At the Heart of the Matter

Yale Cardiologist Writes Book on How to Avoid Heart Disease

By Abram Katz

Today's mega-bookstores have certain hyper-shelves, including aisles devoted to heart disease. Herbal remedies, exercise plans, alternative approaches and diet after diet. Nestled among these volumes of varying value is a modest paperback whose author hopes will give readers straight information.

Dr. Harlan M. Krumholz, professor of cardiology at the Yale School of Medicine, said he wanted to supply readers with unvarnished up-to-date medical knowledge.

"The Expert Guide to Beating Heart Disease," published by HarperCollins, is an "anti-hype book," Krumholz said. The book is 262 pages long and costs $14.95.

"I recognized that there was nothing out there that distilled medical knowledge in a way that people could understand," he said. The "Expert Guide" provides seven basic strategies for lowering the risk of heart disease. Krumholz said the book is intended to help patients make informed medical decisions, but it's not the last word. Unfortunately there is no ultimate truth about heart disease because information keeps evolving, he said.

"There's good solid knowledge," however. "The patient and doctor should collaborate. To do that the patient needs to understand the idea of risk versus benefit" of treatments, Krumholz said.

Cardiovascular disease is the leading cause of death among men and women in the United States. The American Heart Association estimates that 61.8 million Americans have cardiovascular diseases, including 50 million with high blood pressure; 12.9 million with coronary heart disease; and 4.9 million with congestive heart failure. Cardiovascular disease costs the country $351.8 billion a year and claims about 946,000 lives.

"The philosophy of the book is, 'Here's the strongest medical evidence and here's where it breaks down,'" Krumholz said. So treatments are rated from "proven benefit" to "unclear effect," "No effect," and "harmful." Krumholz said medical researchers have learned a great deal about how to prevent and treat heart disease.

Much depends on diet, behavior, and conditions that can be treated or modified. Two factors are completely out of your control: age and family history. But there are ways to reduce the influence of circumstances that cannot be modified. Since circulation, respiration, the endocrine system, and many other organs interact, defining heart disease is not always clear, Krumholz said.

"Since 1948 hypertension, high cholesterol, and sedentary lifestyles have been identified as risk factors," he said. Cholesterol-lowering drugs and blood pressure medications are clear advances, but they may leave many people unaware that they have heart disease, Krumholz said.

The risk factors that can be changed include:

· High blood pressure. If it's over 140/90 and/or you've been told, you have it.

· High blood cholesterol. Standards change, but if your total count is 200 or higher, it could be a problem.

· Diabetes. A fasting blood sugar test of 126 or higher is telling.

· Overweight. If your body mass index is 25 or higher, you're at risk.

· Physical inactivity. Less than 30 minutes of exercise a day heightens the risk.

· Smoking. Heart disease is but one of many diseases that tobacco can promote.

The book's control strategies are dictated by the risk factors.

"You should know your blood pressure, what it was, what it is, and what it should be," Krumholz said. "The same with cholesterol." People need to take ownership of their health risks, he said.

"The book is like a travel guide. It can tell you where you are and where you're going," he said.

Strategies against heart disease don't include anything fancy. Krumholz said people need to:

· Control their blood pressure.

· Manage their cholesterol.

· Exercise.

· Control their weight.

· Watch their blood sugars.

· Quit smoking.

· Take the right medications.

The body of the book details how to achieve each of these goals. Some, like losing weight and quitting cigarettes, are known to be difficult. Others are easier. For example, losing even 10 pounds will lower your blood pressure. Drinking too much alcohol can cause high blood pressure and interfere with hypertension medications.

At the same time Krumholz reports that there is insufficient evidence to suggest that eating more fiber, nuts, soy, or garlic constitute good first-line treatments to lower cholesterol. The roles of alcohol, vitamins C and E to control heart disease are still up in the air. The days of deferring to doctor's orders are up, Krumholz said.

"Now it's more like pilot and co-pilot, not doctor-pilot and passenger," he said. Writing an anti-hype book was a challenge, Krumholz said. Hype grows much faster than facts.

"So many times I hear things that are not supported by evidence. It drives me nuts," he said.