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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