how to prevent heart disease

Regular physical activity helps prevent heart disease by increasing blood flow to your heart and strengthening your heart's contractions so that your heart pumps more blood with less effort. Physical activity also helps you control your weight and can reduce your chances of developing other conditions that may put a strain on your heart, such as high blood pressure, high cholesterol and diabetes. It also reduces stress, which may also be a factor in heart disease.
Heart disease prevention is considered important before and after someone is diagnosed with the condition:

• Primary prevention refers to measures that should be done to reduce the risk of heart disease in everyone.
• Secondary prevention refers to measures to reduce the risk of progression of heart disease in a patient who has already been diagnosed. Many of these measures are similar or the same as those recommended for primary prevention.

Key prevention measures include:

• All patients should stop smoking
• Maintain cholesterol levels at appropriate levels using a heart healthy diet, exercise, and medications
• Maintain an appropriate low blood pressure level
• Maintain an active lifestyle
• Use an antiplatelet drug, such as aspirin, if appropriate (see Medications section of this report)
• Manage diabetes and kidney disease when present

Smoking Cessation

Your doctor should ask about your smoking habits at every visit. Smoking is a chronic condition and often requires repeat therapy using more than one technique.

Cholesterol and Other Lipid Disorders

All patients should start following a heart-healthy diet and exercise regularly, after talking to their doctors.

Healthy diet, regular exercise, and quitting smoking (if you smoke) may prevent heart disease. Follow your health care provider's recommendations for treatment and prevention of heart disease.

Statin drugs are the primary medications used for lowering LDL (“bad”) cholesterol levels. For patients without heart disease, the doctor will start or consider medication, increase dosage of medication, or add new medication when:

• LDL cholesterol is 190 mg/dL or higher.
• LDL cholesterol is 160 mg/dL or higher AND patient has one risk factor for heart disease.
• LDL cholesterol is 130 mg/dL or higher AND patient has either diabetes or two other risk factors for heart disease.
• LDL cholesterol is 100 mg/dL or higher AND patient has diabetes. Even without heart disease, medication may be considered for an LDL cholesterol of 100 mg/dL.

For patients with heart disease, the doctor will start or consider medication, increase dosage of medication, or add new medication when:

• LDL cholesterol is 100 mg/dL or higher
• LDL cholesterol is greater than 70 mg/dL. According to national guidelines, treating a patient with LDL cholesterol levels between 70 - 100 mg/dL is not required but is considered reasonable. This would be true particularly for patients who have had a recent heart attack or have known heart disease along with diabetes, current cigarette smoking, poorly controlled high blood pressure, or metabolic syndrome (high triglycerides, low HDL, and obesity).

Atherosclerosis is thought to be a disease of modern human beings and related to contemporary lifestyles. Its prevalence before the modern era was "suspected" to be much less, but was, in fact, unknown. To resolve this question, a recent study looked back at atherosclerosis across 4000 years of human history by examining mummies from four ancient populations.1 What they found suggests that hardening of the arteries is an old problem--stretching back to the dawn of human history. Perhaps, the study's authors suggested, we are genetically encoded to have heart disease as we age. We just published a blog on this study, but it only scratched the surface on how to prevent heart disease. There's a lot more to this topic than meets the eye...or was reported in the press.

Is Heart Disease Genetic?

It's been generally assumed by most people in the medical field for some time now that atherosclerosis (hardening of the arteries) is caused by smoking, eating fatty foods, high cholesterol levels in the blood, and lack of exercise. In order to once and for all test that theory, the researchers obtained whole body CT scans of 137 mummies from four different geographical regions spanning more than 4000 years. These remains of Individuals from ancient Egypt, ancient Peru, the Ancestral Puebloans of southwest America, and the Unangan of the Aleutian Islands were imaged. Atherosclerosis was regarded as definite if a calcified plaque was seen in the wall of an artery and probable if calcifications were seen along the expected course of an artery.
As just stated, the mummies came from around the world: ancient Egypt, Peru, the southwestern United States, and the Aleutian Islands near Alaska.

• In ancient Egypt, the mummies were deliberately preserved -- a practice largely, but not entirely, reserved for royalty.
• In Peru, the southwestern United States, and the Aleutian Islands, the bodies were naturally mummified by dry air and other conditions.

As it turns out, these ancient peoples did not seem to know how to prevent heart disease. Probable or definite atherosclerosis was noted in 34% of the mummies and in all four geographical populations. That includes: 38% of the 76 ancient Egyptians, 25% of the 51 ancient Peruvians, two of five Ancestral Puebloans, and three of five Unangan hunter gatherers. Specifically, atherosclerosis was present in the aortas (chest and upper abdomen) of 20% of the mummies, in the iliac (lower abdomen) or femoral (thigh) arteries of 18% of the mummies, the popliteal (back of the leg, behind the knee) or tibial (calf) arteries of 18%, the carotid (neck) arteries of 12%, and the coronary arteries of 4% of the mummies. Of the five vascular/arterial beds (minute networks of blood vessels that feed specific area of the body) examined in each mummy, atherosclerosis was present in at least one or two of those beds in 25% of the mummies, in three or four beds in 8%, and in all five vascular beds in 1%. Note: In some cases the mummies' calcified plaques actually outlasted their arteries.
Both male and female mummies had the same amount of plaque. The mummies' estimated ages ranged from 2½ years old to more than 60 years old, with an average age of 36. Mummies of older people had more atherosclerosis than those of the younger mummies.  Curiously, the mean age at death was 43 years for mummies with atherosclerosis versus 32 years for those without. In other words, those with atherosclerosis seemed to live longer. Then again, there was no indication that any of the mummies actually died of heart disease, so it is most likely just a quirk of the numbers resulting from the dangerous lives they lived. And when it came to atherosclerosis in the arterial beds, the mean age at death was more in line with what might be expected. The mean age was 32 for mummies with no atherosclerosis, 42 for those with atherosclerosis in one or two beds, and 44 for those with atherosclerosis in three to five beds. Then again, none of those deaths seemed to be caused by the atherosclerosis. Most likely, they just didn't live long enough to succumb to it.

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