Heart Disease

You never thought much about your heart before. You never had to. After all, it has always done its job without any assistance from you.

But now your doctor is telling you that your heart might be in trouble. You're hearing words like "coronary arteries;' "blockages," and "heart attack." Words that scare you.

Heart disease is scarypartly because it's the nation's leading cause of death, partly because it seems to come on so suddenly. You never would have suspected anything was wrong if your doctor hadn't picked up on it.

In fact, by the time heart disease is diagnosed, it has already been years in the making. It usually results from a combination of a high-fat, low-fiber diet, lack of exercise, and uncontrolled stress, among other factors.

A heart attack is the culmination of a process that starts in childhood. It begins when something injures the lining of the arteries that supply blood to your heart, called the coronary arteries. That "something" usually is highly unstable oxygen molecules, free radicals, that cause oxidative damage. Your immune system sends white blood cells to repair the damage. But in doing so, they cause inflammation and create scar tissue that attracts circulating cholesterol.

Cholesterol is a waxy substance with a fearsome reputation. When cholesterol collects at the site of scar tissue within the arteries, it leads to the formation of deposits called plaques. Over several decades, the plaques grow and slowly narrow your arteries, a process called atherosclerosis.

Plaques are like acne pimples. If one pops, its contents spill into your bloodstream and may completely plug a section of coronary artery that's already severely narrowed by other plaques. Once blocked, that artery cannot deliver food and oxygen to part of your heart, and cells in the affected area die. That's a heart attack.

A number of risk factors have been linked to heart disease. Your risk is elevated if heart disease runs in your family. Older people are at greater risk than young ones, and at any age, men are more vulnerable than women. Other risk factors include smoking, a high-fat diet, high cholesterol, high triglycerides (blood fats), and high homocysteine levels. (Homocysteine is an amino acid derived from methionine, another amino acid that's found in abundance in animal foods.) People who have high blood pressure, are overweight, or have diabetes also have elevated risk. And you may be putting your heart health in jeopardy if you don't exercise very much, if you're under a lot of emotional stress, or if you're socially isolated.

Some risk factors can't be changed. "We're all stuck with our age, gender, and heredity," explains Martha Hill, R.N., Ph.D., professor at Johns Hopkins University School of Nursing and past president of the American Heart Association. "But it's never too late to work on risk factors that can be changed. Even if you've already had a heart attack, risk-factor reduction can prevent another one." And reducing your risk factors with a comprehensive program of alternative therapies-like those that follow-can actually reverse heart disease.

Best Choices

Nutrition

Score a victory through vegetarianism. There's a good reason why a low­fat vegetarian diet is the cornerstone of Dr. Dean Ornish's famed program for reversing heart disease. It works. "No question about it," says Tim Byers, M.D., professor of preventive medicine at the University of Colorado Health Sciences Center in Denver. "A plant-based diet with plenty of fruits and vegetables reduces risk of heart disease."

How does a vegetarian or near-vegetarian diet help? "By preventing and repairing a lot of the damage caused by free radicals," says Alan Gaby, M.D. "Plant foods are high in the antioxidant nutrients-vitamins C and E, beta-carotene, and selenium. The more plant foods you eat, the less likely you are to develop high blood pressure, high cholesterol, obesity, diabetes, and high homocysteine and high triglyceride levels."

A vegetarian diet can also boost the effectiveness of mainstream heart disease medication, studies show.

Journey to the Mediterranean. The Mediterranean diet first attracted scientific attention in the 1960s, when researchers noticed that people in Greece, Italy, Spain, and southern France eat fairly high-fat diets but have much lower rates of heart disease than Americans. As it turns out, people in the Mediterranean region eat little saturated fat and margarine but liberal amounts of mono­and polyunsaturated oils-mostly olive oil.

For several years now, many nutrition experts have been touting the Mediterranean diet as a tasty, heart-healthy way to eat. The Mediterranean diet consists mostly of fruits, vegetables, beans, nuts, and grains, with some cheese, fish, and poultry and very little red meat.

If you've survived a heart attack, a Mediterranean diet can go a long way in protecting you from another. That's what French researchers discovered in the Lyon Diet Heart Trial. They instructed 605 heart attack survivors to eat either a modestly low­fat diet (with meats, saturated fat, and margarine allowed) or a Mediterranean diet. Over the next 5 years, the people following the Mediterranean diet had 72 percent fewer second heart attacks.

Go fishing. Whether you have heart disease or want to prevent it, make fish your dish. Certain cold-water species, including salmon, mackerel, herring, and halibut, are rich in omega-3 fatty acids. Omega-3's are a special type of fat that's actually good for your heart. They help prevent and treat heart disease in several ways, according to the American Heart Association.

"Hundreds of studies have shown that cold-water fish lower cholesterol and triglycerides and help prevent and treat heart disease," says Joseph Pizzorno Jr., N.D.

Make like Bugs Bunny. The cartoon rabbit loves carrots. And carrots and other orange and yellow vegetables as well as dark leafy greens are rich in carotenoids. These antioxidant nutrients, members of the vitamin A family, can help reduce your risk of heart disease.

Throw a tea party. You may not think of tea as being good for heart health, but it is. A study conducted by researchers at the University of Kansas found that some of the flavonoids in tea are considerably more potent antioxidants than either vitamin C or vitamin E.

Be a bean counter. Beans, especially soybeans, are good for your heart, but not for the reason touted in that old playground ditty. Several studies have shown that beans help lower cholesterol.

Supplements

Fight disease with E. In 1993, two landmark Harvard studies-one of men, the other of women-showed that supplemental vitamin E makes a major dent in heart disease. Compared with men who did not take the vitamin, those who did experienced 37 percent fewer heart attacks. And women who took vitamin E supplements for more than 2 years saw their heart disease risk drop 41 percent.

Alan P. Brauer, M.D., recommends taking 400 to 800 international units (IU) a day. But if you are considering taking amounts above 400 IV, talk to your doctor first.

"C" your heart heal. In Britain, 30 percent more people die of heart attacks during winter than during summer. A Cambridge University study offers an explanation for this phenomenon: The British consume nearly 50 percent more vitamin C in summer-90 milligrams a day, compared with 65 milligrams in winter.

Vitamin C appears to be especially beneficial to people with heart disease who smoke. If you want to try taking C, clinical nutritionist Shari lieberman, Ph.D., recommends 500 to 4,000 milligrams a day.

Bank on the Bs. The recent discovery that a high homocysteine level boosts heart disease risk has focused new attention on the B vitamins, which reduce homocysteine.

According to Eric Rimm, Sc.D., assistant professor of epidemiology and nutrition at the Harvard School of Public Health, the heart-healthiest daily doses are 3 milligrams of B6 and 400 micrograms of folic acid. Many supplements supply these higher levels.

Mind your magnesium intake. In a study of Seventh-Day Adventists-most of whom are vegetarian or near-vegetarian­those who ate the most whole-grain breads and nuts (walnuts, peanuts, and almonds) had the lowest rates of heart disease. Part of the reason appears to be that these foods are good sources of magnesium.

Magnesium helps reduce high blood pressure. According to several studies, it also reduces deaths from heart attacks when administered intravenously in emergency rooms. In a study of 930 people treated at Middlesex Hospital in London, researchers gave some patients standard care and the rest standard care plus intravenous magnesium. Among the people who received magnesium, there were 54 percent fewer deaths.

Of course, you can't give yourself intravenous magnesium. But oral supplements also help. Dr. lieberman recommends taking 500 to 1,000 milligrams a day.

Oil your arteries. Fish-oil supplements help keep your arteries open and working properly after angioplasty and bypass surgery. James P. Gapinski, M.D., of the Clement J. Zablocki Veterans Affairs Medical Center in Milwaukee, analyzed seven studies of fish-oil supplementation after angioplasty. He found that taking 3,000 to 6,400 milligrams a day significantly reduced re-narrowing of the arteries.

Befriend coenzyme Q10. Several studies have shown that supplementation with coenzyme Q10 helps treat the chest pain of angina as well as symptoms of congestive heart failure. The latest research suggests that supplementation also reduces your risk of developing arterial blood clots, which can lead to heart attack. Dr. Lieberman recommends taking 50 to 300 milligrams of coenzyme Q10 a day.

Exercise

Get physical. "If you're physically active, you're far less likely to die of a heart attack than people who are sedentary," says William 1. Haskell, Ph.D., professor of cardiovascular medicine and deputy director of the Center for Research on Disease Prevention at Stanford University School of Medicine. "Exercise helps in many ways. It makes your arteries healthier, helps control your weight, lowers your stress and blood pressure, and increases your levels of 'good' high-density lipoprotein (HDL) cholesterol."

Most experts recommend being physically active for at least 30 minutes a day. Your workout doesn't need to be aerobic to help your heart. Even brisk walking helps. You should always check with your doctor before starting any new exercise program.

Do it your way. Any regular, moderate exercise helps treat and prevent heart disease, says Dr. Ornish, who is president of the Preventive Medicine Research Institute in Sausalito, California. His program emphasizes walking and yoga. But any physical activity­including gardening, cycling, dancing, tai chi, and swimming-is beneficial.

Which should you do? "Do what you enjoy;' says Joan Price, a Sebastopol, California, exercise instructor, trainer, speaker, and author of joan Price Says, Yes, You Can Get in Shape! "Don't think of it as exercise. Think of it as fun. If you can't think of any physical activity you enjoy, think back to what you liked as a kid. Chances are, you'll still like it."

Work out for recovery. If you've already had a heart attack, exercise can help you recover. "About 3 weeks after a heart attack, your heart has probably healed enough to allow you to exercise again," says Robert E DeBusk, M.D., director of the cardiac rehabilitation program at Stanford University. "When you do, you get the same benefits that healthy people get: healthier arteries, weight loss, more HDL, less stress, and lower blood pressure."

Of course, you should return to physical activity under a physician's supervision, ideally through a medically supervised cardiac rehabilitation program.

Just don't overdo it. Every winter, there are news reports of people dropping dead from heart attacks while shoveling snow. Researchers in one study concluded that about 5 percent of heart attacks may be triggered by intense exertion. The bottom line: If you're out of shape and are concerned about how much physical activity of any kind you can safely handle, talk to your doctor.

Relaxation Therapies

Change your type A ways. At the University of California, San Francisco/Mount Zion Medical Center, cardiologist Meyer Friedman, M.D., director of the Meyer Friedman Institute, divided 1,013 extreme type A heart attack survivors into two groups. The people in one group received standard care. Those in the other group agreed to quit smoking. They also had to enroll either in a healthy-eating class or in the healthy-eating class plus a counseling program to change their type A behavior.

In true type A style, most of the participants in the counseling program initially dismissed suggestions to mellow out as stupid or ridiculous. But those who stuck with it quickly began to report positive changes in their lives. They felt happier. Their families and colleagues were happier with them. They enjoyed life more and liked taking some time to "smell the roses."

Three years later, the former type A's who had become more type B's could enjoy something else: Compared with the other people in the study, they had just half the risk of second heart attacks.

Discover the magic of mantras. At the State University of New York at Buffalo, John Zamarra, M.D., and colleagues tested the exercise ability of 21 people with heart disease. Then the participants learned transcendental meditation to practice for 20 minutes twice a day at home. Eight months later, they could exercise 15 percent more strenuously before experiencing chest pain.

Enhance recovery with self-hypnosis. Forget the nightclub hypnotists and their big gold watches. Self-hypnosis­which involves meditative deep breathing, muscle relaxation, and visualization of relaxing scenes-has become well-accepted in mainstream medicine, especially as preparation for surgery.

"The evidence is very strong that relaxation therapies help prevent heart attack and aid recovery from them," says stress­management specialist Martin 1. Rossman, M.D. He has produced many relaxation tapes that combine music and visualization exercises. For a catalog, write the Academy for Guided Imagery at P. O. Box 2070, Mill Valley, CA 94942-2070.

Music Therapy

Tune in, tune out. Few medical crises are as stress-provoking as heart attacks. Music reduces levels of stress hormones, says David S. Sobel, M.D., director of patient education and health promotion for Kaiser Permanente Northern California, a health maintenance organization.

To examine whether music therapy could support the heart attack recovery process, Cathie Guzzetta, R.N., Ph.D., professor of nursing at the Catholic University School of Nursing in Washington, D.C., worked with 80 people who were newly admitted to coronary-care units at three hospitals. The study showed that those who practiced the relaxation response or listened to music had significantly lower heart rates and stress hormone levels. Those who listened to music were the least stressed, suggesting that music can be even more relaxing than meditation.

Social Support

Reach out and touch someone. Like Dr. Friedman's you-can-get-mellow class and counseling, the Ornish program includes a similar message as part of a weekly support group. In addition to helping participants evolve away from type A patterns, the support group also helps minimize the social isolation that raises risk of heart attack.

Your local chapter of the American Heart Association might be able to refer you to a support group. Or simply spend more time with family, friends, and others whose company you enjoy.

Make a pet part of your family. More than a century ago, pioneering nurse Florence Nightingale said, "A small pet animal is often an excellent companion for the sick." Her words were largely forgotten until 1980, when Erika Friedmann, Ph.D., of the University of Pennsylvania in Philadelphia, stumbled upon an unexpected correlation: Men who'd had heart attacks were more likely to survive if they had pets.

In the years since Dr. Friedmann's discovery, many studies have shown that human-pet interactions-playing with a dog, having a cat curled up in your lap, or gazing at fish in a tank -can be profoundly relaxing and reduce blood pressure as much as some medications.

Have faith in healing. People who observe a religion typically have close social ties to others in their houses of worship. They also feel that their beliefs bring them into a close relationship with their vision of God.

At Dartmouth Medical School, psychiatrist Thomas Oxman, M.D., studied 232 people who had open-heart surgery. Six months after surgery, compared with those who described themselves as "not religious," those who professed deep religious convictions were 3 times more likely to have survived. The religious people who also had other close social ties were 10 times more likely to have survived.

Herbal Medicine

Gobble garlic. Some mainstream drugs lower cholesterol and triglycerides. Others reduce blood pressure. And some help prevent the internal blood clots that cause heart attack. But garlic does all of these things. "If I wanted to prevent or treat heart disease, I'd use more garlic in cooking and consider taking it in capsule form as well;' says James A. Duke, Ph.D.

To make the most of garlic, you have to eat a fair amount of it-on the order of one to four cloves a day, Dr. Gaby says. If you'd rather not do that, you can opt for the odor­free garlic supplements sold in health food stores.

Odor-free garlic provides all the benefits of fresh garlic, but it's more socially acceptable, Dr. Pizzorno says. Commission E, the German expert panel that evaluates the safety and effectiveness of herbal medicines, recommends an odor-free preparation that contains the equivalent of 4,000 milligrams of fresh garlic-10 milligrams of alliin or 4,000 micrograms of allicin.

Say hello to willow bark. A great deal of research shows that low-dose aspirin­one-half to one standard tablet a day-reduces heart attack risk substantially and aids recovery from mainstream heart surgery. A half-teaspoon of willow bark contains about 100 milligrams of salicin, the herbal precursor of the familiar white pills, Dr. Duke says. "That should be enough to provide aspirin's heart-protective benefits."

You can take willow bark as a tea. Add 1/2 teaspoon of the herb to 1 cup of boiling water. Simmer for 10 minutes, then strain. Drink a cupful of tea a day.

Try hawthorn, the herbal heart tonic. The leaves and flowers of hawthorn are rich in antioxidants, including flavonoids, explains naturopath Donald Brown, N.D., professor of herbal medicine at Bastyr University in Kenmore, Washington. Naturopaths most often prescribe hawthorn to treat congestive heart failure because it strengthens your heart. In addition, the herb improves blood flow through your heart, pumps antioxidants into your blood, and lowers your blood pressure a little. As a result, it helps treat angina and can support recovery from heart attack. Dr. Brown recommends taking 80 milligrams of a standardized hawthorn extract twice a day.

Home Remedies

Quit smoking cigarettes. Regardless of how long you've smoked, your risk of heart attack declines rapidly once you quit. Three years after quitting a pack-a-day habit, you have about the same heart attack risk as life­long nonsmokers, according to the American Heart Association.

Imbibe wisely. Dozens of studies have suggested that a little alcohol-no more than two drinks a day-can reduce your risk of heart disease. "It raises HDL cholesterol, the kind that reduces heart attack risk," Dr. Brauer says.

Researchers with the Pawtucket (Rhode Island) Heart Health Program have estimated that one drink a day-the equivalent of 12 ounces of beer, 5 ounces of wine, or a cocktail made with 1 1/2 ounces of 80­proof distilled spirits-raises HDL levels by about 6 percent in men and 10 percent in women. For every 1 percent that your HDL rises, your risk of heart attack drops about 3 percent.

Should you drink a little to prevent heart disease? That depends on your personal health history, say Columbia University epidemiologists Thomas A. Pearson, M.D., Ph.D., and Paul Terry. You shouldn't drink for good health if you have a drinking problem, if alcoholism runs in your family, or if you have a medical condition that can be aggravated by alcohol, such as liver disease or heart failure.

If none of these applies to you, you may drink, but limit yourself to about two drinks a day. That is equivalent to two 12-ounce beers, two 5-ounce glasses of wine, or two cocktails made with 1 1/2 ounces of 80-proof liquor. And never have more than three drinks in one sitting, they advise.

But if you don't drink, don't start just for the sake of protecting your heart. You can get a good deal of alcohol's benefits without drinking a drop of booze. Just drink red or purple grape juice. It has all the phenols and flavonoids found in red wine, which means that it's high in antioxidants and helps prevent the blood clots that trigger heart attack.

Over-The-Counter Drugs

Make the most of low-dose aspirin. "Aspirin helps prevent the internal blood clots that cause heart attacks;" says Charles Hennekens, M.D., retired professor of medicine at Harvard Medical School. It also helps dissolve clots in people who are having heart attacks.

Many studies have shown that taking one standard aspirin tablet a day or every other day reduces heart attack risk by about 40 percent.

Low-dose aspirin is unlikely to upset your stomach. If it does, you can switch to an enteric-coated brand. These pills dissolve in your intestine rather than your stomach, so they shouldn't cause problems.

Other Good Choices

Chinese Medicine

Move your Blood. Chinese medicine attributes heart disease to a chronic weakness of qi that eventually leads to the blocked flow of Blood through your heart.

"In the Chinese view, the heart not only circulates Blood, it also sustains consciousness;' says Efrem Korngold, O.M.D., L.Ac. "Good circulation promotes tranquillity, and any disturbance of tranquillity-for example, stress-can cause heart disease. In other words, the Chinese view of heart disease dovetails with the Western concept of type A behavior."

To treat heart disease, Dr. Korngold prescribes herbs that open the blood vessels and promote the flow of blood. These include tea, hawthorn, salvia, frankincense, myrrh, santalum wood, aristolochia root, and borneol crystals.

Stimulate heart health. Stimulating certain points around your body with acupressure can help treat heart disease, Dr. Korngold says. The following two points are especially beneficial. Just apply steady, penetrating finger pressure to each point for 3 minutes.

• Pericardium 6, located in the middle of your inner wrist, 2 1/2 finger-widths above the wrist crease
• Heart 8, located on the palm of your hand, between the bones of the ring finger and pinkie

Ayurvedic Medicine

Make arjuna your ally. Ayurvedic physicians believe that heart disease can develop from imbalances in any of the three doshas, according to David Frawley, O.M.D. Your treatment depends on your specific symptoms and constitutional type. But, in general, Dr. Frawley recommends stress management through meditation and anger control and regular moderate exercise in the form of yoga. Along with that, he advocates nutritional approaches that are similar to those now espoused by Western medicine: Eat more fish and less red meat and salt, and drink modest amounts of red wine.

Dr. Frawley also prescribes medicinal herbs such as garlic, hawthorn, ginger, guggul, and arjuna, which he calls "Ayurveda's heart medicine par excellence." Arjuna strengthens your heart's pumping ability. Dr. Frawley says it also stimulates blood circulation and promotes healing after a heart attack. If you want to try arjuna, consult an Ayurvedic practitioner.

Medical Measures

To treat and prevent heart disease, a growing number of mainstream doctors are recommending a combination of low-fat eating, supplements, regular moderate exercise, and stress-management techniques.

In addition, they perform 420,000 angioplasties, 570,000 bypasses, and 2,300 heart transplants every year. None of these procedures is curative. As Dr. Ornish observes, they're simply very expensive and traumatic "bandages."

Recently, some doctors have been using a new treatment for heart disease: antibiotics. Certain chronic infections increase risk of heart attack, so it didn't take long for doctors to try antibiotics in people recovering from heart attacks. A few pilot studies suggest that antibiotics help prevent second heart attacks.

If you're a woman at risk for heart disease, postmenopausal hormone-replacement therapy (HRT) can reduce your risk considerably. It also helps prevent osteoporosis and Alzheimer's disease. Unfortunately, HRT increases risk of breast cancer. If you're interested in HRT, discuss it with your doctor.

Red Flags

Heart attacks are so common that everyone should recognize their symptoms and know how to respond to them.

• Pain, squeezing, pressure, or fullness in your chest that lasts more than a few minutes, or comes and goes
• Pain that spreads up to your neck or out to a shoulder or arm
• Sweating, light-headedness, shortness of breath, or nausea

Few heart attacks produce all these symptoms. The most frequent is persistent chest pain.

If you think you-or anyone-might be having a heart attack, get emergency medical help immediately. Call 911 and say, "Suspected heart attack." Give your name, address, and phone number, and then follow the operator's instructions.

If the person with the suspected heart attack can swallow without difficulty, give him an aspirin, says cardiologist Carl Pepine, M.D., professor in the College of Medicine at the University of Florida in Gainesville.