It can be hard to understand the condition of your heart, that muscular organ so crucial to your health, until it’s too late. Once you’ve had a heart attack, well, that’s a wake-up call. But the smarter route is prevention. so what can we do to keep the all-important heart pumping regularly—before, or after, a heart episode?
[preventing heart disease]
When it comes to the risks that lead to heart disease, there are factors you can’t change, like genetics, age and gender. But you can change your lifestyle and diet, and you should never underestimate how great an impact that can have.
the deadliest disease
“Although we have made great strides in reducing death from heart disease, it still kills more people than every type of cancer,” says Dr. Richard Lee, SLUCare cardiac surgeon and co-director of the Center for Cardiovascular Care. “Prevention is the first thing you should think about before there is a major problem.”
As with so many health issues, when it comes to the heart, the patient is the person most responsible for its health. “The No. 1, 2 and 3 ways I tell patients to strengthen their heart is not to smoke,” Lee says. He also urges them to keep a close eye on their cholesterol, blood sugar and blood pressure, which, if needed, can be controlled through lifestyle modifications and medications. After all, the factors we have the most control over are exercise, eating healthy, managing stress, sleeping and alcohol intake.
cardiac fitness=physical fitness
Atherosclerosis, or plaque build-up in the arteries, can lead to a heart attack or stroke and is often the most common worry among patients, says Dr. Anthony Pearson, cardiologist and director of St. Luke’s Echocardiography Lab. According to the Centers for Disease Control and Prevention, a healthy BMI (body mass index—a number calculated from weight and height) is 18.5 to 24.9. A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or higher is in the obese range. People in those categories have an increased likelihood of health problems.
“When it comes to exercise, I recommend 150 minutes a week of moderate aerobics, which is about 30 to 40 minutes per day, at least four times a week, on a treadmill, bicycle or walking rapidly,” Pearson says. “For optimal weight management, some form of weight training or isometric exercise should also be part of the regimen.”
He adds that only two lifestyle changes raise the good (HDL) cholesterol, which removes bad (LDL) cholesterol from the arteries: exercise and small amounts of alcohol. Lee adds he likes to see exercise every day, even if it’s for short time periods. “Everyone should commit to increasing his or her heart rate,” he says. “Your heart is just a muscle. If you want to get your legs stronger, you walk; you have to use the heart muscle to make it stronger, too.”
the food front
Pearson recommends the Mediterranean diet, which includes two to three servings of fish a week, fresh fruits and vegetables in abundance, legumes, and nuts and oils, particularly olive oil. He says meat and dairy should make up very little of the diet. “The worst thing we can eat is added sugar and processed foods,” he says. “Everyone should avoid sugar, in particular sugar-sweetened drinks and highly processed foods that come in bags and boxes.”
Yes, there are some heart-healthy benefits of alcohol, but both Lee and Pearson stress moderate use. The American Heart Association recommends one to two drinks per day for men and one for women—that can be beer, wine or liquor. “More than this may increase the risk of health problems, including for certain types of cancer,” Pearson says.
de-stress!
“Stress can increase your blood pressure, which can make it harder for your heart to pump blood,” Lee says. “Everyone needs to find a way to decrease their stress.” For some, this might mean exercise, while others prefer yoga, meditation and prayer, which are all good stress relievers, he says. Making sure your body is resting properly through a good night’s sleep also is important, Pearson adds. He recommends a minimum of seven hours, with eight hours optimal.
[knowing the differences]
Heart disease is the leading cause of death among both men and women, even though it is commonly thought of as ‘a man’s disease,’ according to the Centers for Disease Control and Prevention. But symptoms in men and women can differ dramatically, despite some similarities.
different, but the same
Chest pain is the most common symptom in both genders, although men report it more frequently and it might not be as prominent in women, says Dr. Robert Armbruster, a cardiologist and partner with Advanced Heart and Vascular. He adds that women may describe the common symptoms of shortness of breath, nausea and vomiting, but they also may report serveral less common symptoms, such as fatigue, dizziness and palpitations.
Understanding women’s cardiac health and the prevention of coronary heart disease has grown over the years. “The key to having good cardiovascular outcomes for women is early recognition and treatment. Failure to understand a woman’s symptoms can lead to unnecessary delays and worse outcomes,” Armbruster says. “Many recommendations that pertain to men also are applicable to women, but there may be subtle differences that require physicians to tailor their care.”
it’s all about lifestyle
Dr. Lynne Seacord, associate professor in the division of cardiology at Washington University Heart Care Institute in West County, shares the results from a recent study released by the Journal of the American College of Cardiology. “The study found that women with a healthy lifestyle — those who didn’t smoke, had a healthy body mass index, exercised and followed a healthy diet — had an extraordinarily low chance of developing coronary heart disease,” she says.
Unfortunately, only a small minority of the women in the study actually had this healthy lifestyle. A real problem lies in the fact that two-thirds of American women are overweight, which increases their risk for developing hypertension, hyperlipidemia and diabetes, as well as heart disease. “We must reverse the rate of obesity, and it starts at a young age with our parenting,” she adds.
know your body
There are certain cardiac risk factors women should be aware of. “Women who experience pregnancy-related complications such as gestational hypertension and preeclampsia will be at higher risk of hypertension, coronary artery disease and stroke later in life,” Seacord points out. “It’s important that women are aware of this and physicians ask about this history as their patients reach middle age.”
The risk of cardiovascular disease is higher in men at any age than it is for women, but the gap significantly narrows after menopause. This is true for both natural menopause and when a woman undergoes bilateral oophorectomy (ovary removal), Armbruster adds. Why the cardiovascular risk increases is unclear, but he says there are a number of contributing factors, including the alteration of glucose and lipid metabolism, which results in increased LDL (bad cholesterol) and blood sugar levels, as well as evidence that vascular inflammation increases.
the role of hrt
While there was some thought that hormone replacement therapy (HRT ) would help protect post-menopausal women, large clinical trials have not only revealed no benefit, but also shown that supplementation can cause harm, Armbruster says. Seacord adds that while estrogen lowers LDL and total cholesterol, we know that benefit (as well as estrogen’s good effects on bone density) is offset by hormone replacement therapy’s effect of increasing the risk of blood clots—including clots in the legs, lungs and heart. “The Heart Association does not recommend HRT to prevent the development of heart disease or to affect lipid levels,” she says.
[after a heart attack]
A heart attack is a life-changing event. It can be a very emotional time for patients, who are suddenly faced with their own mortality, and for families—for the same reason.
after a heart attack
So what should you do following a heart attack? And what steps can you take to prevent another one? “First and foremost, if you think you are having a heart attack, get to an emergency room as soon as possible by calling 911 and not going by car,” warns Dr. Robert Ferrara, a cardiologist with Mercy Clinic Heart and Vascular. Nearly 50 percent of those who start to experience a heart attack outside of a hospital don’t make it, so it is critical that care begin in an ambulance when possible, he adds.
Once patients have arrived at the hospital, the initial treatment involves immediate restoration of normal blood flow with a stent or, in lowrisk situations, medication treatment, explains Dr. David Sewall, a cardiologist at Missouri Baptist Medical Center. “Then the patient will be thoroughly evaluated for personal risk factors that may have predisposed them to the heart attack,” he says. Once they have an understanding of their personal risk factors, the patient should focus on mitigating those risk factors, with the goal of preventing the progression of coronary artery disease and future heart attacks or events, he adds.
the new normal
“For individuals who are left with normal or only mildly impaired heart muscle function, they can expect to return to full activity,” Sewall says. “Depending on the individual risk factors and the overall strength of the heart muscle, there may be some restrictions.”
Both Sewall and Ferrara stress the importance of being involved in a cardiac rehab program led by experienced cardiac nurses and therapists. These are highly trained to meet both the physical and emotional needs of heart attack survivors.
“A cardiac rehab program is important for patients because once they have left the hospital, they often are nervous about what to expect and what they can do,” Ferrara says. “They gain confidence with the support of fellow rehab patients who have experienced the same thing, and they don’t feel alone.”
reducing risk
Once a person has experienced a heart attack, understanding what needs to change is imperative to both recovery and preventing a future event. “If a heart muscle is weakened, you can’t strengthen the muscle, but you can improve what is left by making it more efficient through exercise, diet and lifestyle changes,” Ferrara says.
He has seen a pattern during his career in which individuals who have suffered a heart attack and truly control and modify their risk factors live out their lives without another heart event. “A heart attack often is a motivator to make healthy lifestyle changes that, if adopted, leave the individual healthier and happier with an improved long-term prognosis,” Sewall adds. “Involving your close family and making it a mutual effort, with buy-in from everyone, is almost key to making the lifestyle adjustments that can prevent progression and future events.”