Interview with Heart Awareness Advocate

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Dr. Gioia Turitto, MD, is Chief of Electrophysiology at New York Methodist Hospital-Cornell Heart Center. As one of the few women practicing invasive cardiology, she is committed to ensuring that women get the CV treatment they need and deserve through spearheading physician & community educational events. Dr. Turitto was born in Rome, Italy and did all her medical training except for EP Fellowship in Italy. EP training was done in the US, in NY and Kansas. She is a member of several organizations, including the American College of Cardiology, Heart Rhythm Society, and American Medical Association. She has published more than 100 peer-reviewed articles and book chapters and has been actively involved in several landmark arrhythmia trials, including SCD-HeFT, a trial of primary prevention of sudden cardiac death, and AFFIRM, a study of rate versus rhythm control management of atrial fibrillation.

It is important for women to know that heart disease kills more American women than all forms of cancer combined, including breast cancer according to the American Heart Association Heart Disease and Stroke Statistics 2009 update. And a woman’s lifetime risk for developing heart disease is very high – more than 1 in 2. And as you age your risk for heart disease increases.

I had the opportunity to ask Dr. Turitto some questions about women and heart health. This is an important topic to me since my mother-in-law passed away from heart disease. Please note: this information below is not a substitute for medical care. As always, you should consult your doctor or healthcare provider.

1. I always hear about the benefits of a low dose aspirin for the heart. Why is it a good thing and is it something everyone should take or only those that are high risk?

Aspirin thins the blood and helps prevent blood clots from forming, which in turn helps prevent heart attack and stroke. Heart attack survivors regularly take low-dose aspirin.

IN FACT, there are clear recommendations to avoid aspirin for primary prevention of cardiovascular disease in women under 55. There is insufficient evidence to recommend it in women over 80. In women of age 56-79, the possible benefits of aspirin have to weigh against the risk of bleeding from the gastro-intestinal tract.

2. What types of foods will help me control my risk of heart disease?

Women should consume a diet rich in fruits and vegetables (at least 4 cups daily); choose whole-grain, high-fiber foods; consume fish, especially oily fish, at least twice a week; limit intake of cholesterol, alcohol, salt, sugar, as well as saturated fat (found in fried foods, fat on meat or chicken skin, packaged desserts, butter, cheese, sour cream); and avoid trans-fatty acids. Fat intake should be limited to less than 7% of total calories, cholesterol intake to less than 150 mg daily, salt consumption to less than 1.5 grams daily. We also recommend improving heart health with at least 150 minutes per week of moderate exercise, and 75 minutes per week of vigorous exercise. An appropriate balance of physical activity and caloric intake (plus formal behavioral programs when indicated) should be used to maintain or achieve an appropriate body weight — for example, a waist size less than 35 inches. The American Heart Association’s website (www.heart.org) is a good source of information on nutrition, physical activity and weight management.

3. What does it mean if my heart beats really fast?

How fast your heart beats depends on your age and physical condition. If you’re concerned about your heart rate, you should see your doctor. When an adult has a heart rate of more than 100 beats per minute (BPM), they may have tachycardia. Tachycardia often is treated by cutting down on coffee and/or alcohol, quitting tobacco use, and getting more rest.

4. If my family has a history of heart disease, does that mean I’m just out of luck….or is it something I can change?

A family history of heart disease is a risk factor for heart disease that you cannot control or change. Other risk factors that cannot be controlled are: age – as you age, your risk for heart disease increases; gender – although more men have heart attacks, more women die of heart disease; and race – race is one factor that affects a person’s likelihood of suffering a heart attack and chances of survival after a heart attack.

While a person may be “out of luck” for those risk factors that cannot be controlled. They can aim to control their diabetes, smoking, high blood pressure and/or obesity and inactivity – risk factors that can be controlled for heart disease.

The five things you can do are:

1. Don’t smoke and avoid second-hand smoke. People who smoke are up to 6 times more likely to suffer a heart attack than non-smokers. If you smoke, QUIT!
2. Aim for a healthy weight. If you don’t know your ideal weight, ask your doctor. The more overweight you are — the higher your risk of heart disease.
3. Get moving. Make a commitment to be more physically active. Everyday, aim for 30 minutes of moderate-intensity activity such as taking a brisk walk, raking, dancing, light weight lifting, house cleaning, or gardening.
4. Eat for heart health. Choose a diet low in saturated fat, trans fat, sodium, and cholesterol. Be sure to include whole grains, vegetables, and fruits.
5. Know your numbers. Ask your doctor to check your blood pressure, cholesterol (total, HDL, LDL, triglycerides), and blood glucose. Work with your doctor to improve any numbers that are not normal.

5. I know high cholesterol is not good for the heart – but what’s the difference between bad cholesterol and good cholesterol?

You’re probably referring to a high “bad” cholesterol level, as cholesterol itself isn’t the problem. Cholesterol, a soft, waxy substance found among the fats in the bloodstream and in all your body’s cells, is an important part of a healthy body because it’s used to form cell membranes, some hormones, vitamin D, bile acids and is needed for other functions. Yes, there are two types of cholesterol: “good” and “bad.” It’s important to understand the difference, and to know the levels of “good” and “bad” cholesterol in your blood. Too much of one type — or not enough of another — can put you at risk for coronary heart disease, heart attack or stroke.

Cholesterol comes from two sources: your body and food. Your liver and other cells in your body make about 75 percent of blood cholesterol. The other 25 percent comes from the foods you eat. Cholesterol is only found in animal products.

Cholesterol can’t dissolve in the blood. It has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol. These two types of lipids, along with triglycerides and Lp(a) cholesterol, make up your total cholesterol count, which can be determined through a blood test.

When too much bad (LDL) cholesterol circulates in the blood, i.e. has high levels, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result. LDL cholesterol is produced naturally by the body, but many people inherit genes from their mother, father or even grandparents that cause them to make too much.

High levels of good (HDL) cholesterol seem to protect against heart attack. HDL tends to carry cholesterol away from the arteries and back to the liver, where it’s passed from the body – removing excess cholesterol from arterial plaque and slowing its buildup. While high HDL levels are good, low levels of HDL (less than 40 mg/dL) increase the risk of heart disease.

This is a really good question, because it leads to a more important issue that women can address – know your numbers. By numbers, I mean your blood pressure, cholesterol (total, HDL, LDL, triglycerides) and blood glucose. While cholesterol levels may seem a bit confusing, as you can see they are very important to heart health but can be changed.

If you need to increase your HDL, regular physical activity, reducing trans fats and eating a balanced and a nutritious diet often work well. If these measures are not enough, your doctor may prescribe medications, although they don’t work as well as lifestyle changes.

To lower levels of LDL cholesterol, individuals should avoid eating saturated fat, trans fats and dietary cholesterol. If high blood cholesterol runs in your family, lifestyle modifications may not be enough to help lower your LDL blood cholesterol. On the other hand, there are many effective medications to reduce your “bad” cholesterol. Everyone is different, so work with your doctor to find a treatment plan that’s best for you.

 

The website offers good patient educational materials for women, and there is a risk assessment test:www.your-heart-health.com

Thank you Dr. Turitto for taking the time to answer my questions and for allowing me to share your responses with my readers.

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