Issue Date: June 11, 2006
A heart disease checkup
Our HealthSmart columnist compares notes with an American Heart Association expert and top cardiologist on how we can prevent heart disease and protect our cardiovascular health.
Our experts
Tedd Mitchell, M.D., USA WEEKEND HealthSmart columnist, is president and medical director of the Cooper Clinic in Dallas.
Ann Bolger, M.D., practicing cardiologist, researcher and teacher, is aprofessor of clinical medicine at the University of California at San Francisco School of Medicine, and chair of the American Heart Association's Council on Clinical Cardiology.
Tedd Mitchell: When should people start to worry about heart disease?
Ann Bolger: I think from childhood.
TM: What's the guideline on when to see a doctor for a checkup?
AB: Starting at age 20 you need to know the basic risk factors -- your blood pressure, your cholesterol -- and somebody ought to talk with you about your family history and what that can tell you about your risk. How often you test for things going forward can depend on your initial risk assessment, but you ought to check your cholesterol at least every five years and your blood pressure at least every two years.
TM: Would you say the biggest issue we face, when it comes to cardiovascular disease, is behavior?
AB: Absolutely. I think the overarching issues are personal responsibility and empowerment. I worry that, as wonderful as science is, we become very complacent and feel that science will fix whatever problem we get ourselves into, and, as you and I know, that isn't the case. If people can understand that the decisions they make today -- to eat fast food regularly, to opt not to exercise, to be lackadaisical about their blood pressure, or to smoke, which is the No. 1 avoidable risk factor for coronary artery disease -- have tremendous ramifications. And they may not get a second chance to make the right decisions.
TM: At my clinic, we focus on making people understand there are things the physician can work with them on, but there are things they need to be working on themselves. It's a hard sell, because we're creatures of habit, and it's difficult for a 30-year-old person who still feels good to break bad habits.
AB: Well, I think people like that need to visit a nursing home. The percentage of people living into very advanced age is going up dramatically, but do you want to face those extra years of life being impaired by heart failure or by the consequences of stroke? It makes me so angry when people have a defeatist attitude and say, "I don't care. I'd rather just die of a heart attack." What I always have to tell them is, "If you are lucky, you'll die."
TM: You may have overwhelming disabilities.
AB: That's right. We are very good at saving people's lives, but we can't keep them from having damage and living with heart failure, living with impaired cardiovascular function or living after a stroke, which can be extremely challenging.
TM: A lot of people think, "If I have the big heart attack and just kick over, that's the end of it."
AB: That's the Hollywood version. It's not what really happens. We need people to understand that every day they have moments of very high risk. When you eat a high-fat meal, for example, the lining of your blood vessels may become inflamed, and the platelets get sticky immediately afterward. In contrast, instead of snacking, if you go for a hike, your average blood pressure and heart rate are going to come down, and your average cardiovascular fitness will have gone up a notch. Even day-to-day things have immediate value -- and immediate risk.
None of us can change a single thing we did yesterday. But the things you do today make you better today, and they will make you better even 10 years from now.
TM: When I was a kid, fast-food restaurants were for a Friday treat. Every other night, Mom and Dad were cooking meals. Now people have meals from restaurants or fast-food places four or five times a week, if not more.
AB: We've become used to a very high-salt and high-fat diet, and even when you give people good choices, they've learned this dietary preference that's very hard to combat.
TM: What can we do about our behaviors?
AB: If we could just get everyone to control their blood pressure and not smoke cigarettes -- just those two things -- the incidence of heart disease and stroke would plummet.
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YOUR CARDIOVASCULAR HEALTH ROAD MAP
Dr. Bolger and Dr. Mitchell recommend:
1. Begin today. Eat a healthier diet and increase your daily physical activity. Whether you take baby steps (such as skipping fries for one meal) or make giant strides (such as exercising for 30 minutes or more each day), each heart-smart choice you make will not only improve your health today but also will improve your chances of staying heart-healthy in the future.
2. Get checked. Even people who appear healthy and have no apparent cardiovascular symptoms may suffer a heart attack or stroke. If you do have a hidden risk, early detection may buy time to correct it.
3. Pass it on. Parents, protect your children's future heart health by being positive role models. Following a healthy lifestyle now is easier than trying to break bad habits later. And if you should need medicine for high blood pressure or cholesterol, you'll need less if you're active, keep your weight down and watch what you eat.
To learn more about heart health, visit the American Heart Association's website at americanheart.org or call 888-242-2222.
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