Cardio Chief Tells
How to Reduce Your Heart Risk
David Rutlen, MD
Medical College of Wisconsin Cardiologist;
Chief, Cardiovascular Medicine;
Director, Cardiovascular Center
Recent studies prove that reducing your heart disease risk factors can have a dramatic impact on how long you live. David Rutlen, MD, the director of the Cardiovascular Center at Froedtert & Medical College, talks about the things you can do to lower your risk of dying from a heart attack.
Q. We all want to reduce heart attack risk. What does the latest research say?
Everyone knows that smoking is bad for the heart, but what a lot of people don't know is that if you are a smoker and you stop smoking, your risk of having a heart attack goes down to baseline within four years — and it falls within the first year. If you stop smoking, your risk of having a stroke is also down to baseline within four years.
Q. What about lowering cholesterol — how much does that help?
There are three important parts of cholesterol — LDL cholesterol, which is the bad cholesterol; HDL cholesterol, which is the good cholesterol; and triglycerides, a related blood fat.
The most recent data suggests that if we can get the LDL cholesterol under 100 in someone who has coronary disease, we substantially reduce their risk of death due to that disease. The risk reduction is about 25% — and you start to see that risk reduction within three years.
Q. How do you get LDL to where it should be?
The first things would be increasing one's level of activity, weight reduction and lowering the amount of fat and total cholesterol in the diet. If that doesn't work, then we have some powerful medications.
If someone has an elevated triglyceride level and we've already controlled the LDL cholesterol, then we should be aiming to get the triglyceride level down. If we can get the triglyceride level under 150, we decrease by a substantial amount the chance of the patient dying from coronary disease or having a heart attack — and we start to see that improvement within two years. The risk reduction ends up approaching 50%.
The most recent data would suggest it's important to raise the HDL cholesterol. We don't have as much data about that, but if the HDL cholesterol — and that's the good cholesterol — is low, we want to get it at least above 40, if not above 50.
Q. How can you increase your good cholesterol?
It is very responsive to more exercise and also to modest amounts of alcohol. There's very good data now that modest amounts of alcohol — no more than one to two drinks a day — are actually beneficial from a cardiac perspective.
Q. How much of an impact can exercise have on heart risk?
Individuals who engage in more physically fit lifestyles, and this means just moderately vigorous activity — swimming, tennis, squash, jogging, running — those individuals are much less likely to develop cardiovascular events over the long run.
Walking is good. Even walking three times a week will probably put someone in a better risk category.
Q. What about high blood pressure?
If we get someone's blood pressure down, we lower their risk. We know now that we want to get the blood pressure pretty close to 120/80. Up until relatively recently, we tolerated higher levels. The first thing to consider would be low-salt diet and weight reduction, but if that doesn't do the trick, we then use medications.
Q. What is "Metabolic Syndrome" and how does it relate to heart health?
The Metabolic Syndrome has been recognized in just the last couple years. It is associated with increased cardiovascular risk.
There are five things that suggest Metabolic Syndrome. First, abdominal obesity — roughly speaking, this is a man with a waistline more than 40 inches or a woman with a waistline more than 35 inches. Second is elevated triglyceride levels. Third is depressed HDL cholesterol — in men, less than 40, and in women, less than 50. Fourth is high blood pressure. And fifth is elevated fasting blood sugar.
If someone has three out of the five, we say they have a Metabolic Syndrome. They are at increased risk for coronary heart disease and we really should focus on changes in lifestyle — weight reduction, low-fat/low-cholesterol diets and increasing levels of activity.