Heart

Heart

Really, all this romanticizing has to stop. Hearts aren''''t achy or breaky, they don''''t cheat or catch on fire with desire. No, the Tin Man couldn''''t have been dancing, singing and witch-busting without one, despite what he told the wizard.

They''''re not instruments, so forget about plucking the old heartstrings. They''''re thief-proof, so stealing someone''''s is out. And for goodness sake, know that wearing your heart on your sleeve could be really messy at dinner parties.

Although the heart was mythologized in song, literature, and language long before Edgar Allan Poe wrote about the telltale one that kept beating from beyond, this fist-size organ is really all business.

Weighing just ten ounces, the heart is a veritable life-support machine--pumping some 2,000 gallons of blood through 60,000 miles of blood vessels every day. Your heart beats 100,000 times a day, forcing the blood through a complex system beginning with the heart''''s four chambers.

First, blood is collected from the body''''s veins and sent to the two chambers on the right side of the heart. The blood first enters the right atrium, which churns it into the right ventricle. The right ventricle then pumps blood into the lungs, where carbon dioxide is removed and replaced with oxygen. The oxygen-filled blood is pumped to the left side of the heart, where it''''s delivered through two more chambers: the left atrium and the left ventricle.

After it leaves the left ventricle the blood enters the body''''s largest artery, the aorta. Then the arteries divide into successively smaller vessels, finally bringing blood to the tissues. Here''''s where the real work begins, with the circulatory system providing oxygen and nutrients to the tissues while also collecting carbon dioxide and waste products.

That''''s a lot of work, but if you take good care of your heart--which means eating right, exercising regularly and not smoking--it should be good for 2.5 billion contractions over the course of a long and healthy lifetime.

Heart Disease: Not for Men Only

True or false: Heart attacks are something that usually happens to hefty middle-aged men who chain-smoke and eat lots of salads--taco salads, that is.

While it''''s true that men between ages 25 and 35 have three times as much heart disease as women, and that men between ages 36 and 49 have 1.7 times the incidence, cardiovascular disease is an insidious killer of women. Although we don''''t get it as often early on, after the age of 75 we do. Remember: Most women don''''t show symptoms until at least ten years later than men.

Still, most of us are in the dark when it comes to understanding our potential for heart disease later in life, says Joseph Alpert, M.D., head of the Department of Medicine at the University of Arizona Health Science Center in Tucson. "Women are somewhat protected as long as they''''re still menstruating," he says. "Some people say that it''''s not a disease women get. Ask ten women the most common killer of women, and they''''ll say breast cancer, but that''''s a complete myth. You''''re five to ten times more likely to die of heart disease."

Impediments to Heart Health

Just what is this much talked­about disease that kills 400,000 women in the United States annually?

The major culprit is atherosclerosis, which causes the heart or the vessels to get clogged. The arteries can get clogged with fat deposits, or plaques, which build over time on the inner portion of the arteries, impeding the flow of blood.

The arteries can grow stiff with age or disease, making them less effective. All this puts a woman at an increased risk of heart attack. A heart attack might not cause death, but it is the death of a portion of the heart--taking place when one or more coronary arteries to the heart becomes clogged or damaged and closes off. If this happens to part of the left ventricle--the heart''''s major pump--blood flow is stopped to the rest of the body.

Heart attacks are just as serious as they sound. Each year, 300,000 Americans who have suffered one die before they can even get to a hospital, with 10 percent of all patients who are hospitalized dying within three days.

That''''s the bad news. But the good news is great: Heart disease truly is something you can head off at the pass, says Howard Hodis, M.D., assistant professor of medicine and preventive medicine and director of the atherosclerosis research unit at the University of Southern California School of Medicine in Los Angeles.

"It''''s a very preventable disease. Simple exercise and dietary adjustment can cut your risk by 50 percent," notes Dr. Hodis. "This is just by lifestyle modification. While cholesterol plays a very important part, it''''s enhanced and sometimes overshadowed by lifestyle."

A Balance of Good and Bad

Call it a tale of two cholesterols. Both are from the lipid family, but one is an evil ne''''er-do-well called low-density lipoprotein (LDL). Then there''''s high-density lipoprotein (HDL), the good guy and hero of our story.

Both types of cholesterol are found in the blood, but too much bad, or LDL, cholesterol, and you could be a prime candidate for heart disease. Anything over 160 milligrams per deciliter (mg/dl) is considered too much. Ideally, your LDLs should be below 130 mg/dl. Your protective HDL cholesterol, on the other hand, should be above 35 mg/dl and preferably above 60 mg/dl to truly be considered your knight in shining armor.

Although the U.S. Public Health Service recommends a reading below 200 mg/dl as the desired cholesterol level, that''''s misleading. The most important thing is your risk ratio when your good cholesterol is compared with your overall cholesterol.

So what can you do if your LDL looks more like the national debt than a healthy 100 or so? Plenty! From eating veggies to taking vitamins, here are just a few of the tips experts give to keep your numbers out of the danger zone.

Get up and go. Exercise is probably the best way of conditioning your heart, because it may also raise your HDL level, notes Sidney Alexander, M.D., cardiologist and former director of the cardiovascular division at Lahey Hitchcock Medical Center in Burlington, Massachusetts.

Although doctors recommend working out at least three times a week for 30 minutes in order to increase fitness, Dr. Alexander says that any kind of movement is a boon to your body. "Go out for a walk. That''''ll improve your fitness. For the person who''''s daunted by jogging or swimming or riding a bike, it''''s great," he notes. "Taking a brisk walk an hour a day uses up lots of calories, and you don''''t hurt yourself."

Little bits of daily exercise also count. "I never take an elevator, and I climb several flights of stairs a day. You could park in the parking space farthest from your building and make yourself walk," he adds.

Any time you exercise for more than a few minutes, you''''re burning a combination of carbohydrates and fat. And 95 percent of your stored energy is fat.

Go mono-a-mono. If you''''re going to use oil, olive or canola oil is the way to go, says Dr. Alexander. They''''re monounsaturated fats, which are easier on the heart than animal fats and tropical oils such as palm and coconut oil, which raise cholesterol levels. "But remember not to use a lot of it just because it''''s not as bad for you. It has lots of calories, so be careful."

A fat rule of thumb: Saturated fats differ from unsaturated ones in that they''''re white, oily substances that are solid at room temperature and are found in meats, butter and cheese. Unsaturated fats are clear, oily substances that are liquid at room temperature.

Let''''s Es-chew the fat. A low-fat diet is the way to go, notes Dr. Alexander. That means getting just 20 to 30 percent or less of your daily calories from fat. "I think if everyone exercised vigorously and was a vegetarian, they would live a lot longer."

Half of all Americans have high cholesterol because of the way they eat--dietary cholesterol is found only in animal food sources such as meat and dairy products, but not in plant food such as fruits, vegetables and beans.

Have your finned and feathered friends for dinner. Fish offers special heart benefits. A number of studies suggest that the omega-3 fatty acids it contains may help your heart, says Dr. Alpert. White-meat turkey and chicken (without the skin) should be second on your list, because they''''re low in total fat and, more important, artery-clogging saturated fat. Choose only the leanest cuts of pork and beef and trim them well before cooking.

Get your fill of fiber. Fiber helps reduce serum cholesterol levels, so you can effectively lower cholesterol by as much as 10 to 20 percent in certain people, says Dr. Hodis. It also helps in that you feel fuller when you munch lots of fiber--therefore leaving less room for things like Snickers bars and ice cream. You can get the fiber you need from food if you eat whole grains, oatmeal, fruits and vegetables. The Daily Value for dietary fiber is 25 grams.

Employ that soy. Replacing cheeseburgers with tofu burgers could be a heart saver, says Bryan Johnstone, Ph.D., assistant professor at the University of Kentucky College of Medicine in Lexington. The key is soy protein, which contains estrogens that may lower LDL cholesterol. Another theory is that soy''''s amino acid pattern has an impact on the oxidation rate of cholesterol, he notes.

In a 1995 study at the University of Kentucky in Lexington that combined the results of 38 clinical trials, researchers found that a diet with soy protein intake of 47 grams per day lowered total cholesterol by 9.3 percent over a minimum of a month''''s time. "We''''re talking about soy substitution, not soy addition," says Dr. Johnstone, one of the researchers. "So if an average diet recommends 70 grams of protein, then we suggest at least 25 grams of soy being incorporated into the diet in lieu of that." This means that somewhere between one-third and one-half of your average daily protein intake would come from soy.

It''''s a snap adding soy to your diet. Soy concentrate is a tasteless powder you can sprinkle on your foods; one ounce added to pasta gives you 24 grams of soy protein. One eight-ounce glass of soy milk contains 4 to 10 grams, adds Dr. Johnstone. "One of the potential implications is that this is why the Chinese have lower levels of cholesterol and heart disease than we do."

E does it. Taking 100 to 400 international units (IUs) of vitamin E a day might be one way to ditch that bad cholesterol, says Dr. Hodis.

In a study of 156 men with heart disease at the University of Southern California in Los Angeles, Dr. Hodis and researchers found that taking daily doses of vitamin E for two years was associated with a reduction in the development of fatty deposits, or plaque, in heart arteries.

Why is E so heart-smart? Antioxidants prevent the oxidation of LDL cholesterol. When there is less oxidation, the LDL cholesterol loses some of its artery-clogging power. The amount taken--100 to 400 IUs--was higher than the Daily Value of 30 IUs, but the higher dosages are safe, Dr. Hodis says.

Replace hormones with hormones. After you''''ve reached menopause, going on estrogen replacement therapy is an effective way of lowering your bad cholesterol while boosting your good, notes Valery Miller, M.D., research professor of medicine at the George Washington University Medical Center in Washington D.C. "Estrogen might have an antioxidant effect--if the LDL is oxidized, it''''s more likely to go into the walls of the arteries, where it causes hardening."

According to Dr. Miller, the estrogen causes smooth muscle in the artery walls to relax, and it may prevent spasms. The National Cholesterol Education Program has issued adult treatment guidelines that say that after diet and exercise, estrogen therapy should be considered next in postmenopausal women, and recommend it before drug therapy for high cholesterol.

In a study of 875 healthy postmenopausal women ages 45 to 64, the women were given either estrogen therapy or a placebo and followed for three years. The estrogen-treated women developed significantly lower LDL cholesterol and much higher HDL cholesterol. Also, estrogen takers had a stable level of fibrinogen, a blood protein that''''s been linked to heart disease, while the nontakers showed an increase.

Although some women are nervous about hormone replacement therapy because of a possible link with increased breast cancer risk, Dr. Miller says the pros definitely outweigh the cons. "They haven''''t conclusively proven the breast cancer relationship, and we know about the benefits, because the data is so consistent and strong."

Take it off. Taking off weight is great, but keeping it off might be the key to lowering your cholesterol, says Rena Wing, Ph.D., professor of psychiatry, epidemiology and psychology at the University of Pittsburgh School of Medicine.

In a University of Pittsburgh study of how dropping pounds affects cardiovascular risk, and the differences between men and women, Dr. Wing found that men are the initial winners in the weight-loss game. Looking at 159 moderately overweight subjects over 18 months, the researchers found that men who lost weight experienced greater decreases in blood pressure, triglycerides and waist-to-hip ratio and had greater increases in HDL cholesterol than women. But modest weight losses (10 to 15 percent of initial body weight) maintained over time resulted in sustained improvements in heart disease risk factors for women as well.

"Women experience an initial decrease in HDL cholesterol with weight loss, then gradually an increase, while men have increases in HDL all along," Dr. Wing notes. "So it is particularly important for women to adhere to weight-loss programs and maintain their weight loss to see the improvement in risk factors."

Even if you haven''''t reached your ideal weight, keeping off the pounds you''''ve managed to lose--25 was the average in the Pittsburgh study--can increase HDL cholesterol and improve other cardiovascular risk factors.

Other Ways to Be Heart-Smart

Even if your cholesterol levels are a dream, you could still be sabotaging your heart health with the little things you do. You know the no-no''''s: smoking, stressing out and not controlling high blood pressure. These all take their toll on your ticker, notes Dr. Hodis. "Folks can have a relatively low LDL and still have heart disease. That may be a result of a poor lifestyle."

Sure, there are factors you have little control over. Diabetes, a disorder of the pancreas that affects the body''''s insulin production, puts women at a higher risk for heart disease than it does men. But watching your weight and also watching out for high blood pressure can ease that risk considerably. You can also control the disease with diet, exercise and medication.

These preventive measures are especially important to African-American women, a very vulnerable group. Up until about age 75, they have higher rates of death caused by heart disease than do women of any other racial groups.

Another factor is simply who your parents are, notes Dr. Alexander. "People who have long-lived parents and grandparents often have the healthiest hearts. Particularly, if they do nothing to jeopardize those good genes by risky behavior."

Studies of families in which heart disease is common before age 55 indicate that if one of your relatives got it early, you''''re at risk of an early heart attack, too. So it''''s even more essential to take advantage of the measures that are known to help reduce your risks.

A Plan of No Attack

Whatever your risks, there are many lifestyle changes that you can make to prevent heart disease. Here are a few doctors'''' tips.

Don''''t be a teetotaler. A glass of red wine a day can''''t hurt you, and it might raise your HDL level, notes Dr. Alpert. "If you like taking a glass in the evening, do it. It has an antiplatelet effect."

Low-dose alcohol is associated with a 30 to 50 percent reduction in heart attacks--a result that compares favorably with the protection of aspirin, stopping smoking, maintaining ideal body weight and reducing cholesterol. In a Harvard study of 85,709 women ages 34 to 59, researchers found that women who drank one to three drinks a week had a lower total mortality from heart disease. The group benefiting most were the women who reported one or more coronary risk factors. Being moderate is the key, researchers say: When drinking exceeds this level, health risks start to rise sharply.

Don''''t smoke. Stop smoking, and you''''ll thank yourself from the bottom of your . . . well, you know, notes Dr. Alexander. Heart problems caused by smoking are twofold: Over the long term smoking predisposes you to hardening of the arteries and puts you at an increased risk of sudden death.

The good news is, if you stop, no matter how much you''''ve smoked in your life, your risk is reduced over time until it''''s nearly as low as the risk for someone who''''s never smoked. (For tips on how to stop smoking, see "Lungs" on page 206.)

Big leaguers, reach out. Although women generally deal better with stress than men do, women in higher-level jobs, such as CEOs of companies, have higher blood pressure than other working women. One solution is for them to find support groups and try to network more, notes Kathleen Light, Ph.D., professor of psychology in the Department of Psychiatry at the University of North Carolina at Chapel Hill.

Studies have shown that women in high-level jobs are more likely to have stress problems than white males in equivalent jobs. In a University of North Carolina study of 72 men and 71 women working full-time outside the home, it was found that 71 percent of women in high-status jobs had high-effort coping, which leads to short-term rises in blood pressure. By comparison, just 36 percent of white men with status jobs had that kind of stress.

"I assume the workplace is more stressful for women and African-American men in part because they''''re more isolated, and they don''''t have the same amount of support from colleagues," Dr. Light says. "If a woman could find a peer group of other women in high-status jobs, the others could be supportive and serve as much-needed confidantes."

Let some things go. For women who have a lot of stress, the advice is, learn to let go and cut yourself some slack, says Dr. Light. "If you want to remain at a high-intensity level at work, you should allow yourself to have a dirty house, and to not be the perfect homemaker as well."

Run down blood pressure. Moderate exercise is a great way to put high blood pressure on the run, notes Dr. Light.

Do You Measure Up? You have a total cholesterol level of 220 milligrams per deciliter (mg/dl). That''''s higher than you''''d like. But your good cholesterol (high-density lipoprotein, or HDL) is a very healthy 110 mg/dl. With those two numbers you can figure out where you stand. This is the formula: Take your total cholesterol and divide it by your HDL. The result is what your risk ratio is. Using this table, dividing 220 by 110, you can figure that your ratio is 2--a very low risk, indeed. Ratio Risk 6.0 High 5.0 Higher than average 4.5 Average 4.0 Lower than average 3.0 Low Walk to Your Heart''''s Content Heart disease is a problem that comes with aging--right? Well, not quite. Problems can start at any age. But no matter whether you have heart disease or not, a walking program is one of the best things you can do for yourself, says Howard Hodis, M.D., assistant professor of medicine and preventive medicine and director of the atherosclerosis research unit at the University of Southern California School of Medicine in Los Angeles. When you walk regularly, the conditioning effect enhances the pumping ability of your heart, which means that you can do more work before your heart gets overtaxed. In addition, a regular walking program may lower your blood pressure, improve your cholesterol profile by raising HDL levels and short-circuit depression. If you have heart disease, you can''''t afford to presume that regular walking is enough, but if you combine your walking regimen with a low-fat, low-sodium diet, don''''t smoke and learn to deal effectively with stress, you can expect to see results and feel measurably better. In addition, of course, there are certain precautions you should take. A doctor should help you determine what level of exercise you can perform safely and how fast your heart can beat before you begin to have chest pain, says Dr. Hodis. The doctor can also determine when you might have silent ischemia, dangerous changes in blood flow that might precipitate a heart attack. By tracking your heart with an electrocardiogram, or EKG, during an exercise stress test on a treadmill, your doctor can find out how hard you can work before you get into trouble. She can then tell you how hard you can exercise without exceeding your danger level. The challenge then is to have a good time walking--but stay within the safety zone. Generally, if you have heart disease or not, your minimum exercise prescription for conditioning is 30 to 40 minutes of comfortable walking, three times a week. Of course, you should work up to this level slowly, with your physician''''s approval. Win or Draw? Butter versus Margarine Which slippery character is worse for blood cholesterol levels--the saturated fat found in butter, cheese, whole milk, ice cream and meat or the trans-fatty acids (trans fats) used in margarines, commercially baked goods and french fries? The American Heart Association says that the worst offender by far is the saturated fat (and cholesterol) in butter. But two scientists at the Harvard School of Public Health made news by tagging trans fat (created when food processors add hydrogen to vegetable oil) as the nastier of the two. The main point is there''''s evidence that too much of either fat helps choke arteries with plaque. Currently, food producers aren''''t required to reveal the amount of trans fats that they add to products, so there''''s no way to know exactly how much is hidden in food you buy. Check out the ingredients list. If any partially hydrogenated vegetable oil is listed in the first few ingredients--especially in a food high in total fat--chances are there''''s more than a trickle of trans. Nature''''s Best Cholesterol Crunchers Believe it or not, there''''s a natural prescription to lower your cholesterol that you don''''t have to go to a pharmacy to fill. If you know where to look, this powerful remedy is available right on the shelves of your supermarket. Just load your cart with fabulous foods that are high in soluble fiber, and you''''ll be stocking up on the safest, healthiest and tastiest cholesterol-crunching substance there is! Scores of studies by James Anderson, M.D., professor of medicine and clinical nutrition at the University of Kentucky in Lexington, and others now have settled earlier questions about whether soluble fiber really does lower cholesterol. Today, most heart experts, including those at the government''''s National Cholesterol Education Program, agree: It works! Though not everyone responds the same, Dr. Anderson''''s research shows that for some people, combining soluble fiber with a low-fat diet can mean cholesterol reductions of 50 points or more. Adding soluble fiber to an already low-fat diet could knock cholesterol down to a safe count and make cholesterol-lowering drugs unnecessary. (See the tips for getting more fiber in your diet in "Nutrition" on page 266. Artichokes, dried apricots and cereals high in oat bran are all fabulous sources of soluble fiber, as are sweet potatoes, brussels sprouts and celery root. Many legumes as well as oat cereals have two grams or more of soluble fiber per serving. Among fruits, oranges and apples are the top sources, but other fruits--such as mangoes, figs, plums, and kiwifruit--are soluble superstars, too. High-fiber wheat-bran cereals are best known as major sources of insoluble fiber, but even they have a very respectable one gram of fiber per serving. Depressurize with Potassium Potassium works as a blood vessel dilator, and when the vessels dilate, your pressure goes down. But this doesn''''t mean that huge amounts of potassium are needed to lower blood pressure. The Daily Value for potassium is 3,500 milligrams, "but it''''s safe to consume substantially more than that," says Harvey Simon, M.D., associate professor of medicine at Harvard Medical School, founding member of the Harvard Cardiovascular Health Center and author of Conquering Heart Disease. The trick is getting enough potassium in your daily menu without going on the chimpanzee diet. Actually, bananas are not the highest source of potassium, which can be found in a wide assortment of fruits and vegetables. One caution: If you''''re taking a potassium-sparing diuretic, which causes the kidneys to hoard the mineral, you should not increase your potassium intake without discussing with your doctor any changes you''''d like to make. Eating to Control Your Blood Pressure If you have high blood pressure (defined as a reading of 140/90 and above), you want powerful medicine to control it. And--as study after study has shown--diet is powerful medicine. A healthy diet can''''t always replace pills and other medical means when blood pressure is elevated, but it often does. Frequently, it can either boost the effect of medication or allow for a lower dose. More good news: Those who are most helped by good eating are the ones who most need help. The higher your blood pressure, the more it is likely to fall if you use your head when you fill your belly. Diet therapy to reduce high blood pressure calls for the following: * An eating plan geared to weight control. For those people who are overweight a low-fat diet (made up of less than 25 percent of calories) high in unrefined complex carbohydrates is ideal. * Limiting sodium intake to the Daily Value of 2,400 milligrams a day (the amount in a level teaspoon of table salt). Discuss with your physician whether it would be wise to limit your sodium intake even more. * Including in your diet a variety of fruits and vegetables that together provide at least 3,500 milligrams of potassium a day. * Getting your Daily Value for magnesium and calcium--400 milligrams of magnesium and 1,000 milligrams of calcium per day for women. The Hostile Heart You''''re in the express line of the supermarket, and the inconsiderate person ahead of you has 15 items--in clear view of a sign that announces "10 items or less." If you get so mad that your half-gallon of Häagen-Dazs turns to mush in your sweaty palms, you just might be hostile--a trait that Redford Williams, M.D., professor of psychiatry at Duke University in Durham, North Carolina, and co-author of Anger Kills, says can put you at increased risk of heart attack. "All the hostility studies we''''ve done show that heart patients who have no social support (a common trait of hostile people) have a threefold higher five-year mortality rate," Dr. Williams notes. "Even healthy people with hostile personalities are four to seven times more likely to die from heart attacks and other serious illnesses." Just what is hostility? It''''s a potent combination of cynicism, anger and aggression that can mess up your mind and your health. So what can you do about it? One way of controlling hostility is to shout "Stop!"--either out loud or to yourself--when you feel anger coming on, depending on the situation. To get started, you could ask someone else to help you, with the friend crying "Stop!" when you start getting mad. Then you could think about a favorite