From the office of Robert S. Grimshaw Jr MD FACP Internal Medicine 3535 Hill Blvd Yorktown Hts NY 914 962-3180 Healthy Heart Guide

2001 Page 2

Preventing Heart Attacks and Strokes:

Diet:
A “Healthy Heart” diet should approach the diet eaten in the Greek islands.  This Mediterranean diet was used in the “Lyon” study and cut the rate of heart attack and other cardiac events by 76% in a 27 month period in a group of patients with known heart disease.  
In simple terms, the diet means:

<    twice the seafood

<    66% more fresh veggies

<    10% more fruit

<    2-4 times the whole grains and beans

<    4 times the olive oil

<    45% less red meat

<    16% less eggs

<    50% less whole milk and dairy products

<    50% less non-olive oils

Sadly, the top 6 sources of calories in the usual American diet are: Whole milk, cola, margarine, white bread, rolls (ready to eat) and sugar.

Exercise:
Vigorous physical activity can markedly decrease the risk of heart attack.  According to Dr. Robert Vogel, Chairman of Cardiology at the University of Maryland, 30 minutes at 75% of your maximum heart rate 1-2 times per week lowers your risk 80%.  Doing it 5 or more times a week lowers your risk 50-fold!
And in the Northern Manhattan Stroke Study, a walk a day reduced the risk of stroke by 62%.

Vitamins:
Homocysteine can lead to athero-sclerosis, and can be brought down by folic acid, B-6 and B-12.
It is estimated that 1 mg. folate daily could reduce strokes by 10% and heart attacks by 15% in the U.S.  Vitamin A in veggies is good, but beta-carotene in pills has lead to an increased risk of lung cancer in  current and former smokers.
Vitamin E 400U daily was shown to reduce the risk of 2nd heart attack 77% in the Cambridge CHAOS study; the effect was not seen, however, in two other trials.  In a small study, Dr. Vogel’s group has shown vitamin E plus 1000 mg vitamin C block the paralyzing effect that fatty meals have on arteries.



Medicines:
We now have proof that “statin” drugs (such as generic lovastatin, Baycol, Lescol, Lipitor, Mevacor, Pravachol, and Zocor) can decrease the risk of heart attack and stroke in men and women, even if they’ve never had symptoms.
There are exciting possibilities that these drugs attack the cause of most heart attacks -- the oxidized LDL causing a ruptured arterial plaque.  Pravachol also seems to lower platelet counts and stabilizes fibrinogen, elements involved in plaque  rupture.
Niacin (Niaspan, etc) is very useful in those with dangerous LDL pattern B or elevated Lp(a) (risk factors we can check on with Berkeley HeartLab).
Estrogen and similar drugs such as raloxifene (Evista) may help.
Several trials are under way studying if medications may be more effective than angioplasty or even bypass surgery — and early indications are that they are!

And Again, Aspirin:
Still one of the most effective drugs ever, 325 mg. of aspirin prevented 39% of heart attacks in a study of 22,000 U.S. physicians.  And there is evidence 81 mg. should be enough.  It’s also useful for preventing second heart attacks (32%) as well as strokes (27%) and total blood vessel disease related death (25%).