An ounce of prevention

Published 5:05 pm Friday, February 3, 2017

Benjamin Franklin’s famous words, “An ounce of prevention is worth a pound of cure,” are especially relevant when it comes to your heart health.

Early prevention is much more rewarding than trying to “fix” the problem after it happens. Simple lifestyle changes — in addition to knowing and controlling your risk factors — will go a long way in preventing heart attacks, strokes and early death. Below, I will discuss the most common risk factors that affect your heart and suggest ways to lower your risk.

Let’s start with the non-modifiable risk factors. They are non-modifiable because you can’t change them. These include your family history and age. In general, our risk for heart disease increases with age. Your risk is also higher if you have history of premature coronary disease in your immediate family: a female first-degree relative (your mom or sister) who had a heart attack or coronary disease when she was less than 65 years or a male first-degree relative (dad or brother) less than 55 years. Heart disease in family members at older age is common and is not counted as a risk factor. Knowing that you have a strong family history should prompt you to be more aggressive in controlling other modifiable risk factors.

Modifiable risk factors are those that you and your doctor can change. By doing so, you can significantly lower your future risk:

  • Obesity, Diet and Life Style: Obesity can increase risk by raising your blood pressure, cholesterol and affecting your ability to exercise. It is estimated that 68 percent of adults are overweight and 34 percent are obese. An ideal heart-healthy diet as defined by the American Heart Association entails that saturated and trans-fat should be limited to less than 7 percent and 1 percent of your daily calories, respectively. Furthermore, you should consume less than 300 mg cholesterol a day and at least two servings of oily fish per week (salmon, trout, herring). Adding nuts to your diet can induce early satiety and improve cholesterol. Additionally, physical activity can help control weight and improve cardiovascular health. It is recommended to exercise at least 30 minutes a day, five days per week.
  • High Blood Pressure: High BP or hypertension is a strong risk factor that can often be easily treated. One third of adults have hypertension (over half of those over 55 years and 70-80 percent of patients over 75 years). Lowering BP reduces risk of heart attack by 20-25 percent, stroke by 30-35 percent and heart failure by 50 percent. In addition to taking medications, limiting your salt intake, alcohol consumption, losing weight and exercising may all help lower your BP. If you have high BP, your daily sodium intake should not exceed 1.5 grams per day. This is the equivalent of less than a teaspoon of salt from all sources per day. Canned, processed and fast foods are especially high in salt. Despite the well-known cardiovascular harms of salt, 90 percent of Americans continue to exceed the daily allowances (2.3 g) in their diets! It is also recommended to limit alcohol to no more than two drinks a day (one drink = 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor) for men and half that amount for women.
  • Smoking: Smoking is a strong risk factor for heart attack and stroke. It is estimated that smoking contributes to 5 million deaths a year worldwide, which accounts for 10 percent of all deaths, and 1.6 million of these deaths are related to cardiovascular disease. Smoking can lower your good cholesterol (HDL), cause spasm and disruption of the inner lining of the coronary arteries and increase tendency to form blood clots. In addition, smoking causes many other illnesses — including cancers — that can add stress to your heart. It is estimated that smoking a pack a day increases your risk of cardiovascular disease by 12 times, and if you are a woman who takes oral contraceptives, the risk goes up to 32 times. Smokers who have a heart attack and continue to smoke have twice the risk of another heart attack than if they quit. Unfortunately, 1,000 Americans stop smoking every day — by dying!
  • Cholesterol: High and sometimes even “normal” cholesterol can increase risk of heart disease and stroke. LDL or “bad cholesterol” carries cholesterol to the blood vessels and causes plaque buildup. HDL or “good cholesterol” carries the cholesterol particles away from the blood vessels to be disposed of in the liver. Cutting down on foods that are high in saturated fat (red meat, dairy products) may lower the LDL. Nuts, oily fish, exercise and avoiding tobacco products may increase HDL. Current guidelines recommend treatment with a class of drugs called statins to the following groups: 1) Those who have history of coronary disease, vascular disease or stroke; 2) Those whose bad cholesterol is greater than 190mg/dl; 3) Diabetics; and 4) Those whose 10-year risk for cardiovascular disease is greater than 7.5 percent. You can calculate your 10-year risk by using one of many smart phone apps (CVRISK2013, ASCVD Suite) or going to You will need to know your cholesterol level and your blood pressure numbers. Treating cholesterol with statins lowers the risk of death from coronary disease by 30-35 percent.
  • Diabetes: Diabetes is a well-known risk factor for vascular disease, strokes and heart attacks. It is not the sugar per se that increases the risk, but rather the insulin resistance that is a hallmark of diabetes. It is estimated that 8-10 percent of the population and 25 percent of those over 65 years old are diabetic. Simple lifestyle changes (regular exercise, weight loss, diet) can decrease the incidence by 50 percent. Presence of diabetes makes it especially important to control other risk factors such as smoking, cholesterol and high blood pressure.

Rony L. Shammas, MD, FACC, FASE, FSCAI, is FASNC interim cath lab director and director STEMI/ACS/Chest Pain Center, Vidant Medical Center.