Saturday, May 01, 2010

Is it Possible to Prevent a Heart Attack?

Your Heart Matters!

Dr. Srinivas Vengala will take questions from our readers in this column for July 1 edition. Please send your questions to .(JavaScript must be enabled to view this email address).

Dr. Srinivas Vengala, M.D., FACC is an assistant professor in Division of Cardiology at University of Alabama at Birmingham, AL. His additional interests are Preventive Cardiology and structural heart diseases. He completed his cardiology training from Allegheny General Hospital/Drexel University, Pittsburgh, PA and his residency from Temple University, PA. He practiced Internal Medicine for three years in PA prior to joining UAB.

Our knowledge of heart disease, its causes and prevention, has dramatically improved in the last 20 years. Unfortunately the incidence is increasing in the younger population, while prevalence continues to be high in higher age groups.

I recently saw a 50 yr old woman in my clinic who was concerned about avoiding a heart attack. Although she was fairly healthy, with controlled blood pressure and normal weight, she wanted help because her sister had a heart attack at 54 and her father had one at 57.

Is it really possible to prevent a heart attack? The question arises for anyone when a loved one is struck down by the condition. Thankfully, there are certain things we can do to decrease the chance of having a heart attack.

Risk factors for heart attack
Let’s first talk about risk factors that can lead to a heart attack. There are multiple factors responsible, but we will go over the major ones which include,

1. Age
2. Genes
3. High Blood pressure
4. High Cholesterol
5. Obesity
6. Diabetes mellitus
7. Smoking

As we all know, we have no control over the first two factors, age and genes (we cannot reverse aging or choose our genes). But we can definitely alter the remaining risk factors to reduce the chances of a heart attack.

So, how can it be done?
In three words: life style modification. When implemented, this simple statement has profound meaning and a dramatic impact.

Essentially, life style modification advocates changing unhealthy habits (smoking, overeating, living a sedentary life style) to reduce the risk of heart disease. One of the most important goals of life style intervention is weight management. Losing excess weight improves blood pressure, reduces cholesterol, and decreases the incidence of diabetes. So, weight loss all by itself reduces other major risk factors and decreases the chances of having a heart attack.

Weight loss and healthy weight maintenance can be achieved by diet, exercise, and behavior modification. One example of a successful life style intervention program is the Diabetes Prevention Program (DPP). This multicenter research study showed that with a minimum of 7 percent weight loss and a minimum of 150 minutes of exercise per week (such as brisk walking) the incidence of diabetes can be reduced by 58 percent and there is also a reduction in heart disease.

Major weight loss can be achieved by diet modification alone. Adding exercise will increase weight loss by a small percentage but the main benefit is in maintaining the weight loss. So diet plays an important role in losing weight and it is essential to set realistic goals. A good initial weight loss goal of 5 to 7 percent of body weight is reasonable when discussing a dietary weight loss program.

Approximately 22 cal/kg is required to maintain current body weight in a normal adult. An average deficit of 500 cal/day should result in weight loss of approximately 0.5 kg/week. So a person weighing about 100 kg requires about 2200 cal/day to keep this weight, and in order to lose about 1 lb (0.5 kg) per week, he or she should lower calorie intake to approximately 1700 cal/day. The rate of weight loss is directly related to the difference between the person’s energy intake and energy requirements. Reducing caloric intake below requirements results in a predictable rate of weight loss.

There are various types of diets: low-calorie diets, portion-controlled diets, low-fat diets, low-carbohydrate diets, Mediterranean diet etc. Numerous trials evaluating diets and weight loss reveal that in the short term (six months) there is some difference, but in the long term (1 year) there was no significant difference between them. Thus, any type of diet that is strictly followed will produce good results, but adherence is the key for long term success. The principal factor for weight loss and healthy weight management is sticking to the diet, irrespective of the type of diet. This means it is wise to choose a diet based on individual preference and eat foods with adequate nutrients which ultimately improve long term adherence.

Conclusions
Heart attack is preventable. Weight loss is the key. Maintaining a healthy weight results in improved blood pressure control, improved cholesterol numbers and a decreased incidence of diabetes. Because of these factors, achieving and maintaining a healthy weight plays a major role in prevention of heart attacks. The first goal for any overweight individual is to prevent further weight gain and keep the body weight stable (within 5 percent of its current level). But most important of all—choose a diet of personal choice and stay with it for long term results.

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