Each year over a
million people in the U.S. have a heart
attack. About half of them die. Many
people have permanent heart damage or
die because they don't get help
immediately. It's important to know the
symptoms of a heart attack and call
9-1-1 if someone is having them. Those
- Chest discomfort - pressure,
squeezing, or pain
- Shortness of breath
- Discomfort in the upper body -
arms, shoulder, neck, back
- Nausea, vomiting, dizziness,
These symptoms can sometimes be
What exactly is a heart attack? Most
heart attacks happen when a clot in the
coronary artery blocks the supply of
blood and oxygen to the heart. Often
this leads to an irregular heartbeat –
arrhythmia - that causes a severe
decrease in the pumping function of the
heart. A blockage that is not treated
within a few hours causes the affected
heart muscle to die.
How to Keep Your Heart Healthy
By Michelle Meadows
Sixty-two-year-old Jack Andre says having a heart
attack in March 2003 was like getting hit in the head
with a baseball bat. "It brought a lot of things to my
attention that I never thought about before," he says.
He was overweight, didn't exercise, and often ate
high-fat foods. But he never connected his lifestyle to
"Six months before the heart attack, my doctor told
me I had borderline high cholesterol and high blood
pressure," says Andre, of Rockville, Md. "But I didn't
think much of it."
That all changed after he experienced heart attack
symptoms--extreme fatigue, dizziness, and back pain.
Tests revealed that Andre had three clogged coronary
arteries. "Now I walk every day at lunch, eat smaller
portions, and I'm a food label reader," he says.
Bonnie Brown, 50, of Baltimore, says she also didn't
change her life until she had a heart attack in 1997. "I
used to smoke, ate cold-cut subs for breakfast, and had
lots of fried foods, all the time, any time," Brown
says. But her heart attack--which she initially mistook
for a bad case of indigestion--led her to give up
cigarettes, improve her diet, and sign up for weekly
water aerobics and line dancing classes.
"There's nothing that motivates people like having a
heart attack or bypass surgery," says Christopher Cates,
M.D., director of vascular intervention at the Emory
Heart Center in Atlanta. "I've found that people think
that heart disease always happens to someone else, until
it happens to them." Experts say that until Americans
change their way of thinking from one of damage control
to one of proactive prevention, heart disease will
remain the No.1 killer of men and women in the United
"In many ways, I think we've become insulated by
high-tech care," Cates says. "As physicians, we are
partners in the health care of our patients, which means
we need to educate them about their risk factors for
heart disease. And they need to have some sense of
ownership about what they can control. They can't simply
look to their doctors or to the FDA or to Medicine, and
say, 'Cure me, but I'm going to eat fatty foods, smoke,
and be sedentary.'"
One of the reasons that some people may shrug off the
possibility of developing heart disease is that it's a
gradual, lifelong process that people can't see or feel.
About the size of a fist, the heart muscle relies on
oxygen and nutrients to continually pump blood through
the circulatory system. In coronary artery disease, the
most common type of heart disease, plaque builds up in
the coronary arteries, the vessels that bring oxygen and
nutrients to the heart muscle. As the walls of the
arteries get clogged, the space through which blood
flows narrows. This decreases or cuts off the supply of
oxygen and nutrients, which can result in chest pain or
a heart attack. Damage can result when the supply is cut
off for more than a few minutes. It's called a heart
attack when prolonged chest pain or symptoms (20 minutes
or more) are associated with permanent damage to the
Every year, more than 1 million people have heart
attacks, according to the National Heart, Lung, and
Blood Institute (NHLBI). About 13 million Americans have
coronary heart disease, and about half a million people
die from it each year.
What's Your Risk Profile?
Risk factors for heart disease are typically labeled
"uncontrollable" or "controllable." The main
uncontrollable risk factors are age, gender, and a
family history of heart disease, especially at an early
The risk of heart disease rises as people age, and
men tend to develop it earlier. Specifically, men ages
45 and older are at increased risk of heart disease,
while women 55 and older are at increased risk. A
woman's natural hormones give some level of protection
from heart disease before menopause.
"Heart disease presents in women an average of seven
to 10 years later than in men," says Patrice
Desvigne-Nickens, M.D., leader of cardiovascular
medicine at the NHLBI. "But after menopause, women
develop heart disease as often as men, and women who
have a heart attack don't fare as well as men." Women
are more likely than men to die from a heart attack.
Though heart disease is the leading cause of death
for both men and women in this country, surveys have
shown that many women don't know it, and that they are
more worried about cancer, especially breast cancer. "We
want women to know that heart disease is not a man's
disease. Rather, heart disease is the leading cause of
death for women, and heart disease is preventable and
treatable," says Desvigne-Nickens.
The NHLBI defines having a family history of early
heart disease this way: A father or brother who had
heart disease before 55, or a mother or sister who had
heart disease before 65. Be sure to tell your doctor if
any of your family members have had heart disease. Andre
says it was only after he had a heart attack that he
learned that he had four uncles who had been diagnosed
with coronary artery disease.
Even if you have uncontrollable risk factors for
heart disease, it doesn't mean that you can't take steps
to limit your risk. Researchers say that controllable
risk factors--physical inactivity, smoking, overweight
or obesity, high blood pressure, high blood cholesterol,
and diabetes--are all major influences on the
development and severity of heart disease.
According to Cynthia Tracy, M.D., chief of cardiology
at Georgetown University Hospital in Washington, D.C.,
the best way to combat heart disease is to know the risk
factors, "own" the risk factors that apply to you, and
address the ones that are controllable. "I think many
people can rattle off risk factors, but then they don't
internalize them to say: 'That's a risk factor for me. I
am at risk for heart disease. And now I'm going to do
something about it,'" Tracy says.
Taking Charge of Your Health
Because of advances in medicine and technology,
people with heart disease are living longer, more
productive lives than ever before. But prevention is
still the best weapon in the fight against heart
disease. As with anything in life, there are no
guarantees. You could do all the right things and still
develop heart disease because there are so many factors
involved. But by living a healthier life, you could
delay heart disease for years or minimize its damage.
Whether you are already healthy, are at high risk for
heart disease, or have survived a heart attack, the
advice to protect your heart is the same.
Get moving and maintain a healthy weight.
Exercise improves heart function, lowers blood
pressure and blood cholesterol, and boosts energy. And
being overweight forces the heart to work harder. But
about 1 in 4 U.S. adults are sedentary.
The general recommendation from the NHLBI is to get
at least 30 minutes of moderate physical activity on
most, and preferably all, days of the week. And you
don't need to run a marathon or buy an expensive gym
club membership to do it. The 30 minutes also don't have
to be done all at once, but can be broken up into
10-minute intervals throughout your day.
"Exercising is like taking the pennies from under the
couch cushions and putting them into your piggybank,"
says Ann Bolger, M.D., a spokeswoman for the American
Heart Association (AHA) and a cardiologist in San
Francisco. "Every little bit counts."
Vigorous exercise like running or doing aerobics
brings more health benefits than lighter intensity
activities, but walking is a great form of exercise.
Brisk walking can get your heart rate up and give you a
solid workout. Walking at a comfortable pace can work
well for many people, too. "The best exercise is the one
you feel good about and can do over and over again,"
Bolger says. And it's easier to work exercise into your
everyday routine than you might think.
For example, Bolger suggests parking farther away
when you go to the grocery store or to your office to
create a longer walk, taking the stairs, walking all the
way around a mall the next time you go shopping, and
walking around your neighborhood. Getting support from a
walking buddy or a walking group can be a good way to
keep you motivated.
Talk with your doctor about what form of exercise is
best for you. Those with severe heart disease, for
example, are advised against strenuous exercise.
Desvigne-Nickens suggests that you teach your
children early that exercise is fun and good for them.
Families can walk together, ride bikes, and chase after
balls in a park. "But we have to show them," she says.
"Our children are exercising their thumbs with computers
and video games, and obesity in childhood is epidemic."
Stick to a nutritious, well-balanced diet.
This advice might make you groan if your usual
lunch consists of cheeseburgers with french fries or
pizza slices topped with sausage. But the good news is
that diet isn't an all-or-nothing affair.
A heart-healthy diet means a diet that's low in fat,
cholesterol, and salt, and high in fruits, vegetables,
grains, and fiber. "But it doesn't mean that you can
never have pizza or ice cream again," Bolger says. You
could start by telling yourself that you will eat a big
leafy green salad first, and then you will have one
slice of cheese pizza, not three slices with sausage.
"Or if you must have a burger, don't get your usual
order of french fries," Bolger suggests. "That alone
cuts hundreds of calories."
Experts point out that a heart-healthy diet should be
the routine. That way, when you have high-fat food every
now and then, you're still on track. Making a high-fat
diet the routine is asking for trouble.
Bolger teaches people about the AHA's Simple
Solutions program, which helps women--often the ones who
do the cooking and grocery shopping--adopt simple ways
to improve eating habits for the whole family. For
example, it's wise to make a grocery list so that you
can carefully plan your meals. "You have to make a
conscious decision to make your snack a bag of grapes
instead of a candy bar or cookies," Bolger says.
Bolger also asks her patients to tell her the food or
food group that gets them into trouble. If you pin that
down you can start to make healthy substitutions. Tell
Bolger that overloading on ice cream is your downfall
and she'll tell you about her recipe for a berry
dessert: Use nonfat yogurt, sweeten it up as much as you
want with a sugar substitute, add a drop of vanilla
extract, microwave frozen strawberries briefly to soften
them up, add the berries, stir it all around, and enjoy.
Like exercise, good eating habits need to start
early. "Teaching your children to eat well is one of the
most loving things you can do for them," Bolger says.
Your children tend to follow your lead, eat what you
eat, and eat what you put in front of them. It's up to
you how often you put a banana in front of them instead
of high-fat cookies.
Look at the Nutrition Facts label on the foods you
buy for guidance. The general rule of thumb is that
foods that provide 5 percent of the daily value (DV) of
fat or less are low in fat, and foods that are labeled
as providing 20 percent or more of the daily value are
high in fat.
Control your blood pressure. About
50 million American adults have high blood pressure,
also called hypertension. The top number of a blood
pressure reading, called the systolic pressure,
represents the force of blood in the arteries as the
heart beats. The bottom number, called diastolic
pressure, is the force of blood in the arteries as the
heart relaxes between beats. High blood pressure makes
the heart work extra hard and hardens artery walls,
increasing the risk of heart disease and stroke.
A blood pressure level of 140 over 90 mm Hg
(millimeters of mercury) or higher is considered high.
The NHLBI recently set a new "prehypertension" level of
any reading above 120 over 80 mm Hg.
Poor eating habits and physical inactivity both
contribute to high blood pressure. According to the
NHLBI, table salt increases average levels of blood
pressure, and this effect is greater in some people than
The National Institutes of Health's DASH diet
(Dietary Approaches to Stop Hypertension) is rich in
fruits, vegetables, and low-fat dairy foods, and low in
total and saturated fat. The DASH diet also reduces red
meat, sweets, and sugary drinks, and it's rich in
potassium, calcium, magnesium, fiber, and protein.
It's important to keep on top of your blood pressure
levels through regular doctor visits. High blood
pressure disproportionately affects racial and ethnic
minority groups, including blacks, Hispanics, and
American Indians/Alaska Natives. The condition is known
as a silent killer because there are no symptoms. If
lifestyle changes alone don't bring your blood pressure
within the normal range, medications may also be needed.
Recent NHLBI research has shown that older, less
costly diuretics work better than newer medicines to
treat high blood pressure. These findings, part of the
Antihypertensive and Lipid-Lowering Treatment to Prevent
Heart Attack Trial (ALLHAT), were published in the Dec.
18, 2002, issue of the Journal of the American
Control blood cholesterol.
Cholesterol is a fat-like substance in the blood. High
levels of triglycerides, another form of fat in the
blood, can also indicate heart disease risk.
As with blood pressure, eating a low-fat,
low-cholesterol diet and engaging in physical activity
can lower cholesterol levels. Your body turns saturated
fats into cholesterol. And the higher your cholesterol
level, the more likely it is that the substance will
build up and stick to artery walls.
The only way to find out your cholesterol levels is
to go to a doctor and have a blood test after fasting
for nine to 12 hours. A lipoprotein profile will reveal
your total cholesterol, which is measured in milligrams
(mg) of cholesterol per deciliter (dL) of blood. Total
cholesterol less than 200 mg/dL is desirable, 200-239
mg/dL is borderline high, and 240 mg/dL or more is high.
Low-density lipoprotein (LDL), also known as "bad
cholesterol," should be less than 100 mg/dL. A level of
100-129 mg/dL is near optimal/above optimal, 130-159 mg/dL
is borderline high, 160-189 mg/dL is high, and 190 mg/dL
and above is very high.
High-density lipoprotein (HDL), also known as "good
cholesterol," protects the arteries from bad cholesterol
buildup, so the higher the HDL, the better. HDL levels
of 60 mg/dL or more help lower heart disease risk, and
an HDL level of less than 40 mg/dL is considered low.
People ages 20 and older should have cholesterol
measured at least once every five years. If lifestyle
changes alone don't adequately budge cholesterol levels,
medications may be needed.
Experts say the drug class known as "statins" marks a
significant advance in preventing heart disease. These
drugs work by partially blocking the synthesis of
cholesterol in the liver, which helps remove cholesterol
from the blood. Along with lowering cholesterol, statins
help stabilize blood vessel membranes. Examples include
Lescol (fluvastatin), Pravachol (pravastatin), Zocor (simvastatin),
and Lipitor (atorvastatin). The most recent addition to
this class, AstraZeneca Pharmaceuticals' Crestor (rosuvastatin),
was approved by the Food and Drug Administration in
August 2003. Even with drug treatment, a
cholesterol-lowering diet and exercise are still
|whole or 2 percent
milk and cream
||use 1 percent or skim milk
||eat baked, steamed, boiled,
broiled, or microwaved foods
|lard, butter, palm
and coconut oils
||cook with unsaturated vegetable
oils such as corn, olive, canola, safflower,
sesame, soybean, sunflower, or peanut
|fatty cuts of meat
||eat lean cuts of meat or cut
off the fatty parts
|one whole egg in
||use two egg whites
|sauces, butter, and
||season vegetables with herbs
|regular hard and
||eat low-fat, low-sodium cheeses
|salted potato chips
||choose low-fat, unsalted
tortilla and potato chips and unsalted pretzels
|sour cream and
||use plain low-fat yogurt,
low-fat cottage cheese, or low-fat or "light"
Prevent and manage diabetes. About
17 million people in the United States have diabetes,
and heart disease is the leading cause of death of those
with the disease. According to the American Diabetes
Association (ADA), 2 out of 3 people with diabetes die
from heart disease or stroke.
Diabetes is a disease in which the body does not
properly produce or use insulin. Insulin is a hormone
needed to convert sugar, starches, and other nutrients
into energy. Another 16 million Americans have
pre-diabetes, a condition in which blood glucose levels
are higher than normal, but not high enough to be
diagnosed as diabetes. Genetics and lifestyle factors
such as obesity and physical inactivity can lead to
One in three people who have diabetes don't know they
have it. See a doctor if you have any diabetes symptoms,
which include frequent urination, excessive thirst,
extreme hunger, unusual weight loss, increased fatigue,
irritability, and blurry vision.
Quit smoking. Ditch the cigarettes
and you'll dramatically lower your heart attack risk.
And if you don't smoke, don't start. Along with raising
your risk of lung cancer and other diseases, the mixture
of tar, nicotine, and carbon monoxide in tobacco smoke
increases the risk that your arteries will harden, which
restricts blood flow to the heart.
Smokers have more than twice the risk of having a
heart attack as non-smokers. According to the AHA,
smoking is the biggest risk factor for sudden cardiac
death, and smokers who have a heart attack are more
likely to die than non-smokers who have a heart attack.
In the first year that you stop smoking, your risk of
coronary heart disease drops sharply, according to the
NHLBI. And over time, your risk will gradually return to
that of someone who has never smoked.
Minimize stress. After having a
heart attack in 1987, Dennis Everett, 61, retired early
from a high-stress job and moved with his wife, Joyce,
from Vienna, Va., to Berkeley Springs, W.Va.--a rural
resort town that gives Everett a relaxing life.
Stress management was a major part of Everett's
recovery, which also included improving his diet, going
for daily walks, and giving up smoking. "I couldn't have
done it without the support of my wife," he says.
"Spouses also have a big adjustment."
The link between stress and heart disease isn't
completely clear, but what's known for sure is that
stress speeds up the heart rate. And people with heart
disease are more likely to have a heart attack during
times of stress.
Everett was serving as coach for a girls' softball
team when the pain he had been experiencing in his left
arm for a few days became unbearable. "It hurt so bad
that I had to hold my left arm up with my right one," he
says. He happened to mention his symptoms to a player's
father, a dentist. "He told me, 'I hate to tell you
this, but those are the signs of a heart attack,'"
Everett says. "That's when we called 911."
Heart Attack Symptoms
Research has shown that people typically wait two
hours or more before seeking emergency care for heart
attack symptoms. It could be because they are uncertain
about their symptoms or concerned that it might be a
false alarm. But clot-busting medications and other
effective treatments that restore blood flow and save
heart muscle are most effective in the first hour
following a heart attack.
Symptoms of heart attack include chest discomfort or
pain, discomfort in the arm(s), back, neck, jaw, or
stomach, shortness of breath, breaking out in a cold
sweat, nausea, and lightheadedness. Most heart attacks
don't involve someone clutching the chest and dropping
to the floor like you might see on TV. It's also
important to know that heart attack symptoms for men can
be different than symptoms for women.
"The classic sign is when someone comes into the
emergency room, puts their fist on their chest, and says
it feels like a squeezing pressure," says Cynthia Tracy,
M.D., chief of cardiology at Georgetown University
Hospital in Washington, D.C. "But it's not always like
that. For women, it may present as back pain, flu-like
symptoms, or a sense of impending doom."
"We need women to be aware of their symptoms, and we
need doctors to put the pieces together and say, 'This
woman is postmenopausal and her mother died of a heart
attack at 47. So even though her symptoms don't sound
classic, I need to investigate her for coronary
When Bonnie Brown, 50, of Baltimore, felt a sharp
pain in the middle of her chest in 1997, she thought it
was indigestion and assumed the feeling would pass. But
something made her tell her sister, Joan Hamilton, 53,
who lived with her at the time. Joan noticed how pale
Bonnie looked and insisted they call an ambulance. Soon
after, doctors confirmed that she was having a heart
Then, amazingly enough, Joan also had a heart
attack--two weeks after Bonnie did. For Joan, her main
symptom was persistent pain in the left arm. "I thought
it was from lifting boxes," Joan says, "but I don't
tolerate pain too well so I checked it out."
Both Bonnie and Joan used to think heart disease was
only for men. Both women are part of the Red Dress
Project, the centerpiece of the Heart Truth campaign,
sponsored by the National Institutes of Health. The Red
Dress Project features a collection of 19 red dresses
from America's most prestigious designers, with the
dresses symbolizing the fact that heart disease is a
women's issue too.
Treating Heart Disease
Once doctors determine that you have clogged coronary
arteries, the treatment plan typically involves a
combination of drugs, lifestyle changes, and procedures
that open up the arteries.
Drugs: Thrombolytic drugs, also
referred to as "clot-busting drugs," are given during a
heart attack to dissolve blood clots in coronary
arteries and restore blood flow to the heart.
Because of its anti-clotting abilities, aspirin is
recognized by the Food and Drug Administration as safe
and effective to help lower the risk of having a second
Other drugs commonly used to treat people with heart
disease include drugs that lower blood pressure,
angiotensin-converting enzyme (ACE) inhibitors, which
help the heart pump blood better, and beta blockers,
which slow the heart down. Nitrates and calcium channel
blockers relax blood vessels and relieve chest pain.
Diuretics decrease fluid in the body. Blood
cholesterol-lowering drugs reduce levels of low-density
lipoproteins (LDL), the "bad cholesterol," in the blood
and increase high-density lipoproteins (HDL), the "good
Angioplasty is a procedure in which a thin tube called a
catheter is put into an artery in the groin and threaded
up to the narrowed artery in the heart. The catheter,
which has a balloon at the tip, is used to widen the
artery. Routinely, tiny mesh wire tubes called stents
are then inserted into the artery to hold it open
permanently. But a major challenge is restenosis, which
is the reclogging or renarrowing of an artery after
angioplasty or stenting.
Maureen Magoon, 67, of Blairsville, Ga., who was
diagnosed with heart disease in 1999, has experienced
problems with restenosis since receiving angioplasty. So
when her doctors at the Emory Heart Center in Atlanta
recently discovered that another one of her arteries was
clogged, they determined that she was a good candidate
to receive the Cypher Stent from Cordis Corp., the first
The new stent, approved by the FDA in May 2003,
releases the drug sirolimus, which reduces the risk that
the artery will reclog. As part of its conditions for
approving the Cypher Stent, the FDA is requiring Cordis
to conduct a post-approval study of 2,000 patients to
assess the long-term safety and effectiveness of the new
device. The agency is monitoring reports of problems
with the stent, as it does with all medical devices.
A process called intravascular radiation therapy,
which uses radiation to kill cells that are clogging an
artery, is sometimes used during angioplasty procedures.
Also known as brachytherapy, this treatment is not
approved for use with the placement of a stent for a
vessel that has never been treated, says Jonette Foy,
Ph.D., a biomedical engineer in the FDA's Center for
Devices and Radiological Health. "Brachytherapy is
approved for vessels that have been previously stented,
but reoccluded over time."
Coronary bypass surgery: In cases of
severe blockages or when someone is unresponsive to
medications or not a candidate for angioplasty, doctors
may perform coronary bypass surgery. This involves
taking a blood vessel from the leg or chest and grafting
it onto the blocked artery to bypass the blockage.
In the last few years, the FDA has approved several
devices that improve heart disease diagnosis and
treatment. For example, after a person has received
coronary bypass surgery, devices are used to catch loose
particles that could potentially float downstream and
clog another artery. This process is known as embolic
C-reactive Protein: A New Risk Factor
Among the new risk factors that may be linked to
increased risk of cardiovascular disease is C-reactive
protein (CRP). It's produced by the liver as a response
to injury or infection and is a sign of inflammation in
the body. Research correlates high levels of CRP with an
increased risk of heart attack and stroke. Though the
evidence is conflicting, some researchers believe that
CRP itself is not a risk factor, but elevated levels of
CRP could mean that some part of the cardiovascular
system is inflamed, which can lead to stroke or heart
attack. Information about CRP and other new risk factors
is still emerging.
Source: Mayo Clinic
For More Information
National Heart, Lung, and Blood Institute
(800) 575-WELL (575-9355)
American Heart Association
(800) AHA-USA-1 (242-8721)