At the age of 32, Joe Piscatella had to pick himself up from the operating table after emergency bypass surgery and learn to recover his full cardiac health through diet and lifestyle. It is now 28 years later, and Piscatella shares his advice in “The Road to a Healthy Heart Runs Through the Kitchen.” Here's an excerpt:
Chapter Two: Assessing Your Risk
Coronary heart disease would be a lot easier to manage if we could trace it to a virus or some other single source. Instead, we’re dealing with a disease that involves more than 250 risk factors. Some of these factors may seem relatively obscure. For instance, research suggests that men who are severely bald on top have up to a 36% greater risk of heart attack than those with full heads of hair. But other factors are out there in plain sight as possible risks that we all have to take into consideration. Elevated cholesterol is one of the best examples. According to data from the Framingham Heart Study, a 1% rise in your total cholesterol level can produce a 3% rise in heart attack risk.
Focus on Diet
Some of the most important cardiac risk factors are influenced by what and how much you eat. These factors include not only total cholesterol, but also LDL and HDL cholesterol, triglycerides, weight, blood pressure, diabetes, coronary inflammation, blood clotting and metabolic syndrome. And that’s good news because it means that once you know your risk levels, you can neutralize many factors that can penalize cardiovascular health by taking the right steps to change your diet.
High cholesterol levels have long been viewed as a major cardiac risk factor, and rightly so. Indeed, Dr. Robert Levy, former director of the National Heart, Lung and Blood Institute, points to elevated cholesterol as “the chief factor for heart attack.” But just as higher cholesterol levels increase the risk for heart attack, decreased levels forecast a reduction in risk.
The amount of cholesterol in the blood is determined by a blood test and is expressed as the number of milligrams (mg) of cholesterol in one deciliter (dl) of blood. (For example, a person with 210 milligrams of cholesterol in a deciliter of blood has a cholesterol level of 210 mg/dl, popularly expressed as a cholesterol “count” of 210.) Initial cholesterol readings should not be etched in stone. Many health professionals now recommend a second test within one to eight weeks of the first. If the readings are within 30 points of each other, use the average of the two values; otherwise, a third test should be performed and the average of all three tests used. You should also be aware that exercise, stress, dieting, body weight change, medications and the phases of a woman’s menstrual cycle can affect total cholesterol readings. Morning levels are usually higher than those later in the day. Smoking before a test can cause higher readings, as can failure to fast for 12 hours beforehand. And lying down for a test can cause lower readings, while sitting up tends to produce higher ones.
The National Cholesterol Education Program, in collaboration with the American Heart Association and a number of other medical authorities, has issued the following guidelines for assessing total cholesterol levels:
Total Cholesterol Risk Classification
Below 200 Desirable200 to 239 Borderline high240 and above High
If your total cholesterol level is somewhere around 200, you’re considered “normal” (think “average”) by today’s standards. But that’s not the best level for cardiac health. The optimal, or ideal, level is actually around 150 and below, particularly for heart patients.
There are a number of tried-and true dietary actions that you can take to control cholesterol effectively:
- Cut down on foods rich in saturated fat (such as red meat and whole-milk dairy products) and trans fat (products made with hydrogenated oils) in favor of foods with fats that promote heart health (olive oil, seafood and walnuts).
- Increase foods rich in complex carbohydrates (such as fruits and vegetables), soluble fiber (oat bran, oatmeal and beans), bioflavonoids (strawberries and eggplant) and antioxidants (foods rich in vitamins C and E and beta-carotene).
- Choose cardioprotective foods. Substitute soy protein for animal protein; consider using cholesterol-lowering margarines containing sterol or sterol esters.
- Use portion control to moderate caloric intake (along with increased physical activity) to lose weight, if necessary.
Carrying too much weight is linked to elevated cholesterol levels and high blood pressure, among other factors that increase the risk of coronary heart disease. An eight-year study of more than 110,000 American women aged 30 to 55, for example, revealed that those who were as little as 5% overweight were 30% more likely than their lean counterparts to develop heart disease. That risk increased to 80% in women who were moderately overweight, while those who were obese were more than 300% more likely to develop heart disease. On the other side of this coin, data show that maintaining an ideal body weight, as compared with being obese, can reduce the risk of coronary disease by 35% to 55%.
The National Institutes of Health recommends using the Body Mass Index (BMI) reproduced on pages 24–25. Find your height and weight on the chart and the corresponding BMI. Then assess your BMI in light of the guidelines on page 26.
BMI Condition Risk Classification
19 to 24.9 Healthy weight Desirable25 to 29.9 Overweight Borderline high30 to 39.9 Obese High40 to 54 Very obese Very high
The link between heart disease and overweight is particularly strong if the excess weight is carried around the middle. Says Dr. William Castelli, former director of the Framingham Heart Study, “People with wide hips and flat bellies may seem overweight, but the extra weight does not seem to increase their cardiac risk as much as that of people with narrow hips and potbellies. Abdominal obesity, which is more a male problem, is predictive of coronary disease.” (See also page 34.)
Striking a balance between calories in and calories out is the key to managing weight. It’s that simple. If you want to lose weight, take in fewer calories and exercise a little more. Some tested principles for managing caloric intake include:
- Don’t diet! Crash dieting is a game for fools. The only thing lost in the long run is money. Smart dietary decisions are based on the question “How do I want to eat for a lifetime?”
- Do not skip meals.
- Do a kitchen makeover. If your refrigerator and cupboard shelves are filled with all kinds of junk food, that’s what you’ll eat. Clean out the high-calorie snacks and restock your kitchen with healthier choices.
- Cut your normal portion size by a third and watch out for supersizing in restaurants.
- Reduce high-calorie foods rich in fat and low-fiber carbohydrates. Eat protein-rich snacks to curb hunger.
- Drink eight glasses of water daily, or other healthy fluids.
Blood pressure is the force needed to move blood through the vascular system against the resistance of artery walls. High blood pressure, or hypertension, occurs when blood pressure exceeds an upper limit for an extended period of time. This condition can take place when arteries become narrow and hardened, often the result of atherosclerosis. Then additional resistance is created, increasing the pressure needed to move blood through the system and making the heart work harder than normal. Over time, this added strain can cause injury to coronary artery walls and result in inflammation. According to the Framingham Heart Study, people with high blood pressure have five times the risk of a heart attack as those with normal blood pressure. Unfortunately, the percentage of people with high blood pressure has been steadily increasing in recent years, particularly in females, African Americans and Mexican Americans.
“The view of blood pressure is changing,” says Dr. Paul Wheaton of Tulane University Health Sciences Center. “Doctors used to consider high blood pressure a disease people either had or did not have. But today we understand that the risk of dying from heart complications caused by high blood pressure is a graded risk. The higher the blood pressure, the higher the risk. The more you can take that pressure down, the more you can get the risk back down.”
Blood pressure is measured when the heart beats (systolic pressure) and then rests (diastolic pressure) and is expressed as two numbers representing millimeters of mercury (mm Hg). A systolic pressure of 120 and a diastolic pressure of 80 are typically expressed as 120/80, or “120 over 80.” “Normal” systolic pressure is below 120; “normal” diastolic pressure is below 80. High blood pressure is defined as any reading above 140/90. In recent years, however, readings between 120/80 and 139/89 have been labeled indications of a condition called prehypertension. The standards below, established by the National Heart, Lung and Blood Institute, reflect the debilitating effect of blood pressure even at lower levels. New science suggests that the risk of heart disease starts to rise with readings as low as 115/75 and doubles for each increase of 20/10.
Blood Pressure ReadingSystolic Diastolic Risk Classification
Below 120 Below 80 Optimal120 to 139 80 to 89 Prehypertension140 to 159 90 to 99 Stage 1 hypertensionAbove 160 Above 100 Stage 2 hypertension
As Americans get older and fatter, the number of adults with high blood pressure has climbed to almost one in three. Fortunately, healthy eating can have a very positive impact on blood pressure.
One study found that overweight people lowered their blood pressure by one point for every kilogram (2.2 pounds) of body weight they were able to lose.
Suggested dietary actions include:
- Use portion control to moderate caloric intake (along with increased physical activity) to shed excess pounds, if necessary.
- Eat less salt and sodium.
- Emphasize potassium-rich foods (such as white beans, tomato paste, yogurt, bananas, apricots, avocados, sweet potatoes, lima beans, tuna, cantaloupe, winter squash and spinach). Cut down on foods low in potassium (such as white bread, doughnuts, soft drinks and junk food).
- Limit alcohol and caffeine.
- Eat foods rich in antioxidants (fruits, vegetables and nuts).
Regular exercise, along with not smoking and stress management, can also help.
Excerpted from “The Road to a Healthy Heart Runs Through the Kitchen” by Joseph C. Piscatella. Copyright © 2005, Joseph C. Piscatella. All rights reserved. Published by Workman Publishing. No part of this excerpt can be used without permission of the publisher.