Heart Smart

Cardiovascular diseases are the No. 1 killer in America, claiming along with stroke more than 910,000 lives annually. Some progress has been made, but the risk factors are still too high, according to the American Heart Association.

In an effort to bring attention to heart disease and stroke, President Bush signed a proclamation declaring February “American Heart Month,” a time to start heart-healthy habits and learn about risk factors for heart disease.

Cardiovascular diseases will cost Americans an estimated $449 billion in lost productivity and medical expenses, according to the AHA. Stroke treatment alone is estimated to exceed $2 trillion by 2050.

The American Heart Association set a goal in 1999 to reduce death rates from heart disease and stroke by 25 percent by 2010. The age-adjusted death rate from coronary heart disease decreased 25.8 percent from 1999 to 2005. The age-adjusted death rate from stroke decreased 24.4 percent in the same time frame, according to the association.

Many factors played a role in the reduced death rates, such as improved medications to lower cholesterol and control high blood pressure and increased tobacco regulations, said Thomas Pfeffer, MD, president of the Los Angeles County division of the American Heart Association and chief of cardiac surgery for Kaiser Permanente Medical Center in Los Angeles.

But the downside is a disparity of outcomes in various populations. The reduction in mortality from heart disease has been less for women and minority populations than for the overall population, Pfeffer said.

Also, risk factors have not been reduced enough. The rate of physical inactivity has declined only 2.5 percent and the prevalence rates for obesity and type II diabetes are increasing, according to the American Heart Association.

Parents must set a good example and not send mixed messages, and schools must be active partners in healthy living, Pfeffer said.

“You can’t have a parent telling a child not to eat a lot of fried, greasy food when they’re doing that themselves,” he said. “It’s a whole education process for a family to make a lifestyle change.”

The dip in the heart disease-related death rate may be due in part to the presidential fitness campaign in the 1960s, but those gains have since been negated, said Alan Cundari, DO, chair of the Department of Family Medicine in the College of Osteopathic Medicine of the Pacific at WesternU.

“We’re not doing as good a job in health fitness for children,” he said. “I think we’re headed down the wrong road.”

Regular exercise is important, said Casey Chaney, PT, PhD, OCS, CSCS, associate professor in the Department of Physical Therapy Education, part of WesternU’s College of Allied Health Professions.

Your body goes into an alarm state when presented with the stress of exercise, she said. If your body is allowed to recover, it will begin to adapt. If you don’t have the opportunity to recover, you can enter into exhaustion and extreme distress.

“With recovery days, there are lots of wonderful physiological adaptations – our heart gets stronger and beats more slowly,” Chaney said. “Even though it beats more slowly it’s pumping more volume of blood with each stroke.”

But without regular activity, the body can actually lose some of the physiological adaptations after just 48 hours, Chaney said.

“More so than strength training, heart-healthy aerobic exercise training requires participation on an every-other-day basis,” she said.

Obesity can be reduced not only by doing aerobic exercise, but by doing resistance training to build up lean body mass, Chaney said. Lean body mass determines how many calories a person burns when you are at rest, i.e., when you are not exercising.

“Having higher lean body mass is really critical to helping reduce the obesity epidemic,” she said.

But it takes effort to get patients to accept lifestyle changes such as regular exercise and a healthy diet. Getting to know a patient is important in this process, said Lawrence Harkless, DPM, professor of podiatric medicine and surgery and founding dean of WesternU’s College of Podiatric Medicine.

“You have to find out who they are and where they’re going,” he said. “Once you find out what’s important to them, you can find small things they can do.”

When they take even a small step and succeed, praise them, he said.

“If you can take time to meet them where they are, they will want to do the best they can to help themselves,” Harkless said. “Once you pour your heart out, they will respond.”

For more information about American Heart Month and the American Heart Association, visit the Web site www.americanheart.org.