Healthy Hearts

I’m not going to tell you anything you don’t know,” says Amy Dumont, director of Cardiovascular Services at St. Joseph Hospital in Nashua. The department brings together laboratory services, diabetes care, cardiovascular treatment, wound care and cardiac rehabilitation into one unified program. “We are committed to a prevention model,” Dumont continues. “We know what to do but the message isn’t heard.”

10 Tips for Heart Health

The message is this: See your primary care physician regularly for screening; be physically active; practice good nutrition; stop smoking. These four factors are critical in preventing heart disease, stroke and diabetes. Progress has been made in identifying and treating heart disease, but Dumont says prevention must be the primary goal.

As president of the New Hampshire Heart Association, Dumont sees disturbing trends statewide: a 26 percent increase in childhood obesity in the past decade and a “massive increase” in type 2 diabetes, a preventable disease. “We are exposing children earlier to these risks,” she says. “Soon it may be common for parents to outlive their children.”

Dumont calls the sedentary lifestyle/high fat diet a U.S. epidemic. She recommends a statewide heart health partnership that includes schools, health care facilities, industry and government. If the message of a healthy lifestyle is not heeded, she expects to see, in the not-too-distant future, patients in their 30s with cardiovascular disease, needing valve replacements and other procedures now typical of patients in their 60s.

Though this presents a disturbing picture, treatment of heart disease has improved. People with heart disease are living longer. People over 70, who once would have been “too old” for heart surgery, often do well. New techniques are less invasive and recovery is more likely. Medications, especially the statin drugs, reduce the risk of heart attack for many. “With new technology we will capture disease earlier,” says Dumont. “Bypass surgery and angioplasty will be used less often. In five to 10 years we will be scanning people instead of using cardiac catheterization.”

Dr. Andrew Torkelson underscores that message: “The most critical risk factor for heart disease today,” he says, “is the epidemic of obesity.” Torkelson is a cardiologist at Dartmouth-Hitchcock Medical Center in Lebanon. He supports his statement with statistics. In 1991, 12 percent of the population were obese; in 2000, that figure was 21 percent.

There is an alarming increase in patients with metabolic syndrome, he says, which increases the risk for heart disease, stroke and diabetes. The syndrome is characterized by excess weight around the waist, elevated triglycerides, low HDL /high LDL cholesterol levels, insulin resistance and elevated C-reactive protein in the blood. “Waistline fat is unique,” he says. “ It is loaded with cells that secrete inflammatory proteins. Inflammation leads to the buildup of plaque on artery walls.”

“We understand the process,” he continues, “but the bottom line is too many calories. Our agricultural system produces 3,900 calories per person per day. The average person needs up to 2,500 calories maximum.”

He gives other startling figures. American children and youth derive 20 percent of daily calories from snacks, mostly high-sugar, high-fat crackers, chips and sweets. The average American eats 139 meals a year out, a majority at fast-food restaurants, drinks 56 gallons of soda and ingests 34 teaspoons of sugar a day. There has been a fourfold increase in consumption of French fries and potato chips in the past two decades. We have switched the typical breakfast menu from eggs to bagels and cereal. “We start the day infused with sugar,” he says.

Paradoxically, heart attack rates have declined in the past four years. Torkelson regards this as a lull before the storm. “It is still early,” he says, “but two million teens are diabetic. At age 21, 70 percent of American males show some signs of coronary disease. It’s just a matter of time until we see the results of these recent changes.”

Dartmouth-Hitchcock Medical Center is participating in clinical trials of a new medication, designed to raise the level of HDL, the good cholesterol. Taken in combination with a statin drug, which lowers LDL cholesterol, the medication appears promising. Torkelson wonders, however, if the reaction of patients will be, “I’m on these great medications, so I can eat whatever I want.”

“For most of us, preventing heart disease is a lifestyle issue,” Torkelson says. An individual can achieve a 30 percent decline in risk by walking three miles a day. Diet changes, in combination with smoking cessation, could bring a 40 percent risk reduction. He recalls the national focus on health in the 1960s through the President’s Council on Physical Fitness and asks, “Where is our focus today? We need that kind of national effort.”

Amy Dumont wants organizations across the state to launch a unified heart health campaign. But individuals can make a difference, she suggests. “Speak up about food choices in your local school, promote local exercise programs, talk about these issues.” NH