Ozgen Dogan MD FACC
Assistant Professor of Clinical Medicine
Columbia University NY, NY
New-York Presbyterian Hospital, Long Island College Hospital

Heart disease is the most common disease in the world. It is more common than all cancers combined. For example; breast cancer is the cause of mortality in 1 out 25 postmenopausal women; however 1 out of 2 women has heart disease. 40% reduction in mortality has been achieved in heart disease in the last 40 years. Most of this is due to prevention. Diet and lifestyle modification are important approaches to the prevention and treatment of atherosclerotic vascular disease. Smoking, hypertension, elevated cholesterol, diabetes, obesity and physical inactivity are the risk factors for heart disease. I will try to summarize lifestyle and diet modifications that will create heart disease free years for all of us.

For every 1% reduction in total cholesterol, the risk of developing heart disease is reduced by 2%. Ideally bad cholesterol, LDL, should be less than 100 and good cholesterol, HDL, should be more than 55. Exercise, seafood and smoking cessation will increase HDL levels. Soy products may do the heart some good; they reduce cholesterol by 10% by decreasing its absorption and stimulating thyroid hormone production.

The Mediterranean diet has become increasingly popular as a heart-healthy style of eating. Olive oil and whole grain bread can account for up to 50-60% of total calories; however this diet is also rich in beans, fresh fruits, and vegetables. Much of the fat from this diet plan is monosaturated fat from olive oil which appears to raise the level of HDL A recent study found a 44% reduction in cardiac events by increasing the quantity of fish in the diet. Fish highest in omega-3 fatty acid include mackerel, herring, sardines, salmon and tuna. You can also replace butter with a spread made from olive oil, choose hazelnut for a snack instead of cheese; cook exclusively with olive oil or canola oil; include avocado in your salad; and consume more garlic, which lowers blood pressure and thins the blood.

A recent study published in the respected medical journal Circulation showed the benefits of tea. Both short term and long term tea consumption improved blood flow in the arteries studied. Artery function following tea consumption was equivalent to healthy control patients, suggesting that tea restored normal artery function in these patients with known coronary heart disease. Tea has long been known to contain antioxidant flavonoids, also found in many other food sources such as apples, broccoli, onions and red wine. These scavengers of oxidation may inhibit damaging effects to artery walls that lead to plaque formation and impaired artery function.

Make exercise part of your daily routine. Regular exercise promotes a healthy weight, a reduction in blood pressure, an increase in HDL and reduces the risk for the development of adult onset diabetes. Regular exercise lowers bad cholesterol, LDL, raises good cholesterol HDL, lowers blood pressure and body fat . Before starting an exercise program or enrolling a gym check with your doctor. Start with an activity that is comfortable for you; do not run the marathon the first day; go with an exercise buddy.
Short segments of exercise throughout the day are equally beneficial to one long exercise session. Combining exercise with relaxation techniques like yoga, tai chi, qi gong will especially help people with high stress jobs. Type A personality, combined with emotional stress may increase heart disease by 4 times..

Folic acid and vitamin B6 and B12 reduce homocystein levels. Homocystein is an amino acid, which is abnormally elevated in 30% of people; it increases plaque formation in the heart.

On the beneficial effects of selenium, vitamin E, Coenzyme Q-10, l-carnitine, magnesium and garlic the jury is still out. More research is needed to prove their benefit for risk reduction.

Heart disease warning signals include uncomfortable chest, shoulder or jaw pain or pressure; shortness of breath, sweating or fainting.25% of all heart attacks are silent, meaning no symptoms at all. Heart disease is not random like a lottery; the more risk factors you have more likely it will happen. It is a very long process; it usually takes many decades. If you have risk factors, screening by a physician, blood tests and sometimes a stress test, EKG will identify the problem.

It is possible to stop heart disease formation or progression with the risk modifications I have summarized. Wishing you a future without heart disease.

Dr. Ozgen Dogan MD FACC