Medical Compass: An ode to heart health this Valentine’s Day
Building heart-healthy habits improves the likelihood we’ll be around for those we love
By David Dunaief, M.D.
This February, we celebrate both Valentine’s Day, an opportunity to celebrate those we love, as well as American Heart Month, a chance for us to build awareness of heart-healthy habits.
The good news is that heart disease is on the decline due to a number of factors, including better awareness in lay and medical communities, improved medicines, earlier treatment of risk factors and lifestyle modifications. We are headed in the right direction, but we can do better. Heart disease is something that is eminently preventable.
Reducing our risks
Risk factors for heart disease include obesity, high cholesterol, high blood pressure, smoking and diabetes. Unfortunately, both obesity and diabetes are on the rise. For patients with type 2 diabetes, 70 percent die of cardiovascular causes (1). However, high blood pressure, high cholesterol and smoking have declined (2).
Inactivity and the standard American diet, rich in saturated fat and calories, also contribute to heart disease risk (3). The underlying culprit is atherosclerosis, fatty streaks in the arteries.
Another potential risk factor is a resting heart rate greater than 80 beats per minute (bpm). In one study, healthy men and women had 18 and 10 percent increased risks of dying from a heart attack, respectively, for every increase of 10 bpm over 80 (4). A normal resting heart rate is usually between 60 and 100 bpm. Thus, you don’t have to have a racing heart rate, just one that is high-normal. All of these risk factors can be overcome.
When medication helps reduce risk
Cholesterol and blood pressure medications have been credited to some extent with reducing the risk of heart disease. The compliance with blood pressure medications has increased over the last 10 years from 33 to 50 percent, according to the American Society of Hypertension.
In terms of lipids, statins have played a key role in primary prevention. Statins are effective at not only lowering lipid levels, including total cholesterol and LDL — the “bad” cholesterol — but also inflammation levels that contribute to the risk of cardiovascular disease. The Jupiter trial showed a 55 percent combined reduction in heart disease, stroke and mortality from cardiovascular disease in healthy patients — those with a slightly elevated level of inflammation and normal cholesterol profile — with statins.
The downside of statins is their side effects. Statins have been shown to increase the risk of diabetes in intensive dosing, compared to moderate dosing (5).
Unfortunately, many on statins also suffer from myopathy (muscle pain). I have had a number of patients who have complained of muscle pain and cramps. Their goal when they come to see me is to reduce and ultimately discontinue their statins by following a lifestyle modification plan involving diet and exercise. Lifestyle modification is a powerful ally.
Making lifestyle changes
The Baltimore Longitudinal Study of Aging, a prospective (forward-looking) study, investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five servings or more of fruits and vegetables daily with <12 percent saturated fat had a 76 percent reduction in their risk of dying from heart disease compared to those who did not (6). The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet. These results are impressive and, to achieve them, they only required a modest change in diet.
The Nurses’ Health Study shows that these results are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Many times, this is the first manifestation of heart disease in women. The authors looked at four parameters of lifestyle modification, including a Mediterranean-type diet, exercise, smoking and body mass index. There was a decrease in SCD that was dose-dependent, meaning the more factors incorporated, the greater the risk reduction. There was as much as a 92 percent decrease in SCD risk when all four parameters were followed (7). Thus, it is possible to almost eliminate the risk of SCD for women with lifestyle modifications.
Monitoring your risk of heart disease
To determine your progress, we use cardiac biomarkers, including inflammatory markers like C-reactive protein, blood pressure, cholesterol and body mass index.
In a cohort study of high-risk participants and those with heart disease, patients implemented extensive lifestyle modification: a plant-based, whole foods diet accompanied by exercise and stress management. The results showed an improvement in biomarkers, as well as in cognitive function and overall quality of life. The best part is the results occurred over a very short period to time — three months from the start of the trial (8). Many patients I have seen have had similar results.
Ideally, if patient needs to use medications to treat risk factors for heart disease, it should be for the short term. For some patients, it may be appropriate to use medication and lifestyle changes together; for others, lifestyle modifications may be sufficient, as long as patients take an active role.
By focusing on developing heart-healthy habits, we can improve the likelihood that we – and those we love – will be around for a long time.
(1) Diabetes Care. 2010 Feb; 33(2):442-449. (2) JAMA. 2005;293(15):1868. (3) Lancet. 2004;364(9438):93. (4) J Epidemiol Community Health. 2010 Feb;64(2):175-181. (5) JAMA. 2011;305(24):2556-2564. (6) J Nutr. March 1, 2005;135(3):556-561. (7) JAMA. 2011 Jul 6;306(1):62-69. (8) Am J Cardiol. 2011;108(4):498-507.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.