Online extras O'Brien Family Statistics Target numbers for a healthy heart Also this week: What you didn't know about your heart New health facts Are you in transition? (Life-changing tips and quiz) Ask Dr. Tedd Mitchell a health question Housecall #2: Arthritis. Asthma. Migraines.

Keeping Family Health at Heart

Meet the O'Briens. This hard-working couple and their three smart kids already are intimately familiar with cardiovascular disease. That's why they're the first of five families our medical expert, Tedd Mitchell, M.D., will check in on this year. It's free advice you'll want to take to heart.

Heart disease doesn't just run in the O'Brien family. It gallops.

Bill, who runs his own oil and gas company in Shreveport, La., had a heart attack scare this summer at age 49. That's not too surprising: His dad had chronic heart disease and died at 56 of a pulmonary embolism.

Maria, a manager who has early cholesterol buildup in her arteries, saw her dad have a quadruple cardiac bypass in his mid-50s.

Two of the three O'Brien children already have cholesterol at or above the "normal" limit of 200. In fact, Ellie, a 20-year-old honor student and ballet dancer, has had readings up to 300 since she was in the sixth grade.

I selected the O'Briens to be the first family in my five-part "house call" series in

USA WEEKEND Magazine because I believe awareness of cardiovascular disease, its prevention, treatment and genetic legacy, is the single most important health issue facing all families today.

I met with the O'Briens, but I could have discussed heart disease with millions of other families -- no doubt including yours. I hope you'll follow along today and pick up several vital heart strategies for yourself and your loved ones.

Later this year, I'll make more house calls on other families and deal with important family health topics including allergies, asthma, arthritis, cancer, diabetes and hormones.

But today, let's make a big dent in the No. 1 killer of Americans -- cardiovascular disease. We'll talk about symptoms, treatment and prevention.

Bill's heart scare

Like many other men in their 40s, Bill has had to hang up his running sneakers for a good pair of walking shoes. During one of his walks this summer, he felt a strange sensation in his chest that he described as "pressure." If he could just belch, he thought, it would help. He chalked it up to indigestion. That weekend, while carrying furniture to a daughter's college dorm, he had the same "indigestion." A few days later, it came back. Soon after, on a trip to New York City, he had an intense spell while walking up six flights of stairs, with sweating and a burning in his chest. "I felt like my chest was going to explode." Bill did what any typical American man would do: He took some antacids. But the episodes came more frequently, triggered by less and less physical exertion. Still feeling unwell, he struggled through airports to get home, where he saw a cardiologist. An EKG went nuts, and the next thing Bill knew, he was getting nitroglycerin and a surgical procedure called a cardiac catheterization.

During the cath, blockages were found in two blood vessels around Bill's heart. So the cardiologist performed an angioplasty with placement of stents, which are small tubular devices (imagine tiny drinking straws) designed to get blood flowing past the blockages.

The next day, Bill was home and -- to wife Maria's chagrin -- already doing light exercise. Two days later, he was back at work. Bill began a cardiac rehabilitation program and continues to do aerobic exercise and weight training three days a week. Considered the "poster boy" at his cardiac rehab center, Bill's new dedication to his regimen of diet, exercise and medication has helped him drop his "bad" LDL cholesterol level 91 points, down to just 60.

So what are the lessons to be learned from Bill's situation? Several things stand out:

Listen to your body. Being able to identify heart disease symptoms can be a lifesaver. A major clue that Bill's "indigestion" was cardiac in nature is that it was consistently associated with exertion. Many people, especially women, don't feel the classic symptom of "an elephant standing on my chest."

Remember: Anything that requires increased heart work (such as exertion) also increases the heart's need for oxygen. If there are blockages in the vessels that feed oxygen to the heart, then it will lack oxygen, which triggers symptoms. The medical term for this is angina pectoris. Other symptoms precipitated by exertion, such as "indigestion," shortness of breath, neck pain, jaw pain and even arm pain, can be caused by heart disease. These often are called angina equivalents.

Bottom line: In grown-ups, any unusual feeling brought on by physical activity needs to be evaluated by a doctor.

Understand the medical options. Fortunately, we live in an era of great knowledge about the causes of coronary disease, and we have proven strategies to deal with those causes. Plus, life-saving medications and surgical techniques have been developed.

Bill's coronary artery stents are a relatively new addition to the cardiologist's toolbox. This procedure (performed through an artery in the leg or arm) can keep many patients from needing extensive coronary bypass surgery. Even bypass is much less risky and traumatic than it was in the early days. Because physicians today know so much more about the illness than the doctors of yesteryear did, they can give their patients detailed, individualized treatment.

Basically, treating coronary disease is a two-step approach. First, you fix the "plumbing." That means something must be done to improve the blood flow in blocked areas. In mild cases, medication to dilate (open) the blood vessels may be all that's necessary. In more severe cases, some surgical procedure usually is required. The type of procedure depends on a number of factors, including the extent of disease in the arteries, the location of a specific blockage, the strength of the heart muscle and the presence of other medical conditions. Decide which intervention is most appropriate by consulting with a cardiologist who knows your case well.

After the blockage is fixed, it's on to step two: Address what caused the problem. Some of the more common contributors to heart disease are stress, diet, tobacco, high blood pressure, high cholesterol and diabetes. Studies show that aggressively lowering these risk factors significantly improves the chances of preventing and recovering from heart disease.

In fact, experts have recently redefined -- to tougher levels -- target goals for high blood pressure, high cholesterol and diabetes, because improved numbers mean improved prevention and recovery. (See box, page 8.) To achieve these new targets, medication often is required, so it's a must to partner with a health care professional you trust.

Live the lifestyle. Follow-up with your physician is crucial, but adopting a healthful lifestyle is just as crucial for managing heart disease. A diet low in saturated fats and sugar, coupled with exercise, absolutely is the way to go. This lifestyle sounds easy, but most folks find maintaining it to be a great difficulty.

Help is available.

Registered dietitians can analyze your present diet to help you make simple, effective adjustments. For a referral, call your local hospital or contact the American Dietetic Association at 1-800-366-1655 or www.eatright.org/find.html.

Personal trainers can design suitable activity programs to fit your needs. Call gyms to find a trainer with a college degree in a health-related field such as exercise physiology, kinesiology, health promotion, or health and wellness.

Where such services are not handy or practical, guidelines from organizations such as the American Heart Association, the American College of Sports Medicine and others can help guide you in your plan.

In fact, I recommend you work with your doctor and get screened before starting an exercise program. This gives a professional a chance to approve you for exercise, evaluate your fitness level and design a much more detailed program.

Maria's high cholesterol

Like many other women, Maria is "in management" at the office and at home. She recognizes she has a type-A personality and confesses, "The way I handle stress gave me a huge risk." And she worries about her family's history of heart disease.

In fact, because her father had bypass surgery in his mid-50s, Maria underwent a study called an electron beam tomogram, or EBT scan. This is a new method for looking at the coronary vessels to diagnose heart disease, in many cases long before it is clinically apparent.

Early buildup of cholesterol plaques was found in her coronary arteries, which is unusual for a woman in her 40s. (See the latest news on plaque)

So Maria has taken an aggressive approach to cardiovascular prevention. In addition to improving her habits, she visited her doctor and is now taking medication to lower her cholesterol. She follows a basically vegetarian diet (although she continues to have a strong affinity for sweets), walks regularly and understands the importance of follow-up visits with her doctor.

What lessons can we learn from Maria's situation? Some important features include:

"No symptoms" doesn't mean "no disease." For many, the first clue people have that there is a problem is when they have a heart attack. Bill was lucky because he had some warning symptoms; Maria's disease was silent. That is not unusual, so do not wait for symptoms.

Women do get heart disease. Unfortunately, many patients (and physicians) mistakenly believe heart disease is a "male" problem. Although women are at a lower risk during their reproductive years, they are not immune. Additionally, once a woman goes through menopause, her risk for heart disease increases significantly; it even catches up to that of a man over the next decade or two. Today, Maria is in a good position: She knows she has a predisposition to heart disease, so she can make effective changes that should serve her well over the long run.

Early diagnosis is important. Although the EBT technology that discovered Maria's heart disease is not available in many areas, and controversy exists about its best application, it's clear this scanner is effective at finding early coronary disease.

Early detection gives patients and physicians a head start in aggressively intervening in risk factors. The technology also allows non-invasive follow-up to assess the effectiveness of therapy.

Stress hurts health. Maria exercises and tries to meditate, but stresses are an ingrained part of her life. People often ignore or deny the effect stress has on them. Maria's understanding of that gives her the insight necessary to work toward making changes.

You can't change your personality type, but you can understand it. If you are a self-motivated, driven person, try to make your day-to-day routine as stress-free as possible. Don't place yourself in situations that bring out the worst in your behavior; instead, limit the things you involve yourself with to those that are the most important to you.

By establishing that priority system, you can limit the interactions and scenarios that are bad for your stress level. It's an important part of your long-term prevention program.

A classic stress- management resource is the book "Beyond the Relaxation Response", by Herbert Benson, M.D. For fun, try a book called "The Man Who Mistook His Job for a Life", by Jonathon Lazear.

Have the kids seen their future?

In most ways, the O'Brien kids are representative of America's youth. Their day planners are filled with social, school and sports activities.

And like many other teenagers and young adults, they have a family history of heart disease.

It already has begun to manifest itself. Nicole, 22, has a cholesterol level that runs around 200; that's at the extreme edge of "normal." Ellie, 20, has had cholesterol levels of 250 to 300 since she was 12; sometime this year she'll probably start taking prescription drugs for her cholesterol balance. William, 17, just had his first cholesterol check; it was a normal 189.

All are aware of their legacy. They have the chance to make changes that should reduce their long-term risks for problems.

What do the O'Brien kids need to do to reduce their risks over the long term? Are there lessons we can learn from their situation? Here are a few important points:

Genes count. Their father's family has heart disease, which raises Bill's risk. Their mother's family has heart disease, which raises Maria's risk. The fact that Bill and Maria both have heart disease multiplies the risk for their children.

Remember, if you have a history of someone in your family being diagnosed with heart disease at an early age (before 65), particularly if that family member is a mother, father or sibling, your risks may be increased.

Modify the risks. Paying attention to cardiovascular risks isn't at the top of every kid's to-do list, but when a family history of heart disease is present, it should be a concern.

The American Heart Association has come up with a nice acronym to remember the risks for cardiovascular disease, and I like to modify it slightly.

Keep in mind the word WATCHeS, which stands for:

• Weight.
• Activity.
• Tobacco.
• Cholesterol.
• High blood pressure.
• Sugar (diabetes).

Kids with family histories need to learn that these are the modifiable risks. They need to know the target goals for cholesterol, blood pressure and blood sugar (see box on page 8), then create strategies to achieve them. When they implement a program to reach the goals, they stand a good chance of reducing their long-term risk of heart disease.

In young people, prevention programs should emphasize lifestyle. The O'Brien kids are athletic and try to watch what they eat, but high school and college offer endless opportunities for dietary disaster. Their metabolisms are revved up for growth, so eating lapses don't pad their waistlines and may not seem to affect their health. But cholesterol and blood fats can be compromised. The solution for the O'Brien kids -- and all of us -- is to build a lifelong preference for exercise and nutrition.

For starters, the kids need to reduce intake of foods that raise cholesterol. Because saturated fats are the primary problem when it comes to elevating cholesterol levels, foods high in these should be limited. Fatty meats, fatty dairy products, whole eggs, heavy desserts and organ foods (such as liver) need to be limited. Of course, you typically don't have trouble getting kids to limit their intake of liver.

Next, the O'Briens can emphasize foods that tend to lower cholesterol levels. Particularly helpful: foods that contain oats. The U.S. Food and Drug Administration has even allowed certain oat foods to have the statement: "Three grams of soluble fiber from oatmeal daily, in a diet low in saturated fat and cholesterol, may reduce the risk of heart disease."

Finally, from a dietary standpoint, children with a history of high cholesterol may want to emphasize "nutraceuticals." These are low-fat foods fortified with plant sterols and stanols; studies show they can reduce LDL cholesterol levels. Talk to your doctor about this possibility.

The combination of regular exercise and appropriate nutrition leads to a healthy body weight, which also helps with long-term heart risk.

Ellie is tackling her modifiable risks. "I have a really good eating pattern. I exercise daily and I concentrate on being heart-healthy. I feel confident about the precautions I've been taking."

Take-home message

During my "house call," I was glad to see that the O'Brien family has decided to take charge of cardiovascular risks. Doing so should increase the quantity of their lives; it certainly will improve the quality of their lives. As an added benefit, by adopting a heart-healthy lifestyle, they'll also be reducing long-term risks for most other causes of death.

There's a lot to learn from this family's health history and habits. Many of you are faced with similar issues, and I hope you can muster the time and energy to make simple but important changes.

Fighting heart disease is "team work," Ellie says. "My mom always has goodies around for the holidays, mostly for other people. My dad will reach for one M&M and we're like, 'No, Dad!' It's made us realize how important health is on an individual level and also within the whole family."

The O'Briens are working hard to be healthy for the long haul. So should you and your family.

Contributing Editor Tedd Mitchell, M.D., is medical director of the Wellness Program at the celebrated Cooper Clinic in Dallas. Patty Rhule contributed to this report.

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