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You might feel all right, but when tests of health do not measure up, there's a toll on heart
By Tracy Wheeler
Beacon Journal medical writer
Published on Tuesday, May 20, 2008
Heart disease has long been the nation's No. 1 killer.
Its reign, though, may be coming to an end, with heart-related death rates dropping by 25.8 percent since 1999.
That's proof that we do have some control over this pervasive health threat.
Ultimately, it comes down to exercising and eating right for most of us. But even for those with a family history of heart disease, knowing your numbers — blood pressure, waist circumference, cholesterol and blood sugar — can help loosen heart disease's death grip.
High blood pressure
It's called the ''silent killer'' for a reason.
''High blood pressure is a sneaky disease,'' said Dr. Cynthia Pordon, a cardiologist at Akron's Northeast Ohio Cardiovascular Specialists. ''They might not realize they have it because they have no symptoms to say, 'Oh, hey, your blood pressure is up.' ''
But 65 million Americans have high blood pressure, which is also known as hypertension. And research has made clear that, untreated, these people are at an immensely increased risk of heart disease, stroke, kidney disease and death.
Today's guidelines recommend a blood pressure reading below 140-over-90. For those with diabetes or kidney disease, the goal is to get to 130-over-80 or below.
It used to be that doctors would recommend that patients cut their salt intake and start exercising more to lower their blood pressure, then check their readings a few months later to see whether they're improving, said Dr. Deepak Bhatt, associate director of the Cleveland Clinic's Cardiovascular Coordinating Center.
Now, though, most doctors want to start medications sooner than later.
''The fact of the matter is that most people in real life can do all those things — to the extent that they say they do — and it doesn't end up having much of an effect on their blood pressure,'' Bhatt said.
However, he said, if someone can manage to drop 10 or 20 pounds, it can drop a person's risk of heart disease from borderline to low.
At the same time, though, medications don't work equally well for everyone. Some people can see improvement with one drug. Some people will need a combination of drugs.
In either case, the key is to actually take the drugs.
''In mild to moderate cases, a person doesn't feel anything,'' Bhatt said. ''If they feel fine, it's difficult to convince people to take their medications.''
One other important fact patients need to keep in mind about blood pressure: Make sure your doctor is checking it.
A recent Stanford University School of Medicine study found that patients' blood pressure was taken in just 56 percent of all patient visits, though it was checked in 93 percent of visits by those with hypertension. The study also found, though, that just 39 percent of those being treated for high blood pressure were at the recommended blood pressure level.
Only 20 percent of
hypertensive patients who also had diabetes or kidney disease had their blood pressure under control.
Waist circumference
It's no secret that obesity contributes to heart disease.
And research is showing that a person's waist size has a direct link to the risk of heart disease, Bhatt said. Some doctors might suggest knowing your body mass index (a complicated formula that takes into account height and weight) but waist circumference is a lot simpler to figure out.
''It's pretty easy,'' Bhatt said. ''Just take a measuring tape and measure your waist — where you put your belt.''
A measurement greater than 40 inches for men and 35 inches for women means your risk of heart disease, diabetes and high blood pressure is high.
If you find yourself in this situation — or even if you don't, really — it's imperative to eat better (more fruits and vegetables, more fiber, less fat and fewer calories) and exercise more (at least 30 minutes of moderate-intensity aerobic activity, like walking, five days a week; or 20 minutes of vigorous activity, like jogging, three days a week).
Pordon has seen firsthand how important weight loss is. She's had patients who have been able to get off their diabetes and high blood pressure medications by losing a lot of weight, whether through nutrition-and-exercise programs or gastric bypass surgery.
Cholesterol
Cholesterol isn't just one number, it's several: HDL (high-density lipoprotein, the ''good'' cholesterol), LDL (low-density lipoprotein, the ''bad'' cholesterol), and triglycerides (another harmful form of blood fat).
For most people, Bhatt said, an LDL of less than 130 is ''acceptable,'' though getting below 100 is ''optimal'' for those with heart disease.
LDL levels of 130 to 159 are considered borderline high, while 160 to 189 is considered high and anything over 190 is very high.
For total cholesterol readings, a reading under 200 is desirable, 200-239 is borderline high and anything over 240 is too high. Triglycerides should fall below 150, while 200-499 is considered high.
''I tend to focus on the bad cholesterol more than the total cholesterol,'' Bhatt said, ''because right now, as close as we can tell, it most correlates with risk of heart disease.''
Cholesterol medications have come under heat lately, but they've ''been proven beyond a shadow of a doubt to save lives in appropriate patients.''
Cholesterol drugs are not considered appropriate for young, healthy, active adults, he said.
But a study published last week by Medco Health Solutions found that treatments for high cholesterol and high blood pressure are the most-used medications by the general population. In fact, among men 20 to 44, the use of cholesterol drugs surged more than 80 percent over a recent seven-year period.
The National Institutes of Health recommend that younger adults (men 20 to 35 and women 20 to 45) avoid cholesterol medications and instead undertake therapeutic lifestyle changes.
Even for those people, though, it's important that they know their readings, Pordon said.
''What helps with compliance is knowing your numbers and knowing your goals,'' she said, ''rather than me saying, 'Oh, you need to lose weight. You need to watch your cholesterol.'
''If they can watch the trends and know their progress, they'll be more compliant. I see that in a lot of my patients. Some of them even get upset when we don't do blood work.''
Blood sugar
What's blood sugar got to do with heart disease? Isn't that what diabetics have to worry about?
Yes, they do. But so does anyone concerned about heart health.
Having diabetes — or a blood sugar reading over 125 — presents the same heart disease risk as having already had a heart attack.
Heart disease and stroke strike diabetics twice as often as others. More than 65 percent of deaths in diabetes patients are attributed to heart and vascular disease.
But by keeping an eye on your blood sugar, you can prevent this.
Guidelines now warn of pre-diabetes, a blood sugar reading of 100 to 125.
''When the doctor tells you that you're in the pre-diabetic stage, that's the time to really worry about your diet and exercise,'' Pordon said.
According to the American Diabetes Association, people who develop type 2 diabetes almost always have pre-diabetes first. And recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes.
''If you've had that warning of pre-diabetes,'' Pordon said, ''it's important to start following recommendations from your doctor.''
Like everything else on this list, those recommendations will include exercising and eating right.
The big picture
''Everything's kind of inter-related,'' Bhatt said. ''If you need to lose weight, if you have borderline high blood pressure or high blood sugar, that can be the difference between needing medications and not needing medications. Moderate degrees of weight loss can prevent these things.''
Bhatt understands that it's difficult to change habits, but it's crucial. He suggests that people start by incorporating physical activity into their everyday lives, such as taking the stairs, parking farther away from stores, and walking more.
As for eating, he said: ''The best type of diet is one with fewer calories. Eat less. In many respects, we're eating ourselves to death.''
A good starting point, he said, is ''whatever food you eat, take away one-fourth. You may be hungry for a few months, but your body adapts.''
Tracy Wheeler can be reached at 330-996-3721 or tawheeler@thebeaconjournal.com.
Heart disease has long been the nation's No. 1 killer.
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