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