cholesterol by 20 percent in just three weeks. Other research showed that a diet high in whole grains can cut a woman’s risk of dying from heart disease by up to 15 percent. And dozens of studies confirm that eating oats has a cholesterol-lowering effect.
• Seeing red. Drinking alcohol in moderation raises HDL, or ‘good,’ cholesterol and ‘thins’ the blood, reducing the likelihood of clots that can cause heart attack and stroke. Red wine offers additional benefits. Its dark pigments are rich in bioflavonoids that prevent the oxidation of LDL, or ‘bad,’ cholesterol, making it less likely to stick to artery walls. Research showed that people who drank two 8-ounce glasses of red wine a day were 40 percent less likely to have a heart attack than those who didn’t imbibe. But don’t overdo it’too much alcohol raises your triglyceride level. And if you have an alcohol problem, the harm far outweighs any potential benefit. Instead of drinking alcohol, you can get bioflavonoids from black and green tea, onions, kale, and apples.
• Schedule a checkup. Until age 65, you should have your blood pressure checked at least every other year. At age 65, you should have it checked at least annually. Most doctors also recommend a yearly cholesterol screening if you have high cholesterol or other heart-disease risk factors. Your doctor may also recommend electrocardiography (an ECG) to evaluate your heart health. While you’re there, ask about a simple blood test for a substance called C-reactive protein. According to Harvard researchers studying 28,000 healthy women, this test helped predict heart attack risk better than cholesterol tests.
• Consider folate and vitamin B6. These vitamins lower elevated levels of homocysteine, a substance in the blood that may raise your risk of heart disease. A daily intake of more than 400 mcg of folate and 3 mg of B6 appears to reduce the risk of heart disease in women.
• Go fish. Fish oil capsules contain omega-3 fatty acids, which act as anticlotting agents. Check with your doctor before taking them to avoid interactions with other medications.
• Get garlic. Garlic capsules offer the health benefits of garlic without odor. Choose pills that supply 4,000 mcg of allicin and take 400 to 600 mg a day.
• Minimize stress, a risk factor for heart disease. Try meditation or visualization or yoga. Prayer may also help. Take brisk walks with a friend; your conversation may add extra stress relief.
• Don’t get mad‘it’s bad for your heart. A study of nearly 13,000 people found that those who were quick to anger were almost three times more likely to have heart attacks than their cooler-headed peers.
• No ifs, ands, or butts. According to the Heart and Stroke Foundation of Canada, smoking is the single most preventable cause of heart disease. Thirty percent of all coronary-related deaths each year are from smoking. After five smoke-free years, you run the same risk for heart disease as nonsmokers.