Stop heart attacks and strokes: Best advice

Mariell Jessup, a cardiologist at the University of Pennsylvania and president of the American Heart Association, walks two of her Bichon Frise dogs, Armani and Daisy, near her Villanova, Pa., home.
  • The American Heart Association president offers her best advice for heart health.
  • Exercise helps your heart in many ways.
  • One in three adults in the USA have high blood pressure.
  • Cardiologist Mariell Jessup, president of the American Heart Association, says if she could have people do three things for the heart, she would advise: “Do some exercise for exercise’s sake every day. Never smoke cigarettes; stop immediately if you do. And keep your blood pressure controlled. Check it to make sure.”.

    Jessup and other top experts in heart disease from around the world are at the American Heart Association’s Scientific Sessions in Dallas this week. They will be discussing new guidelines for the prevention of cardiovascular disease and stroke, including a new formula for the assessment of risk for heart disease and a new approach to the treatment of cholesterol.

    Cardiovascular disease accounts for one in three deaths in the USA, government data show. About 800,000 people die each year from cardiovascular disease, but as many as 200,000 of the deaths from heart disease and stroke could be prevented if people made healthy lifestyle changes: They should stop smoking, maintain a healthy weight, do more physical activity, consume less salt and manage their high blood pressure, high cholesterol and type 2 diabetes, a recent government report said.

    USA TODAY asked Jessup, a professor of medicine at the University of Pennsylvania Heart and Vascular Center, to talk about how Americans can take control of their heart health.

    Q: Why is it so important to control blood pressure?

    A: High blood pressure is a key risk factor for the development of heart attack, stroke, heart failure and kidney failure. If we could control blood pressure, it is estimated that we would have 50% less heart failure. About one in three U.S. Adults have high blood pressure, and more than half of people with hypertension don’t have it under control.

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    High blood pressure is defined as a reading greater than or equal to 140/90 mm/Hg. High blood pressure means the blood running through your arteries flows with too much force and puts pressure on your arteries, stretching them past their healthy limit and causing microscopic tears. The scar tissue that forms to repair those tears traps plaque and white blood cells, which can lead to blockages, blood clots and hardened, weakened arteries.

    That sounds sort of gruesome, but the good news is it’s totally preventable. It’s treatable with lifestyle and medication, if necessary. And those scars can be healed over time.

    Q: How does exercise improve heart health?

    A: It improves it in so many ways. It helps control our blood pressure. It helps keep our weight down. It helps skeletal muscles use oxygen more efficiently, and it helps build new channels for the heart’s blood flow called collateral vessels.

    Q: What other numbers are important to know?

    A: When doctors say know your numbers, they are really telling you to keep track of your risk factors for heart disease. Besides blood pressure, the numbers we talk about for risk factors are BMI (body mass index, a number that takes into account height and weight), cholesterol and blood sugar, meaning whether or not you have type 2 diabetes or are at risk for developing it.

    Q: How does being overweight or obese harm your heart?

    A: It makes more work for the heart. It tends to raise our blood pressure, and it leads to the development of type 2 diabetes in so many people.

    Q: What should women know about cardiovascular risks?

    A: Heart disease is the No. 1 killer of women, not breast cancer. Heart disease is a five-times-bigger killer than breast cancer. Some of the same risk factors for heart disease are risk factors for breast cancer — lack of physical activity and obesity. So if women exercise regularly and keep a healthy weight, they are reducing their risk of heart disease and breast cancer.

    Q: How does stress affect heart health?

    A: Stress probably contributes to higher blood pressures, but mostly stress leads people to make poor lifestyle choices. A lot of people will say that they are too stressed to stop smoking or too stressed to cook so they eat fast food. Or they think they’re too stressed to exercise. A stressful lifestyle clearly is related to heart disease and sudden death, but we don’t understand all the mechanisms. There are a lot of ways that stress affects heart disease that we don’t understand.

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    Q: Why is it important to lower sodium intake?

    A: Lower sodium intake is critical to lowering blood pressure. What the American Heart Association says is ideally, we should consume no more than 1,500 milligrams of sodium a day. Most Americans consume about 3,600 milligrams or higher a day. If people could at least reduce their sodium intake by 1,000 milligrams, that would be great, even if they can’t get it down to 1,500 milligrams. Sodium is in a lot of processed food and fast food.

    Q: What do the new heart disease prevention guidelines say?

    A: There are four parts of it: the treatment of overweight and obesity; lifestyle; how to calculate cardiovascular risk; and how to treat cholesterol. There is a new formula for calculating risk of heart disease. The reason it’s new is that heart attack risk used to be calculated based on white Americans, but the new risk assessment is more broadly based, and it takes into account African Americans. It looks at different endpoints, and it takes into account heart attacks and strokes. There is going to be a lot of discussion about this at the (American Heart Association) meeting. It may be very controversial — which is fine. Controversy means discussion and stimulates clinicians to focus on the new issues. Doctors will ask: Why use this risk calculation? Why not use the old one? The calculation of risk will determine who gets treated for high cholesterol, so it’s a really big deal.

    The cholesterol guidelines are very different, too. In the past, clinicians have focused on lowering a person’s LDL, a blood test of the “bad” cholesterol. Now the guidelines are suggesting that clinicians identify people at risk rather than a blood test representing risk, and treating the individual according to their level of risk. It’s going to cause a huge conversation.

    Q: What progress is being made in extending and improving lives after a heart attack or stroke?

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    A: We’ve done a great job in reducing deaths from heart disease and stroke, and that’s good. Our advice to patients who have suffered these diseases is to focus on healthy living. Just because someone has suffered the consequences of cardiovascular disease does not mean that a healthy lifestyle is useless. In fact, it is even more vital than ever. Don’t give in to despair, there is great hope.

    Q: What would you like to see happen to help prevent heart disease?

    A: We want to reduce heart disease and stroke even more by preventing its occurrence at all. We want to improve all Americans’ lives. We want people to make healthy choices the default choice. Instead of having to find a corner of the cafeteria that has healthy food, wouldn’t it be nice if the whole cafeteria offered healthy food, and you had to find the unhealthy food in the corner?

    It’s always better to walk the steps instead of taking the elevator. Wouldn’t it be nice if you had to go out of your way to find the elevator? Wouldn’t it be nice if they hid the elevator, and the stairs were easy to find, or if the stairs were right near the elevator? Wouldn’t it be great if it were easy to walk through neighborhoods, if there were sidewalks everywhere and it were safe to walk in every city?

    If you can get to the age of 50 without any risk factors, chances are you won’t develop heart disease. We have the tools to control the risk factors and prevent disease, so you can lead a healthier life well into your golden years.

    Q: What is the latest research on blood thinners?

    A: Blood thinners markedly reduce the risk of stroke in patients with atrial fibrillation and are necessary for several other medical conditions. There will always be a balance between the risk of bleeding and the risk of stroke with all these available drugs, but the newest agents are already proving to be more effective and safer than our traditional standby blood thinner, warfarin. New agents will be presented at the heart association meeting.

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