How To Lower your Risk of Heart Disease

The leading cause of death right now is Cardiovascular Disease and statistics has shown that 1 in 3 will die from Cardiovascular Disease and it has also been the leading cause of death from China since the 1990's. In fact, cardiovascular disease is the number one killer among women and it kills more women each year than all cancers, tuberculosis, HIV/AIDS and malaria combined.

There are a number of factors for the increasing risk of cardiovascular disease, mainly:

1. Obesity
   
2. Smoking
   
3. Lack of exercise
   
4. Excessive drinking
   
5. Lack of antioxidants
   
   
6. Insufficient fiber intake
   
7. High levels of total cholesterol
   

 

Cardiovascular disease, regardless of heart attack or stroke, is often a "silent killer" with little or no advance warning or symptoms. The first sign of a problem is often death by heart attack or stroke.

You can go HERE and calculate your risk of having a heart attack in the next 10 years.

According to the World Health Organization, cardiovascular disease causes 17.5 million deaths in the world each year. Cardiovascular disease is responsible for half of all deaths in the United States and other developed countries, and it is a main cause of death in many developing countries as well. Overall, it is the leading cause of death in adults.

In the United States, more than 80 million Americans have some form of cardiovascular disease. About 2400 people die every day of cardiovascular disease. Cancer, the second largest killer, accounts for a little more than half as many deaths.

Coronary artery disease, the most common form of cardiovascular disease, is the leading cause of death in America today. But thanks to many studies involving thousands of patients, researchers have found certain factors that play an important role in a person's chances of developing heart disease. These are called risk factors.

Risk factors are divided into two categories: major and contributing. Major risk factors are those that have been proven to increase your risk of heart disease. Contributing risk factors are those that doctors think can lead to an increased risk of heart disease, but their exact role has not been defined.

The more risk factors you have, the more likely you are to develop heart disease. Some risk factors can be changed, treated, or modified, and some cannot. But by controlling as many risk factors as possible through lifestyle changes, medicines, or both, you can reduce your risk of heart disease.

Major Risk Factors

High Blood Pressure (Hypertension). High blood pressure increases your risk of heart disease, heart attack, and stroke. Although other risk factors can lead to high blood pressure, you can have it without having other risk factors. If you are obese, smoke, or have high blood cholesterol levels along with high blood pressure, your risk of heart disease or stroke greatly increases.

Blood pressure can vary with activity and age, but a healthy adult who is resting should have a systolic pressure below 120 and a diastolic pressure below 80.

 

High Blood cho lesterol One of the major risk factors for heart disease is high blood cholesterol. Cholesterol, a fat-like substance carried in your blood, is found in all of your body's cells. Your liver produces all of the cholesterol your body needs to form cell membranes and to make certain hormones. Extra cholesterol enters your body when you eat foods that come from animals (meats, eggs, and dairy products).

Although we often blame the cholesterol found in foods that we eat for raising blood cholesterol, the main culprit is the saturated fat in food. (Be sure to read nutrition labels carefully, because even though a food does not contain cholesterol it may still have large amounts of saturated fat.) Foods rich in saturated fat include butter fat in milk products, fat from red meat, and tropical oils such as coconut oil.

Too much low-density lipoprotein (LDL or "bad cholesterol") in the blood causes plaque to form on artery walls, starting a disease process called atherosclerosis. When plaque builds up in the coronary arteries that supply blood to the heart, you are at greater risk of having a heart attack.

Diabetes. Heart problems are the leading cause of death among people with diabetes, especially in the case of adult-onset or Type 2 diabetes (also known as non-insulin-dependent diabetes). Certain racial and ethnic groups (African Americans, Hispanics, Asian and Pacific Islanders, and Native Americans) have a greater risk of developing diabetes. The American Heart Association estimates that 65% of patients with diabetes die of some form of cardiovascular disease. If you know that you have diabetes, you should already be under a doctor's care, because good control of blood sugar levels can reduce your risk. If you think you may have diabetes but are not sure, see your doctor for tests.

 

Obesity and Overweight. Extra weight is thought to lead to increased total cholesterol levels, high blood pressure, and an increased risk of coronary artery disease. Obesity increases your chances of developing other risk factors for heart disease, especially high blood pressure, high blood cholesterol, and diabetes.

Smoking. Most people know that cigarette and tobacco smoking increases your risk of lung cancer, but few realize that it also greatly increases the risk of heart disease and peripheral vascular disease (disease in the vessels that supply blood to the arms and legs). According to the American Heart Association, more than 400,000 Americans die each year of smoking-related illnesses. Many of these deaths are because of the effects of smoking on the heart and blood vessels.

Research has shown that smoking increases heart rate, tightens major arteries, and can create irregularities in the timing of heartbeats, all of which make your heart work harder. Smoking also raises blood pressure, which increases the risk of stroke in people who already have high blood pressure. Although nicotine is the main active agent in cigarette smoke, other chemicals and compounds like tar and carbon monoxide are also harmful to your heart in many ways. These chemicals lead to the buildup of fatty plaque in the arteries, possibly by injuring the vessel walls. And they also affect cholesterol and levels of fibrinogen, which is a blood-clotting material. This increases the risk of a blood clot that can lead to a heart attack.

Physical Inactivity. People who are not active have a greater risk of heart attack than do people who exercise regularly. Exercise burns calories, helps to control cholesterol levels and diabetes, and may lower blood pressure. Exercise also strengthens the heart muscle and makes the arteries more flexible. Those who actively burn 500 to 3500 calories per week, either at work or through exercise, can expect to live longer than people who do not exercise. Even moderate-intensity exercise is helpful if done regularly.

Gender. Overall, men have a higher risk of heart attack than women. But the difference narrows after women reach menopause. After the age of 65, the risk of heart disease is about the same between the sexes when other risk factors are similar.

Heredity. Heart disease tends to run in families. For example, if your parents or siblings had a heart or circulatory problem before age 55, then you are at greater risk for heart disease than someone who does not have that family history. Risk factors (including high blood pressure, diabetes, and obesity) may also be passed from one generation to another.

Also, researchers have found that some forms of cardiovascular disease are more common among certain racial and ethnic groups. For example, studies have shown that African Americans have more severe high blood pressure and a greater risk of heart disease than whites. The bulk of cardiovascular research for minorities has focused on African Americans and Hispanics, with the white population used as a comparison. Risk factors for cardiovascular disease in other minority groups are still being studied.

Age. Older age is a risk factor for heart disease. In fact, about 4 of every 5 deaths due to heart disease occur in people older than 65.

As we age, our hearts tend not to work as well. The heart's walls may thicken and arteries may stiffen and harden, making the heart less able to pump blood to the muscles of the body. Because of these changes, the risk of developing cardiovascular disease increases with age. Because of their sex hormones, women are usually protected from heart disease until menopause, and then their risk increases. Women 65 and older have about the same risk of cardiovascular disease as men of the same age.

Contributing Risk Factors

Stress. Stress is considered a contributing risk factor for heart disease because its effects on the heart are not completely understood. Also, the effects of emotional stress, behavior habits, and socioeconomic status on the risk of heart disease and heart attack have not been proven. That is because we all deal with stress differently: how much and in what way stress affects us varies from person to person.

Researchers have identified several reasons why stress may affect the heart.

• Stressful situations raise your heart rate and blood pressure, increasing your heart's need for oxygen. This need for oxygen can bring on angina pectoris, or chest pain, in people who already have heart disease.
   
  
• During times of stress, the nervous system releases extra hormones (most often adrenaline). These hormones raise blood pressure, which can injure the lining of the arteries. When the arteries heal, the walls may harden or thicken, making it easier for plaque to build up.
   
  
• Stress also increases the amount of blood clotting factors that circulate in your blood, making it more likely that a clot will form. Clots may then block an artery narrowed by plaque and cause a heart attack.
  

Stress may also contribute to other risk factors. For example, people who are stressed may overeat for comfort, start smoking, or smoke more than they normally would.

Sex hormones. Sex hormones appear to play a role in heart disease. Among women younger than 40, heart disease is rare. But between the ages 40 and 65, around the time when most women go through menopause, the chances that a woman will have a heart attack greatly increase. From 65 onward, women make up about half of all heart attack victims.

Birth control pills. Early types of birth control pills contained high levels of estrogen and progestin, and taking these pills increased the risk of heart disease and stroke, especially in women older than 35 who smoked. But birth control pills today contain much lower doses of hormones and are considered safe for women younger than 35 who do not smoke or have high blood pressure.

But if you smoke or have other risk factors, birth control pills will increase your risk of heart disease and blood clots, especially if you are older than 35.  According to the American Heart Association, women who take birth control pills should have yearly check-ups that test blood pressure, triglyceride, and glucose levels.

Alcohol. Studies have shown that the risk of heart disease in people who drink moderate amounts of alcohol is lower than in nondrinkers. Experts say that moderate intake is an average of one to two drinks per day for men and one drink per day for women. One drink is defined as 1½ fluid ounces (fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-proof spirits, 4 fl oz of wine, or 12 fl oz of beer. But drinking more than a moderate amount of alcohol can cause heart-related problems such as high blood pressure, stroke, irregular heartbeats, and cardiomyopathy (disease of the heart muscle). And the average drink has between 100 and 200 calories. Calories from alcohol often add fat to the body, which may increase the risk of heart disease. It is not recommended that nondrinkers start using alcohol or that drinkers increase the amount that they drink.

It is never too late—or too early—to begin improving heart health. Some risk factors can be controlled, while others cannot. But, by eliminating risk factors that you can change and by properly managing those that you cannot control, you may greatly reduce your risk of heart disease.

 

 

Are You Depressed? How To Tell, What To Do

 

At any given time, it's estimated that five to seven percent of Americans suffer from depression. Yet, many of these people are too embarrassed to seek help. It is not uncommon for individuals suffering from depression to wonder just when it is necessary to seek help.

Many times, I hear comments like the following from depressed patients:
"I really thought this was something I could handle."
"I feel so weak, like I have failed."
"I should be able to control things so I don't get depressed."

Many of these people also tell me that others have made especially cruel remarks to them concerning their depression, including:
"You don't have anything to be depressed about."
"You just need to make yourself get out (or get up -- or get over it)."
"I was depressed and I got over it -- so should you."

I don't think the people who made these remarks would say similar things to someone with a more traditional "medical" illness, such as cancer, diabetes or heart disease. Unfortunately, we still operate out of prejudice and ignorance when it comes to diseases of the brain, or as the more archaic name refers to it... mental illness.

It is important to realize that depression is a disease, a medical illness. It is the result of abnormalities in the brain that appear to be caused by extended periods of stress and duress, from which the brain is unable to re-establish its normal mood. It is actually a "multi-system" disease, meaning that since the brain controls multiple functions or systems when impacted by depression many of these other functions are affected.

The result is a disease with a variety of symptoms that can interfere with a wide range of daily activities and functions. Depression can also be genetically based. Like diabetes, heart disease and other chronic illnesses, it can run in families. Along with evidence of a relationship between alcoholism and depression, there are socioeconomic factors, including economic class and marital status, which seem to create an increased risk as well. The presence of concurrent physical illnesses serves as a stress factor that can precipitate a depressive episode. Given a combination of these risk factors and the presence of unremitting stress, it is not surprising that the development of a depressive episode becomes "an illness waiting to happen."

What then is this disease called depression, and when should someone seek treatment? There are well-established guidelines and criteria for making the diagnosis. This diagnosis is generally based on the presence of any combination of the following symptoms for at least 2 to 4 weeks:

• Depressed mood most of the day, nearly every day
  
• Decreased interest or pleasure in one's daily activities
  
• Major changes in weight and/or appetite
  
• Insomnia or hypersomnia
  
• Agitated or slowed thinking
  
• Fatigue, loss of energy -- all activities seem to require excessive effort to complete
  
• Feelings of worthlessness, inappropriate or excessive guilt
  
• Decreased ability to think or concentrate; indecisive thinking
  
• Recurring thoughts of death or suicide; this does not always include a wish or plan to die but an acceptance of the belief that "others would be better off without me."
  

This list highlights the more prominent features of depression, but it is not all-inclusive. Many women complain of being easily frustrated, irritable or angered, worried about their "lack of patience with my children or my spouse." Others report not wanting to talk with friends, citing a lack of energy or interest in doing so. Their answering machine becomes a sentinel, screening their calls and limiting their interactions. Even their ability to function in the workplace is seriously compromised. There are complaints of problems with memory, concentration, attention and recall. Depressed workers may also experience reduced productivity. In severe cases, individuals who were outstanding employees begin to risk losing their jobs.

It takes incredible strength, courage and faith to seek treatment and commit oneself to it. Which brings us to the question of treatment -- what works and why? Treatment must be individualized. Medications for depression are safe, effective and must generally be continued for at least a year once the depression is controlled.

The patient and physician should then determine together whether it is time to discontinue medications and/or change the approach to treatment. The steps for achieving wellness begin with a personal inventory of one's life: eating habits, exercise patterns, the spiritual self, relationships (at work, home, with friends and family), and other aspects of one's lifestyle, which give pleasure, joy and satisfaction.

Addressing those factors that have gradually stressed the brain enough to make the person depressed will create an understanding of where one's efforts for change should be directed. However, such a necessary "journey" of understanding cannot be fully successful if one is struggling against severe depression. Therefore, I advise my patients to recognize that the healing process may take some time. There is no quick fix to the situation. However, once the medications have become effective, patients experience renewed strength as well as a return of the ability to establish a normal life. Patience and faith are critical factors in this healing process.

blog test

Bone Density and FRAX Testing

What Is FRAX?

Old way to be responsible: Ask your doctor about a bone density test. New way: Find a doctor who knows her FRAX -- and if you've never heard of it, you're not alone.

 

FRAX is not a miracle pill or a fancy piece of equipment. Unveiled by the World Health Organization in February, it is an elegant patient assessment formula that works in a risk-calculating computer program. And though not yet widely known, it is rocking the osteo-establishment, pulling focus away from bone density -- doctors' long-trusted yardstick for measuring the strength of the skeleton as it ages -- to spotlight what many experts believe is the overriding concern: determining a person's risk of actually breaking a bone (in other words, fracture risk assessment, or FRAX). That assessment matters to millions of people; in the United States, half of all postmenopausal women and a substantial number of older men will suffer a potentially life-altering fracture.

 

The revelation behind FRAX: Bone density is not the single best indicator in determining the risk of those fractures. It's still crucial, but a short list of other key factors, such as having a parent who broke a hip, is now also considered significant. "FRAX gives us the capacity to quantify these risk factors and look at how they interact with each other. For people with low bone mass, it's a far more rational and reasonable way to assess fracture risk," says Robert Lindsay, MD, one of the authors of a guide that the National Osteoporosis Foundation published in conjunction with the debut of the new formula. The upshot for women? FRAX, rather than bone density testing alone, is the best way to determine who needs treatment.

 

Both the guide and the FRAX formula are currently available to physicians. If your doctor is forward-thinking, she may already be using these tools; if she isn't, you may need to prod her a little. The best way to start is by asking about FRAX and the National Osteoporosis Foundation guidelines at your next ob-gyn or primary care appointment. Meantime, here's what you should know.

 

Lindsay and others hope that FRAX will help clear up the confusion that's existed since 1994, when the World Health Organization first announced criteria for diagnosing osteoporosis. Before then, the disease -- characterized by porous and fragile bones -- was typically diagnosed when an elderly woman showed up at the emergency room after breaking her hip or wrist. But by the mid-1990s, after-the-fact diagnosis was no longer good enough. A new class of drugs, bisphosphonates, which reduce fracture risk, was soon to be introduced. The medications, which include Fosamax and Actonel, were expensive and not without side effects, including slow healing, difficulty swallowing, inflammation of the esophagus, gastric ulcer and, in rare cases, increased possibility of infection after dental surgery. There has also been concern that long-term use of these drugs may result in an accumulation of older bone in the skeleton (because the drugs slow down the activity of scavenger cells, which clear away older bone to make room for new). Right now this is more a theory than a finding, but the thinking is that over time these drugs might make the skeleton more, not less, brittle.

 

The World Health Organization hinged its 1994 criteria on the one measure of bone health then available: the bone mineral density scan. The organization's rating system involved T-scores, which compared a postmenopausal Caucasian woman's bones with those of a 30-year-old. A T-score of -1 (one standard deviation below normal) and above was considered normal bone density; below -2.5 was considered osteoporosis; and any score between -2.5 and -1 was considered osteopenia, itself not a disease but an indicator of borderline low density. The lower the score, the thinking went, the more porous and fragile the bone -- and the greater the risk of breaking it. Therefore, women with low T-scores were more likely to be treated with medication.

 

Nearly 15 years later, however, experts disagree on who truly needs a prescription. There's no controversy surrounding women whose T-scores scream osteoporosis. But a far greater number of scores register in the gray area of osteopenia, and there has been no clear guidance regarding whether they should prompt treatment. "Some doctors will take a 55-year-old woman with a -1.5 T-score and put her on medication. Others will have a 75-year-old woman with the same score and leave her alone," says Ethel S. Siris, MD, of Columbia University and president of the National Osteoporosis Foundation.

 

The net result: A considerable number of younger postmenopausal women whose risk of fracturing a bone in the near future is statistically minuscule are being treated prematurely or unnecessarily. Nelson B. Watts, MD, of the University of Cincinnati Bone Health and Osteoporosis Center, says that if 30-year-old women submitted themselves en masse to the World Health Organization's measurement criteria, fully 16 percent would be diagnosed with osteopenia.

 

The other, perhaps more troubling, side of this story: Under the current parameters, many older people who face immediate grave risk of fracture aren't getting treatment, simply because their T-scores don't demand it. At Oregon Health & Science University, a 2005 study of women age 65 and older found that, based on the World Health Organization's bone density criteria, more than half of the women who suffered hip fractures did not technically have osteoporosis.

 

To learn more and take a risk assesment test go

http://www.shef.ac.uk/FRAX/tool.jsp?locationValue=9