Heart disease is the leading cause of death for both
men and women in the US, with one in four
deaths attributed to it.
The culprit, generally, is coronary artery disease, in
which plaque builds up in your arteries, blocking blood
supply to this most vital organ. It can cause heart attack,
heart failure and arrhythmias.
Aside from being deadly, coronary heart disease was
projected to have cost the country more than $108 billion
in 2010. This includes the cost of health-care services,
medication and lost productivity.
Whoís most at risk for a heart attack? Those of us with
high blood pressure, diabetes, high cholesterol or a smoking
habit, and those of us who are obese.
Unfortunately, more than 90 percent of Americans are not as
healthy as they could be, according to a paper published in
Circulation, a journal of the American Heart Association.
When many Americans go to the doctor, they get a standard
physical exam without tests to check their hemoglobin A1c
and their fasting glucose, which can reveal whether they
have diabetes. Also overlooked, oftentimes, are blood-pressure
readings that are taken on three separate visits, which
can reveal hypertension, or even fasting blood tests to assess
the ratio of good cholesterol to bad cholesterol.
Most patients sitting in the doctorís office are obese
and yet have never had their body mass index calculated
nor had it explained to them.
In our office, we do the belly-button check. If you canít
see it, then yes you are overweight. Belly fat is worse
than any other fat on your body because it indicates fat
around your vital organs.
Smoking is obviously a problem, and itís also something
that people tend to lie to themselves about. So when
patients tell me they smoke half a pack a day, I round it
up to a pack a day.
In all fairness, patients canít be blamed for not knowing
their true health status. Unfortunately, most doctor visits
are targeted to a patientís complaint. For example,
someone who has come in complaining of a sinus problem
will be treated for a sinus problem and will not be
risk-stratified for heart disease, even though he or she
may be obese or may smoke.
There are numerous reasons people donít get a comprehensive
evaluation, such as insurance coverage, time
constraints and reimbursement.
Okay, I know youíve heard it before, but itís true: Stop
smoking, eat well and exercise. A few key changes can
make an enormous difference in your health. Your
lifestyle is not only your best defense against heart disease;
itís also your responsibilityóand not something that
can be dealt with in a few minutes in your doctorís
The approach to a better life includes the following:
1. Getting active: Make the time! Start with walking and
chart your progress. Also park farther from your destination
and take short brisk walks throughout your workday.
2. Manage cholesterol: Eat foods that are low in cholesterol,
trans fats and saturated fats, as well as foods high
in fiber. Schedule a cholesterol screening, maintain your
proper weight and, if your doctor prescribes cholesterol
medication for you, take it!
3. Healthy eating: Stock your kitchen with healthy food.
Buy less junk and more produce. Also eat from each of
the basic food groups and, at least twice a week, have
some fish. And whatever you do, stay away from
4. Lower your blood pressure: Reduce sodium, limit
alcohol and stress.
5. Control your blood sugar: Have it checked regularlyAlso, reduce your consumption of simple sugars, such
as sodas, candy and desserts. And engage in moderate intensity aerobic exercise, which helps your body
respond to insulin. And, again, take medication or insulin if it is prescribed for you.
6. Lose weight: Itís crucial to know the recommended
calorie intake for your age, gender and level of physical
activity. Also track calories. Even if you only do it for a few days, youíll learn a lot about your habits. Finding out the amount of calories
you take in, compared to the ones you burn off allows you to plan accordingly.
7. Stop smoking: Work towards replacing the craving you have for tobacco with
healthier options, and if you backslide figure out why and try, try, try again. Also
talk with your health-care provider or look for a smoke-cessation program.
Many hospitals and public health departments offer hotlines and group support
with trained staff.
I recommend that people take care of their bodies the way they take of their
carsóor at least should take care of their cars.
Also visit your doctor for risk stratification to determine if you are prone to
heart disease, diabetes, high cholesterol or high-blood pressure. If you do, or if
you smoke or are obese, your doctor may want to do an EKG, a stress test or an
All this may take extra time and money, but, as with your car, itís the right
thing to do so you arenít stranded on Monday when you have to go to work, or
on Saturday when you have to buy groceries, or later this afternoon, when you
pick up the kids from soccer practice.
Or you might look at caring for your health like you do going to the DMV to
get your car registered. Yes, itís inconvenient, but the consequence of having
expired tags when you get pulled over is something you donít want to deal
with, so every year you take care of it.
The common denominator here is consequences.
Most people donít see their doctor as regularly as they do their mechanic,
because many of us do not take seriously the imminent threat to our health
from not following our doctorís recommendations. Most people think that you
go to the doctor only when youíre sick.
No matter where you stand, itís never too late to make better choices for your
health. But you need a goal, a plan and the commitment to live better.
1. Follow up with your doctor for maintenance as you would for care for your car.
2. Donít wait until you break down.
3. Be a good steward of your health and know your status.
4. Be inquisitive and informed; patients who ask questions and are knowledgeable
tend to get better care.
Remember, you can stop heart disease in its tracks. Start small and make one
change at a time. Before you know it, youíve abandoned poor choices and
begun making powerful ones.
Get your children on the program with you: More than a third of American kids
are overweight, which can be the foundation of lifelong problems. Set a good
example for you family, and you will reap the benefits.
by Moses DeGraft-Johnson, MD
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