NATIONAL HEART HEALTH MONTH TAKE HEALTH ADVICE TO HEART CARDIOVASCULAR DISEASE THE NO. 1 KILLER, BUT IT'S PREVENTABLE.

Byline: Nancy Dillon

Staff Writer

Michael Moline snapped awake at 1:30 a.m. with a pinching sensation in his left shoulder blade.

The Agoura Hills dad, 48, had tweaked his back playing tennis a few days prior and assumed the new pain was related. He got up, sank into his executive chair and comfortably surfed the Internet for the next two hours.

Glendale resident Vardin Vardanian, 49, was driving west on the 101 Freeway when he felt a backache. He pulled off at Laurel Canyon, fought off a powerful wave of drowsiness and called his wife.

His first thoughts ran to a back injury diagnosed in his native Armenia. His wife convinced him to check with a doctor, and he drove another 20 minutes to the Kaiser Permanente medical offices staffed with Armenian-speaking doctors in Glendale.

Both men are lucky to be alive today. They, like Valencia resident Cynthia Impens, suffered serious heart attacks within hours of their initial hints something was wrong.

Toothpaste made her feel ill

For Impens, then 43, the first inkling was even less obvious. She was brushing her teeth on a Sunday morning when the taste of her regular toothpaste suddenly made her feel sick. She then felt a burning sensation in her throat and started sweating a few minutes later.

February is National Heart Health Month, and countless public figures have rallied to get the word out. We've all heard the headlines by now. But it bears repeating that cardio health isn't just a topic for people of a certain size, age or background.

Moline, Vardanian and Impens were all in their 40s when their heart attacks hit. And all three had received clean bills of health from their regular doctors just a few months earlier.

Common risk factors absent

"I wasn't fat, I didn't smoke, and my blood pressure was a very normal 120/70," Moline says of his condition before the attack. "It was hard to accept that my armor was dented. Not just kinked, but dented. You never think it will happen to you."

Moline credits his survival to the baby aspirins his wife convinced him to take that life-or-death morning, Aug.6, 2005. The little pills bought him enough time to get to a physician's office in Sherman Oaks, where he suffered a heart attack while hooked up to a monitor.

He underwent sextuple bypass open-heart surgery at Encino-Tarzana Regional Medical Center four days later.

"You can go and have a general physical, be told you're absolutely fine and walk out and have a heart attack," said Dr. Uri Ben Zur, interventional cardiologist at Encino-Tarzana hospital. "(Moline) was in fine shape, eating properly, but nobody ever looked specifically to see if he was prone to plaquing of the arteries."

Ben Zur recommends that everyone, especially those older than 30, ask for a cardiovascular evaluation. And if any of the risk factors are positive, these people should go on to stress testing, he says.

Vardanian was a smoker, so even though his cholesterol was normal, he was a agood candidate for such an evaluation. It might even have prevented the attack that hit minutes after he reached Kaiser that critical day last month.

He's now grateful his quick-thinking caregivers rushed him to a newly established acute heart attack care facility at Glendale Adventist Medical Center, where he received an emergency balloon angioplasty.

More than 79 million Americans live every day with some form of cardiovascular disease, and more than 910,000 Americans die from it every year.

Except during the 1918 flu pandemic, cardiovascular disease has been the No.1 killer in the United States every year for more than a century.

So what can we do to keep our hearts in good health, even if we feel OK today?

First and foremost

"The most important things are getting your cholesterol under control and exercise. And if you smoke, stop smoking," says Dr. Joseph Bornheimer, interventional cardiologist at Glendale Adventist.

Bornheimer also recommends a Mediterranean diet that's low in fat and high in fresh vegetables, fish and fiber.

Moline, now 49, has taken this advice to heart. The father of two who works as an agent for Major League Baseball players no longer eats red meat, chicken or fast food and spends an hour climbing the famous Santa Monica Stairs three times a week.

He's lost 32 pounds, and his blood pressure is down to 100/58. And he discovered a love for Fuji apples.

"The first thing I tell people is to really put their faith in diet and exercise. It seems like that's the cure," he says. "I feel like I'm 18 years old. It's unbelievable."

Vardanian has given up pizza and smoking. And Impens is taking a beta-blocker and aspirin every day, in addition to hitting the gym.

"Even if you're doing everything right, you still need to be cautious," Impens says.

With that in mind, Here are some American Heart Association recommendations:

Stop smoking. Now. And if someone in your household smokes, encourage them to quit. Everything else you do to keep your heart healthy can be canceled out if you smoke, experts say.

Get your cholesterol checked. Fat lodged in your arteries is a disaster waiting to happen. Sooner or later it could trigger a heart attack or stroke. You need to determine the levels of harmful LDL and helpful HDL cholesterol in your blood. You're aiming for an LDL level of less than 130 milligrams per deciliter (mg/dL), with less than 100mg/dL being the optimum. Women should aim for an HDL level greater than 50 mg/dL. Men should aim for 40 mg/dL.

If your LDL levels are elevated, try to limit the saturated fat in your diet to no more than 10 percent of daily calories. And you should limit your cholesterol to less than 300 milligrams each day. This means cutting down on egg yolks, animal fats, organ meats and shellfish. One egg yolk contains about 200 milligrams of cholesterol.

Have your blood pressure checked at least every two years. Aim for "normal" blood pressure levels below 120/80. If your blood pressure is high on two successive visits, your physician may prescribe medication.

Limit saturated fat to less than 7 percent of calories each day. For someone eating 2,000 calories, that's less than 15 grams a day.

Avoid trans fats, the heart-hazardous sludge that's created when vegetable oils are hydrogenated to make them more solid. Common products high in trans fat include stick margarines, vegetable shortenings, cookies and crackers.

Be physically active every day. Research has shown that getting 30 to 60 minutes of physical activity on most days of the week can help lower blood pressure, lower cholesterol and keep your weight at a healthy level.

Nancy Dillon, [phone]

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THE WARNING SIGNS

Some heart attacks are sudden and intense, similar to the dramatic "movie heart attack," where no one doubts what's happening. But most heart attacks build slowly, with only mild pain or discomfort as clues something is wrong. Often, people affected with these more subtle warning signs wait too long before getting help. The following symptoms may be indications that a heart attack is happening to you:

Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.

Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

Shortness of breath. May occur with or without chest discomfort.

Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness.

Source: The American Heart Association

CAPTION(S):

3 photos, box

Photo:

(1 -- cover -- color) the heart of the matter

Know the signs of a coronary attack - they're not always what you'd expect

Tony Cenicola/The New York Times

(2) Michael Moline, 49, of Agoura Hills survived a major heart attack and has taken his doctor's advice seriously. He has lost 32 pounds, no longer eats red meat, chicken or fast food and climbs the Santa Monica Stairs three times a week.

(3) Ultrasound technician Anna Terbarsegyan examines Cynthia Impens, 48, of Valencia, who survived a heart attack and now has semiannual appointments with her cardiologist.

Evan Yee/Staff Photographer

Box:

THE WARNING SIGNS (see text)