Author Q&A
What are some of the risk factors of coronary heart disease that we are least likely to know about?
Unfortunately most people don’t know the simple, basic risk factors—LDL (the “bad” cholesterol), blood pressure, and body mass index (a measure of obesity). Together, these 3 risk factors plus smoking and diabetes, predict more than 80% of the risk for heart disease.
We also have a growing list of emerging (and sometimes surprising) risk factors for heart disease. These include rheumatoid arthritis, sleep apnea, periodontal/gum disease and even air pollution.
Do 1-2 glasses of wine a day really stave off heart disease?
People who drink moderately are less likely to develop coronary artery disease and more likely to live longer than people who abstain from alcohol. This makes biological sense, as alcohol increases HDL cholesterol and reduces blood clotting. The evidence is solid, but we don’t have conclusive proof that wine staves off heart disease. Nevertheless, a glass of wine (or a beer or a scotch) a day can be part of a heart healthy lifestyle.
Is exercise ever bad for you?
Regular exercise is almost always good for you and for your heart. Nobody should be afraid to walk briskly for 30 minutes per day. But there are a few situations in which you need a doctor’s advice before embarking on a strenuous exercise program. See your doctor if you have one of the following: Aortic stenosis, Hypertrophic obstructive cardiomyopathy, Marfan syndrome, a known coronary artery disease (history of heart attack, stenting, bypass surgery or angina), or two or more of these risk factors: diabetes, smoking, high blood pressure, high cholesterol, family history of early heart disease (before age 50). You should stop exercising and consult your physician if you experience chest pain. If chest pain during exercise continues more than 5-10 minutes after you stop, you should call 911.
Is sex considered exercise?
The answer to this question depends upon what you do and for how long. On average, sex with a customary partner lasts for five to fifteen minutes and consumes about as much energy as walking one mile in twenty minutes. The younger and more vigorous among us may double or even triple this figure, reaching the threshold of vigorous exercise. Alas, these people are the exception. We can make an argument for sex as a heart-healthy behavior. A healthy sex life correlates with a healthy heart. People who have sex more often are less likely to develop cardiovascular disease. While this observation does not necessarily mean that sexual activity prevents heart disease, it suggests that sex can be part of a heart-healthy lifestyle.
Why do doctors advise taking aspirin if you have a heart condition, or are experiencing a heart attack?
Aspirin decreases blood clotting by interfering with the action of platelets. When someone has a heart attack, a blood clot usually forms at the site of a plaque in one of the heart’s arteries. Taking an aspirin at the first sign of chest pain can prevent the heart—attack causing blood clot from extending and may even help to dissolve it. Make sure that this is an uncoated aspirin and that you chew it to get the medicine into the blood stream as quickly as possible.
For people who have coronary artery disease, taking a baby aspirin each day helps prevent clot formation and heart attacks in the first place. However, for most people who do not yet have heart disease, aspirin is usually not recommended and may cause more harm than benefit.
Which heart tests do you need and when?
Doctors order too many tests. Based upon what they read on the Internet and see on billboards, patients ask for too many tests. Most of us do not need high-tech, high-radiation heart tests. But every adult needs to know a little bit about his or her own heart health.
Blood pressure: Measure every two years in most people and every few months in those with hypertension or cardiovascular disease.
Lipid profile/cholesterol blood test: Have your first test by age 20. If it is normal, repeat it every five years. If any values are abnormal or you have cardiovascular disease, have this blood test annually. If you are on a statin or other cholesterol-lowering medicine, get this test every 6 months.
BMI (Body Mass Index): Check this yourself annually by entering your height, weight, age and gender at the website www.nhlbisupport.com/bmi. The BMI screens for obesity. An ideal BMI is 20 to 25. Remember that the old adage is true—muscle weighs more than fat. This means that a very muscular person may have an elevated BMI without being obese.
Fasting blood sugar: If you are overweight or have diabetes, your doctor should check your fasting blood sugar at your annual physical. A normal value is less than 100.
Avoid tests that you don’t need. Annual stress tests are almost never necessary. Cardiac CT scans and calcium scores expose people to radiation and have no proven benefit: avoid them for now.
How does stress affect the heart?
Today we understand the link between emotional stress and heart attacks. In the patient with coronary artery disease, stress can trigger a heart attack by causing release of hormones and chemicals that increase blood pressure and heart rate and also increase the tendency for blood to clot. Anger is a common heart attack trigger, with up to 3% of heart attacks preceded by bouts of intense anger. Managing emotional stress can be life-saving for the patient with coronary artery disease.
Is red meat really that bad for the heart?
Red meat contains large quantities of saturated fat, which is linked to increased LDL cholesterol and an increased risk of heart disease. An occasional steak or hamburger is fine, but a diet that includes daily consumption of red meat, especially when compared to a diet rich in fish, is associated with an increased risk of developing coronary heart disease. If you do eat meat, choose less fatty cuts and limit portion sizes.
What questions should I, as a patient, ask before going into surgery?
When your cardiologist says that you need heart surgery, ask 3 key questions:
1. What in my heart is broken?
2. Will fixing my heart make me live longer?
3. Will fixing my heart make me feel better?
You should have heart surgery only if something in your heart is broken and fixing it will benefit you.
You want to make sure that you have the right surgeon, which means a surgeon with the expertise you need. Ask them:
1. How many of these operations do you do each year?
2. What are your results?
3. What are the risks of major complications: stroke, heart attack, death?
4. Is there a minimally invasive way to do my operation?
5. How are you going to control my postoperative pain?
Why is this book so important? How is it different than other books on heart disease?
This book is about proven strategies to achieve and maintain heart health. Today there is simply too much health information on the Web and on the bookshelves. Some of it is accurate, but much of it is completely wrong. Your heart-health is too important for you to get sucked in by ridiculous fads. You can’t afford to make critical mistakes based upon incorrect and confusing information. In this book, we detail the evidence, dispel the myths and distill the truth. Let us guide you to a life of sustained heart health.
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