Heart Care for Life: Developing the Program That Works Best for You

No two hearts are exactly alike. No two cases of heart disease are exactly alike. And certainly, no two people who suffer from it are alike, nor are their lifestyles. Many heart patients--a marathon runner in her 30s, an overweight middle-aged bus driver who smokes heavily, a relatively "healthy" 85-year-old retiree--bear almost no resemblance to each other. So why do so many of us, lay people and sometimes even healthcare professionals, talk about "heart disease" like it's a single entity?

That's a question Barry L. Zaret, MD, eminent cardiologist and co-author (along with Genell Subak-Sharpe) of Heart Care for Life: Developing the Program That Works Best for You (Yale University Press, 2006, ISBN: 0-300-10869-9, $26.00), wants us all to ponder this National Heart Month.

"Every case of heart disease is like a snowflake or a fingerprint," he says. "You just won't find two exactly alike. So it follows that no two treatment regimens are going to be exactly identical. What does this mean for heart patients? I think the most important point is this: you know you better than anyone else, including the most gifted, insightful physician in the world.

So you need to take a critical role in the design of your own lifelong program of care."
That is the main point of Zaret's groundbreaking book: patient empowerment. Heart Care for Life-- which is filled with practical advice, instructional case histories, questions to ask your doctor, and more--rejects short-term fixes and one-size-fits-all programs and urges patients to take control of their own health. Though certain characteristics are common to each form of heart disease and its treatments, these constants must be tempered against individual variables.

Here are a few of Zaret's insights:

· Understand the concept of constants and individual variables. Core values form the constants of cardiovascular health and include issues related to medical and surgical therapy, obesity, diet, exercise, stress, smoking, and various forms of diagnostic testing. Variables comprise the individual differences that define specific patients and are critical in developing a workable lifelong heart program . . . For example, a diet that does not take into account individual tastes, food preferences, and eating habits is generally a waste of time and effort. Socioeconomic status, education, presence of other diseases (comorbidity), occupation, interaction with one's spouse and family, and many other individual factors also affect the success of any treatment.

· Exercise. There is no excuse not to. Virtually everyone can undertake an exercise program, regardless of age, health, work schedule, and other circumstances. The book describes a patient named Alice, a 45-year-old mother of three, who believed exercise was dangerous after she had two heart attacks. But an exercise physiologist designed a regimen for her that started with walking ten to fifteen minutes a day. She started out walking to and from school with her children and eventually began lifting weights with a group of teachers in the school gym. "Alice is a prime example of a very busy person who can find time to exercise and--more important--enjoy the experience," write the authors.  "No matter how busy you are, you can find the time to exercise the recommended four or five times a week."

· Find the weight loss approach that works best for you. If you are overweight, as many heart patients are, you will need to find a way to take in less energy than you expend. It is usually best to combine a moderate reduction in calories with an increase in exercise. The key is in determining how you're going to cut those calories. Heart Care for Life offers several approaches to choose from: counting calories, cutting fats, and counting carbs. "Counting calories might work if you're a disciplined person who responds well to rules and structure," reflects Zaret. "If you enjoy a mostly vegetarian fare--lots of pasta, veggies, fruits, whole grains, and beans--cutting fats might be the way to go. Just choose what works for you. Diet is not a sometimes-thing--it's what you eat and drink every day of your life."

· Take control of stress. There is a lot of evidence suggesting that constant stress is linked to heart disease. That said, there is no way to remove all stress from your life. In fact, you wouldn't want to if you could. But there are things you can do to modify the harmful effects of stress. Again, what you do depends on your individual circumstances, lifestyle, and mindset. "For some people, daily exercise is enough to counter stress and, at the same time, improve heart health," notes Zaret. "Others might consider psychotherapy. Still others might strive to build a social network, adopt a pet, practice yoga or tai chi, or undergo biofeedback or anger management training. 

· Read up on the latest medical advances. In addition to the aforementioned "lifestyle" components, you may also benefit from prescription drugs, alternative therapies, or surgical procedures--or any combination thereof. Heart Care for Life provides a thorough, yet reader-friendly guide to the latest and best treatments available. Only by understanding what's out there can you work with your doctor to craft your own program of care. "Do not underestimate the value of knowledge," says Zaret. "Too many heart patients prefer to bury their heads in the sand and just follow doctor's orders. But ignorance is not bliss. An educated patient is a confident patient--and one well-equipped for partnering with his or her physician."

· Be mindful of issues relating to your age, gender, and race. Heart Care for Life has a separate section on "Populations with Special Concerns." Why? Well, because a 55-year-old African-American woman starting Hormone Replacement Therapy is very different from, say, the 85-year-old male mentioned in the opening paragraph who worried that he was "too old" for bypass surgery. (Incidentally, he was not too old--and the surgery was successful.) "Women tend to delay treating cardiovascular disease, elderly people tend to have high blood pressure, African-Americans have the world's highest death rate from heart attacks," says Zaret. "If you fall into one or more of these categories, these are facts you need to know when determining your treatment program. Again, and it can't be said too often, knowledge is power."

· Realize that emerging biologically based therapies offer reason for hope. All human beings need to believe that a brighter future lies ahead. Heart patients are certainly no exception. Dr. Zaret devotes a chapter to three biologically based therapies currently being developed--growing new blood vessels, stem cell therapy, and gene therapy--and connects them to that sustaining sense of hope we all need. "Work in these areas will expand and develop, while new areas of potential treatment involving biologically based therapies will appear on the scene," he promises. "Clearly, there is substantial scientific reason for patients and their families to feel hopeful that they, too, will benefit from these discoveries and their applications to heart disease."

Besides the fact that helping shape your own heart health plan is far more effective than being a passive recipient of "doctor's orders," it gives you a sense of control. And that, says Zaret, may make all the difference in your prognosis.

"Having no control over your own destiny is a recipe for depression and hopelessness," says Zaret. "If you don't emotionally 'buy into' your lifelong program, you almost certainly won't stick with it. And if you somehow manage to force your life into someone else's mold, you'll find the experience exhausting and joyless.

"That's why we wrote Heart Care for Life ," he adds. "We want people to know that having heart disease does not mean letting the condition define or defeat you. Work with your doctor to make decisions that feel right to you and you can stride toward a healthier future with a sense of accomplishment, power, and--most important of all--hope ."

About the Authors:
Barry L. Zaret, MD, is Robert W. Berliner Professor of Medicine and professor of radiology, Yale University School of Medicine. Dr. Zaret served as chief of the section of cardiology at Yale from 1978-2004 and has been a pioneer in developing the field of noninvasive diagnosis in cardiovascular disease, with an emphasis on nuclear cardiology. Genell Subak-Sharpe, MS, is president of G.S. Sharpe Communications, Inc. and has produced or collaborated on more than forty books in health and medicine.

About the Book:
Heart Care for Life: Developing the Program That Works Best for You
By Barry L. Zaret, MD, and Genell Subak-Sharpe, MS
To be published in February 2006
By Yale University Press
$26.00 hardcover, 288 pages