Detect It Early, Hit It Hard
Sometimes life isn't fair, and if you're a guy, heart disease is one of those times. Sorry, but just being male automatically makes your risk of developing and dying from heart disease higher than it is for women--a lot higher. And the stakes are big. In 2002 heart disease caused more than 1 in every 4 deaths of American men, snuffing out nearly 341,000 lives. Usually the first symptom is a heart attack.
But new ways to detect risk early are being developed, along with new risk factors to look for. To begin, those whose high risk is known are treated as if they already have heart disease, so, to change that fate, doctors are hammering hard at those risk factors that can be modified. "As we get better at assessing risk, we take the highest-risk people and we really treat them aggressively," says Daniel Rader, a cardiologist at the University of Pennsylvania School of Medicine.
Beyond identifying high-risk patients, there is more emphasis on catching those at intermediate risk, who have a 10 to 20 percent chance of developing heart disease within the next decade. In the past, such people were generally told to wait and see if things got worse. That's now considered russian roulette.
An initial evaluation for heart disease is surprisingly simple, no more than providing a medical history, giving a little blood, and submitting to a quick physical. That's because the major flags are well known: high blood pressure; elevated levels of LDL, the bad cholesterol; smoking; diabetes; a family history of heart problems; and, as noted depressingly, simply being a man.
New flags. It's no longer enough, for one thing, to keep track of your total cholesterol (which should be below 200 milligrams per deciliter). "Every man, regardless of age, should know not only his total cholesterol but his LDL and HDL cholesterol level as well," says Rader. (HDL is the good cholesterol, which reduces risk.) Moreover, any man at intermediate risk or higher needs to have his cholesterol checked regularly.
The notion of what levels to shoot for has also changed over the years. The current thinking is that a man with a couple of major risk factors--say a smoker in his 50s--should strive for an LDL level below 100 mg/dL. Every point cut from the LDL number means a 1-point drop in heart disease risk. A man's HDL should be no less than 40 mg/dL.
How do you achieve these numbers? Expect your doctor to plead with you or lecture you to improve your diet (more produce and fiber, less saturated fat) and exercise regularly. Even if lifestyle changes can't lower your LDL and raise your HDL to ideal levels, stick with it. "If a person only makes small changes, that might mean that you need to take less medication," says Mary Frank, a family physician in Rohnert Park, Calif.
These days medication is virtually synonymous with statins, a class of drugs that can slash LDL levels by more than half and also bump up HDL a bit. Lipitor, one of the most potent statins available, is the top-selling drug in the nation.
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