Better Health & Living

Issue: August 2008
Is Your Heart Really Safe?
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Is Your Heart Really Safe?

by Susan Flagg Godbey

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After a heart attack killed TV newsman Tim Russert in June, Americans have new cause for worry. Russert, 58, kept his coronary artery disease under control with medication and exercise, and a stress test less than two months earlier found no problems.

“It shook people up a bit when this happened,” says cardiologist Richard A. Stein, MD, professor of medicine at New York University Medical Center in New York City and author of Outliving Heart Disease: The 10 New Rules for Prevention and Treatment. “It’s important to remember that what happened to Tim Russert is rare, but possible. It underlines the importance for everyone of maintaining good heart health in every way possible.”

Here’s what you need to know about cutting your risk of a fatal heart attack, whether or not you now have heart disease.

I keep my cholesterol and blood pressure low with diet, exercise, and prescription medications. Am I doing enough?

You can dramatically improve your heart health, but the truth is that like most things in life, there’s no 100 percent guarantee for your heart. Very small plaques in your artery walls could fracture and lead to the development of a clot that could block arteries in your heart. That’s always a possibility if you have heart disease or risk factors for it, or even if you seem to have no risk factors. The best thing you can do to protect yourself is to really partner with your doctor to help you stay on top of all the things that keep your heart healthy—diet, exercise, controlling your weight, and not smoking, as well as maintaining healthy blood pressure and cholesterol levels.

My cholesterol and blood pressure numbers are naturally healthy, but they’ve been creeping up a little lately.  Am I in trouble?

The majority of heart attacks happen to people with near-normal or slightly elevated cholesterol levels, so you’re smart to pay attention to your numbers and be aware of any changes. To outwit heart disease, you have to be sensitive to early warning signs. Keeping your LDL cholesterol low and your “good” HDL high is smart, as is keeping your blood pressure low and healthy.

What are the healthiest numbers to aim for? If you have diabetes or peripheral artery disease or have already had a heart attack or stroke, keeping your LDL below 100—and getting it as low as 70—will reduce your risk of a heart attack. This may mean taking a cholesterol-lowering statin if your doctor recommends it. If you don’t have any risk factors, the American Heart Association says the optimal LDL level is 100 to 129 mg/dl. Your HDL, the “good” cholesterol that takes LDL out of your bloodstream and back to the liver to be eliminated, should be at least 45 mg/dl for men and 55 mg/dl for women.

We used to think that keeping blood pressure below 140/90 was healthy, but newer research shows that your risk of a heart attack or stroke begins to rise at levels lower than that. A healthy blood pressure goal is to shoot for 130/80 if you have heart disease or are at high risk for it.

My family has a history of early heart attacks. Do I need extra tests or scans to look for signs of trouble? 

You may. If you have a parent, brother, or sister who developed heart disease at an early age (before 55 in men or 65 in women), you should pay even closer attention to your own heart health. If your cholesterol and blood pressure are at healthy levels, your doctor may still want to do an extra check such as an ultrasound check (carotid intimal medial thickness test) of the large artery on either side of your neck or an EBCT (electron-beam computed tomography) to look for tiny calcium deposits in artery walls or an ultrasound check (carotid intimal medial thickness test) of the large artery on either side of your neck. Both look for signs of atherosclerosis and can help your doctor decide whether you need a cholesterol-lowering drug to reduce your heart disease risk.

Do any of those “heart health” supplements really work?

I recommend just a few basic supplements because many of the single-nutrient supplements we thought would lower risk, such as vitamins C and E and beta-carotene, actually do nothing or may even be slightly detrimental. And I don’t think that garlic supplements and coenzyme Q10 are very effective either. What I do suggest, especially for people over age 60, is a basic multivitamin. If you’re over 60, use a senior formula that’s low in iron to protect against iron overload. And if you don’t eat fish twice a week, take fish-oil capsules every day so you get about one 1 gram of omega-3 fatty acids. In three large studies of over 100,000 people, fish oil reduced the risk of sudden death due to irregular heart rhythm.

By Susan Flagg Godbey and the editors of Better Health & Living®

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