The heart of the matter: steps you can take to lower your risk of heart disease.

Jim Allen, a 58-year-old married Caucasian male, woke up at 3:00 a.m. with tightness in the middle of his chest, radiating to his back, neck, and arms. He was mildly short of breath and drenched in a cold sweat. Within 10 minutes his symptoms had resolved, and he went back to sleep. The following day he had two similar episodes of no known disease and considers himself to be in good health. There is no history of heart disease in his family.

On arrival in the emergency department, almost 18 hours after his initial pain, Mr. Allen was noted to have normal vital signs (pulse, respirations, blood pressure, and temperature). His only complaint was a faint residual discomfort in both arms. His heart and lungs were normal on examination. His electrocardiogram (EKG) demonstrated no abnormality.

At 9:00 p.m., after taking a dose of medication for the arm pain, his heart stopped.

This true story is repeated (with minor variations) thousands of times every day in hospital emergency rooms.

In 1990, one and one-half million Americans suffered a heart attack and one third (almost 500,000) of them died. Most of those deaths occurred outside the hospital and within two hours of the onset of pain. One out of every five of those who died had no warning at all--no prior symptoms of heart disease.

Incredible life-saving technology is readily available today in the medical centers that serve our communities. But the finest and most advanced technology is of no benefit to those who never reach the hospital.

We understand quite well some of the most important contributing elements to ischemic heart disease (or coronary artery disease). We call them "risk factors," because they increase the risk that a person with these characteristics will develop heart disease and become vulnerable to a heart attack or sudden death. W can't change our gender (men are at greater risk than women), nor can we choose our parents (some families are at greater risk), nor turn back the clock (aging adds to risk). But we can do something about these potential risk factors.

Cholesterol

Elevated levels of total cholesterol and LDL (low-density lipoprotein) cholesterol are directly associated with heart disease and deaths from heart attacks. Total cholesterol less than 200 is considered low risk, while a value over 240 places one in the high-risk category. High cholesterol levels often respond to a diet low in fat and cholesterol, weight loss, and medication. it should be noted that high levels of HDL (high-density lipoprotein) cholesterol are thought to have a beneficial effect.

Cigarette Smoking

Evidence is abundant, indisputable, and incriminating--cigarette smoking is directly associated with ischemic heart disease. The good news is that within only a few years of quitting smoking, the risk approaches that of nonsmokers.

Hypertension

High blood pressure is associated with death and disability from heart disease. Dietary measures, including salt restriction and weight loss, along with medication may be required to control hypertension.

Inactivity

An inactive, sedentary, couch-potato lifestyle increases the risk of heart disease, Regular exercise, conversely, contributes to effective control of a number of the risk factors, including elevated cholesterol, hypertension, obesity, and diabetes.

Obesity

As body weight increases above "normal" or healthy ranges, so does the incidence of associated risk factors, including high cholesterol, hypertension, and diabetes. Weight loss yields a corresponding reduction in these risk factors.

Diabetes Mellitus 

Abnormally elevated levels of blood sugar, even in the absence of full-blown diabetes, are associated with an increased incidence of heart disease, particularly in women. Effective control is dependent upon dietary measures and, sometimes, medication.

And What About Stress?

Stress was once thought to be a significant risk factor for heart disease. While this theory is not entirely disproved, more recent research suggests that a certain amount of stress is healthy. The infamous hard-driving, overachieving, type A personality may not be as vulnerable to heart disease as we once thought.

Denial

Although not generally considered a risk factor, denial, a stubborn unwillingness to admit that anything is wrong and seek help in a timely manner, is nevertheless responsible for an incalculable number of untimely and unnecessary out-of-hospital deaths. "Waiting it out" with chest pain and shortness of breath is nothing less than cardiac roulette.

Ted Hamilton, M.D., is, medical director of Florida Hospital Centra Care in Orlando, Florida