Heart Disease Risk Factors And Prevention
How does smoking affect my heart?
Smoking as an activity causes more deaths in this country then any other. It causes more deaths then accidents or suicides or homicides. Nearly 45,000 people a year die because they smoked. So certainly we don't want to have people smoke. We don't want children to start smoking. We'd like people not be exposed to second hand or environmental tobacco smoke because smoking has affects on the heart and blood vessels in many different ways. Exposure to smoke makes the lining of the blood vessels not work so well. So it's function to keep blood flowing smoothly along and not stopping to clot is diminished by smoking. Smoking makes platelets, the blood cells that are in blood that helps us form clots, more likely to stick together. So on both sides of the equation you're much more likely to form clots, our blood vessels are more likely to be constricted and those are the effects we can easily see. Of course because cigarettes and tobacco is not regulated by the FDA, things can be put into cigarettes that are in fact harmful in ways we don't even know about. Things like ammonia and cyanide, things we would consider poisonous in any other circumstance can be put in cigarettes and there's no regulation of it at all. So the American Heart Association feels strongly and advocates strongly for the FDA to have regulatory power over tobacco, an important drug that is taken by many people in this country. So that the FDA could prevent some of this adulteration of what is already a harmful substance, but in addition we advise people who have heart disease to certainly not smoke and talk with their doctor about the many ways in which we can help them quit smoking. Many, many people have quit, others can, and we can help them do it.
How is alcohol abuse related to heart conditions?
Alcohol is a problem for the heart in many different ways. We know that simply in terms of the risk factors, alcohol increases triglycerides and blood pressure, blood pressure particularly being a risk not only for heart disease but for stroke. This has deleterious effects on the heart muscle as well. It also increases the risk of atrial fibrilliation, a common heart rhythm problem that can directly lead to clots forming in the heart and be showered throughout the body to affect organs like the brain, the kidneys, the legs, and even the heart itself. So, alcohol taken in excess is a serious problem. Alcoholic cardiomyopathy, a problem with the muscle function of the heart that's caused by drinking to excess, can make the heart function so poorly that the patients actually develop heart failure, simply due to alcohol. In some cases, that reverses when the patients stop drinking alcohol, it's always worth trying that to see if in fact the heart muscle can be brought back close to normal, but in many it is irreversible, damage will be done and patients will be dependent on medications to help control their heart failure for the rest of their lives. So drinking to excess can harm the heart in many different ways. In addition, patients that have heart disease often need to take blood thinners; medications that make their platelets not stick so much and not form a clot so readily. Alcohol is a great risk in the circumstance of people taking blood thinners or any kind, or any platelet agents.
Is red wine good for my heart?
People are always interested in the issue of whether in fact wine and alcohol is good for the heart or bad for the heart. And there have been recent studies looking at antioxidants in red wine that appear to have a beneficial effect on the heart, in mice, but of course many things that are good for mice don't turn out to be good for people, so evidence in mice doesn't take us very far. It's always an interesting observation. I'm sure the mice had a good time. But in fact when we look at the evidence about red wine in particular, and people and their hearts, the evidence is a little mixed as to whether red wine is good for the heart. Certainly drinking too much alcohol, including red wine, is bad for the heart. There's no question but that it affects heart muscle, that cardiomyopathies can occur where the heart muscle doesn't work well -- we actually call that an alcoholic cardiomyopathy -- so that we don't want people to start drinking red wine or other alcohol with the idea that it's beneficial. If people are already using red wine, then to restrict that to the levels in which some potential benefit to the heart has been seen -- that is, not more than two glasses of red wine a day for a man, or two drinks, not more than one glass of red wine for women -- would seem to be prudent, and certainly more research needs to be done to see if the effects that are seen on some fractions of the good cholesterol (HDL), but not on all fractions, translate into a benefit to the heart from red wine. So far, it's an observation and association, but not really a proven fact.
Are coffee and green tea good for my heart?
There are a number of foods and drinks that we commonly take in and people wonder if they are healthy or not healthy for their hearts. Many of these contain compounds that we've hoped would be helpful.For example, antioxidants in teas and flavanoids in multiple different foods and products. Are those really healthy for the heart ? There are speculative mechanisms by which they might be. But in fact, we don't really have sufficient data to say, as yet. The trials of antioxidants,where we've actually given people with heart disease, antioxidants, or people at high risk, antioxidants, haven't shown a benefit. And we've done that in thousands of people now, over many years and the benefit still hasn't emerged. So it looks as though at least in that setting, giving an antioxidant doesn't seem to help much. Again it doesn't seem to harm on the other hand. So if it doesn't harm and it's the food that you like , no reason not to take it. But you wouldn't want to feel that you could avoid the other things , you should be doing to control your risk factors and feel that you could count on a food or drink like green tea that has antioxidants and hope that it would protect your heart. In terms of coffee people often worry that coffee will be bad for their heart, because for many years we actually forbade people from drinking it in coronary carians. And then studies were done that showed, that in fact drinking coffee, even in the early days after a heart attack wasn't harmful and didn't increase your risk of having serious heart rythm problems. So while coffee in someone who never drinks coffee will raise the blood pressure just a little, by the time you are at the second or third day of drinking your regular coffee, it has very little or any effect and is certainly OK for people to drink who have heart disease .
Do "antioxidants" contribute to heart health?
There has been a great deal of interest in antioxidants and their potential effect in heart disease since we discovered that LDL, the bad cholesterol, is actually oxidized as it is taken into artery walls. That oxidation is an important facet of it becoming part of the atherosclerotic plaque, the cholesterol plaque, hardening of the arteries. It would make sense then that antioxidants would deoxidize something and that might be of benefit. Unfortunately, antioxidants haven't been shown to have an effect in reducing coronary disease, even when they are used in patients who have demonstrable coronary disease. So, they don't seem to prevent another episode and in some circumstances they actually can have a harmful effect.
How can magnesium benefit my heart?
Magnesium is a very important chemical in the body. And in fact, in patients who have heart rhythm problems, it's really quite important to be certain that their magnesium levels are normal. So magnesium levels are often checked in patients who are having serious ventricular arrhythmias. On the other hand, supplementing magnesium in people in whom it's not low doesn't appear to have a beneficial effect. And that's now been studied, in a large study supported by the National Institutes of Health, and benefit in taking supplementary magnesium was not seen.
Can "Coenzyme Q-10" or other supplements aid the heart?
There's currently no evidence that Coenzyme Q-10 is a benefit in the prevention or treatment of heart disease. I'll say an extra word about supplements in general. One difficulty with using supplements is that, because they are completely unregulated by the Food and Drug Administration, you don't really know when you purchase them how much of the active ingredient is actually present. In some supplements, testing of supplements that one could buy over the counter has shown enormous ranges; thousand-fold differences in the actual amount of what was thought to be the active ingredient in a particular preparation, even under the same brand name, even in what would look like it was the same block. So, you can't be sure what you're getting, testing hasn't been done in most cases to demonstrate a benefit, and while many of them may be harmless some do interact (as with some of the antioxidants) with other medications. So, it's important to discuss them with your physician or health care provider to be certain they're not interfering with other medications, and to be sure that you're not avoiding other medications in favour of an unproven treatment.
What is the "French paradox"?
Well the French paradox may not be so much of a paradox. There is the concept that in other countries, France among them, heart disease may be lower even though the diet may be higher in the amount of fat that's eaten. But in fact, if we look at diets in many other places, what we find is that saturated fat may actually be quite low even though the total amount of fat in the diet is higher. So more of the fat may come from unsaturated fats, mono-unsaturated fats like olive oil, poly-unsaturated fats, rather than the saturated fats that we find in animal and dairy products here. In addition, portion control and, in terms of quantity, is also a major factor in those diets. So that a croissant in France is about half the size of a croissant at any bakery in the United States. In addition, in most other parts of the world, people get more exercise than they do in the United States. Now, it's not that the rest of the world doesn't have problems with obesity and overweight, as well. And in fact, the rest of the world is catching up to the United States in the degree to which obesity and overweight affect their populations and other nation's governments and health organizations have become concerned about that just as we are in this country.
