Risk Factors for Heart Disease: Frequently Asked Questions

Does smoking increase your risk of heart disease?
Smoking is a major risk for several diseases including heart disease, stroke, and several cancers. Even low-tar cigarettes and light smoking can increase the risk of heart disease substantially. There are now several alternative approaches to helping people stop smoking. These include nicotine-replacement patches and gum as well as oral medication.
Can the heart rebuild its strength after quitting smoking? How long before it gets back to normal?
If you are able to stop smoking, your risk of a heart attack or stroke decreases within a few weeks. The risk goes down to that of a nonsmoker within about 2 years. In addition, a lot of patients comment that they feel healthier and have more energy after they've stopped smoking.
Is hypothyroidism a risk factor?
Hypothyroidism can increase blood cholesterol levels and that contributes to heart disease; however, if the hypothyroidism is being treated with a thyroid hormone, then the cholesterol returns to normal.
Are birth control pills a contributor to heart disease?
Birth control pills can cause a small increase in the risk of thrombosis and heart attack. That occurs mainly in people who have been on the pill for more than 10 years and who smoke cigarettes.
Is heart disease hereditary?
There is an increase in the risk of heart attack if a first-degree relative (parent or sibling) has had a heart attack or stroke. That is mainly seen when the relative has had a heart attack before the age of 45 if they are male, 55 if they are female. Obviously, you cannot change your family history, but a positive history should suggest the need to improve all the other risk factors like stopping smoking and decreasing cholesterol.
Is heart disease an irreversible condition?
Heart disease is potentially reversible by attending to risk factors like cholesterol, blood pressure, and smoking. Several studies have shown, for example, that aggressive lowering of blood cholesterol with LDL levels below 100 can open up blocked coronary arteries at least partially. Perhaps I should explain that LDL cholesterol is the "bad" cholesterol component.
If heart disease is in your family history, at what age should you begin paying attention to heart health and what tests should you have done regularly?
If you have a family history of heart disease, it is wise to have your blood cholesterol checked after the age of 18 and regularly thereafter. The patient should also have their blood pressure checked annually as well as tests for diabetes. Perhaps more importantly, one should maintain a healthy lifestyle at any age. That includes no cigarettes, a heart-healthy diet, and regular exercise.
What changes in diet do you recommend?
I would suggest a diet that is balanced among all the main food groups, with fat content making up no more than 30 percent of calories and most of that fat being unsaturated. I would not advise patients to eat a diet that is restricted in carbohydrates or fruits and vegetables, because this may adversely affect vitamin intake and blood cholesterol.
Do most overweight people develop heart disease?
Being overweight can increase the risk of heart disease in several ways. There can be a ten-fold increase in risks of high blood pressure and diabetes. In addition, being overweight will decrease the HDL or "good" cholesterol, which is now recognized as a major risk factor. If you are overweight, it is important to diet and exercise in order to lose weight and reduce these risk factors.
Can stress cause heart disease?
Stress can increase the risk of heart disease, although we still do not know how this happens. A sudden physical or emotional stress can certainly lead to an episode of angina or even a heart attack.
What are the warning signs of heart disease?
Heart disease can manifest as chest pain, tightness or discomfort. Sometimes even shortness of breath can be a symptom of a heart attack. Any unusual restriction in your activity could be a warning sign of heart disease. Dizziness or a fast or irregular heart beat is another symptom.
Is vitamin E good for your heart?
Vitamin E is taken by many people; however, recent clinical trials have suggested that it is not effective in reducing the risk of heart disease, at least in patients who've already had one heart attack. There have now been two clinical trials involving more than 20,000 patients with placebo or 400 units of vitamin E a day. There was no benefit of vitamin E in either trial. For that reason, I do not normally recommend vitamin E.
Are diet pills bad for your heart?
There are some kinds of diet pills that have been shown to cause damage to the valves of the heart. This is a different kind of heart disease from a heart attack, and the pills responsible have been withdrawn from the U.S. market. There are some newer treatments that do not affect the heart, and these can be useful in reducing body weight.
What is valvular heart disease?
Valvular heart disease is where the valves of the heart that are responsible for maintaining one-way blood flow through the heart become thickened or weakened. This can lead to shortness of breath, dizziness, fatigue, and even stroke.
Do you recommend taking an aspirin a day?
I would recommend aspirin for patients who have already had a heart attack, stroke, atherosclerosis in other blood vessels, or who have diabetes or well-controlled hypertension. Aspirin has been shown to reduce the risk of heart attack and stroke by about 25 percent when taken in a dose of 325 mg or less a day. However, even low doses of aspirin can cause a slight increase in the risk of bleeding into the brain. For that reason, we do not normally recommend aspirin for low-risk patients who have not yet had a heart attack or stroke.
How is high cholesterol treated in teens?
There is one condition in children called familial hypercholesterolemia that can cause heart attacks in teenagers. In these individuals, we recommend treatment of high cholesterol with the same drugs that are used in adults. I would not treat high cholesterol in teenagers with drugs unless this disease were present. I would recommend, however, that children and teenagers who have high cholesterol follow a heart-healthy diet with restriction in the amount of saturated fat.
What is cardiac rehab?
Cardiac rehabilitation refers to a structured program of dietary advice, smoking cessation, and graded exercise. These programs are used in patients who have had a heart attack and also in patients with a diagnosis of angina or other cardiac conditions. It is important that trained staff supervise the exercise program for such patients. Once patients have completed the cardiac rehab program, then they can continue their exercise and diet at home.
How is heart disease related to strokes?
Heart disease is commonly caused by atherosclerosis (hardening and blockage of the arteries), and this process can also cause strokes. Most strokes are due to a blood clot that forms either in the brain or travels from a narrowed artery in the neck. We know that treating risk factors for atherosclerosis can reduce both heart attacks and stroke. For example, cholesterol lowering can reduce the risk of a stroke by about 25 percent.
Is it true that a glass of red wine is good for your heart?
There is information that having one or two drinks per day can reduce the risk of heart attack. This may be because wine drinking or alcohol in general increases the level of good cholesterol, or HDL. However, this applies only to moderate intake of alcohol. The benefit is lost at higher levels of drinking. The benefit is not restricted to red wine; the data would suggest any kind of alcohol-containing drink might have some cardiac benefit.
But what are the effects on your liver? (Having a drink a day?)
It is true that high levels of alcohol can cause liver disease; however, the death rates in patients who have 1-2 drinks per day are lower than in patients who have no drinks per day, suggesting that the liver effects do not occur with modest alcohol consumption.
Does garlic help lower your cholesterol?
There is some evidence that garlic may reduce cholesterol; however, many studies have been contradictory. The largest study has shown little or no benefit. My advice would be that if a patient is interested in garlic, they should try it for 3 months and then have their cholesterol rechecked.
What is a stress test?
A stress test is a test where the electrical activity of the heart is monitored using an electrocardiogram (ECG or EKG), while the patient exercises on a treadmill. It can give information about blood flow to the heart and can suggest whether there are narrowed blood vessels. However, it is important that this test be performed only in patients who are at high risk of heart disease or who have symptoms to suggest heart disease, because there can be a false-positive test that may lead to worry and further unnecessary tests.
Is salt bad for your heart?
Salt in the diet can cause an increase in blood pressure in some patients. For that reason we usually recommend that salt intake be restricted to moderate levels. It is particularly important to watch salt intake if a patient has high blood pressure that is not controlled with usual therapy. Many foods, such as potato chips, peanuts, and ready-made meals, have very high salt content.
What is the most often-performed heart surgery?
The most commonly performed heart surgery is coronary artery bypass grafting. It is used to redirect blood around blocked coronary arteries to allow the heart to function normally. In patients who have had this surgery, we are very aggressive in controlling all of their risk factors. This is necessary because vessels used for surgery are more sensitive to risk factors like cholesterol.
What happens if heart disease is left untreated? Does it often go untreated?
If heart disease is not treated, it can cause severe angina, heart failure with shortness of breath on even mild activities. The risk of death is increased. Most physicians are now very familiar with treating heart disease, so it does not often go untreated.
Are cardiac scans a good way of detecting heart disease? What exactly is a cardiac scan?
One of the tests that has recently been used to detect heart disease is a coronary calcium CT scan. This detects calcium in areas of blocked arteries in the heart. It is a simple test, but we do not yet know how good it is at predicting risk. For example, I would be reluctant to defer treatment of a risk factor like cholesterol just because the coronary calcium scan was negative.
What is the relationship between AIDS and heart disease?
AIDS can be linked to heart disease in several ways. First, the AIDS virus can infect the heart and cause cardiomyopathy. This is a condition where the heart muscle gets weak and cannot contract properly and the patient has symptoms of shortness of breath. Second, some of the newer drugs to treat the AIDS virus can increase blood triglyceride levels and decrease good, or HDL, cholesterol. There have been reports of AIDS patients suffering heart attacks prematurely after being treated with these drugs. Most physicians now routinely monitor blood lipids in patients on these drugs.
How important is diabetes as a risk factor?
The importance of diabetes is often underestimated. Recent studies have shown that if a patient has diabetes, their risk of a heart attack is increased five-fold above a patient who does not have diabetes. In addition, we know that treating blood pressure and cholesterol in diabetic patients can dramatically reduce the risk of heart disease. For that reason it is very important that patients with diabetes have their BP and cholesterol values checked frequently and are treated appropriately.
Does their risk increase if it is adult onset diabetes?
Studies that I was referring to were done primarily in patients with adult-onset diabetes, so the answer is yes. The other important intervention that can sometimes cure adult-onset diabetes is weight loss by diet and exercise. In fact, weight loss is probably more effective than some of the drugs prescribed.
Can children get heart disease?
Yes, children can get heart disease. The main type that they get is called congenital heart disease, and that is conditions like a hole in the heart that affects newborns. There are rare genetic conditions that can elevate blood cholesterol so high that teenagers can have heart attack conditions.
What do nitroglycerites do?
Nitroglycerin is a drug that has been used for many years to relieve symptoms of angina. It works by dilating or opening up coronary arteries that are partially blocked. It can relieve symptoms of angina within a few minutes. If you have to take nitroglycerin more frequently than usual, it may be a sign the heart disease has worsened and you should seek medical advice in that case.
Can exercise really make your heart stronger?
Exercise has huge benefits. It reduces blood pressure and increases HDL, or good cholesterol. It improves the number of blood vessels in the heart and in the rest of the body. So exercise makes it less likely that you will have a heart attack and if you do have a heart attack, it's likely that it will be less severe. In addition, exercise is a very important component of any weight-loss program.
What is congestive heart failure?
Congestive heart failure is a condition where the heart does not pump as much blood as it should. This can result in fatigue, muscle weakness, and shortness of breath. In addition, the patient may have swelling of their legs. There are many new and effective treatments for congestive heart failure.
Is red meat bad for your cholesterol?
Red meat contains a lot of saturated fat. If you eat red meat every day, it is likely that your cholesterol is about 10-20 percent higher than it should be. Alternatives to red meat include chicken, fish, and turkey, as well as nonmeat protein sources like nuts and beans.
How long does it take to lower your cholesterol once you change your diet? Weeks? Months?
It usually takes 2-4 weeks for a change in diet to start to influence cholesterol levels. However, the full effect of a change in diet may not be seen for up to 3 months.
What cholesterol level is recommended for a heart attack patient?
The most important cholesterol level is the LDL or bad cholesterol level. This is calculated as the cholesterol minus HDL cholesterol minus triglyceride divided by 5. We recommend that in someone who's had a heart attack, the LDL be reduced to less than 100. This will often require the use of the statin drugs. These drugs are very safe and some of them have been shown to reduce the risk of heart attack by 35-40 percent.

William Haynes, MD
Formerly in the Division of Cardiovascular Disease