BYPASS Heart Disease

HEALTHY LIFESTYLE CHOICES CAN STOP GENETIC RISK IN ITS TRACKS

Some might say it's a miracle that 53-year-old Barry Sears, Ph.D., author of the best-selling Zone diet books, is still alive. Both his father, a world-class athlete, and his grandfather died of heart disease at age 53. On top of that, Sears had three brothers who succumbed to heart disease in their mid-50s.

Instead of feeling like a marked man, however, Sears elected to take control of his health. Five years ago, he made a series of powerful lifestyle changes specifically designed to beat heart disease. So far, he's winning the battle. While many medical experts stop short of saying definitively that heart disease can be prevented by adopting healthy habits, plenty of others believe it is indeed possible to beat your genes. And virtually all cardiac health practitioners acknowledge that such factors as a nutritious diet, regular exercise, stress management and emotional balance can dramatically reduce your risk--"even for someone with a family history like mine," says Sears.

This strict regimen of prevention begins with the Zone diet Sears devised. His meals consist of one-third protein and two-thirds fruits and vegetables to control insulin, one of the primary hormones that regulates blood sugar. Too much insulin can increase blood pressure and create high levels of cholesterol and the blood fats called triglycerides.

Six days a week, Sears puts in an hour of exercise, alternating between stretching and weight lifting with at least some running every day. And to reduce stress, he begins each day with a 20-minute meditation session. "I was a college athlete, and I can do as many or more things now than I could 20 years ago," he says. "I'm more active and more mentally alert." Even more important, he's alive.

Arresting Cardiac Facts

Sears' example is a valuable lesson in surviving--and thriving--for the millions of Americans at risk for cardiovascular disease (CVD), a disorder of the heart and blood vessels. It's the No. 1 killer in the United States, claiming the lives of more than 2,600 people each day--an average of one every 33 seconds. In fact, CVD kills more people annually than the next seven leading causes of death combined. The latest figures from the American Heart Association (AHA) report that 953,110 Americans died of CVD in 1997, while 539,577 died of cancer. No less than 41 percent of Americans will die from some form of heart disease, the AHA reports.

The most common types of CVD are, in order of prevalence, high blood pressure, coronary heart disease (CHD) and stroke (an interruption of blood flow to the brain). CHD, caused by a narrowing of the blood vessels that feed the heart, is the most dangerous. CHD can become deadly if vessels become so clogged with fatty deposits of cholesterol (atherosclerosis, or hardening of the arteries) that blood flow is impaired. This reduced blood flow causes the chest pain known as angina. If blood flow to the heart is severely reduced or halted altogether, it can cause a heart attack.

Coronary heart disease typically strikes men in their mid-40s and post-menopausal women in their mid-50s (estrogen has a protective effect until levels drop during menopause). Because medical research before World War II focused primarily on men, many doctors weren't aware of the risk CHD poses to women, says cardiologist Elizabeth Ross, M.D., an AHA spokeswoman. It wasn't until the 1980s, she notes, that scientists confirmed heart disease kills more American women than any other disease.

It's also fairly common for women to suffer heart attacks without any early warning signs. Studies show that almost two-thirds of women and half of the men who die suddenly from heart attacks reported no previous symptoms. Symptoms include chest pain, shortness of breath, a feeling of heaviness and tightness or pain and burning behind the breastbone or in the arms, neck or jaw.

These sobering statistics, however, are intended for inspiration rather than intimidation. Half the battle is educating yourself about heart disease and your particular risks. Then you can arm yourself with this knowledge to declare war on the hereditary or lifestyle factors that threaten to shorten your life. Like Barry Sears, you may find a strategy that not only addresses heart disease, but improves your overall health.

The Family Factor

Just because a relative succumbed to CVD doesn't necessarily mean you've inherited a heart problem. Contrary to popular belief, the relationship between heredity and heart health isn't that simple. "In order for you to have a genetic risk, your relatives must have early forms of CVD," stresses Ross. That means a father or brother suffered a heart attack before age 45, or a mother or sister before 55, she explains. The more relatives who developed heart disease early in life, the greater your risk.

If family members have died relatively early from CVD, yet you don't have standard markers like high blood pressure, be sure to ask your doctor whether you may be vulnerable to lesser-known risk factors like emotional stress. "If you have a family history, you really have to dig deeper," says cardiologist Stephen T. Sinatra, M.D., author of several books on cardiac health, including Heart Sense for Women (Life-Line Press, 2000).

There's plenty of conclusive evidence that lifestyle factors can give genes a run for their money. Consider a July 2000 study in the New England Journal of Medicine about women who reformed their risky habits. These women started eating a heart-healthy diet, controlling their weight, exercising regularly and stopped smoking. The result: an 83 percent lower risk of heart attack. "A healthy lifestyle will neutralize a genetic risk even to the point of reversing it," Sinatra insists.

When experts talk about inherited risks for CVD, they aren't referring solely to your DNA. You also learn attitudes and behaviors from parents as surely as you inherit physical characteristics. These traits are just as influential as inherited problems like high blood pressure or cholesterol levels. A large part of beating genetic risks is learning how to change potentially harmful family habits. You'll have to modify your ways if, for example, you picked up the family penchant for routinely exploding in rage or living on processed foods. And abiding by the lifestyle that's best for your own heart health may help you avoid becoming dependent on drugs to control risk factors.

Heartbreakers

Most of us have ar least one risk factor for heart disease. For example, you could have high cholesterol and not know it. It's also common for problems like high blood pressure to set in with age. Keep in mind that negative emotions like depression and loneliness are as detrimental as any physical disorder. And eating a diet heavy in saturated fats or counting channel-flipping as exercise may be taking a toll on your heart. Whatever the case, preventing heart disease is a compelling motivation to get annual checkups so you can nip potential problems in the bud.

To reduce the risks for heart disease, you need to be on a first-name basis with the enemy (named below). You'll encounter these heart hazards--some well established and others just now being recognized--in your everyday life. And for every risk, there's at least one potential solution.

Smoking. Nicotine in commercial tobacco products narrows and damages artery linings, doubling to quadrupling smokers' risk of sudden cardiac death. Even exposure to secondhand smoke increases risk of death from CVD by as much as 30 percent--depending on how much and how often you're exposed.

High blood pressure (hypertension) doubles the chances of developing CVD. Hypertension damages the heart because the cardiac muscle must work harder to move blood through the body. One in four adults has hypertension, but almost one-third of Americans with this condition aren't aware they have it. So be sure to have your blood pressure checked regularly. Traditionally, blood pressure is considered high if it's consistently 140/90 or higher; yet many doctors now draw the line at 130/85.

High levels of blood cholesterol, which are greatly affected by diet, also make you twice as vulnerable to heart disease. Like blood pressure, cholesterol levels tend to increase with age. Ideally, total cholesterol readings should be less than 200 milligrams (mg.) per deciliter (mg/dl), with anything above 200 considered high. Nearly 100 million American adults have cholesterol levels above 200. But there's more to cholesterol than just one number. Measuring levels of low-density lipoprotein (LDL cholesterol--the "bad" type that accumulates inside arteries) and high-density lipoprotein cholesterol (HDL, the "good" type that removes excess LDL from blood) is also vital. LDL levels should be 130 or below; HDL levels of 60 or higher are considered protective, but you may be in trouble if your level is 37 or lower in men and 47 or lower in women. These recommendations hold true regardless of your total cholesterol count.

Triglycerides are another blood lipid (or fat) that increase risk for heart disease--possibly by as much as three times, according to a recent study. Like cholesterol, triglycerides can come from dietary sources but also are manufactured within the body. Triglyceride levels over 200 are considered hazardous, Ross says.

Diabetes (high blood sugar) makes you twice as vulnerable to CVD. High blood sugar levels characteristic of the chronic disease cause progressively more damage to blood vessels. In fact, two-thirds of diabetics die of CVD. While 10.2 million Americans have been diagnosed with diabetes, an estimated 5.4 million are unaware they have the disease.

Physical inactivity is a more serious risk factor than many of us want to believe. A whopping 48 million Americans are considered sedentary, meaning they don't get enough exercise to maintain health. Sedentary lifestyles contribute directly to heart-related problems and increase the chances of developing other risk factors, like obesity and high blood pressure.

Obesity goes hand-in-hand with physical inactivity. "Apple-shaped" people (whose waist measurement is nearly as large as or bigger than their hips) are more at risk than "pear-shaped" people (who carry extra fat around hips and thighs). Apple types are associated with other risk factors, such as unhealthy blood pressure levels and high LDL cholesterol.

"New millennium" risk factors have been the subject of many recent studies. Doctors now are just beginning to understand and watch out for these emerging markers of heart disease, which can be measured by one simple blood test. Sinatra believes the presence of any two of these factors amount to a potential to develop CVD. They are:

* Homocysteine, an amino acid produced by ineffective protein metabolism (that has been linked to anger), which in high levels can damage blood vessels; less than 10 mini-moles per liter (umol/L) is recommended. (See "The Heart of the Matter," in the Healthy Lifestyles section, p. 6).

* Lipoprotein(a), or lp(a), a fatty protein in LDL cholesterol that can increase risk for blood clots; levels should be 30 to 60 mg/dl or below.

* Fibrinogen, an inflammatory protein produced in the body that can clot blood if levels are too high; under 300 mg/dl is acceptable, and anything over 360 is high.

* The antibody C-reactive protein (CRP) a marker for chronic inflammation that could indicate a cardiovascular infection; recommended levels are less than 0.8 mg/dl.

* Excessive iron, or ferritin levels in the blood; acceptable levels are under 200 mg/dl.

* Emotional risk factors are what Sinatra dubs "the missing link" to heart health, noting that half of all heart attack victims don't fit the standard risk profile. Negative emotional states like hostility or depression provoke physiological changes in the body that are, over time, just as damaging as hazards like high blood pressure or a sedentary lifestyle. "Research shows that our emotions are intimately connected to our immune systems," Sinatra adds.

This may seem like a long list of worries, but look closely and you'll see these heart disease harbingers for what they are: lifestyle issues that are well within your control.

Do It Yourself

Recognizing the damage you're doing to your heart--whether it's a high-fat diet, sedentary lifestyle or explosive temper--is an important first step in fighting heart disease. But then you must walk the walk. Avoiding CVD doesn't necessarily mean adopting a routine as rigorous as Sears', but it will involve working with your doctor to find an approach that works for your body. Even though heart-healthy habits take effort, the rewards are ample. Along with strengthening your heart, you'll improve your appearance, mood and overall health in the process.

The first place to start making changes is with obvious threats to well-being. If you're a smoker--even a so-called "social" smoker--the most vital preventive step is kicking this dangerous habit. Your heart, Ross says, will respond almost immediately. "Within days or weeks, your risk will start to fall dramatically, even if you've smoked for years," she says. And just one year after you quit smoking, your CVD risk decreases by 50 percent.

Next on your hit list should be physical fitness. Being sedentary seems fairly normal in our culture, where people spend their days at a desk and evenings on the couch. But our bodies were actually designed to be more active, and the heart--a muscle that responds directly to activity levels--needs regular workouts to stay in shape, says Kenneth Cooper, M.D., founder and chairman of the Cooper Aerobics Center in Dallas. "A high level of fitness can compensate for major risk factors," he stresses.

Even walking briskly for about 30 minutes several days a week reduces the risk of a fatal heart attack by 50 percent, Cooper says. Ideally, that would be five times a week at three miles per hour. (For more exercise guidelines, see "Raising the Bar" in the Healthy Lifestyles section, p. 8.) Beyond pumping up the heart, exercise increases your ability to use oxygen, elevates the amount of blood pumped with each heartbeat, decreases blood pressure and lubricates joints. "Almost every system of the body is positively affected by exercise," Kenneth Cooper notes.

Let's say you're religious about your morning power walks and you've eliminated major health threats like smoking. There are at least three more opportunities every day to take cardiac health into your own hands. Eating nourishing food is not only good for the heart but also makes aging a more graceful process, says Margo Denke, M.D., nutrition researcher and endocrinologist at the University of Texas Southwestern Medical Center in Dallas. For those with acceptable blood pressure levels and a family history of heart disease, a healthy diet low in saturated fat and sodium can slow the increases of cholesterol and blood pressure that normally come with age.

The AHA's recently updated recommendations emphasize overall eating patterns rather than, say, just limiting harmful fats to a percentage of total calories. You'll do your heart a favor by eating a varied diet that includes five daily servings of fruits and vegetables and six daily servings of grains.

If you don't already eat soy, consider adding such foods as tofu, tempeh, soy beverages and soy nut butters to your diet. If it's eaten on a regular basis, soy lowers total and LDL cholesterol levels. Tea is another ally for cardiac health. The latest studies show that black and green teas reduce the risk of CVD because they lower LDL cholesterol as well.

Forget having a donut with that mug of tea, though. Baked goods, fried foods, commercially prepared snack foods and some hard margarines all contain what cardiologists now call the most unhealthy fat of all--trans fatty acids. The result of hydrogenation, a process that solidifies liquid oils at room temperature, these trans fats injure blood vessels. Since they're used so widely in commercially prepared foods and have yet to be listed as a separate ingredient on food labels, it's hard to determine how much of these dangerous fats you're eating. The safest plan: Stay away from prepared foods that contain hydrogenated oil.

Because saturated fats increase LDL cholesterol levels, they are also considered heart hazards. Vegetarians have an easier time keeping these fats to a minimum because they're mostly found in animal products. Yet saturated fats are also contained in tropical oils (like coconut and palm), so consider cooking only with the healthier monounsaturated oils, such as olive and safflower. These monounsaturated fats actually lower harmful LDL cholesterol without decreasing helpful HDL cholesterol. Aside from oils, good sources include flax seeds, nuts and tofu.

Even more beneficial are omega-3 fatty acids. These polyunsaturated fats lower hypertension and reduce levels of cholesterol and triglycerides. Some studies show that omega-3's can decrease the incidence of sudden cardiac death by 50 to 70 percent, notes Dean Ornish, M.D., founder and director of the nonprofit Preventive Medicine Research Institute in Sausalito, Calif., and author of the seminal work Dr. Dean Ornish's Program for Reversing Heart Disease (Random House, 1990). Food sources of these essential omega-3's include nuts, soy products, avocado and flaxseed oil. Sinatra recommends taking 2 tablespoons of ground, organic flax seeds mixed with soy milk daily. Those who prefer supplements can take 100 mg. to 200 mg. daily of DHA--a vegetarian source of omega-3 derived from algae.

More Love, Less Stress

It's common sense that you can't fend off heart disease--not to mention a number of other health hazards--without paying attention to diet and exercise. The role of emotional factors, however, has yet to become widely acknowledged. Over the past decade, studies have begun to link a higher risk for heart disorders to anger, hostility, depression, loneliness and even cynicism. (For more information, see "Emotional Rescue" in the Healthy Lifestyles section.) Some physicians believe one's state of mind wields vital influence on heart health. "Nothing has a greater impact on how long we live than love and intimacy, including cholesterol-lowering diets, drugs or surgery," says Ornish, who also wrote Love and Survival: The Scientific Basis for the Healing Power of Intimacy (HarperCollins, 1998).

Emotions affect more than your psyche; they generate measurable physical reactions in the body. For example, a stressful lifestyle or a crisis like the death of a child or losing a job can cause a flood of stress hormones, such as adrenaline and cortisol, to be released in the body--spiking cholesterol and blood pressure levels. Sinatra, who practices in Manchester, Conn., also cites emotional exhaustion as another source of cardiac stress, one that's more frequently present in women because of their dual responsibilities in the home and workplace.

All too often, women focus on pleasing everyone else and relegate their own needs to the back burner, explains Christiane Northrup, M.D., author of Women's Bodies, Women's Wisdom (Bantam, 1994). "There isn't a single supplement, act or drug that can do for women what they can do for themselves," she says. For self-preservation, Northrup suggests this daily practice: Shut the door, turn off the phone and practice being "available to yourself," even if it's just for 10 minutes.

Even though you should reserve some time for yourself, contact with family and friends is a known antidote to another potential heart problem--loneliness. Nurturing relationships protect your heart from the effects of stress and depression. Recent research shows that seniors who experience depression are 40 percent more likely to develop heart disease than those who don't. And your companion doesn't necessarily have to be human. Having a pet can also boost emotional health. One study showed that stockbrokers who owned dogs or cats experienced half the increase in blood pressure during stressful situations as did their petless coworkers.

Many people incorporate daily meditation into their stress-busting routine, but there are more options than the traditional way, practiced sitting crossed-legged on the floor, Northrup says. "Women often need to use their bodies instead of sitting in a strange position that hurts their knees," she says. Even taking a long walk can have a soothing effect on the mind.

With so many ways to adopt a heart-healthy lifestyle, perhaps the most vital aspect of your prevention plan is motivation. After all, it only takes a little time to toss a salad, take a brisk walk or pet the dog. Your efforts, Elizabeth Ross says, will be repaid generously. "Health is like a bank account," she says. "You have to put something in for there to be anything available when you need it."

RELATED ARTICLE: supplemental protection

Most nutrition experts believe it's best to try to meet all your nutritional needs with whole foods. But even the healthiest diet may exclude some nutrients that provide extra protection against heart disease. Supplements providing therapeutic levels of certain antioxidants, vitamins and minerals can bridge that gap, says cardiologist Stephen T. Sinatra, M.D. This applies even more to vegetarians because some of these heart helpers are found in high levels only in animal products, including coenzyme [Q.sub.10] (co[Q.sub.10]), the amino acid L-carnitine and alpha lipoic acid (ALA).

People who are at risk for heart disease may need to increase some of these levels, but should consult with their doctors about specific dosages. Healthy people who aren't presently at risk can protect themselves by taking the following amounts per day, preferably with food, Sinatra says. If possible, divide these daily doses into three and take one-third with each meal.

* 200 to 400 international units (IU) vitamin E

* 3 to 6 milligrams (mg.) of the antioxidant lutein

* 400 mg. magnesium

* 1,000 mg. calcium (1,500 mg. after menopause)

* 800 micrograms (mcg.) folic acid

* 10 mg. vitamin [B.sub.6]

* 100 mcg. vitamin [B.sub.12]

* 20 mg. niacin (vitamin [B.sub.3])

* 10 mg. riboflavin (vitamin [B.sub.2])

* 10 mg. thiamin (vitamin [B.sub.1])

* 600 mg. vitamin C

* 250 to 500 mg. L-carnitine, an amino acid that helps keep triglycerides in check and boosts HDL (good) cholesterol

* 1,000 mg. of trimethylglycine (TMG), if levels of homocysteine are greater than 10; found in red beets, broccoli and spinach. This nutrient converts harmful homocysteine into a more beneficial amino acid

* 60 to 90 mg. co[Q.sub.10], or up to 150 mg. if there's a family history of heart disease; an antioxidant whose vegetarian sources include peanuts, broccoli and spinach but in such low quantities that supplements are necessary

* 50 to 100 mg. ALA, an antioxidant that helps prevent hardening of the arteries

* 100 mg. N-acetylcysteine (NAC), a variant of the amino acid L-cysteine whose only vegetarian source is nuts (although in low levels); it helps prevent hardening of the arteries

* 30 to 60 mg. oligomeric proanthocyanidins (OPCs), a bioflavonoid compound derived from grape seed or pine bark extracts (sold by brand name Pycnogenol), which helps lower LDL cholesterol and reduce excessive blood clotting

resources

AMERICAN HEART ASSOCIATION (800) AHA-USA1; www.americanheart.org

ADULT CONGENITAL HEART ASSOCIATION www.achaheart.org

NATIONAL HEART SAVERS ASSOCIATION 402-398-1993; www.heartsavers.org,

HEART ASSOCIATION ON VEGETARIAN DIETS www.veggie.org/veggie/vegdiet.html

NATIONAL STROKE ASSOCIATION (800)-STROKES; www.stroke.org

KATY KOONTZ, a freelance writer based in Knoxville, Tenn., writes about health, travel and spirituality.

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