Doctors, like all the rest of us, like stories with happy endings. Family physicians, internists, cardiologists, and heart surgeons—all of whom treat patients for heart disease—enjoy telling those tales that end happily.
George E. Cimochowski, MD, chief of cardiac surgery at the Wyoming Valley Health Care System, Wilkes-Barre, tells about a successful attorney in his area, once a non-exercising heavy smoker with badly damaged arteries, who did a 180-degree turn in lifestyle. Recently, when someone asked about the man's health, Dr. Cimochowski responded: "I think he may now be healthier than you and me."
Steven Ettinger, MD, Associate Professor of Medicine, Penn State Milton S. Hershey Medical Center, has several similar stories. One of his involves a 37-year-old woman, formerly both a smoker and obese. She was in serious trouble, but exercise and a low-fat diet turned her life around.
Donald Kovacs, MD, a Carlisle family physician, describes a man with an advanced case of coronary artery disease who barely survived a heart attack. "No one thought he'd get out of the ICU [intensive care unit] alive," Dr. Kovacs says. "But he's doing quite well due to the fact that he's a regular walker-a couple of miles per day."
These kinds of stories, however, represent shafts of light shining through dark clouds. Dr. Ettinger points out that 1.1 million Americans have heart attacks annually. About 480,000 of these are fatal-and not just fatal, but quickly fatal. "This means," Dr. Ettinger says, "that almost half of them die suddenly before they can receive potentially life-saving treatment."
Five Major Risk Factors
There are five major risk factors for heart disease, and all but one are at least partially under your control.
- Family History—This risk factor is the only one you can't do anything about. It's not a preview of impending doom, just a caution light on life's highway. If your father had heart problems before age 55 or your mother had problems before age 65, you should ask your doctor for regular tests and be especially careful to minimize other risks.
- Smoking—This is entirely within your control, and heart health is only one of many reasons to quit.
- Cholesterol—Cholesterol abnormalities, meaning both high LDL (bad cholesterol) and low HDL (good cholesterol), in many cases, are in your control through diet and exercise. Often, however, medication may be needed.
- High Blood Pressure—Hypertension (chronic high blood pressure), Dr. Ettinger says, is often called "the silent killer" because it's a condition with few or no self-evident symptoms. It's largely controllable through diet and exercise or, as with cholesterol levels, through medication.
- Diabetes—Although diabetes is hereditary in the sense that your genes may put you at risk for it, you may still be able to avoid its onset, or delay the disease for many years. Once again, the keys are exercise, diet, and sometimes prescription drugs. (People with the most serious form of diabetes also need to take insulin.)
As you'd expect, the more of these risk factors you have, the greater the danger. In fact, many Pennsylvanians are at special risk due to an aging population, eating habits of many people who think a meal isn't complete without lots of meat, and a relatively high incidence of smoking. Dr. Cimochowski sums up, "You combine smoking with a high-fat diet, and it's an absolute prescription for coronary artery disease."
Stress
Many physicians would add stress to the list of risk factors, although it's not quite clear how it figures in. Part of the problem is that it's subjective: what is stressful for one person may not be stressful to another, and vice versa. Nevertheless, many successful heart therapy programs, particularly after heart surgery, involve relaxation techniques such as meditation and guided imagery.
Women and Heart Disease
Before menopause, women have fewer heart attacks than men, but after that their risk is the same.
And young women don't get a free pass on the lifestyle issues. "I operate on many young women," Dr. Cimochowski says. "We commonly see diabetic, smoking females under the age of menopause with serious coronary heart disease."
Dr. Cimochowski adds that the success rate for arterial bypass surgery averages about 97-98 percent, but he and his colleagues in Wilkes-Barre take more satisfaction from another statistic: a low rate of repeat business.
"We don't have a zero re-operation rate," Dr. Cimochowski says, "but the number of our people who come back after surgery is much lower than the national average. We believe that's because of the strong emphasis by our surgeons, not only the internists and the cardiologists, on a low-fat diet and exercise."
Of course, the reason for eating sensibly and staying active isn't to avoid a second round of heart surgery. It isn't even to avoid the first round. "I think that exercise is one of the most important factors for leading a healthy life," Dr. Kovacs says. "I don't think you can feel really good without being physically fit. That's the point I try to make with my patients."
Living a healthier lifestyle makes you feel good, most of the time, year after year. That kind of story, at least when you're its hero, beats a one-foot-in-the-grave, heart-attack survival yarn any day.
How Not to Eat Your Heart Out:
Avoiding the High-Protein, Low-Carb Craze
The American Heart Association (AHA), which has fought fad diets for many years, has taken aim at five popular high-protein diets:
- The Atkins diet
- The Zone
- Protein Power
- Sugar Busters
- The Stillman Diet
Best-selling books promoting these diets claim that they help people lose weight while eating unlimited amounts of red meat and high-fat dairy products. They urge cutting out carbohydrates from breads, potatoes, corn, and other starchy vegetables.
You will lose weight on these diets, often fast. But there's a catch. Going heavy on meat also means going heavy on saturated fats. When you lose weight, your total cholesterol may even drop temporarily, but the saturated fats soon raise the level of LDL ("bad") cholesterol.
Worse, people on high-protein diets tend not to eat foods high in fiber like whole-grain breads, fruits, and vegetables. They keep calories down but lower their levels of HDL ("good") cholesterol, which helps to clean out your arteries.
The AHA says that staying on these high-protein, low-carb diets for long periods of time increases your risk for heart disease, stroke, diabetes, kidney disease, and even some forms of cancer.
The AHA urges that you eat a balanced diet that includes complex carbohydrates-fruits, vegetables, and whole-grain breads and cereals. Non-fat dairy products are fine, too, and eggs, while high in cholesterol, pack in lots of nutrition. You need to balance foods for long-term health.
A Healthy Heart: By the Numbers
You can learn a lot about your risk for heart disease from just a few numbers, all easy to come by. Here's how some of the more important risk factors are measured.
Fat
One of the simplest statistics is one you probably know already: the size of your waist. There are exceptions, but a waistline of more than 35 inches for women and 40 inches for men usually indicates overweight.
Body Mass Index (BMI)
A bit more scientific measure that applies equally to men and women is BMI. This is a highly accurate indicator of the percentage of your body that's fat. The numbers come from body weight (in kilograms) relative to height (in meters, squared).
You needn't do the math. Your doctor or librarian can help you find a lookup table, or you can find easy-to-use calculators on the Web that only require you to know your weight in pounds and your height in feet and inches.
Blood pressure
First, visit almost any shopping mall or drug store and ask where to find their sphygmomanometer. Explain that it's the gizmo that combines a cuff, a pressure registering system and a stethoscope to measure your blood pressure. Most malls and many pharmacies have them around for free check-ups.
This device gives you two numbers:
- Systolic pressure—how much pressure your heart needs to pump blood out to your body, and
- Diastolic—the pressure needed to get blood back into your arteries.
You're hoping for 120/80 or lower. If your first number is over 140 and the second over 90, that's called "hypertension." Make an appointment with your doctor. Remember, if you're diabetic you should aim for 130/80.
Cholesterol
You can't test for cholesterol yourself, but testing requires only a small blood sample, usually drawn by pricking your thumb or finger. You'd like the total number (a measure of the quantity in your blood) to be under 200. A reading between that and 239 puts you in a worrisome zone. Anything 240 or above is definitely high.
You'd also like the LDL's ("bad") cholesterol to be under 130; 160 and above is high. You want triglycerides to be low, too; a reading under 200 is normal.
And there's that one cholesterol number you want high. The HDLs ("good") cholesterol should measure 35 or above; anything under that signals "risk factor."
Profile
Donald J. Kovacs, MD, Family Practice
Yellow Breeches Family Practice Clinic, Boiling Springs, PA
Few people can convincingly claim to be in better shape at age 51 than they were at age 25. But when Donald Kovacs, MD, says that, he's believable.
At age 25 he was still smoking, having started as a teenager. He didn't break his tobacco addiction until 15 years ago. When asked if it was hard to quit smoking, Dr. Kovacs jokes, "It was easy. I did it hundreds of times. Actually, it was hard quitting and easy to start up again. I finally quit for good when my second child was born."
Now Dr. Kovacs is addicted to exercise. That includes a wide range of indoor and outdoor activities—mostly for pleasure, he says. Whether easy or strenuous, it's built around something most people can manage—daily walking.
An Ohio native, Dr. Kovacs has lived in Pennsylvania since 1976. He and his colleague, Bradford Wood, MD, work out of the Yellow Breeches Family Practice Clinic, named for a world-famous Cumberland County trout stream.
"I walk two or three miles a day," Dr. Kovacs says. "During the week one of those miles is often down to the Yellow Breeches Creek with one or more of my office staff. It takes about 15 minutes, and we enjoy a little exercise in the lovely rural scenery. A couple of them make that part of a bigger exercise program and have lost a considerable amount of weight. And I often walk a mile or two with my wife in the evening."
In mild weather he rides a bike, usually twice a week for an hour or two per outing-enough for 15 to 30 miles. During winter he keeps his riding muscles in shape by spinning sessions at the Carlisle YMCA, where he also does strength training once a week.
"I don't think of most of that as exercise," he says. "It's fun. I find being out in nature restorative. It's a mental thing as well as a physical thing."
Dr. Kovacs emphasizes to his patients that it's never too late to start exercising. "There are studies," he says, "that have taken 90-year-olds in nursing homes and started them on weightlifting programs. Some people who've been wheelchair-bound have gotten up and started walking."
Dr. Donald Kovacs lives in Carlisle, PA and has worked as a family physician at the Yellow Breeches Family Practice in Boiling Springs for over 22 years. He and his colleague, Dr. Brad Wood, try to encourage a "Heart-Healthy Lifestyle" in their patients and to practice it themselves.