prevent heart disease

Think You’re Not at Risk for Heart Disease? Take This Test and Find Out

April 13, 2015 by James Bogash

Heart disease is not something that we need to educate the public on. Everyone’s got ideas on how to prevent heart disease.

But, apparently, there’s some massive disconnect between what we need to do and what we are doing. A recently study revealed that not a single person out of 1,731 were living a lifestyle that included Life’s Simple 7 established by the American Heart Association. Not a single one.

But I’m confident that not a single person out of the 1,731 actually wanted to have a heart attack or leave his or her family with the untimely death of a loved one.

So why the disconnect? This particular study may help give you some insight as to why YOU haven’t adopted at least the Simple 7.

In it, researchers looked at a group of 5,863 patients and asked about his or her individual perception of risk of heart disease based on established risk factors. The patient’s perceived risk was then compared to his or her ACTUAL risk based on established risk factors.

Individuals were asked to rate his or her heart disease risk for the next years as low, intermediate or high. Based on these responses, they were classified as hypo-perceivers (the patient’s perceived his or her risk of heart disease as lower than it actually was) and normo-perceivers (the patient’s perceived risk was on par with his or her actual risk). Here’s what they found:

Cardiovascular risk was intermediate in 45.7% and high in 54.3% of individuals as estimated by the Lifetime Risk Score (LRS).
Shockingly, 83.9% were hypo-perceivers, thinking that they were at a lower risk than they actually were.
A mere 16.1% estimated their risk correctly.

Talk about a massive disconnect. First of all, EVERYONE in the study had at least an intermediate risk for heart disease. This is a sad reflection on the overall state of health. But how could so many of these patients be so unaware at how great his or her risk is??

The rest of the study may give us some insight into just how much our “take a pill to fix it” society has screwed up our perceptions:

Smokers were 204% more likely to underestimate their risk.
Those with cholesterol problems were 121% more likely to underestimate risk.
Sedentary people were 167% more likely.
Those who took meds? A whopping 350% more likely to underestimate his or her risk.
On the flip side, those with a higher BMI (64%), high blood pressure (43%), depression (54%) and stress (60%) were at a lower risk of hypo-perception.

I have said this time and time and time again. Taking medications to “fix” your problems does no such thing. In almost every situation, medications give you a false sense of security. Even though your blood pressure, cholesterol or blood sugar has gotten better on the meds, it translates very weakly into actually changing your risk of the things you are really worried about like heart attacks, stroke or death.

In other words, you will die with better numbers, but you WILL STILL DIE.

While this is a strong statement, we have seen it play out over and over in the medical literature. This study just reinforces the fact that our drug-oriented medical approach is creating a society that BELIEVES it is at a lower risk for heart disease, when in reality, it is not. There is a very high likelihood that you have some degree of risk for heart disease, unless you have adopted at least Life’s Simple 7 (click here for more info on the Simple 7 and see where you stand….personally I’m at a 9.4/10 because my BMI suggests I should lose 4 pounds, but my actual body fat percentage is where I want it to be).

Take the test yourself and let me know how you scored in the comments section!

Taking Care of Your Heart? 7 Habits You Need NOW

April 8, 2015 by James Bogash

I’m going to go out on a limb and state that death from heart disease is almost 100% preventable. So why is it still the #1 killer in the US and other industrialized nations?

Doesn’t this seems like a contradiction? If it’s so easy to prevent and research has shown what you need to do to protect your heart, so why the disparity? Maybe the researchers are all wrong and heart disease is just genetic. Given how often I hear this in my office, the “genetics” excuse has got to be at least partially correct, right?

Maybe the things you need to do to protect your heart are just too extreme to adopt. A lifestyle along the lines of the Dalai lama hidden in the mountains of Tibet? Running with the Hazda hunter-gatherers in east Africa? Hunting seals with the Inuit Eskimos of Greenland? Spending every waking moment in the gym on the treadmill or chanting a mantra in a yoga class?

Not even close. The American Heart Association have identified 7 key factors for ideal cardiovascular health (termed “Life’s Simple 7”). NONE of these are even remotely impossible to obtain. You just need to make the choice. Here they are:

Being a non-smoker
BMI < 25 (it is actually better to go by body fat percentage or waist-to-hip ratio–any “buff” weightlifter will have a higher BMI than this)
Physical activity at least 150 min/wk moderate intensity or 75 min/wk vigorous intensity or combination (regular readers will know I’m a big fan of short-burst aerobic, which has been shown to have better cardiac benefits)
At least 4-5 components of a Healthy Diet Score (a pretty simple task, actually…details by clicking here)
Total cholesterol less than 200 mg/dl (UNMEDICATED!!!!)
Blood pressure less than 120/80
Fasting blood sugar less than 100 mg/dl

With this in mind, this particular study looked at 1,731 adults (average age 56.8) to see how much these 7 factors had an effect on plaquing of the arteries feeding the heart muscles (specfically measured as coronary artery calcium, or CAC, scores as measure by cardiac CT). The CAC rating goes from 0 to 400, with anyone having a score of 100 or more to be considered as having heart disease. Using this scale, here’s what they found:

The average number of ideal cardiovascular lifestyle factors was 3.
Not a sinlge participant (out of 1,731) met all 7 factors.
Those who had 2 factors were 63% less likely to have a 100 CAC score.
Those who had 3 factors were 62% less likely.
Four or more factors had a 73% lower chance of having a CAC of 100 or more.

Now, I’m not saying that a 73% lower chance means heart disease has been prevented. There are other ways to check for heart disease besides CAC. But it sure has to be a good thing. Keep in mind that these 7 factors are really the low hanging fruit of prevention. When you get into more specific heart-healthy lifestyles (avoiding chemical exposures like BPA and Teflon, short-burst aerobic, a good night’s rest, etc…) these numbers will skyrocket. For those really interested in learning more, you can check out my Heart Disease eBook on Amazon by clicking here.

To me, though, the sickening part is that NONE out of 1,731 adults were meeting all 7 factors for heart disease prevention. NONE. As in ZERO. Is our society that incredibly sick that making lifestyle choices to protect our heart is out of the question?

Until we wake up as a society, stand up and say “enough is enough,” heart disease, a completely preventable condition, will continue to top the charts as the #1 killer.

Cholesterol Lowering Drugs & Your Good Cholesterol–Bad News

February 20, 2015 by James Bogash

aspirin to protect your heart — Sergey Yarochkin/Dollar Photo Club

Despite all the less-than-stellar research on cholesterol lowering drugs, the powers-that-be want us to take even more of it.

The latest “cholesterol guidelines” released late in 2013 have drastically increased the number of patients who would potentially be given a statin. They have finally dropped the fallacy that total cholesterol has any value (you know–total cholesterol–that lab value that you were taught to pay attention to so doctors would know when to put you on a cholesterol lowering medication..) and basically state that you should be given a statin if your doctor THINKS you might be at risk for a heart attack.

I have certainly been a vocal opponent of the statin class of drugs because the numbers just don’t make any sense. Treat 1,000 people for 5 years to prevent 11 heart attacks (instead of 22 people who would’ve had heart attackes without the drugs), while at the same time causing diabetes in 8 more. A net gain of 3. Out of a thousand. In 5 years.

That just sucks in my book.

And “they” think we should use it more on more patients. None of this takes into account the very long list of side effects from this class of drugs (other then the already mentioned increased risk of diabetes).

And, as we treat more and more patients with cholesterol lowering drugs, the amount of people experiencing side effects is just going to skyrocket. But at least they are not going to have a heart attack because of the statin drugs.

Right?

I guess that all depends.

This particular study looks at one of those little-known secrets about drugs to lower cholesterol. While they all lower cholesterol levels (for whatever that is worth), in some individuals the drugs also lower HDL (the “good”) cholesterol. This is generally not a good thing. Specifically, researchers looked at 724 patients who had just started treatment with statins after having a heart attack and followed for 6 to 9 months.

Eighty-six percent (620) of these patients had his or her HDL-C level increase during the course of the study, while 14% (104) of patients had his or her HDL cholesterol go down. Here’s what the researchers found when they looked closer at the group that had HDL levels drop:

Both groups had their LDL cholesterol levels drop below 100 mg/dl.
Adverse cardiovascular events (including death from all causes, heart attacks and stroke) happened more frequently in the decreased HDL group.
To be precise, this lower HDL group had these events at over TWICE the rate (15.4% vs 7.1%).
Overall, those who had lowered HDL as a result of the statin drugs (to protect the heart, I might add) were 95% more likely to have a cardiac event.

Let’s get this straight. A drug given to lower cholesterol levels actually lowered good cholesterol levels in 14% of those patients taking them. In this 14%, they were 95% MORE likely to have a cardiac event??

THIS is the wonder drug that seemingly all of medicine is hanging their hats on to save the world from heart disease? I‘ll take lifestyle changes, thank you.

Preventing Heart Disease: Do Cardiologists Help?

January 18, 2015 by James Bogash

cardiologists and heart disease — pixdesign123/Dollar Photo Club

Don’t get me wrong. I don’t inherently have a problem with cardiologists. But, for heart disease to be almost entirely preventable and remain the #1 killer in the industrialized world, we’ve absolutely dropped the ball.

I just don’t see any excuse for a clearly preventable disease to be the #1 killer.

And I cannot accept the fact that medicine is doing better at preventing cardiac deaths (largely due to technology saving lives when the fecal matter hits the fan). We are doing absolutely awful at preventing cardiovascular disease.

This is in the face of a truly massive amount of evidence on how to prevent cardiovascular disease using lifestyle. Maybe cardiologists are really spending the time needed to educate their patients about the best lifestyles to drastically lower the risk of having a heart attack or stroke and patients just aren’t listening. Or maybe mainstream medicine is so caught up in procedures and prescriptions that they have let lifestyle advice to patients fall to the wayside.

The answer likely lies somewhere in between. I think society is just as heavily to blame because we have created an illusion where medicine actually fixes things. You do not need to exercise or change your diet because the drug you are taking has lowered your blood pressure, stopped your irregular heartbeat or lowered your cholesterol. And when that doesn’t work you can go in for a quick in-and-out Roto-rooter procedure and you’re good to go.

If society really knew just how little these approaches really help things might change. And I think that the foundation for this perceptual change needs to begin with the cardiologists. It is a profession that needs to stand up and work as hard as possible to destroy itself.

While destroying itself sounds a wee bit, well…self-destructive, this is the way our office functions when it comes to chiropractic care. I tell patients that it is our job to destroy the practice by pushing for patients to become more active, eat right, treat injuries appropriately and engage in positive musculoskeletal behaviors like yoga.

While it don’t think it will ever happen, it’s still the attitude that we maintain every day.

Cardiologists need to hop on board with this attitude and take a good hard look at what kind of information they are giving their patients. It would be hard for any professional to look at a client, customer or patient and tell them straight on that he or she has little to offer.

Certainly cardiologists have procedures they can offer to patients. And, at the end of it all, there is absolutely no doubt that cardiologists are amazing at saving lives. But they just seem to have a hard time diverting current patients from needing that end-of-the-line lifesaving procedure.

I thought all of this would be a good primer for this particular study. In it, researchers looked at cardiac outcomes during 2 large, national cardiology conferences over the course of 9 years. They then compared these same outcomes to 3 weeks before and 3 weeks after the conferences to see how rates compared.

One would think that, with hospital cardiologists being out of town during these big conferences, it would spell trouble for patients who have heart disease during these time periods.

But here’s what they found:

In teaching hospitals, risk of high risk patients dying from heart failure during the meeting times was lower (17.5% vs 24.8%).
Deaths from cardiac arrest were also lower during meeting times (59.1% vs 69.4% ).
Rates of percutaneous coronary intervention (PCI–the procedure used to put stents in blocked arteries) were, as expected, lower during meetings (20.8% vs 28.2%;). However, lower rates of PCI did not affect a high-risk heart attack patient’s chance of dying (39.2% vs 38.5%–in other words, despite not having cardiologists to do these procedures, no one was dying any faster).
On the flipside, in nonteaching hospitals, there was no difference in the risk of dying or having a procedure (both high- and low-risk patients ).
There was also no higher risk of dying in teaching hospitals for low-risk patients.

Wow.

Not sure that there’s any other way to look at this other than saying that there is a chance that teaching hospitals may be doing slightly more harm than good when it comes to the cardiovascular departments.

As an example, it is estimated that half of the non-emergency cardiac stenting procedures are unnecessary. Considering that these procedures have risks associated with them, it would not be a surprise to see less procedures leading to less deaths.

In an area that has several teaching hospitals, I can assure you that the perception of these teaching hospitals by patients is very high and many will bend over backwards trying to get into them for their problems.

That just may not always be the best idea. The bottom line is that, even in prestigous teaching hospitals, your cardiovascular health may be better off where it has always been–inside you.

Had a Heart Attack? Skip the Meds and Do this Instead

June 13, 2014 by James Bogash

While having a heart attack is never a good thing, it does not mean life is over. Or at least, if you make the right choices.

Regular readers of the Rantings will of course know where this conversation is going. Newer readers will likely not be shocked either. So why, given that we all know that healthy lifestyle changes are good for the heart, am I bothering to write this at all?

Because I just don’t understand.

The benefits of the right lifestyle changes are just flat-out powerful. So why, given the power of lifestyle changes, do we still lose almost 600,000 people annually in the US alone, putting heart disease at the top of the list of killers in the US.

Following mainstream medical advice, EVERY heart attack patient will be put on medications. Statins, blood thinners, blood pressure medications and probably some cyanide just to round it off. Lifestyle changes are given tongue in cheek. “Quit smoking.” “Lose weight.” “Eat better.” “Exercise more.” These are GOALS, not treatment plans. I can’t tell you how often patients have been given these goals, but no real idea of how to attain them.

The reality is that very few doctors, cardiologists included, have neither the training NOR the time to educate patients about what they need. Medications are what they know best and physicians use the tools they are most comfortable with. There is also the small possibility that cardiologists think that lifestyle changes are NOT really all that helpful and that patients won’t follow them anyway. Based on the results of this particular study, if this is your cardiologist’s opinion, it’s time to find a new one.

In it, researchers looked at 4,174 participants with coronary heart disease. Ideal lifestyle factors were broken out into 4 categories:

Physical activity ≥4 times/week
Nonsmoking
Highest adherence to the Mediterranean diet score
Waist circumference <88 cm for women (just under 35″) and <102 cm for men (just over 40″)

I think we can all agree that these are some pretty easy guidelines that everyone can attain. And, if you have already had a heart attack and feel that these guidelines are too stringent, then by all means keep your life insurance premiums paid up. I really don’t have more to say–it’s your LIFE on the line here.

So what did the researchers find? Here’s the results:

Physical activity ≥4 versus no exercise 31% lower risk of another heart attack and 29% lower risk of dying (which, we can all agree, is NOT the desired outcome).
Non-smoking versus smoking 50% lower risk of heart attack and 47% lower risk of death.
Mediterranean diet adherence led to 23% lower heart attack risk and 16% lower risk of death.
Waist circumference did not make any difference.

But here’s where things get interesting. You see, lifestyle changes, unlike medications, are additive. When you add these healthy behaviors together you get even more bang for your buck. Here’s what happened when participants added lifestyle changes together:

Compared to those with ZERO lifestyle factors, those with at least one had a 40% lower risk of another heart attack and 35% lower risk of death.
Those with two factors had 51% lower (heart) and 43% (death).
Three factors led to a 62% lower risk of another heart attack and 59% lower risk of dying.

Three factors. Not even all 4. Just adopting 3 of these factors slashed your risk of having a second heart attack and dying far more than any medication could ever hope for. Is YOUR life worth these changes?

Had a Heart Attack? 3 Critical Things to Know

April 21, 2014 by James Bogash

After your heart attack you want to do everything possible to prevent a second event. But few things will be as powerful as the choices you will make now.

Whether you had an actual heart attack with resulting damage to the heart, or had a stent put in or the full blown open heart surgery you are still in a very high danger level. Your cardiologist will certainly put you on statins (regardless of your cholesterol level) and make sure your blood pressure is under control. But these are the primary tools of the cardiologist. And yet, they are not the most powerful tools.

If you really, really do NOT want to have another cardiac event, lifestyle HAS to be a factor in your recovery. Granted, if you are a smoker it will be made very clear to you that quitting is not an option. Any provider you see will make this recommendation. However, the depth of knowledge on the specifics of nutrition and exercise is not usually there for most cardiologists (I am, of course, generalizing here). Many will refer you to a nutritionist, but most nutritionists will stick with the “party line” of salt restriction and saturated fat reduction (ok, ok…so I’m generalizing AGAIN).

Here’s the reality. The recommendations we give for both primary and secondary prevention of heart disease still suck. They are general recommendations that don’t get down to the specifics that can make a very large difference. We hear about eating nuts to protect your heart, but not about how these nuts should be raw with no added omega-6 oils (cottonseed, peanut, soybean). It’s these subtle differences that can make all the difference in outcomes.

The same goes for aerobic exercise. I have made it no secret that I’m a big fan of short-burst aerobic activity, and yet the general recommendations are still limited to sustained-type aerobic exercise like walking for 30 minutes a day.

So what’s the point of my rant? That, even though the recommendations given are general, they are still very, very powerful. And this particular article outlines just how powerful. Researchers followed 4,174 patients for just over 4 years who were undergoing cardiac rehab after an acute event to see how much adoption of ideal lifestyle factors had on the risk of another heart attack or death (which is, arguably, worse). The ideal lifestyle factors were:

Physical activity ≥4 times/week
Non-smoking
Sticking with a Mediterranean diet (highest compliance)
Waist circumference under 35 inches for women and 40 inches for men

Here’s what the researchers found:

Exercise (versus sitting on your butt) led to a 31% lower rate of a future cardiac event and 29% lower risk of death.
Not smoking (versus keeping your life insurance premiums paid) led to a 50% lower risk of a future event and 47% lower risk of dying.
Those who were more strict with a Mediterranean diet (versus not at all) had a 23% lower risk of another heart event and 16% lower risk of death.
Waist circumference, however, did not make a difference.
But, when patients had 3 of the ideal factors that made a difference (versus none), the risk for another cardiac event 62% lower and risk of death was a respectable 49% lower.

It is clear from this that the approach is NOT about a single change. Rather, it is the combination of multiple positive changes that goes a very long way towards making sure you’re going to be alive in 5 years.

The American Heart Association’s Step 1 Diet Failure

January 16, 2014 by James Bogash

Along with the USDA’s food guide pyramid’s demonizing of all things fat, for many years the AHA focused on steering the public towards a low fat diet.

This idea seemed to run hand in hand with the idea that cholesterol in foods and in our bloodstream was the major contributor to heart disease. However, even with the research we had at the time, you really had to squint and look at it cock-eyed to decide that low cholesterol and low fat diets were THE answer to heart disease.

In hindsight, we can see how miserably we have failed at avoiding heart disease with this approach. And we might as well throw walking around the block in the same category (instead of a more intense, short-burst aerobic approach).

The Mediterranean Diet, on the other hand, has never had a focus on fat. Rather, it had a focus on actually making monounsaturated and omega-3 fats as part of the diet. While this was not the only aspect of the diet, it was in direct contrast with the AHA’s and the USDA pyramids’ message of low fat.

This particular article reviews the overall idea that diet plays a substantial role in heart disease, with a special focus on the power of the Mediterranean diet. The beauty of the Mediterranean diet is that it is not a “developed” diet, but rather the indigenous diet of a population that was known to have a very low risk of heart disease. Aspects of the Mediterranean diet include:

Lowered animal protein intake, mostly from fish.
Higher intakes of fruits and vegetables.
Grain intake is whole grain, not processed junk.
Focus on the use of olive oil and other monounsaturated fats like nuts and seeds.

There is not a single aspect of the Mediterranean diet that gives it its power. Rather, it is the combination of food compounds that gives it so much cardioprotection. As an example, the higher fat intake of the diet actually helps in the absorption of lycopene present in the tomatoes. This is a good thing because lycopene has a potent ability to protect the heart.

This benefit on the heart of this dietary approach alone speaks to the power of the diet. Adding in exercise (most notably short-burst aerobic), stress management and avoidance of environmental chemicals known to increase the risk of diabetes and heart disease will lower your risk down to almost nothing.

Fiber to Prevent Heart Disease: 5 Facts to Know NOW

January 15, 2014 by James Bogash

While everyone is aware that fiber is good for us, I think few actually understand just how powerful it can be. Fewer still understand the types of fiber and actively plan fiber intake as part of our diets.

First, a primer on fiber.

In general, there are two types. Insoluble fiber is the “roughage” that your mom told you to eat more of. This is the stuff that does not get digested at all, but makes it intact into the sewage system. It can act as a sponge for toxins in the gut as well as keeping “things” moving along. Whole grains and vegetables are great sources.

Soluble fiber, which our digestive system cannot break down, does get further broken down by the bacteria in our gut, leading to compounds known as short chain fatty acids, the most important of which is butyrate. Butyrate is a tonic for the cells of the intestinal tract, leaving them healthier and lowering the risk of cancer and autoimmune conditions of the gut like Crohn’s disease and ulcerative colitis. The short chain fatty acids also play a role in balancing our blood sugar and hunger hours and hours after our food is ingested. Good sources include beans, whole grains, fruits, vegetables and nuts.

When looking to increase the fiber in your diet, do not be fooled by tricky confectionary companies that cheat by adding things like bran fiber into the cereal box to artificially up the fiber content. Much like everything else in the food we eat, it is likely the combination of the fiber and other countless nutrients in the foods we eat that have the best benefits. Cheat by throwing in just the fiber and the benefits are not likely to be as great. That’s why it’s best to avoid foods by the major confectionary companies with household names you grew up with and eat foods naturally high in fiber.

Now, back to this particular study. In it, researchers followed 11,113 subjects, from 20 to 79 years of age for 5 years as part of the National Health and Nutrition Examination Survey (NHANES) to look at the relationship between heart disease risk, inflammation (as measured by C-reactive protein, or CRP) and fiber intake. Here’s what they found:

Those young adults with a higher dietary fiber intake had a 271% greater chance of being classified as having a low risk of heart disease.
In middle aged adults, the chance of having a low risk was 213%.
When looking at those young adults who had an intermediate lifetime risk, those with higher fiber intake had a 198% greater chance.
In middle aged adults, those who had a higher fiber intake had a 265% greater chance of having an intermediate risk.
In general, the high the fiber, the lower the C-reactive protein levels.

To put it a little plainer, in all adults, those with the highest intake of fiber were much more likely to live their lives at a low risk of heart disease. On the opposite end of the spectrum, those with less fiber intake were more likely to live a life at a high risk of heart disease. This protection may have come from an overall lower level of inflammation, a major player in heart disease.

For a disease that remains a number one killer in modernized countries, the evidence remains that heart disease is almost entirely lifestyle driven. With this in mind…

How much fiber did YOU have today?