Ways to protect your heart

by Zubair Ahmed
Did you know that open-heart surgery has a stink all its own? It's a burning-blood fragrance -- a whiff of baking roadkill you'd swerve to avoid during a bike ride. Only deeper, richer -- tinged with death, and sweetness. I know because I inhaled a lifetime's worth of open-heart fumes recently, standing at the elbow of Toby Cosgrove, M.D., chairman of cardiovascular surgery at the Cleveland Clinic. He was performing a valve repair and coronary bypass on an old high-school pal of his, and he had invited me, a heart patient at his clinic, to watch. And, surprisingly, sniff. Let me remind you: Mortality stinks.

Every channel flipper has done it: You're happily sampling the emptiness, click by click, when you flash into a gory moment on the Learning Channel. That was my life last summer: from Wild On! to a close-up of bloody surgical gloves in an instant -- only for real, with my own heart in the spotlight and no remote to press. And I have to watch this program to its conclusion.

Here's the deal: I'm 5'10'', 150 pounds, 46 years old. I've been wearing 32-inch-waist jeans since college. I've had blood work done every year for the past 7, just for the sheer pleasure of acing an exam: My LDL (bad) cholesterol numbers averaged in the low 140s, my triglycerides below 160. And, until recently, those were considered Get Out of Heart Disease Free scores.
The R.N. who evaluated my last blood test wrote, "Your chemistry results look great. CAD [coronary-artery-disease] risk is under the normal range. No recommendations at this time." She confirmed what I saw in the mirror: a guy who was doing everything right. I work out at least four times a week, lifting weights, running, playing flat-out full-court basketball for an hour at a time. I've completed two marathons in the past 5 years, and pulled myself to the top of Grand Teton. I'm also an editor at the magazine you hold in your hands, so I've learned and lived as much health advice as anybody. But none of that prevented a 99 percent blockage in my heart's left anterior descending artery. And if that can happen to me, friends, it most assuredly can happen to you. Who, you?

Well, only if you're an adult American male. (Men over 45 are the most likely to be incubating the clot that will kill them.) Fifty-one percent of you guys--and that makes 60 million of you strolling around, averting your eyes from articles like this one--will discover your heart problem by having what the cardiologists chillingly call an "event." That is, a heart attack.
For an estimated 80,000 of these men, the first symptom is one not even I would miss: death. It's pure luck that I wasn't one of those surprise stiffs, with a starring role in our feature "Death by Exercise," which you'll find later in this issue. If you consider my sorry case an indictment of everything this magazine preaches, you can stop reading here. To me, it says something else: If a guy with all the right numbers, the right exercise habits, and a live-forever diet--or so I thought--is at grave risk of sudden death, then a lot of us are. It also tells me that the long line of nurses and doctors who told me I was fine, just fine, had no clue. And that should make you wonder what might be happening in your arteries right now, as well. Here's something men are good at: dropping dead of heart disease. Every year, cardiovascular problems cause nearly half of U.S. male deaths--a third of them by complete surprise.

Don't follow that pack. Every year scientists discover new ways men can protect their hearts--from steps you can take to avoid problems, to drugs and gadgets that can help if you already have heart disease. We asked heart researchers to boil it down to 10 simple rules men can follow.

Get the Latest, Greatest Test
That's the highly sensitive C-reactive protein test, or HSCRP. A study reported in the New England Journal of Medicine found that this blood test is twice as effective as a standard cholesterol test in predicting heart attacks and strokes. It measures the levels of a specific blood protein that indicates that you have inflamed heart arteries--the kind that rupture and cause heart failure.

When researchers at Brigham and Women's Hospital in Boston monitored 30,000 women for 3 years, they found that those with the highest levels of CRP suffered a much higher rate of heart attacks and strokes. And this result is perfectly applicable to men, says Paul Ridker, M.D., the lead study author.

"Since half of all heart-attack victims have normal cholesterol levels, the HSCRP test is a much better way to figure your true risk," he explains. Ask your doctor to perform the $15 HSCRP test (not the standard CRP test; that's important) along with your regular cholesterol test. "That gives you plenty of time to make some serious lifestyle changes to reduce the risk," concludes Dr. Ridker.

Keep up With Your Exercise
Over the past 4 decades, dozens of studies have shown that exercise is good for your heart. But here's the catch, according to a recent survey: You're only as strong as your last workout.

Doctors from the Framingham Heart Study in Massachusetts compared people who'd only recently started exercising with those who used to exercise regularly but stopped. Their finding: The cardiovascular mortality rate was 40 percent lower among the current exercisers.

"The benefits of exercise wear off quickly," says Scott Sherman, MD, of the UCLA school of medicine. Fortunately, the benefits of exercise also show up quickly, so if the only physical activity you ever have is moving pawn to knight six, you're not dead--yet. "The study shows that for sedentary patients, it's never too late to start being active," says Dr. Sherman.


Are you at risk for sudden death
Heart attacks aren't just for older, overweight men with high cholesterol and high blood pressure. Doctors are seeing patients in their 40s come in with heart disease due to self-inflicted risk factors, according to Ilan Wittstein, M.D., an assistant professor at The Johns Hopkins University School of Medicine and its Heart Institute. Middle-aged men need to be on guard. Even if you work out and eat healthy, you could still be at risk.

Beware of Risk Factors
"In half of the cases of heart attacks, the heart attack is the first time the patient finds out about heart disease," says Richard A. Stein, director of preventive cardiology at Beth Israel Medical Center and spokesperson for the American Heart Association. More than 60 percent of heart attacks have to do with simple lifestyle issues, such as diet, exercise and cigarette smoking, and easy to detect and treat medical issues such as high blood pressure and high cholesterol. "Men need to know about the risk factors that predict the majority of heart disease cases," Stein says.


Stress Less
Research shows that not only do you have to watch your diet, exercise, and avoid smoking and excessive alcohol to prevent a heart attack, it's imperative to be aware of your family history and to manage your stress level. According to the 2004 INTERHEART study in the Lancet, stress is one of three main risk factors for coronary artery disease, and is responsible for a fifth of heart attacks worldwide.

Stress played a very important role in what may have caused the heart attack of Ken Lay, the founder of Enron Corp, says Wittstein. Convicted of conspiracy and fraud, Lay faced 25 to 40 years in prison before his untimely death. "If we look at medical literature over time, we find many good examples of how stress can have a profound affect on the heart," says Wittstein, who co-authored last year's study on "broken heart syndrome" in The New England Journal of Medicine. "We can't prove that heart attacks can be caused by stress, but we know that people who are under higher stress, have a greater risk of developing heart disease," Whittstein adds.

Release the Pressure
But it's possible to lessen your risk of heart disease by using calming stress management techniques, say these experts. Duke University Medical researchers conducted a study with 107 patients who had a history of heart problems. To lower the risk of future heart attacks, researchers divided the patients into three treatment groups; a third of the group exercised, another third received standard care, and the last third learned stress management techniques through 4 months of therapy and training. The stress management group fared the best with a 74% reduction in cardiac events over the 5-year analysis.

Stress management techniques can include getting therapy, or be as simple as taking up yoga, practicing tai chi or using meditation techniques for five minutes every day. "It's proven that relaxation techniques lower blood pressure and improve bloodflow," Dr. Wittsetin says.