Caring for Your Heart with John Farquhar, M.D.

Last Editorial Review: 10/23/2003

By John Farquhar
WebMD Live Events Transcript

Join John Farquhar, MD, to discuss how to maintain a healthy heart, recognize warning signs, causes of chest pains, and managing blood cholesterol.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Event_Moderator Welcome to WebMD LIVE! Our guest today is cardiologist John Farquhar, MD, and the topic is 'Caring for Your Heart.' Dr. Farquhar is the founder of the Stanford Center for Disease Prevention and Health Promotion and a professor of medicine and disease prevention at Stanford University. He is the director of the World Health Organization Collaborating Center for Chronic Disease Prevention. He is also the author of The American Way of Life Need Not be Hazardous to Your Health , The Last Puff , and Diagnosis Heart Attack, which is due out this year. He is a member of the Institute of Medicine, the World Health Organization Expert Advisory Panel on Cardiovascular Diseases, and chair of the International Advisory for the International Hearth Health Conference. Welcome, Dr. Farquhar! How are you today?

John_Farquhar_MD Just fine.

Beth8_WebMD Long story short, I'm concerned with the effects of Mitral Valve prolapse with pregnancy. I'm 10 weeks pregnant and am currently on disability. I have severe swelling in my upper abdomen and area up between my ribs. Also have shortness of breath & chest pain.

John_Farquhar_MD I am not an expert in this field. I think that it is very important that you consult both with a gynecologist and a cardiologist on this matter, and soon.

yingeleh_WebMD Both of my grandfathers died at age 55 of heart attacks. How much more at risk am I because of this?

John_Farquhar_MD Family history is important but only as a clue. It is essential that you have all of your potential risk factors studied, for example, your BP, total cholesterol, HDL, LDL, triglycerides, plasma homocysteine and Lp(a). When you have worked out your own risk factors, you may find that any genetic inheritance from your grandparents has not been passed on to you.  You see, it is most important to know your own risks.

Event_Moderator What is heart disease?

John_Farquhar_MD The word heart disease in this country usually refers to coronary heart disease. There are 500,000 deaths/year from coronary disease. Congestive heart failure has about 50,000 deaths/ year.  Many of these are the end result of coronary disease, but some come from cardiomyopathy or from untreated hypertension. So heart disease as a phrase usually means coronary disease. In some countries where rheumatic heart disease is more common than in the US, more people have this as the source of their heart disease. There are many fewer cases of cardiomyopathy, some of arrhythmias due to genetically determined problems in the heart's conduction system--but these are quite uncommon. Some arrhythmias, common in older individuals is in fact due to coronary disease as well. So you see that we always return to heart disease being largely coronary artery disease

brendaw1_MSN What is the difference between congestive heart failure, and coronary disease?

John_Farquhar_MD Congestive heart failure is a failure of the heart's muscle to pump efficiently. About 75% of the time this is due to past heart attacks, or myocardial infarctions.  The myocardial infarctions or MI's are due to coronary artery disease, which is secondary to atherosclerotic plaques in the arteries. About one quarter of cases of congestive heart failure, also called CHF for short are due to hypertension alone. The way that hypertension causes CHF is by making the heart pump against resistance for many years. The heart muscle enlarges but finally "wears out."

jrd35_WebMD What are the best ways to find out if I am at risk for heart disease?

John_Farquhar_MD The best way is to get your blood pressure measured about 4 or five times, take the average.  Of equal importance is to get your cholesterol measured about 2 or 3 times over a few weeks. If your total cholesterol is over about 175 mg/dl, then get HDK, LDL and triglycerides measured. Know that if you smoke cigarettes, you are at great risk for heart disease on that alone.  Risk factors are additive and even multiplicative. A person with low levels of the standard risk factors may have about 1/30th the risk of one with high levels of one with high levels. Important to know as well is your level of exercise. Any degree of exercise becomes protective but 40 minutes of brisk walking 4 times a week is highly protective. If there is a family history of heart disease, then the new risk factors of blood levels of homocysteine and Lp(a) should be measured. Also know if you are depressed, that is a risk factor. Levels of stress, especially if you have anger and hostility, acts as a risk factor as well probably by raising levels of cortisol and catecholamines.

yingeleh_WebMD What effect does smoking have on the heart?

John_Farquhar_MD Smoking seems to damage the heart in many different ways. First, there seems to be a direct effect on the endothelial cells that line the coronary arteries. This then promotes entry of cholesterol into the sub endothelial spaces. The molecular mechanisms of this endothelial damage are rather intricate and not fully understood, but it occurs. A second mechanism is that cigarette smoking lowers the plasma levels of HDL (high density lipoprotein cholesterol),  the protective fraction of cholesterol.  A 3rd mechanism is that smoking increases platelet aggregation, which promotes clot formation and can result in the thrombus that is the final path of a myocardial infarction.

brendaw1_MSN I was a pack a day smoker for 20 yrs. I quit 9 yrs. ago. Will this help reverse heart disease, at all?

John_Farquhar_MD After one day of stopping smoking there is a rapid reduction in risk, perhaps about 1/3rd less. After one year the risk falls further, and over a ten year period you reach the level of risk of a "never smoked" state. The reason for it taking a longer time to get the "never smoked" risk level is that smoking has caused atherosclerotic plaques to build up in the arteries, and it takes time for the artery to heal itself, but it can. Congratulations on stopping. The reason for a quick reduction in risk after stopping is that the platelet stickiness goes down and also the tendency of smoking to cause arrhythmias also falls.

Rachelq_WebMD When should you consult a doctor about chest pains, and are there different types of chest pains?

John_Farquhar_MD Almost any chest pain deserves serious consideration. There are different types. The ones most indicative of coronary pain or "angina" are those that are heavy or squeezing in nature, lasting for 3 to 8 minutes and located under the breastbone, some with radiation to the jaw, to the left arm and shoulder. Any severe pain of this sort lasting more than 8 minutes is an alarm for a heart attack itself and requires immediate action. This action includes chewing and swallowing two aspirin, getting 911 and get to an emergency room within an hour. Other kinds of pain from heart attacks may be disguised as indigestion, a feeling of fullness high in the abdomen. There are, of course, chest pains that are trivial, often very brief stabbing pains, or those that last in a minor way for hours; these are usually not indicative of coronary problems.

mikeey_WebMD Does aspirin prevent heart attacks?

John_Farquhar_MD Aspirin is kind of a magic drug even though it is so commonly used. An aspirin may help the body dissolve a clot that may be the final event in a "coronary thrombosis" that leads to a heart attack or "myocardial infarction". The body has mechanisms for clot lysis of its own, aspirin helps. But an emergency room using more powerful clot busters is the order of the day--aspirin may be of considerable help but not to rely on. Chronic use of low dose aspirin, 81 mg/day, is often advised for those who have had a heart attack.

brendaw1_MSN In my family history there are high cholesterol readings. My reading is about 250 ,and I am taking Lipitor 40 mgs. Am I a candidate for always high readings or can that be reduced farther?

John_Farquhar_MD That can definitely be reduced further and should be. If your HDL is really high you will have protection from that. Working hard on your diet can reduce the total amount of lipitor that you might need. There are new margarines that can lower your cholesterol by about 10%. Recently it has been found that n-3 fatty acids present in canola oil, salmon, tuna or sardines can assist in heart attack prevention--they don't have to lower cholesterol to do that. Vitamin E at about 200 IU/day also helps as does about 500mg of vitamin C. These help stabilize the LDL molecule so that it is less likely to get into the artery.

jrd35_WebMD Does a glass of wine a day really help prevent heart disease?

John_Farquhar_MD Yes, but make sure it is red wine. The skin of the grape is what you need, so almost all of the benefit can come from eating grapes, drinking grape juice or eating raisins. The wine industry doesn't want to hear that. The effect of materials in the grape skin are acting to stabilize the LDL molecule as does vitamin E and vitamin C. The grape skin issue shouldn't get you away from all the other risk factors that need attention.

brendaw1_MSN Is a lot of water and/or diet colas harmful to my heart? I had a triple bypass in 1993.

John_Farquhar_MD Water won't hurt. Diet colas won't hurt unless they give you too much caffeine. Some people say that we should stop taking diet drinks so that our palates can start to lower our interest in sweet things. Cutting down on sugars and easily absorbed carbohydrates has many benefits, especially for those who have high triglycerides, and often ignored risk factor.

Event_Moderator What do you find the general public is most uninformed or misinformed about as it relates to taking care of their heart?

John_Farquhar_MD Taking the long view about prevention. Most often it is ignoring diet, exercise and weight. Most people are well versed in the smoking issue. On diet, it most often is ignoring what we know about the benefits of eating. About 4 to 5 servings of vegetables/ day. Of course many are still eating too many hamburgers and too much fast food.  That is part of our hurry up culture. The tendency of Americans to gain weight is a very large problem and getting worse. One reason is that serving sizes in restaurants have risen; we never allow ourselves to have one minute of the day without food.

yingeleh_WebMD How bad for the heart are hydrogenated oils?

John_Farquhar_MD Very bad, for two reasons. First reason is that hydrogenated fats are saturated fats, and saturated fats raise total cholesterol and LDL cholesterol. Second reason is that hydrogenation also produces what are called "trans" fatty acids. Although these are unsaturated, with one double bond, they act the same as saturated fats. Some margarines are now available without trans fatty acids, these are better. a lot of convenience foods are made with hydrogenated fat, like cookies, crackers, etc. This increases the shelf life of the product but is bad for human life. Good question. We need labels that show amounts of trans fat as well as amount of hydrogenated fat.

Event_Moderator We've reached the end of our show. Our guest today has been Dr. John Farquhar. Thanks to our audience for joining in today. And thanks so much, Dr. Farquhar, for taking the time to respond to our audience! You're welcome back any time!

John_Farquhar_MD My pleasure, it was nice being with you all today. Many good questions.

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