Heart Disease – Number One Cause of Death

Heart disease prevention information from the Orlando Heart Center:

Heart disease is the number one cause of death in the United States. Fortunately, we now know ways to reduce our risks. Use this information to help you lead a healthier and longer life.

Risk Factors

The following lists primary risk factors for developing heart disease.

Count your total risk factors:

Male 45 years or older

Female 55 years or older

Female under age 55 with premature menopause not treated with estrogen replacement therapy


High Blood Pressure

Diabetes mellitus

Family history of heart disease (a parent or sibling under 55 if male, or under 65 if female)

High total blood cholesterol

Low HDL (good) blood cholesterol (you can subtract one risk factor if HDL is higher than 60)

High LDL (bad) blood cholesterol

High triglyceride blood level

Obesity – 30% or more overweight

Sedentary lifestyle

History of vascular disease

Total risk factors

Unfortunately, certain risk factors such as family history and gender cannot be changed. However, by modifying other risk factors, the odds of having a heart attack can be substantially reduced. For individuals with heart disease, the lowering of the LDL cholesterol below 100 mg/dl (milligrams per deciliter of blood) can stabilize coronary disease or even promote regression of coronary disease.

Below is a brief discussion of various risk factors and preventive measures that can be taken. More detailed explanations are available at http://www.americanheart.org/ and http://www.acc.org/.

Lipids: Cholesterol and Triglyceride

The fat and fat-like substances in the blood are called lipids and include both cholesterol and triglycerides. Cholesterol is present in every cell of your body. It is used to form cell membranes and part of some hormones. The body manufactures the majority of required cholesterol, mostly in the liver; therefore, excessive dietary cholesterol intake is unnecessary and may be harmful. Animal foods such as meats, poultry, fish, seafood, egg yolks, and dairy products are rich in cholesterol. Plant foods such as fruits, nuts, seeds, vegetables and grains do not contain cholesterol.

Cholesterol will not dissolve in the bloodstream; it is transported to and from cells by special carriers called lipoproteins. The low density lipoprotein (LDL) is the major cholesterol carrier in the blood and contributes to plaque formation in the arteries. When clots form at the site of plaques, blood flow is interrupted, leading to heart attacks or strokes. Thus LDL cholesterol is known as the bad cholesterol.

The high density lipoprotein (HDL) is mostly made by the liver. It is thought to carry cholesterol away from the arteries and away from plaques back to the liver where it is eliminated. Thus high levels of HDL cholesterol are good; likewise, low levels increase the risk of heart attacks. HDL levels are difficult to raise. Exercise appears to help; less clear is the role of alcohol. Two drinks of alcohol per day may help raise HDL; more than two can contribute to high blood pressure, high triglycerides, liver disease, and weakening of the heart muscle.

Triglycerides are blood fats derived from food and manufactured in the liver. Although less of a risk factor than high cholesterol, elevated triglyceride levels are associated with heart disease. Levels less than 200 mg/dl are considered normal. Levels between 200 and 400 mg/dl increase risk of heart attacks, and higher levels (400 to over 1000 mg/dl) add risks of pancreatitis (inflammation of the pancreas) and diabetes.

Know the Numbers!

Lipid levels should be measured on fasting blood samples. Based on multiple studies, the following guidelines for blood lipid levels are recommended by the National Cholesterol Education Program:

Total Cholesterol
less than 200 mg/dl desirable
200 – 239 mg/dl borderline high the risk of heart disease may increase two-fold
240 mg/dl and higher high the risk of heart disease is substantially increased

less than 200 mg/dl normal
200 – 400 mg/dl borderline high
400 – 1000 mg/dl high
greater than 1000 mg/dl very high

LDL Cholesterol
less than two risk factors and no coronary heart disease below 160 mg/dl
two or more risk factors and no coronary heart disease below 130 mg/dl
coronary heart disease (prior heart attacks, angioplasty, or heart surgery) below 100 mg/dl

HDL Cholesterol
women over 40 mg/dl
Men over 35 mg/dl

A more sophisticated subtype analysis of lipid levels is now commercially available and should be discussed with your physician for unusual clinical circumstances.

Basic Diet Information

Dietary modification is the first step in controlling cholesterol. A healthy diet should limit total cholesterol intake to no more than 300 milligrams per day. Total fat intake of less than 40 grams per day will aid in weight loss and lipid management. Different types of fats exert different effects on cholesterol levels.

Saturated fatty acids in the diet raise cholesterol. Animal foods high in saturated fatty acids include red meat, poultry skin, and dairy products. Plant foods high in saturated fatty acids include coconut oil, tropical oil, and cocoa butter. Saturated fatty acids should be less than 10 percent of total calories each day.

Polyunsaturated and monounsaturated fatty acids may help reduce cholesterol levels when substituted for saturated fatty acids. They should be less than 10 and 15 percent of your daily calories respectively. Oils high in polyunsaturated fats include vegetable cooking oils, such as corn, safflower, sunflower, and soybean. Better choices are found in monounsaturated oils such as olive and canola oils.

Unfortunately, changes in diet will not always provide the necessary response in blood lipid levels; genetic factors also exert an influence. During the last several years, major advances in drug therapy have helped lead to substantial reductions in lipid levels. Consultation should be made with your doctor to choose the appropriate therapy.

Vitamin E has anti-oxidant properties and has been shown to help cholesterol reduction when taken at 400 – 800 IU (international units) per day.

Stop Smoking

Cigarette smoking is arguably the greatest threat to a healthy heart. Cigars are also linked to higher incidences of heart disease. Your primary care physician can provide suggestions about the current therapies and drugs that help you stop smoking.

Control Diabetes

Diabetes is associated with premature atherosclerosis and small vessel disease. Tighter control of blood sugar levels is thought to reduce complications secondary to diabetes. Appropriate weight loss in Type II diabetes reduces the risk of cardiac disease.


Aerobic exercise helps protect against heart disease. The greatest benefit is achieved with at least three 30-minute exercise sessions per week. Activities do not need to be strenuous. Walking, swimming or bike riding are some of the easier habits to adopt.

Aspirin A Day

Aspirin is an effective blood thinner. Patients with heart disease should take one aspirin per day to lessen the risk of heart attacks. The usual dosage is one adult aspirin (325 mg). Coated aspirin is recommended to reduce gastric irritation and a baby aspirin (81 mg) can be used for individuals unable to tolerate full strength. Patients with allergies to aspirin should discuss alternatives with their physicians and in most cases aspirin should be avoided in patients on Coumadin.

What is Homocysteine?

Homocysteine is an amino acid found in the blood. Elevated levels are associated with increased risk of heart and vascular disease. Unfortunately accurate measurement of homocysteine levels is not yet readily available for all cardiac patients. Diets high in folic acids and B vitamins lower homocysteine levels, but no controlled studies have directly shown that dietary supplements lower the risk of heart disease. With that caveat, a balanced diet and a multivitamin with folic acid and B vitamins may be beneficial.

Vascular Disease: Neck and Leg

Blocked arteries in the neck, the carotid arteries, can lead to stroke when sufficiently narrowed. Stethoscope examination of the neck can detect sounds called bruits which often indicate carotid artery blockage. The severity can be estimated by carotid ultrasound and doppler evaluation and appropriate treatment can be instituted.

Claudication is the name of the leg pain usually first noticed with blocked leg arteries. It typically occurs with walking a specific distance and is relieved by rest. Palpation of the leg pulses and doppler evaluation of the legs can help guide treatment.

Carotid artery disease and vascular disease of the extremities is strongly correlated with coronary artery disease. If you have vascular disease, you should discuss appropriate screening tests for heart disease with your physician.

High Blood Pressure

High blood pressure, called hypertension, is directly related to coronary artery disease and thickening of the heart muscle. The majority of high blood pressure is called essential hypertension and is readily treatable. Typically the goal is a pressure below 140/90 (systolic/diastolic). Proper diets including low sodium diets, exercise, and appropriate weight loss all help in controlling blood pressure. There is a wide range of medications available for blood pressure control.

Less common causes of hypertension include kidney disease, vascular disease, or rare tumors. Consult your physician for proper evaluation.


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