LOCK IN HEART HEALTH

More women die from stroke or heart attack than from all cancers combined. Our holistic health plan will help keep you out of danger

ON A ROUTINE TRIP to the eye doctor in 2002, go-year-old Gina Brandolino got disturbing news. The optometrist noticed fuzzy, white rings around her corneas, a sign of high cholesterol usually seen in the elderly. The Bloomington, Ind., graduate student promised she'd get a cholesterol test, but she wasn't worried; she carried a svelte 130 pounds on her 5-foot 4-inch frame. "I was young and thin," she says, "heart disease was the last thing on my mind."

Not for long. A simple blood test soon confirmed the eye doctor's suspicion: Brandolino's cholesterol count was a jaw-dropping 249. (A score of 240 is considered dangerously high.)

Brandolino's cholesterol levels were unusual for a healthy woman in her 305, but her casual attitude toward heart disease wasn't. "Most women still don't see heart disease as a risk," says Rita Redberg, M.D., director of women's cardiovascular services at the University of California, San Francisco School of Medicine. "How can you prevent what you don't see as a problem?"

But describing women's heart disease as a problem is putting it mildly. At the rate we're going, two in every five women will die of heart attack or stroke.

Heart disease is an umbrella term covering all clinical conditions that take a toll on the heart. The most common of these is atherosclerosis, a narrowing of the arteries that results when cholesterol, fat, and cellular waste stick to artery walls and harden, much like mineral buildup in a pipe. These deposits (called plaque) block the flow of blood, placing strain on the heart. Plaque buildup also increases the likelihood of blood dots, which can lead to a heart attack (when a dot blocks a blood vessel that feeds the heart) or a stroke (when a dot blocks a blood vessel that feeds the brain).

How do you know if your pipes are clogged or clear? The first step is to get your numbers checked.

KNOW THE SCORE
If you're otherwise healthy, don't call a cardiologist Instead, simply piggyback a heart checkup with your next Pap smear. "OB-GYNs can absolutely run routine checks for you," says Karla Kurrelmeyer, M.D., a cardiologist who specializes in women's heart disease at Methodist DeBakey Heart Center in Houston.

When you make your next appointment, tell the scheduler you're also interested in a basic heart checkup, including a blood pressure check and a nonfasting cholesterol screen. Then, look into your family health history and other risk factors. (For more information, see "What Are Your Risks?" on page 68.) In hindsight, Brandolino might have foreseen a problem had she connected the dots: Not only had her father suffered a heart attack at age 50, but three of her four grandparents had died of heart disease. "My dad's, attack was scary but didn't seem relevant to me," she says. "Now I know it's important to look back more than one generation."

If your checkup reveals a total cholesterol count over 200, Kurrelmeyer recommends, van calling your primary care physician and requesting a full fasting lipid panel, which will give you more in-depth information, such as your HDL (good) and LDL (bad) cholesterol counts, and your levels of triglycerides — a form of fat that in high quantities can be an indicator of heart disease. (For a simple guide to understanding your blood pressure, cholesterol, and triglyceride scores, see "What the Numbers Mean," right.)

MAKING HEART-FRIENDLY CHOICES
IF, AFTER CHECKING your blood pressure and cholesterol, your doctor says you're in the clear, that's not the time to get complacent. "Your life expectancy shifts within three months of adopting a new lifestyle," says Mehmet Oz, M.D., a cardiac surgeon and director of the cardiovascular institute at Columbia University Medical Center in New York City. "That can be good news or bad, depending on whether you adopt healthy habits or bad ones. Either way, you can't rest on yesterday's laurels." With that in mind, here's what you can do keep your ticker in tip-top shape.

MOVE YOUR BODY
Exercise is a boon to the heart — it releases nitric oxide, a substance that lowers blood pressure, and soothes inflamed arteries so plaque is less likely to accumulate on blood vessel walls. "In the prevention of heart disease, if I had to choose between diet and exercise. I'd always put exercise first," says Oz. "Thin people in poor shape don't do as well as fat people in good shape." As evidence, he points to a 2006 study in the Journal of the American Medical Association that found women who were fat and fit were less likely to suffer heart attacks and strokes than their peers who were willowy but woefully out of shape. "Of course, I'd rather see [people improve] both [diet and exercise]," he says, "but exercise is the better predictor of longevity."

When Brandolino discovered she'd inherited a high risk for heart disease, she leapt into action. Always active but not very disciplined, she resolved to exercise at least 30 minutes five days a week — no excuses. Depending on her mood and the weather, she now jogs, in-line skates, walks, plays softball, or jumps rope. "Now I'm stronger, I sleep better, and I don't get as many colds," she says. "That helps me stick with it."

You don't have to be as zealous as Brandolino to protect your heart. Although the American Heart Association recommends at least 30 minutes of moderate exercise five times a week, several short bursts of activity actually may be better for your heart than one long stint at the gym. Walking, gardening, and even vacuuming count toward your daily quota. In a September 2006 study published in the Journal of Hypertension, researchers at Indiana University found that four short, brisk walks scattered throughout the day were more beneficial than a 40-minute workout. Although both types of exercise (continuous and intermittent) equally reduced blood pressure, the effect lasted longer after short bursts compared with the long session. "We were really surprised," says Janet Wallace, Ph.D., professor in the Department of Kinesiology at Indiana University, "This shows you don't have to go to the gym all the time to see results."

EAT WELL
After exercise, the best way to take care of your heart is to be a smart eater. Eating fresh foods shields the heart for the long haul by staving off weight gain and diabetes, both risk factors for heart disease. In the short run, high-fiber, low-trans-fat foods flush the heart's plumbing and keep it working smoothly day after day. "What you eat for dinner tonight will influence your chance of having a heart attack tomorrow," says Oz. "It's that closely related." For a happy heart, follow these five rules.

FOCUS ON FIBER. Upping your fiber intake can lower your risk of heart disease by roughly 30 percent, according to a 2004 report in the American Journal of Clinical Nutrition. There are two types of fiber: soluble and insoluble. Foods high in soluble fiber, such as oats, rice bran, barley, strawberries, and citrus fruits, help lower cholesterol. Foods high in insoluble fiber, such as whole wheat breads and pastas and most vegetables, are also filled with heart-healing antioxidants, including vitamin E, selenium, and phenolic acids. In the blood, these antioxidants keep fat molecules from oxidizing so they're less likely to clog artery walls. Aim for six daily servings of whole-grain foods, including whole wheat bread, oatmeal, brown rice, quinoa, and bran.
PEEL SOME PRODUCE. Fruits and vegetables are another important source of fiber and antioxidants. Try to get at least nine servings a day. This recommendation is based in part on studies like Harvard's Nurses' Health Study and Health Professionals Follow up Study, which tracked the diets of nearly 110,000 people over 14 years. Those who ate the most fruits and veggies (eight or more servings a day) had 30 percent fewer heart attacks and strokes than those who got 1.5 servings or less a day. Especially heart-friendly choices include leafy greens, cruciferous veggies such as broccoli and Brussels sprouts, and citrus fruits and berries. If nine servings feels overwhelming, take baby steps: Harvard researchers found that for every single serving of fruits and vegetables you add to your daily diet, your risk of heart disease drops by 4 percent.
GET YOUR OMEGA-35. Dozens of studies show that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DMA), the two omega-3 fatty acids in fish oil, lower triglyceride levels, reduce blood pressure, and boost arterial function. The American Heart Association encourages healthy adults to eat at least two four-ounce servings of oily fish, such as salmon, mackerel, and sardines, a week. On other days, reach for foods rich in alpha-linolenic acid (ALA), a third source of omega-3s found in flaxseeds, canola oil, and walnuts. But don't rely solely on ALA for your omega-3s: The body converts only 10 percent to 15 percent of ALA into omega-gs.
ELIMINATE TRANS FATS. Calorie for calorie, no other macronutrient increases your risk of heart disease more than trans fatty acids, which sneak into your diet through fast foods, packaged snack foods, crackers, and bakery goods made with hydrogenated (hardened) vegetable oils. For every 2 percent of your daily calories that come from trans fats, your risk of heart disease soars 23 percent, according to a 2006 review in The New England Journal of Medicine. Trans fats increase harmful LDL cholesterol, decrease beneficial HDL cholesterol, and promote inflammation — all of which endanger the health of your heart.
Although the Food and Drug Administration has been requiring food makers to list trans fats on nutrition labels since January 1, 2006, you shouldn't believe everything you read. If a food contains less than 500 milligrams of trans fatty acids per serving, the maker can list the trans fat content as zero. That might seem safe enough if you ate just one cookie or two crackers, but several servings of hidden trans fats per day can take a toll on your heart. Your best bet is to steer clear of processed foods. If you do indulge, inspect the list of ingredients on the label and walk away from foods containing partially hydrogenated oils.

5. IMBIBE INTELLIGENTLY. The first studies touting alcohol for heart health looked just at men. Whoops! Researchers trying to fill the gender gap have found some important differences between the sexes. For instance, a study published last May in the British Medical Journal's online edition found that men gained significant protection against heart disease with one alcoholic drink a day, but women needed just one drink per week to get a similar effect. The bottom line? For women, the protective effect of alcohol comes down to how much, not how often. "While up to four ounces a day is fine," says Kurrelmeyer, "don't feel compelled to raise a daily drink for your heart." One 12-ounce beer or four ounces of red wine a week will do nicely.

If you crave more dietary guidance, ask your doctor to prescribe a visit to a registered dietitian. A nutritionist helped Brandolino add fiber to her diet and subtract saturated fat: In came more fruits and veggies, along with ground flaxseed; out went the nightly bowl of pasta smothered in cheese.

Thanks to changes in her diet and exercise habits, Brandolino was able to reduce her total cholesterol score to 193 (a 56-point reduction) within a year of that life-changing eye exam. "Some people consider heart disease a low-level problem they can live with," says Brandolino, "but I took it as a serious threat to my health and was determined to turn it around."

SUPPLEMENTAL INSURANCE
Exercise and a healthy diet are essential to heart health, but for some people this disease-fighting duo may not be enough. Lyrtn Lunceford, an academic administrator in San Diego, was shocked when a routine test revealed her total cholesterol level was 233. The then 40-year-old exercised three to five days a week and wasn't overweight. For the next two years, she stepped up her diet and exercise efforts, but her cholesterol level didn't budge. Finally, in a last-ditch effort to dodge cholesterol-lowering medication, she started swallowing a blend of aged garlic and red yeast rice. Within two months, her cholesterol count tumbled to 184. "The difference was remarkable," says Lunceford, now an ardent supporter of supplements.

If, like Lunceford, you eat like a saint, exercise like a pro, and keep your weight down but your cholesterol or blood pressure readings are still high or borderline, you may want to talk to your doctor about supplements before jumping on the pharmaceutical bandwagon. If you're premenopausal, heart medications might not be helpful, says Redberg. "Prescription medications for lowering cholesterol have been shown to be effective," she explains, "but they don't seem to prevent heart attacks."

On the flip side, many herbs, vitamins, and minerals show promise in treating heart disease, are less expensive than drugs, and cause fewer side effects. "It's absolutely worth asking your cardiologist about supplements," says Mitchell Krucoff, M.D., a cardiologist and professor at Duke University Medical School. "If he or she is not open to the idea, find a new physician — being close-minded about alternative therapies is not acceptable anymore."

If you and your doctor decide you should try supplements, you'll be in good company. A 2003 study published in the American Heart Journal found that 64 percent of people with heart disease were using alternative therapies either in addition to or as a substitute for conventional treatments. Naturopath Jennifer Nevels, N.D., chair of the department of women's integrative medicine at Southwest College of Naturopathic Medicine in Tempe, Ariz., routinely observes supplements boosting the health of her heart disease patients. When asked to share the top five heart-healing supplements in her medicine cabinet, Nevels recommended the following natural options.

1. FISH OIL
Why: If you have heart disease, getting a beneficial dose of omega-3s through diet alone can be tough.

Dosage: 1,500 milligrams twice a day.

Tip: For best results, choose a supplement with two key omega-3s: EPA and DHA. To minimize mercury exposure, look for the phrase tested for heavy metals on the label.

2. RED YEAST RICE
Why: This traditional Chinese remedy works like statin drugs, inhibiting the body's cholesterol-making enzyme.

Dosage: 600 mg twice a day.

Tip: Since it acts like a statin, red yeast rice can cause side effects and is best taken under the guidance of a naturopath or physician.

3. CO-ENZYME Q10
Why: "I recommend CoQ10 to everyone with heart disease, especially if he or she is taking a statin or red yeast rice," says Nevels. That's because the cholesterol-making enzyme that statins inhibit is also responsible for producing the body's natural supply of CoQ10. Every cell needs CoQ10 for energy. Without it, the body loses steam.

Dosage: Up to 300 mg a day.

Tip: CoQ10 relies on fat to help it absorb properly, so choose oil-based capsules over dry tablets.

4. MAGNESIUM
Why: Some experts refer to magnesium as "nature's calcium-channel blocker" because the mineral keeps calcium from penetrating heart cells and making the organ work harder. Magnesium also promotes muscle relaxation and slows blood clotting.

Dosage: Up to 800 mg a day.

Tip: For best absorption, look for magnesium glycinate.

5. GARLIC
Why: Antioxidant-rich garlic makes blood platelets more slippery and therefore less likely to form clots that cause heart attack or stroke.

Dosage: Up to 900 mg a day.

Tip: Don't hesitate to experiment with different products. Lunceford didn't get results until she traded in her plain garlic supplements for a blend of aged garlic and red yeast rice. Caveat: Garlic has natural blood-thinning properties; if you're already taking blood thinners, talk to your doctor before using garlic.

If you to have choose between improving your diet and getting more exercise

Herbs, vitamins, and minerals are usually less expensive than drugs and often as effective.

If your doctor isn't open to supplements, find a new physician. Being close-minded about alternative therapies is not acceptable anymore.

WHAT THE NUMBERS MEAN
Use this simple reference to better understand your blood pressure and cholesterol scores.

WHAT: Blood Pressure

WHY IT MATTERS: The higher the number, the harder your heart is working to pump blood through your body.

OPTIMAL: Below 120/80

BORDERLINE: 120-139/80-89

DANGEROUS: 140/90 and up

WHAT: Total Cholesterol

WHY IT MATTERS: Too much cholesterol in the blood can clog arteries and slow blood flow to the heart, leading to heart disease.

OPTIMAL: Below 200

BORDERLINE: 200-239

DANGEROUS: 240 and up

WHAT: LDL (Bad) Cholesterol

WHY IT MATTERS: Low-density lipoprotein, 3 mix of cholesterol and protein moving through the bloodstream, Is the main source of arterial plaque buildup.

OPTIMAL: Below too mg/dL

BORDERLINE: 130-159 mg/dL

DANGEROUS: 160 mg/dL and up

WHAT: HDL (Good) Cholesterol

WHY IT MATTERS: High-density lipoprotein carries cholesterol away from the arteries and back to the liver so it can be eliminated from the body.

OPTIMAL: 60 mg/dL and up

BORDERLINE: 59-40 mg/dL

DANGEROUS: Less than 40 mg/dL

WHAT: Triglycerides

WHY IT MATTERS: Though high triglyceride levels don't seem to contribute to plaque buildup in arteries, they are associated with high cholesterol and heart disease.

OPTIMAL: Less than 150 mg/dL

BORDERLINE: 150-199 mg/dL

DANGEROUS: 200 mg/dL and up

WHAT ARE YOUR RISKS?
Each of the following factors compounds your likelihood of having heart disease now or in the future. While risk factors such as age and genetics are out of your control, quitting smoking, losing weight, and preventing or managing diabetes are steps you can take to help protect yourself.

FAMILY HISTORY: When it comes to heart disease, family history is a stronger predictor for women than it Is for men. Pay closest attention to the women In your family, especially any siblings, says Karla Kurrelmeyer, M.D., a cardiologist specializing In women's heart disease at Methodist DeBakey Heart Center in Houston. Your genes are most closely matched to those of your sibs, so if a sister has heart disease, consider it a big warning sign. "You're at greater risk tf your siblings have heart disease rather than your father or mother." If your father had heart disease prior to age 45 or if your mother had it before age SS, that's another red flag. Finally, look for patterns not only with Immediate family members but also with close relatives like aunts, uncles, and grandparents.
ACE: A woman's risk of heart disease climbs lockstep with her age, especially after menopause. Estrogen protects the heart by weeding out harmful LOL cholesterol, nurturing beneficial HDL cholesterol, and keeping arteries open. But when estrogen levels plummet during and after menopause, the extra protection is gone. This is just one more reason to start taking care of your heart when you're young, says Kurrelmeyer. "The earlier you start, the better; if you wait until you're 60, you will have lost a lot of valuable time."
BELLY FAT: Carrying fat around your middle predisposes you to heart disease because abdominal fat promotes Inflammation, which damages arteries. A waist circumference of 35 inches or more could put you in the danger zone, according to a 2006 study published in the Journal of Women's Health.
SMOKING: Smoking is the cause of 50 percent of heart attacks among middle-aged women. "Smoking is still the number one preventable cause of heart disease," says Rita Redberg, M.D., director of women's cardiovascular services at the University of California, San Francisco School of Medicine. "Kicking the habit at any age will tower your risk."
DIABETES: Untreated or poorly treated diabetes can damage blood vessels and hinder the heart's performance in both men and women. And for women, diabetes also negates estrogen's protective effects. As a result, women with diabetes are more than four times more likely to suffer from heart disease than nondiabetic women.
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By Catherine Guthrie

Photography by Mark Lund

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