Heart Pounding of a Different Sort. By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Direct to consumer advertising has throngs of patients showing up at my office asking for multiples of cholesterol testing in the hopes that the results may vindicate a poor life style. The tests are done in the fasting state to check your genetic predisposition. It is useless as a marker of your diet, but for some it continues to be a contest. "Smart ads" on the tube suggest that taking a pill will make up for the poor lifestyle. We are continually refining our knowledge of what causes heart attacks and how to prevent them. It seems that the heart attack rate in our society continues to increase despite millions of people taking cholesterol pills now. Equating overeating junk food and obesity with heart attacks is a tad too simple. Thinking that fat blocks arteries until they are choked off is also an oversimplification. I see lots of obese seniors who seem to have made it to ripe old ages. Thanks to television, most of us consider cholesterol to be evil. A recent study published in The Lancet caught my eye. The researchers looked at the evidence provided by numerous industry-backed studies suggesting that treating slightly elevated cholesterol numbers was of some benefit. They simply removed small sub-groups of severely afflicted patients, which lent most of the studies a marginal positive result. They found that for the majority of patients taking lipid-lowering drugs without any other health problems, there seemed to be no clear benefits. Of interest is that this is the largest consumer group. To a large degree the blame probably does fall on us doctors. This is not to suggest that if you have had a heart attack, are diabetic or have heart disease that you should stop. The point is that lifestyle changes are probably the most important, but hardest to achieve factors.

Our bodies manufacture the different sub-types of cholesterol for specific uses. They do not simply float around and cling to the side of our arteries. In some people it is the case, and there is enough plaque accumulated to significantly alter flow. When the flow cannot deliver enough oxygen to the heart, symptoms such as pain or breathlessness occur and something must be done. Things like enlarging the artery size with a stent or by-pass surgery are utilized. But heart attacks are often caused by blood clots occurring in the arteries. How these clots are formed used to be a bit of a mystery. Our main arteries are three ply structures. Excess cholesterol sub-particles such as VLD-L can lodge in the middle layer producing bulky structures called atheroma. Most of the atheroma don't really reduce flow significantly. What can happen is that the inner artery lining called the endothelium might sustain a micro-tear. When that happens, the body responds just like it does to any cut. Inflammation cascades and various cell types arrive to attempt repair, and platelets form clots thinking that bleeding is occurring. These clots stop the flow of blood and can result in the damage that is seen with a heart attack. The clots can be dissolved with clot-busting drugs if given quick enough. The process produces elevations in certain particles measured in the blood and work has been ongoing to use these various particles as predictors, but remains largely unproven at this time. Most predictive indexes incorporate multiple factors.

The best solution to worrying about your heart is to translate the worrying into lifestyle change motivation. How many pounds above that ideal weight are you? Do you exercise at least three times a week and a lot more? Are you overwhelmed by nutrition terms and labeling? Thinking that medication is a quick answer to patch flaws in our lifestyles is sure sign of health trouble.