Heart Health Part Four: When Diet and Exercise Aren’t Enough

Navy Hospital Corpsman 1st Class Harvey Canto measures medication in the pharmacy. In many patients, when diet and exercise are not enough to sufficiently improve blood pressure and cholesterol values, prescription medications have been proven to save lives. (U.S. Navy photo by Mass Communication Specialist 3rd Class Lacordrick Wilson)

Ok, so you’re doing all you can to take care of your heart. You’ve thrown out the cigarettes, you’re eating meals with plenty of fruits and vegetables that are low in sugar, salt and saturated fats and you exercise every day. But your blood pressure and cholesterol are still too high, and your heart might be suffering the consequences. Now what? As they say in the ads: sometimes, diet and exercise aren’t enough.

“Even if you’re doing all you can, there is often residual risk due to persistently elevated blood pressure and cholesterol levels,” said Army Lt. Col. Todd Villines, the cardiology consultant to the Army Surgeon General and a practicing cardiologist at Walter Reed National Military Medical Center.“Sometimes our family history (genetics) is a bit stronger than all the good we try to do to keep our hearts healthy. It’s what we call an unmodifiable risk.”

Fortunately, the Military Health System does a good job of screening for cardiovascular risk factors, Villines said. Annual personal health assessments, better known as PHAs, often catch elevated blood pressure and bad cholesterol levels that pose increased long-term risk if left untreated. He added if you have a family history of heart disease (heart attack, stroke or blocked artery in the heart or blood vessels requiring a stent or heart bypass surgery) in a close relative, this could indicate a genetic propensity to problems in your future. Villines said no matter your background, the best advice is to talk with your doctor about your estimated risk of developing heart disease or having a stroke. But just because it runs in your family doesn’t mean it has to run in you, too. “A conversation with your doctor can make all the difference,” said Villines.

Villines also pointed to the value in what is known as a coronary artery calcium scan. This low-radiation dose scan of the heart looks for evidence of cholesterol build-up containing calcium that occurs in the arteries that supply blood to the heart. These scans can accurately detect and quantify the amount of heart artery plaque and offer a more accurate way of evaluating a patient’s risk for heart disease, particularly in those who use medications to lower blood cholesterol, known as statins. “I would offer this test to someone middle-aged who has a family history of heart disease or has some risk factors for heart disease, but there remains uncertainty as to whether they need to take a statin to lower their cholesterol and reduce their heart disease risk. A calcium scan, unlike an equation that estimates risk, gives patients and their doctors a much clearer picture of what is going on.”

In many patients, when diet and exercise are not enough to sufficiently improve blood pressure and cholesterol values, prescription medications have been proven to save lives. For example, in patients at high risk for developing heart disease, statin therapies and blood pressure control, in accordance with national guidelines, are proven to reduce the risk of a first heart attack, stroke or dying from heart disease. Villines said the right combination of diet, exercise, and where appropriate, medications can help you and your heart live a long, healthy life.

“We can help people with a wide variety of risks that could affect their heart health,” he said. “The key is knowing your risk factors and having the best plan of action to control them all.”

For more information on taking care of your heart, check out the Integrative Cardiac Health Project, a source to help recognize the risks for cardiovascular disease along with strategies to improve and sustain healthy lifestyle behaviors. Also, the Military Health System website makes resources available on its Heart Health page.

By: Military Health System Communications Office