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January 30, 2008 > Managing Your Risks for Heart Disease

Managing Your Risks for Heart Disease

Learn About Controlling Your Risk Factors at Upcoming Seminar

Heart disease is the number one cause of death in the United States. Yet people who pay attention to certain risk factors can dramatically reduce their chances of developing heart disease.

"Some risk factors for heart disease are beyond your control, such as your age and family history, but you can manage many of the other risks," says Washington Hospital cardiologist William Nicholson, M.D.

"Three of the most common risk factors for heart disease that can be managed are high blood pressure, high cholesterol and diabetes," he explains. "In many cases, people can manage these three risk factors by making changes in their lifestyle, such as eating a proper diet, getting plenty of exercise and reducing excess body fat. When lifestyle changes aren't enough to control these conditions, though, your physician may prescribe medications."

To help you learn about your risks for heart disease, as well as medications for controlling your risk factors, Dr. Nicholson and Lina Huang, PharmD, a pharmacist at Washington Hospital, will present a Health and Wellness seminar on Tuesday, February 5 from 1 to 3 p.m. The seminar will be held in the Conrad E. Anderson, M.D. Auditorium at 2500 Mowry Avenue in Fremont. To register to attend, please call (800) 963-7070.

High Blood Pressure (Hypertension)

Blood pressure is the force of blood against the walls of the arteries that carry oxygen-filled blood from the heart to the body. When there is increased tension or pressure in the arteries, the heart has to work harder.

Because high blood pressure usually has no symptoms, getting periodic blood pressure measurements is the only way to catch the problem early. According to the National Institutes of Health, a blood pressure reading that is consistently higher than 140/90 is an indication that blood pressure needs to be brought under control.

Some lifestyle changes can help reduce blood pressure by several points, including stopping smoking, reducing alcohol intake, losing weight, reducing salt intake and perhaps increasing your intake of potassium, calcium and magnesium.

"When lifestyle changes don't do enough to control hypertension, there are a variety of medications that are very effective in lowering blood pressure," says Dr. Huang.

Some of the most commonly used drugs to treat hypertension include:
* Diuretics, which flush excess water and sodium from the body by increasing urination to reduce the amount of fluid in the blood and open the blood vessels to increase blood flow.
* Beta blockers that slow the heartbeat, thereby lessening the burden on the heart.
* ACE (angiotensin-converting enzyme) inhibitors that reduce the production of a hormone that causes blood vessels to narrow.
* Calcium channel blockers, which prevent calcium from entering the muscle cells of the heart and blood vessels.

High Cholesterol

There are two types of cholesterol: LDL, sometimes called the "bad" cholesterol that is the main cause of harmful fatty buildup in the arteries called atheroschlerosis, and HDL or "good" cholesterol that carries blood cholesterol back to the liver where it can be eliminated.

High total and LDL cholesterol levels along with low HDL cholesterol can increase heart disease risk. In general, the recommendations are to keep the total cholesterol level below 200, with the LDL level below 160 and the HDL level above 40. For people with diabetes or a family history of heart disease, a physician may recommend lower LDL and higher HDL levels.

Lifestyle changes to reduce "bad" cholesterol levels include a diet with reduced saturated fat and cholesterol along with physical activity and weight control. When diet and exercise alone are not enough to reduce cholesterol - or if a patient is genetically predisposed to high blood cholesterol - various medications are available.

"Statins such as Mevacor, Zocor, Pravachol and Lipitor reduce the production of cholesterol by the liver," Dr. Huang says. "Statins are usually the drug of choice because they reduce not only cholesterol but also atherosclerosis. Not everyone can take statins, though. In some people it can increase liver enzymes to dangerous levels. For other people it may cause muscle pain that can develop into something more serious. Also, for people whose main problem is high triglycerides rather than cholesterol, other drugs may be more effective."

Other drug treatments for high cholesterol include:
* Niacin (nicotinic acid), which lowers total and LDL cholesterol and raises HDL cholesterol and can also lower triglycerides. The dose needed to control cholesterol is much higher than the US RDA for niacin, so it must be taken under a doctor's care.
* "Resins" such as Questran and Colestid bind up bile acids in the intestine and prevent them from recycling through the liver, which in turn causes the liver to increase its uptake of cholesterol from the blood.
* Fibric acid derivatives that are used mainly to lower triglycerides can also help increase HDL cholesterol levels.


Diabetes

According to the American Heart Association, even when blood sugar levels are under control, diabetes increases the risk of heart disease. The risks are even greater if blood sugar is not well controlled.

"People who are unable to control their blood sugar levels through diet and exercise have a variety of medication options," Dr. Huang notes. "The standard drugs include sulfonylureas such as Blyburide and Blypizide that increase the production of insulin by the pancreas. Another drug, metformin (such as Glucophage), increases the sensitivity of the body to the uptake and effects of insulin.

"There are many new diabetes medications becoming available," she adds, "including Actos and Avandia, both of which help reduce insulin resistance that interferes with the body's ability to turn blood sugar into energy. "


Topic: Do You Have Heart Disease and Would You Like to Decrease Your Risk Factors
When: Tuesday, February 5
Time: 1 to 3 p.m.
Where: Conrad E. Anderson, M.D. Auditorium (2500 Mowry Ave.)
Call: (800) 963-7070 to register

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