Keep Your Heart Healthy

with Dharam Pal Jain, M.D., Cardiologist, Columbia St. Mary’s

Posted: Feb. 1, 2004

Are you at risk for heart disease? That’s a question to take seriously.

The American Heart Association reports that coronary heart disease is the single largest killer in the United States. It’s estimated that about 700,000 people will have a coronary attack and about 500,000 will have a recurrent attack. And about 42 percent of those who experience an attack in a given year will die from it.

Dharam Pal Jain, M.D., Cardiologist, Columbia St. Mary's "A stress test would be a good idea, especially if you have multiple risk factors."

According to Dr. Dharam Pal Jain, cardiologist with Columbia St. Mary’s, an awareness of the risk factors can do much to prevent the onset of the disease – if you can modify some of those factors.

Dr. Jain said you are at risk if you’re a man over 45 years old, or a woman over 55. Smokers are at risk, as are people with blood pressure over 140/90, individuals with total cholesterol levels over 200 or “good” cholesterol levels less than 40. Those with a family history of heart trouble, particularly if your father, mother, brother or sister had a heart attack at an early age are at risk, as are people who lead a sedentary life, or have a Body Mass Index (BMI) score of 25 or more.

“Diabetics are at a very high risk,” he emphasized.

Dr. Jain advises patients with risk factors to work aggressively at reducing them. “First, I tell those leading a sedentary life to get into an exercise program,” he said. “Exercising at least four or five days a week can help. Take a brisk walk for 20 to 40 minutes, or swim, or ride a bike or jog. Even household activities such as mowing the lawn or raking leaves or vacuuming involves multiple muscle usage and can provide an aerobic benefit.”

Dr. Jain said people should get their doctor’s OK before starting a vigorous exercise program. “A stress test would be a good idea, especially if you have multiple risk factors.”

Weight control also is important, he said. “Your ideal weight is depicted by your Body Mass Index or BMI, which is calculated by a formula.” (See formula below.)

“Another way of judging if you’re overweight is your waist circumference. If you’re male it should be 40 inches or less. If you’re female it should be 35 inches or less,” he explained.

“If you have diabetes, you’re at three to four times higher risk of heart disease than non-diabetics,” he cautioned. “You need aggressive treatment, and need to take better care of yourself. Doctors treat diabetics as if they already have heart disease.”

The best way to monitor diabetics is to test for the fasting blood sugar level, which should be less than 110. Another test, the Hemoglobin A1C test, checks one’s average blood sugar level for the past two or three months. “Depending on the extent of the disease, diabetes can possibly be controlled with exercise, diet and weight loss alone, but ultimately, medication may be needed. Also, a diabetic’s cholesterol and blood pressure levels should be lowered to minimize the risk of heart disease.”

High cholesterol is probably the most important risk factor, according to Dr. Jain. “You need to know your levels of good cholesterol (HDL) and your bad cholesterol (LDL). If you have two or more risk factors, your LDL should be less than 130, and it should be 100 or less if you’ve got heart disease or diabetes. If you have no risk factors or only one, your LDL should be 160 or less. HDL should be 40 or higher for men; 50 or higher for women.”

A low-fat, low-cholesterol diet, along with exercise and weight loss can improve cholesterol levels, he said. If that doesn’t help, statin drugs can do the trick.

“Definitely, stop smoking. We do our best to convince patients to stop smoking. It’s well known that it’s dangerous. If a patient is motivated to quit, there are treatments that can help: nicotine substitutes, acupuncture, hypnosis, and medications such as Wellbutrin.”

Dr. Jain said the desired blood pressure for people with risk factors for heart disease is130/80 or less. “If you’re in the safe range you don’t need drug therapy, but if you’re in the high range, you should try to bring it down with exercise, weight loss, and salt and caffeine restriction. If those activities don’t work, drug therapy that can control blood pressure may be necessary.“

He recommended taking one regular or baby aspirin daily as another preventive measure. “It’s been shown that aspirin can cut the risk of blood platelets sticking to each other and causing heart attacks,” he said. “If you have difficulty tolerating aspirin, you can take coated aspirins and should consult your doctor.”

Formula to Find Your Body Mass Index (BMI)
Take your weight in kilograms (your weight in pounds divided by 2.2), then divide that by your height in meters squared (1 meter equals 39 inches) to get your BMI. Or go to www.nhlbisupport.com/bmi/bmicalc.htm.

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