Heart Disease

What is Heart Disease?

Heart disease is the buildup of fatty deposits, sometimes called plaque, in the arteries supplying blood to the heart. This can lead to a narrowing of these arteries and noticeable pain in the chest upon physical exertion. However, until the arteries are significantly narrowed, there may be no symptoms at all. The deposits in the arteries can contain cholesterol in an unstable form that can suddenly rupture into the bloodstream. This can cause a blood clot large enough to totally shut off (occlude) the artery, choking off the blood supply to the heart muscle. This is called a heart attack. Without oxygen carried by the red blood cells, the oxygen-starved part of the heart muscle dies, making it dysfunctional. Even if the victim survives, the damaged heart is less capable of pumping blood. Heart failure, whereby the heart is incapable of meeting the body’s demands, may eventually result. Rapid medical treatment of a heart attack may suffice to open the affected arteries fast enough to avoid permanent damage to the heart muscle.

The Risk Factors for Heart Disease

There are several risk factors for heart disease, some of which we can control and others beyond our control. Being a man is a major risk factor. Men have a greater risk of heart attack than women, and men suffer the disease at a younger age. Even after menopause, when the heart attack risk of women greatly rises, men continue to be at greater risk for dying of a heart attack. Age is another factor we cannot control. More than 80% of heart attacks occur after age 65. A third factor beyond our control is our heredity. Heart disease tends to run in families and is more prevalent among some racial groups (e.g. blacks, Mexican Americans, American Indians, and Hawaiians). Some of the racial disparity may be related to the prevalence of obesity in these groups which can lead to Type II diabetes, a strong risk factor for circulatory disease. Also, the psychological stress of living as a less-privileged minority has been cited as a possible contributing factor to the higher heart disease rate.

Do not be discouraged if you have one or more of the risk factors beyond your control. There are several risk factors you can control, and these can greatly counteract the effects of the non-controllable risk factors. The following is a list of scientifically-determined risk factors for heart disease that can be affected by behavioral changes. Of these, physical inactivity, blood cholesterol levels, smoking, and high blood pressure are the most important:

  • Physical Inactivity: The least active 20% of the population has twice the risk of heart disease as the most active 20%. The greatest decrease in heart disease risk is when moving from the least active to next least active group. Physical activity is probably the most important single factor that we can control in preventing heart disease because, in addition to its independent effects, it is often effective in improving other risk factors such as blood cholesterol levels, blood pressure, and body weight.

  • Blood Cholesterol: People with cholesterol levels much above average are at higher risk for heart attack. The most dangerous form of blood cholesterol is in the form of low-density lipoproteins (LDLs), which contribute to deposits in the arterial walls. In contrast, cholesterol in the form of high-density lipoproteins (HDLs) help protect against buildup of arterial plaque. Cholesterol-related risk factors for heart disease include:
    • High level of total cholesterol: 200-239 mg/dL is borderline high, while greater than 240 mg/dL is high, with a risk for heart disease double that of a man whose level is below 200 mg/dL
    • High level of LDL cholesterol: Below 130 mg/dL is good, 130-159 mg/dL is borderline high risk, 160-189 mg/dL is high, and above 189 mg/dL is very high risk.
    • Low level of HDL cholesterol: A level of 40 mg/dL or below is considered a major risk factor for heart disease. A level of 60 or higher is considered heart protective.
    • High ratio of total cholesterol to HDL cholesterol

  • Smoking: Heart disease is 2-4 times more prevalent among smokers than non-smokers, and smokers have twice the risk of a fatal heart attack. Cigarettes are the worst offenders, but pipe and cigar smoking still significantly increases the risk of heart disease. People who don’t smoke themselves but are exposed to second-hand smoke are also at increased risk.

  • High Blood Pressure: Blood pressure is listed as systolic/diastolic mmHg. Desirable levels are systolic below 120 mmHg and diastolic below 80 mmHg. Levels of 120-139 mmHg systolic and 80-89 mmHg diastolic are considered precursors to high blood pressure, while levels of 140+ systolic and 90+ diastolic represent high blood pressure.

  • Blood triglycerides: Below 150 mg/dL is normal, 150-199 mg/dL is borderline high, 200-499 mg/dL is high, and above 500 mg/dL is very high risk.

  • Excessive Alcohol Consumption: While up to 2 drinks per day for males may reduce the risk of heart disease, a contention currently in controversy, drinking in excess can increase the risk of heart disease.

  • Diabetes: Heart disease is much more common among diabetics than non-diabetics. Over three-fourths of diabetics die of heart disease or other disease related to circulatory impairment.

  • Excess body fat: Particularly when deposited around the waist, excess body fat raised the risk of heart disease. Too much body fat also increases the risk for heart disease as follows:
    • Raises total cholesterol
    • Raises LDL cholesterol
    • Lowers HDL cholesterol
    • Raises triglycerides
    • Increases Type II diabetes risk

  • Stress: Increasing evidence suggests a relationship of stress to cardiovascular disease. Factors such as job strain, social isolation, financial difficulties and family conflict all contribute to stress levels.

  • How to Lower Your Heart Disease Risk

    The following steps can be taken to reduce your risk of heart disease. Of course, it would be ideal if you could take all steps appropriate for you. But not everyone is prepared to do all that is necessary to reduce their risk because of a multitude of reasons such as difficulty in breaking habits, lack of time, distaste for certain foods or activities, etc. However, it is important to take whichever steps you feel you can. Any step is better than none of them, and each will independently provide benefit. So, just do as much as you feel you can handle, and add more as you feel up to it.

    • Increase Your Physical Activity:

      Before beginning an exercise program, it is important to determine if you need a physician‘s clearance. Our Exercise Risk Questionnaire will help you determine whether you are ready to start exercising or whether you need a physician’s clearance to begin.

      The American Heart Association recommends at least 30 minutes of physical activity 5 or more days per week. The preferred exercises are those that are continuous like walking, running, rowing, swimming, and bicycling. However, you will still get benefit from discontinuous forms of exercise like gardening, housecleaning, home-repair, golfing, bowling, tennis, weight-lifting, and softball. The most important thing is to become more active.

      You have the greatest likelihood of increasing your physical activity level over the long term if you find a form of exercise you enjoy or, at the very least, one that you don’t find unpleasant. Most people can find the time to do some physical activity they enjoy. One way of avoiding boredom is to do 2 or more different types of exercise each week rather than the same exercise every day. See our physical fitness program guidelines.

    • Reduce Your Total Cholesterol and LDL Cholesterol Blood Levels:

      Cutting down on the following foods will reduce your total and LDL cholesterol levels:

      • Trans fats: Avoid any product whose ingredient list includes partially hydrogenated oil, shortening, or margarine. Notable offenders include cookies, crackers, and cakes, cereal bars, and frozen dinners.

      • Saturated Fats: These are mainly found in meats, full-fat dairy products, and tropical oils. Therefore, you should limit meat intake to 8 oz per day, choose leaner cuts of meat such as chicken breast and top round steak, and trim visible fat before cooking. Use skim or 1% milk and low-fat or fat-free yogurt and other dairy products. Use cheese sparingly as even reduced fat cheese such as part-skim mozzarella and ricotta still contain a fair proportion of fat.

      • Cholesterol: All flesh food, including fish, meat, and poultry contain relatively large amounts of cholesterol. So do other animal products such as milk and eggs. Thus these foods should be eaten in moderation, with vegetables, fruit, and grains (whole-grain if possible) making up a large proportion of the diet.

      Some foods can help reduce your total cholesterol and LDL-cholesterol levels. According to the Mayo Clinic, these include:

      • Foods containing soluble fiber such as oatmeal, oat bran, apples, and pears
      • Walnuts - All nuts are high in calories, so be careful not to increase daily caloric intake.
      • Fish rich in omega-3 fatty acids such as salmon, sardines, mackerel, tuna, lake trout, and herring
      • Olive oil - The Food and Drug Administration recommends 2 tablespoons a day. Of course, this is most palatable if used to sauté vegetables or as salad dressing.
      • Food fortified with plant sterols or stanols, including some orange juices, yogurt drinks and margarines (avoid those containing hydrogenated fats).

      An Alternative to Statin Drugs?
      Many Americans currently take statin drugs like Lipitor and Zocor in order to lower their cholesterol levels, and there has been little evidence of undesirable side effects associated with their use. Yet a small minority of people suffer from muscle pains and weakness when taking them. Since these drugs act on the liver, a doctor does a liver-function blood test before prescribing statins.

      A recent study showed that a natural food supplement called Red Yeast Rice or Red Rice Yeast (1800 mg/day) reduced LDL cholesterol levels an average of 27% among men who could not tolerate statins. However, even though Red Yeast Rice is available in health food stores, it is advisable to get a liver function test before taking it because it may contain natural statins. Also, a recent study of a number of brands of red yeast rice showed greatly varying quantities of the active ingredient. And some of the supplements were contaminated with a fungus toxic to the kidneys. Unfortunately, the brands were not identified in the article, making it difficult for anyone to know which ones are safe and effective.

    • Raise Your HDL Cholesterol Blood Level:

      The following steps can be taken to raise your HDL level:

      • Do aerobic exercise regularly: The evidence suggests that the amount of aerobic exercise (e.g. running, cycling, swimming, walking) you do is more important than the exercise intensity in raising your HDL level. So it‘s advisable to do aerobic exercise at least 3-4 times a week for at least 20 minutes but 30-40 minutes if you can. Make sure to check our Exercise Risk Questionnaire to determine whether you need a physician’s clearance before exercising.
      • Drop weight if you carry excess fat: This should raise your HDL level especially if your waist circumference at navel level is greater than your hip circumference at its widest point.
      • If you smoke, quit!
      • Eliminate trans fats from your diet:Avoid foods whose ingredient lists contain partially hydrogenated vegetable oil, shortening, or margarine.
      • Alcohol: One to two drinks per day seems to have a positive effect on HDL level. However, it is not recommended that men who do not drink or drink occasionally raise their alcohol intake because of the associated risk of motor vehicle accidents and violence. Also, alcohol tends to have a negative effect on a man‘s testosterone level, which is undesirable for most men.
      • Use olive oil: The monounsaturated fat in olive oil helps raise the HDL level. Canola oil is less expensive than olive oil and contains a high percentage of monounsaturated fat. However, it is also high in polyunsaturated fat, which appears to have a negative effect on a man’s testosterone level.
      • Eat more soluble fiber:In addition to lowering the LDL level, soluble fiber can raise your HDL level. Good sources include oatmeal, oat bran, apples, and pears. Soluble fiber is also recommended for colon health.
      • Talk to your doctor about niacin treatment: Niacin, a common B-vitamin, can raise HDL levels. However, in the doses required, niacin is considered a drug. Therefore, it is necessary to see a doctor and getting a liver function test before embarking on such treatment.
      • Do not follow a low-fat diet: Low-fat diets are not recommended because they both depress HDL level and deprive the body of essential fatty acids that cannot be manufactured by the body. Fats are also needed for testosterone production. Don’t be afraid to get 25-35% or your calories from fat, with the preferred forms being monounsaturated (e.g. from olive oil), and omega-3 (e.g. from fatty fish). However, because fats are high is calories, you must be careful not to overeat. The good new is that fats tend to reduce hunger.
    • If you smoke, quit!:

      The U.S. Surgeon General has reported that a man who quits smoking for 15 years has the same risk of heart disease as that of a lifetime non-smoker. Yet the persistence of the habit in the face of its widely known health risks makes it obvious how difficult it is to quit smoking. Even U.S. President Barak Obama, who promoted and signed into law strong anti-smoking legislation, admitted “falling off the wagon” in his effort to quit smoking. Despite such difficulty, smoking cessation yields great rewards to a man’s health and that of his family and friends.

      Follow these Steps to Successfully quit smoking:

      1. make the decision to quit
      2. set a date that you will quit
      3. select a quitting plan
      4. find a way to cope with the difficulty of withdrawal
      5. fight against reverting to the habit
    • When deciding on your quitting plan, consider the following methods, which have been shown in studies to be the most effective:

      • Get help from a no-cost phone-based program: All U.S. states run no-cost phone-based smoking cessation programs, which double the chances of successfully quitting. The American Cancer Society (1-800-ACS-2345) runs a Quitline® program that connects you to smoking cessation counselors who plan an individually-tailored program using printed materials, medicine, classes, support groups, or family and friends.

      • Enlist the support of family and friends in your effort to quit: Friends and family can provide support and encouragement. Spend more time with friends and family members who do not smoke.

      • Join a support group: You can check with your health insurance company or local hospital for support groups in your area. Or call the American Cancer Society to help you find a group.

      • Join a smoking-cessation program: The most effective programs meet for at least 20-30 minutes 4-7 times over a period of at least 2 weeks and involve individual or group counseling. Nicotine Anonymous sponsors free 12-step programs. Call the American Cancer Society for information about programs run by it local branches, the American Lung Association, or your local health department. Avoid programs that charge high fees, involve pills or shots, promise an easy cure, or fail to provide references from satisfied customers.

      • Talk to your doctor about nicotine replacement therapy: For some smokers who try quitting, nicotine replacement therapy, in the form of a patch, chewing gum, nasal spray, inhaler, or lozenge, can help ease pain of nicotine withdrawal - a major reason for failure to quit. The nicotine dosage is usually tapered to zero over a period of 8 weeks to 5 months. Use nicotine replacement therapy only under a doctor‘s supervision. If you have existing heart disease, your doctor may decide that the risks of nicotine therapy are not worth the benefits.

      • Ask your doctor about anti-smoking prescription drugs: While mens-fitness-and-health.com prefers natural solutions, the benefits that smoking-cessation provides to a man‘s health may warrant the use of prescription medication if all natural means fail. A number of different drugs have been used for this purpose. For example Varenicline (Chantix™) has been shown to more than double the chance of successfully quitting.

      • Beware of methods with little or no evidence of success: The following smoking cessation methods have little or no evidence of effectiveness.. If you really want to try one of these methods, go ahead. But if it doesn‘t work, don’t give up. Try one or more of the methods listed above.
        • hypnosis
        • acupuncture
        • cold laser
        • anti-smoking diets
        • herbal supplements
        • atropine/scopolamine therapy
        • nicotine delivery methods other than those listed above