Call for your Health

Coronary heart disease (also known as coronary artery disease) is actually a disease of the arteries that supply the heart with blood and nutrients. A diagnosis of coronary artery disease is made if any artery is 60% occluded. A heart attack, or myocardial infarction (death of heart muscle tissue), occurs when an obstruction or spasm disrupts or terminates blood flow to a portion of the heart muscle. The amount of heart muscle damage is determined by the location of the obstruction or spasm and the speed with which medical intervention is begun. Heart attacks of any magnitude produce irreversible injury and myocardial tissue death. It usually takes 5 to 6 weeks to form a fibrous scar around dead cardiac tissue. This area of dead tissue can no longer contribute to the pumping of blood, resulting in a less efficient heart. Massive heart attacks that cause extensive muscle damage result in death.Although most heart attacks occur after the age of 65, the dysfunctions leading to them often begin before adolescence. These processes are insidious and often go undetected until, without warning, a heart attack occurs. The attack is sudden but the circumstances leading to it are long standing. In fact, there is considerable evidence that the silent phase of coronary heart disease has pediatric origins.

The ongoing framingham study, which began in 1949, identified the risk factors connected with heart disease. Cigarette smoking, high blood pressure, elevated cholesterol levels, diabetes, obesity, stress, physical inactivity, age, gender, and family history were found to be highly related to heart attack and stroke. As the risks were discovered, the realization evolved that heart disease was not the inevitable consequence of aging or bad luck but an acquired disease that was preventable. After a few years, researchers realized that preventive efforts should begin in childhood, and more years passed before they investigated the prevalence of these risks among children and adolescents.

Autopsy studies of 18 year olds have shown a positive relationship between blood cholesterol levels and the prevalence of fatty streaks on the walls of the coronary arteries and aorta. The evidence indicates that the average cholesterol level in children in overfed, under exercised societies such as the united states is too high.

High blood pressure has been reported in children as young as 3 years of age, and blood pressure levels generally continue into adulthood. 4 Almost 19% of high school seniors smoke cigarettes daily, and the use of smokeless tobacco products has increased substantially among 17 to 19 year old men. An estimated one in five youngsters between the ages of 5 and 17 years are substantially overweight; that is, a minimum of 20% above their desirable weight.

Autopsy studies of american combat battle casualties, whose average age was 22 years, in the korean and vietnam wars showed obstructions in the coronary arteries. Native korean and vietnamese soldiers had clean and open arteries. These obstructions are caused by atherosclerosis, which is a slow, progressive disease of the arteries that can originate in childhood. It is characterized by the deposition of plaque beneath the lining of the artery. Plaque consists of fatty substances, cholesterol, blood platelets, fibrin, calcium, and cellular debris that anchor to a roughened site in the artery. Several theories have been advanced regarding the development of rough spots in arteries, but whatever the trigger, the smooth muscle cells beneath the lining erupt and form a network of connective tissue that eventually becomes plaque. Plaque enlarges over many years beneath the linings of arteries, causing them to narrow. The affected portion of the myocardium becomes ischemic (lacking sufficient blood flow). This eventually leads to two possibilities. First, bleeding may occur in the plaque, or second, a blood clot may form on the surface of the plaque. In either case, a heart attack or stroke may occur if the arterial channel is shutdown as a result. The atherosclerotic process is responsible for 80% of the coronary heart disease deaths in the united states.

As many as one third of all heart attacks are imperceptible to the victim. These events usually involve small areas of the heart muscle and may go unnoticed unless verified by an electrocardiogram (ECG). The ECG remains abnormal for about 72 hours after a silent heart attack. If the diagnosis is not made during this time, it will probably be missed. The typical heart attack is very noticeable, and the symptoms are overt.

Atherosclerotic lesions are more likely to form where single arteries branch into two smaller arteries. Vessel diameters reduce where branching occurs. This increases blood turbulence, which produces greater damage at these sites. This combination of events renders these sites more vulnerable to injury and the development of plaque. This phenomenon may occur in the arteries leading to the brain, kidneys, lungs, and legs, as well as the heart.

Coronary heart disease may be delayed or prevented by keeping the risk factors associated with heart disease in check. Most can be modified and controlled through appropriate lifestyle behaviors.

Many medical authorities consider cigarette smoking the most harmful of the preventable risk factors associated with chronic illness and premature death. Approximately 40% of male smokers and 28% of female smokers die prematurely. Smokers have twice the risk of having a heart attack and are two to four times more likely to die suddenly from a heart attack than are nonsmokers.Hypertension results from peripheral resistance to blood flow, and cigarette smoking contributes to peripheral resistance by constricting the arterioles. Smoking significantly exacerbates the effects of high blood pressure. Although the number of people who smoke is declining, 46.3 million adults (25.7% of the population) continue to smoke.

Harmful Products In Cigarettes

Nicotine, carbon monoxide and other poisonous gases, tars, and chemical additives for taste and flavor are the hazardous products in cigarettes. Carbon monoxide and nicotine have a devastating effect on the heart and blood vessels. Nicotine is an addictive stimulant that increases the resting heart rate, blood pressure, and metabolism. It should be reclassified as a drug and placed under the jurisdiction of the food and drug a dministration (FDA). Carbon monoxide, a noxious gas that is a by product of the combustion of tobacco products, displaces oxygen in the blood because it has a greater affinity for hemoglobin. The diminished oxygen carrying capacity of the blood is partly responsible for the shortness of breath that smokers experience with mild physical exertion.

Cigarettes and other tobacco products are not regulated by the FDA because tobacco is not classified as a food or drug. Therefore the tobacco industry is under no mandate to disclose the nature and type of chemicals that are added to tobacco products.

These products may be harmful. The public has a right to know, but the tobacco industry has successfully resisted attempts by government agencies and consumer groups to force disclosure.

The harmful effects of cigarette smoking are insidious and take time to appear. The medical profession measures the damage from smoking in pack years. Smoking one pack of cigarettes per day for 15 years is equal to 15 pack years . Two packs per day for 15 years is equal to 30 pack years . Medical problems become evident after 25 to 30 pack years.

The challenge of Quitting

To quit the tobacco habit, you have to first break the addiction to nicotine and then break the psychological dependence on smoking. This involves a change in behavior, as well as effective ways to deal with the social and situational stimuli that promote the desire to smoke. Men have been more successful quitters than women. Data from 1974 to 1992 show that smoking among women decreased by 8% while smoking among men decreased by 15%. Today, more young women than young men are smoking, representing a reversal of a long standing trend. The increasing number of young women smokers, coupled with the number of years that women have been smoking, has reversed another trend: lung cancer has replaced breast cancer as the leading cause of cancer death among women.

Complicating the effort to quit, particularly among young women, is the fear of gaining weight. Approximately 65% of those who quit do gain weight, but the physiological adaptations that occur may only account for a 7 to 8 pound weight gain. The physiological mechanisms responsible are probably associated with a slowing of metabolism and slower transit time of food in the digestive system so that more is absorbed by the body. Weight gain beyond 8 pounds is probably caused by altered eating patterns rather than physiology. Food smells and tastes better. It may substitute for a cigarette, especially during social activities. It may provide some of the oral gratification previously obtained from smoking, and it may relieve tension. Weight gain can be avoided by eating sensibly and exercising moderately and frequently.

As a group, smokers are 7% thinner than non smokers, but smokers tend to distribute more fat in the abdominal area. The waist to hip ratio (WHR) is greater in smokers even though they are thinner. This fat distribution is not only aesthetically unappealing but also predisposes to coronary heart disease, diabetes, stroke, and some forms of cancer.

Anabolic steroid use by nonathletes is on the rise. This is particularly true for young men. A nation wide survey of 3403 male high school seniors indicated that 6.6% of this group were current users or had previously been users of steroids and that 25% of the current users showed signs of dependency. According to this report, the improvement in physical appearance reputed to occur with steroid use, accompanied by peer approval of those physical changes, functioned as a powerful reinforcer for continued use.Heavy steroid users were more likely than light users to take two or more steroids concomitantly and more apt to take these drugs by injection rather than in pill form. Injection as a method of delivery is highly characteristic of drugs that involve addiction. The steroid “hook” is insidious and powerful: 30% of the heavy users vowed that they would not discontinue steroid use if steroids were proved to cause liver cancer, 31 % would not stop if they proved to cause heart attacks, and 39% would not stop if they proved to cause infertility.

Although definitive evidence of the long term effects of steroid use is not available, the potential for long term harm is certainly real. Predicting how and when the effects of steroids will be manifested is impossible because people respond individually to those drugs as a result of differences in body chemistry. The steroid effect is complicated further because “black market” preparations contain additives, and some preparations are contaminated. The potential for harm is readily discernible; 80% to 90% of all steroids used are purchased through the black market.

Beginning weight trainers should keep a daily log of their training activities. The advantages of keeping such a record far outweigh the minimal amount of bother, time, and effort required to make the entries during the workout. Each entry should be recorded during the rest period between sets.

The advantages of maintaining a daily training log include the following:

• You will always know which exercises you performed and the amount of weight that was used for each.
• You will always know the number of repetitions and sets that you performed of each exercise.
• The training log provides an objective account of your improvement. You can compare the amount of weight you are currently lifting with the amount at the beginning of your training.
• The training log provides an accurate history. The training log is a motivating device that provides objective feedback of performance improvement.

• Flexibility refers to the range of motion at a joint or series of joints and is specific to each joint .
• Factors that influence flexibility of a joint are the bony structure, the amount of tissue at the joint, and the elasticity of the muscles, tendons, and ligaments at the joint.
• Flexibility is influenced by age, gender, and physical activity.
• The maintenance of flexibility of the hamstrings and low back muscles is important in the prevention of low back pain .
• Normal body weight and good posture are also necessary for a healthy back.
• Ballistic stretching is counterproductive to improving joint elasticity and may contribute to injury.
• Static stretching is the recommended type of exercise. Stretches should be held for 15 to 30 seconds and repeated at least twice.
• Stretching should not be painful.
• Stretching exercises can be performed daily.
• Proprioceptive neuromuscular facilitation is the most effective but most difficult form of stretching.
• Proprioceptive neuromuscular facilitation combines passive movement with isometric contractions .
• The most accurate measurement of flexibility is obtained with a goniometer.
• Low back pain is the most common reason for visiting a physician.
• Factors associated with low back pain include excess weight, poor posture, inactivity, fatigue, weak abdominal muscles, high heels, and stress.
• Discuss what guidelines should be followed for safe and effective stretching.

Vitamins are organic compounds (compounds made up of carbon atoms bonded to hydrogen atoms) that are necessary in small amounts for good health. The body can break vitamins down, but it cannot produce them. Vitamins have to be supplied in the diet. Unlike carbohydrates, fats, and proteins, vitamins yield no energy. Instead, some serve as catalysts that enable energy nutrients to be digested, absorbed, and metabolized. Some vitamins also interact with minerals. For example, vitamin C facilitates iron absorption, vitamin D improves calcium absorption, and thiamine requires the mineral magnesium to function efficiently.Diets deficient in the RDA of vitamins may impair the physiological processes of the body and lead to deficiency diseases. The dietary allowances have been defined as the amounts of vitamins needed to prevent outright deficiency diseases, such as scurvy. This definition may soon change. The food and nutrition board of the national research council is considering revising the RDA by increasing the consumption of certain nutrients to reduce the risk of chronic disease. One major advantage of a varied diet is that it helps ensure consumption of the right amount and balance of those vitamins related to many of the major chronic diseases.

Vitamins are grouped into two categories water soluble and fat soluble. Water soluble vitamins include vitamin B complex and vitamin C. They are present in the watery components of food, distributed in the fluid components of the body, excreted in the urine, needed in frequent small doses, and are unlikely to be toxic, except when taken in megadoses (very large quantities).

Fat soluble vitamins include vitamins A, D, E, and K and are found in the fat and oily parts of food. Because they cannot be dissolved and absorbed in the bloodstream, these vitamins must be absorbed into the lymph with fat and transported in lipoproteins. When consumed in excess of the body’s need, fat soluble vitamins are stored in the liver and fat cells. Their storage makes it possible to survive for months or years without consuming them. At least three of the fat soluble vitamins (A, D, and K) may even accumulate to toxic levels. Megadoses of these vitamins should be avoided.

Antioxidant Vitamins

Three vitamins are classified as antioxidants vitamins C, E, and beta­carotene . Antioxidants are protective substances because they help neutralize the activity of free radicals. Free radicals are naturally produced chemicals that arise from normal cell activity. Whenever the body uses oxygen or is exposed to a toxin, such as cigarette smoke, it forms free radicals. These unstable chemicals can damage cells throughout the body. They may damage a cell’s DNA in ways that lead to cancer, may interact with cholesterol in the bloodstream and form oxidized LDL may cause cataracts and rheumatoid arthritis, and may be a factor in the physiological changes associated with the aging process. Anything that interferes with the destructive effects of free radicals offers a health advantage. Vitamins C, E, and beta carotene are believed to prevent the oxidation of cholesterol and other molecules linked to the diseases mentioned previously, most notably heart disease and cancer. A common cooking practice illustrates this antioxidant effect: some foods like bananas, peaches, apples, and potatoes quickly turn brown when exposed to air. However, when such foods are dipped in lemon or orange juice, the vitamin C in the juice acts as an antioxidant and prevents sues of your body. It is required in the breakdown and absorption of some amino acids, other minerals (such as iron), and the formation of some hormones. It may also help the immune system prevent infections. As an antioxidant it may playa role in prevention of atherosclerosis and some forms of cancer.

Contrary to popular opinion, vitamin C does not prevent the common cold. Scientifically controlled studies reveal no difference in the incidence of colds when comparing vitamin C users with nonusers. On a positive note, however, some studies suggest the symptoms of a cold may be shortened by a day or two.

The RDA of vitamin C is 60 mg, 70 mg during pregnancy, and 90 mg during lactation. For smokers the RDA is 100 mg because smoking appears to destroy some vitamin C. Studies designed to test for antioxidant benefits typically set the dosage level at 500 mg. Megadoses (2000 mg) of vitamin C offer little benefit to the body and may be harmful. As a water soluble vitamin, doses in excess of the body’s requirement are excreted through the kidneys. In other words the body can only absorb so much. Side effects of large doses are diarrhea and abdominal discomfort. For those individuals who absorb excess iron, supplements of vitamin C could be dangerous. Large intakes may also produce errors in the results of some diagnostic tests (for example, hemoccult test, glucose in urine test).

Good sources of vitamin C are citrus fruits and green vegetables, including lemons, grapefruit, limes, oranges, tomatoes, broccoli, and green peppers .

Beta-carotene (provitamin A)

Vitamin A comes in several forms, such as preformed retinoids found in animal products that are ready for use by the body and carotenoids found in plants. Carotenoids are called provitamin A because they must first be converted to the retinoid form if they are to be used for vitamin A functions. More than 600 carotenoids are found in nature; 50 of them have potential vitamin A activity. The most potent form is beta carotene. The retinoids and carotenoids combine to form what is generally referred to as vitamin A.

Before the body can use vitamin A, it must first be separated from beta carotene. Beta carotene is a precursor of vitamin A. The process of freeing vitamin A from beta carotene prevents oxygen from releasing free radicals. This is called an antioxidant effect and is associated with the health benefits mentioned previously.

Vitamin A is needed for normal vision, skin maintenance, bone and teeth development, growth, and reproduction. It also plays a role in the DNA and RNA functions of cells.

The RDA of vitamin A is 1000 retinol equivalents (RE) for men and 800 RE for women. Dairy products, fish, and butterfat are good sources of preformed vitamin A. Beta carotene is plentiful in pigmented vegetables and fruit, such as carrots, sweet potatoes, oranges, and leafy green vegetables . Preformed vitamin A (the retinoid component) is fat soluble, can be stored in the body’s fat cells, and can be toxic in megadose quantities. This has important implications for women who are of childbearing age and/or are considering pregnancy. Vitamin A, when taken during pregnancy, is helpful in cell differentiation and is an essential nutrient in a baby’s development. Excessive amounts of vitamin A during early pregnancy, however, may impose risks of birth defects. A study conducted at boston university school of medicine involving 22,748 pregnant women found that the babies of women who consumed more than 10,000 international units (IU) (approximately 3000 retinol equivalents) of vitamin A each day, or nearly four times the recommended amount, were more likely to be born with malformations of the head, heart, brain, and spinal cord. The amounts that place babies at risk are found in a single pill in some vitamin supplements and can be readily obtained if more than one vitamin supplement is taken each day. Researchers concluded the study by urging women to avoid taking supplements that exceed 4000 to 8000 IU (1200 to 2400 RE) daily, the amount commonly found in prenatal multivitamins.

Beta carotene, on the other hand, is not associated with an increased risk of birth defects. For most people it would be nearly impossible to get too much beta carotene because it is water soluble. The major side effect of excessive consumption of beta-carotene is orange discoloration of the skin.

Vitamin E

Vitamin E is a fat-soluble vitamin found in vegetable oil, margarine, meats, nuts, and whole grain cereals and breads . The RDA is 10 mg (15 IU) for men and 8 mg (12 IU) for women. antioxidant studies typically administer 200 to 400 IU of vitamin E supplements. Vitamin E plays a role in the formation of red blood cells and maintenance of nervous tissues and aids in absorption of vitamin A. Claims that vitamin E improves the skin, heals scars, prevents stretch marks, slows the aging process, and increases fertility are more folklore than fact.

The strongest evidence of the antioxidant benefits of vitamins exists for vitamin E,17 A review of 21 epidemiological studies measuring vitamin E in either diet or blood demonstrated cancer fighting benefits. Also, two large scale studies involving 87,000 women and 40,000 men respectively found that vitamin E supplements (100 to 250 IU) for at least 2 years reduced heart disease risk by 40%.18 Its role as an antioxidant in combating heart disease and cancer has increased its popularity, and it is approaching vitamin C as the nation’s favorite supplement. Still the scientific community has not reached a consensus opinion on the use of vitamin E supplements. Some studies report contradictory findings. Also, some experts raise some of the same questions and offer the same criticisms as those for the betacarotene-lung cancer study mentioned earlier. Consequently, experts are divided in their opinion about vitamin E supplements. Some recommend supplements on the basis that there is little to lose and much to be gained; others warn of the dangers of tampering with the body’s biochemistry. It is likely to take several years before a strong consensus emerges.

Folate, Vitamin B6, Vitamin B12

Folate, previously referred to as folacin and folic acid, is a part of the vitamin B complex and combines with vitamins B6 and B12 to form parts of DNA and RNA and to make heme the iron containing protein in red blood cells. They also assist in the metabolism of amino acids. Vitamins BG and B 12 are plentiful in foods, and few people need to worry about deficiencies with the possible exception of strict vegetarians. Good sources of these vitamins are meat products, dairy products, eggs, spinach, whole wheat bread, and breakfast cereals.

Folate, as its name implies, is found in foliage leafy vegetables, such as lettuce and spinach. It is also found in citrus fruits, whole grain bread, and cereals. Of the three B vitamins mentioned here, folate is the one in which Americans are most likely to fall short.

The RDA for B6 is 2 mg for men and 1.6 mg for women. For B12 the RDA is 2 micrograms (mcg) for men and women. Folate RDA is 200 mcg for men and 180 mcg for women. Because folate has been associated with a reduction in the chances of neurological birth defects, such as spina bifida, a woman planning a pregnancy may be advised by her physician to eat foods rich in folate and possibly to take a 400 mg supplement.

Current interest in folate supplements was sparked by recent studies that demonstrated that people whose blood levels were low in folate had high homocysteine levels. Homocysteine is an amino acid that plays a role in the formation of two other amino acids, cysteine and methionine. To work properly, these amino acids require three B vitamins folate, B6′ and B12 . If these vitamins are in short supply, homocysteine levels might rise. High homocysteine levels are thought to increase the risk of heart disease. The compound has also been implicated in several other diseases, including cancer, diabetes mellitus, and neurological disorders. In a harvard study, epidemiologists checked homocysteine levels in frozen blood samples drawn several years ago from men participating in an ongoing study. Compared with healthy subjects, the 271 men who had gone on to have heart attacks had much higher homocysteine readings. A follow-up study at the university of alabama, birmingham compared 100 men who had been diagnosed with heart disease with 100 men who had not. The heart patients, like those in the harvard study and more than a dozen other studies, had substantially higher levels of homocysteine. In all of these studies the high levels of homocysteine were associated with a shortage of folate.

The precise mechanism for the association between homocysteine levels and heart disease isn’t clear. Animal studies show that injections of homocysteine can scar artery walls, triggering plaque deposits and blocked arteries. It is also speculated that homocysteine combines with low density lipoproteins to exacerbate arterial damage. Whatever the reason, one thing appears clear high homocysteine levels are associated with low folate levels. In the absence of folate, along with vitamins B6 and Bw homocysteine concentrations circulate unabated. There is speculation from the scientific community that during the next several years homocysteine levels might replace cholesterol as a major risk factor of heart disease.

The best way to lower homocysteine concentrations is to consume enough B vitamins. Emphasis should be on folate, which is more effective than B6 and B 12 in reducing elevated homocysteine levels. Getting the RDA of folate is easily achieved by following the food guide pyramid. Megadoses of folate should be avoided to prevent the possibility of a false negative for anemia (too few blood cells) caused by a vitamin B 12 deficiency. If folate supplements are taken, tell your physician so that the appropriate tests can be ordered.

As a medical remedy, aspirin dates back 2000 years. Traditionally, aspirin’s primary function was to relieve pain and reduce fever and inflammation. Recently, investigators have become interested in aspirin’s other qualities, namely, its anticlotting properties. The early attention was focused on people who had a previous heart attack or stroke and on those who had angina pectoris. Aspirin therapy was found to decrease the risk for a subsequent cardiovascular event. The results from 25 studies indicated that low dose aspirin

• Lowered the risk for major cardiovascular or cerebrovascular complications by 25%.
• Lowered the total death rate for a vascular event by 15%
• Reduced the risk of nonfatal heart attack by 32%
• Reduced the risk of nonfatal stroke by 27%.

Taking aspirin within a couple of hours after a heart attack has reduced mortality by 23% during the first 5 weeks following the attack. Aspirin plays an important role in preventing a second or third heart attack. Its potential for preventing an initial heart attack was addressed in the physician’s health study. One standard aspirin tablet taken every other day lowered the heart attack risk by 44 % in a population of male physicians 40 to 84 years of age.

Because the subjects in these studies were men, the effect of aspirin use on women is unclear. However, a study of a large population of nurses is currently underway to determine if women respond similarly to preventive and therapeutic aspirin therapy.

The ideal aspirin dosage required to protect the heart is not known. Available evidence suggests that less than one tablet every other day is sufficient. The best dose may be less than a quarter of a tablet. In the case of aspirin for protection against a first heart attack, more of the drug is definitely not better.

Aspirin reduces the risk and incidence of heart attack because of its anticlotting properties. It prevents the blood platelets from clumping together to form a plug. When a plug develops at the site of a diseased coronary or cerebral artery, a heart attack or stroke will occur.

Even though aspirin appears to be effective in preventing heart attacks and strokes, current medical advice is to consult a physician to determine if it is desirable for you. Regular aspirin usage does have undesirable side effects. It can cause gastrointestinal distress and internal bleeding. The most serious complication of aspirin use occurs in people with uncontrolled hypertension, which is the leading cause of a hemorrhagic stroke. Because aspirin promotes bleeding, the risk of a stroke of this type becomes greater than aspirin’s preventive effect against a heart attack.

Though often neglected, flexibility is one of the most important components of health-related fitness. Several factors influence flexibility, including age, gender, and level and type of physical activity. Youngsters are more flexible than adults because tendons lose their elasticity with age. However, in activity may playa greater role than the aging process in the loss of flexibility because muscles and other soft tissues lose elasticity when not used. Active individuals are usually more flexible than sedentary people. Women tend to be more flexible than men because the hormones that permit women’s tissue to stretch during the childbirth process facilitate all body stretching. The range of motion for most movements begins to decline in the mid twenties for men and at approximately 30 years of age for women.Inflexible muscles around the joints limit range of movement, eventually inhibiting activities of daily life. This is most frequently seen in older people who have difficulty reaching down to tie their shoes or bending over to get a drink of water from a fountain. Lack of flexibility in the shoulders can affect performance of normal duties, such as reaching overhead to change a light bulb or remove a can from a cupboard. Tight muscles may also contribute to joint deterioration by subjecting the bones to excessive pressure, causing pain and abnormalities in joint lubrication. Regular flexibility exercises can improve body posture. Flexibility exercises following aerobic activity reduces muscle soreness.

Maintenance of flexibility is most important for the prevention of low back pain. For example, a sedentary lifestyle characterized by sitting for long periods leads to a loss of flexibility and increases the likelihood of low back injury. Flexibility of the hamstring muscles (a group of muscles in the back of the thighs) and the low back muscles, along with abdominal strength, good posture, and normal body weight, are essential for a healthy back.