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Answers to Questions about Heart Disease
The New York Times
by Dr. Elizabeth Nabel
April 17, 2007
Dr. Elizabeth Nabel, a practicing cardiologist and researcher studying the
genesis of plaque in coronary arteries, became director of the National Heart,
Lung and Blood Institute on Feb. 1, 2005. Her answers to readers’ questions
about heart disease appear below.
Q. Having gotten atherosclerosis, does it ever get better
in any way or is the disease merely one to be treated? What is the prognosis
with this disease? Will the treatment merely delay the end result awhile, and if
so, how long? - John Cook
A. Atherosclerosis affects the arterial wall and, once
present, will not disappear. The most important question is not whether
atherosclerosis is present but how it behaves. Some people have heart attacks
and die with very little atherosclerosis, while others have widespread disease
that never even causes symptoms. The key is treatment that prevents heart
attacks and damage to the pumping function of the heart. Damage occurs most
often when the lining covering places in the artery where there is
atherosclerosis (plaques) breaks down. The blood is exposed to what is inside
the plaque and forms clots, blocking the blood supply to a portion of the heart,
which results in the death of heart muscle cells. These cells do not grow back
and, if the patient survives, are replaced by scar tissue. This sort of event
can also cause a bad heart rhythm that can result in sudden death.
Fortunately, there are treatments that reduce the risk of heart muscle damage
and fatal bad heart rhythms in individuals with atherosclerosis. These include
drugs, like aspirin, that make it harder for the blood to clot, drugs that lower cholesterol
and families of drugs, beta-blockers and ACE inhibitors, that work by a variety
of mechanisms to help the heart live with blockages without incurring additional
damage. The best results are obtained when patients work with their doctor to
achieve a medication regimen and practice a healthy lifestyle that controls blood pressure, maintains low blood cholesterol and appropriate blood sugar
levels, and avoids smoking. Eating nutritiously, getting regular physical activity, and maintaining a
healthy weight are also key heart-healthy habits.
What happens to a patient with atherosclerosis depends on the behavior of the
disease, not just its presence. With proper treatment, including attention to
risk factors – cholesterol level, blood pressure, diabetes, not smoking, not being overweight or obese, and physical inactivity - many
patients with atherosclerosis will never have heart attacks, fatal heart
rhythms, or weak pumping function.
Q. Current heart imaging detects calcium in the heart.
Exactly what is the relationship between calcium and heart disease? - Elliot
Herskowitz
A. Specks of calcium are often deposited in the walls
of the coronary artery where atherosclerosis or “hardening of the arteries” has
developed. Because calcium shows up easily on X-rays, and particularly on CT
scans, it can be seen on certain types of CT scans of the chest. The amount of
calcium seen correlates with the amount of atherosclerosis in the coronary
arteries and is related to the likelihood of developing a heart attack in the
future. However, it does not necessarily correlate with stenosis, or narrowing
of the heart arteries, which indicates specific areas of the heart that might be
involved in a heart attack. These scans are not used in people who have already
had a heart attack.
It is important to understand that calcium intake does not influence calcium
build-up in arteries, so people should not limit their intake of calcium because
of this concern. It is also important for people to know that the benefit of
screening using CT scans to detect calcium in the coronary arteries is not
known. Heart scans may be offered in some mall screenings. However, getting
tested in a medical setting also allows your doctor to interpret the results for
you and evaluate your need for further testing. Regardless of whether a person
has calcium deposits in their coronary arteries or not, the same basic messages
about preventing heart disease apply.
Q. What dietary changes can you make to help lower your
cholesterol? Please be specific. For example, how many eggs can you eat a day? -
Tracy Wallace
A. To lower your cholesterol through dietary changes,
limit the amount of saturated fat, trans fat, and cholesterol that you consume.
More specifically, try making the following changes to your diet:
- Select lean meats, remove skin from poultry before cooking, and eat nonfat
or low-fat dairy products.
- Increase consumption of fish, fruits, vegetables, beans, and whole grains.
- When possible use liquid vegetables oils that are high in unsaturated fats,
like canola, corn, and olive oils. Choose soft tub margarines that are low in
both saturated and trans fats.
- Choose low fat preparations such as baking, steaming, roasting, stewing, or
boiling instead of frying.
- Aim for no more than four egg yolks per week, including egg yolks in baked
goods and processed foods.
More detailed tips on eating a heart-healthy diet are available online here:
http://nhlbisupport.com/chd1/Tipsheets/resourceroom.htm
To continue reading this Q&A on heart health, click the article link at the top of the page.
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