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Heart to Heart: A Personal Plan for Creating a Heart - Healthy Family

Heart to Heart: A Personal Plan for Creating a Heart - Healthy Family

by Lori Mosca, Mehmet Oz (Foreword by)

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Finally, information meets inspiration for today's busy spouse, parent, caregiver, provider...and everything else you're expected to be.

You worry about your father's bad habits. Your mother's refusal to listen to her doctor. Your spouse's cholesterol. Your children's diet. For better or worse, you're the center of your family's universe and the person trying


Finally, information meets inspiration for today's busy spouse, parent, caregiver, provider...and everything else you're expected to be.

You worry about your father's bad habits. Your mother's refusal to listen to her doctor. Your spouse's cholesterol. Your children's diet. For better or worse, you're the center of your family's universe and the person trying desperately to keep them all healthy. As if you weren't busy enough!

Dr. Lori Mosca is not only one of America's top doctors; she is also a wife, a mother and a daughter. She's been where you're standing, and her message is simple: To improve your family's health, you have to start with yourself. And there are three steps to do it.

Know It. Knowledge is power. This goes beyond diet and fitness to stress management, personal fulfillment, daily attitude and spiritual practice. Happiness and health are not mutually exclusive.

Nurture It. Take care of your heart, but also your soul. Don't deprive yourself of what makes your life enjoyable. Nurture the better, healthier parts of your routine. Gradually incorporate changes that make you healthy, happy and vital.

Share It. Lead by example and your family will follow. Have healthy fun together and share not just your knowledge but your time. A healthy heart isn't another item on your "to do" list, but a new attitude that will make life easier-and give you more time and energy to share with those you love.

Dr. Lori Mosca has helped thousands take control of their lives and their health. Her proven program for family heart health is transforming the practice of medicine in hospitals and doctors' offices across the nation. Now let it transform you and your family-for life!

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Read an Excerpt



The Wake-Up Call

'Nothing in life is to be feared,
only to be understood.'

—Marie Curie

'I feel like I have a vice on my chest.'

I'll never forget those words from my very first 'patient.' It was 1982, and I was twenty-three, a second-year medical student studying for the medical boards in the wee hours of a morning in May. Until that point in my career, medicine was confined to lectures and textbooks. But then came the 2 a.m. knock, knock at my door—and the wake-up call that would change my life forever. It was my dad.

'Dad? Dad, what's the matter?'

If I ever saw a heart attack, this is it, I remember thinking when I saw my father, Joe LaBella, a fifty-three-year-old mail carrier from Syracuse, New York, bracing himself against the threshold of my childhood bedroom. It was like something you might now see in a movie or a television commercial for a heart disease drug: Dad's fist was clenched to his heart, his T-shirt dampened in a stripe right down the middle. Clearly, Dad was in trouble, but at least he didn't have to go far to look for help. To keep expenses down throughout medical school, I lived at home. Dad simply had to lumber up a flight of stairs. Still, what I offered in terms of convenience, I lacked in experience. Dad was probably having a heart attack. That much I knew. But what to do?

Call an ambulance? As it turns out, that wasn't an option. A proud Italian male, my father insisted that I not lift the phone—that we quietly slip out of the house to a local emergency room. 'Don't tell your mother, and don't call the rescue squad, because it will wake her,' he instructed, refuting my plan. That was just like Dad, not wanting to bother or worry anyone. He never wanted to let on if he was having a problem. Still, the fact he came to me for help clued me in. This must be really bad. I thought for a second. If I insist on phoning for help anyway, Dad will probably worry so much about upsetting Mom that he'll have an even worse heart attack and drop dead. I reasoned that I had been a lifeguard for ten years by then, so I knew CPR. I could help him if he had a problem. So that was that. We got in the car and headed to the emergency room.

CPR—An Important Skill

When the heart stops completely during an attack (cardiac arrest), and the person loses consciousness and stops breathing, cardiopulmonary resuscitation (CPR) can save lives. I remember clearly one patient whose life was saved because his wife knew and performed CPR. It's an important skill to know that can help you be prepared in the event of a heart attack or another life-threatening situation. To locate a CPR training center near you, log on to the American Heart Association Web site at www.americanheart.org and check under the 'Find a Class' option.

On our clandestine mission, Dad and I drove down Woodbine Avenue, past the rows of small but well-kept single- and double-family homes. They were filled with the children, parents and grandparents we knew, people who shared everything from driveways to major life experiences. We moved to the Syracuse neighborhood after our family of seven outgrew a flat in the inner city. As I'd done a thousand times since I was old enough to drive, I stopped at the intersection, waiting to turn left onto James Street, which would take us to the hospital. In the middle of the night, the streets were eerily empty. Still, I dutifully waited at the red light for what seemed like hours. Fortunately, Dad had his senses. 'Go through the light, Lori,' he said gently, peering into my eyes. It was then it hit me. Dad's really having a heart attack. He might die. The fear welled up. I pressed on the accelerator.

You can probably imagine the doctors, nurses and orderlies running around in the emergency room, putting IVs in Dad, just trying to do all this stuff. I told the attending physician I was a medical student and pretty sure my father was having a heart attack. When the emergency room physician showed me the results of Dad's electrocardiogram (ECG), which is the most important initial diagnostic test to be administered when a heart attack is suspected, I pretended I could read it, but my mind was spinning. 'Your father is having a heart attack, and I need you to make a decision,' she said. I was filled with dread. Making a life-or-death call was the last thing I wanted to do in that already stress-filled moment. In fact, what began running through my mind like a ticker tape was not, What can we do to treat Dad? but What could we have done to prevent this?

As it turns out, the hospital was participating in one of the early pharmaceutical clinical studies of thrombolytic therapy, testing what we now call 'clot-busting' drugs, which are used to dissolve blood clots blocking an artery during a heart attack. We now know that clot busters open up the artery and restore blood flow to the heart. They're crucial for stopping a heart attack in its tracks. To be most effective, they need to be administered as soon as possible after symptoms begin.

But at that point in medical history, we were still finding our way. Folks in the throes of a heart attack like Dad would be needed to help researchers make that determination. Did I want Dad to participate in the clot-buster study? I yearned to call my mother, who was still at home, asleep, to get her input, but there wasn't time. 'You need to decide right now,' the physician said.

I took a minute to explain the situation to my father, who was by this time rigged to an arsenal of equipment, an unnerving beep . . . beep . . . beep in the background. Maybe he would know what to do. Don't dads know everything? 'You decide,' he said. My twenty-three-year-old mind ran through the options. If Dad received the new drug, there was some risk of internal bleeding, which wasn't good. But there was also a chance that the damage his heart endured from the heart attack would be reduced. Yes, no. Yes, no. I weighed the options. 'He should participate in the clinical trial,' I told the physician, who promptly made a telephone call that would determine if Dad would receive the experimental drug or not. Unfortunately, we were told that he did not meet all the criteria to be in the study.

I broke the news to Dad, who was cringing from pain, even though he was receiving morphine. Now what? Over 40 percent of first heart attacks are fatal. I didn't know that statistic then. Still, I had a sense there might only be minutes left, so I finally called my mother and broke the news. I didn't want to rob her of the chance to say good-bye. We decided not to wake up my younger brother John, a junior in high school sleeping at home, because he was scheduled to take the SATs that morning. Later, he too, would become a doctor, but for now he was my little brother and I needed to shield him. Then I went back to Dad's bedside and took his hand. 'You're a great dad,' I began to stammer. I could feel myself losing it. He turned to me from behind the veil of tubes. 'Don't start to show it,' he said.

I was taken aback, but I got it. The last thing Dad needed was for me to be a window to the end. He wanted me to be strong. But how could I be? To pull myself together, I took refuge in the nearest restroom. There, I was struck by the hospital-regulation basic white sink with overhanging mirror. Feeling a familiar tug from my Catholic upbringing, I couldn't help but notice how much the fixtures looked like an altar. Kneeling on the bathroom's chilly tile, I pleaded with God not to take my father. Please don't let him die. Hope­fully, at a time when there was doubtless ample suffering in the world, I could garner God's attention. I didn't know what else to do.

I just couldn't imagine what I would do without my father. Dad had been my support for so much of my life, through all my forays into competitive sports, from grade school through medical school. And I still needed him. My mother was proud of me, and always there for me, but I someday wanted to walk down the aisle at my wedding on my father's arm.

Everybody deals with crises differently, and when my mother arrived at the hospital, my father got a scolding. 'Joe, I told you not to smoke,' she said. It was true. My father had acquired the habit during his army days, and we were all constantly hounding him to quit. And even though Dad was a mail carrier who got lots of exercise, his physical fitness didn't override his smoking. Interestingly, just prior to his heart attack, he was told his total cholesterol was normal. But we would later learn that he actually had low levels of HDL, the 'good' cholesterol that protects the heart against heart disease, which wasn't reflected in Dad's 'total' number. Admittedly, Dad's diet could have been better. Even ­walk­ing several miles a day couldn't undo all those years of Italian sausage!

Wisdom 911

I learned so many important lessons on that early morning in May, right before I was to start my clinical training and the second two years of medical school: seeing a heart attack happening and experiencing such a huge loss of control, having to make dire life-or-death decisions in an instant; feeling I was about to lose someone I loved—without the chance to tidy up affairs or really tell him how much he meant to me. With heart disease, the leading killer of both men and women in the United States, it's no doubt that countless people experience a similarly frightening scenario, whether it be a stranger on the subway, a close family member or a coworker who was just a minute ago typing away at his desk. We all hear stories. And based on the statistics, there's a good chance that one day that person could be you or your father, mother, spouse, friend or grandparent—either as victim or ­rescuer.

What could Dad or we have done differently to avoid this medical crisis? As it turns out, plenty! Because, despite all of the scary statistics surrounding heart disease, there's a fact that most of us overlook: it is preventable. It doesn't have to happen to you or someone you love. If you play your cards right by knowing and taking a few small steps, which I'll discuss throughout this book, you can avoid being the one in the emergency room who is making those tough medical decisions or undergoing treatment. And that's my mission: to help you take action to prevent heart disease and live a long, healthy life.

Your Heart—The Inside Story

But first, a biology lesson. To defeat heart disease—public health enemy number one—you should get familiar with your heart. Your heart is the most important muscle in your body because if it stops working, so does everything else. Here's a brief job description of what your heart does and what can go wrong.

Each day, your heart works hard for you, continuously pumping blood throughout your body, whether you're reading quietly or racing for the bus. About the size of your fist, your heart beats (expands and contracts) an average of one hundred thousand times each day and circulates about two thousand gallons of blood. Because the heart is the epicenter of your body, it gets fed first with blood from coronary arteries. They're responsible for keeping the heart well supplied with a lifeline of oxygenated, nutrient-rich blood.

During a heart attack, the blood supply to the heart becomes severely reduced or cut off because one or more arteries become blocked by a blood clot. Blood clots don't happen by themselves. When arterial plaque is soft and filled with cholesterol, it builds up in arteries and becomes unstable and inflamed. Through a complex sequence of biochemical events, it then develops a crack or fissure, which releases substances that encourage clot formation. To be specific, it's usually a clot attached to a plaque that causes a heart attack because no blood can get through to supply oxygen and other nutrients to the working heart muscle. That's why risk factors for plaque buildup—inflammation and clotting—are important to be aware of and track.

When a heart attack occurs and blood flow is restricted, the heart muscle may not be able to effectively propel blood to the rest of the body, including the lungs. Subsequently, cells in the heart muscle don't receive enough life-giving oxygen and begin to die, which starts happening in just a few minutes. Because heart cells don't regenerate, the loss is permanent and can cause disability or even death. Time is of the essence. When symptoms of a heart attack occur, the clock starts ticking. In fact, half of the deaths from heart attacks occur in the first three or four hours after symptoms begin.

But if we take steps to recognize heart disease early on, it's much more treatable. It's akin to breast cancer and mammography screening. It's better to be aware of the signs and symptoms of heart disease and take heed by alerting your doctor as soon as possible that something's up. Awareness is key.

Know the Warning Signs

Over half of those who die suddenly from a heart attack—two-thirds of whom are women—have no previous recognized symptoms. Like my father, many people don't even know they have heart disease until the heart sets off its flare guns in the form of a heart attack. In the United States, heart disease will strike an estimated 1.2 million this year alone according to the National Heart, Lung, and Blood Institute, and kill over five hundred thousand. But, in retrospect, the signs may have been there but missed or dismissed. The symptoms, especially in women, can be sneaky.

Knowing these warning signs may someday save a life—and it may be yours or that of someone you love.

Common Signs and Symptoms of Heart Disease:

• Chest discomfort or pain (angina). This is the most typical ­symptom of heart disease. It's usually discomfort in the center of the chest or an uncomfortable pressure or pain that lasts for more than a few minutes or goes away and comes back. Other symptoms include heaviness, tightness, pain, burning, pressure or squeezing, usually behind the breast bone (sternum). These symptoms might radiate down the left arm or to the jaw or back.

• Shortness of breath. The feeling that you can't catch your breath is another classic sign of an impending heart attack. It often accompanies chest discomfort, but it can occur alone or before the chest pain starts.

• Sweating (or diaphoresis). Many patients, like my father, break out in a cold sweat; feeling clammy is a classic sign of a heart attack. It usually accompanies chest pain.

Medically known as a myocardial infarction, a heart attack is a medical emergency. We now realize that the best thing you can do if you or someone you know has chest pain is to immediately call 911 or your local emergency services (if 911 is not available in your area) because the time between the onset of symptoms and getting treatment is a critical determinant of survival. Don't wait. Far too many lives are lost because individuals are unsure of what's wrong, not realizing that time is critical. Clearly, it's better to be safe than sorry. Emergency services ­personnel can begin treatment as soon as they arrive.

When you call 911, you may be instructed to have the person experiencing symptoms chew one noncoated adult or two baby aspirin (if he or she is conscious), which helps improve the chances of survival by reducing the clot in the artery. If you're not instructed to use aspirin, do it anyway (as long as there's no aspirin allergy). But don't make the mistake of many and chew the aspirin, then wait for the pain to subside before making your 911 call. Pick up the phone first.

Also, check the time your symptoms began, so you can tell medical personnel. Why is timing so important? Remember the clot busters I mentioned in conjunction with my father's heart attack? Thanks to research, thrombolytic therapy and/or percutaneous coronary intervention (i.e. angioplasty) is now standard treatment for heart attack patients. Thrombolytics help preserve the heart muscle by dissolving clots that block an artery, which restores blood flow, like unkinking the garden hose. But here's the catch: for clot busters to be most effective, you need to receive them as soon as possible after the start of heart attack symptoms and preferably within one hour. Unfortunately, research shows the average patient with a heart attack waits two hours before seeking medical care after symptoms start. Don't take a 'wait and see' approach because rapid action and intervention can not only save heart muscle, but possibly your life!

Less Common Warning Signs of Heart Disease

Heart attacks don't always give themselves away with classic signs. Sometimes symptoms are subtler. These less-common indicators of heart disease are considered atypical because most people experience more traditional signs. However, women are more likely to have atypical symptoms than are men. I've had many female patients recount how unusually tired they felt, for example, for about a month prior to their heart attacks. Tell your doctor if you have any of these symptoms:

• Unexplained fatigue

• Dizziness/light-headedness

• Headache

• Upset stomach/nausea

• Rapid heartbeat

• Feeling of impending doom

Some of these symptoms sound common. We all may have experienced them at one time or another. How do we know when to be concerned and seek medical care? First of all, note whether the symptoms occur with physical exertion or emotional strain. If the symptoms disappear with rest, they're more worrisome for heart disease. For example, I've had patients describe headaches that came on whenever they exerted themselves. That's an atypical symptom of heart disease that should be evaluated, especially if you have a family history or risk factors for heart disease.

Are the symptoms progressive in nature? If they're coming on more frequently or lasting longer, it may suggest unstable heart disease or a type of crescendo angina. I had a patient with frequent headaches that were increasing in severity. None of the physicians he saw could find anything wrong. Sure enough, he ended up having a heart attack and came to me after the fact to see how to ­prevent it from recurring. The first thing we talked about was recognizing that once you have an atypical symptom, that's most likely the way your heart disease is going to manifest itself again. That's Mother Nature's specific way of telling you that your heart isn't getting enough oxygen or blood. Anytime this patient has increasing headaches, he is on high alert to take it seriously and contact me.

Your Heart Disease Prevention 'Coach'

As the director of Preventive Cardiology for NewYork-Presbyterian Hospital of Columbia and Cornell Universities in New York City, my life's work is to enhance the heart health of my patients and the public through high-quality and novel clinical service, research and educational programs. Inspired by my father's experience, I'm particularly committed to a family-centered approach to prevention. There's plenty of information out there about how to reduce your chances of having a heart attack, but sometimes your doctor may not talk to you about it. In medical school, we're trained to treat acute problems, with much less focus on how to prevent them. After I finished my internal medicine residency training, I pursued a fellowship in preventive cardiology so I could fill knowledge gaps in prevention that I knew someday might save a life, even of someone in my own family.

As a clinician, researcher and daughter, I've seen firsthand what happens when people take their health for granted. Professionally, I've witnessed the challenges well-intentioned patients have with incorporating positive lifestyle changes—and making them stick. I've also seen people die, or have their loved ones die, because of denial and lack of knowledge about how to prevent heart disease. It's devastating to lose someone we love too early in life, especially due to something preventable like heart disease. But why do we often wait until it's almost too late? That question took root on that May morning during my father's heart attack.

My passion for a career in preventive cardiology was further galvanized when, as an attending physician at the Syracuse Veterans Administration Hospital, I treated many veterans who had diseases and conditions—from diabetes and obesity to high cholesterol and high blood pressure—that resulted from poor lifestyle habits. I felt ill equipped to counsel these patients on the importance of eating better, getting more exercise and quitting smoking. The field of preventive cardiology was just emerging in the late 1980s when I was setting out; the medical profession was just beginning to make the connection between improving health habits and reducing disease risk. Even today, my own research shows doctors don't feel very effective in helping their patients reduce their risk of heart disease. That's why public awareness and education programs are so important. Knowing this, I sought a master's degree in public health and a Ph.D. in ­epidemiology. I realized that I needed more formal research ­training to find out the best ways to help doctors and patients alike.

Now, as the president of the American Society for Preventive Cardiology and the third woman in history to be chair of the American Heart Association Council on Epidemiology and Prevention, I'm so grateful to be in a position to forge a national research and public health agenda in prevention, and to develop strategies to translate science into real-life practice. I'm funded by the National Institutes of Health and have received early and mid-career research awards from the National Heart, Lung, and Blood Institute. I'm committed to seeing the tremendous advances in science used to improve public health.

Consider that an estimated 64 million Americans have one or more forms of cardiovascular disease (CVD), which includes acute heart attack, stroke and other forms of vascular ­disease throughout the body. While there are many forms of heart disease—from valve infections such as endocarditis to arterial conditions such as peripheral arterial disease—I'm going to focus on preventing atherosclerotic CVD, or hardening of the arteries, which is the main cause of heart attacks. The good news is that most of what we do to prevent heart attacks also helps prevent strokes and the hardening of other arteries throughout the body. According to the American Heart Association, heart disease kills more Americans than cancer, AIDS and drunk driving combined. I firmly believe that if we don't do more to personally combat CVD for ourselves and our families, it's going to prematurely claim the lives of millions more.

Our children are especially at risk for heart disease. Naturally, we want our kids to be healthy and stay that way throughout adulthood, but with tempting vending machines infiltrating schools and physical education programs being cut or eliminated across the country, it's no wonder that almost 9 million U.S. kids are now overweight or obese.

The problem doesn't end once the braces come off. Overweight kids have as much as an 80 percent chance of staying that way as adults and suffering from weight-related health problems earlier on, such as type 2 diabetes and, you guessed it, CVD. Given the staggering statistics and all that the medical profession knows about heart disease, we aren't doing enough to prevent the onslaught. Knowledge isn't enough. It's going to take a personal commitment. Let this book be your wake-up call to action.

In Heart to Heart, I'm going to have a personal discussion with you about CVD—not only as a researcher and clinician, but also as a daughter, wife and mother. I'll present a family-centered approach—and I use the term family liberally for whatever your circle of support and influence is. Like it or not, studies show that health habits emanate from the top down, and in this book, you're at the top. If you practice heart-healthy habits, so will your spouse, significant others, children, friends and anyone else you may touch. If you're taking care of your parents or other elders, they're apt to take your lead as well. It's a big responsibility, but somebody's gotta do it. But don't be afraid; I'll give you plenty of help for steering everyone in the right direction. (There's a reason why my sons, who are twelve and fifteen years old, selected a Mother's Day card that referred to me as 'the advice channel.')

The chapters in Heart to Heart represent a distilled version of my twenty years of practice and ongoing education since medical school. I incorporate the ways I try to keep my own family healthy. In the following pages, I'll help you learn how to effectively:

• Make health—yours and that of your family—your top ­priority.

• Assess your CVD risk and genetic susceptibility, based on your personal and family medical history.

• Manage two major and common risk factors for CVD: high blood pressure and high cholesterol, and help your family do so as well.

• Understand the lifestyle risk factors that contribute to CVD, including obesity, smoking, stress, poor diet and lack of exercise, and how much of an impact making just small steps in the right direction can help.

• Motivate your loved ones to exercise regularly and eat a heart-healthy diet.

• Grasp the new heart-health guidelines and understand what they mean for you and your family.

• Get a big-picture perspective on heart health, including how seemingly unimportant habits, like routinely taking time for yourself, can actually help keep this major killer at bay.

• Talk to your doctor about the diagnostic tests you may need to improve your odds if your family or personal medical ­history is stacked against you, and other effective ways to help your doctor help you.

I'm also going to help you:

• Understand alternative/complementary therapies for CVD. From belladonna to yohimbine, herbal therapy is an area of treatment you may be investigating. I'll give you my take on this emerging field of medicine in relation to CVD prevention and discuss the potential efficacy and the risk of other over-the-counter therapies, such as antioxidants, multivitamins and other supplements.

• Learn about major blood pressure, cholesterol and diabetes drugs for when lifestyle isn't enough to minimize your CVD risk. I'll also provide a detailed discussion on CVD drugs you may have heard about, including statins, ACE inhibitors/
ARBs, beta-blockers, aspirin therapy and other blood thinners/
antiplatelet agents.

• Put prevention into action by role-modeling healthy lifestyle habits for your family.

Throughout, I'll share lessons learned over the years from my patients who became my teachers, and my own personal experiences as a physician-scientist, wife, mother and daughter, and how I try to practice what I teach. I'll share with you the life skills I've tried to arm my sons with that I hope someday they'll pass down, too, just like a cherished family recipe. You, too, may be the cog in the wheel of your family's heart health, and through a family-centered approach, I hope to help you keep moving in the right direction.

Boomers at Risk

Contrary to popular belief, although the risk of CVD increases with age, it's not only a disease of the old. In fact, baby boomers—those born between 1946 and 1964—are especially at risk, be­cause that's when the disease tends to start—in middle age— although often silently, at first.

CVD doesn't discriminate based on income or celebrity status. We all know someone with CVD, even if we don't know them personally. Former president Bill Clinton, for example, who was just fifty-eight when he underwent successful quadruple coronary bypass surgery at our hospital in September 2004, is a heart disease survivor and boomer. President Clinton was fortunate because he got medical intervention before having a heart attack, which might have been fatal. It was a wake-up call for him and millions of Americans around his age. If it can happen to a former president who has access to the best medical care in the world, it can happen to any one of us. The good news is that just like the former president, we can adjust and make positive lifestyle changes that can save us.

If you're a baby boomer like Bill Clinton and me, you're one of seventy-six million Americans at an age in which CVD should be on your radar screen. It's a disease that threatens to kill a majority of our generation. In fact, 34 percent of men (5.6 million) and 29 percent of women (6.3 million) between the ages of forty-five and fifty-four already have CVD. According to the Centers for Disease Control and Prevention, that percentage increases to approximately half the U.S. ­population between the ages of fifty-five and sixty-four (12.1 million). Bottom line: if you're a boomer, you're not too young for CVD. In fact, now's the time to take steps to prevent the full-blown onset of it.

Wake Up Before It's Too Late

For me, it wasn't too late. In the end, my prayers were answered. Dad's heart wasn't extensively damaged by the heart attack in 1982. He survived that, as well as bypass surgeries of the heart, the legs and the carotid arteries feeding the brain. At seventy-six and married fifty years to my mom, he enjoys playing golf and being with his grandchildren. My two boys love to laugh at his jokes and get lessons on how to play pool—and above all, they think he is 'really cool.' I wish all stories had such a happy ending.

Unfortunately, many don't. I'll never forget the letter from a ten-year-old boy who donated $400 to the University of Michigan Division of Cardiology, where I served as director of Preventive Cardiology. The letter struck a chord because it echoed how I felt about my own father, and my older son happened to also be ten at the time. The boy was getting ready to go to school when the phone rang and his mother answered. When she put the phone down, she had to tell her son that his father had died of a heart attack during his business trip. He would never come home. To this day, reading his letter is difficult for me to get through. The fourth-grader wrote:

. . . so in this envelope is an amount of $400.00. I hope this money will help stop heart disiese [sic] and save someone's life. You don't relieze [sic] how much something means to you until it's gone. The time we had together I wouldn't sell for the world. I would give anything to have just one more day with him.

Many patients, like this boy's father, don't get another shot. And that's the problem with heart disease. You don't always get a warning or the opportunity to put everything in order or the chance to prevent what didn't have to kill you in the first place. I have dedicated my career to heart disease prevention because I don't think any child should ever have to get that phone call. Here was a little boy, putting on his backpack, running out the door to school. He didn't get to grow up with his father or even say good-bye. This isn't how it has to happen. Knowledge is the power to change our lives as we know them. Action is the ability to change how we live. Congratulations for taking the first step to a long and healthy life.


We'll complete this and every chapter with three key points I hope you'll remember about preventing heart disease. Three is a favorite number for me not just because I love triathlons, which I'll talk about more in the exercise chapter, but because I have a habit of summarizing the most important facts from any lecture I've heard or given down to three. Here are three from this chapter I hope you'll take to heart.

1. Don't think it can't happen to you. If heart disease affects over sixty-four million Americans, you or someone you love could easily be one of them. One American dies of cardiovascular disease every thirty-three seconds. The good news is that heart disease is preventable. You don't have to become a statistic.

2. Know the symptoms. The symptoms of heart attacks are: chest pain, shortness of breath, pain radiating down the arm or through the jaw, neck or back, or cold sweating. Be aware of these less common symptoms, too, which may signal a heart attack is on its way: unexplained fatigue, dizziness/light-headedness, nausea, head­ache, rapid heartbeat, a feeling of impending doom.

3. Don't wait. The greater the time delay between identifying symptoms and getting to an emergency room, where lifesaving drugs and interventions are available, the greater the chances a heart attack will lead to extensive heart damage. It's what we call 'time to needle.' Fast treatment can mean the difference between life and death. If you or someone you know is experiencing symptoms of a heart attack, call 911 or your local emergency services immediately. Often they can start life-saving treatment even before you get to the hospital, so it's important they transport you. Remember, when symptoms start, so does the clock.

©2007. Lori Mosca, M.D. All rights reserved. Reprinted from Heart to Heart-A Personal Plan for Creating a Heart - Healthy Family. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, without the written permission of the publisher. Publisher: Health Communications, Inc., 3201 SW 15th Street, Deerfield Beach , FL 33442.

Meet the Author

Lori Mosca, M.D., M.P.H., Ph.D., is Director of Preventive Cardiology at New York-Presbyterian Hospital, Associate Professor of Medicine at Columbia University College of Physicians and Surgeons, and the founder and Director of the Columbia Center for Heart Disease Prevention in midtown Manhattan. She lives in Northern New Jersey.

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