A Healthy Heart By Aram Chobanian
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 A healthy heart is usually a matter of personal choice. Most of the major causes of heart disease are preventable but, unfortunately, preventive measures are not widely practiced.
If you have been diagnosed as having atherosclerosis, or "hardening of the arteries," you are not alone.
Did you know that one of four Americans suffers from cardiovascular disease, and that, incredible as it. seems, heart disease and its many complications account for as many deaths as all other diseases combined? This means that one of every two deaths can be attributed to heart disease. Atherosclerosis and resulting heart and blood vessel problems head the list.
If this sounds frightening, it should. If you have atherosclerosis, the good news is there are many contributing factors within your control.· The three most important factors-hypertension, high blood cholesterol and cigarette smoking (each capable of doubling or even tripling your risk of a heart attack)--can be controlled through diet, proper exercise and a successful smoking cessation program.
If the water pipes in your sink were rusty and clogged, chances are you'd repair them. In atherosclerosis, cholesterol and other fatty substances build up inside your blood vessels like the rust in old pipes and impede the How of oxygen-rich blood to your heart. Once your vessels have been damaged by cholesterol deposits, scar· tissue may form around the "injured" artery and enlarge the obstruction. The result can be severe chest pain and, eventually, heart attack.
Cholesterol is the main substance found in obstructed arteries. This is often called "plaque." Table B depicts the stages of atherosclerosis.
Although cholesterol is a fatty substance needed by the body to build cells and make hormones, high blood cholesterol forces the progression of atheroselerosis, increasing the chances for a heart attack or stroke.
The evidence for this relationship between high cholesterol and atheroselerosis is overwhelming. In experimental animal studies, it is virtually impossible to produce atheroselerosis without the presence of high blood cholesterol. A landmark study, referred to as the Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT), showed that men who reduced their blood cholesterol levels through diet in combination with cholesterol-Iowering drugs had fewer heart attacks than men whose cholesterol remained elevated.
Because cholesterol does not dissolve in blood, it must be carried in packages of fat and protein called "lipoproteins." These are manufactured in the body. Two of the most important kinds of lipoproteins are high-density lipoproteins (HDL) and low-density lipoproteins (LDL). HDL is of ten referred to as "good cholesterol" because it is believed to remove excess cholesterol from body tissues and carry the cholesterol away for excretion. LDL is of ten referred to as "bad cholesterol" because it tends to deposit cholesterol on artery walls, contributing to the development of atherosclerosis.
Higher levels of HDL cholesterol (thought to protect against heart disease) have been seen in people who exercise regularly, don't smoke and drink only moderately. Higher LDL cholesterol levels have been associated with sedentary living, obesity and diets high in saturated fats.
Elevations in LDL cholesterol may also be the result of genetics. it has been shown clearly that members of families afflicted with the problem have a very high risk of premature death from heart attacks.
Your physician determines whether or not your blood cholesterol is too high by measuring your levels of total blood cholesterol, HDL and LDL cholesterol and comparing these values to established guidelines. The National Institutes of Health recently recommended cholesterol levels below 200 mg/dl.
About 25 percent of the population in each age group falls into the "moderate-risk" category, and about 10 percent of the population in each age group faIIs into the "high-risk" category. The latter group often includes individuals with genetically high cholesteroI.
Both moderate- and high-risk groups need to reduce dietary fat and cholesterol; those in the high-risk group may also need drugs to help lower cholesterol.
High blood cholesterol levels can be caused by heredity and the foods you eat. Foods high in saturated fat-such as animal products like meat, eggs, butter and cheese-contribute to elevated blood cholesterol levels. Same plant sources of fat-like coconut, palm and palm kernel oils-also contain saturated fats.
Some fats appear to lower blood cholesterol levels. Recent studies suggest that monounsaturated fats, such as olive oil, may have this characteristic.
Polyunsaturated fats-such as corn, safflower and sunflower oils-are also recommended as substitutes fur saturated fats.
The ratio, or balance, of the types. of fat you eat is important for heart health.
It is advisable to restrict your fat intake to fewer than 30 percent of the calories you consume each day, with fewer than 10 percent from saturated fats. The ratio of polyunsaturated fats to saturated fats is called a P:S ratio and can be found on many food labels. This information can help you control the amount and type of fat you consume each day.
As you can see, a major factor within your control-your diet-"-Can help to lower body cholesterol.
Other risk factors for heart disease are:
. cigarette smoking
. high blood pressure (hypertension)
. diabetes mellitus
. obesity
. lack of exercise
If your blood cholesterol level is high, these risk factors are even more dangerous. They act synergistically to compound the effect of each.
Smoking can more than double your risk of a heart attack. it appears somehow to damage artery walls, allowing cholesterol to accumulate faster. But if you quit, your risk of a heart attack is rapidly reduced. If you quit for at least LO years, your risk drops to that of a non-smoker.
High blood pressure, or hypertension, speeds up atherosclerosis. it seems to damage blood vessels and thereby promotes the accumulation of cholesterol in artery walls. It is a very important risk factor and one that can be readily controlled. It is estimated that between 57 and 59 million Americans have this silent evil, but many are unaware of it.
Blood pressure is the pressure exerted by the blood against the blood vessels. A pressure of 120/80 is considered normal. The top pressure (systolic) is the peak value created when your heart contracts. The lower figure (diastolic) is the minimum value present when your heart relaxes. When blood pressure increases, your heart must work harder to circulate your blood.
High blood pressure is defined as any value greater than 140/90, much lower than the values doctors once thought were safe. There's a continual increase in the risk of cardiovascular disease as blood pressure rises above 130 for sytolic pressure and above 85 for diastolic pressure. Approximately a quarter of all American adults have blood pressure above 140/90 and, even more surprisingly, two-thirds of Americans over age 65 have blood pressure above this level.
An informed person can take steps to reduce this risk factor. First, have your blood pressure checked by a doctor or nurse. Being overweight is a contributing factor to high blood pressure. So is excessive consumption of salt. You may also need medication to lower blood pressure.
Diabetes, a disease that causes high blood sugar, is another significant risk factor for heart disease. Although the exact reason is poorly understood, high blood sugar is associated with damage to blood vessels and acceleration of atherosclerosis. The most common type of diabetes occurs in overweight adults, and weight control, proper diet and, sometimes, medication should be used to bring blood sugar down and help delay the development of heart disease.
Obese people are more at risk for atherosclerosis than those at their desirable weight. Being overweight may produce abnormal fats in the body that contribute to heart disease. Obese people are also more likely to have addi tional risk factors such as hypertension and diabetes.
Lack of exercise, common in obese people, is also associated with a greater risk of heart disease. Studies show that individuals who exercise regularly have higher amounts of HDL, or "good cholesterol," than sedentary people. Elevations in HDL, accomplished through exercise, may protect against heart disease.
Source: A Plan for Low-Cholesterol Living
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