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Hal Higdon's 7-7-70 Quest - American Heart Association

By Hal Higdon

How to Prevent Heart Disease

Sitting in the crowded waiting room, I saw people around me who seemed old, infirm, obese: not the sort you'd expect to encounter at a 5-K starting line. One individual needed the help of a walker. Moving tediously, he joked to the nurse, "If I have to take a treadmill test, we're in trouble."

I wondered: What am I doing here among all these unhealthy people?

I wasn't old, I wasn't ill, and I certainly wasn't overweight. Yet, despite my background as a runner, the truth remained: I had coronary heart disease! Maybe we all do to a point, but mine now had been properly diagnosed. Kenneth H. Cooper, M.D. made the initial assessment at his Aerobics Clinic in Dallas, Texas. Using an ultrafast CT scan, he detected calcification around my main coronary artery. A follow-up exam several months later at Rush-Presbyterian Hospital in Chicago confirmed Dr. Cooper's diagnosis and revealed a calcium score of 480 and a homocystene level of 16, putting me in the 95th percentile of high risk. Later, I had a surgical catheterization under the supervision of Franklin Wefald, MD, a cardiologist at Elkhart General Hospital in Indiana. Dr. Wefald said that I "passed," that my blood circulation remained good, but he prescribed medication to arrest, if not reduce, the buildup of plaque that had reached 40 percent in one of my arteries.

How could this happen to a well-conditioned athlete? Isn't running supposed to prevent heart disease? I've run continuously since high school. I never smoked. I follow a low-fat diet. Until recent tests, my cholesterol count consistently had been 180 or lower. I have a low-stress job, one I enjoy. Every second or third year I visit Dr. Cooper for a physical examination and have always been placed in the 95th percentile of low risk. To shift suddenly from low to high risk didn't make sense to me.

Yet dare I deny the evidence? The calcification of my arteries did not happen overnight. The plaque must have been building up for years, if not decades. Most likely it was genetic, inherited from my parents who died of heart attacks. My high level of fitness may even have disguised the problem. The increasing availability of highly sophisticated machines, however, now makes diagnosis easier and more precise. My experience should motivate all of us to look in the mirror. Nobody is immune. But you don't have to wait to be diagnosed with coronary heart disease to modify your lifestyle. Even young people can change habits so as to modify their risk factors. It's never too early and never too late. Here's how to keep your heart healthy:

The Case for Exercise

The case for exercise as a means of preventing coronary heart disease is overwhelming, insists Paul D. Thompson, MD, director of preventive cardiology for Hartford Hospital in Connecticut. "There are a multitude of epidemiological studies that have looked at people who are active in occupations and at leisure," states Dr. Thompson. "In all those studies, the more active you are, the less likely you will suffer from a heart attack."

Research into cause-and-effect goes back to 1802 and to a physician named William Heberden who first described angina, the chest discomfort that is symptomatic of inadequate blood flow to the heart. In his Commentaires on the History and Cure of Diseases, Dr. Heberden admitted that he wasn't certain how to treat angina, but described a patient who "set himself the task of sawing wood for half an hour every day and was nearly cured."

But few people saw wood any more. It's easier to drive to the Garden Center in your S.U.V. and pick up a cord for your fireplace. Twentieth Century Man (and Woman) sit in front of computers rather than labor in the fields. If you want to prevent heart disease, you need to program time for exercise. Physical Exercise--and specifically running--can have a positive effect on several risk factors:

* Body weight: Exercise more and weigh less. Run or walk a mile, and you burn 100 calories. Burn 3,600 calories and you lose 1 pound. Overweight people are more likely to have heart disease. "Body weight is not a major risk factor," admits Larry Gibbons, MD, medical director of the Cooper Clinic, "but it contributes to many of the other risk factors, particularly diabetes."

* Diabetes: Control your weight and you're less likely to get adult-onset diabetes. One complication of diabetes is heart disease. Exercise not only burns excess glucose in the blood stream, but apparently improves insulin function. Many diabetics who exercise can decrease their insulin shots. "Fewer people who exercise develop diabetes as they age," says Dr. Thompson."

* Blood Lipids: The most significant risk factor is cholesterol, since this compound causes plaque to block arteries. Exercise somewhat lowers the bad LDL cholesterol, but more important: it raises the level of the good HDL cholesterol, a proven artery-cleanser. Exercise also lowers triglycerides.

* Blood Pressure and Stress: Exercise not only lowers systolic and diastolic pressure, but it prevents the development of high blood pressure. Another related risk factor is stress, including anger, hostility and depression. "Exercise is a proven stress eliminator," says Dr. Gibbons.

* Smoking: It's difficult to smoke while you exercise. Many individuals discover that by embracing a positive addiction like running, they can more easily eliminate their negative addiction of cigarettes.

All of the benefits of exercise on the cardiovascular system are not entirely understood by heart scientists. Dr. Thompson speculates that exercise helps to relax the coronary arteries so they open up. Exercise also increases the amount of blood pumped with each heartbeat. This lowers the workload, so the heart muscle uses less oxygen. Increased blood flow also promotes the development of collateral routes: bypasses around semi-blocked arteries that can help you survive a heart attack if one occurs.

How far do you need to run? There's no easy formula, says Dr. Thompson: "To a point, the more you run, the more protection you get. While a 1-mile walk is good; 3 miles jogging seems to be better. At higher mileages, you reach a point of diminishing returns, but the exact mileage is hard to pinpoint, and it certainly varies with individuals." Research at the Cooper Clinic, however, suggests that most benefits occur by 3 miles, but you need to be regular--at least five days a week (thus, 15 miles a week). Running some of those 3-mile workouts at a faster pace (85% of maximum heart rate) seems to offer more benefits, but may create additional risk for those with arteries already partially blocked.

"The major risk is for people who have hidden heart disease, or who develop symptoms and ignore them," cautions Dr. Thompson. Exercise, however, is not a panacea. As I discovered when tested at the Cooper Clinic, all the running I did failed to immunize me from coronary heart disease. For maximum benefits, you need to combine exercise with a healthy diet:

The Case for Diet

While exercise is essential if you want to prevent coronary heart disease, diet and nutrition rank equal in importance. It's the other edge of the preventive sword. Why place so much emphasis on diet? In Eat Your Way to a Healthy Heart, Liz Applegate, Ph.D. explains: "More than half the deaths that occur every year in the U.S. are a direct result of clogged arteries that cause heart attacks and strokes. Twice as many people die of heart and other vascular diseases than cancer. Food is your best weapon against heart disease."

The first rule of managing heart health with nutrition is getting the fat content of your meals into the 20 to 30 percent range. For most people, this means lowering fat content, but some individuals already on very low-fat diets may actually need to increase fat intake. The best fats are the monounsaturated fats found in olive oil, canola oil and nuts. Also ranking high among nutritionists are the Omega-3 fats found in fish, as well as in flaxseed meal and oil. The worst are the saturated fats found in animal products and processed foods, which also contain artery-clogging hydrogenated fats, or trans-fats.

"You need to know your blood lipid profile to make effective food choices," explains Joanne Milkereit, R.D. at the Medical University of South Carolina. "Individuals who choose low-fat diets may have low levels of LDL cholesterol, but, surprisingly, they sometimes have high triglycerides and not enough of the (good) HDL cholesterol." Milkereit cites a National Institutes of Health recommendation that cholesterol should be measured in all adults 20 years of age and over at least once every five years. HDL cholesterol can be measured at the same time. Consult a physician to determine whether you should change your diet to improve your lipid profile; consult a dietitian for advice on how to do it.

Heart strategy is also important. It's not only what you eat, but when you eat it, claims Nancy Clark, RD, director of nutrition services at Sportsmedicine Brookline in Massachusetts and the author of Nancy Clark's Sports Nutrition Guidebook. Clark identifies breakfast as the key meal of the day. "Fortify yourself for a high-energy day by eating a hearty breakfast featuring a fiber-rich cereal covered with lots of fruit, and you won't get as hungry later in the day," she says. "Add a good lunch, and you'll be less likely to snack on fatty foods that are bad for your heart."

Current research identifies fiber as important for heart health. Dr. Applegate recommends that in addition to choosing that high-fiber cereal (she prefers oats), keep peels on fruits and select whole versions of other grain products. She also likes beans, particularly kidney beans and lentils. "The amount of fiber in beans is staggering," says Dr. Applegate. "Everybody should be eating beans four or five times a week." While you are getting the fat out, get into your diet the vitamins that research suggest promote a healthy heart. These would include the antioxidant vitamins C and E along with carotines. And although many cardiologists prescribe supplemental vitamins such as B6, B12 and Folic Acid to help keep homocysteine levels low, nutritionists such as Milkereit, Applegate and Clark prefer that individuals first seek those vitamins in the refrigerator rather than in the medicine cabinet.

Here are some heart-healthy foods they suggest you add to your table:

* Oil and Nuts: Researchers suspect that the olive oil present in the diets of people living in Mediterranean countries is one reason people from those countries have a lower rate of heart attacks than Northern Europeans. Choose an olive oil-based salad dressing instead of the creamy kind. Almonds and peanuts (including peanut butter) also are good sources of monounsaturated fats. And don't add monounsaturated fats without subtracting saturated fats. "If you are already getting 30 percent of your calories from fats, adding olive oil and nuts will be too much," warns Milkereit.

* Fish: Eskimos traditionally followed diets containing as much as 50 percent fats, yet rarely died of heart attacks. One reason is because the fats they ate typically were Omega-3 fats found in cold-water fish. (This is a liquid form of fat different from the hard fat found in butter and diary products.) Rather than clog arteries, Omega-3 fats lower blood cholesterol and triglycerides and decrease the likelihood of blood clots by making platelets in the blood less "sticky," thus less likely to stick to artery walls. Salmon, a fish found in the waters around Alaska, but also in the Great Lakes, is a particularly good menu choice. "If you don't eat fish at least once a week," suggests Dr. Applegate, "you aren't taking advantage of a heart-healthy diet." Tuna, as well as salmon, is a particularly good source of Vitamin B12.

* Veggies: "Go for the (carotene-rich) dark green stuff, such as broccoli and spinach" advises Clark. Spinach is a good source of Folic Acid, often prescribed for heart patients. Clark recommends any vegetables with deep color such as tomatoes and carrots. "No vegetables are bad," she says. "Some are just nutritionally better than others." Milkereit's favorite vegetable is the sweet potato, which she would rather see on the plates of carbo-loading runners than pasta. "Pasta attracts a lot of attention, but it's made from processed grain," she says. Beans are good heart protectors, particularly soybeans.

* Soy: Regardless of how it comes--tofu, miso, natto, tempeh, soymilk, soyu flour, soybeans, soynuts, soy sauce--soy has leaped to the top of the charts among nutritionists seeking to prevent heart disease. Soy contains phytochemicals that prevent blood clots from forming. Dr. Applegate recommends that runners get at least one serving of soy into their diets each day. "When soy protein is substituted in the diet for other proteins such as milk or beef, cholesterol levels fall off the chart," she says.

While I always followed what I considered a well-balanced diet, because I ate a wide variety of lightly processed foods and got sufficient carbohydrate to fuel my long runs, the various scans and tests I took indicated that I still had room for improvement. Fortunately, I have begun to take steps to assure that I will continue to run into the millennium. I now watch my diet even more closely and have begun to take supplements, including Folic Acid, Niacin, Norvasc and baby aspirin under Dr. Wefald's supervision.

When Dr. Wefald called with the results of my most recent blood test, he said all the numbers looked good. My triglycerides were at 122, and my total cholesterol had dropped from 212 to 184. My (bad) LDL cholesterol fell from 144 to 105; my (good) HDL went from 50 to 54, resulting in an impressive LDL/HDL ratio of 1.94. My homocysteines were now TK. I plan to make some additional dietary changes to improve even those numbers

According to Pamela Douglas, MD of Harvard Medical School: "The most powerful thing you can do to prevent heart disease is to exercise and eat well. Fitness is tremendously important in preventing heart disease, but you have to utilize a nutritional diet as well. Do so, and you will reap the benefits for years to come.

("How to Prevent Heart Disease" originally was published in a slightly different version in the November 1999 issue of Runner's World under the title "Take It To Heart." Copyright 1999 by Hal Higdon, all rights reserved.)

More information on Heart Disease:
What's Your Heart Risk?
10 Favorite Foods
For the Future
The Hearts of Women

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