Heartfelt advice.

Cardiovascular disease accounts for forty-two percent of the nation's deaths. Particularly tragic and frightening have been recent reports in media of the sudden deaths of athletes who seem healthy, vibrant, and successful up to the moment of their demise.

What causes these fatal attacks? This question was put to cardiologist Oscar B. Garfein, M.D., of Roosevelt Hospital in New York City.

"Statistically, there are four reasons why these highly trained athletes die sudden deaths," says Garfein. First, they may have a condition known as hypertrophic cardiomyophathy that may show no symptoms and that may be inherited or acquired.

"The second statistical cause of sudden death is due to an anomaly or unusual congenital condition that also shows no symptoms.

"The third cause is premature coronary heart disease, a hardening of the arteries usually seen in older people, which can occur in the young as well.

"The fourth cause is myocarditis, an inflammation of the middle layer of the heart wall."

There are certain risk factors that are known to cause, or are associated with, the development of coronary heart disease: elevated cholesterol, cigarette smoking, hypertension, high blood pressure, diabetes, and a family history of heart disease.

Eating a well-balanced diet that is high in fiber and low in fat is a step toward a healthy heart. Cholesterol, a certain concentration of fat found in the blood (a condition which may be hereditary), is significantly modifiable through diet. Generally, a cholesterol level below 200 mg is acceptable; between 200 and 239 mg is borderline high; and anything over that is high. Medication may be necessary to help control levels.

"Cholesterol comes in several different forms," says Garfein, "two of which are very important in diagnosing and treating coronary artery disease. Low-density lipoprotein (LDL), referred to as `bad' cholesterol, and high-density lipoprotein (HDL), referred to as `good' cholesterol. An excess of LDL cholesterol may be deposited on and clog the walls of arteries over time and eventually lead to cardiac problems.

"High-density lipoprotein, however, takes cholesterol from the arterial walls and carries it to the liver for elimination. A high concentration of HDL is associated with decreased cardiac risk."

Smoking also creates a significant risk for coronary heart disease. Quickly addictive, it is one of the most difficult of habits to break. Even after one quits smoking, it takes between one and two years for an ex-smoker's cardiovascular disease risk to decrease.

Normal blood pressure for an adult is up to 140 over 85 (systolic over diastolic). Hypertension is blood pressure that is consistently measured as greater than 140 over 90. The systolic number represents the pressure when your heart is at work and the diastolic number is your blood pressure when your heart is at rest. Elevated blood pressure can lead to kidney failure, stroke, or heart attack. High blood pressure is associated with no symptoms. The only way you can tell if you have hypertension is by having your blood pressure measured. Reducing consumption of salt, caffeine, and alcohol might have an immediate effect on lowering blood pressure. (Hypertension is only a medical term for high blood pressure. Nothing else. It does not mean tension, emotional pressure, upset, or stress.)

Diabetes can raise the risk of heart attack threefold. People with a history of cardiovascular disease in their family are also at risk.

"Beyond those known factors," says Garfein, "there is a huge number of people who have coronary disease without any of these risk factors. Obviously, there are factors, but they are not as yet identified. The most recent association has been with the concentration of an amino acid called homocystine in the blood. People with an inborn biochemical disease called homocystinuria--and even people without the disease who have normal levels but levels at the higher end of the normal spectrum--have a greater incidence of coronary heart disease than people who have normal levels but are at the lower end of the scale. Here, again, this may be modifiable and the concentration of homocystine reduced through diet with the administration of folic acid, a vitamin found in green, leafy vegetables. This is still hypothetical, but then fifty percent of the risk factors are unknown."

Students miss the opportunity to strengthen the heart if they exit from dance class before the big or small jumps--the high-energy curve of the class--or if they don't continue with the class because they are out of breath to the point of being slightly uncomfortable. Endurance is gained only by doing intense exercise, taking a short period of rest, then performing even more intense exercise. Notice the choreography of a male variation composed in the last century. The solo begins with tour de force steps, follows these with a walk upstage as a rest, then alternates heavy breath-using steps with restful steps until a final round of high jumps or successive tours.

Garfein, an advocate of strength training, says, "Most exercises that have a cardiovascular effect do not really affect the heart directly, but affect secondary changes in the physiology of the peripheral muscles. The slowing of the heart rate, the lowering of blood pressure, and the improvement in exercise capacity is most often due to the fact that the peripheral muscles work more easily and efficiently so that the heart doesn't have to work as hard.

"The importance of exercise at any age cannot be emphasized enough. Dance teachers seem to maintain a high degree of energy and health throughout their later years for two basic reasons that I believe can be generalized. One can speculate that these teachers were endowed from the beginning with special physiological advantages or that they made themselves special by what they did. However, the first asset, as I see it, is that teaching keeps you involved with the young so that you tend not to become socially ossified. Teaching keeps you mentally as well as physically active. From a spiritual point of view, if dance is your mission--something you want to do because it is rewarding--the combination of these assets contributes to health and sets the teacher on an upward trajectory of life."