How You Can Prevent Heart Attacks: A Cardiologist Explains
Even though I never watched The Sopranos, last week's shocking death of James Gandolfini grabbed my attention and it seems like I've been reading every article about it. I'm haunted by the image of a 13 year-old boy on a vacation alone with his famous father, finding his dad down and fighting for every breath. And the thought of the 9-month-old and young wife at home, grieving his death, pierces my soul.
I don't have access to Mr. Gandolfini's medical records, so I can't say for certain what he was (or wasn't) doing to care for his health. But I wonder if he knew that he was at risk for suffering the most common fatal disease in the Western world. My hunch is that if he had taken time on his 50th birthday to review his health, he would've been found to have a treatable and ultimately, reversible condition.
My point? The goal of being heart attack-proof is not a fantasy.
Here are some of the steps that anyone can take before it's too late.
1. Take charge of your lifestyle.
Any serious effort to lower the risk of heart disease, cancer, and other chronic diseases begins with a plant-based, whole foods diet, low in inflammatory and glycemic potential. Some programs that have been scientifically shown to lower heart disease risk include those of: Dr. Dean Ornish, Dr. Caldwell Esselstyn, Dr. John A. McDougall, Dr. Neal Barnard, Dr. Joel Fuhrman, and Nathan Pritikin.
Mr. Gandolfini is reported to have dined on a high fat meal of foie gras and prawns soon before his death. Studies have shown that eating high-fat meals worsen artery function within one hour, making people immediately more prone to injury and clotting.
Here are some other simple habits that promote heart health:
- Don't smoke. The power of not smoking to avoid heart disease must be emphasized, to everyone, repeatedly.
- Get moving! Regular movement most days of the week is essential. (It can be walking, intense aerobics, weights, or yoga.)
- Manage stress. Stress management using meditation and other breathing practices or relying on tools such as www.HeartMath.com is crucial.
- Be social! Enjoying friends, family, religious connections, and laughter are real preventive therapies.
2. Get tested.
Advanced cholesterol testing measuring LDL cholesterol particle number and size provides more predictive information than routine estimates of cholesterol fractions.
Inflammation, commonly elevated to dangerous levels in obese individuals due to the production of toxic chemicals in abdominal fat, can be assessed by measuring the high sensitivity C-reactive protein (hs-CRP). Other mediators of risk such as serum homocysteine, lipoprotein(a), ferritin, fibrinogen, glucose, insulin and testosterone levels are helpful in assessing each person's individual risk.
3. Ask for imaging exams.
The value of a coronary CT calcium scan is grossly under appreciated, even though hundreds of medical publications support it. Almost all persons with silent or symptomatic heart disease will have calcified plaque that can be identified and quantified.
I am a member of the Society of Heart Attack Prevention and Eradication (SHAPE) and the first physician in Michigan to be certified by this organization. Most insurance companies still refuse to pay for these calcium CT or CIMT screening exams but for about $200 for one or both tests, a person can generally obtain results in his or her hometown. I have read over 10,000 of these CT scans and they reveal so much; the only risk is a dose of radiation that can be lessened in impact by taking a dose of antioxidant vitamins 45 minutes before the CT exam. I am sure that if Mr. Gandolfini had had one of these scans at age 50, his silent heart disease would have been revealed in time to offer various strategies of risk reduction.
The American health care system is in reality a disease care system with inadequate amounts of education, testing and payment for preventive services.
Fortunately, this is changing, albeit too slowly. Heart attacks do not need to happen. The identification of asymptomatic disease found through advanced testing can be addressed by serious nutritional counseling, exercise plans, stress management training, and the institution of prescription and supplemental therapies that heal arteries and can reverse conditions (such as arterial damage and blood clotting abnormalities) that trigger heart attacks.
While we sadly cannot bring back Mr. Gandolfini, we can get serious about making heart attacks a rare novelty, as was the case only 100 years ago.