Prevention of Heart Disease
By Dr. Sattar Abbasi
Clinical Professor of Medicine
University of California, Los Angeles

In my last article, I discussed the risk factors, which lead to heart attacks. In this piece I will discuss the ways and means to prevent heart disease.
Lifestyle modification is the best way to prevent heart attacks and strokes. While risk factors such as age, male gender, heredity, cannot be changed other risk factors which make us prone to heart attacks are modifiable. These are as follows.
SMOKING: Smoking increases the risk of heart attack and stroke two- to threefold. Even secondhand smoking increases the risk significantly. Every effort should be made, at any age, to stop smoking. Self-help is available on the Internet. If this is not enough, medical help should be sought.
HYPERTENSION: Blood pressure should be checked at least once every two years if it is normal at the baseline. Optimum blood pressure is 110-120 systolic and 70-80 diastolic. The higher the blood pressure, the more the risk of heart attacks and stroke. Low salt diet, weight reduction, exercise and adequate rest are best ways to keep blood pressure lower. However sometimes medications are necessary.
There are a variety of drugs available now for high blood pressure with no significant or minimum side effects. Blood pressure of less than 140/85 may be acceptable for those who have no other risk factors but in general the lower the blood pressure the better. However blood pressure lower than 100 systolic may cause symptoms in some people such as lightheadedness and fatigue and should be avoided as well.
CHOLESTEROL (LIPIDS): Cholesterol may be checked in non-fasting state. However triglycerides are affected by a meal and should be tested after a 12-hour fast. There is a linear relationship between the level of cholesterol and the chance of heart attack. Optimum total cholesterol should be less than 180 mg/dL. Lower levels are desirable in people with multiple risk factors. Total cholesterol has two main components: one is call LDL (low density lipoprotein), and the other is HDL (high density lipoprotein). In about one-third of the patients who have heart attacks, the only lipid abnormality may be low HDL. This is typical of Asians whose total cholesterol may be "normal," but HDL is too low and their total cholesterol/HDL ratio is too high. The HDL should be kept above 40 in males and 50 in females. The LDL level is targeted according to the risk. In otherwise healthy adults without any risk factors for heart disease, LDL should ideally be kept below 130 mg. In higher risk patients, LDL should less than 100 mg and in the highest risk group the LDL should be kept below 70 mg. Halting the progression or even regression of atherosclerosis has been shown in individuals with the lowest cholesterol level.
Triglycerides are another type of lipid, which also carry high risk, especially in females and should be kept below 150 mg fasting. All lipids can be modified by diet and exercise. However, in high risk individuals, statins with or without niacin are important to optimize LDL, HDL and triglycerides.
DIABETES MELLITUS: It is now accepted that diabetes confirms a very high risk for heart attacks and strokes. All efforts should be made to prevent diabetes mellitus, or control blood sugar adequately in established diabetics, to avoid complications such as heart attack, stoke, kidney failure or neuropathy. Diet and exercise again are the best way to help. As a screening for diabetes mellitus a fasting blood sugar of more than 100 mg or less than 125 mg suggests glucose intolerance. This needs attention. Blood sugar of over 126 mg is consistent with diabetes mellitus. Individuals with a family history of diabetes should take extra precautions to prevent or postpone diabetes mellitus.
NUTRITION: A major key factor in the prevention of heart disease, stroke and diabetes or even some forms of cancer is proper nutrition. We are what we eat, is a true saying. The goal is to have ideal body weight, and reduce saturated fats and salt intake. One pound of body weight equals 3500 calories. If one reduces calories by only 250 a day and burns 250 calories a day by exercise, one would reduce body weight by one pound in one week (i.e. 500 calories x 7 = 3500 calories = 1 pound). It is helpful to cut back on calories by eating more vegetables and some fruits which have bulk and fiber but are less caloric. To avoid sudden shifts of body sugar it is important to avoid or minimize intake of simple starchy foods such as white breads, rice, potatoes and cookies. These are the so-called "high glycemic foods," which raise the blood sugar quickly with subsequent drop of blood sugar causing more hunger. Whole grain bread, pasta and brown rice are better substitutes. Total carbohydrates may be kept between 40 to 60% of total daily calories. Overweight individuals should eat less carbs.
Fat intake should be less than 35% of the total calories and mostly in the form of mono- or polyunsaturated fats such as olive or canola oil. Saturated fats such as butter and full-fat cheese and milk should be kept at less than 10% of calories and less than 7% in individuals with multiple risk factors or established heart disease. Avoid trans fatty acids, i.e. deep fried and processed foods, regular margarine, cookies and cakes as these fats are detrimental to vascular health. Omega-3 margarines such as Benecol or Smart Balance are a better substitute. Avoid deep frying, even with vegetable oil, as they become degraded to trans fatty acids. Coconut oil which is more saturated oil withstands deep frying better.
Protein should be about 15 to 20 % of the calories. These should be derived preferably from vegetable sources such as beans and lentils, and from fish. Eating fatty fish twice a week, such as salmon especially wild variety to avoid excessive mercury. is recommended.
One simple method of a healthy diet is to visually divide your plate into quarters. Fill half with vegetables (the more colorful the better), a quarter with some kind of starch such as potato, rice or whole grain bread, and the other quarter with proteins. One ounce of nuts is a healthy snack between the meals.
EXERCISE: Thirty minutes of any activity, walking, cycling, etc., five days a week is the minimum recommendation. Exercise has many beneficial effects on our bodies, but we all have excuses to avoid or postpone regular exercise. Schedule a fixed time for exercise daily as you do for a meal or a social event. If other members of the family are involved, exercise can be fun rather than a chore.
ASPIRIN: To prevent heart attacks and strokes, a low-dose aspirin (75 to 81 mg) is recommended for males over 40 and females over 50, especially for those at high risk. The benefits of aspirin outweigh the potential side effects such as stomach upset and/or bleeding.
METABOLIC SYNDROME: More recently metabolic syndrome has been recognized as it identifies high-risk individuals who have multiple risk factors for development of coronary artery disease. Metabolic syndrome is said to be present if three or more of the five components exist in an individual. These are waist size equal or greater than 38 inches in Asian males and 34 inches in females, a fasting blood sugar of 100 mg or more, low HDL (less than 40 mg in males and 50 mg in females), high triglycerides (greater than 150 mg) and hypertension (greater than 139/85 mmHg).
South Asians have a high rate of metabolic syndrome, especially higher waist to hip ratio. Abdominal fat is metabolically active and is associated with insulin resistance which causes havoc to the body tissues. Again lifestyle modification is the most effective and least expensive way to prevent metabolic syndrome.
We think that health is a given gift and we do not have to do much to keep ourselves healthy. But sooner or later unhealthy lifestyles will get us into trouble, worst of all a heart attack or stroke. An ounce of prevention is always better but it does require some discipline which will pay dividends in the long run. By following the above guidelines, it is estimated that one could reduce a chance of heart attack by 80%. We have an opportunity to do just that.
In my next article I will discuss the early signs of heart attack and how to get quick help and forestall major damage to the heart or death. (Dr. Abbasi can be reached at: asabbasi@cox.net)


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