Men's Health: Heart Disease

Men's Health Series

In 2001, more than 430,000 men died of heart disease in the U.S. This amount exceeds the total number of the four next most common causes of deaths such as cancers, accidents, chronic respiratory disease and diabetes. Researchers have made great progress in understanding heart disease and its risk factors, but they still cannot predict who will get coronary heart disease. As many as one of every five heart attacks occurs among apparently healthy individuals who have none of the major risk factors: smoking, high blood pressure, high cholesterol and diabetes. Half of all heart attacks happen to men who don't have high cholesterol, the most anxiously tracked risk factor.

Join cardiologist Sidney Smith, M.D., director of the Center for Cardiovascular Science and Medicine at the University of North Carolina, online Thursday, May 6 at 2:45 p.m. ET, to discuss the importance of cardiovascular health.

This week, The Washington Post's Health section features a special report on men's fitness and health. Cardiovascular health is one of the leading concerns in men's health.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

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Sidney Smith, M.D.: Cardiovascular disease (heart disease and stroke) are the leading cause of death in men. Unfortunately, over 300,000 sudden deaths occur outside the hospital and it's the first sign that the patient has heart disease. For that reason, there is a growing feeling that it's not enough to do bypass surgery on people who survive but what we really need to recognize and do more of is prevention. To recognize that heart disease and stroke can be prevented and it doesn't need to happen! If you are a man, you can see your kids graduate from high school and college and you don't have to die young. It is important to recognize the risk factors.

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Washington, D.C.: Although there is the benefit of weight loss, do low carb, high protein diets such as the Atkins diet raise heart disease risk factors over an extended period of time?

Sidney Smith, M.D.: We don't have good data for an extended period of time and I'm concerned about that aspect of the Atkins diet. I think the Atkins diet is important in that it recognizes high carbohydrate intake but it doesn't recognize the problems with saturated fat. I think the South Beach diet is better in that regard and the recommendations from American Heart should be careful about carbohydrate intake and saturated and trans saturated fats.

So diet is a really cornerstone in our strategies to prevent heart disease. It centers around behavior and eating the right foods. The three important aspects of behavior are eating the right foods, getting daily physical activity and avoiding cigarette smoke. Those three goals would dramatically reduce the problems we have from heart disease and stroke. In addition, we have high blood pressure, high cholestorol and diabetes which are all major factors that lead to heart disease and stroke.

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Sweltering in Southern California: Good afternoon.

I'm 35 (male), 6'1", 165lbs, never smoked, light drinker, eat healthy & exercise, but not a fanatic - some days a donut and steak slip in. My blood pressure is usually around 120/70 and I just qualified for some "super preferred" life insurance so I assume I'm in decent heart health. Plus my family doesn't have a history of heart problems until well into their 80's.

So, assuming I stay the course do I have anything to worry about? Once in a while I hear of some guy my age or around 50 passing away from a heart attack who by all measures was in good health, so that's a bit of a concern. Any advice?

Sidney Smith, M.D.: Keep up the good work and also be sure to have your blood pressure measured at regular intervals (every one to two years) because even though your blood pressure is good now, it can increase as you get older. Both blood pressure and cholesterol should be measured regularly (within every 3 years as you go forward would be a good approach in your 30s). You sound in excellent health and continue your healthy lifestyle but be careful to have your blood pressure and cholestoral checked at regular intervals and if they go up as you get older, then they need to be treated.

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Washington, D.C.: Good afternoon, I am a 37 year old male, lost my brother three years ago who was then 38, no autopsy was performed. 41 year old female first cousin died of a heart attack last year. I went to a cardiologist and had a CT done which he thought looked clean, and am on Zocor and my cholesterol is now excellent. I lift weights three nights a week and row on a crew. Problem? I CANNOT quit smoking! not a heavy smoker, 4-5 per day, but I have tried everything including hypnotherapy! Any suggestions? I dont want to die of a heart attack!!!

Sidney Smith, M.D.: Smoking is very dangerous and you got to find a way to stop. There are some therapies such as Bupropion as a medical therapy can sometimes be helpful. With your family history and high cholestorol and in addition of taking a statin for high cholestorol, you should take a baby aspirin a day. But don't give up on your efforts to stop smoking. It is one of THE MOST important things you can do and look at one of the good hospital programs in the D.C. area and you may want to call the American Heart Assoc., American Lung Assoc. or American Cancer Society for references.

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Arlington, Va.: I had open heart surgery 9 months ago and have recovered well. My doctors suggest that I spend 3 days a week on the gym... but given my busy schedule and lots of traveling overseas ... I am having lots of trouble to go back to the Gym. Please advise on a effective program or routine that I can use to get me to fulfil the 3 days recommend training program. I would appreciate some specific training material or set of exercises rather than the generic - do some aerobics and you will be OK. Thanks

Sidney Smith, M.D.: Generally, it depends on the condition of your heart. Most programs advise 30 min of physical activity daily and it doesn't have to be strenuous activity on the treadmill-- it can be walking briskly or swimming. It is important to get 30 min of daily activity a day and this could include the stairs at your work. I suggest that you go to a cardiac rehabilitation program and you don't have to go to a gym to exercise. Don't say that you are too busy to exercise because you are saying you are too busy for your heart. If you don't exercise and take care of your heart, then you won't be around to be busy!

I have the same problem where my days are long. So I look for ways to exercise in my daily life. In the hospital, I always take the stairs. I also exercise first thing in the morning before I go to work because I end up staying late for something that needs to be done.

For men concerned with cardiac health, I think aerobic exercise is better than lifting weights -- such as walking, jogging, swimming or riding a bike. If you play golf, walk around the course instead of riding in an electic cart.

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Bethesda, Md.: A physician friend of mine told me a few years back that one major cause of heart attacks were diseased coronary arteries that appear to come out of nowhere. He said the only early way to detect its presence was to do an angiogram.

I am concerned because, although my cholesterol level is low, my father and each of my parents' fathers died from heart attacks. My father's first heart attack came when he was 59 years old.

I have three questions. First, if a diseased coronary artery is detected early enough, is there any effective response other than a bypass operation? Second, are there any other good ways (ultrasound, magnetic resonance)to detect a diseased coronary artery? Third, how realistic are the prospects for an effective predictive test for people with good cholesterol levels, such as those described in yesterday's Post article?

thanks.

washingtonpost.com: What Can You Do to Reduce Your Risk? (Post, May 4)

Sidney Smith, M.D.: The important thing is to know your risk factors. You should do a risk assessment and that involves more than knowing your cholestorol. If you are intermediate risk, something like EBCT or CRP might be helpful. There are therapies to be taken to reduce the risk: aspirin, medication to lower blood pressure and cholestorol and definitely stop smoking if you smoke.

If you don't have symptoms, the medical therapies are important because they tend to reduce the likelihood of a plaque splitting and cutting off the artery. So, it is very important to exercise on therapies that stabalize the plaques and keep them from rupturing. Bypass surgery and angioplasty is really only helpful for people who have symptoms of chest pains. They do not prevent from future plaques from rupturing. Medical prevention therapies are important.

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Washington, D.C.: Other than aspirin, garlic, and water, what else in the kitchen helps thin the blood?

Sidney Smith, M.D.: We can't talk about thinning the blood but the right diet are very helpful. Some people think that soy and fish oils affect the clogging of blood -- that's why some people take Omega 3 capsules. However, I do not advise garlic because I don't think the evidence is that strong. Smoking causes the blood more prone to clot. In terms of clotting, there are not a lot of studies on foods and how they contribute to the build up of plaque.

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Denver, Colo.: I eat a diet that's very low in fat, with lots of vegetables and grains and almost no red meat. An HMO "gatekeeper" physician told me, after a recent checkup, that my cholesterol scores look very good but my triglycerides are high. He didn't put me on medication or say to change my diet, but I'm concerned because everything I've read says that high triglycerides indicate a risk of cardiovascular disease and/or diabetes. Is there anything I might consider doing? Other tests I might ask for which would reveal potential problems?

Sidney Smith, M.D.: If the triglycerides are up, exercise and weight loss can help lower triglycerides. Reduce carbohydrates and simple sugars may help as well. People with diabetes can have triglycerides so you might want to get checked for that.

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Los Angeles, Calif.: What is the natural process so the plaque is building up at the arteries?
I had two stent in the LAD and I have 60% of plaque in RCA Coronary artery,why the doctor did not insert stent on RCA? I worry about it.
Processed food are unhealthy for the heart due chemical additive?
Thanks for you comment
Manny

Sidney Smith, M.D.: Usually we don't put stent in blockages that are 50% or less because they are not thought to be severe enough to cause symptoms. It is very important to take medication to lower cholosterol -- aspirin, beta blocker and ACE inhibitor. All of those medications will tend to keep the plaque from progressing and clotting off.

If you lower cholestorol a lot you can break plaque down but generally, it is important to stabilize them and keep them from getting worse and causing symptoms.

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Silver Spring, MD: I know that nitroglycerin is usually prescribed for most people who've had heart attacks or any sort of cardiac procedure. Of course it seems to treat the symptoms not the cause, and temporarily at that. Is nitro still a drug of choice or are other things poised to replace it?

Sidney Smith, M.D.: It still is very good in treating symptoms for chest pain.

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Sidney Smith, M.D.: The response to this program is very gratifying and shows very much interest in preventing heart disease. In closing, we suggest that people go to the American Heart Association web site where you can get further information on diet and different types of heart disease and appropriate treatment.

Basic tips again:
Get regular physical aerobic activity
Eat the right foods -- low in saturated fat, plenty of fruits and vegetables and whole grains and not high in carbohydrate.
And definitely no smoking
Get regular check ups on your blood pressure and cholestorol.

Thank you.

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