Tips for Prevention

The number one killer in America today is a disease that can often be prevented.

According to the American Heart Association, heart disease is the nation's single leading cause of death for both men and women. At least 58.8 million people in this country suffer from some form of heart disease.

And on the whole, cardiovascular diseases (the combination of heart disease and stroke) kill some 950,000 Americans every year.

But the good news is that measures can be taken to prevent heart disease. Studies show that nearly everyone can become more heart healthy by following a few key steps, such as eating a healthy diet, exercising, quitting smoking, and maintaining a healthy body weight.

Still, there are many misconceptions about heart disease: "The biggest misconception is that heart disease only happens to the elderly," said Elizabeth Schilling, CRNP with the Center for Preventive Cardiology Program at the University of Maryland Medical Center.

In fact, according to the American Heart Association, almost 150,00 Americans killed by cardiovascular disease each year are under the age of 65. And one out of every 20 people below the age of 40 has heart disease.

Heart Prevention photo

What is heart disease?

Heart disease is any disorder that affects the heart's ability to function normally. The most common type of heart disease is coronary artery disease, which is the narrowing or blockage of the coronary arteries. Some people are born with abnormalities (congenital heart disease). Various forms of heart disease include:

Risk Factors

There are many risk factors for heart disease; some are inherited, but others are quite controllable.

Uncontrollable risk factors include:

  • Family history of heart disease (especially with onset before age 55)
  • Diabetes mellitus
  • Age (65 and older)
  • Women, after the onset of menopause -- generally men are at risk at an earlier age than women, but after menopause, women are equally at risk

Controllable risk factors:

  • Cigarette smoking
  • Being overweight by 30 percent
  • Hypertension -- high blood pressure
  • High cholesterol levels (specifically, high LDL cholesterol and low HDL cholesterol and high triglycerides)
  • Stressful lifestyle
  • Sedentary lifestyle (physical inactivity)

"We know the risk factors that appear to promote heart disease," said Michael Miller, M.D., director of the Center for Preventive Cardiology at the University of Maryland Medical Center and an associate professor of medicine at the University of Maryland School of Medicine. "The factors, such as high blood pressure, high cholesterol, family history, cigarette smoking, diabetes -- those have been pretty well established. But some risk factors are congenital, meaning that people are born with them. Congenital risks would include people who have problems with their heart valves, and people who inherit genetic problems that promote hardening of the arteries."

Raising the Good Cholesterol

Most people are usually concerned about their total cholesterol levels, and their amount of LDL (the "bad cholesterol"). But in reality says Dr. Miller; low HDL levels are also closely linked to coronary heart disease. According to his recent article in the Cleveland Clinic Journal of Medicine, a low level of the "good cholesterol" (HDL-C) is the most common lipoprotein abnormality in people with coronary heart disease. These low levels best predict the risk of heart disease, even when the total cholesterol is within the normal range.

The National Cholesterol Education Program defines an HDL reading below 40 as an independent risk factor for heart disease.

Lifestyle measures for raising your HDL levels include weight loss, drug therapies, and omega-3 (fish oil) supplementation. In addition, moderate daily alcohol consumption (about 1 to 2 oz a day) can raise HDL levels by 5 to 10 percent

While there are no magic dietary bullets that raise HDL levels, Miller cautions that merely replacing fat with carbohydrates without reducing caloric intake can cause good cholesterol levels to fall by as much as 20 percent 

He also favors using monounsaturated fats, such as olive oil and canola oil, in exchange for either saturated fats or carbohydrates.  Monounsaturated and polyunsaturated fats, help lower blood cholesterol when used in place of saturated fats.

But even more important than diet and weight loss is regular aerobic exercise.

As Miller stated in his article, "aerobic exercise is perhaps the most important lifestyle intervention for raising a low HDL level." Miller says the benefit is "dose related"--the more aerobic exercise you do, (such as running, brisk walking, swimming or cycling) the higher the good cholesterol will be. And the duration of the exercise rather than the intensity appears to have the biggest influence. Good cholesterol rises about a milligram for every four or five miles run/ covered each week.

Laughter and Tea May Prevent Heart Disease

Two people laughingLifestyle changes such as losing weight, lowering cholesterol and quitting smoking reduce certain risk factors. But did you know that drinking tea and laughing might also be beneficial?

Maryland Heart Center physicians are studying some of these preventive measures.

"Our research revolves around trying to attain a greater understanding as to how important those positive influences are in reducing heart attack event rates," stated Miller.

He says that two of the most protective factors against heart disease are high levels of HDL (good cholesterol) and also factors that may reduce stress, such as laughter.

In fact, a recent study by cardiologists at the University of Maryland Medical Center found that laughter, along with an active sense of humor, may help protect against a heart attack. The study, which was the first to indicate that laughter may help prevent heart disease, found that people with heart disease were 40 percent less likely to laugh in a variety of situations compared to people of the same age without heart disease.

Reduce Stress with a Good Laugh

So why do stress reduction techniques -- laughter in particular-- reduce the risk of heart disease?  To answer that, it helps to know how mental stress can potentially damage your heart.

"When you're under a lot of stress there are chemicals that are released that cause blood pressure and the heart rate to go up, cause platelets to clump together and all of those set up a series of reactions that could enhance the process of plaque formation and development," said Miller. "So people that appear to be under lots of stress all the time are at increased risk [for heart disease] even if they don’t have a family history of heart disease or if they don't have diabetes."

Conversely, reducing stress, with laughter in particular, can have the opposite effect.

"We think laughter is an active process and may have a direct impact on improving the lining of the blood vessels," explained Miller. Reducing stress also benefits the heart by lowering the blood pressure, and heart rate.

"The ability to laugh may have important implications in societies such as the U.S. where heart disease remains the number one killer," Miller said. "We know that exercising, not smoking and eating foods low in saturated fat, will reduce the risk of heart disease. Perhaps regular, hearty laughter should be added to the list."

Other stress reduction methods can also help.

"Limiting stress in ways that are accomplishable, that don’t take up a lot of time and are easy to do would help to facilitate the process of stress reduction," said Miller.  He says that any of stress-reducing methods, including yoga and meditation, may be "quite helpful in reducing the risk of coronary events."

A New Reason to Drink Tea

In addition to laughter, drinking tea and eating antioxidant foods can also protect you against heart disease.

In fact, cardiologists at the University of Maryland Medical Center have concluded that drinking black or green tea (which contain antioxidants) may help reduce a potentially harmful constriction of blood vessels after a high-fat meal. Their study adds to a growing body of research that suggests antioxidant-rich foods (such as vegetables and fruits) and beverages may help to prevent heart disease.

"We're talking about foods that contain anti-oxidants such as fruits and vegetables like tomatoes, which contain lycopene or broccoli that contain other protective antioxidants," noted Miller. "Vegetables and fruits have natural antioxidants which are probably going to be more protective than supplements."

If you're going to drink tea, you might want to skip the milk. A recent article cited new research which has found that adding milk to tea negates the health benefits. The study findings were published in the January 9th, 2007 online edition of the European Heart Journal. Dr. Robert Vogel, a University of Maryland Medical Center cardiologist and professor of medicine at the University of Maryland Medical School who was quoted in the article, advises his patients not to have milk in tea. See the article here.

Preventing Heart Disease

General Prevention Tips

One of the keys to preventing heart disease is getting risk factors under control, such as high blood pressure and high cholesterol levels. Main prevention tips to follow:

  • Eat a heart-healthy diet
  • Improve cholesterol levels
  • Exercise
  • Control diabetes
  • Control high blood pressure
  • Control weight
  • Manage stress
  • Quit smoking

The bottom line for prevention, says Schilling, is to follow a heart-healthy lifestyle.

"Maintain an ideal body weight, and exercise one hour a day, seven days a week," advises Schilling. As part of a heart healthy diet, she recommends following a balanced diet with approximately 30 percent of calories from monounsaturated fats such as olive oil, canola, fish and nuts and limit saturated fats.

Also limit carbohydrates, sugar or any sugar food including white flour.

Regular Screenings

Screening for Heart DiseaseScreening is also an important way to prevent heart trouble. "The earlier you start screening and treating it, the more disease you can prevent," said Shilling.

That means getting your blood pressure and cholesterol checked at the appropriate times.

Shilling says adults 25 and older should have their cholesterol screened and should also be screened for diabetes starting in the 20's. High blood pressure checks should also start in the 20's.

The Center for Preventive Cardiology evaluates patients not only for the presence of heart disease, but also for all cardiovascular diseases.

"Our goals are to evaluate for all areas that someone could possibly have a blockage," said Schilling. "We do screening for the total body risk-- not just the heart, but for all cardiovascular diseases, including blockages and clotting of the heart, legs, and kidneys. When we see patients for cardiac disease we want to look at the whole body, look at the entire scope of the vascular system."

This would include screenings of the carotid arteries, coronary arteries, testing for PAD/PVD, and renal artery stenosis.

The Center will offer non-invasive methods of detecting hardening of the arteries, biochemical tests, and other state-of-the-art tests.

"We are going to be among the first in the country to offer a genetic screening in combination with non-invasive tests to try to identify individuals who may be at increased risk for early coronary disease," said Miller. In addition, patients will also have the opportunity to enroll in some of the Maryland Heart Center's new clinical trials.

After screening patients, Heart Center physicians and staff work specifically on modifying the risk factors in order to prevent the onset or progression of cardiovascular disease.

"We are offering an extremely aggressive risk factor modification program with intensive follow up," said Shilling. "We make sure you get to goal, whether it's with lifestyle modification, medications as appropriate, exercise therapies or diet."

This is accomplished with a combination of individual and group therapies such as diet, food preparation, weight control and smoking cessation classes.

"We are trying to establish a wellness center where we'll be able to have a one-stop shopping for patients coming in with heart disease, diabetes or high blood pressure," said Miller. "Patients will have the opportunity to see experts in each of these areas. We are trying to coordinate a program that's tailored for individuals that are affected by any of these disorders."

This page was last updated: July 8, 2013

         
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