No matter the lifestyle, men can benet from a routine that refocuses our attention to health.
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In this special issue, Dr. Barbara Roberts and Dr. Brian Bilchik explore how cardiovascular disease aects men and women dierently as well as what we can do to prevent it.
Heart disease is the leading cause of death for men of all racial and ethnic groups, and although about half of all heart disease deaths occur among men and half among women, more than 70% of heart disease deaths among men occur before the age of 65. Data from 44 years of follow-up in the original Framingham Study and 20 years of surveillance of their children has given us important insight. For people who are 40 years old, the lifetime risk of developing heart disease - particularly from arterial narrowing - is 49% in men and 32% in women. For those who reach 70 years old, the lifetime risk is 35% in men and 24% in women. This is largely preventable!
I think I know what to do about my heart health I just cannot get it done.
What are the barriers to implementing preventive strategies on a personal basis? First, let us dispel the no pain - no gain myth as well as the old joke that everything pleasurable turns out to be illegal, immoral, or fattening. Healthy behaviors should not be mysterious or complicated, and the rewards can be immense. But gratication is not instantaneous, and some barriers for men to reach a healthy state can include procrastination, disorganization, denial, self-destructive tendencies, and diculty receiving constructive advice (nagging) from your spouse.
Heart disease is the number one cause of death for women worldwide
If what happened to women was considered the norm, scientists might instead have tried to identify what factors in men were making them susceptible to heart disease at a younger age than women.
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Get organized
One of the best things you can do to get healthy is to get organized. You might nd yourself falling into one of two extremes, either your life is so scheduled there is not time to take care of yourself or your life is so unstructured that
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INSIDE
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Presidents message Big changes coming to the Lown Forum Development in action Save the date Mens heart health (cont.)
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Womens heart health (cont.) How should I take my coee regular or decaf? Patient prole: Living longer and feeling better
NewsBeat
Healthy dining out
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PRESIDENTS MESSAGE
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FO RUM in your home environment to unclutter. Get the clothes o your treadmill/ stationary bike. Review your pantry and get rid of snacks, candy, and salty things.
Nutrition
Certain foods make us hungrier - yes really! Rened carbohydrates (the whites), sweet things, even articial sweeteners, can make us hungry. Pay attention to your waist size. Fat cells (adipocytes) are very metabolically active, the fatter we are the hungrier we get. Fat cells cause inammation, create insulin resistance, and glucose metabolism issues, and this feeds the hunger cycle. As with most addictions - the habituation to overeating, especially energy dense food, takes at least three months to diminish the craving. Alcohol can also make us hungry, but it also contains calories and it decreases our inhibitions - a triple whammy when it comes to nutrition. Watch the salt, especially if you have high blood pressure. Salt will elevate blood pressure and make you more resistant to medications. My patients generally want less medication, and decreasing salt intake can be quite eective. Remember that 80% of the salt we eat is embedded in our food - the more we eat, the higher our salt ingestion and the more resistant our blood pressure. There is good information that controlling obesity would eliminate up to 48% of hypertension. On average, blood pressure falls 0.5 to 2.0 mmHg for every 1.0 kg of weight that is lost. Furthermore, a sustained 4 to 5 mmHg decrease in blood pressure among those with systolic blood pressure >140 or diastolic blood pressure >90 can reduce the incidence of stroke up to 42% and heart attack up to 14%. American adults have access to quick, energy dense, salty food and as a result we have become addicts. These fast foods are cheap, they are subsidized, and they accelerate the path to death and disease. The so called Happy Meals that are underpriced and have a prize are the trap to future addiction. Your best bet is to avoid fast food altogether.
Physical activity
Once you nd time for yourself, you should make sure it also includes physical activity. Optimally you should participate in sustained activity 30 minutes every other day. This will keep your vessels healthier, lower blood pressure, and improve energy, and you may even see an increase in your HDL cholesterol, the good cholesterol. If you feel like you have no time, even exercising for a quick 10 minutes every day will make a dierence. You can be creative with exercise too, it should not be a burden. Socialize around physical activity instead of around food (the Meet to Eat syndrome). Music is a great motivator. I tell all my patients to dance, and this usually brings a smile to their face - hopefully they act on this as well. Some data that proves the benet of consistent gentle exercise: Physical activity habits were analyzed in 10,269 Harvard alumni (their average age was 58) in a retrospective study over 12 years. Those men who engaged in moderately vigorous sports activity (dened as brisk walking, recreational cycling or swimming, home repair, and yard work for 30 min/day on most days) had a 23% lower risk of death than those who were less active. Another study published in a report of the Honolulu Heart Program also showed the benet of regular walking. More than 700 retired nonsmoking men (their average age was 69) who were capable of participating in a lowintensity activity on a daily basis were enrolled. The distance walked was measured at baseline and data then collected over a 12-year period. After adjustment for age, men who walked more than two miles per day had a signicantly lower chance of dying than those who walked less than one mile.
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women, more risk accrues due to high levels of another blood fat, called triglycerides, and to low levels of good HDL-cholesterol. Therapeutic lifestyle interventions such as smoking cessation, maintenance of normal body weight, regular exercise, and a heart-healthy, plant-based diet benet both women and men and should be the rst steps taken in any preventive approach. Women are more likely than men to die after bypass surgery, even though they often appear to have less severe degrees of artery narrowing, and have better heart function, on average, than men do. This is partly due to the fact that women are more apt than men to have high blood pressure, heart failure, and diabetes. They are also on average older than men when they undergo bypass surgery. But it is younger women who have higher mortality rates post-operatively compared to men of the same age. Women are also more apt than men to have complications when they undergo procedures to open narrowed arteries, that is, angioplasties and stenting. In studies that looked at the results of automatic implantable debrillators (AICDs), devices which are used to abort potentially fatal abnormal heart rhythms in people with heart failure, men who had these devices had better survival than those treated with medications, but this same benet of AICDs was not found in women. However, there is one cardiac treatment from which women derive more benet than men. Certain people with weakened heart muscle (cardiomyopathy) and a specic nding on the EKG called left bundle branch block (LBBB) may benet from a new form of pacemaker called a bi-ventricular pacemaker. In a study of more than 1200 people with cardiomyopathy and LBBB, women had signicantly greater reductions in risk of death or heart failure, heart failure alone, or death from any cause, than men did. Signicant dierences exist between men and women when it comes to heart disease. Women have dierent risk factor weighting, and may derive less benet from certain medicines/interventions. More research needs to be done to understand these gender dierences so that both women and men can receive optimal advice on prevention strategies and treatment options. Barbara H. Roberts, MD, FACC, is Director of The Womens Cardiac Center at the Miriam Hospital in Providence, Rhode Island and is an Associate Clinical Professor of Medicine at Brown Universitys Alpert Medical School. One of the top cardiologists in the United States, she serves on the Lown Foundation Board of Directors and the Heart Health Advisory Committee for Womans Day Magazine. Dr. Robert's next book, The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs will be published by Simon & Schuster in April 2012.
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FO RUM But for many people, a cup of coee serves as an energizing pick-me-up. That is because caeine mimics the eect of adrenaline in the body, causing small increases in heart rate and blood pressure in most people. Excess caeine can produce a sustained rapid heart rate, which is why many doctors suggest their patients reduce caeine intake. However, we should not dismiss caeine consumption as bad just because it can cause an increased heart rate. In a study performed by our group several years ago, we determined that even in patients with known serious rhythm problems of the heart, coee (both regular and decaf) posed no additional risk of aggravation of arrhythmia. Caeine stimulates the blood vessels, specically the arteries of the body. In some cases, blood pressure rises - but only a small amount - as a result of the constriction of the blood vessels. This is where and how the potential benet of caeine is seen. It turns out that in older people, an exaggerated decline in blood pressure may occur after a meal as blood is diverted to the stomach to help with digestion. When an older person stands up after a meal - especially after a large one - the drop in blood pressure can cause a faint as less blood goes to the head. The caeine in a cup of coee can provide the right amount of additional tone to the blood vessels and prevent a fall - an important preventive measure! The benets of caeine often outweigh the low risks, and a daily cup of caeinated coee can be a hearthealthy way to start your day.
PATIENT PROFILE
see no benet. I asked every doctor two questions, Ken said. What were risks of the procedure? And what were the benets? It was clear there were a lot of risks, but no one could tell me why I should get stents for the two minor blockages. Looking for answers, Ken heard about the Lown Center from a friend. Dr. Bilchik spent 45 minutes with me just talking during my rst visit. He asked me so many questions about what happened that it really blew me away. He gave me a chance to tell my entire story. He told me I did not need the procedures. My heart, he explained, was healthy and getting good circulation without the stents. After our talk, it seemed like such a simple decision. I chose to not have the procedures. Three years on and Ken feels as healthy as ever. Listening to a patient is crucial. Dr. Bilchik was the only one who answered my questions he took the time to have a risk/benet discussion with me. I had two concerns that determined my choice: Will I live longer and will I feel better? For me, if the answer is no to those two questions, there is no benet to the procedures. Dr. Bilchik was the rst to give me those answers with simple and clear rationale.
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NewsBeat
Dr. Vikas Saini attended the National Summit on NonCommunicable Diseases in New Delhi, India on August 23-24, 2011. The theme of the meeting was Universal coverage and NCDs and Dr. Saini was a speaker for the panel discussion on Service needs to tackle NCDs: Prevention and Control. On September 14, 2011 Dr. Vikas Saini spoke at Mercy Hospitals annual leadership event held in Portland, ME. His talk, Navigating the channel: Avoiding avoidable care in a cost-conscious era was part of an event that brought together providers, friends, and leadership of Mercy Health Systems of Maine. Benn Grover represented ProCor and the Lown Foundation at the United Nations High-level Meeting on Non-communicable Diseases in New York City on September 1920, 2011. Advocating for action on non-communicable diseases: Leveraging technology and social media, a report he coauthored, was presented during a side event hosted by the Healthy Caribbean Coalition, Global Health Council, Young Professionals Chronic Disease Network, and PAHO. Benn Grover also facilitated a concurrent session, titled The world mobilizes for non-communicable disease prevention: The NCD Alliance and the UN Summit, during the 9th National Forum for Heart Disease and Stroke Prevention in Maryland on September 22-23, 2011. Dr. Tom Graboys book - Life in the Balance: A Physicians Memoir of Life, Love, and Loss with Parkinsons Disease and Dementia - is now available for purchase through the Barnes & Noble NOOK. For more information please visit: www.tomgraboys.com. Dr. Charles Blatt was a guest speaker at Temple Emanuel in Newton, MA on November 8, 2011. The topic of his talk was heart health prevention. Shannon Brownlee, author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, Acting Director of the New America Health Policy Program, and Co-Director of the 2012 Avoidable Care Conference, spoke at the Lown Foundation on November 11, 2011. The title of her talk was: From stents to PSA tests: Involving patients in decisions that matter most to them. On November 17, 2011 Benn Grover was a guest speaker on an Emerson talk radio program that focused on the health and development burden of non-communicable diseases in developing countries.
Educational opportunities
Interested in hosting a lecture on a heart health topic by one of our physicians at your worksite or community organization? Please contact us at info@lownfoundation.org or 617-732-1318 (x3355).
CONTACT US
Lown Cardiovascular Research Foundation
21 Longwood Avenue Brookline, MA 02446 USA (617) 732-1318 info@lownfoundation.org www.lownfoundation.org www.lowncenter.org www.procor.org
Advisory Board
Martha Crowninshield Herbert Engelhardt Edward Finkelstein William E. Ford Renee Gelman, MD Barbara Greenberg Milton Lown John R. Monsky Jerey I. Sussman David L. Weltman
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here for a chart on healthy portions). Ask for a smaller portion or take part of the meal home. Avoid all you can eat buets or specials as well as pre-meal appetizers and bread. Ask your companions to share an entre. Do not go out to eat while starving. Decide in advance what to eat to avoid temptations.