4. CARDIOVASCULAR DISEASE IN MEN

The American Heart Association reports that heart attack is the single biggest killer of American males. Men are more likely to die of stroke and are almost twice as likely to die of heart disease than are women. High blood pressure increases the risk for stroke and heart attack and men under age 55 are much more likely to suffer from high blood pressure than are women.

We’ve provided you with some information about high cholesterol, heart attacks, high blood pressure and congestive heart failure:

Cholesterol
Cholesterol is a paradox: Everyone needs it, but for some people it's a potential killer. Cholesterol contributes to such vital bodily functions as building new cells, insulating nerves and producing hormones, vitamin D and bile acids, which aid digestion.

Normally, the liver makes all the cholesterol the body needs. But there are many dietary sources of cholesterol, too. Cholesterol is found in foods derived from animal products, although these foods can be processed to remove the waxy substance. Foods derived from plant products do not contain cholesterol. A diet high in saturated fats can raise blood cholesterol, too, particularly in people genetically predisposed to high blood cholesterol levels.

Symptoms:
A high level of cholesterol (greater than 200 mg/dl) in the blood does not have obvious symptoms, but can be a risk factor for other conditions that do have recognizable symptoms, including angina, atherosclerosis, heart disease, high blood pressure, stroke and other circulatory ailments.

• Soft, yellowish skin growths or lesions called xanthomas may indicate a genetic predisposition to the body's inability to process cholesterol and triglycerides normally.
• Obesity and diabetes may be associated with high cholesterol levels.
• In men, impotence may be due to arteries affected by excessive blood cholesterol.

Causes:
Having high cholesterol is determined largely by the luck of the genetic draw. Some families are genetically blessed with low total cholesterol or high levels of HDL or "good" cholesterol regardless of diet or lifestyle. Other families suffer from various hereditary disorders that significantly increase the risk for high cholesterol; the most prevalent of these disorders are also associated with obesity and diabetes. People with such a genetic predisposition who eat a diet high in saturated fats are very likely to have high blood cholesterol.

Long-term studies have shown that stress can raise blood cholesterol levels, especially since stress can lead to poor eating habits that may increase cholesterol intake.

On the positive side, vigorous exercisers, such as long-distance runners, tend to have high HDL-cholesterol levels.

Prevention:
Advice from your doctor about cholesterol reduction is likely to echo that of nutritionists and most alternative practitioners: Adopt a diet low in fat and cholesterol, lose weight, exercise regularly and if you smoke, quit.

High Blood Pressure
Blood pressure refers to the force of blood pushing against artery walls as it courses through the body. Like air in a tire, blood fills arteries to a certain capacity. Just as too much air pressure can damage a tire, so can too much blood pressure threaten healthy arteries.

Any disturbance in the normal beating pattern of the heart is called an arrhythmia, or irregular heartbeat. Practically everyone experiences some version of an arrhythmia on occasion, usually in the form of a mild palpitation or a "skipped" heartbeat. (In fact, what feels like a skipped beat is really an early beat, weak enough not to be felt, then a one- or two-second pause, followed by a relatively forceful beat; the delay between beats feels like a skip.) Mild, isolated disturbances of this sort are normally harmless. On the other hand, a recurrent arrhythmia, should be checked by a physician.

Symptoms:
In the vast majority of cases, there are no clear warning signs of hypertension (high blood pressure). If symptoms do occur, they may include:

• Headaches, chest pain or tightness, nosebleeds, and numbness and tingling; you may have severe hypertension.
• Excessive perspiration, muscle cramps, weakness, palpitations, and frequent urination; you may have secondary hypertension, possibly caused by a tumor or an adrenal gland disorder.

High blood pressure is more likely in:

• People with a family history of high blood pressure, heart disease, or diabetes
• African Americans
• pregnant women or women who take birth control pills
• People over age 60
• People who are overweight
• People who are not active
• People who drink excessively
• Smokers
• People who eat foods high in fat or sodium

Causes:
In as many as 95% of reported hypertension cases in the United States, the underlying cause cannot be determined. This type of high blood pressure is called essential hypertension. Patients who suffer organ damage as a result of high blood pressure are said to have malignant hypertension; the diastolic pressure in such cases usually exceeds 130. Malignant hypertension is a dangerous condition that develops rapidly and requires immediate medical attention.

High blood pressure tends to run in families, for example, and it is more likely to affect men than women.

Essential hypertension is also greatly influenced by diet and lifestyle. The link between salt and high blood pressure is especially compelling. People living on the northern islands of Japan eat more salt per capita than anyone else in the world and exhibit the highest incidence of essential hypertension.

Other factors that have been associated with essential hypertension include obesity; diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical activity; and chronic alcohol consumption.

Prevention:
You can help keep your blood pressure at a healthful level and reduce your risk of heart disease by making a few changes in your lifestyle.

• Watch what you eat. Stay away from salt and fat, concentrating instead on foods that are high in fiber, calcium, and magnesium.
• Get plenty of exercise. Regular aerobic workouts condition the heart and keep blood vessels dilated and working properly.
• If you are overweight, try to trim down. Even a small weight reduction can make a big difference.
• If you smoke, now is the time to stop.

Heart Attack
In order to keep pumping, day in and day out, the heart requires its own constant supply of oxygen and nutrients. Two large, branching coronary arteries deliver oxygenated blood to the heart muscle. Should one of these arteries or branches shut down, a portion of the heart is starved of oxygen and fuel, a condition called ischemia. If an ischemic attack lasts too long, the starved heart tissue dies. This event defines a heart attack, otherwise known as myocardial infarction -- literally, "death of heart muscle."

Symptoms:

• A prolonged crushing, squeezing, or burning pain in the center of the chest. The pain may radiate to the neck, one or both arms, shoulders, or the jaw.
• Shortness of breath, dizziness, nausea, chills, sweating, weak pulse.
• Cold and clammy skin, gray pallor, a severe appearance of illness.
• Fainting (rare)

Causes:
Most heart attacks are the end result of coronary heart disease, an atherosclerotic condition that clogs coronary arteries with fatty, calcified plaques. (As blood flow is gradually impeded, the body may compensate by growing a network of collateral arteries to circumvent blockages; the presence of collateral vessels may greatly reduce the amount of heart muscle damaged by a heart attack.) In the early 1980s, researchers confirmed that the precipitating cause of nearly all heart attacks is not the obstructive plaque itself, but the sudden formation of a blood clot on top of plaque that cuts off blood flow in an already narrowed vessel.

While the step-by-step process leading to heart attack is not fully understood, major risk factors are well-established. Some can be controlled. Of these, the main ones are high blood pressure, high cholesterol, obesity, smoking, and a sedentary lifestyle. Stress is also believed to raise the risk, and exertion and excitement can act as triggers for an attack.

Men over the age of 50 with a family history of heart disease are predisposed to heart attack. High levels of estrogen are thought to protect pre-menopausal women fairly well from heart attack, but the risk increases significantly after menopause. Some women opt for hormone replacement therapy after menopause; the choice should be made with full knowledge that elevated estrogen levels also increase the risk for breast and uterine cancers.

Prevention:

• Stay in touch with friends and family. Research shows that people with poor social support are more vulnerable to heart disease. Also, seek ways to control feelings of anger and hostility; these emotions may add to heart attack risk.
• Assess your heart attack risk profile and make appropriate changes to diet and lifestyle early.
• If you are at high risk for heart attack, have yourself tested regularly for silent ischemia.
• Talk with your doctor about taking an aspirin daily. Studies have shown that this regimen significantly reduces the risk of heart attack.
• Regular aerobic exercise greatly enhances efforts to prevent or recover from heart attack. If you already have a heart condition, schedule a stress test before beginning an exercise program in order to determine how much exertion is safe.
• Reduce stress and have a positive attitude
• Keep salt, sugar, and saturated fat to a minimum to reduce cholesterol, control blood pressure, and control weight. Eating magnesium-rich foods such as nuts, beans, bran, fish, and dark green vegetables may help prevent heart attack.
• Vitamins A, C, and E. Fruits, vegetables, and grains supply many of the needed antioxidant.
• Eating root vegetables such as carrots may also help prevent heart attack. These vegetables lower cholesterol over the long term and reduce blood-clotting activity.

Congestive Heart Failure
Congestive heart failure (CHF) is a condition in which the heart can't pump blood effectively to the body's tissues and other organs. This usually occurs when a person has narrowed or hardened coronary arteries (the vessels that supply blood to the heart muscle), has previously suffered a heart attack, or has high blood pressure.

In CHF, the weakened heart pumps less blood than usual -- too little to push enough circulated blood back into the heart to repeat the journey. So blood stalls, or congests, in the body's tissues. This makes it even harder for the heart to push blood through the arteries on the next beat.

Doctors divide CHF cases into four levels of increasing severity:

• Class I: Physical activity unaffected, and the patient has no unusual fatigue, shortness of breath, palpitations, or pain during normal activities.
• Class II: The patient may experience mild fatigue, shortness of breath, palpitations or pain during normal activities and slight limitations on normal activities.
• Class III: The patient experiences fatigue, shortness of breath, palpitations or pain during normal activities; activities are dramatically limited.
• Class IV: The patient is uncomfortable even at rest. Discomfort increases with activity.

Symptoms
Sometimes, people with CHF do not have any symptoms. The most common symptoms of CHF are:

• Shortness of breath with exercise or difficulty breathing at rest or when lying flat
• Swollen legs, ankles, or abdomen
• Dry, hacking cough or wheezing
• Fatigue, palpitations, or pain during normal activities
• Weight gain from fluid retention
• Increased need to urinate during the night
• Dizziness or confusion
• Rapid or irregular heartbeats

Causes
Many patients have both of the most common causes of CHF:

• Coronary artery disease (narrowing or hardening of arteries that supply blood to the heart muscle, usually caused by a build-up of fats and cholesterol)
• High blood pressure (hypertension)

CHF may also be caused by other conditions that weaken or interfere with the heart, including:

• Previous heart attack
• Heart valve disease
• Damage to the heart muscle (cardiomyopathy)
• Heart defects present at birth
• Infection of the heart valves or muscle (endocarditis or myocarditis)
• Diabetes mellitus
• Chronic kidney disease

Prevention

• Avoid physical and emotional stress
• Avoid fatigue by planning rest periods and gradually increasing daily activities
• Treating high cholesterol with drugs to reduce blockages in the coronary arteries has been shown to reduce heart failure rates by 30%.
• Drug therapy to lower blood pressure has been shown to reduce heart failure rates by 40% to 60%.
• Early diagnosis and treatment of heart-valve abnormalities can prevent CHF caused by chronic volume overload of the heart's left chamber.

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