James Gandolfini's tragic death as one of our entertainment stars is a wake up call to all of us. James Gandolfini died of heart disease at the premature age of 51. Now that his 2013 film Enough Said is available on DVD, we will again miss this star who won three Emmies, seven Screen Actor Guild Awards and a Golden Globe. We will miss his outstanding portrayals and moving roles.
Since heart disease is the number one killer of both men and women in the United States, recalling Gandolfini's death should make each of us ask, could this happen to me? And as Barbara Streisand, a leading heart health advocate points out, women as well as men (maybe even more than men: The Yentl syndrome) should be asking this question since women more often have unsuspected heart problems.
Is James Gandolfini the only celebrity who has had heart disease? Not at all! At the very young age 51, James Gandolfini died suddenly of heart disease. Surgery corrected Star Jones' valvular heart disease. Chest pains prompted Rosie O'Donnell to find out she had coronary heart disease and have a stent inserted. After his quadruple coronary artery bypass surgery at age 57 in 2004, Bill Clinton again had problems requiring double coronary artery stents in 2010. And in August 2013, George W. Bush had stents to keep his heart disease controlled. Are you next?
This disease is all around us. In 2010, approximately 598,000 men and women died of heart disease, accounting for 25 percent of all deaths in the U.S. So it is time we all knew all about the risks of the disease, how to prevent it, and how to recognize a heart attack.
And in what is to me the Year of Health 2014, it's even more important to personally know these facts. With more people having health insurance, and no more doctors, the time and attention our doctors have to advise each of us about risk assessment, prevention and emergency care is shrinking. So as I emphasize in my book Surviving American Medicine, it is time for each o f us to take control of our medical care and bring specific questions about heart disease (and other illnesses as well) to our doctors for personalized answers.
What causes heart disease? This not-at-all surprising list includes diabetes, being overweight or obese, having a poor diet, high blood pressure, not having exercise, smoking, high cholesterol or triglyceride levels, a family history of heart disease, and drinking excess alcohol. In people who are taking medicine to control any of these factors, not taking medicine (which is very common!) is an added risk.
Each of us should be aware of the symptoms that cause people to go to the doctor and which often are the first signs of undiagnosed heart disease. These include shortness of breath; fatigue; pain (in the chest, neck, back, arms or even stomach); irregular heart beat (palpitations) or ankle swelling. Acute sudden problems that should make us go to the emergency room immediately (and by ambulance or 911 call if possible) include pain, feeling weak or faint or dizzy, having a cold sweat, pressure in the chest, or sudden onset of irregular heart beat.
Here are my nine tips for preventing and caring for heart disease:
• Know your own personal risk: take the few minutes to calculate your own 10-year risk of heart disease online with a Heart Disease Risk Tool. Then discuss your risk with your own doctor. If your doctor does not take the time to get you a good prevention plan, get a second opinion with another primary care physician or with a cardiologist.
• Check in my book Surviving American Medicine for advice on how to get a longer visit with your physician to discuss heart disease care and prevention.
• Remember, preventive care is a 100-percent covered benefit under the Affordable Care Act (ObamaCare) in 2014, so insist on receiving your prevention visit.
• Follow a good diet that can reduce risk of heart disease: low salt, low fat, more fruits and vegetables (at least five helpings each day).
• Don't smoke. And if you do, get the help of your doctor (as well as your family and friends) to help you stop smoking. Medicines can help you be successful, but you have to get your physician's help for prescriptions and monitoring.
• Know your own blood pressure, and if it is at all borderline (I use the criteria above 120 systolic or 80 diastolic), see your doctor for preventive medicines and monitoring. At any pharmacy, big box store or online, buy yourself a home blood-pressure monitor and record your BP in your own diary to keep it under control.
• Know your fasting blood-sugar level. If it is over 100 mg/dl, discuss with your doctor lowering it by diet and/or mild medicine.
• Know your BMI, the measure of being overweight or obese. Discuss with your doctor if your BMI needs some improvement. I suggest keeping it at least under 30 (threshold for being obese) -- and preferably under 25 (upper range of normal) with diet and exercise.
• Do exercise daily, and keep a diary of how well you are doing. Enlist the help of your family or friends (even your physician) to keep you on track (pun a little intended).
Try to take this advice to heart, your heart, and that of your loved ones. Do this for a heart attack-free 2014.