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February is American Heart Month, and UAB News helps break down everything you need to know about heart health. From the importance of knowing your family history of heart disease, to how you should eat and live to keep your ticker in tune, News You Can Use has the answers. Plus, heart health shouldn’t be ignored until adulthood; we’ll offer keen advice and tips on how to teach kids to be and stay heart healthy. Heart disease is the leading cause of death for both women and men in the United States, and UAB experts from across the board, including the current president of the American Heart Association, want to help keep you heart smart.
Men and Women's Heart Health
Adults are not the only ones who should focus on good heart health. One University of Alabama at Birmingham (UAB) primary care physician said starting heart-healthy habits at a young age can help build a future free from cardiovascular disease.
 Heart disease is the leading cause of death in the United States, according to the Centers for Disease Control and Prevention.
“The process of atherosclerosis, which is the hardening of the arteries and is known to cause heart attacks, strokes and sudden death, has been shown to begin in early childhood,” said Zachary Stone, M.D. “It’s important to concentrate on healthy lifestyles in children to prevent adult cardiovascular disease.”
Stone outlined three areas to watch in children: diet, activity levels and smoke exposure.
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Sherron Simmons lived her life as the picture of good health: she exercised regularly, ate healthy and did not smoke. That is why it was a shock for her to learn in 2007 that the main left artery to her heart was 90 percent blocked.
“I knew heart disease ran in my family, but I thought my chances of getting heart disease were very slim; especially since I was never overweight and knew I was doing things to prevent it,” Simmons explained.
University of Alabama at Birmingham (UAB) Department of Epidemiology Professor and Chair Donna Arnett, Ph.D., says family history is one of the strongest predictors of heart disease.
“If you look at how heart disease occurs, about 80 percent takes place in people with a strong family history,” said Arnett, who is serving as the president of the American Heart Association (AHA).
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Despite treatment advances for coronary heart disease over the past 20 years, black men and women still have twice the risk of fatal coronary heart disease compared with white men and women, according to a study from the University of Alabama at Birmingham appearing in the Nov. 7, 2012 issue of the Journal of the American Medical Association.
Most of this disparity may be due to greater risk factor burden among blacks — including smoking, diabetes and hypertension — suggesting that it could be eliminated with better risk factor control, the researchers say. The study is being released early online to coincide with the American Heart Association Scientific Sessions being held in Los Angeles from Nov. 3-7.
Coronary heart disease rates in the United States have steadily declined since the 1970s for all racial groups. But UAB researchers analyzing death certificate information and other data from four U.S. cities found a steeper decline between 2000 and 2008 in acute coronary heart disease deaths for whites than for blacks, actually widening the longstanding disparity. Data from Kaiser Permanente suggests that hospitalizations for heart attacks between 2002 and 2007 declined greatly, but more so for whites than for blacks.
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If you ask women to name the No. 1 cause of death, most will say cancer. But University of Alabama at Birmingham (UAB) experts say more women die from heart disease than all forms of cancer combined, and many of these deaths are preventable.
“One of every three women will die of heart disease,” says Donna Arnett, Ph.D., chair of the Department of Epidemiology in the UAB School of Public Health. Arnett, who is president of the American Heart Association, says one in eight women get breast cancer and as many as 94 percent survive, yet women are more afraid of cancer than heart disease.
“I think with all the media coverage of breast cancer, women are unaware that heart disease actually kills more women, young and old,” Arnett says.
“For some reason women still don’t perceive themselves to be at risk for heart disease,” says Vera Bittner, M.D., professor of medicine in UAB’s Division of Cardiovascular Disease and section head of Preventive Cardiology.
“Women see it as a men’s disease, and they are more likely to interpret chest discomfort as coming from indigestion instead of a heart attack,” says Bittner.
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The healthy heart movement in recent years has focused largely on heart disease as the No. 1 killer of women. But the same statistic is true for men, and the reality is grim: The first sign that a man has coronary heart disease could be death, says one University of Alabama at Birmingham expert.
 Coronary heart disease is caused by a buildup of plaque in the arteries to your heart, affecting the flow of blood and oxygen to your ticker. More than half of the deaths due to heart disease in 2008 were in men, and coronary heart disease is the most common type of heart disease, according to the Centers for Disease Control and Prevention.
“Half of the men who die suddenly of coronary heart disease have no previous symptoms,” says Alan Gertler, M.D., associate professor of medicine in UAB’s Division of Cardiovascular Diseases and part of UAB’s Heart & Vascular Services. “The first manifestation of a heart problem oftentimes is sudden death.”
So where do the men’s heart problems start? Gertler says it can date very early in life.
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Heart disease, cancer and stroke are the leading causes of death in women of all ages in the United States, according to the Centers for Disease Control and Prevention. To get ahead of these chronic health issues and possibly prevent them from worsening, experts at the University of Alabama at Birmingham urge women to get tested for key measures throughout their lives.
 In addition to going in for regular medical check-ups, the U.S. Preventive Services Task Force also encourages women to follow their screening guidelines. These guidelines recommend that women begin being screened for blood pressure, cervical cancer, cholesterol, diabetes and sexually transmitted diseases starting around age 20, or as otherwise advised by their doctors. Breast cancer and colorectal cancer screenings are suggested starting around age 50 and a bone mineral density test around 65 years of age.
“Screening tests are a prescription for prevention and for empowerment, giving women the opportunity to be in charge of their health,” explains Stephen Russell, M.D., UAB assistant professor of internal medicine.
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Science of Heart Health
After two heart attacks and 10 stents, Rick Vinson had a decision to make — do nothing and likely die from heart disease like his father or take a chance at having a long life.
Vinson chose the latter. After receiving his last stent in October 2010, he entered a cardiac rehab program at the University of Alabama at Birmingham. Since then he has dropped 20 pounds, his cholesterol has dropped to 141 from 315 and his triglycerides are down to 149 from 465.
Unfortunately, many heart patients never get the chance reap the benefits of cardiac rehab.
“Research has shown fewer than 20 percent of patients eligible for cardiac rehab are actually referred to a program,” says Vera Bittner, M.D., section head, Preventive Cardiology, medical director of the UAB cardiac rehab program and co-author of a January 2012 scientific advisory for the American Heart Association on increasing referral and participation rates in cardiac rehab. “A recent analysis from the Medicare database estimated that there is a 35 percent reduction in mortality among people who attended cardiac rehab compared to those who did not. And other research studies have shown a 15 to 25 percent reduction in the number of recurrent heart attacks in people who have been to cardiac rehab. These definitely are not negligible health benefits.”
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Older adults who have low diastolic blood pressure are at increased risk for developing new-onset heart failure, according to new research from the University of Alabama at Birmingham published today in Hypertension, a journal of the American Heart Association.
 Diastolic blood pressure measures the pressure in your blood vessels between heartbeats, when your heart is resting. It is represented by the bottom number in a blood pressure reading. Systolic blood pressure measures the amount of pressure that blood exerts on vessels while the heart is beating. It is represented by the top number in a blood pressure reading.
The study coined and defined the term “isolated diastolic hypotension,” which occurs when the diastolic blood pressure is low (less than 60 mm Hg) and the systolic blood pressure is not low (above 100 mm Hg). This is similar to a condition called isolated systolic hypertension, when the systolic blood pressure alone is elevated (above 140 mm Hg) but the diastolic blood pressure is not elevated (less than 90 mm Hg). This condition is common in older adults and also is a risk factor for heart failure.
“Our findings showed that older adults who have low diastolic blood pressure but not low systolic blood pressure were more likely to develop new-onset heart failure than those with higher levels of diastolic blood pressure,” said Ali Ahmed, M.D., professor of medicine in the Division of Gerontology, Geriatrics and Palliative Care, director of the UAB geriatric heart-failure clinic and the study’s senior investigator. “Older adults with low diastolic blood pressure also had higher risk of death.”
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Living Heart Smart
Dining out can negatively impact waistlines and heart health, but a University of Alabama at Birmingham (UAB) expert offers simple steps to help.
 According to a LivingSocial Dining Out Survey, Americans eat out, on average, four to five times each week. This can present health issues, because what people choose to eat when they dine out tends to have more calories, fat and saturated fat than the meals they would have prepared at home.
According to the U.S. Department of Agriculture, each meal or snack eaten away from home adds an average of 134 calories that day, compared with the same meals or snacks prepared at home; one additional meal away from home each week can translate to roughly two extra pounds in a year. And, the Centers for Disease Control and Prevention (CDC) has linked obesity to people eating meals in restaurants where portions are large.
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Cutting back on sodium and increasing physical activity are not the only ways to improve heart health – a good night’s sleep can also help promote cardiovascular health. One expert at the University of Alabama at Birmingham (UAB) says not getting enough sleep can have harmful heart-health effects.
 The ideal amount of sleep is between six to eight hours, said cardiologist Alan S. Gertler, M.D., associate professor of medicine in UAB’s Division of Cardiovascular Diseases and part of UAB’s Heart & Vascular Services.
“Deep, high-quality sleep is needed to lower heart rate and blood pressure, which reduce stress on the heart,” Gertler explained.
Heart rate and blood pressure also rise and fall during rapid eye movement (REM) in response to dreams. According to the National Institutes of Health, those variable rates also contribute to making the heart healthier.
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Most people associate fiber with good digestive health – but it also has a significant impact on heart health.
 Dietary fiber, found in fruits, vegetables, whole grains and beans, “has been shown in research to help lower cholesterol,” said Jody Gilchrist, nurse practitioner at the UAB Heart & Vascular Clinic at Acton Road.
Dietary fiber is a carbohydrate that comes from plants and is classified as soluble or insoluble. Insoluble fiber adds bulk to the diet, helps prevent constipation and is the fiber most responsible for keeping your digestive tract healthy. Soluble fiber acts like a sponge, Gilchrist said. It makes you feel full quickly, which helps control how much you eat, and therefore weigh. An added benefit of soluble fiber is that research has shown it can help lower LDL or “bad cholesterol” by interfering with how the body absorbs cholesterol from foods.
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 High-fat, low-carb foods are a popular choice for dieters, but new laboratory research by University of Alabama at Birmingham cardiologists indicates these may be detrimental to the health of people who have ischemic cardiovascular disease or a predisposition to heart attacks.
UAB cardiologist Steven Lloyd, M.D., Ph.D., will present the animal-model studies in four moderated poster sessions during the 2012 American College of Cardiology Scientific Sessions Sunday, March 25, 2012, in Chicago.
“Obesity and heart disease are major public health issues and are the leading causes of other disease — including diabetes, stroke and death,” Lloyd says. “Many overweight people turn to a high-fat, low-carb diet because of its effectiveness; but research has yet to adequately assess safety, and there is insufficient evidence to recommend them for people seeking to lose weight.”
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Food is your friend and your biggest foe. A healthy diet sustains us, but a poor diet can raise blood pressure, cholesterol, blood sugar levels and weight and put you at risk for heart disease.
 “Diet is just one component of the overall cause of heart disease,” says Donna Arnett, Ph.D., chair of the Department of Epidemiology in the University of Alabama at Birmingham School of Public Health and president-elect of the American Heart Association. But, Arnett says, it can exert a strong influence.
Heart disease is the most common cause of death for both men and women in the United States, according to the Center for Disease Control and Prevention. Diets high in saturated fats and cholesterol can lead to atherosclerosis, or a hardening of the arteries caused by build-up of plaque.
Sodium also is considered the culprit for the one in three Americans who develops high blood pressure. Sodium attracts water into your cells; the increased fluid raises your blood pressure and subsequently raises your risk of stroke and heart attack, heart failure and death, Arnett says.
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Gardening or just lounging on the deck on hot and humid summer days can be tough to get through but when you like to spend time outdoors exercising or playing sports, it can be especially rough on your body. University of Alabama at Birmingham cardiologist Alan S. Gertler, M.D., has some stay-cool, heart-healthy tips to help you avoid heat-related illnesses and continue to do the outdoor physical activities you love.
 What’s happening to your body
“Physiologically, the heat of summer increases stress on the heart, particularly during exercise. Exercise and the air temperature increase core body temperature, and high humidity further complicates the situation because sweat doesn't easily evaporate from your skin. Your body responds by diverting more blood to the skin to cool itself, which results in less blood flow to the muscles and consequently an increase in heart rate.
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