February Is American Heart Month -- Heartfelt Advice for Heart Health

Since 1964, the first year when February was designated “American Heart Month,” a lot of progress has been made in reducing the incidence of death from heart disease. That progress has accelerated in recent years, thanks to greater awareness of heart disease risks, earlier detection, new medications and minimally invasive procedures for treating blood vessel blockages caused by coronary artery disease.

According to the American Heart Association (AHA), the death rate from heart disease fell about 38 percent between 2003 and 2013 (the last year for which statistics have been reported). Yet heart disease is still the number one cause of death in the United States, killing more than 370,000 people a year.

“The more you know about heart disease, the more you can do to reduce your risks,” says Sangeetha Balakrishnan, MD, a cardiologist with Washington Township Medical Foundation.

“The first thing you need to know is your ‘numbers’ that relate to heart disease risks,” she explains. “Those numbers include your blood pressure, your cholesterol levels, your body mass index (BMI) that is based on your height and weight, and your blood sugar levels, since diabetes is a risk factor for heart disease, too. Once you know your numbers, then you can target those areas that need improvement.”

High Blood Pressure

Blood pressure is the force of blood against the walls of the arteries that carry oxygen-filled blood from the heart to the body. Blood pressure is generally recorded as two numbers, with the top number measuring the pressure in the arteries when the heart contracts. The lower number measures the pressure in the arteries when the heart is at rest. The AHA recommendation for healthy blood pressure is 120/80 or less. High blood pressure (hypertension) is defined as 140/90 or higher. A blood pressure reading that is consistently higher than 140/90 needs to be brought under control.

“When there is increased tension or pressure in the arteries, the heart has to work harder, Dr. Balakrishnan says. “Because high blood pressure usually has no symptoms, getting periodic blood pressure measurements is the only way to catch the problem early.”

Cholesterol

There are two types of cholesterol: LDL, sometimes called the “bad” cholesterol that cases fatty buildup in the arteries called atherosclerosis, and HDL or “good” cholesterol that carries blood cholesterol back to the liver where it can be eliminated. High total and LDL cholesterol levels along with low HDL cholesterol can increase heart disease risk. Triglycerides are another type of fat in the blood. A high triglyceride level combined with low HDL cholesterol or high LDL cholesterol also is associated with atherosclerosis.

Cholesterol is measured in levels of milligrams per deciliter of blood (mg/dL). In general, total cholesterol – which includes LDL, HDL and 20 percent of triglycerides, should be less than 200 mg/dL. The optimal guideline level of LDL cholesterol is less than 100 mg/dL. For HDL, the recommendation is a level greater than 45/ mg/dL, and the higher the better.

Obesity and BMI

BMI is a useful measure of being overweight or obese. BMI is calculated based on your height and weight. The normal range for BMI is between 18.5 and 24.9. A person is considered overweight with a BMI between 25.0 and 29.0. A person is considered obese with a BMI of 30.0 or above.

“Being overweight or obese can make the heart work harder,” says Dr. Balakrishnan. “It also can increase your blood pressure and your LDL cholesterol and triglyceride levels, as well as your risk for type 2 diabetes.”

Blood Glucose Levels

Because diabetes can contribute to heart disease, controlling high blood sugar (glucose) levels is an important step in reducing your heart disease risks. High levels of blood sugar can cause changes that lead to a hardening of the blood vessels. A normal sugar level is less than 100 mg/dL after not eating (fasting) for at least 8 hours. A normal A1C level is below 5.7 percent.

“Most doctors today consider the A1C test a better indicator because it measures average blood glucose over the past two to three months,” Dr. Balakrishnan observes. “The A1C test measures what percentage of hemoglobin — a protein in red blood cells that carries oxygen — is coated with glucose. The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications, including heart disease.”

Lifestyle Changes Can Improve Your Numbers

“Some of the risk factors for heart disease are beyond your control, such as your age, gender and family history of heart disease,” Dr. Balakrishnan admits. “Still, many risk factors can be managed through various lifestyle changes. Lifestyle changes that can help reduce blood pressure include stopping smoking, reducing alcohol consumption, losing weight and reducing salt intake.”

Lifestyle changes to reduce “bad” cholesterol numbers would include a diet that is high in fiber and low in caloric density, saturated fats and “transfats.”

“In recent years, there have been changing opinions on the health hazards associated with consuming dietary cholesterol,” Dr. Balakrishnan notes. “Although high LDL cholesterol in the blood is an important risk factor for heart disease, dietary cholesterol – found in eggs, meat and other food sources – is not as important as limiting consumption of saturated fats and sugars in controlling your blood cholesterol.

“You really have to watch out for transfats, which were added to many processed foods to increase their shelf life,” she adds. “Transfats have been removed from many processed foods, but they still can be found on labels of some processed foods, although they might be labeled as ‘hydrogenated oil.’ It’s important to note that you do need some fat in your diet, but I recommend the ‘good’ fats found in foods such avocados and nuts. Also, the American Heart Association recommends eating fish, such as salmon, twice a week for the benefits of omega-3 fatty acids and because fish is much lower in saturated fat than red meat and poultry.”

These same dietary practices also can help with weight loss and controlling your blood sugars.

“The other side of the equation is to get plenty of exercise,” Dr. Balakrishnan suggests. “On average, you should get 30 to 40 minutes of cardiovascular exercise for three to four days a week. To get a general target for your heart rate, take the number 220, subtract your age, and then shoot for 70 to 80 percent of that number for ‘strenuous’ exercise. If you are not accustomed to strenuous exercise, start by shooting for 50 percent of the target rate and then build up gradually. You should always consult your doctor before starting any new exercise program.”

When Lifestyle Changes Aren’t Enough

If making changes in your lifestyle doesn’t control your risk factors for heart disease, various medications may help:

• Medications for lowering blood pressure might include beta blockers to slow the heartbeat, ACE (angiotensin-converting enzyme) inhibitors to keep blood vessels from narrowing, calcium channel blockers to prevent calcium buildup in the heart and blood vessels, and diuretics to flush excess water and sodium from the body.
• Statins are usually the drugs of choice to reduce the production of cholesterol, but some people cannot tolerate statins. Other medications might include niacin, “resins” such as Questran and Colestid, and fibric acid derivatives to lower triglycerides and increase HDL cholesterol levels.
• Medications that might be used for controlling high blood glucose could include drugs that increase the production of insulin, increase the body’s sensitivity to insulin, or that help reduce the body’s resistance to insulin.

Watch for Symptoms of Heart Disease

Dr. Balakrishnan cautions that if you do experience any symptoms of heart disease, you should consult a doctor right away.

“The most prevalent form of heart disease is coronary artery disease, in which atherosclerosis decreases blood flow to the heart and other parts of the body,” she says. “Coronary artery disease symptoms, which might be induced by exercise or happen at rest, could include pain, tightness or pressure on the left side of the chest; shortness of breath, or profuse sweating. Women also may experience atypical pain in the shoulder, jaw, neck or upper abdomen.”

Diagnosing heart disease typically would involve a thorough physical exam, including an EKG. Other tests for heart disease might include an echocardiogram – an ultrasound of the heart – to assess the pumping and valve function of the heart, and a treadmill stress test if the patient can exercise. Patients who cannot exercise may have pharmacological testing to induce stress on the heart with medications. If blocked arteries are suspected, an angiogram would be performed to locate and possibly treat the blockages.

“In some cases, surgery might be necessary to treat the blockages in the arteries, but it is much more common today to treat patients with minimally invasive procedures such as angioplasty and the insertion of stents,” Dr. Balakrishnan says. “Angioplasty and stenting, usually performed under minimal sedation in about an hour as an outpatient procedure, involve dilating a narrowed or blocked blood vessel by using a balloon catheter and a metal stent -- a mesh tube – to act as ‘scaffolds’ to keep the blood vessel open."

“While these procedures are much less invasive than surgery, it’s still better to avoid coronary artery disease in the first place,” she adds. “You need to take good care of your heart. It’s the only one you’ve got.”

If you need help finding a physician, visit www.whhs.com and click on the link for “Find Your Physician.”

For more information about heart disease risks, symptoms and treatments, visit the American Heart Association website at www.heart.org. A BMI calculator also is available at the AHA website.