Recognizing the Signs:
Roadmap to a Healthy Heart
by Louis McKinley
January 2, 2004
From time immemorial, people have
tuned into life's lessons that come from the heart. Sadly,
times are changing: If you're like most inhabitants of
today's harried world, you may be too distracted to detect
important clues about your cardiovascular circumstances.
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
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
* 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
* Diabetes: when excess blood sugar persists,
physiological processes begin that endanger the heart and
* 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
* 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
"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
* 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
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
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
"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
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.
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
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;
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).
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
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
"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."
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