How's your heart? Do you know your numbers for blood pressure, cholesterol and blood glucose?
And are you living right: not smoking, exercising briskly for 30 to 45 minutes a day, maintaining a healthy weight? Are you limiting alcohol, sodium and saturated fats?
Do you know your family history? And are you keeping up with those doctor visits?
The action plan for a healthy heart may start with a partnership between you and your doctor, but it hinges on the lifestyle decisions you make every day.
That message hit home for Eileen Corning a few years ago. She let her annual physical slide, watched her weight creep up, wasn't exercising and couldn't shake a salt habit. At age 45, the Seminole resident had high cholesterol, a stressful job and a family history of heart disease.
Yet she never suspected a heart problem in November of 2007 when a worse than usual case of indigestion kept her up all night.
"I ignored it and went about my routine. I went to work the next day," says Corning, now 48 and vice president of human resources at Largo Medical Center.
When she finally went in for a physical in December 2007, an electrocardiogram, or EKG, revealed she'd had a heart attack. Her thoughts went to that attack of indigestion.
"It's a night I'll never forget," Corning says. "It was a big wake-up call."
Dr. Vibhuti Singh, chairman of cardiology at Bayfront Medical Center in St. Petersburg, says heart health management starts with primary prevention, exactly what Corning ignored for two years before her heart attack.
"In general, for all adults who have no diagnosed heart disease, no diabetes, no symptoms, this is what they should be doing medically," says Dr. Singh.
• Starting at age 18, men and women should have their blood pressure, cholesterol and blood glucose checked. If all the results are normal those tests would be repeated every five years up to age 40 for men, and up to age 50 for women. If at any point there are abnormal readings, or diabetes or obesity develops, the tests should be repeated annually.
• Between ages 40 and 45 for men and ages 50 and 55 for women, adults need all the primary prevention tests mentioned above, plus an EKG, a baseline chest X-ray, a urinalysis, a thyroid hormone test, a stress test and an eye exam, says Singh.
"By looking at the tiny capillaries in the eye, we can see, very clearly, damage from blood pressure or diabetes," diseases that often start silently, without obvious symptoms.
If all the test results are normal, these screenings may be repeated every three to five years; abnormal results may warrant re-checking annually.
For people who have been diagnosed with diabetes or heart disease, have had a stent placed, bypass surgery, a heart attack, chest pain or any other symptom of heart disease that their doctor wants to examine further, Singh explained that more advanced prevention steps are needed.
The goal is to prevent a second event or worsening of heart disease and damage to other organs. These tests may include: echocardiogram, cardiac catheterization, electrophysiology tests, ultrasounds and CT heart scans. Diabetics fall into this secondary prevention category even without cardiac symptoms. Because of their high risk for heart disease they should be screened annually with all the tests for primary prevention, plus some in the secondary tier of tests, as recommended by their doctor.
Sharon Brooks, 63, a registered nurse at Englewood Community Hospital in Charlotte County, knew she was in this category. Her cholesterol, blood pressure and weight were all in check, she didn't smoke and was a regular fitness walker. But she also had diabetes for 40 years.
When her blood sugars became uncharacteristically unstable last December, her doctor ordered a CT scan of her heart. Her health insurance wouldn't cover the test, but she considered it a $300 Christmas present to herself and paid cash.
The test showed a substantial blockage in her heart that required treatment with a stent, a tiny wire mesh tube that props open vessels.
"It took me a week to get over the shock that this really happened to me without symptoms," says Brooks. "I was a cardiac nurse before. I knew about prevention. I knew how to take care of myself. I felt I was in excellent physical shape. When it happens in spite of all these good things you do for yourself, it comes as quite a shock."
Most patients in secondary prevention also need daily medication. Brooks takes a prescribed daily aspirin, statin, beta blocker and ACE inhibitor to keep heart disease from advancing.
It all starts with you
Chief among all preventive measures for heart disease is lifestyle modification. Dr. Singh says three steps are a must: Don't smoke, exercise daily (Singh echoes the American Heart Association advice to get a pedometer and take 10,000 steps a day), and maintain a healthy body weight. Add to that a heart-healthy diet which includes omega 3 fatty acids, plus fruits, vegetables and fiber-rich whole grains.
Eileen Corning exercises regularly, watches what she eats and has lost 30 pounds since her heart attack. She reminds women that their symptoms of a heart attack may not be the stereotypical chest pains — indigestion, nausea and back pain can all be symptoms for women.
"Don't ignore what your body is telling you," she says. "It's hurting for a reason."
Sharon Brooks continues to walk 2 miles a day, four to five times a week, but with more intensity. Since getting the stent, she says she has more endurance. "I was never short of breath before, but now it seems I could just walk forever," she says.
That's good, because heart disease prevention takes a lifetime.
Contact Irene Maher at firstname.lastname@example.org