Cardiologist Mariell Jessup, president of the American Heart
Association, says if she could have people do three things for the
heart, she would advise: "Do some exercise for exercise's sake every
day. Never smoke cigarettes; stop immediately if you do. And keep your
blood pressure controlled. Check it to make sure."
other top experts in heart disease from around the world are at the
American Heart Association's Scientific Sessions in Dallas this week.
They will be discussing new guidelines for the prevention of
cardiovascular disease and stroke, including a new formula for the
assessment of risk for heart disease and a new approach to the treatment
Cardiovascular disease accounts for one in three deaths in the USA,
government data show. About 800,000 people die each year from
cardiovascular disease, but as many as 200,000 of the deaths from heart
disease and stroke could be prevented if people made healthy lifestyle
changes: They should stop smoking, maintain a healthy weight, do more
physical activity, consume less salt and manage their high blood
pressure, high cholesterol and type 2 diabetes, a recent government
USA TODAY asked Jessup, a professor of medicine at
the University of Pennsylvania Heart and Vascular Center, to talk about
how Americans can take control of their heart health.
Q: Why is it so important to control blood pressure?
High blood pressure is a key risk factor for the development of heart
attack, stroke, heart failure and kidney failure. If we could control
blood pressure, it is estimated that we would have 50% less heart
failure. About one in three U.S. adults have high blood pressure, and
more than half of people with hypertension don't have it under control.
High blood pressure is defined as a reading greater than or equal to
140/90 mm/Hg. High blood pressure means the blood running through your
arteries flows with too much force and puts pressure on your arteries,
stretching them past their healthy limit and causing microscopic tears.
The scar tissue that forms to repair those tears traps plaque and white
blood cells, which can lead to blockages, blood clots and hardened,
That sounds sort of gruesome, but the good news
is it's totally preventable. It's treatable with lifestyle and
medication, if necessary. And those scars can be healed over time.
Q: How does exercise improve heart health?
It improves it in so many ways. It helps control our blood pressure. It
helps keep our weight down. It helps skeletal muscles use oxygen more
efficiently, and it helps build new channels for the heart's blood flow
called collateral vessels.
Q: What other numbers are important to know?
doctors say know your numbers, they are really telling you to keep track
of your risk factors for heart disease. Besides blood pressure, the
numbers we talk about for risk factors are BMI (body mass index, a
number that takes into account height and weight), cholesterol and blood
sugar, meaning whether or not you have type 2 diabetes or are at risk
for developing it.
Q: How does being overweight or obese harm your heart?
It makes more work for the heart. It tends to raise our blood pressure,
and it leads to the development of type 2 diabetes in so many people.
Q: What should women know about cardiovascular risks?
Heart disease is the No. 1 killer of women, not breast cancer. Heart
disease is a five-times-bigger killer than breast cancer. Some of the
same risk factors for heart disease are risk factors for breast cancer -
lack of physical activity and obesity. So if women exercise regularly
and keep a healthy weight, they are reducing their risk of heart disease
and breast cancer.
Q: How does stress affect heart health?
A: Stress probably contributes to higher blood pressures, but mostly
stress leads people to make poor lifestyle choices. A lot of people will
say that they are too stressed to stop smoking or too stressed to
cook so they eat fast food. Or they think they're too stressed to
exercise. A stressful lifestyle clearly is related to heart disease and
sudden death, but we don't understand all the mechanisms. There are a
lot of ways that stress affects heart disease that we don't understand.
Q: Why is it important to lower sodium intake?
Lower sodium intake is critical to lowering blood pressure. What the
American Heart Association says is ideally, we should consume no more
than 1,500 milligrams of sodium a day. Most Americans consume about
3,600 milligrams or higher a day. If people could at least reduce their
sodium intake by 1,000 milligrams, that would be great, even if they
can't get it down to 1,500 milligrams. Sodium is in a lot of processed
food and fast food.
Q: What do the new heart disease prevention guidelines say?
A: There are four parts of it: the treatment of overweight and
obesity; lifestyle; how to calculate cardiovascular risk; and how to
treat cholesterol. There is a new formula for calculating risk of heart
disease. The reason it's new is that heart attack risk used to be
calculated based on white Americans, but the new risk assessment is more
broadly based, and it takes into account African Americans. It looks at
different endpoints, and it takes into account heart attacks and
strokes. There is going to be a lot of discussion about this at the
(American Heart Association) meeting. It may be very controversial -
which is fine. Controversy means discussion and stimulates clinicians to
focus on the new issues. Doctors will ask: Why use this risk
calculation? Why not use the old one? The calculation of risk will
determine who gets treated for high cholesterol, so it's a really big
The cholesterol guidelines are very different, too. In the
past, clinicians have focused on lowering a person's LDL, a blood test
of the "bad" cholesterol. Now the guidelines are suggesting that
clinicians identify people at risk rather than a blood test representing
risk, and treating the individual according to their level of risk.
It's going to cause a huge conversation.
Q: What progress is being made in extending and improving lives after a heart attack or stroke?
We've done a great job in reducing deaths from heart disease and
stroke, and that's good. Our advice to patients who have suffered these
diseases is to focus on healthy living. Just because someone has
suffered the consequences of cardiovascular disease does not mean that a
healthy lifestyle is useless. In fact, it is even more vital than ever.
Don't give in to despair, there is great hope.
Q: What would you like to see happen to help prevent heart disease?
We want to reduce heart disease and stroke even more by preventing its
occurrence at all. We want to improve all Americans' lives. We want
people to make healthy choices the default choice. Instead of having to
find a corner of the cafeteria that has healthy food, wouldn't it be
nice if the whole cafeteria offered healthy food, and you had to find
the unhealthy food in the corner?
It's always better to walk the
steps instead of taking the elevator. Wouldn't it be nice if you had to
go out of your way to find the elevator? Wouldn't it be nice if they hid
the elevator, and the stairs were easy to find, or if the stairs were
right near the elevator? Wouldn't it be great if it were easy to walk
through neighborhoods, if there were sidewalks everywhere and it were
safe to walk in every city?
If you can get to the age of 50
without any risk factors, chances are you won't develop heart disease.
We have the tools to control the risk factors and prevent disease, so
you can lead a healthier life well into your golden years.
Q: What is the latest research on blood thinners?
Blood thinners markedly reduce the risk of stroke in patients with
atrial fibrillation and are necessary for several other medical
conditions. There will always be a balance between the risk of bleeding
and the risk of stroke with all these available drugs, but the newest
agents are already proving to be more effective and safer than our
traditional standby blood thinner, warfarin. New agents will be
presented at the heart association meeting.