Heart health

Chest pain, shortness of breath the first signs of heart problems in men


Special to The Miami Herald

When it comes to heart health, many men tend to adopt a “macho approach.”

“A lot of men think, ‘It can’t be any heart problem. That can’t be any issue for me,’ pretending they are going to be a tough guy,” said Dr. Robert Hendel, professor of medicine and radiology and associate chief of clinical cardiology at University of Miami’s Miller School of Medicine. “But if someone has chest pain or shortness of breath, they should get checked out.”

Indeed, chest pain and shortness of breath are the first signs of a heart problem in men. Studies show that erectile dysfunction also may be one of the earliest signs of heart disease. When there is build up of plaque in the body, the smaller arteries — such as the ones in the penis — are the first to be affected, reducing blood flow.

“You have to be concerned that if there’s vascular disease in erectile dysfunction, there may be a vascular disease going on somewhere else,” said Dr. Todd Heimowitz, general and interventional cardiologist at the Heart Institute at Mount Sinai Medical Center in Miami Beach.

In the United States, heart disease is the leading cause of death for men, killing more than 300,000 men in 2009 – or one in every four male deaths, according to the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention.

Typically, men develop heart disease at a younger age than women. While men in their 50s become more at risk for heart disease, women’s risk increases after menopause.

“Heart disease becomes a significant concern for men in their fifth decade,” Hendel said. “But every decade of life increases the risk of having heart problems.”

The good news is that there are habits that men can adopt to decrease their risk of heart disease. Among those habits:

Diet: “Achieve the right weight,” said Dr. Marc Gillinov, a cardiac surgeon at Cleveland Clinic in Cleveland, Ohio and co-author of Heart411: The Only Guide to Heart Health You’ll Ever Need. “Look in the mirror and ask yourself, ‘Do I look good? Do I look trim?’ ”

Fad diets in the U.S. often encourage people to cut all fat from their meals — an idea Gillinov said is incorrect as there is “good” and “bad” fat in different foods.

A recent study in Spain showed that 30 percent of heart attacks, strokes and deaths from heart disease could be prevented in people at risk who follow a Mediterranean diet of lean meat and fish, fruits, vegetables, beans, nuts, and olive oil and a glass of wine.

The findings, published in the New England Journal of Medicine, were the result of the first major clinical trial to measure the diet’s effect on heart risks.

In the study, about 7,500 people who were overweight, were smokers or had diabetes were chosen at random to follow either a Mediterranean diet or a low-fat diet, which turned out to be like an American diet, with red meat, soda and commercially prepared baked goods. Those on the Mediterranean diet reduced their risk of heart attacks, strokes and deaths from heart disease by 30 percent compared with those on the low-fat diet.

“I am a heart surgeon and if I wanted to put myself out of business, and I am going to design a diet, I am going to end up with the Mediterranean diet,” Gillinov said. “You can even make Mediterranean-style pizza. I’ve done it. It tastes great.”

A glass of red or white wine is a staple of the diet, and according to Gillinov, alcohol increases high-density lipoprotein, or the good cholesterol. It also makes blood platelets more slippery and less likely to form blood clots, which leads to cardiovascular disease.

“I would never tell a heart patient, ‘You should stop drinking moderately,’ ” he said.

Exercise: “It’s an absolute myth that people who have heart issues cannot exercise,” said Gillinov, adding that only patients with the most severe heart problems should consult a doctor before starting a workout regimen. “At a minimum, start walking. You don’t need any fancy equipment. Just your feet and dome shoes.”

High-density lipoprotein, or the good cholesterol, increases through exercise, especially cardio or anaerobic exercise. Said Gillinov: “Exercise is like medicine. It comes in different doses. And the bigger the dose, the better for your heart.”

Sleep apnea : When breathing is interrupted, lowered or altogether stopped because of sleep apnea, blood pressure “skyrockets,” Gillinov said. That is why sleep apnea has been associated with high blood pressure, a heart disease risk factor. In addition, there is a link between the amount of sleep a patient gets and their risk for cardiovascular disease: Less than six hours a night and more than eight hours puts people at risk for coronary artery disease, Gillinov said.

Blood pressure: Keep this under control. Blood pressure above 135 for the systolic, or upper limit, and above 85 for the diastolic, or lower limit, is considered high, Hendel said.

Cholesterol: Levels can be modified by a proper diet but are largely affected by genetics, said Hendel, adding that high low-density lipoprotein, or the bad cholesterol, can be targeted through medications known as statins. A build-up of low-density lipoprotein in the arteries may lead to a heart attack once the cholesterol breaks off and a blood clot forms, said Heimowitz. Doctors focus on keeping a patient’s low-density lipoprotein levels lower than 100 milligrams per deciliter.

Diabetes: The increase of blood sugar can lead to coronary heart disease, heart failure and arrhythmias. Type 2 diabetes, a condition where the body becomes resistant to insulin, can be targeted by weight loss.

Smoking: Decreases the amount of oxygen traveling to the heart, and increases blood pressure and blood clotting. Heimowitz, the Mount Sinai cardiologist, said that one cigarette decreases the nitric oxide in the arteries’ lining, increasing blood pressure. “We think about it being toxic to the lungs,” he said. “But in fact all those chemicals are toxic to the arteries in our bodies.” Indeed, 20 percent of all heart-disease deaths in the U.S. are directly related to smoking; smokers have a two- to four times higher chance of having a heart disease.

“Whether you are a male in his 50s or 30s, doing what you can to avoid what we call these modifiable risk factors is important,” Hendel said. “We need to make sure we take these precautions before.”

While proper diet, exercises, smoking cessation and statins for cholesterol are the general methods to target heart-disease risk factors, recently more and more men have added supplements in their fight against heart disease.

So says Dan Alhadeff, chief operating officer for Nutri-Force Nutrition, a Northwest Miami-Dade-based manufacturer of custom-made nutritional supplements, vitamins and nutraceuticals.

“The general trend of focusing a bit more on preventative nutrition is very demonstrated in men’s cardio health,” Alhadeff said.

About one year ago, Nutri-Force Nutrition launched CardioCore Heart Support, a comprehensive soft-gel pill that aims to reduce low-density lipoprotein.

It includes omega 3 fatty acids, phytosterol, which are part of plants and have shown to reduce the absorption of low-density lipoproteins, and coenzyme Q10, which people produce when they are younger, but production lowers with age and can lead to heart disease.

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