The Tribune Democrat, Johnstown, PA

February 16, 2013

Doctors break down biggest risk factors for heart attacks

Randy Griffith
rgriffith@tribdem.com

JOHNSTOWN — Those who want to reduce their risk of heart disease can be overwhelmed by information, advice and programs offered through friends, businesses  and the media.

But one local expert said it is important not to be discouraged.

Joe Shetler, an exercise physiologist and nutritionist, said there is a very easy way to begin a healthier lifestyle.

“No pun intended, but the first step is taking that first step and beginning some sort of walking program,” Shetler said from Memorial Medical Center, where he is coordinator of the employee wellness program.

“I tell people all the time, if they could put a daily fitness walk into a pill form, it would be the most prescribed medicine in the world.”

Local cardiologists would agree.

Although experts in all areas of heart care stand ready to treat patients struck with cardiovascular disease, they would rather help their would-be patients prevent an attack, vascular surgeon Dr. William Tretter said.

“The reality of heart disease is that a tremendous part of it is preventable,” Tretter said. “Physical activity and diet are tremendously important. We need to start with our kids in prevention.”

Not all risk factors for heart disease can be controlled, said Dr. Archana Sodagam, Johnstown’s newest cardiologist. Family history, age and being male all increase the likelihood of cardiovascular conditions.

“You can’t do anything about those,” Sodagam said. “A modifiable risk factor is something you can change.”

Tobacco use, obesity, poor diet, inactive lifestyle, high blood pressure, diabetes and high cholesterol are all risk factors people should consider controlling, she said.

 “If you have one or more risk factor, it puts you at higher risk of developing cardiovascular disease,” Sodagam said “Smoking is the most important.”

Shetler agreed, adding it is not just heart disease.

“If you are a smoker, quitting would be the No. 1 thing you should do,” Shetler said. “That is one of the best things you can do to reduce the risk of cardiovascular disease, and one of the best things you can do for your overall health.”

Beyond smoking, Shetler said, most of the other controllable risk factors will improve by increasing physical activity and eating a healthy diet. Control of weight, cholesterol, blood pressure and diabetes are all linked to diet and exercise.

A healthy heart is essential to overall health and quality of life, he added. The heart’s job is to send the blood, carrying oxygen and nutrients, throughout the body. A diseased heart is not as efficient. That reduces the amount of oxygen and nutrients sent to the other organs and muscles, making them less efficient.

Although cardiologists have traditionally been trained in aggressive treatment of heart disease, there is an increased focus on prevention, Sodagam said.

“I think it’s easier taking care of people who already have a manifestation of heart disease,” Sodagam said. “It is more of a challenge in prevention.”

Health systems are leading the way, but more employers are introducing wellness programs to reduce health insurance costs, Shetler noted. Conemaugh has used incentives such as contests and prizes to help employees meet weight loss and exercise goals, he said.

Shetler suggests exercising up to 150 minutes a week. Sessions of at least 30 minutes provide the biggest return, he added.

“If you are just starting, you can do three 10-minute sessions,” he said. “You’ll want to build up to 30 minutes.”

But while goals will help, Shetler said people should check with their doctors and do a little research on their own before jumping into a wellness program.

“It’s important to know your numbers,” he said. A body mass index of 24.9 or lower, cholesterol under 200 and blood sugar under 100 for those without diabetes are considered healthy, Shetler said.

Shetler recommends focusing on one or two risk factors to start. Although diet and exercise can affect many other factors, just reducing high blood cholesterol or getting blood pressure under control will have significant impact.

For those who have symptoms of cardiovascular disease or who have had cardiac events, the goals may change, Sodagam said.

“But the way you do it would be the same,” she said.

Cardiac patients and those with significant risk factors for heart disease are eligible for cardiac rehabilitation through most insurance plans, said Michelle George, program manager at Memorial’s Cardiac Fitness Center.

Cardiac rehab programs also are offered at Windber Medical Center and Somerset Hospital.

Memorial’s fitness center is staffed by registered nurses who monitor patients as they build up strength and endurance. The program also offers nutritional expertise, smoking cessation help and a psychologist offering stress management techniques. Stress is another modifiable risk factor.

“It is teaching lifestyle modifications they need to make,” George said. “You want to try to slow down the progression of the disease, but the individual has to want to make the changes.”

To start making the change, George’s advice is like Shetler’s:

“Get out there and move.”

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