HEALTHMATTERS

HAVE A HEART:
Minimizing Your Risk For Heart Disease
By Linda Hepler, BSN, RN

ebruary is the season of hearts and flowers, a time to shake off your winter doldrums and look forward to the promise of spring. February is also American Heart Month, a time to consider taking better care of that ticker. According to the American Heart Association, heart disease (including stroke) is the leading cause of death for both men and women. In fact, heart disease kills an estimated 630,000 Americans each year. Were surviving longer once we have heart disease, says Jonathan Fialkow, MD, FACC, FAHA, FABCL, Medical Director of EKG, Stress Lab and Cardiac Rehabilitation at the Baptist Cardiac and Vascular Institute in Miami, Florida. But theres still a high prevalence of developing it. The term heart disease, explains Dr. Fialkow, covers a wide range of conditions, but in the United States the most common heart condition is coronary artery disease (CAD). CAD occurs when theres a plaque accumulation in the coronary arteries, which are the blood vessels that supply blood and oxygen to your heart muscle. As plaque (consisting of fatty deposits) builds up in the arteries, it thickens and hardens, narrowing the vessels in a process called atherosclerosis. Atherosclerosis results in decreased blood delivery to the heart, and may produce angina, or chest discomfort, due to the diminished oxygen supply. Over time, the heart muscle may weaken, leading to heart failure (an inability to pump effectively) or dangerous heart rhythms. Sometimes, the plaque completely blocks an artery
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carrying blood to the heart, resulting in a heart attack. Recent research has shown that inflammation plays a big role in the progression of atherosclerosis, too. While the major risk factors for CAD are aging (over 50), strong family history of heart disease, a sedentary lifestyle, smoking, hypertension (high blood pressure), elevated cholesterol and diabetes, says Dr. Fialkow, any condition that causes inflammation can increase your risk. This, he says, includes diseases such as psoriasis, asthma and arthritis anything that triggers systemic inflammation. What to do to decrease your risk of developing CAD? The obvious answer is to make lifestyle changes to reduce your risk factors, such as not smoking, exercising regularly to keep your weight down and prevent diabetes, and eating a healthy lower fat diet. If you do have a disease such as hypertension, diabetes or arthritis, its important to keep it in good control. This means regular physician visits for monitoring and treatment as well as prevention of other conditions. And since artery clogging cholesterol is carried in lipoprotein particles in your blood, the United States Preventive Services Task Force (USPSTF) recommends a periodic lipid profile for men aged 35 and older and women aged 45 and older, as well as for those 20 and older who have increased risk for CAD. This blood test measures your total cholesterol value as well as breaking down the numbers into an HDL (good cholesterol) result and an LDL (bad cholesterol) result. It also measures triglycerides, another type of lipid (or fat) in your blood, and calculates a non-HDL

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value, which is obtained by subtracting the HDL cholesterol level from the total cholesterol. The non-HDL calculation is the sum total of bad fats, which includes LDL cholesterol plus the cholesterol contained in very low density lipoprotein (VLDL, the main carrier of triglycerides). Non-HDL cholesterol is a better predictor of your heart disease risk than LDL, says Dr. Fialkow. Those at especially high risk of CAD should have advanced lipid testing, he adds. Advanced testing, such as an LDL particle number (LDL-P), can be useful because some people have a normal LDL cholesterol number, yet have smaller LDL particles, which more easily invade the artery walls and lead to plaque formation. Your physician may order other tests based upon the results of your history, physical exam and lipid profile, such as an EKG or stress testing. He or she will also use these results to come up with the best diet and drug therapy to prevent the onset or progression of atherosclerosis. >>

Anti-Inflammatory Diet

Recent research suggests that diet plays an important part in causing inflammation, which may contribute to the risk for heart disease. A high carbohydrate intake, especially those carbohydrates in sugary foods like sodas and pastries and in refined, highly processed foods, can precipitate an increased number of LDL particles, says Dr. Fialkow.

While popular anti-inflammatory diets vary in specifics, a general guideline includes:

n 5 or more servings of fruits and veggies each day n Minimal saturated fat (red meats, whole fat dairy foods, hydrogenated oils like palm and coconut) n Plenty of omega-3 fatty acids, found in oily fish (or fish oil supplements) and walnuts n Limited intake of refined carbohydrates, such as white rice, pasta and breads n Whole grains, such as brown or wild rice, oats and quinoa n Lean protein sources such as chicken, turkey and soy n Avoidance of refined and processed foods n Anti-inflammatory spices, such as ginger and curry

Yoga For Heart Health

Many who practice yoga swear by it for reducing stress and helping with balance. But some yoga practitioners, such as Lynn Anderson, PhD, ND, of Los Angeles, California, believe that it may help with heart health. Yoga doesnt actually prevent heart disease, she says. Although studies have shown that yoga practitioners have better heart health in general. According to Dr. Anderson, the major benefit of yoga is that when youre working and stretching the muscles, youre improving circulation and oxygen to all of the body organs, including the heart. While it cant replace a healthy diet and aerobic exercise, she believes that yoga can be a beneficial part of a heart healthy lifestyle.

Dr. Phils Fab Four Heart-Healthy Supplements

Most cardiac doctors prescribe one or more supplements for their patients in order to keep the heart healthy. Phillip Harvey, PhD, RD, FACN, CNS, Chief Scientific Officer of Max Muscle LLC, offers his top four picks:

1. Omega 3 Fatty Acids are considered essential fatty acids, meaning that your body needs them for

survival. But the body cant produce them on its own. We get omega 3 fatty acids from food sources or supplements. The three main forms of omega 3s are eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha linolenic acid (ALA). According to Dr. Harvey, EPA and DHA (found in fatty fishes and fish oil supplements) are the most important forms of omega 3s for heart health, as they reduce inflammation, reduce LDL cholesterol and lower triglycerides.

2. Coenzyme Q10 (CoQ10) is a substance similar to a vitamin. Its found in every cell of the body and is 3. Psyllium, a water soluble fiber, is often overlooked, but is a very important fiber for heart health, says Dr. 4. Resveretrol is derived from grape skins, and according to Dr. Harvey, is a powerful antioxidant. Research
suggests that it may help protect the lining of the hearts blood vessels, and may also reduce inflammation and the risk of blood clotting.
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highly concentrated in the heart, says Dr. Harvey. Although the body produces CoQ10 itself, levels decline with age and with some prescription medications, so some doctors believe that supplementation is important. Harvey. Studies show that a diet high in water soluble fiber like psyllium is associated with lower triglyceride levels and a lower risk of cardiovascular disease.

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And thats the good news. By taking care of your heart with a healthy lifestyle and regular medical care, youll greatly minimize your risk for heart disease and enjoy many more Februarys to come. MS&F

Advancing Technology

erri Powers, who lives in Connecticut, is a personal trainer and a professional singer/ songwriter. But since age 6, she has struggled with arrhythmia, or irregular heart rhythm, that caused bouts of a pounding heart and extreme anxiety. By her mid 30s, the episodes had escalated, severely impacting her life. I felt like a walking time bomb, says Kerri. I could do something as simple as bend over and pick something up, or cough, and go into an arrhythmia. In 2010, Kerri had an episode of arrhythmia that didnt go away. She was taken to the hospital, where she was given a powerful medication called adenosine, which has unpleasant side effects such as lightheadedness, flushing, sweating, nausea and numbness of the limbs. After this uncomfortable experience, Kerri decided to undergo cardiac ablation a procedure that corrects heart rhythm problems with a long catheter threaded through a vein in the groin to the heart, where a radio frequency pulse destroys the tissue in the heart that is responsible for triggering the arrhythmia. But rather than opting for a typical ablation procedure, where the doctor manipulates the stiff catheter manually using live X-ray images to guide the tube to the heart, Kerri agreed to a minimally-invasive robotic ablation system called the Steriotaxis magnetic navigation system. This cutting edge technology allows the doctor to sit in a separate control room, using a joystick and computer-controlled magnets to guide the movement of a soft catheter precisely, millimeters at a time, into place, where the ablation can be done. Kerris procedure was performed with perfect precision and with a lower risk of complications and less radiation exposure to her and the physician than a traditional ablation procedure. She was up and literally running in a week and a half, and has been arrhythmia free ever since. Technology such as robotic-assisted surgery is changing the landscape of cardiac care, says Aseem Desai, MD, FACC, a cardiac electrophysiologist who treats patients at Mission Hospital in Mission Viejo, California. Remote magnetic navigation system uses a 3D CT scan, so you can see inside of the body and get to places you wouldnt ordinarily get to with a normal procedure. You have much better control, he says. Its kind of like that movie Fantastic Voyage. In addition to robotic and other minimally invasive cardiac procedures, an exciting new technology is the left ventricle assist device, or LVAD. Implanted just beneath the heart, this device is used to help those who are in the end stages of heart failure by acting as an artificial pump, taking blood from the lower chamber of the heart and pumping it into the aorta, where it can be carried to the rest of the body. It operates with a battery pack worn on the outside of the body. The LVAD was initially designed to take over for faltering hearts until a patient was able to undergo a heart transplant. But today, its being used long-term in older heart failure patients who are ineligible for heart transplants due to complicated medical conditions. It used to be a transition therapy, but now its a destination therapy, says Dr. Desai. It gives people a better quality of life. Yet to come in heart technology? Many researchers believe that stem cell therapy will some day be able to heal damaged hearts. Stem cells are unspecialized cells, often taken from the patients own bone marrow. These cells have several unique properties, one being that they can transform themselves into whatever type of cell is needed such as bone, skin or heart. Once infused into the body, they travel to the area of damage and repair the tissue. As the cells are working to restore the damage, they have the ability to divide and produce more stem cells, allowing the body to eventually heal itself and function normally again. Heart stem cell clinical trials are ongoing at Cleveland Clinic in Ohio as well as other facilities, but while results are promising, this therapy is not ready for prime time. MS&F
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Whats The Dentist Got To Do With It?

Believe it or not, your dental health has something to do with your cardiac health, says Nicholas Toscano, DDS, MS, New York City based periodontist. Without a doubt, theres a connection between what goes on in the mouth and what goes on in the rest of the body, he adds. One of the most well researched areas in dental health is the link between periodontal disease and heart disease. A recent study, conducted by researchers from Cornell University in New York and the University of Gothenburg in Sweden, found that the bacteria present in plaque removed from the coronary arteries of 15 heart disease patients was the same bacteria present in the mouth, especially that found in those with infection from periodontal disease. Your mouth is a dirty place, says Dr. Toscano. The bacteria in your mouth will enter the bloodstream and set up an inflammatory process in the body. Dr. Toscanos recommendation? Regular dental checkups and cleaning, every six months for most people and even more frequently for those at high risk for CAD.

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