This is the first in a three-part series on heart disease and the latest advances in treating it.

Coronary heart disease (CHD) is the nation’s number one killer. This year alone, more than a million Americans will be affected by heart disease, and some 480,000 will die as a result. The statistics are frightening, but you can take steps to reduce your risks for CHD.

What is coronary heart disease?

“Coronary heart disease occurs when arteries leading to the heart become clogged with cholesterol, other fatty substances, and calcium,” explains Andrew Benn, M.D., director of Non-invasive Cardiology at John Muir Medical Center, Walnut Creek Campus. “The narrowing process progresses over time. When the accumulated plaque suddenly cracks open forming a clot that closes an artery supplying blood to the heart, a heart attack occurs. The affected part of the heart muscle can be damaged unless blood flow is promptly restored.”

What are warning signs of a heart attack?

In general, warning signs persist for more than a few minutes. They may come and go. You may experience a few but not all symptoms, or none of the following:

• Chest pain or discomfort (pressure, tightness, squeezing or burning)
• Chest pain that spreads to the neck, jaw, or to one or both arms
• Shortness of breath; trouble breathing
• Nausea or vomiting
• Sweating or cold, clammy skin
• Weakness, dizziness or fainting

“Women usually have milder, less obvious symptoms than men, especially before menopause,” adds Patrick Kavanaugh, M.D., chairman, Division of Cardiology, at John Muir Medical Center, Concord Campus Medical Center. “With women’s life spans increasing, their incidence of heart disease after age 60 is approaching that of men.”

What you can do

If you or someone you know has signs of a heart attack, you must act fast. Don’t minimize or ignore the symptoms. Call 9-1-1 and wait for an ambulance. This is preferable to having someone drive you to the nearest emergency room in case complications occur en route to the hospital. Never drive yourself! You should loosen tight clothing, sit or lie down, and try to remain calm.

You may be instructed to chew an adult-strength aspirin or take nitroglycerin (if prescribed). CPR by a properly trained person is appropriate if the victim is not breathing and has no pulse. “Taking one aspirin daily cannot in itself prevent a heart attack, but it may limit your complications,” says Dr. Kavanaugh.

How does heart disease develop?

Almost every adult has some build-up of fatty substances inside their artery walls. The condition may worsen through a variety of risk factors. If a blockage is 70 percent or more, your heart may still receive enough oxygen while you’re resting. However, during exertion or excitement, you may experience chest pain (angina) or breathlessness due to reduced blood flow. These symptoms generally subside with rest.

What are risk factors for heart disease?

• A family history of heart attack before age 55
• Smoking
• High cholesterol; both LDL (“bad cholesterol”) and HDL (“good cholesterol”) measurements are needed
• High triglycerides (above 200)
• High blood pressure (above 140/90)
• Obesity (more than 20 percent above ideal weight)
• Diabetes
• Sedentary lifestyle
• Stress
• High homocysteine levels—(up to one-third of heart attack victims have elevated blood levels of the amino acid homocysteine)
• Post-menopausal women without hormonal replacement

In the last decade, there has actually been a dramatic decline in the number of deaths from heart attacks. In 1970, nearly a million Americans died of heart attacks. Most experts believe that increased awareness of cardiovascular risk factors and their correction has played a major role in cutting the death toll.

“Except for your family history, every one of the lifestyle factors is correctable or controllable,” says Dr. Benn. “The physician needs to carefully follow the patient’s risk factors. Both patient and physician must be strongly committed to making the necessary lifestyle changes and modifying the existing risk factors.”