Heart Disease Prevention - Reducing Your Risk

You can reduce your risk of having a heart attack—even if you already have coronary heart disease (CHD) or have had a previous heart attack. The key is to take steps for prevention and control of your heart disease risk factors.

Six Key Steps for the Prevention of Heart Disease.

Taking these steps will reduce your risk of getting heart disease and having a heart attack:

Use your browser's "back" button to navigate the heart disease prevention menu.

Stop smoking is the top priority in Heart Disease Prevention

Lower high blood pressure

Reduce high blood cholesterol

Aim for a healthy weight

Be physically active each day

Manage diabetes

Smoking Cigarettes - Top Priority in Heart Disease Prevention

Cigarette smoking greatly increases the risk of fatal and nonfatal heart attacks in both men and women. It also increases the risk of a second heart attack among survivors. Women who smoke and use oral contraceptives have an even greater risk than smoking alone. The good news is that quitting smoking greatly reduces the risk of heart attack. One year after quitting, the risk drop to about one-half that of current smokers and gradually returns to normal in persons without heart disease. Even among persons with heart disease, the risk also drops sharply one year after quitting smoking and it continues to decline over time but the risk does not return to normal.

The Virtual Office of the Surgeon General is a Web site of the U.S. Surgeon General. It contains information to help smokers quit. The U.S. Food and Drug Administration has approved five medications to help you stop smoking and lessen the urge to smoke. They are:

• Bupropion SR - available by prescription
  
  
• Nicotine gum - available over-the-counter
  
  
• Nicotine inhaler - available by prescription
  
  
• Nicotine nasal spray - available by prescription
  
  
• Nicotine patch - available by prescription and over-the-counter

All of these medicines will more or less double your chances of quitting and quitting for good. You will find details on this information and more at the Virtual Office of the Surgeon General.

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Lower High Blood Pressure

High blood pressure makes the heart work harder. It increases the risk of developing heart disease, as well as kidney disease and stroke.

Also called hypertension, it usually has no symptoms. Once developed, it typically lasts a lifetime.

Blood pressure is recorded as two numbers–the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes). For example, a measurement would be written as 120/80 mm Hg (millimeters of mercury). Normal blood pressure is less than 130 mm Hg systolic and less than 85 mm Hg diastolic. An optimal blood pressure is less than 120 mm Hg systolic and less than 80 mm Hg diastolic. A consistent blood pressure reading of 140/90 mm Hg or higher is considered high blood pressure. If the systolic and diastolic pressures fall into different categories, the higher category is used to classify blood pressure status.

To help prevent or control high blood pressure, you should: lose excess weight; become physically active; follow a heart healthy eating plan, including foods lower in salt and sodium; limit alcohol intake; and, if you are prescribed a medication, take it as directed. The main types of high blood pressure medications are: diuretics, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin antagonists, calcium channel blockers, alpha blockers, alpha-beta blockers, nervous system inhibitors, and vasodilators. It’s important that you take medication as prescribed and control your blood pressure to below 140/90 mm Hg.

To learn more about high blood pressure:

A Web page on how to lower high blood pressure, which includes information on treatments, such as a healthy eating plan and types of medications.

Publications about high blood pressure.

A special Aim for a Healthy Weight Web page that explains how to assess your risk for developing obesity-related diseases, such as heart disease, and how to lose weight sensibly.

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Reduce High Blood Cholesterol

The level of cholesterol in the bloodstream greatly affects the risk of developing heart disease. The higher the level of blood cholesterol, the greater the risk for heart disease or heart attack.

Why? When there is too much cholesterol (a fat-like substance) in the blood, it builds up in the walls of arteries. Over time, this buildup causes arteries to become narrowed, and blood flow to the heart is slowed or blocked. If the blood supply to a portion of the heart is completely cut off, a heart attack results.

Various factors affect cholesterol levels: diet, weight, physical activity, age and gender, and heredity.

High blood cholesterol itself does not cause symptoms. You may not know your blood cholesterol level is too high. So, it’s important to have your cholesterol measured. Adults age 20 or older should have their cholesterol checked at least once every 5 years. It best to have a blood test called a lipoprotein profile. This test measures total cholesterol, "good" and "bad" cholesterol, as well as triglycerides, another form of fat in the blood.

High cholesterol is treated with lifestyle changes–a heart healthy eating plan, physical activity, and loss of excess weight–and, if those do not lower it enough, medication. Medications include statins, bile acid sequestrants, nicontinic acid, and fibric acids.

To learn more about high cholesterol:

A special web page about cholesterol that explains how to lower high blood cholesterol for those who want to prevent or already have heart disease

Publications about cholesterol.

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Aim for a Healthy Weight

A healthy weight is crucial for a long, healthy life. In 1999, almost 108 million-or 61 percent of-adults in the United States were overweight or obese. Being overweight or obese increases your risk of heart attack. And, it increases your risk of developing high blood cholesterol, high blood pressure, and diabetes-each of which also increases your chance of having a heart attack. If you are overweight, even a small weight loss-just 10 percent of your current weight-will help to lower your risk of developing those diseases.

Two of the measures that assess whether or not a person is overweight are body mass index (BMI) and waist circumference. BMI is a measure of weight relative to height. To check your BMI, choose this online calculator. Waist circumference measures abdominal fat. The risk for developing heart and other diseases increases with a waist measurement of more than 40 inches in men and more than 35 inches in women.

To be at their best, adults need to avoid gaining weight and many need to lose weight. Losing weight and keeping it off depends on a change of lifestyle that combines sensible eating with regular physical activity, not a temporary effort to drop pounds quickly. If you need to lose excess weight, talk with your health care provider about developing an action plan, which includes a hearty-healthy, low-calorie, nutritious eating plan and physical activity.

To learn more about weight control:

A special aim for a healthy weight web page that explains how to assess your risk for developing obesity-related diseases, such as heart disease, and how to lose weight sensibly

Publications about a healthy weight

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Be Physically Active Each Day

Being physically active reduces the risk of heart-related problems, including heart attack. Physical activity can improve cholesterol levels, help control high blood pressure and diabetes, and manage weight. It also increases physical fitness, promotes psychological well-being and self-esteem, and reduces depression and anxiety.

Those who have already had a heart attack also benefit greatly from being physically active. Many hospitals have a cardiac (or heart) rehabilitation program. A health care provider can offer advice about a suitable program.

To protect your heart, you only need to do 30 minutes of a moderate-intensity activity on most and, preferably, all days of the week. If 30 minutes is too much at one time, you can break it up into periods of at least 10 minutes each.

If you have been inactive, you should start slowly to increase your physical activity.

If you have coronary heart disease, check with you health care provider before starting a physical activity program. This is especially important if you are over age 55, have been inactive, or have diabetes or another medical problem. Your health care provider can give you advice on how rigorous the exercise should be.

To learn more about physical activity:

Take this short quiz: Check Your Physical Activity and Heart Disease IQ

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Manage Diabetes

Diabetes mellitus affects more than 16 million Americans. It damages blood vessels, including the coronary arteries of the heart. Up to 75 percent of those with diabetes develop heart and blood vessel diseases. Diabetes also can lead to stroke, kidney failure, and other problems.

Diabetes occurs when the body is not able to use sugar as it should for growth and energy. The body gets sugar when it changes food into glucose (a form of sugar). A hormone called insulin is needed for the glucose to be taken up and used by the body.

Symptoms of diabetes include: increased thirst and urination, weight loss, and blurred vision, hunger, fatigue, frequent infections, and slow healing of wounds or sores.

There are two main types of diabetes: insulin-dependent, or type 1, and noninsulin-dependent, or type 2. Type 1 usually appears suddenly and most commonly in those under age 30. Type 2 diabetes occurs gradually and most often in those over age 40. Up to 95 percent of those with diabetes have type 2. You’re more likely to develop type 2 if you are overweight or obese, especially with extra weight around the middle, over age 40, have high blood pressure, or have a family history of diabetes. Diabetes is particularly prevalent among African Americans, Asians, and Native Americans.

Because of the link with heart disease, it’s important for those with diabetes to prevent or control heart disease and its risk factors. Besides diabetes, major risk factors for heart disease include smoking, high blood pressure, high blood cholesterol, physical inactivity, and overweight and obesity.

Fortunately, new research shows that the same steps that reduce the risk of heart disease also lower the chance of developing type 2 diabetes. And, for those who already have diabetes, those steps, along with taking any prescribed medication, also can delay or prevent the development of complications of diabetes, such as eye disease and nerve damage.

According to the research, a 7 percent loss of body weight and 150 minutes of moderate-intensity physical activity a week can reduce the chance of developing diabetes by 58 percent in those who are at high risk. The lifestyle changes cut the risk of developing type 2 diabetes regardless of age, ethnicity, gender, or weight.

To reduce the risk of developing diabetes, as well as heart disease, you should:

• Follow a heart healthy eating plan, which is low in saturated fat and cholesterol, and moderate in total fat.
  
  
• Aim for a healthy weight.
  
  
• Be physically active each day–try to do 30 minutes of moderate-intensity physical activity such as brisk walking on most and, preferably, all days of the week.
  
  
• Don’t smoke.
  
  
• Prevent or control high blood pressure.
  
  
• Prevent or control high blood cholesterol.

If you already have diabetes, you can delay its progression, or prevent or slow the development of heart, blood vessel, and other complications by following the steps given above and these:

• Eat your meals and snacks at around the same times each day.
• Check with your doctor about physical activities that are best for you.
• Take your diabetes medicine at the same times each day.
• Check your blood sugar every day. Each time you check your blood sugar, write the number in your record book. Call your doctor if your numbers are too high or too low for 2 to 3 days.
• Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.
• Brush and floss your teeth and gums every day.
• Take any prescribed medication for other conditions, such as coronary heart disease.
• Check with your doctor about taking aspirin each day if you have heart disease.

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For more on diabetes:

NIDDK Web site. (This link opens a second browser window. Simply close that window to return to this page.)

Please see the NHLBI Web Pages on the following coronary heart disease risk factors:

High Blood Cholesterol: Live Healthier, Live Longer.

High Blood Pressure: Your Guide to Lowering High Blood Pressure.

Weight Control: Aim for a Healthy Weight.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/
9000 Rockville Pike
Bethesda, Maryland 20892

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Heart Disease Prevention - The Science of Garlic

By Decker Weiss: NMD, AACVPR

Today, garlic is one of the most researched plant medicines. By 1996, more than 1,800 scientific studies had investigated garlic’s medicinal properties.2 Through these studies, garlic has been verified as an important natural supplement in the treatment of many health problems.

Why is garlic so beneficial?

Garlic chemistry is very complex. It’s rich in many active components, including 75 different sulfur compounds. Allicin, the substance that gives garlic its characteristic odor (and to those who partake of its goodness —garlic breath) is the compound that’s most prized. Most garlic producers strive to grow garlic plants with a high allicin yield.3 Without allicin, garlic might not have any benefit at all.

However, as important as allicin is to garlic growers and harvesters alike, the concentration of allicin in an intact clove of garlic is astonishingly small. This is because allicin is protected in the clove by cell walls. It is only after the cell walls are crushed or cut that garlic cloves release their allicin.3

While allicin itself has beneficial health effects, its greatest strength is in what it yields. Once allicin is released, many compounds are formed. These compounds are responsible for most of garlic’s health benefits. 4 Allicin itself is highly unstable. In fact, allicin cannot be detected in the bloodstream or urine at any time after eating garlic.5

Allicin is also destroyed by stomach acid. Many commercial garlic products are enteric-coated. The tablets go through the stomach intact without dissolving. This delivers the garlic tablet to the small intestine, where the tablet dissolves and releases its allicin. From the small intestine, allicin’s many compounds are formed and then enter the bloodstream. This form of supplementation also avoids the development of garlic breath.5

Is it true that garlic is good for the heart?

Garlic has many beneficial properties that improve the health of the heart and circulation. These include:

• antioxidant activity6
• anti-clotting agent7,8
• inhibition of atherosclerosis (hardening of the arteries)9
  
• reducing “bad” cholesterol levels in the blood10
• raising “good” cholesterol levels in the blood11
• lowering blood pressure12,13

Recently, there have been some reports in the news that discount garlic’s ability to lower cholesterol. Why is there such a difference in garlic research results?

Prior to 1995, studies consistently concluded garlic lowered cholesterol levels. However, since 1995, many clinical trials have concluded garlic has no effect in lowering cholesterol levels in the blood. Researchers, concerned about these findings decided to determine why this occurred.5

The researchers, under the direction of Dr. Larry D. Lawson, examined the garlic supplements used in the studies that found no beneficial effect. One such study published in The Journal of the American Medical Association in 1998, concluded that garlic had no effect on serum cholesterol.14

While allicin cannot be detected in blood or urine, it can be detected in the breath. Using the exact products previously studied (same lot numbers and year of manufacture), Dr. Lawson measured the JAMA study’s test product, a garlic oil. When Dr. Lawson tested study subject’s breath after taking the garlic oil, minimal allicin was detected.

However, when Dr. Lawson encapsulated the same oil in gelatin capsules and had study subjects swallow the capsules, the same oil produced three times as much allicin.5

A recent meta-analysis (a large review study of several other studies with statistical analysis) of clinical trials concluded the use of garlic to lower cholesterol was, at best, of questionable value. Most of the studies published after 1995 that concluded garlic had no effect on serum cholesterol used non-enteric-coated tablets.15

Dr. Lawson studied the tablets used in these trials and determined the tablets dissolved in the stomach. The allicin was released too early, was destroyed by stomach acid, and never reached the bloodstream. 5

Dr. Lawson concluded the trials used poor-quality products. He further concluded that when enteric coated tablets are manufactured using garlic containing high allicin potential, serum cholesterol lowering effect should be noted. He urged new clinical trials with such supplements.5

There has also been some controversy comparing the effectiveness of supplements made with fresh garlic and those made from aged garlic extract. Is there any way to determine which type of garlic supplement is the most effective?

Some manufacturers of garlic supplements believe allicin is not the effective compound in garlic. These companies manufacture aged-garlic extract (AGE) products. They have initiated, funded, and conducted many studies regarding the safety of garlic juice, garlic powder, and enteric-coated garlic tablets. The studies have compared these products to their AGE products. The studies frequently conclude fresh garlic and enteric-coated garlic are harmful to stomach lining and can cause ulcers.16,17 However, recently at the American Herbal Products Association’s International Garlic Symposium, several noted garlic researchers and experts disagreed with these findings. During a roundtable discussion, the consensus determined there have been no successful independent replications of the AGE studies. Furthermore, the roundtable concluded that several ethnic groups consume large amounts of raw garlic every day without any associated ill effects. There has never been a clinically noted association of garlic consumption and ulcer formation. And, finally, the scientists questioned the validity of the study results due to sponsor-associated bias.18

What evidence is there for the anticancer benefits of garlic?

Much research has examined garlic’s role in the inhibition and prevention of various types of cancer. Some of these studies have evolved from the observations that certain ethnic groups who eat a lot of garlic in their diet have a low incidence of certain types of cancers.19

In a recent meta-analysis, the authors concluded garlic was especially effective in preventing stomach and colon cancers.20-22

Are there any other scientifically documented health benefits to garlic?

Garlic is a powerful detoxifying agent that can protect against various liver toxins. In an experimental study, garlic protected against acetaminophen (Tylenol®)-induced liver toxicity.23 This means that individuals who are taking Tylenol® may find garlic is beneficial. Garlic can also kill harmful bacteria, fungi, and viruses.24-26

Is there a recommended daily dosage for allicin?

Based on a great deal of clinical research, a medically validated commercial garlic product should provide a daily dose of a total allicin potential of 4,000 micrograms (mcg). This dosage equates to roughly one to four cloves of fresh garlic.19 Be sure to read labels; demand products that deliver a guaranteed yield of allicin and are enteric-coated to prevent premature release in the stomach.

Conclusion

Garlic is indeed a unique plant. It has a long and colorful history as both food and medicine, and is highly valued as both. Scientific study has provided understanding of the many benefits of garlic as a supplement. And, most importantly, many loyal enthusiasts worldwide attest to healthier hearts and improved lives simply from using garlic supplements.

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References

1. Riddle JM. Garlic’s history as a medicine. Presentation at the American Herbal Products Association International Garlic Symposium. July 31, 2001.

2. Garlic. In: Blumenthal M, ed. Herbal Medicine: Expanded Commission E Monographs. Austin, Tex: American Botanical Council; 2000:139-148.

3. Ellmore GS, Milano E, Feldberg RS. Navigating the clove: mapping bioactive compounds in garlic (Allium sativum). Presentation at the American Herbal Products Association International Garlic Symposium. July 31, 2001.

4. Robbers JE, Tyler VE. Garlic. In: Tyler’s Herbs of Choice. New York, NY: The Haworth Herbal Press; 1999:132-137

5. Lawson LD, Wang ZJ, Papadimitrou D. Allicin release under simulated gastrointestinal condition for garlic powder tablets employed in clinical trials on serum cholesterol. Planta Med. 2001;67:13-18.

6. Ho SE, Ide N, Lau BH. S-allyl cysteine reduces oxidant load in cells involved in the atherogenic process. Phytomedicine. 2001;8:39-46.

7. Ali M, Thomson M. Consumption of a garlic clove a day could be beneficial in preventing thrombosis. Prostaglandins Leukot Essent Fatty Acids. 1995;53:211-212.

8. Gadkari JV, Joshi VD. Effect of ingestion of raw garlic on serum cholesterol level, clotting time and fibrinolytic activity in normal subjects. J Postgrad Med. 1991;37:128-131.

9. Orekhov AN, Grunwald J. Effects of garlic on atherosclerosis. Nutrition. 1997;13:656-663.

10. Silagy C, Neil garlic as a lipid lowering agent—a meta-analysis. J R Coll Physicians Lond. 1994;28:39-45.

11. Morcos NC. Modulation of lipid profile by fish oil and garlic combination. J Natl Med Assoc. 1997;89:673-678.

12. Al-Qattan KK, Khan I, Alnaqeeg MA, Ali M. Thromboxane-B2, prostaglandin-E2 and hypertension in the rat 2-kidney 1-clip model: a possible mechanism of the garlic induced hypotension. Prostaglandins Leukot Essent Fatty Acids. 2001;64:5-10.

13. Qidwai W, Qureshi R, Hasan SN, Azam SL. Effect of dietary garlic (Allium Sativum) on the blood pressure in humans-a pilot study. J Pak Med Assoc. 2000;50:204-207.

14. Berthold HK, Sudhop T, von Bergmann K. Effect of a garlic oil preparation on serum lipoproteins and cholesterol metabolism: a randomized controlled trial. JAM 1998;279:1900-1902.

15. Stevinson C, Pittler MH, Ernst E. Garlic for treating hypercholesteremia: a meta-analysis of randomized clinical trials. Ann Intern Med. 2000;133:420-429.

16. Sumiyoshi H. New pharmacological activities of garlic and its constituents. Nippon Yakurigaku Zasshi. 1997;1:93-97.

17. Kasuga S, Uda N, Kyo E, Ushijima M, Morihara N, Itakura Y. Pharmacologic activities of aged garlic extract in comparison with other garlic preparations. J Nutr. 2001;131:1080-1084.

18. Amagase H, Block E, Bordia A, Lawson LD. The controversial issues surrounding allicin versus non-allicin containing products. Presentation at the American Herbal Products Association International Garlic Symposium. Aug. 1, 2001.

19. Reuter HD, Koch HP, Lawson LD. Anticancer effects. In: Koch HP, Lawson LD. Garlic: The Science and Therapeutic Application of Allium sativum and Related Species. Baltimore, Md: Williams & Wilkins; 1998:176-187.

20. Fleischauer AT, Arab L. Garlic and cancer: a critical review of the epidemiologic literature. J Nutr. 2001; 131:1032S-1041S.

21. Knowles LM, Milner J Possible mechanism by which allyl sulfides suppress neoplastic cell proliferation. J Nutr. 2001;131:1061S-1066S.

22. Lamm DL, Riggs DR. Enhanced immunocompetence by garlic: role in bladder cancer and other malignancies. J Nutr. 2001;131:1067S-1070S.

23. Hu JJ, Yoo JS, Lin M, Wang EJ, Yang CS. Protective effects of diallyl sulfide on acetaminophen-induced toxicities. Food Chem Toxicol. 1996;34:963-969.

24. Guo NL, Lu DP, Woods GL, et al. Demonstration of the anti-viral activity of garlic extract against human cytomegalovirus in vitro. Chin Med J (Engl). 1993;106:93-96.

25. O’Gara EA, Hill DJ, Maslin DJ. Activities of garlic oil, garlic powder, and their diallyl constituents against Helicobacter pylori. Appl Environ Microbiol. 2000;66:2269-2273.

26. Ledezma E, Marcano K, Jorquera A, et al. Efficacy of ajone in the treatment of tinea pedis: a double blind and comparative study with terbinafine. J Am Acad Dermatol. 2000;43:829-832.

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Congestive Heart Failure Prevention - CoQ10

According to one scientific study, CoQ10 has been shown to:*

• Restore healthy heart function in congestive heart failure patients.
  
  
• Reduce the likelihood patients needed to take high blood pressure medication.
  
  
• Provide rapid protective effects in patients with a heart attack if administered within 3 days of the onset of symptoms.

Where can I find a good source of standardized Allicin?

Natrol has a high-powered garlic supplement to help maintain healthy lipid levels. Utilizes Spectral testing to ensure proper dietary balance. Each caplet delivers 3,600 mcg allicin yield.

Natrol Garlipure Max Allicin 600MG 100 Cplts $7.79 Swanson Vitamins Search for Item NA191

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