REDUCING the RISK of HEART DISEASE

To ward off heart disease it is necessary to do two things: keep the heart muscle strong and keep the blood flowing. The simpler part of the effort is keeping the heart muscle strong. This is done through aerobic exercise. Exercise is also important to keeping the blood flowing, but it not sufficient.

Diabetes, obesity, smoking, high cholesterol and high blood pressure all lead to problems with blood flow in the in the arteries that can result in a heart attack. And prevention is all. Once you get to the point that a blockage is starting to develop blockage, large amounts of plaque already exit in the arteries. You should not wait until there are symptoms of heart disease to begin the cure.  By then you are fighting a rear-guard action.

To prevent the disease, risk factor modification and lifestyle changes are absolutely crucial. It is not adequate top rely on drugs. Says John Canto, a cardiologist at the Watson Clinic in Lakeland, Fla. "You can't smoke, gain weight, not exercise and just take a statin and expect to have a great outcome."

RISK FACTORS YOU CAN'T CHANGE

You just can't do anything about some things that increase your risk of having a heart attack. Still, it's essential to know how they contribute to your global risk profile:

• being male

• being African American, Hispanic or another minority

• getting older, particularly over 60

• having parents or siblings with heart disease (particularly a father who had a heart attack before 55 or a mother who had one before 65).

RISK FACTORS YOU CAN CHANGE

In approximate order of their ability to reduce your risk, here are some actions you can take:

• Quit smoking. No single act can reduce your risk more dramatically. A year after quitting, your heart disease risk is reduced by half.

• Stay active. A recent study in Circulation shows that 20 minutes on an exercise bike every day is more effective at relieving angina, or chest pain, than a procedure in which a stent is used to open a blocked vessel. After a year, 88 percent of the men in the study, all of whom had cardiovascular disease, who completed the exercise training had no heart attacks or other heart problems, compared with 70 percent of the men with the stent.

That study builds on years of research that shows exercise is one of the best things you can do for your heart health. Exercise can help control cholesterol, diabetes and obesity, as well as lower blood pressure. Working out helps lower the risk of heart disease even in the presence of other risk factors. Aim for 30 minutes of moderate activity nearly every day. For additional heart protection, according to the American Heart Association (AHA), you'll need to get 30 to 60 minutes of exercise three or four days a week at 50 to 80 percent of your maximum exercise capacity.

• Eat wisely. Heart-healthy eating means eating less saturated fat and trans fat; more healthy fats of the kind you find in nuts, fish and olive oil; fewer low-quality carbohydrates like you find in white bread, white rice and sweets; and more fruit, vegetables, beans and whole-grain foods, especially those with soluble fiber such as oatmeal, barley, citrus, strawberries and apples.

Folic acid and vitamins B 6 and B 12 reduce homocysteine levels. Nobody knows if this reduces heart disease risk, and the AHA doesn't recommend folic acid supplements. But it does recommend people get enough folic acid in their diets. It is added as a fortification to wheat flour and occurs naturally in citrus, tomatoes and many vegetables.

• Don't drink too much. Here's the paradox: Drinking too much alcohol will raise triglyceride and blood pressure levels, but moderate amounts of alcohol seems to increase levels of HDL, the good cholesterol. There is good evidence that people who drink moderate amounts of alcohol have less heart disease than those who don't drink at all.

The AHA recommends that if you do drink alcohol, do so in moderation. This means an average of one or two drinks per day for men. Nobody recommends starting to drink alcohol to reduce heart disease risk.

• Stay slim. Overweight and obesity are independent risk factors for heart disease. Maintaining a healthy weight will be a natural consequence of following the preceding recommendations on exercise, diet and drinking. But if you are starting out overweight or obese, you'll need to achieve a healthy weight by burning up slightly more calories than you take in, until you gradually reach your healthy weight. After that, it's a matter of balancing the food input and the calorie burn over the long term.

Achieving a healthy weight will reduce the risk of developing diabetes, high blood pressure and high blood lipids, which are themselves risk factors for heart disease.

Said Clyde Yancy, professor of internal medicine and cardiology at the University of Texas Southwestern Medical Center at Dallas: "As mundane as it sounds, the first and most important initiative for the young adult healthy male to acknowledge is that weight management is the first step to take to prevent heart disease."

• Take aspirin, maybe. While there is good evidence that aspirin can prevent both first and second heart attacks in at-risk people, you don't want to put yourself on an aspirin regimen without consulting your doctor. Aspirin can cause gastrointestinal bleeding and may increase the risk of stroke, so aspirin isn't recommended for everyone.

The U.S. Preventive Services Task Force, an independent panel of scientific experts, recommends low-dose aspirin for those at increased risk for heart disease, including men over age 40 and younger people with a risk factor such as smoking, diabetes or high blood pressure. The AHA says if a person has a 10-year risk of heart disease greater than 10 percent, the benefits of aspirin outweigh the risks. Most people who have already had a heart attack should be taking aspirin.