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Are you at risk for heart disease? Would you know what to do if you were? Although there now are effective ways to strengthen a damaged heart, preventing or delaying heart disease should be our top priority —for heart trouble is still one of the major killers in our country. Most risk factors for heart disease can be controlled, but too many of us continue to ignore them. We lead lives that foster unhealthy hearts. And while many Americans try to stay fit, millions of others don’t, often because they don’t know how.

That’s why PARADE and the American Heart Association have designated 2005 The Year of the Heart. On these pages you will find the first in a series of special sections we’ll publish this year devoted to your heart’s health. “We have the research and the knowledge,” says AHA President Alice Jacobs. “We know that there are simple steps you and your family can take to reduce your risk. We hope that you will make 2005 your Year of the Heart.”

I remember when Cardiologists used to focus on treatment—for an acute heart attack, or heart failure, or a serious rhythm abnormality, or a heart-valve problem. While therapy is still critical and constantly improving, there has been a great deal of recent emphasis on prevention. And it is paying off. Last month, it was announced—for the first time ever—that the number of deaths from heart disease for Americans under age 85 is now less than those from cancer. Mortality from both diseases is falling, but more so from heart disease than from cancer. However, says the AHA, deaths from all cardiovascular diseases (heart disease but also stroke and blood- vessel problems) still outnumber cancer deaths. Now, more than ever, we must take advantage of what we know to keep the numbers falling.

Your Job: Control the Risk Factors

Prevention is more than wishful thinking; its effectiveness is documented by facts and figures. We really can avoid premature heart disease by teaching our kids the right lifestyle in their early years. Doctors are emphasizing to premenopausal women—long considered resistant to heart disease—how to modify the risk factors already present that may give them heart trouble later in life. When we discharge cardiac patients from the hospital, whether after a heart attack or cardiac surgery, we not only prescribe the medications they need to control their symptoms but also teach them what to do to lessen the likelihood that their problem will recur.

Eliminating or modifying the risk factors that we always knew contributed to atherosclerosis (hardening of the arteries) has had a measurable impact. The only factors we are not able to influence are genetic vulnerability, gender and aging. You can’t choose your ancestors or (yet) alter your genes. But if you stop smoking, normalize high blood pressure, reduce elevated cholesterol levels, control high blood sugar, lose weight and exercise regularly, you can improve your odds—and we have the numbers to prove it! So here’s what to do:

Stop smoking. More than 440,000 Americans die each year from smoking-related illnesses, according to the Centers for Disease Control and Prevention. Cigarette smokers are two to four times more likely to develop heart attacks and coronary heart disease than nonsmokers. Men have a slightly higher risk than women. If you smoke and are in your 20s, you are reducing your lifespan significantly. On average, lifetime smokers have a 50% chance of dying from a smoking-related illness. But if you stop now (it’s never too late) and remain tobacco-free, you can virtually nullify that risk. One year after quitting, your risk of heart disease drops by 50%, according to the World Health Organization. Within 15 years, a former smoker’s risk of dying from heart disease approaches that of a lifetime nonsmoker.

Lower your cholesterol. Statistics also have documented the enormous benefit of lowering your blood cholesterol level, whether by diet or medication or a combination of both. Almost everyone who’s had a heart attack or bypass surgery is now given a statin, a type of cholesterol-lowering agent, regardless of his or her cholesterol level. The statin drugs that reduce cholesterol also reduce the level of C-reactive protein, a marker of inflammation.

Control your blood pressure. There are many medications now available to treat high blood pressure without the side effects that were common with the older drugs. Normalizing blood pressure greatly reduces the risk of both stroke and heart attack by slowing down the formation of arterial plaques that narrow the blood vessels everywhere in the body—especially in the brain, heart, kidneys, eyes and legs.

Control your blood sugar. Almost 80% of people with diabetes die of some form of heart or blood-vessel disease. That risk can be reduced by keeping sugar levels as close to normal as possible. We also now have identified a condition called prediabetes. Millions of people whose blood sugar is only slightly elevated can be protected from developing the full-blown disease—and its life-threatening complications—by losing weight, exercising and, if necessary, taking oral medication to lower their blood sugar.

Lose weight. Excess weight is the most difficult risk factor to control, as evidenced by all the diets and “miracle pills” that come and go. Despite Atkins, South Beach, Beverly Hills, Scarsdale and all the other diets that have hit the best-seller lists, the old reliable formula still holds: Calories in should be less than calories out. That means eating less (fewer “calories in”) and exercising to burn the calories you do consume (more “calories out”).

But exercise, good for both the mind and the body, must be done on a regular basis, not just when you feel like it. It doesn’t need to be exhausting or unpleasant. Choose the kind that you enjoy and set aside a minimum of 30 minutes a day on most days of the week to do it.

Here’s the bottom line: Cardiovascular diseases remain the No.1 cause of death in this country. Thanks to modern advances in prevention and treatment, they really don’t have to be. You don’t have to go it alone. Heart health should be a joint venture with your doctor, who is best suited to help you.

If You Think You're Having a Heart Attack

Some heart attacks are sudden and intense—the kind you see in the movies, where everyone immediately knows what the problem is. But most real-life heart attacks start slowly, with mild pain or discomfort. Often the patient isn’t sure what’s wrong and may wait too long before seeking help.

Warning Signs

Here are some of the signs that can mean a heart attack is happening:

* Chest discomfort. Most heart attacks involve discomfort in the center of the chest that either persists or comes and goes. It can be a sensation of pressure (like someone sitting on your chest), squeezing, fullness or pain.

* Discomfort in other areas of the upper body. There may be pain or discomfort in one or both arms, the back, neck, jaw or stomach.

* Shortness of breath. A feeling of being unable to catch your breath may accompany the chest discomfort or occur without it.

* Other warning signs may include breaking out in a cold sweat, nausea or light-headedness.

What To Do

* Get to a hospital right away. If you or someone you are with
has chest discomfort, especially with one or more of the other warning signs of a heart attack, don’t wait longer than five minutes before calling for help.

* Phone 911. This is almost always the fastest way to get lifesaving treatment. The emergency medical services (EMS) staff can arrive as much as an hour sooner than someone traveling to the hospital by car. The paramedics on the staff are trained to revive someone whose heart has stopped.

* If you can’t reach the emergency medical services, have someone drive you to the hospital right away. Do not drive yourself.

The Heart, How It Works—and What Can Go Wrong

The Heart’s Parts

Although the heart is a single organ, it is composed of several different structures:

The heart muscle pumps blood out of the heart to nourish every other organ of the body.Coronary arteries deliver blood to the heart muscle.

Valves (two on each side of the heart) direct blood flow in and out of the heart and among its four chambers: two upper (atria) and two lower (ventricles).

Septum is a muscle down the center of the heart. It separates the right side, where blood returns from the body on its way to the lungs to refresh its oxygen content, from the left, where the oxygen-enriched blood is pumped out to the rest of the body.

Pericardium is a sheath or envelope on the outside that covers and protects the heart muscle.

The electrical system consists of pathways that deliver the signals to keep the heart beating.

Heart Trouble. The term “heart trouble” can denote several different problems, depending on which part of the heart is affected. These include:

* Coronary artery disease. See “A Network of Coronary Arteries” at left.

* A weakened heart muscle. Causes include a previous heart attack that leaves less healthy tissue to contract; long-standing, untreated high blood pressure, which can strain the heart muscle, forcing it to work harder to get blood into the arteries; a long-standing valve disease, which affects blood flow, enlarging and weakening the various heart chambers; or a virus or other infection that has affected the heart.

* A septum thickened by disease. This interferes with blood flow within the heart.

* An electrical system gone awry. Blocked or erratic signals interfere with normal muscle contraction, causing the heart muscle to beat too quickly or irregularly—leading to possible heart block, cardiac arrest, ventricular fibrillation or chronic valvular disease.

Aorta
Carries oxygenated blood out of the heart to nourish the body

Right atrium
Receives blood from the body

Right ventricle
Pumps blood to the lungs for fresh oxygen

Pulmonary artery
Carries blood to the lungs

Left atrium
Receives oxygenated blood from the lungs

Valves

Septum

Left ventricle
Pumps oxygenated blood around the body

Pericardium

A Network of coronary arteries located on the heart’s surface (left) delivers fresh blood to the heart muscle. Coronary artery disease refers to the buildup of plaques in these arteries, narrowing them (angina pectoris) or blocking them completely and causing a heart attack.

Taking Our Pulse
The PARADE/Research!America Health Poll

Americans are increasingly aware of the importance of taking preventive measures to ensure heart health, according to the latest poll by PARADE and Research!America, a nonprofit public-education and advocacy group that promotes medical research. The poll was conducted by the Charlton Research Co.

What Americans Know About Heart Disease

What disease is the most common cause of death in the U.S.?

Nearly half (47%) of those polled named heart disease as the leading cause of death, while 33% said cancer. In reality, cancer surpassed heart disease as the No. 1 killer of Americans under 85 (98.4% of the population) for the first time in 2002. The drop in deaths from heart disease can be attributed in part to fewer smokers, better surgical techniques and improved drugs.

Have you and your doctor ever discussed how to keep your heart healthy?

Nearly 65% said they have had such a conversation.

Don't know: 32%
Cancer: 30%
Heart disease: 23%
Other diseases: 15%

What disease or condition do you believe we have made the most progress in preventing, treating and curing?

Most of those polled were unaware that research has made significantly more progress preventing and treating heart disease than other diseases. Cardiovascular disease is the only group of diseases for which the mortality rate has decreased dramatically in the last half-century; in many cases, research has turned it from a killer into a chronic disease or found ways to prevent it altogether.

Have you changed your own behaviors in an effort to lower your risk of developing heart disease?

Although 73% replied that they had changed their behavior, obesity—a major risk factor—has increased in the United States. Still, the numbers reflect that many Americans are making lifestyle changes.

Risk factors are behaviors or conditions that make it more likely for a person to develop a disease. Which of these is a risk factor for heart disease?

(Percent that believes these are major factors)

Being obese/overweight: 92%
High blood pressure: 89%
Smoking: 87%
High Cholesterol: 84%
Lack of exercise: 78%
Family history: 75%
Stress: 74%
Elevated blood sugar: 55%
Age: 42%
Gender: 18%

For More on Heart Health

Visit www.americanheart.org to learn about the American Heart Association’s Go Red for Women campaign, which encourages women to protect their heart health. You’ll also find learning tools and more on prevention, diagnosis and treatment of heart disease. Or call 1-888-AHA-2222.

PARADE Health Editor Dr. Isadore Rosenfeld is a former member of the advisory panel to the U.S. Secretary of Health and Human Services. He also is the author of nine best-selling books. His latest is “Dr. Isadore Rosenfeld’s 2005 Breakthrough Health” (Rodale).