Monday, June 11, 2007

Fight Deadliest Killers: Heart Disease and Stroke

Look at the clock. In the next three minutes, 10 people in America will suffer a coronary event or stroke, and only six of them will survive. According to a recent report by the American Heart Association (AHA), coronary heart disease (CHD) affects more than 15 million Americans; over five million more are affected by stroke. Heart disease and stroke are two of the biggest causes of death in this country, according to Mt. Sinai's Focus on Healthy Aging.

“Heart disease and stroke are a similar process in different locations,” says Steven R. Levine, MD, a professor of neurology at The Mount Sinai Stroke Center. Both are frequently caused by atherosclerosis, or hardening of the arteries, and the primary risk factors are the same for both: hypertension, diabetes, high cholesterol, and tobacco use—the four things that significantly increase your risk of cardiovascular disease.

According to Bruce Darrow, MD, PhD, assistant professor in the Division of Cardiology at Mount Sinai Medical Center, roughly 90 percent of the people who have heart attacks have at least one of those four risk factors. Dr. Levine notes that if you have all four, plus heart disease, there’s a 50 percent chance that you’ll have a stroke within the next 10 years. Even if none of the four risk factors pertain to you now, understanding them could help prevent you from developing one of these conditions in the future.

Coronary heart disease. CHD, also called coronary artery disease (CAD), refers to the accumulation of plaque within the arteries of the heart. If you have CHD, you most likely won’t experience any symptoms until the later stages of the disease. Left untreated, however, CHD can lead to a heart attack and often death. The lifetime risk of developing CHD after age 40 is 49 percent for men and 32 percent for women. CHD can be blamed for one of every five deaths that occurred in the U.S. in 2004.

Fortunately, doctors and hospitals continue to develop better ways to diagnose cardiovascular diseases. “In general, we have more and more tools to help determine someone’s risk of coronary disease. In addition to regular stress tests and electrocardiograms, we can use CT (computed tomography) scans of the heart as well as CRP (c-reactive protein) to determine risk,” says Dr. Darrow.

Recent research suggests that patients with elevated levels of CRP are at an increased risk for cardiovascular disease. To measure the CRP level, a “high-sensitivity” CRP test is performed and analyzed by a lab. This test is designed for greater accuracy in measuring low levels of CRP, which allows the physician to assess your cardiovascular risk.

The main goal of CHD treatment is to improve blood flow to the heart. Doctors often recommend that patients take a low-dose aspirin (usually 81 mg) daily to prevent the risk of heart attack. Aspirin works by reducing your risk of developing blood clots. There are also prescription medications available that help to relax arteries and increase blood flow. Some of these drugs include statins to lower cholesterol; nitrates to dilate the arteries and veins; and beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors to lower blood pressure. Lifestyle changes are also crucial for successful treatment of CHD (see “What You Can Do” box).

Stroke and TIA. The term “stroke” refers to a brain injury that occurs when the blood supply to the brain is interrupted. There are two major types of stroke: ischemic and hemorrhagic. Ischemic (a restriction in blood supply) can be due to thrombosis (a clot inside a blood vessel), an embolism (an object, such as a piece of plaque or a blood clot, that travels from another part of the body and causes a blockage in a blood vessel), or systemic hypoperfusion (decreased blood flow through an organ). Hemorrhagic stroke can be attributed to bleeding in or around the brain. Approximately 80 percent of strokes are due to ischemia. In adults over age 55, the risk of stroke is greater than one in six.

A transient ischemic attack (TIA), often referred to as a “mini stroke,” occurs when the blood supply to the brain is temporarily disrupted. TIAs last for less than 24 hours. People who have a TIA have a 10-year stroke risk of 18.8 percent and a combined 10-year risk of stroke, myocardial infarction (MI), or vascular death of 42.8 percent.

“It’s important to remember that stroke is treatable if captured within a short period of time,” says Dr. Levine. Tissue plasminogen activator (tPA) is used by doctors and hospitals to dissolve blood clots in stroke victims, but must be administered within the first three hours after the onset of symptoms in order to be effective. In addition, doctors use an MRI to pinpoint the exact location of the blockage in the brain and to make decisions, at selected stroke centers, about dissolving or retrieving clots in the brain within six to eight hours from symptom onset. Physicians also use “telemedicine” that allows a remote stroke specialist to assist in the diagnosis and treatment via video conferencing.

Mitigating your risk. To help ensure that you don’t become another cardiac statistic, talk to your doctor about the main risk factors for CHD and stroke. Controlling blood pressure, cholesterol and diabetes, and quitting smoking, can significantly reduce your risk. Studies have shown that people who don’t smoke, exercise at least half an hour per day, and maintain a healthy diet low in trans fats and sugar and high in fiber, folate, and omega-3 fatty acids, have a significantly decreased risk of developing cardiovascular disease.

If you smoke, quit. Smoking dramatically increases your risk.
Add healthy foods to your diet including fruits, vegetables, whole-grain foods, poultry, fish, and low-fat dairy.
Limit your intake of red meat, high-sugar foods, salty foods, and foods high in total fat, trans fat, and saturated fat.
Exercise for at least 30 minutes a day. Walking, swimming, and bicycling are great forms of exercise that help reduce your risks.

• Numbness or weakness in the
face, arm, or leg
• Confusion, trouble speaking,
or understanding
• Difficulty walking, dizziness, or
loss of balance or coordination
• Difficulty seeing out of one or
both eyes
• Severe headache with no
known cause

• Chest discomfort
• Discomfort in the arms, back,
neck, jaw, or stomach
• Shortness of breath
• Cold sweat, nausea, or

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