How to identify your major risk factors and diminish their danger.

Printer-Friendly Version ALSO WITH THIS ARTICLE Use These Numbers To Map A Plan For Prevention

Call them “lucky seven” if you want, even though your heart’s health depends more on taking most or all of these seven steps than leaving your well-being to blind luck.

Research findings from the past 12 months — highlighted below — underlie most of the strategies.

Not sure where to begin? Consider starting by checking on how well you stack up against gold standards for heart health (see “Use These Numbers to Map a Plan for Prevention"). Then focus first on any of the “big four” factors that put you at risk.

The “Big Four”
New in the past year: Some 80 to 85 percent of cases of coronary heart disease (CHD) link up with at least one of just four risk factors: smoking, high blood pressure, cholesterol abnormalities, and diabetes.

That’s the conclusion of a Cleveland Clinic study, which dispels the myth that as many as half of people with heart disease have no major cardiac risks (August 20 2003 Journal of the American Medical Association). The findings leave less room for chance or mystery factors. And they mean that your health choices count more than most people previously believed. Here’s how to choose well:

1. Don’t smoke. Smoking is responsible for about one of every five cardiovascular deaths. Quitting clears this dark cloud. The smoking-related risk of developing CHD drops by half one year after a smoker kicks the habit, according to information compiled by the World Health Organization.

New in the past year: Evidence that among people who already have heart disease, stopping smoking can reduce mortality from all causes by 36 percent (July 2 2003 Journal of the American Medical Association).

Take control now: If you smoke, talk with a physician about aids like nicotine gum, nasal sprays and patches, combined with short-term counseling.

If you’ve tried to stop before and failed, try again. It takes the average smoker three to six attempts before tobacco is yesterday’s menace.

2. Control blood pressure. New in the past year: Guidelines released last spring lowered the range of “normal” blood pressure to less than 120/80 millimeters of mercury (mm Hg). The guidelines designate “optimal” blood pressure as 115/75 mm Hg (May 2003 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure). “High blood pressure is rampant in western society,” says Gary S. Francis, M.D., director of the Coronary Intensive Care Unit at The Cleveland Clinic. “If you live long enough, almost everyone seems to get it.”

Take control now: If you’re overweight, slash your systolic blood pressure (the upper number) by five to 20 points, by losing 22 pounds. Shave eight to 14 points by following the DASH diet (Dietary Approaches to Stop Hypertension). It’s low in fat and high in fruits, vegetables, whole grains, and low-fat dairy products. Take off four to nine points by exercising, with your doctor’s approval, for 30 minutes on most days of the week.

3. Manage your cholesterol. Lipid abnormalities, such as high levels of LDL (“bad”) cholesterol or low levels of HDL (“good”) cholesterol, are well-known risk factors for coronary artery disease and heart attack. As a general rule, each one percent increase in LDL raises the risk of developing coronary artery disease by two to three percent.

The “optimal” guideline level of LDL is less than 100 milligrams per deciliter (mg/dL). New in the past year: research from The Cleveland Clinic suggesting that when LDL levels drop well below 100, under the force of a potent statin drug (atorvastatin), the dangerous inner wall of plaque inside heart arteries stops growing. Guidelines won’t change, though, unless and until ongoing research confirms that low-low LDL means less CHD.

But statins appear to protect the heart in other ways as well. “It’s not just the lipid-lowering that seems to benefit patients,” Dr. Francis says. “It may also be the drugs’ anti-inflammatory activity. As a result, a statin would be considered even in patients with relatively normal lipid profiles but who have other cardiovascular risk factors.”

Take control now: You should have a fasting lipoprotein profile performed at least every five years. If abnormalities turn up in blood tests, the National Cholesterol Education Program suggests “therapeutic lifestyle changes” (TLC). That’s a diet low in saturated fat, high in soluble fiber, such as oat bran, oatmeal, apples, and other fruits and vegetables. Weight management and, again, 30 minutes of physical activity on most days of the week are the other key components of the TLC program.

4. Prevent or manage diabetes. Like hypertension, type 2 diabetes is a silent disease. As a result, nearly half of people with this form of diabetes (by far the most common type) aren’t aware that they have it. Diabetes damages blood vessels throughout the body, including heart arteries.

Take control now: People older than 50 should undergo a fasting plasma glucose test at least once every three years. If you have risk factors for diabetes, such as obesity or a family history of the disease, your doctor may recommend more frequent testing. “With type 2 diabetes, if you lose weight and achieve an ideal body weight, in many cases the risks revert toward normal,” Dr. Francis says.

Three more strategies are gaining importance as many Americans gain weight, endure more stress, and turn for better or worse to alternative medicines.

5. Limit fast food. Steer away from the drive-through fast food lanes, Dr. Francis says, and “avoid any diets that are enormously high in fat and salt....No one is saying that you have to eat twigs and bark. But to eat fast food all the time just isn’t good for you.”

6. Get treatment for depression. A number of well-conducted studies suggest that depression, anxiety, and hostility all take a toll on the heart. (One of the latest appeared in the November 19 2003 Journal of the American College of Cardiology.) Heart patients who are depressed, for example, have “stickier” platelets, increasing the risk of blood clots. The message from your emotional heart is that if you are chronically anxious, angry or depressed, you should seek treatment.

7. Take prescribed medicines. Non-compliance with recommended treatment is a significant problem that contributes to an untold number of cardiovascular deaths. “Some of it has to do with cost,” Dr. Francis says. “Some of it is the fact that patients have no symptoms. And some of it is a sense of alienation from conventional medicine — wanting to take herbs and other things.” The reality is that most heart patients require multiple medications.

The plethora of drugs may be daunting. But taking medications as prescribed loads the odds of longer life in your favor.