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One-half of American men and one-third of women 40 and younger will develop heart disease at some time in their lives, according to the Centers for Disease Control and Prevention, in Atlanta. But there are other reasons why for men the situation is particularly dire. Not only do they suffer from cardiac disease an average of 10 years earlier than women, they're also more likely to die prematurely from it: Men account for more than 70 percent of heart-disease deaths occurring before age 65.
Yet healthy middle-aged men "tend to minimize the potential risks and symptoms" of a cardiovascular condition, says Michael Fleming, MD, president of the American Academy of Family Physicians. "It's not uncommon for a man to come in to see me and say, 'I've been having this chest pain for the last two months,' and be unaware that he may be moments away from a heart attack." Here are five new heart facts men -- and the women in their lives -- need to know.
Uncontrolled anger and hostility have long been linked with heart disease in men, but a study published in March is the first to show that a fiery temper can cause a specific heart-rhythm disorder known as atrial fibrillation (AF), which can lead to stroke and death. The study followed 1,769 men and 1,913 women whose average age was 49. Men who scored high on several standard psychological tests that measured anger (meaning they had more angry outbursts, got furious when criticized, and said their tempers frequently made them feel like hitting someone) and hostility (meaning they were more likely to act contemptuously toward others) were 10 to 30 percent likelier to develop AF than men who were not angry or hostile. The hotheaded ones were also 20 percent likelier to die from any cause. In contrast, emotional eruptions didn't affect women's heart health, perhaps because they develop rhythm disorders later than men.
Another possibility: "Anger and hostility may not be risk factors for women," says head researcher Elaine D. Eaker, ScD, president and owner of Eaker Epidemiology Enterprises in Chili, Wisconsin.
Particularly worrisome for the men: In the same study, two-thirds of the men who developed AF did so before age 60, and most of them had no known signs of heart disease. "AF usually occurs in older people who already have had structural problems with their hearts," says Dr. Eaker. "The take-home message is that for men, letting your anger out is not necessarily good if you express it in a fiery, hotheaded way." The results, published in Circulation, the journal of the American Heart Association, suggest that if your man is prone to temper tantrums, you should help him relax before he blows a gasket.
The next time you accuse the man in your life of hanging out with the guys too much, consider this: Men who spend time with friends on a regular basis are about half as likely as their isolated counterparts to develop heart disease.
A 2004 study published in the European Heart Journal followed 741 50-year-old men for 15 years and noted their levels of social support. It found that friendless men were more likely to have evidence of inflammation in their blood vessels. While the mechanisms by which relationships make for a healthier heart are still unclear, researchers note that the differences in the men who had many friends versus those who didn't were not related to stress or standard risk factors for heart disease, such as smoking, obesity, and high blood pressure.
When it comes to the "bad" LDL cholesterol, can you go too low? The answer appears to be no. Currently, guidelines call for LDL cholesterol to be less than 100 mg/dL. But a March study led by Steven Nissen, MD, a cardiologist at the Cleveland Clinic, in Ohio, suggests that intensive treatment with a statin drug that reduced LDL even lower than the recommendation had a significant benefit.
In examining more than 500 patients with coronary artery disease, Dr. Nissen and colleagues found that the men (and women) who took a high 80-milligram dose of Lipitor (considered an intensive cholesterol-lowering regimen) reduced their LDL to an average of 79 mg/dL, while those taking 40 mg of Pravachol (considered a moderate cholesterol-lowering regimen) had levels that averaged 110 mg/dL. A subsequent study of 4,000 patients sponsored by the makers of Pravachol came up with similar results: Within a month, the patients taking Lipitor had significantly lower risk of heart attack, bypass surgery, angioplasty, and death than patients taking Pravachol.
"This is a stunning change of direction," says Dr. Nissen. "Of the 36 million Americans eligible for treatment, only 11 million are actually receiving statin drugs, let alone the maximum dosage. It means we have to get physicians to be much more aggressive." How low should you go? That's still under investigation, but researchers are talking about an LDL of 60 or less. Men, however, shouldn't pop pills in lieu of lifestyle changes. "If you smoke, stop. It's deadly," Dr. Nissen says. "If you have high blood pressure, get it treated. And, women, if you want your husbands to live longer, get them off the couch and on an exercise program."
Men with coronary artery disease are often treated with angioplasty, a minimally invasive procedure that uses a small flexible tube, or stent, to open clogged arteries. But now it appears that a mere 20 minutes a day on an exercise bike may be more effective than angioplasty at preventing a subsequent heart attack, according to a report in the March 2004 issue of Circulation.
The study involved 101 men ages 70 and younger, all of whom had at least a 75 percent narrowing of one artery, who were randomly assigned to either the exercise regimen or the stenting procedure. After a year, both groups had an improvement in symptoms such as less chest pain, but 88 percent of the men who exercised were spared a heart attack, compared with 70 percent of the men who underwent angioplasty, an 18 percent advantage. Because this was a small study, it's too early to suggest all men swap angioplasty for exercise. But meanwhile, adding exercise to medical treatment is always a good move.
Cardiologists typically advise men with high blood pressure not to imbibe alcohol because heavy consumption can raise blood pressure. But new research suggests that light to moderate drinking reduces the risk of death from heart disease among this group of men. A study of 14,000 male physicians over age 40 with hypertension found that those who had one to two drinks a day (any type of alcohol) were 44 percent less likely to die of heart disease over a five-year period than hypertensive men who rarely or never drank.
The results, published in the Archives of Internal Medicine, were no surprise to lead researcher J. Michael Gaziano, MD, a cardiologist at Brigham and Women's and the Veterans Affairs hospitals in Boston. "It didn't make sense that these people should avoid alcohol completely," he says. "In more than 100 studies, light to moderate drinking reduced the risk of death from any cause." This protection is probably due to the fact that alcohol raises levels of good cholesterol, which helps reduce the amount of plaque in the arteries. While official guidelines aren't likely to change soon, it can't hurt to talk to your doctor about the benefits and risks of moderate drinking.
Originally published in Ladies' Home Journal magazine, June 2004.