PRESCRIPTIONS
How to cut your risk of heart disease
By Landis Lum
Q.Does heart disease really kill more women than breast cancer?
A. Ten times more women die from heart disease than from breast cancer. However, in a recent poll, only 18 percent of women correctly identified heart disease as the leading cause of death — 39 percent thought it is breast cancer.
In the United States, more than 500,000 women die of heart disease each year. Two-thirds of such women who die suddenly had no previous heart disease symptoms.
There are things you can do to help prevent heart disease — and the rest of this column pertains to men as well.
Get a fasting blood sugar test, especially if you're overweight. Any value over 100 is too high and increases your chance of heart disease.
Two values over 126 means you likely have diabetes.
To reduce blood sugars, get more exercise. Walk an extra 10 minutes twice a day. Lose weight if overweight. An extra half-hour of exercise a day is twice as powerful as drugs in reducing blood sugars or preventing diabetes.
Other heart disease risk factors are smoking, high cholesterol, low HDL (good) cholesterol, and high blood pressure. If diet and exercise alone don't lessen these risks enough — like getting your blood pressure to less than 140 over 90 — you may need drugs.
Taking herbs, vitamins, and anti-oxidants won't reduce heart disease risk. In fact, taking extra vitamin A or beta-carotene actually worsens heart disease risk. If you have diabetes or other risks, don't fool around — you may need drugs.
There are two kinds of drugs I liken to Armour-All (which conditions and protects vinyl): statins like Lovastatin or Lipitor, and ACE-inhibitors like Lisinopril.
Both keep the inner lining of the blood vessels (the endothelium) smooth and flexible, improving their function and preventing platelets and cholesterol from sticking and clogging them up.
Both help prevent heart attacks and strokes. Guidelines from the Feb. 10, issue of the journal Circulation say that anyone at high risk — a 20 percent or greater chance of heart disease in the next 10 years — should be on both.
You or your doctor can figure this out by going to www.intmed.mcw.edu/clincalc/heartrisk.html and entering values for good (HDL) and total cholesterol, blood pressure, age, sex, smoking and diabetes status.
Those at moderate (10 to 20 percent) risk may also benefit. Ask your doctor.
Following up
In my column on Dec. 12, 2003, I quoted older guidelines advising anyone with a 6 percent or higher risk to ask their doctor about taking daily aspirin to prevent heart attacks. The newer Circulation guidelines advise that women ask about aspirin if their risk is above 10 to 20 percent, as the aspirin studies were done primarily in men and may not apply to women until their risk is a bit higher.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i John A. Burns School of Medicine. Send questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or islandlife@honoluluadvertiser.com.
