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Help your heart.


Coronary heart disease has been described as the greatest sustained epidemic confronting mankind. But surprisingly, it was a medical rarity not so long ago. Indeed, not until 1912 did the first detailed clinical description of a heart attack appear in the medical literature. From then to the early 1960s, death rates from coronary heart disease increased relentlessly.

In the 1960s, death rates from coronary heart disease started to fall off. During the past two decades, death rates from this killer disease have decreased by almost 40 percent in the United States. However, despite its recent precipitous decline, coronary heart disease remains the major health problem in this and most other Western countries. Currently, an estimated 6 million Americans carry a clinical diagnosis of coronary heart disease. Nationally, more than 1 million heart attacks cause a half a million deaths per year, making coronary heart disease the leading cause of death in the United States. Unfortunately, of these deaths from coronary heart disease, many are instantaneous. Moreover, although the medical profession has made great strides in treating the clinical consequences of coronary heart disease, such as angina and heart attack, the survivors of a heart attack often remain at least partly disabled.

So considerable emphasis is now being placed on coronary heart disease prevention--that is, the prevention of a first or recurrent heart attack.

Coronary Heart Disease Risk Factors

Coronary heart disease most commonly results from the buildup of fatty deposits in the walls of the arteries that supply the heart with blood and oxygen. The precise cause of these deposits is still not completely understood. However, a number of major scientific studies have clearly demonstrated that coronary heart disease does not occur randomly in a given population. In fact, the risk of developing coronary heart disease is largely dependent on the presence or absence of certain factors, the so-called "coronary heart disease risk factors." Although some of these risk factors cannot be changed--for example, age, sex, and parental history of coronary heart disease--others are profoundly influenced by lifestyle and health habits, and they can, therefore, be modified. Modifiable risk factors include elevated blood cholesterol levels; cigarette smoking; high blood pressure; sedentary lifestyle; obesity; and type-A behavior. Of the modifiable risk factors, elevated blood cholesterol levels have recently attracted considerable attention, and the National Heart, Lung and blood Institute has launched a national cholesterol-education program to inform Americans about the need to lower blood-cholesterol levels.

Cholesterol Transport

Cholesterol, a fatlike substance, is an essential constituent of all cells in the body. It plays an important role in several metabolic processes. Of all the cholesterol in the body, only about 7 percent circulates in the blood. This circulating cholesterol, however, determines the risk of developing coronary heart disease. Because cholesterol is not soluble in water, it is transported in the blood in combination with proteins. These cholesterol-protein packages, called lipoproteins, are classified according to their density. Low-density lipoproteins (LDLs) contain the greatest percentage of cholesterol. They are responsible for depositing cholesterol in the walls of the coronary arteries; LDL-cholesterol is, therefore, often called "bad cholesterol." In contrast, high-density lipoproteins (HDLs) help remove cholesterol from the body. HDL-cholesterol is often referred to as "good cholesterol." High levels of LDL-cholesterol increase any predisposition toward coronary heart disease, whereas high levels of HDL-cholesterol provide partial protection against coronary heart disease.

Benefits of Cholesterol Lowering

Although the precise cause of coronary heart disease is unknown, recent studies have demonstrated that we can still deal with this disease quite effectively simply by modifying risk factors. The Lipid Research Clinics Coronary Primary Prevention Trial, using dietary modifications and a cholesterol-lowering drug in middle-aged men, showed beyond doubt that coronary heart disease can be deterred by decreasing elevated blood-cholesterol levels. In this study researchers found that each 1 percent reduction in blood cholesterol produced a 2 percent reduction in the number of heart attacks. Thus, men who reduced their cholesterol levels by 25 percent cut their risk of suffering heart attacks by half. more recently, the Cholesterol-Lowering Atherosclerosis Study showed that cholesterol-lowering dietary and drug therapy may slow the progression of coronary heart disease and, in fact, even cause some regresson of cholesterol buildup in arteries.

Cholesterol Screening

Because lowering elevated blood-cholesterol levels does reduce coronary heart disease, the government is campaigning for Americans to "know your cholesterol level, and if it is high, do something about it." One recommendation of the National Cholesterol Education Program is that blood cholesterol levels be measured in al adults age 20 years and over. This measurement may be made in the "nonfasting" state. Levels below 200 mg/dl are classified as "desirable blood cholesterol," those 200 to 239 mg/dl as "borderline-high blood cholesterol," and those 240 mg/dl and above as "high blood cholesterol." Persons with desirable blood cholesterol levels should ensure that their levels do not rise and should have another cholesterol test within five years. Persons with cholesterol levels of 200 mg/dl or greater should have the value reconfirmed within one to eight weeks. Those with confirmed borderline-high blood cholesterol levels and no coronary heart disease or two other risk factors (being male is considered to be a risk factor) need no further evaluation. However, they should attempt to lower thei cholesterol levels, using primarily dietary changes, and be reevaluated after one year. Persons with borderline-high blood cholesterol levels and increase risk because of definite coronary heart disease or two other risk factors, as well as those with high blood-cholesterol levels, should undergo lipoprotein analysis. In these individuals, LDL-cholesterol levels rather than total cholesterol levels should then be used for clinical decision making about cholesterol-lowering therapy.

General Dietary Recommendations

Blood-cholesterol levels are influenced by many factors, including age, sex, weight, stress, exercise, and diet. Of these, dietary modifications are most important for controlling cholesterol levels. To lower blood-cholesterol levels through dietary changes, it is often necessary to.

* Attain and maintain ideal body weight. To lose weight, you must take in fewer calories than you burn.

* Reduce the fat content of you diet and replace part of the saturated fat with unsaturated fat. Choose lean cuts of meat, poultry, and fish; trim fat off meats and remove skin from chicken before cooking; use skim milk or 1 percent milk instead of 2 percent or whole milk; eat cheeses with no more than two to six grams of fat per ounce (such as low-fat cottage or low-fat farmer cheeses); use tub margarines or liquid vegetable oils (such as safflower, corn, and olive oil) instead of butter, lard, shortenings, and foods containing palm and coconut oils; reduce your intake of processed and commercially prepared foods made with saturated fats or oils; and read labels carefully to determine both the amount and type of fat present in foods.

* Eat less high-cholesterol food. In particular, the use of organ meats (such as liver and kidney) and egg yolks should be moderated.

* Choose foods that are good sources of complex carbohydrates (starch and fiber) such as whole-grain breads and cereals, fresh fruits, fresh vegetables, pasta, rice, and dry beans and peas.

Generally, blood cholesterol levels should begin to fall two to three weeks after starting a cholesterol-lowering diet and, over time, may drop by 30-55 mg/dl. In certain instances, however, more specific dietary guidelines will be necessary for optimum cholesterol lowering, and assistance should then be obtained from a registered dietitian or qualified nutritionist, in conjunction with your physician.
COPYRIGHT 1988 Saturday Evening Post Society
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Copyright 1988 Gale, Cengage Learning. All rights reserved.

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Author:Gordon, Neil F.
Publication:Saturday Evening Post
Date:Mar 1, 1988
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