One of the most widely recognized causes of premature death worldwide today is heart disease. Although this may sound very depressing, the reality is that the incidence of premature deaths caused by heart disease has significantly declined in recent years. Although progress has been made in the treatment of heart disease, additional effort needs to be made to prevent this illness as much as possible. Heart disease often takes a toll on the sufferer's and his family's lives. Treating heart disease can also be very complicated, requiring specialized human resources, equipment and medication. The costs of such treatments are also very high. In summary, prevention is better than the cure. Let's now review the other factors.

Who Are At Risk?

People who have a family history of heart disease are probably the most at risk. So, bear in mind that if hereditary heart disease is prevalent in your family it would probably be a wise step to discuss this aspect with your doctor and to have regular annual appointments with him to check for potential problems. Be assured that if you do this, your chances of circumventing heart disease will be so much better.

Heart Disease Is A Leading Cause For Fatalities

Although more men are prone to heart disease than women, it is the most widely recognized cause of death in women. Strangely enough the observation that women live longer than men is also still true. Women therefore have to take certain measures to prevent the onset and development of heart disease.

Recognition Of The Problem Often Occurs Too Late

Doctors and specialists today, armed with improved technologies, are able to diagnose and treat heart disease more comprehensively than ever in the past. Unfortunately, by the time most people realize that they are suffering from heart disease, it would have escalated to an advanced stage that poses a treatment challenge for physicians. Often the onset of the illness only comes to light when the person has already been afflicted by a stroke or heart attack.

Of the many contributing factors of heart disease in people, smoking cigarettes is the most critical. Other factors such as elevated blood cholesterol levels as well as obesity, high blood pressure, sedentary lifestyles and diabetes heighten the incidence of heart disease. The person who does not deny these risk factors will have a better understanding and chance of survival should he or she be afflicted by some form of heart disease. Obviously it will mean making some necessary lifestyle changes.

Tremendous advances in medical technology have been made in many areas and also in terms of treatment protocols for sufferers of coronary heart disease. The development of drugs specifically designed to prevent heart attacks has increased and are readily available. Surgical techniques have advanced tremendously since the days of Dr. Chris Barnard and the first heart transplant. Both drug and surgery treatment protocols are designed for the elimination of heart problems and the restoration of proper heart function. The success of these developments is documented by the sharp decline of fatalities due to heart disease.

Steps Forward In Dealing With Heart Disease

Many new preventive measures have been developed to reduce the problems associated with heart disease. In addition to the advances in medical treatment for people suffering from heart disease, public awareness for these illnesses has increased dramatically. People are educating themselves with regards to the good benefits of a healthy lifestyle, staying away from smoking and drugs and working out to a cardiovascular exercise routine that is specifically designed to exercise the heart to make it stronger.

This statement by no means indicates that heart disease is not a serious threat, or that heart disease can be circumvented with minor treatment programs. Not at all! Heart disease is a serious health condition the danger of which can never be underplayed. But it is interesting and important to realize that heart disease is no longer the death threat that it was in years gone by.

Check Ups Can Prevent Heart Problems

Regular examinations by the doctor will not prevent heart disease from happening, but these examinations may have a significant impact on your heath if they are able to nip a heart problem in the bud before it becomes serious. This makes sense with regards to any illness. Detecting heart disease early in its developmental stages can motivate the patient to obtain treatment as a matter of urgency. When treatment is received promptly, the higher the chances are to successfully treat the heart disease before it turns out to be life threatening. Because this is so important regular - at least annual - checkups are necessary for those who might be at risk for heart disease.


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Heart disease can be caused by many different things and comes in many different forms. When the heart valve becomes diseased, one of two things happens: it doesn’t close tightly enough (called incompetence) to keep blood from backing up into the chamber from which it flowed; or, it doesn’t open widely enough (called stenosis) to allow adequate amounts of blood to flow into the chamber.

Heart disease is very common. Heart disease is the leading cause of death in the United States. The tendency to develop heart disease can be genetic. However, certain lifestyle factors such as diet, smoking, and stress make a big difference in whether or not a person will develop heart disease.

Many of the symptoms of heart attack can be brought on by digestive disturbances or other less serious conditions. But only sophisticated medical tests can determine for sure if you're having a heart attack. Heart attacks may vary from person to person, and from heart attack to heart attack. Women, for example, may experience "atypical' symptoms such as pain between the shoulder blades rather than crushing chest pain. This may result in them delaying seeking treatment. That is a great mistake.

Heart disease symptoms can be hard to recognize. You may not have any symptoms, or you may experience chest pain and shortness of breath, especially with physical exertion. Heart disease symptoms can be different in women. It's important to know when it might be an emergency.

Signs and symptoms of heart disease occur when plaque buildup in the coronary arteries causes a reduction in blood flow to the heart. You can have heart disease for many years without experiencing symptoms. Often, the first symptom comes in the form of a heart attack. Other common heart disease symptoms include chest pain or discomfort, shortness of breath, faster heartbeats, and dizziness.

Symptoms of heart disease in the case of arrhythmias usually occur when one realizes that his or her heart is occasionally missing a beat. Often these are harmless palpitations which are caused by an excessive consumption of stimulants such as caffeine. However, one should go to a doctor to rule out symptoms of heart disease. Arrhythmias are the result of heart valve problems, which might be indicative of damage to the valve itself. They are often cured by a “shock” which may regulate heart beats, but there is a risk in this treatment, since a clot could become dislodged and cause a heart attack or stroke.

Anybody can have heart disease. It is how we take care of our heart that actually lessens the chance we have coronary heart diseases like atherosclerosis (blockage of blood in the artery), ischaemic heart disease (reduction of blood supply to the heart), cardiovascular disease (often involving the heart and the blood vessels), and pulmonary heart disease (failure of the right side of the heart to function.)


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INTRODUCTION: Heart disease is a number of abnormal conditions affecting the heart and its blood vessels. Also called cardiovascular disease, it mainly affects older people and indicates that there are problems with the heart and blood vessels.

It has become the leading cause of death in the United States, is a major cause of disability, doesn't go away, but by working with your doctor, you can live longer and feel better. Types of cardiovascular disease include: Coronary artery disease (CAD), the most common type and is the leading cause of heart attacks.

In 2003, almost twice as many females died of cardiovascular disease (both heart disease and stroke) than from all cancers put together. The older she gets, the more likely she is to have cardiovascular disease; however women of all ages should be concerned.

African American and Hispanic American/Latina females are more prone to get heart disease because they tend to have a greater number of risk factors such as obesity, lack of exercise, elevated blood pressure, and diabetes than White females. Women of color are also more likely to die of the disease.

Having diabetes elevates your chances of developing heart disease and high levels of triglycerides are linked to the disease in some people. Also Being obese increases your risk. Chest or arm pain or discomfort can be a symptom of cardiovascular problems and a warning sign of an actual or impending heart attack.

If your father or brother had a heart attack before age 55, or if your mom had one before age 65, you're more likely to get heart disease. Birth control pills can present risks for some women, especially women older than 35, women with elevated blood pressure, diabetes, or high cholesterol and those who smoke.

Nearly 700,000 people die of heart disease in the United States a year. You can find out more about heart disease by calling the National Women's Health Information Center at 1-800-994-9662.

The chance of developing coronary disease can be reduced by taking steps to prevent and control those factors that put people at larger risk for cardiovascular disease and heart attack. The very best ways to prevent the disease are to control high blood pressure, diabetes or a elevated cholesterol level and, if you smoke, stop smoking.

CHOLESTEROL: What does a high level of cholesterol have to do with heart disease? It can clog your arteries and keep your heart from getting necessary blood. People with high blood cholesterol or elevated blood triglycerides often have no symptoms, so have your blood cholesterol and triglyceride levels checked often. If your levels are high, talk to your physician about what you can do to lower them. You may be able to decrease your levels by eating better and exercising more, if not, your physician may prescribe medication to lower and bring it under control.

When there is excess cholesterol in your blood, it can build up on the walls of your arteries, forming plaque and causing blood clots. There are basically 2 types of cholesterol: Low-density lipoprotein (LDL) is frequently called the "bad" type because it can block the arteries that carry blood to your heart. High-density lipoprotein (HDL) is called the "good" type because it takes the bad cholesterol out of your blood and stops it from building up in your arteries.

All women 20 years of age and older should have their blood cholesterol and triglyceride levels checked at least once every five years. If you are overweight, losing weight can help reduce your total cholesterol and LDL ("bad cholesterol") levels.

Try to consume more foods low in saturated fats, trans fats, and cholesterol. Skim (fat-free) or low-fat (1%) milk and cheeses, and low-fat or nonfat yogurt, Fruits and vegetables (try for five a day), Cereals, breads, rice, and pasta created from whole grains (such as "whole-wheat" or "whole-grain" bread and pasta, rye bread, brown rice, and oatmeal), Limit consumption of organ meats (liver, kidney, brains), Egg yolks, Fats (butter, lard) and oils, Packaged and processed foods.

There are 2 diets that may help reduce your cholesterol: Heart Healthy Diet and Therapeutic Lifestyles Changes (TLC) Diet. Exercise can help reduce LDL ("bad cholesterol") and raise HDL ("good cholesterol"). If your MD has prescribed medicine to reduce your cholesterol, take it exactly as you have been told to.

CONCLUSION: Heart disease is not contagious - you can't get it like you can the flu or a cold. It is a general term that refers to a variety of acute and chronic medical diseases that affect one or more of the components of the heart. The signs you describe to your physician will help to decide if you need to be tested for heart disease. Your physician will also check if you have any conditions that can increase your chance of developing the disease.

These conditions include: high blood pressure, diabetes, smoking, elevated cholesterol level, menopause in women, family members who have had heart disease at a young age. If you have cardiovascular disease, your angina can be treated by treating the heart disease. Maintaining a healthy diet and weight in addition to a regular exercise program can help you avoid developing heart disease.

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Testosterone is predominantly produced by the testes in men. Small quantities are produced by the ovaries in women. The adrenal glands also produce small amounts in both sexes. Testosterone plays a key role in sexual functioning. Besides helping in the production of sperms, this steroid hormone also enhances libido, increases energy, helps produce red blood cells and protects against osteoporosis. Testosterone is an androgen and an anabolic steroid.

The blood levels of testosterone vary over a wide range. Testosterone levels gradually start declining during the third or early fourth decade of life at a constant rate. As a result, older men have significantly lower levels compared to their younger counterparts. Testosterone levels may also be low due to several diseases. The cutoff number is 250 ng/dL, levels below these are considered low.

What is the connection between testosterone and heart disease?

Low testosterone levels have been associated with increased risk of development and death from cardiovascular disease. In a recent study by Laughlin and associates, men with low levels and in the lowest quartile were 40% more likely to die early, especially from cardiovascular diseases. These findings were unaffected by age, lipid levels and other risk factors. The study involved 794 men aged 50-91 years, who were monitored for 20 years. The study was published in 2008 in the Journal of Clinical Endocrinology and Metabolism.

In 2007, results of the European Prospective Investigation into Cancer in Norfolk Study were published in Circulation. In this study, Khaw and associates monitored 11,000 patients aged 40-79 for their testosterone levels and death. They found that the latter were inversely related - low testosterone levels correlated with a higher rate of death from cardiovascular disease, cancer and all other causes.

In another study, Shores and colleagues, found that low testosterone levels were associated with an increased risk for mortality in male veterans. The male population was over 40 years of age and did not have prostate cancer. The study was done in Seattle and published in the Archives of Internal Medicine in 2006.

How does low testosterone cause cardiovascular disease?

The exact mechanism by which low testosterone causes cardiovascular disease is not clear, but there are several postulated mechanisms . Patients with low testosterone levels tend to have more visceral obesity. Visceral obesity is responsible for the apple shaped body (as compared to the pear shaped body, in which the fat is predominantly deposited in the hips and buttocks). More commonly, this is called the 'pot belly' or 'beer belly'. The visceral fat is packed in between the internal organs in the peritoneal cavity (abdominal cavity). In contrast the subcutaneous fat is found under the skin and the intramuscular fat in the skeletal muscle. Visceral fat is more metabolically active and synthesizes more heart unhealthy fatty acids, triglycerides, and adipokines than nonvisceral fat. Low testosterone is also associated with the development of metabolic syndrome and diabetes. In a study published in 2007, men in the lowest levels of testosterone were four times more likely to develop diabetes when compared to men with the highest levels. This data from the Third National Health and Nutrition Examination Survey, was published by Selvin and group in Diabetes Care. Patients with low testosterone levels have higher levels of insulin and triglycerides, both detrimental to the cardiovascular system.

Should you take testosterone to reduce heart disease?

There has been no scientific study in which testosterone replacement has been found to reduce heart disease. A study has just not been done. However, English and associates found that in patients with established coronary artery disease, testosterone replacement reduced exercise induced chest pain. This data was published in the European Heart Journal in 2000.

Summary

Testosterone is a predominantly male hormone produced by the testis and adrenals. It is responsible for libido in both sexes and the production of sperms in the male. It is also associated with increased energy, production of red cells and prevention of osteoporosis. Testosterone levels normally decline with age, with older men having a much lower levels than their younger counterparts. Low testosterone levels have been linked to an increased incidence of cardiovascular disease and mortality, and death from all causes. There is no published research on whether taking supplemental testosterone will reduce cardiovascular disease and death.

Dr. Shashi K. Agarwal is a Board Certified Internist and Cardiologist with a private practice in New York City and New Jersey. He is also a diplomate of the American Board of Holistic Medicine and the American Academy of Anti-Aging Medicine.

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Dyerberg and group in 1978 reported in the Lancet, a health paradox that they noted in the Greenland Eskimos. The Eskimos, despite a high-fat diet, had a low rate of coronary heart disease. The researchers postulated that a protective effect was provided by the fatty oils present in their diet, rich in meat from seals, caribou and fish. Since then, this inverse relationship between fish intake and cardiovascular disease has become well established.

Fish oils are rich in omega-3 fatty acids. Along with omega-6 fatty acids, they are called polyunsaturated fatty acids (PUFAs). Both of these fatty acids cannot be synthesized by humans and are therefore considered 'essential'. Besides fish, omega-3 fatty acids are also found in walnuts, flaxseed, canola oil, broccoli, cantaloupe, kidney beans, spinach, grape leaves, Chinese cabbage, and cauliflower. Two omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are health and heart protective. A third kind, alpha-linolenic acid, is less potent. Omega-6 fatty acids are detrimental to heart health, and have been associated with depression. Omega-6 fatty acids are abundant in refined vegetable oils commonly used for cooking.

What is the link between fish oil intake and cardiovascular disease protection?

Several studies have shown an inverse relationship between fish consumption and coronary heart disease and death. In the DART study, 2003 men with a previous history of a heart attack were divided into two groups and monitored - one group had an increased fish oil consumption, either by diet or by supplementation compared to the other group, The increased fish oil group had a 29% reduction in death. Studied by Burr and group, this data was published in Lancet in 1989.

In a large GISSI-Prevenzione trial, 11,324 patients with a history of a heart attack were randomly assigned into groups; each group was given either 850 mg omega-3 fatty acid, 300 mg vitamin E, both, or neither. The results showed that the group given the fatty acid alone had a 45% reduction in sudden death and a 20% reduction in all-cause mortality. This was published in Lancet in 1999.

In a review of 11 studies, Markmann and Granbaek found that in populations at a higher risk of coronary heart disease, intake of 40-60 grams of fish per day could reduce the risk of death by 40%-60%. They published their data in the European Journal of Clinical Nutrition in 1999.

How do omega-3 fatty acids protect against heart disease?

Fish oils lower blood pressure and serum triglyceride levels. They also have anti-arrhythmic, anti-thrombotic, anti-atherosclerotic, and anti-inflammatory properties. They also improve endothelial function. All these effects protect against heart attacks from coronary heart disease and sudden death due to an irregular heart rhythm.

How much omega-3 fatty acids do you need?

It is recommended that the daily intake of omega-3 fatty acid be 2.85 g/day. Healthy marine sources are fresh tuna, sardines, salmon, herring, trout and oysters. Fish should be grilled, baked, or broiled -- not fried. Fried fish loses all of its benefits. This lack of benefit from fried fish was documented by Mozaffarian in the Cardiovascular Health Study published in Circulation in 2003. As noted earlier, omega-3 fatty acids are also found in walnuts, flaxseed, canola oil, broccoli, cantaloupe, kidney beans, spinach, grape leaves, Chinese cabbage, and cauliflower. Recently, omega-3 fatty acid enriched eggs have become available in the supermarkets and can help meet the daily requirements. If one is unable to eat enough fish or other food sources of omega-3 fatty acids, fish oil supplementation should be considered. The usual amount is 1 gm EPA and DHA per day, although your physician may recommend higher doses in certain situations.

Is fish safe?

Fish at the top of the food chain often contain significant levels of methylmercury, polychlorinated biphenyls, dioxins, and other environmental contaminants. These include mackerel, shark, swordfish, and tile fish (golden bass or golden snapper). The FDA advises pregnant women, women wanting to become pregnant, nursing mothers and children to avoid these fish as they may be at an increased risk of mercury intoxication.

Are fish oils safe?

In general, most fish oils sold over the counter in the USA are safe. The FDA in 1997 indicated that the consumption of up to 3 g EPA + DHA/day from all sources is safe for American adults. Fish oils do not interact with other drugs and usually have no side effects. Fishy aftertaste can be lessened by keeping the supplements in the freezer. Rarely nausea, bloating and belching can occur. Excessive intake may cause bleeding. There is only one FDA approved fish oil preparation in the USA. It is available by prescription under the trade name of Omacor. Because of a patented refining process, toxins such as mercury are completely removed, It also has more PUFAs - 90% compared with 60% in some commercially available products. This makes Omacor more reliable and efficacious.

Summary

The heart protective effects of omega-3 fatty acids are very compelling. These essential polyunsaturated fatty acids are abundant in fish and certain vegetables and nuts. People at a high risk of developing heart disease or who have established heart disease, should supplement their diet with fish oil capsules providing 1 gm EPA and DHA per day. It would be prudent to discuss this therapy with your physician.

Dr. Shashi K. Agarwal is a Board Certified Internist and Cardiologist with a private practice in New York City and New Jersey. He is also a diplomat of the American Board of Holistic Medicine and the American Academy of Anti-Aging Medicine.

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You're in the mall, the supermarket, or heading for the departure gate at the airport when you see someone ahead of you slump to the ground. As you glance around to see if anyone else is aware of what just happened, you notice a sign that says "AED" or "Defibrillator" with an arrow pointing to a box. Would you know what to do?

According to the American Heart Association, approximately 350,000 people die from sudden cardiac arrest each year in the United States alone. The majority of people exhibit no prior symptoms, so they have no warning. The current national survival rate for Sudden Cardiac Arrest is less than 5%, often because emergency medical services cannot reach them in time. The likelihood of successful resuscitation decreases by about 10% with every minute that passes.

Sudden Cardiac Arrest is most often the result of the electrical activity of the heart becoming disorganized, causing it to beat ineffectively. This arrhythmia is called ventricular fibrillation. This results in a lack of blood flow or pulse, causing loss of consciousness, cessation of breathing, and leads to death very rapidly unless properly treated. CPR is important in maintaining blood flow to the vital organs of the body for a short period of time, but defibrillation is the most effective treatment for returning a heart in ventricular fibrillation to its normal rhythm. Until recently, only credentialed health professionals and trained emergency medical service personnel were able to provide defibrillation to victims of Sudden Cardiac Arrest. Precious minutes were lost from the time of collapse to the arrival of life-saving equipment. With widespread access to defibrillators, it is estimated that an additional 40,000 lives could be saved each year in the U.S. alone.

The efficacy of defibrillation is directly tied to how quickly it is administered. The American Heart Association has determined that maximum effectiveness is achieved if defibrillation takes place within 3 to 5 minutes of collapse. After 10 minutes, the likelihood of a positive outcome is extremely poor. The importance of quick and effective intervention is outlined in the AHA's "Chain of Survival" concept; early access, early CPR, early defibrillation, early advanced care. (americanheart.org)

The proliferation of Public Access Defibrillators (PAD) since the 1990s and their accompanying PAD Programs has done much to educate the public about early access defibrillation. Public access defibrillators can be found in mass transit terminals, on commercial airplanes and in shopping malls. They are currently required by law in Federal and State government buildings, health clubs and nursing homes, with numerous bills now before Congress to provide them in an ever growing list of public facilities.
The American Heart Association and the American Red Cross are just two of the nationally recognized organizations providing lay persons all of the information and training necessary to competently assess a victim, administer CPR if indicated, and to operate an AED safely and effectively. Numerous local training and consulting organizations accredited by the American Heart Association or the American Red Cross are also available to provide training and certification.

Keeping knowledge current increases confidence. With increased confidence, the likelihood of bystander participation and positive intervention outcome increases as well. Consider the millions of "Baby Boomers" between 45 and 60-plus years of age. And getting older. They might be your customers, neighbors, co-workers, parents, or even you.

Anyone has the ability to save a life. With just a little training, everyone can have the chance to be a hero.

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If you thought letting your children spend their youth playing videogames and eating Fritos was just good, harmless fun, you're wrong. Researchers at the University of North Carolina (Chapel Hill) have found that kids who lead inactive lifestyles - that means getting less than 20 minutes a day of moderate-intensity physical activity - are 5-6 times more likely to be at risk of heart disease than kids who get the 60 min-, utes recommended by the Centers for Disease Control and Prevention.

Q: Is there any relationship between a crease in the earlobe and heart disease?

The relationship between earlobe crease and heart disease, primarily coronary disease (heart attacks), was first suggested more than thirty years ago and has been studied many times in various populations. Some Greco-Roman statues in the Louvre Museum in Paris show the earlobe crease, so the finding goes back 2,000 years or more. The results of some studies indicate that the earlobe crease is associated with age, and age is associated with vascular disease. Others conclude that the crease is an independent predictor of heart disease and, more recently, carotid artery thickening. Whatever, the relationship is not that good because many people without the crease have heart attacks and many with the crease do not. Given my choice of a predictor of atherosclerosis and heart attacks, I'd pick the cholesterol level over the earlobe crease. But even the cholesterol is not perfect, since almost half of those with heart attacks can have normal cholesterol levels.

Q: I am under treatment for angina. When I have an attack of chest pain, I usually can get rid of it with nitroglycerin. My neighbor, exactly my age, has the same thing: coronary artery disease with angina attacks. His doctor is treating him with leg pumps. He says he has had no angina since he started the treatment. Would this help me?

A: The procedure, enhanced external counterpulsation, has been around for 10 years.

A series of cuffs, like blood pressure cuffs, is wrapped around the patient's legs. At a very precise moment in the heart cycle, the cuffs are sequentially inflated, with the lowest cuff inflated first. The pumping maneuver increases blood flow back to the heart and to the heart muscle. Angina is chest pain that comes on with activity. It indicates that one or more of the heart arteries have a blockage. People with artery blockage get enough blood to the heart muscle when they're resting, but, when they are active, the blockage prevents the increased flow required for the extra effort the heart must make. The result is the chest pain called angina.

Some people who have undergone a series of EECP treatments have fewer attacks after the treatment, and some have even discontinued medicine for angina.

EECP has yet to win universal approval. People who judge the effectiveness of medical treatments want more evidence before they recommend it for everyone. Would it work for you? Only a trial with it will tell you.

Q: There's a yellow streak on both my eyelids. What is this? Does it mean eye trouble?

A: Those streaks are xanthelasmas (ZANN-thul-AS-muhs), an aggregation of cells filled with cholesterol. In half of people with them, they indicate high blood cholesterol or high blood triglycerides. If you haven't had a check of your cholesterol or triglycerides, you should have one.

They are not a sign of eye trouble. If you find them cosmetically distressing, they can be removed.

Q: What's a "chemical" depression? I have two relatives who say that's what they have.

A: Brain cells communicate with each other through chemicals with names such as dopamine, serotonin and norepinephrine. One current and popular theory about depression cites an imbalance of one or more of these chemicals as the cause. Antidepressants restore the normal balance.