Every year about 1.1 million Americans have heart attacks, according to the National Heart, Lung and Blood Institute, and about 476,000 of them die as a result. Heart attacks kill more Americans than any other disease, and many of those who survive them are disabled by shortness of breath or chest pains. All victims, regardless of how well they feel, are at risk of having another attack.
Medical science has learned a great deal about heart disease in the last couple of decades, knowledge that can help a man ward off a heart attack or deal with the aftermath of one. Drugs have advanced as quickly as learning, so that today an individual can drastically affect his vulnerability and his chances of survival by paying close attention to his own habits and medical developments, and acting when appropriate.
So-called lifestyle choices should be the first consideration for most men over 40. That means exercise. It’s important for a man to get enough exercise, and if he doesn’t then he may have to deal with consequences like hypertension and excess weight. It also means eating less of the foods heavy in artery-clogging cholesterol and fat. And all too often it means kicking the habit of smoking. Smoking constricts the blood vessels and makes the heart work much harder.
The heart muscle requires plenty of oxygen-carrying blood, and when it doesn’t receive enough, it begins to deteriorate. This affects the rate and strength of the pumping action. If a blood clot occurs, or if the openings in the blood vessels have been narrowed by atherosclerosis — a buildup of plaque on the vessel walls — a heart attack can occur. But the causes of heart attack remain various and, like the functioning of the muscle itself, complicated. Solutions to them are often subtle and interrelated.
Since the early years of the century, doctors have known that cholesterol can contribute to atherosclerosis. Years ago scientists discovered that men with high levels of cholesterol who took the drug cholestyramine to reduce it, were 19 percent less likely to have a heart attack. Subsequent research showed that reduction of cholesterol in the blood could actually reverse plaque buildup.
Then in 1987 drugs known as statins became available in this country. There are many competing brands of statins for reducing so-called “bad” cholesterol, low-density lipoprotein (LDL). They inhibit the enzymes that produce LDL, sometimes by as much as 40 percent, but are not nearly as effective at boosting the “good” cholesterol, high-density lipoprotein (HDL). Statins are easy to take and most users experience no side effects.
However, statins aren’t always effective and are not a substitute for exercise and good diet. Most doctors will not prescribe them until after they’ve tried more conventional methods of cholesterol reduction. And once a doctor prescribes these drugs, he should check the patient’s cholesterol levels and liver function every six to 12 weeks. That said, there are three types of statins that have proven effective in limiting heart attack and stroke: lovastatin, pravastatin and simvastatin. Another popular, less expensive statin is fluvastatin. There are many on the market, and physicians must weigh the subtly differing effects of these drugs.
Cholesterol circulating within the arteries tends to accumulate at points where inflammation has occurred. Inflammation is a natural reaction to injury or infection, and researchers have been asking for years what causes the low-level inflammation inside blood vessels. Whatever the cause, anti-inflammatory medications have proven effective, including simple aspirin. Doctors advise men over 40 and heart-attack survivors to take a low-dosage, coated aspirin — 81 mg. is standard — daily to help prevent cholesterol buildup and blood clots.
One of the main contributors to heart attack is hypertension, but many American men ignore the fact that they suffer from it. If improvements in diet and exercise, and reduction of salt intake, don’t work, a man with hypertension may be given a diuretic to flush more sodium from his system. He may also be given what is known as a beta-blocker, often prescribed for those who have already had a heart attack. Beta-blockers lower hypertension by slowing both the rate and pumping force of the heart by inhibiting the action of adrenaline and a related hormone, noradrenalin.
Precisely because beta-blockers do slow the heart, many doctors are reluctant to prescribe them. According to a study recently published in the Journal of the American Medical Association, about half of 115,000 men age 65 or older who suffered a heart attack and would clearly have benefited from beta-blockers were not advised by their doctors to take them. Another study, in the New England Journal of Medicine, indicated that heart-attack survivors who took beta-blockers had a 40 percent lower mortality rate than those who did not take them.
A more recent development than the beta-blocker is something called the ACE inhibitor. This medication inhibits the natural reshaping of the heart that makes it a less effective pump, and so helps prevent a second heart attack. ACE (angiotensin-converting enzyme) inhibitors are also prescribed for hypertension and are thought to help stabilize cholesterol plaques in the arteries. Studies have shown that ACE inhibitors, given immediately after a heart attack, reduce mortality overall and, if taken for an extended period after a heart attack, can prevent 22 percent of the deaths among the sickest survivors.
Yet another factor in heart disease may be the immune system, according to a report published recently in the Archives of Internal Medicine. Researchers looked at the antibodies in 270 men with elevated LDL, and found that those with the highest levels of certain antibodies were at greatest risk. Antibodies are generally thought to be good, but the heart is affected by various components in the body in ways that are still unclear.
One clear and indisputable fact is that the best, early antidote to heart attack is a vigorous life and a healthful diet.
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