ATLANTA -- Gary Peter's family history came calling one hot,
summer morning two years ago.
Knock. Knock.
The 36-year-old felt a shoulder pain as he got ready to go to
work. The day before, he had felt nauseous after a run. It was
during his morning shower that Peter's ticking genetic time bomb
really exploded. A heart attack got him, just as it had his mom and
dad. Hours later, a gurney whisked him toward emergency angioplasty
surgery.
``Both my parents have heart disease, so I knew I was
predisposed to it,'' said Peter, a Georgia Tech professor. ``But I
didn't think it would strike at such a young age.''
At 5-foot-10, 170 pounds, fit, active, a nonsmoker who ate a
low-fat diet, Peter was not your typical ``heart attack waiting to
happen.'' Even the paramedics and emergency room doctors thought
so.
``They were resistant to believing I was actually having a heart
attack. They didn't even turn on the siren and they drove side
streets to the hospital. My wife beat them there,'' he said.
``There were no apparent risk factors other than my genetics.''
Some 58 million Americans have cardiovascular disease, and of
those, half have a family history of bad hearts hanging over them,
called a genetic predisposition. The magnitude of risk increases
for a person based on how many first-degree relatives -- mother,
father, brothers, sisters -- died before age 55 or were hospitalized
for heart disease before age 55. If two or more relatives did, risk
increases 53 percent; one relative, 35 percent. If a first-degree
relative suffered cardiovascular disease at any age, there's an
added risk of 6 percent to 16 percent of suffering cardiovascular
problems, a 1986 University of Utah School of Medicine study found.
``Genetics is one of the most important predictors of heart
disease,'' says Dr. Laurence S. Sperling, cardiologist at the Emory
HealthCare Heart Center and medical director of the Emory HeartWise
Risk Reduction Program. ``The first-degree relatives of mom, dad
and siblings are most important to consider: Were they smokers or
obese? Some people can do everything right -- eat right, exercise
and not smoke, yet they still develop heart disease at a young
age.''
Case in point -- Peter, one of Sperling's patients. Peter says
his father was a longtime smoker and his mother had high blood
pressure. Both had elevated cholesterol, something Peter assumed he
was controlling with a good diet and exercise. However, the cause
of his heart attack was a complete blockage of a major heart
artery. A blood clot had broken off from the fatty cholesterol
plaque forming within the artery.
Peter's overall cholesterol was 250 -- a reading of 240 or over
immediately raises a red flag for doctors, who usually order more
tests. But Peter says he didn't know his cholesterol was so high.
Often, the first sign of high cholesterol is a serious cardiac
event, the reason why heart disease and high blood pressure are
often called ``the silent killer.'' According to the American Heart
Association, 57 percent of men and 64 percent of women who die
suddenly from heart disease had no previous symptoms. Overall,
about one-third of people suffering heart attacks die.
Despite the luck of personal family history, individuals can
still do plenty to keep themselves from becoming a heart attack or
stroke statistic. Maybe your dad smoked -- increasing his heart
disease odds by 300 percent, or maybe your brother was obese, ate
high-fat food, and acquired Type 2 diabetes, a highly lethal
combination.
``About 50 percent of risk of heart disease comes from genes and
50 percent-plus comes from environmental factors,'' Sperling says.
These are the things you do or don't do every day, such as
smoking, taking a brisk walk or other regular physical activity,
keeping your weight under control, or gobbling potato chips at
lunch, hamburgers for dinner and never, ever turning down birthday
cake at the office.
Yes, yes, yes, we know we are tempting fate by playing Russian
roulette with these diabetes and heart-disease risk factors. This
is where hospital and health care preventative heart disease
programs come in, such as the ones at Emory, Piedmont, St. Joseph's
and Northside hospitals -- Atlanta's major cardiac wellness centers.
Emory's HeartWise program, going into its third year, not only
works with people who've suffered heart problems, but those who
don't yet feel any symptoms. Helping people with heart disease
family risk learn how to lower risk factors they can control is a
growing trend in cardiovascular care.
``You can't change your genetics,'' Sperling says. ``But you can
greatly alter your genes reaching their potential. Heart disease is
the No. 1 cause of premature death in this country, but people
still seem to be under the impression it's a disease of old men.''
The statistics belie that. Though only 1 in 10 women will
develop breast cancer if they live to age 75 (1 in 8 if she lives
past age 85), 1 in 2 women will have heart disease. And 35 percent
of all cardiovascular disease deaths are premature -- before age 75.
At age 39, Sheryl Winn knew she was at risk because of her
weight, high cholesterol and family history. But even Winn, a
former cardiac nurse, didn't know just how susceptible she was to
ending up like her mom and dad. Her mother died following a balloon
angioplasty to open clogged heart arteries, and her father, now 74,
underwent two bypass surgeries following a heart attack.
A blood test revealed Winn had high levels of homocysteine, an
amino acid that damages arterial walls if it concentrates in the
blood. Winn's condition is caused by one of 38 genes identified as
heart disease markers. Folic acid supplements help control it. Winn
also is using her treadmill at home and has altered her meals after
a dietitian scrutinized what she ate. She's lost 43 pounds and is
trying to lose 50 more and lower her cholesterol before resorting
to prescription drugs.
``Prevention is the real key with cardiac disease,'' says Winn,
who teaches nursing at Emory University and lives in Dallas. ``Any
time you have a heart attack, you lose some function of the heart
muscle and you never get it back.''
Winn is signing up for all the HeartWise tests and consultants,
even though her health insurance is not picking up the entire tab,
a common occurrence when it comes to heart prevention costs.
Checking insurance coverage is part of the HeartWise services.
Sliding scale fees can be charged based on income, and a
scholarship fund established by patients with insurance helps those
lacking coverage. Medicare does cover most costs.
Insurance paid for Winn's initial visits and blood work, but not
her nutrition counseling, and it probably won't pitch in for her to
join the clinic's exercise facility, she says. Winn also expects to
be left with the $500 bill to undergo an Ultrafast CT scan that
could spot plaque forming.
``I'm not having any symptoms now of heart disease, but I want
to know if there was some potential blockage because then I can do
something about it,'' Winn says.
Assessing risk for heart disease is done with a complete family
history and physical examination. Patients can also be put on a
treadmill tethered to a heart monitor to test cardiac function, or
undergo an echocardiogram, where they hear the drum of their heart
and see the heart muscle. An action plan follows, tailored to each
individual through appointments with exercise physiologists,
dietitians and doctors who may prescribe drugs to treat
cholesterol, blood pressure or diabetes. Many classes are also
offered for reducing stress, quitting smoking and managing blood
pressure.
Three floors above the Emory heart clinic is a new workout
facility chock-full of every conceivable exercise machine to raise
a person's heart rate, along with weight machines. Yoga,
cardio-kickboxing and aerobic classes are also offered. A nurse
keeps close tabs on patients, but the facility also is used by
healthy Emory employees who pay a user fee.
At Piedmont Hospital's Fuqua Heart Center of Atlanta, two
programs are geared toward those who've already experienced a
cardiac event: Inpatient education and 12 weeks of early outpatient
classes that include exercise, EKG treadmill monitoring,
nutritional assessment and stress and smoking cessation classes.
A third program is geared toward prevention for those with
heart-disease risk factors or for individuals with at least three
months' time since their cardiac event.
``We think it's good for people with risk factors to be in with
people who've undergone heart attacks or cardiac surgery,'' said
Dr. John Cantwell, Piedmont's co-director of preventive cardiology
and cardiac rehab. ``They learn from one another.''
St. Joseph's Hospital offers a ``Heart School,'' open to the
public to learn how to ward off heart disease. It also sees
hundreds of people at its wellness center who haven't experienced
any cardiac symptoms and want to keep it that way, as well as those
who've undergone bypasses and heart transplants.
``We see a lot of obese people and people with hypertension,''
says Mark Ervin, St. Joseph's wellness/rehab manager, ``but the
staff is qualified to take care of them.''
Despite the heart heritage that caught up to Peter, he says he
believes he can beat, or at least stall, the disease from rapping
again on his door.
``Being a scientist, I may look at it differently. I know
there's a genetic component, but it's not cancer, it's heart
disease,'' says Peter, whose cholesterol has dropped to 170 through
exercise, dietary changes and medication that's monitored through
the Emory HeartWise program. ``At least with heart disease, you
have more self-control over it. You can play a more active role.
It's a day-to-day disease. I have to be vigilant.''
