And while heart lessons may be more complicated than simply connecting the physiological dots, understanding those heart messages are imperative for improving and maintaining your heart health.

Every cell in your body relies on heart-powered blood flow to keep it supplied with nutrients, oxygen, hormones and other natural chemicals necessary for survival. Without that supply of life-giving substances, few cells in the body-including those within the heart itself-can survive very long.

And just as damage to a major roadway can cause mayhem with traffic patterns, damage to blood vessels and the heart can wreak a lumpy cardiovascular havoc that blocks the passage of blood and endangers your heart's well-being.

Your Heart Disease Chances

Within the last ten years, scientific research performed by investigators around the world has focused on the specific factors that most strongly influence your chances of developing heart disease and suffering either a heart attack or a stroke.

While much of your risk depends on your genetic inheritance and family history, several factors that determine your heart health are within your control.

The most important factors you can do something about include:

* Smoking: free radicals generated by burning tobacco causes significant damage to blood vessels and other cells

* Lack of exercise: the human body is designed for consistent, moderate physical activity; without exercise, the body slacks off in creating antioxidant protection for arteries

* Diabetes: when excess blood sugar persists, physiological processes begin that endanger the heart and arteries

* Cholesterol: when oxidized (a chemical process that has been compared to a kind of internal rusting), cholesterol can form artery-blocking plaque; antioxidant nutrients like vitamin C and natural vitamin E may help the body limit this process

* High blood pressure: excessive pressure within the blood vessels raises the risk of damage to the heart and arteries; a program of weight loss and exercise can help control blood pressure

* Being overweight: the extra body fat carried around your middle is linked to a greater risk of heart problems

Heart Attack Signs

Do you think you know what a heart attack feels like? Well, if you think it feels like a dramatic pain somewhere in your chest that knocks you to the floor, you're probably wrong. "Most heart attacks do not look at all like what one of my colleagues calls the 'Hollywood' attack-the heart attack you see on television or in the movies," warns Julie Zerwic, MD, professor of surgical nursing who has studied what happens when people develop heart disease and suffer damage to their hearts.

"The symptoms [of heart problems] are not necessarily dramatic. People don't fall down on the floor. They don't always experience a knife-like, very sharp pain. In fact, many people describe the sensation as heaviness and tightness in the chest rather than pain," she says. And, if you're a woman experiencing a heart attack, you may not even feel discomfort specifically in your chest. Instead you may experience a severe shortness of breath. The apparent ambiguity of the discomforts caused by a heart attack lead many people to either ignore them or take hours to realize they need to go to the emergency room at the hospital.

Consequently, much fewer than half of all individuals undergoing a heart attack actually go to a hospital within an hour of the start of the attack. That delay can be a fatal mistake.

"Timing is absolutely critical," laments Dr. Zerwic. "If treatment starts within a hour after the onset of symptoms, drugs that reestablish blood flow through the blocked coronary artery can reduce mortality by as much as 50%. That number drops to 23% if treatment begins three hours later. The goal is to introduce therapy within two hours."

However, in Dr. Zerwic's research, only 35% of non-Hispanic whites go to the hospital within an hour of the start of a heart attack. And among African-Americans, the number of people going to the hospital right away drops to a frighteningly low 13%.

Often, people will lie down or use a heating pad to relieve the tightness they feel in the chest," says Dr. Zerwic. "They may take some medicine and wait to see if that works. All these steps postpone needed treatment."

Signs of a possible heart attack include:

* Chest discomfort: Heart attacks most frequently cause discomfort in the center of the chest that can either go away after a couple of minutes (and come back) or persist. The discomfort may feel like strong pressure, fullness or pain.

* Upper body discomfort: An attack may set off pain or discomfort in either or both arms, and/or the back, neck, jaw or stomach.

* Shortness of breath: Chest discomfort is frequently accompanied by shortness of breath. But it's important to note that shortness of breath can take place even in the absence of chest discomfort.

* Other signs: You can also break out in a cold sweat, or feel nauseated or light-headed.

A Woman's Sleep Signs

If you are a woman who suddenly experiences a marked increase in insomnia and puzzling, intense fatigue, you may be in danger of an imminent heart attack.

In an attempt to understand how women's symptoms of heart problems differ from those of men, researchers talked to more than 500 women in Arkansas, North Carolina and Ohio who had suffered heart attacks. (Technically, what they had experienced is referred to as acute myocardial infarction.)

They found that chest pain prior to a heart attack was only reported by about 30% of the women surveyed.

More common were unusual fatigue, sleep disturbances and shortness of breath (Circulation Rapid Access, 11/3/01).

"Since women reported experiencing early warning signs more than a month prior to the heart attack, this [fatigue and sleep problems] could allow time to treat these symptoms and to possibly delay or prevent the heart attack," says researcher Jean C. McSweeney, PhD, RN, nursing professor at the University of Arkansas for Medical Sciences in Little Rock. In Dr. McSweeney's study, more than nine out of ten women who had heart attacks reported that they had had new, disturbing physical problems more than a month before they had infarctions.

Almost three in four suffered from unusual fatigue, about half had sleep disturbances, while two in five found themselves short of breath.

Other common signs included indigestion and anxiety.

"Women need to be educated that the appearance of new symptoms may be associated with heart disease and that they need to seek medical care to determine the cause of the symptoms, especially if they have known cardiovascular risks such as smoking, high blood pressure, high cholesterol, diabetes, overweight or a family history of heart diseases," says Dr. McSweeney.

Dr. McSweeney warns that, until now, little has been known about signs that women are having heart trouble or heart attacks. The fact that most of Western medicine's past attention has been on heart problems in men has obscured the warning signs in women. As part of Dr. McSweeney's studies, she and her fellow researchers have discovered that more than 40% of all women who suffer a heart attack never feel any chest discomfort before or during the attack.

"Lack of significant chest pain may be a major reason why women have more unrecognized heart attacks than men or are mistakenly diagnosed and discharged from emergency departments," she notes. "Many clinicians still consider chest pain as the primary symptom of a heart attack."

Vitamins for Diabetes and Heart Disease

Having diabetes significantly raises your chance of heart disease, which means that keeping your blood sugar levels under control can reduce your chances of suffering a heart attack.

Today, 17 million Americans have diabetes and, as the country's population in general gains weight and fails to exercise, the number of people suffering this problem continues to grow.

The first line of defense against diabetes consists of exercise and weight control. All you have to do is take a brisk walk for 30 minutes a day to drop your chances of diabetes (American Journal of Epidemiology 10/1/03).

"We have found that men and women who incorporate activity into their lifestyles are less likely to develop type 2 diabetes than those who are sedentary. This finding holds no matter what their initial weight," said Andrea Kriska, PhD, professor of epidemiology at University of Pittsburgh Graduate School of Public Health.

To help your body fight the development of diabetes, researchers also recommend vitamin C and natural vitamin E.

Researchers working with lab animals at the University of California at Irvine have found that these antioxidant vitamins can help insulin (the hormone-like substance secreted by the pancreas) reduce harmful blood sugar. In addition, these vitamins shrink the chances of organ damage that can be caused by diabetes (Kidney International 1/03).

In this investigation, these vitamins also helped reduce blood pressure, another risk factor that raises heart disease risk.

"Blood pressure was lowered to normal, and free radicals were not in sufficient numbers to degrade the sugars, proteins and nitric oxide," notes Nick Vaziri, MD, professor of medicine at the University of California. "We think this shows that a diet rich in antioxidants may help diabetics prevent the devastating cardiovascular, kidney, neurological and other damage that are common complications of diabetes."

Free Radical Blues

Dr. Vaziri and his group of researchers found that untreated diabetes raised blood pressure and increased the production of free radicals, caustic molecules that can damage arteries and the heart. Free radicals can change blood sugar and other proteins into harmful substances, boosting tissue and heart destruction.

In Dr. Vaziri's work with lab animals, he found that treating diabetes with insulin lowered blood pressure and helped keep sugar and protein from changing into dangerous chemicals, but allowed the free radicals to subvert nitric oxide, a chemical the body uses to protect itself from free radicals.

In this investigation, adding vitamins C and E to insulin insulated the body's sugars, proteins and nitric oxide from oxidative assault. This produces a double advantage: Lowering the risk of heart disease and other damage to the body from diabetes.

Maitake, an Oriental mushroom that has been shown to have many health benefits, can also be useful for people with diabetes who are trying to avoid cardiovascular complications. Laboratory studies in Japan demonstrate that maitake may help lower blood pressure while reducing cholesterol (Biological & Pharmaceutical Bulletin 1997; 20(7):781-5). In producing these effects, the mushroom may also help the body reduce blood sugar levels and decrease the risk of tissue damage.

No Smoking!

Tobacco smoke is one of the most notorious causes of heart problems. In the same way a hard frost exerts a death grip on a highway, the smoke from cigarettes can freeze up arteries and hamper their proper function. A healthy artery must stay flexible to comfortably allow adequate circulation.

But "...when blood vessels are exposed to cigarette smoke it causes the vessels to behave like a rigid pipe rather than a flexible tube, thus the vessels can't dilate in response to increased blood flow," says David J. Bouchier-Hayes, MD, professor of surgery at the Royal College of Surgeons in Ireland, who has studied the deleterious effects of tobacco.

This rigidity is called endothelial dysfunction. When arteries are rigid, blockages gum up vessels, clots and other impediments to blood flow appear, and your risk of heart attack and stroke increases (Circulation 2001 Nov 27; 104(22):2673).

This condition can also cause chest pain (angina) similar to that caused by a heart attack, and should be evaluated by a knowledgeable health practitioner.

Although all experts recommend you stop smoking to lower your heart disease risk, some studies have found that Pycnogenol(r), a pine bark extract that helps the body fight inflammation, may ease some of smoking's ill effects.

In a study of platelets, special cells in the blood that can form dangerous blood clots, researchers found that Pycnogenol(r) discouraged platelets from sticking together (American Society for Biochemical and Molecular Biology 5/19/98). By keeping platelets flowing freely, this supplement may alleviate some of the heart-threatening clots that tobacco smoke can cause.

In Ayurvedic medicine, a traditional therapy from India, an herb called guggul has also been used to lower the risk of blockages in arteries. This herb, derived from the resin of the mukul tree, has been shown to reduce cholesterol by about 25%. People taking this herb have also reduced their triglycerides (harmful blood fats) by the same amount (Journal Postgraduate Medicine 1991 37(3):132).

The Female Version of Heart Disease

Medical experts who have examined heart disease in men and women have found some striking differences.

For one thing, women often don't suffer from the crushing chest pain that for most people characterizes a heart attack; instead, many women experience back pain, sweating, extreme fatigue, lightheadedness, anxiety or indigestion, signs that can be easily misread as digestive troubles, menopausal symptoms or indicators of aging.

The genders also differ in how heart disease poses a threat. While men seem most endangered by the buildup of blockages in arteries, women apparently are more at risk from endothelial dysfunction. But more study needs to be done since, in many cases, researchers have been unable to pin down the precise mechanism that causes many women to die of heart disease.

Scientists have found that the number of women in their 30s and 40s who are dying from sudden cardiac arrest is growing much faster than the number of men of the same age who die of this cause. But research by the Oregon Health & Sciences University and Jesse E. Edwards Cardiovascular Registry in St. Paul, Minnesota, shows that while doctors can pinpoint the coronary blockages that kill men, they can't find specific blockages in half of the female fatalities they have studied (American Heart Journal 10/03).

"This was an unexpected finding. However, the study underscores the need to focus on what is causing these younger women to die unexpectedly because the number of deaths continues to increase," says Sumeet Chugh, MD, a medical professor at Oregon.

Since the failure of arteries to relax probably contributes to heart disease in many women, eating red berries, or consuming supplements from berries such as chokeberry, bilberry or elderberry, may be important in lowering women's heart disease risk. These fruits help arteries expand and allow blood to flow freely.

Red berries are rich sources of flavonoids, polyphenols and anthocynanins. The anthocyanins are strong antioxidants that give the berries their color. Research at the Indiana University School of Medicine have found that these chemicals can interact with nitrous oxide, a chemical produced by the body, to relax blood vessels (Experimental Biology conference 5/20/02).

Working Out

As researchers work to devise lifestyle roadmaps that can steer you around the perils of heart disease, they are finding that exercise is a key path to avoiding cardiovascular complications.

A 17-year study of about 10,000 Americans found that those who exercised and kept their weight down (or took weight off and kept it off) experienced a significantly lower risk of heart problems (Preventive Medicine 11/03).

"The fact is that those who both exercised more and ate more nevertheless had low cardiovascular mortality," says Jing Fang, MD, of the Albert Einstein College of Medicine in the Bronx, New York. Burning calories in physical activity may be the secret to reducing heart disease risk and living longer, she says.

Dr. Fang's research used information collected from the First National Health and Nutrition Examination Survey in 1975 and then computed how much people exercised, how their body mass indices varied and which of these folks died of heart disease during the next two decades.

In the study, more than 1,500 people died of heart disease. Those who worked out and consumed more calories cut their risk of heart disease death in half.

Exercise Is Essential

"Subjects with the lowest caloric intake, least physical activity, and who were overweight or obese had significantly higher cardiovascular mortality rates than those with high caloric intake, most physical activity, and normal weight," Dr. Fang notes. The individuals in the study who were overweight and didn't exercise had a bigger risk of heart disease even if they tried (and succeeded) at eating less.

"This suggests that heart disease outcome was not determined by a single factor, but rather by a compound of behavioral, socioeconomic, genetic and clinical characteristics," according to Dr. Fang.

According to researchers, if your job requires a great deal of physical activity, your health will be better if you get another job. Exercise on the job not only doesn't decrease your risk of heart disease, it may actually raise it. The reason: On-the-job activity is linked to heart-endangering increases in job stress.

Research into this subject, performed at the Keck School of Medicine of the University of Southern California, found that while recreational exercise slowed hardening of the arteries, workers who had to exert themselves during the workday had arteries that were blocked at a younger age (American Journal of Medicine 7/03).

In this study, researchers examined about 500 middle-aged employees as part of what is called the Los Angeles Atherosclerosis Study.

"We found that atherosclerosis progressed significantly faster in people with greater stress, and people who were under more stress also were the ones who exercised more in their jobs," says James Dwyer, PhD, professor of preventive medicine at the Keck School. According to Dr. Dwyer, "This suggests that the apparent harmful effect of physical activity at work on atherosclerosis-and heart disease risk-may be due to the tendency of high-activity jobs to be more stressful in modern workplaces.

"It appears from our findings that the psychological stresses associated with physically active jobs overcomes any biological benefit of the activity itself."

Playful Workouts

On the other hand, the scientists found that heart disease drops dramatically among those who exercise the most in their spare time. In the study, people who vigorously worked out at least three times a week had the lowest risk. But even those who just took walks enjoyed better heart health than people whose most strenuous activity was working the TV remote. Dr. Dwyer says, "These results are important because they demonstrate the very substantial and almost immediate-within one or two years-cardiovascular benefit of greater physical activity."

Lowering your risk of heart disease is substantially up to you. Listen to what your heart tells you it needs; then, exercise your right to fetch some cardiovascular necessities.