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The Second Opinion

Q: How do genetics and heredity affect my likelihood for developing heart disease?

Dr. Jim Mumper: Genetics play a big role in the health of your heart. If you have a family history of heart disease, you may be at greater risk for heart attack, stroke and other heart ailments. Simply put, the closer the relative, the greater your heart disease risk. If you have a "first-degree" relative — a mother, father, sister or brother — who had heart disease at an early age, that increases your risk of developing heart disease early, too.

There are also other available tools to determine how your particular genetic make-up can influence the health of your heart. For example, we can now look at how an individual's body is programmed to process certain kinds of fats – especially those that are the least heart-friendly. From this, more effective diet regimens and recommendations can be made. Although you can't eliminate the influence of genetic factors, by adopting a healthy lifestyle, you can substantially reduce your risk. A great first step is to make sure you know your family medical history. Then, schedule an appointment with your physician to discuss how you can best reduce your chances of developing this devastating disease.

Q: We all know that stress can affect your heart. What are some tips to keep my stress level under control?

Dr. Virginia Kladder: First, become aware of your stressors and your emotional and physical reactions. Next, recognize what you can change. Are you able to avoid or eliminate your stressors? If not, can you reduce their intensity? Third, reduce the intensity of your emotional reactions to stress by working toward seeing the stress as something with which you can cope rather than something that overpowers you. It's important to learn how to moderate your physical reactions to stress. Slow, deep breathing will bring your heart rate and respiration back to normal. Relaxation techniques can reduce muscle tension. Electronic biofeedback can help you gain voluntary control over such things as muscle tension, heart rate and blood pressure. Medications, when prescribed by a physician, can help in the short term in moderating your physical reactions.

However, they alone are not the answer. It is crucial to build your physical reserves. Exercising for cardiovascular fitness three to four times a week (moderate, prolonged rhythmic exercise is best, such as walking, swimming, cycling or jogging), eating well-balanced nutritious meals, maintaining your ideal weight, avoiding nicotine, excessive caffeine and other stimulants and getting enough sleep are all important. Finally, maintain your emotional reserves. Do this by developing some mutually supportive friendships/relationships. You can also pursue realistic goals which are meaningful to you, rather than goals others have for you that you do not share.

Q: How would you suggest that I screen for heart health?

Dr. Stuart Solan: There are many factors that can affect a person's heart health. Two of the most important factors that we can control are high blood pressure and high cholesterol. By monitoring these two critical components in heart health, we can help reduce our risk for heart disease. Blood pressure: This is a simple test that can have lasting effects on your risk for heart attack and stroke. You should have your blood pressure checked routinely with a goal of maintaining a reading below 140/90. Even better, you should strive for a reading of below 120/80, depending on your individual health condition.

If your blood pressure is routinely above the guidelines, then modifications to your diet and lifestyle may be all that are needed to affect positive change. In other cases, it may be necessary to begin pharmacologic therapies or more diagnostic studies to determine the cause of the hypertension.

Cholesterol: Everyone over the age of 20 should get their cholesterol levels measured at least once every five years. High cholesterol itself does not cause any symptoms – so many people are unaware that their levels may be too high. To assess your cholesterol level, your doctor will usually perform a simple blood test called a lipoprotein, or lipid, profile. It evaluates the following: LDL (low density lipoprotein cholesterol, also called "bad" cholesterol), HDL (high density lipoprotein cholesterol, also called "good" cholesterol), Triglycerides (also called very low density lipoprotein) and your total cholesterol level. If your cholesterol is found to be high, your doctor will recommend various treatment options ranging from dietary/lifestyle changes to medication.

Other screening options: While blood pressure and cholesterol are two of the easiest and most important ways to screen for heart health, advances in medicine and technology have led to several other options. Computed tomography scans (heart scans or CT scans) are an effective way to screen for the very earliest signs of atherosclerosis, or the build-up of calcified plaque on the inside of our heart's arteries. Another option is vascular ultrasound. Vascular ultrasound of the carotid arteries can help show if there is any narrowing due to plaque. This narrowing could be an early indicator of stroke risk. It is important to note these are not the only options available.

By meeting with your physician and discussing your individual health profile, you can collaboratively decide what options are best for you.

Q: What are some exercises to keep my heart healthy?

Dr. Leon Spiers: Before any exercise program is started, it is extremely important to consult your physician. Your physician can review your overall health, conditioning and medical history to determine what level of exercise would be appropriate for your individual situation. For heart health, it is important to get the blood flowing. Aerobic exercises have the best benefits for the heart. These are exercises that involve large muscle groups, strengthen the heart and lungs, and improve the body's ability to process oxygen. Examples of these types of exercises are walking, jogging, bicycle riding, elliptical training, swimming and group aerobics. If you are just beginning, go slow and gradually increase the duration and intensity of each workout after it becomes too easy for you to complete.

The end goal, and to achieve the most cardiovascular benefit from the workout, is to complete an aerobic exercise session lasting at least 20 minutes in duration three to four times each week. It's easy to get discouraged about exercise. It's often hard to fit into a busy lifestyle. But rest assured that doing something, or anything, is better than doing nothing at all.

Q: What are some heart healthy eating tips?

Dr. Wu-Pong: This question is a great reminder that heart disease is the result of many different risk factors which can be affected by our dietary choices.  Generally, those with no specific risk factors for heart disease (diabetes, hypertension, hypercholesterolemia, family history of cardiovascular disease, or obesity) may only need to follow a diet that allows them to maintain an ideal body weight or percentage body fat.  This often means portion control rather than focusing on the foods making up a given meal. 

Those who are obese or have diabetes will need diets with an appropriate total calorie count, low in simple carbohydrates (to minimize overwhelming the available insulin), low in fat and cholesterol, and high in lean proteins and complex (high-fiber) carbohydrates. Those with hypertension, will generally find that maintaining a very low sodium intake will assist in managing blood pressure control. Those with high cholesterol may find that keeping their proteins very lean by substituting fish (tuna, salmon and others) or beans (particularly soy) in place of other meats, increasing fiber (whole grain products, oatmeal, fresh produce, etc.) and possibly supplementing with Omega 3 fish oils can help improve their chances of avoiding cardiovascular disease. 

Q: How does heart disease affect women differently than men?

Dr. Patricia Burkwall: Heart disease is no longer considered a disease that only affects men. In the past, women usually received less aggressive treatment for heart disease and were not referred for diagnostic tests as often. As a result, when many women were finally diagnosed with heart disease, it was usually more advanced disease and their prognosis was poorer. We now know that cardiovascular disease affects more women than men and is responsible for more than 40 percent of all deaths in American women.

Heart attack symptoms in women may be different from those experienced by men. While they may still have the typical warning signs of unexplained nausea, sweating, radiating pain in the chest, left arm and jaw, a crushing sensation of the chest (or like an elephant is on their chest) and shortness of breath, women may only experience pain or a burning sensation in the upper abdomen or back, lightheadedness, an upset stomach and sweating. Because they may not feel the typical pain in the left half of their chest and radiating down the arm, many women may ignore symptoms that indicate they are having a problem.

Women need to be aware of the risk factors for cardiovascular disease and the importance of making lifestyle changes that may reduce those risks. Factors such as race, increasing age, diabetes, and a family history of heart disease cannot be changed. Other risk factors, however, can be changed or eliminated by making informed decisions about cardiovascular health. These risk factors include hypertension, high cholesterol, obesity, stress, sedentary lifestyle and tobacco usage. The best course of action is for you to learn as much as possible about heart disease and then make a commitment to incorporate important lifestyle changes to reduce your risk. A good place to start is the Web site of the American Heart Association at www.americanheart.org.

LAST TIME OUT: Getting a physical .