1. Take responsibility for your health.
Cardiovascular disease is the major cause of death in America,
accounting for 34 percent of deaths, many suddenly and almost all of
them premature. This is down from 40 percent just four decades ago,
mainly due to treatment of common risk factors. If you have diabetes,
your risk increases dramatically. The best prevention against heart
disease and stroke is to understand the risks and treatment options. The
greatest risk is ignorance or misinformation. The first step is to take
responsibility for your health.
2. Know your risks.
The most influential risk factor for cardiovascular disease is age –
the older you are, the greater your risk. The second is your genetic
make-up. Although everyone is excited by the scientific progress in
genomics research, conclusive gene tests are still in their infancy.
But, as I tell our medical students, “A good family history is a poor
man’s gene test.” We have long known that if your parents, grandparents,
or other relatives were afflicted with or died of heart disease,
diabetes or stroke, your risk is much greater.
3. Don’t smoke or expose yourself to second-hand smoke.
The evidence is overwhelming that cigarette smoking and second-hand
exposure to smoke increases the risks of heart disease, lung disease,
peripheral vascular disease and stroke.
4. Maintain a healthy blood pressure.
High blood pressure, called hypertension, is known as “the silent
killer” as it goes without symptoms in most individuals. High blood
pressure causes wear and tear of the delicate inner lining of your blood
vessels. The higher your blood pressure (BP) the greater your risk. The
risk begins to increase from a pressure of 115/70 mmHg and doubles for
each 10 mmHg increase in systolic (the larger number) and 5 mmHg
increase in the diastolic (the smaller number). Heredity and increasing
age raise the risks. Measuring blood pressures at home reflects more
accurately your risk than having the blood pressure taken at a
physician’s office. It is worth the investment to get a cuffmeter.
It is best not to rely only on the readings at your doctor’s office
as some individuals suffer from “white coat” hypertension – their BP is
up only when they are at the doctor’s office. Others have “masked”
hypertension – higher when not in the doctor’s office. Prognosis is best
related to home BP. But for home blood pressure readings, you should
not use finger or wrist units – only regular upper arm units.
5. Monitor your cholesterol (blood lipids).
Abnormal or high blood lipids (fats) are a major contributor to
cardiovascular disease. Your blood lipids include the LDL (bad
cholesterol; remember as “Lousy cholesterol”), HDL (good cholesterol;
remember as “Healthy cholesterol”) and triglycerides. The lower your LDL
and the higher your HDL, the better your prognosis. The amount of
cholesterol in your blood is determined mainly by three factors: the
amount produced by the liver (this is largely genetic), the amount
absorbed from the intestinal tract (some from what you eat, but a lot
more from cholesterol produced by the liver and excreted into the
digestive tract) and, finally, age – your cholesterol increases with
age. If you are at risk, medication is almost always necessary to lower
the LDL or to raise your HDL. The ideal ratio of total cholesterol
divided by HDL cholesterol is 3.0. If higher, you might need diet as
therapy. The problem with diet is that, in general, it can only decrease
total blood cholesterol by about 10 percent. If you have a strong
family history or elevated Lp(a) (a rare abnormal cholesterol that
increases the risk), drug therapy is usually needed.
6. Limit your calories.
Fad diets do not work. If any of them did, we all would be on THAT
one, wouldn’t we? The obesity rate in Americans is alarming,
contributing to a near epidemic of diabetes, which is a cardiovascular
disease. If you have diabetes, your risk is the same as someone who
already had a heart attack. Obesity is caused by consuming more calories
than your body burns. Abdominal obesity is the major risk. Portion
sizes and the amount of sugars in the American diet have dramatically
increased over the past few decades. At the same time, the daily amount
of exercise has been decreasing. It is good advice to “drink slim”
(water, tea, coffee). Use portion control before you start eating and
push away from the table before you are “full.”
7. Make exercise a daily habit.
The lack of exercise is contributing to the obesity epidemic in
Americans. Studies indicate that walking two miles a day is optimal for
overall health, and those two miles of walking do not have to be done
all at once. Exercise does more than burn calories; it also activates
genes that are beneficial to health in other ways. Plus, exercise is one
of the best treatments for depression and anxiety. However, exercise
alone cannot control or reduce your weight – you must also modify your
diet.
8. Pick your pills wisely.
There is a great interest in alternative medicine and understandably
so, because patients want to be empowered to take responsibility for
their own health. However, many take alternative medicines because of
the way they are marketed. The mere fact that a substance is “natural”
does not prove its health benefit. After all, nobody in their right mind
would take arsenic simply because it is “natural.” It is important to
know that research data are often lacking for alternative medications,
supplements and vitamins, none of which are regulated by the U.S. Food
and Drug Administration (FDA).
Do we ever prescribe alternative medicines? On occasion we do! The
major risk with many alternative medications is that the patient thinks
they are doing something to improve health, when in fact they are not.
Although some vitamins have been shown to possibly help some conditions,
to date none have been shown to decrease the risk of cardiovascular
disease. There are some rare exceptions, such as fish oils and niacin
(vitamin B). It is also important to note that high doses of some
vitamins may interfere or counteract the beneficial effects of some
prescription drugs.
9. Reduce stress.
Stress contributes to cardiovascular disease and, if severe, can
cause a heart attack or sudden death. There are plenty of options that
help reduce stress, such as regular exercise, adequate sleep, striving
for a good marriage, laughing, volunteering or attending religious
services. Watching TV generally does not relieve, but can aggravate
stress. Also, try to avoid situations and people who make you anxious or
angry.
10. Stay informed: Science changes constantly.
The only constant is change. This is especially true in medicine as
new techniques and new insights develop constantly. Do not believe every
piece of “scientific information” you find in the media or
advertisements. An overwhelming number of research studies that make it
into scientific publications are poorly designed or yield data that are
not representative, e.g., due to a lack of a sufficient number of
participants. Keep in mind that many studies are financed or sponsored
by individuals or companies with a vested interest in gaining favorable
results. The situation can be especially confusing when scientific
studies yield different or even contradicting results, and this happens
quite often.
Sar
