Heart Health - Prevention, Reduce Stroke Risk and Turn Back the Clock on Your Ticker

our Heart Attack Prevention Plan

Italian researchers found that having a resting heart rate above 70 beats per minute (bpm) increases your risk of dying of heart disease by at least 78 percent. Follow the tips below to help drop your bpm and improve your odds.By The Editors of Men's Health
Men's Health

1. Attack Your Cardio
Run hard, don't just jog. "Exercise increases your heart's efficiency, reducing the number of heart beats you need to achieve bloodflow," says John Elefteriades, M.D., the chief of cardiothoracic surgery at Yale University. Interval training can increase your heart's stroke volume (the amount of blood it pumps with each heart beat) by about 10 percent, but slower, sustained running has no effect on it, according to an American College of Sports Medicine study. Try a four-minute run at 90 percent of your maximum heart rate, and then jog for three minutes at 70 percent. Repeat the interval three times. Do this routine three times a week, as the study participants did. Keep track with a Suunto t3c Heart Rate Monitor. ($190, suuntowatches.com)

2. Trade Massages With Her
Regular massages may soothe a rapid heart beat. Relaxation techniques reduce your body's production of adrenaline, norepinephrine, and epinephrine, stress hormones that rev up your heart in the face of danger, says Atman P. Shah, M.D., an assistant professor of medicine at UCLA. A 2007 British study found that people who received an hour of reflexology treatment (a type of foot or hand massage) had rates that averaged almost 8 bpm lower than when they went without.

3. Sleep More Soundly
The neighbor's barking dog can wreak havoc on your heart rate. In a 2007 study, Australian researchers used sound to wake people multiple times. After each noise-induced arousal, heart rates spiked an average of 13 bpm. Try Hearos Xtreme Protection Series earplugs—they can reduce noise by 33 decibels. ($4, walgreens.com)

4. Don't Try to Hold It
If you gotta go, you really should go. Taiwanese researchers who studied 40 people with early heart disease found that the stress of having a full bladder steps up the heart rate by an average of 9 bpm. When your bladder expands, it increases activity in your sympathetic nervous system. This may cause your coronary vessels to constrict, forcing your heart to beat more often—all of which might boost your heart-attack risk.

5. Savor Some Snapper
In a 2007 UCLA study, people who took a 1-gram fish-oil capsule every day reduced their resting heart rates by an average of 6 bpm after just two weeks. Fish oil may help your heart respond better to your vagus nerve, which controls heart rate. The result is a slower resting heart rate and better heart-rate responsiveness, says Dariush Mozaffarian, M.D., Dr.P.H, a cardiologist at Brigham and Women's Hospital and Harvard medical school. Try Nordic Naturals (nordicnaturals.com).

Calculate Your Resting Heart Rate
Before rising from bed in the morning, take your pulse. (Place the tips of your index and middle finger on your wrist, and count the beats for a minute.) Do this for three  days and figure the average. A typical man's rate is about 70 bpm, but athletes' are lower. If an exercise program refers to maximum heart rate, find yours by subtracting your age from 220.

Can your heart bounce back?
The faster your heart rate drops after exercise, the lower your risk of dying of a heart attack, according to a 2005 study in the New England Journal of Medicine that followed 5,713 men for 23 years. Subtract your heart rate at one minute after a workout from the maximum heart rate you reached during the workout. If the difference is more than 35 beats per minute, you're probably not at an increased risk. Otherwise, check the numbers below to determine your risk of dying of a heart attack.

• Percentage increase in risk of sudden death due to a heart attack: 110
• Drop in heart rate one minute after exercise (measured in beats per minute): < 25
• Percentage increase in risk of sudden death due to a heart attack: 30
• Drop in heart rate one minute after exercise (measured in beats per minute): 25-30
• Percentage increase in risk of sudden death due to a heart attack: 40
• Drop in heart rate one minute after exercise (measured in beats per minute): 31 to 35

7Steps to Reduce Stroke Risk
By: Bill Gottlieb

A man's last years ought to be spent strapped to the fighting chair of a game-fisher
while battling a black marlin, not tethered to a nursing-home bed, incontinent and 

unable to talk. But the latter is a likely scenario if you're one of approximately 

600,000 Americans who will have  a stroke this year.

"Your chance of dying is 20 percent-but you have a 40 percent chance of being 

disabled and a 25 percent chance of being severely disabled," says David Spence, 

M.D., director of the  stroke-prevention center at the Robarts Research Institute 

in Canada.

An ischemic stroke—the kind that affects most men—occurs when an artery to 

the brain is blocked by arterial plaque that has broken loose and caused a blood 

clot. In fact, it's just like a heart attack, only instead of heart cells dying for lack 

of blood, brain cells are kicking off-thousands of brain cells. Perhaps paralyzing 

half of your body. Or slurring your speech. Or plunging you into senility.

But a "brain attack" is not inevitable.

"Fifty to 80 percent of strokes can be prevented," says David Wiebers, M.D., 

a professor of neurology at the Mayo Clinic and author of Stroke-Free for Life. 

"Making the simple choices at 25, 35, or 45 years of age can make an enormous 

difference in preventing stroke when you're in your 60s, 70s, or 80s."

Strike back at stroke with these seven strategies.

Swallow Nature's Blood Thinner

Loma Linda University researchers found that men who drank five or more 

8-ounce glasses of water daily cut their stroke risk by 53 percent compared with 

guys who drank fewer than three glasses. Water helps to thin the blood, which in 

turn makes it less likely to form clots, explains Jackie Chan, Dr.P.H., the lead 

study author.

But don't chug your extra H2O all at once. "You need to drink water throughout 

the day to keep your blood thin, starting with a glass or two in the morning," 

adds Dr. Chan.

Swig Less Soda

Unless it's the diet stuff. The Loma Linda University researchers also discovered 

that the men who drank large quantities of fluids other than water actually had a 

higher risk of stroke—46 percent higher.

One theory is that sugary drinks like soda draw water out of the bloodstream, 

thickening the blood.

Another explanation may be the boost in triglycerides caused by sipping liquid 

sugar. "Elevated levels of triglycerides-any level above 150-are a risk factor for 

arterial disease," says Daniel Fisher, M.D., an assistant professor at the New 

York University School of Medicine.

Count to 3

You may have just lowered your stroke risk.

In a study published in the journal Stroke, researchers noted that of 2,100 men, 

the anxious guys were three times more likely to have a fatal ischemic stroke 

than the more serene men. "Anxiety causes chronic overproduction of dopamine, 

a neurotransmitter that regulates the brain's control of circulation," says Ernest 

Friedman, M.D., a professor of psychiatry at Case Western Reserve University.

Counting to three—or reining in your racing mind in any other way—helps by 

stabilizing your levels of serotonin, the antidote to excess dopamine, says Dr. 

Friedman.

Hold Your Breath

At least when you're around a smoker. University of Auckland researchers found 

that people exposed to secondhand smoke are 82 percent more likely to suffer 

a stroke than those who never inhale.

It seems that carbon monoxide promotes clot formation by interfering with nitric 

oxide, a biochemical that relaxes blood vessels. "To get rid of every single bit of 

carbon monoxide after a night at the bar, you'd have to breathe fresh air for 

about 8 hours. But most of the carbon monoxide will be gone from your body in 

the first hour," says Laurence Fechter, Ph.D., a professor of toxicology at the 

University of Oklahoma.

So on your way home, make sure you roll down the car windows and start 

sucking in some clean air.

Beat Homocysteine

Research suggests that people with high blood levels of this amino acid are more 

likely to stroke out than those with low readings. Extra folate will help reduce the 

risk, but only for some people. "Fifty to 60 percent won't respond with lower 

homocysteine," says Seth J. Baum, M.D., medical director of the Mind/Body 

Medical Institute, a Harvard affiliate.

Dr. Baum recommends 1,000 micrograms (mcg) of folate, plus 25 milligrams (mg) 

of vitamin B6, 1,000 mcg of B12, and 1,800 mg of the amino acid 

N-acetyl-cysteine (NAC). "With folate, B6, B12, and NAC supplements, almost 

everyone will have normal homocysteine levels," says Dr. Baum.

Pick Up an Iron Supplement

Aerobic exercise is antistroke medicine. Can't run or cycle to save your life? 

Then lift. "Regular resistance training decreases blood pressure, elevates HDL 

cholesterol, lowers LDL cholesterol, and decreases the stickiness of the blood," 

says Jerry Judd Pryde, M.D., a physiatrist at Cedars-Sinai Hospital in Los Angeles.

If you don't already weight-train, try the American Heart Association program: 

Lift weights two or three times a week, targeting the major muscle groups. For 

each of the following, choose a weight you can lift eight to 12 times at most, and 

do one set to fatigue: bench press, shoulder press, lying triceps extension, biceps 

curl, seated row, lat pulldown, crunch, squat, Romanian deadlift, and calf raise.

Never Miss Another Flu Shot

Think of it as a sort of stroke vaccine. French researchers found that people who 

received a flu shot every year for the 5 years prior to the study were 42 percent 

less stroke-prone than those who didn't. "Chronic infections and the resultant 

inflammation might cause damage to the arteries and increase the risk of blood 

clots," says Pierre Amarenco, M.D., the study author.

And the best time to get stuck? The first week in November. That's because 

most flu epidemics start in December, and it takes about 2 weeks for the shot 

to kick in, says Robert Belshe, M.D., director of the vaccine center at St. Louis 

University.


5 secrets to turning back the clock on your ticker
By Erin Hobday

I was 11, sitting at our kitchen table with my dad and two sisters, when Dad's 

eyes suddenly rolled back in his head.

He slumped and fell clean off his chair, hitting the cold tile floor with a thud. 

The three of us jumped up, shrieking, and I dialed 911. Dad came to before 

the paramedics arrived, and he told us not to worry. "It was nothing," he said, 

and then made us swear not to tell Mom.

Flash forward 12 years. Dad, 51, is walking around a hospital room with 

two stents and a pacemaker in his chest, the calling cards of his heart attack. 

If he (and his doctor) had known back then what I know now, his heart 

muscle might not have suffered irreparable damage. Passing out, you see, is 

a sign of arrhythmia, a treatable condition that causes heart attacks, strokes, 

even sudden death.

Over the past few years, cardiologists across the country have begun 

aggressively trying to prevent heart disease in at-risk men, rather than treating 

them only after their blood pumps have broken down. "My patients who 

follow a preventive treatment program almost always live free of heart attacks," 

says Arthur Agatston, M.D., author of The South Beach Heart Program. To 

help you spot subtle risk factors and correct them before they bury you, we 

canvassed cardiologists at leading research institutes to compile this list of things 

they wish you knew.

Your Heart's Mortal Enemy is Often Invisible to Doctors

"I was taught in medical school that when a heart attack happens, vessels have 

closed gradually, like pipes filling up with sludge," says Dr. Agatston. "We now 

know that blockages occur suddenly, from soft-plaque ruptures, which often go 

undetected by standard cholesterol tests and exercise stress tests." The soft 

plaques resemble pimples in the arterial walls, except instead of pus, they're 

filled with cholesterol.

Why it's so dangerous: When those pimples pop, a small blood clot forms to 

heal the injury, followed by scar tissue and tiny calcifications along the arterial 

wall. By then, you're already incubating an attack, which strikes when a violent 

explosion of one of the pustules creates a clot big enough to block an artery.

How to ID the problem: If you have a family history of heart disease, schedule 

a 64-slice CT scan. It's the only test that snaps pictures of the heart quickly 

enough to reveal minute calcifications in the coronary arteries. Just make sure 

the scanner has ECG dose modulation, the latest radiation-limiting technology. 

If trouble's spotted, you may need statins.

How to defend yourself: Toss pecans onto your salad or into your oatmeal. 

Loma Linda University researchers had 24 people replace 20 percent of their 

daily calories with pecans for a month, and found the nuts lowered levels of 

lipid oxidation (the process that turns cholesterol into plaque) by 7 percent, 

enough to help ward off arterial damage. "Pecans are rich in gamma-tocopherol, 

a form of vitamin E that isn't in supplements," says lead author Ella Haddad, 

Dr.P.H., R.D. Even a handful a day can help, she says.

An Untrained Heart Won't Reach the Finish Line

Not every heart test needs to take place in a cath lab. In a 23-year study of 

6,000 men in the New England Journal of Medicine, researchers revealed that 

the greatest predictor of death from heart attack was the ability of a man's 

heart rate to adapt during and after a workout. "The faster your heart rate goes 

down after exercise, the healthier you are," says Steven Nissen, M.D., 

chairman of cardiovascular medicine at the Cleveland Clinic.

Why it's so dangerous: Those men whose heart rates didn't drop by at least 

25 beats per minute (bpm) within 1 minute of finishing an intense workout 

were more likely to suffer a fatal heart attack than those whose heart rates 

dropped efficiently. The reason? How your heart adapts to exercise is a 

good indication of how well it will respond to the extreme stress produced 

before and during an actual infarction.

How to ID the problem: Complete 10 minutes of sprints, check your heart 

rate, and then check it again 1 minute later.

How to defend yourself: Improve your heart-rate variability by applying the 

principles of interval training to your lifting regimen. Wear a heart-rate 

monitor and don't end your first set until the monitor reads 160 bpm, says 

Alan Stein, C.S.C.S. "Then wait till it drops below 130 bpm to begin your 

next set."

You've Never Even Heard of the Cholesterol that Wants You Dead

Researchers now realize that the size of cholesterol particles is even more 

important than their number. Small particles of LDL, called Lp (a), are a 

particularly damaging form of cholesterol, according to Michael Ozner, M.D., 

medical director of the Cardiovascular Prevention Institute of South Florida. 

These particles aren't only smaller, they have a tail, says Dr. Ozner, making 

it easier for them to sneak into the arterial wall. On the flipside, the larger 

your HDL particles, the more easily they can usher LDL cholesterol out of 

your arteries.

Why it's so dangerous: A recent study in the Journal of the American College 

of Cardiology reveals that people with high Lp (a) were 10 times more likely 

to suffer a heart attack than those with lower levels.

How to ID the problem: Ask your doctor to schedule a Vertical Auto Profile 

(VAP) test. (Check it out at www.the vaptest.com. It's covered by most 

insurance plans.) This detailed blood profile includes a measure of Lp (a)--

an ideal level is below 10 milligrams per deciliter--as well as big and small 

HDL particles.

How to defend yourself: Diet, exercise, and even statins have proven 

ineffective against Lp (a). But in a review of 8 years of studies on prescription 

niacin, Dutch researchers determined that swallowing 2 grams of this potent 

B vitamin lowered Lp (a) by 17 percent and raised the number of large HDL 

particles by 18 percent. Ask your doctor for a slow-release version of niacin. 

Research has shown that these formulations produce fewer side effects.

Carbohydrates, Not Fat, are the Real Heartbreakers

The more carbohydrates you consume, the higher your blood sugar and, in 

turn, your levels of insulin, a hormone that lets us use sugar as energy. But 

excess insulin may also increase your risk of heart disease, according to a 

review in Preventive Medicine. "The inflammatory process leading to 

hardening of the arteries is mediated through insulin," says Wolfgang Kopp, 

M.D., the study's lead author. Translation: High levels of insulin boost your 

body's production of stress hormones, which send blood pressure 

skyrocketing. That increased pressure damages the arterial wall, making it 

easier for cholesterol to slip inside.

Why it's so dangerous: Insulin may not act alone. It's theorized that the 

excess carbohydrates that cause insulin to increase to an unhealthy level 

are turned into triglycerides in your liver. And the more triglycerides you 

have circulating in your bloodstream, the more Lp (a)--the lethally small 

cholesterol--you're likely to have.

How to ID the problem: Johns Hopkins University researchers showed 

that for every 1 percent increase in hemoglobin A1c (HbA1c), an indicator 

of long-term blood-sugar levels, patients experienced a 14 percent increase 

in heart-disease risk. If diabetes appears anywhere on your family tree, 

schedule an HbA1c test. A level higher than 4.6 percent of total hemoglobin 

often warrants dietary changes and sometimes blood-sugar-lowering drugs.

How to defend yourself: Pour yourself a cabernet. According to a recent 

study in the Annals of Epidemiology, small amounts of alcohol may help 

control your blood sugar, and, by extension, your insulin. Researchers 

studied the drinking habits of people with type-2 diabetes and found that 

compared with teetotalers, those who indulged in just one alcoholic beverage 

per night had levels of HbA1c that were 1.3 percentage points lower on 

average.

Your Heart Might Be Misfiring

One in four men will develop an irregular heartbeat, or arrhythmia, by the 

time they reach 40. Yet they often don't experience obvious symptoms until 

they're clutching their chests during cardiac arrest or they suffer a stroke. 

Your heartbeat originates in the sinoatrial (SA) node, a collection of 

specialized heart cells that acts as your heart's control center, says Jennifer 

Cummings, M.D., director of electrophysiology research at the Cleveland 

Clinic. "It reacts to information from your body and brain about how much 

blood needs to be pumped, then sends an electrical impulse telling your heart 

when to beat."

Why it's so dangerous: "When an arrhythmia occurs, the heart stops listening 

to the SA node, turning its attention to other electrical signals," says Dr. 

Cummings. One form of arrhythmia, called atrial fibrillation, or AFib, can occur 

even in young athletic men. "It's like there are 300 voices inside the heart telling 

it what to do," says Dr. Cummings. Chaotic heartbeats cause the blood to swirl 

and eddy instead of flowing smoothly through the ventricles, and clots form as 

a result.

How to ID the problem: One telltale sign of an arrhythmia is a dramatic decline 

in endurance. If your regular cardio workout is suddenly a lot more exhausting, 

ask your doctor for an EKG. If that comes up clear, request a Holter monitor. 

It records your heart rhythm for 24 hours to detect more infrequent missed beats. 

Passing out may also be a sign of serious heart-rhythm trouble.

How to defend yourself: One of the most common causes of arrhythmia is high 

blood pressure, so keep yours under 120/80 millimeters of mercury. A massage 

may provide pleasurable stress relief. In a recent University of South Florida 

study, people who underwent three 10-minute massages a week experienced 

an 18-point drop in their systolic blood pressure and a 5-point drop in their 

diastolic blood pressure after just 10 sessions.

Relax--You're Not Dying

Four alarming chest sensations that can impersonate an infarction

A Fluttering or Pounding Heartbeat

"Some perfectly healthy and normal individuals may feel extra or skipped 

heartbeats on occasion, and those can be benign," says P.K. Shah, M.D., 

a Men's Health cardiology advisor. If the sensation is brief and the onset 

gradual, they are probably the harmless result of too much caffeine or stress. 

However, frequent flutterings, or those accompanied by lightheadedness or 

dizziness, could be serious.

Chest Pressure When You Swallow

If you feel a squeezing pain beneath your breastbone and it hurts to swallow, 

especially in the evening, you may just have heartburn or, at worst, an 

esophageal spasm. But if it persists most nights of the week, see your doctor 

to rule out gastroesophageal reflux disease or other more serious conditions.

Shooting Pain on One Side

"Sharp, fleeting pain on the left side of the chest is typically not life-threatening," 

says John Elefteriades, M.D., a Men's Health cardiology advisor. It can signal 

pleurisy (an inflammation of the lung lining), a muscle pull, or even a broken bone.

Mild Pressure, Shortness of Breath, and Numbness

Hyperventilation is commonly mistaken for a heart attack. If the pressure in your 

chest isn't severe, and you lose feeling in your lips or hands, you may simply be 

hyperventilating. Lie down, try to relax, and breathe into a paper bag for 5 

minutes. 

Still have symptoms? Call 911
.