| Posted February 20, 2014 | By Joel Phares, M.D. | Categorized under Men's Health, Women's Health |

Although cardiovascular disease is the No. 1 killer in America, it doesn't have to be. If we can make simple lifestyle changes such as losing weight and kicking the smoking habit, we greatly reduce our risk of cardiovascular diseases.

What is the best thing I can do to make sure my heart stays healthy?

Stop smoking. If you smoke - stop. That's the number one most important thing as well as the hardest thing to do. You get such a mortality benefit from stopping smoking. Your life expectancy is three times higher in many areas, not just heart-related if you don't smoke.

I tell my patients we can manage the diabetes and the cholesterol, but if you keep smoking, we will be putting more stents in. I've seen it too many times and it's tragic. If you aren't a smoker, the next thing would be if you are diabetic, get that under control. If you are overweight, then you need to lose weight and exercise. It can be hard to lose weight, but it can be done.

What tests should I be doing to make sure my heart is healthy?

I recommend getting your cholesterol checked. I get a baseline cholesterol on just about everybody. In addition, a check of your blood pressure and glucose are all very informative and can be ordered by your primary care doctor. You may have heard of getting a calcium score and that has its place in people who have three or more of the traditional risk factors. That test has added benefit, but until you stop smoking, get your blood pressure under control and get your cholesterol checked, I'd hold off on spending the money for the calcium score. Too many people are ignoring these basics and going for the more esoteric, high-dollar testing that has little impact when what you really need to do is get your blood pressure down and lose the excess pounds.

Remind me again about cholesterol. Which one is bad and is the other one really good?

You need to know your total cholesterol. Based on that, you can measure your HDL, or good cholesterol. You subtract your HDL from your total cholesterol and that gives you your LDL, or bad cholesterol. It's also good to know your triglycerides. If that number is over 400, you have to make a correction in the HDL/LDL math calculation. The (good) HDL takes the small (bad) LDL particles and acts like a truck. The HDL carries the LDL to the liver where it gets metabolized and excreted. LDL is what causes blockages in the heart. The body has to do something with the LDL and if it isn't getting to the liver fast enough, it gets deposited in the walls of the arteries. The arteries in your heart are so small they get blocked much easier than other arteries that are much larger. So you may have blockages other places in your body, but you will notice the ones in your heart first because they are so small, it only takes a tiny amount.

What are the best exercises I need to be doing for my heart?

I tell people to do what they enjoy. Start with 20 to 30 minutes a day 3 days a week. My rule of thumb is that the exercise you are doing needs to make you break a sweat. Once you can get going, you can augment your activity level from there. I don't give people hard and fast guidelines. If you want to work with a trainer, that's great, but if you like to bike, walk, swim - do it. You want to shoot for a sustained increase in your heart rate. If you have been sedentary and want to start exercising, I'd say get a stress test first just to make sure it's safe. When you are ready, get out and break a sweat. 

I know that heart disease is the No. 1 killer of women. What should I be doing to make sure I'm not part of that statistic?

Reduce the traditional risk factors. Stop smoking. Lose weight. Get your blood pressure under control. If you are diabetic, manage your diabetes. Heart disease can present differently in women. The textbooks were written based on the symptoms and presentation of middle age white men. How they presented was documented and taught. Women can present differently sometimes. The most common presenting symptom in women is shortness of breath, whereas in men, it tends to be chest tightening.

I was just diagnosed with type 2 diabetes. I was told that it increases my risk of cardiovascular disease. What is the relationship between the two?

Diabetics have high sugar, which goes along with high cholesterol and promotes high blood pressure. The higher sugar levels in the blood promote deposition of cholesterol and fat in the walls of the arteries. That's why it's imp to get these things under control. Cholesterol is deposited in arteries throughout the body, not just your heart. A lot of type 2 diabetes is related to obesity. If you can lose the weight, many times we are able to reduce medications and sometimes stop them completely.

Do energy drinks have any damaging effects on the heart?

Most energy drinks have a lot of sugars and caffeine in them. Those things alone don't damage the heart, but if you have a pre-disposition to an abnormal heart rhythm, like atrial fibrillation, high caffeine levels can provoke that. I will tell patients with a history of abnormal heart rhythms to avoid excess caffeine. One cup of coffee will have no effect on someone like me and give someone else the shakes, so it's hard to say how much is too much. On average, one to two cups of coffee is OK unless you have a pre-disposition to sensitivity to caffeine. If you know you have abnormal heart rhythms, stay away from caffeine as much as possible.

Is atrial fibrillation life-threatening?

Atrial fibrillation is not a life-threatening disease. It won't cause you to drop dead. It will cause your heart to race and make you feel out of breath. It might make you feel dizzy or cause discomfort in your chest. Over time, you have the risk of stroke. When you have atrial fibrillation, the top part of the heart isn't contracting properly and anytime you have stasis of blood, it causes clotting. When your heart is out of rhythm, if a clot forms, when your heart gets back into rhythm, the clot can eject from the heart and go to the brain and cause a stroke. If you think you have atrial fibrillation, it's important to be seen. It can be managed. It can require medications and follow-up, but you can live a normal life with it.

Are heart conditions hereditary?

That's a complex question. Yes and no. It depends on what kind of condition you are talking about. As far as blockages in the heart, there is a genetic component to that. But when you compare it to other risk factors, the genetic part is really small, but it's there. By virtue of your genes you can make too much cholesterol. There is another condition of the heart that causes an abnormal thickening of the heart muscle called hypertrophic cardiomyopathy. This is genetic and can be fatal, especially in younger patients. You may remember Hank Gathers, the college basketball player who collapsed and died on the court - on national television in 1990 when he played for Loyola Marymount University. This is what caused his sudden death. It is hereditary, so if you have it, all your first degree relatives need to be screened for it.  It's easy to diagnose with an ultrasound.