5 secrets to turning back the clock on your ticker
Over the past few years, cardiologists across the country have begun aggressively trying to prevent heart disease in at-risk men, rather than treating them only after their blood pumps have broken down. "My patients who follow a preventive treatment program almost always live free of heart attacks," says Arthur Agatston, M.D., author of The South Beach Heart Program. To help you spot subtle risk factors and correct them before they bury you, we canvassed cardiologists at leading research institutes to compile this list of things they wish you knew.
"I was taught in medical school that when a heart attack happens, vessels have closed gradually, like pipes filling up with sludge," says Dr. Agatston. "We now know that blockages occur suddenly, from soft-plaque ruptures, which often go undetected by standard cholesterol tests and exercise stress tests." The soft plaques resemble pimples in the arterial walls, except instead of pus, they're filled with cholesterol.
Why it's so dangerous: When those pimples pop, a small blood clot forms to heal the injury, followed by scar tissue and tiny calcifications along the arterial wall. By then, you're already incubating an attack, which strikes when a violent explosion of one of the pustules creates a clot big enough to block an artery.
How to ID the problem: If you have a family history of heart disease, schedule a 64-slice CT scan. It's the only test that snaps pictures of the heart quickly enough to reveal minute calcifications in the coronary arteries. Just make sure the scanner has ECG dose modulation, the latest radiation-limiting technology. If trouble's spotted, you may need statins.
How to defend yourself: Toss pecans onto your salad or into your oatmeal. Loma Linda University researchers had 24 people replace 20 percent of their daily calories with pecans for a month, and found the nuts lowered levels of lipid oxidation (the process that turns cholesterol into plaque) by 7 percent, enough to help ward off arterial damage. "Pecans are rich in gamma-tocopherol, a form of vitamin E that isn't in supplements," says lead author Ella Haddad, Dr.P.H., R.D. Even a handful a day can help, she says.
Not every heart test needs to take place in a cath lab. In a 23-year study of 6,000 men in the New England Journal of Medicine, researchers revealed that the greatest predictor of death from heart attack was the ability of a man's heart rate to adapt during and after a workout. "The faster your heart rate goes down after exercise, the healthier you are," says Steven Nissen, M.D., chairman of cardiovascular medicine at the Cleveland Clinic.
Why it's so dangerous: Those men whose heart rates didn't drop by at least 25 beats per minute (bpm) within 1 minute of finishing an intense workout were more likely to suffer a fatal heart attack than those whose heart rates dropped efficiently. The reason? How your heart adapts to exercise is a good indication of how well it will respond to the extreme stress produced before and during an actual infarction.
How to ID the problem: Complete 10 minutes of sprints, check your heart rate, and then check it again 1 minute later.
How to defend yourself: Improve your heart-rate variability by applying the principles of interval training to your lifting regimen. Wear a heart-rate monitor and don't end your first set until the monitor reads 160 bpm, says Alan Stein, C.S.C.S. "Then wait till it drops below 130 bpm to begin your next set."
Researchers now realize that the size of cholesterol particles is even more important than their number. Small particles of LDL, called Lp (a), are a particularly damaging form of cholesterol, according to Michael Ozner, M.D., medical director of the Cardiovascular Prevention Institute of South Florida. These particles aren't only smaller, they have a tail, says Dr. Ozner, making it easier for them to sneak into the arterial wall. On the flipside, the larger your HDL particles, the more easily they can usher LDL cholesterol out of your arteries.
Why it's so dangerous: A recent study in the Journal of the American College of Cardiology reveals that people with high Lp (a) were 10 times more likely to suffer a heart attack than those with lower levels.
How to ID the problem: Ask your doctor to schedule a Vertical Auto Profile (VAP) test. (Check it out at www.the vaptest.com. It's covered by most insurance plans.) This detailed blood profile includes a measure of Lp (a)--an ideal level is below 10 milligrams per deciliter--as well as big and small HDL particles.
How to defend yourself: Diet, exercise, and even statins have proven ineffective against Lp (a). But in a review of 8 years of studies on prescription niacin, Dutch researchers determined that swallowing 2 grams of this potent B vitamin lowered Lp (a) by 17 percent and raised the number of large HDL particles by 18 percent. Ask your doctor for a slow-release version of niacin. Research has shown that these formulations produce fewer side effects.
The more carbohydrates you consume, the higher your blood sugar and, in turn, your levels of insulin, a hormone that lets us use sugar as energy. But excess insulin may also increase your risk of heart disease, according to a review in Preventive Medicine. "The inflammatory process leading to hardening of the arteries is mediated through insulin," says Wolfgang Kopp, M.D., the study's lead author. Translation: High levels of insulin boost your body's production of stress hormones, which send blood pressure skyrocketing. That increased pressure damages the arterial wall, making it easier for cholesterol to slip inside.
Why it's so dangerous: Insulin may not act alone. It's theorized that the excess carbohydrates that cause insulin to increase to an unhealthy level are turned into triglycerides in your liver. And the more triglycerides you have circulating in your bloodstream, the more Lp (a)--the lethally small cholesterol--you're likely to have.
How to ID the problem: Johns Hopkins University researchers showed that for every 1 percent increase in hemoglobin A1c (HbA1c), an indicator of long-term blood-sugar levels, patients experienced a 14 percent increase in heart-disease risk. If diabetes appears anywhere on your family tree, schedule an HbA1c test. A level higher than 4.6 percent of total hemoglobin often warrants dietary changes and sometimes blood-sugar-lowering drugs.
How to defend yourself: Pour yourself a cabernet. According to a recent study in the Annals of Epidemiology, small amounts of alcohol may help control your blood sugar, and, by extension, your insulin. Researchers studied the drinking habits of people with type-2 diabetes and found that compared with teetotalers, those who indulged in just one alcoholic beverage per night had levels of HbA1c that were 1.3 percentage points lower on average.
One in four men will develop an irregular heartbeat, or arrhythmia, by the time they reach 40. Yet they often don't experience obvious symptoms until they're clutching their chests during cardiac arrest or they suffer a stroke. Your heartbeat originates in the sinoatrial (SA) node, a collection of specialized heart cells that acts as your heart's control center, says Jennifer Cummings, M.D., director of electrophysiology research at the Cleveland Clinic. "It reacts to information from your body and brain about how much blood needs to be pumped, then sends an electrical impulse telling your heart when to beat."
Why it's so dangerous: "When an arrhythmia occurs, the heart stops listening to the SA node, turning its attention to other electrical signals," says Dr. Cummings. One form of arrhythmia, called atrial fibrillation, or AFib, can occur even in young athletic men. "It's like there are 300 voices inside the heart telling it what to do," says Dr. Cummings. Chaotic heartbeats cause the blood to swirl and eddy instead of flowing smoothly through the ventricles, and clots form as a result.
How to ID the problem: One telltale sign of an arrhythmia is a dramatic decline in endurance. If your regular cardio workout is suddenly a lot more exhausting, ask your doctor for an EKG. If that comes up clear, request a Holter monitor. It records your heart rhythm for 24 hours to detect more infrequent missed beats. Passing out may also be a sign of serious heart-rhythm trouble.
How to defend yourself: One of the most common causes of arrhythmia is high blood pressure, so keep yours under 120/80 millimeters of mercury. A massage may provide pleasurable stress relief. In a recent University of South Florida study, people who underwent three 10-minute massages a week experienced an 18-point drop in their systolic blood pressure and a 5-point drop in their diastolic blood pressure after just 10 sessions.
Four alarming chest sensations that can impersonate an infarction
A Fluttering or Pounding Heartbeat
"Some perfectly healthy and normal individuals may feel extra or skipped heartbeats on occasion, and those can be benign," says P.K. Shah, M.D., a Men's Health cardiology advisor. If the sensation is brief and the onset gradual, they are probably the harmless result of too much caffeine or stress. However, frequent flutterings, or those accompanied by lightheadedness or dizziness, could be serious.
Chest Pressure When You Swallow
If you feel a squeezing pain beneath your breastbone and it hurts to swallow, especially in the evening, you may just have heartburn or, at worst, an esophageal spasm. But if it persists most nights of the week, see your doctor to rule out gastroesophageal reflux disease or other more serious conditions.
Shooting Pain on One Side
"Sharp, fleeting pain on the left side of the chest is typically not life-threatening," says John Elefteriades, M.D., a Men's Health cardiology advisor. It can signal pleurisy (an inflammation of the lung lining), a muscle pull, or even a broken bone.
Mild Pressure, Shortness of Breath, and Numbness
Hyperventilation is commonly mistaken for a heart attack. If the pressure in your chest isn't severe, and you lose feeling in your lips or hands, you may simply be hyperventilating. Lie down, try to relax, and breathe into a paper bag for 5 minutes. Still have symptoms? Call 911.