As reported by the New Britain Herald, January 9, 2005.

Heart Disease Dangers Exist for Both Genders

By Tricia Stuart

FARMINGTON -- Peter Schulman, a cardiologist at the University of Connecticut Health Center, is a medical warrior against unhealthy lifestyles.
"Smoking is so addicting. When I have told someone to quit and they have a heart attack two years later, I hate telling them, ‘I told you so.’"

He despises the high cost those lifestyles take in terms of suffering and death, and as long as that battle exists, he will fight it.

Schulman points out that, according to the American Heart Association, heart disease is the leading cause of death in the U.S. While he realizes that most people will wait until it’s almost too late to make positive lifestyle changes, he is passionate about trying to get people to wake up before it is too late.

"(Heart disease) kills more people than the next six causes of death combined. Heart disease in men is going down; in women, it is going up. Every year in the 1900s, except for the flu epidemic in 1918, heart disease was the leading cause of death in the U.S.," he said.

Schulman cites smoking as the leading cause of heart disease.

"In 1969, when the surgeon general stated that smoking can be hazardous to health, there began to be a down-turn in heart disease."

The main risk factors for heart disease, said Schulman, are cigarette smoking, high cholesterol, hypertension (high blood pressure), diabetes, a family history of heart disease, increasing age and a sedentary lifestyle. Studies have shown that males are also more likely to get heart disease than females.

"If you want to have a heart attack or a stroke, keep smoking. The best incentive for quitting is a heart attack," said Schulman.

Schulman is not a proponent of dieting for the sake of dieting or for the intention of losing weight, but he has looked at diet plans for heart health.

"None of the published diet plans proved beneficial: Weight Watchers, Optifast, Jenny Craig. Only Weight Watchers had benefit in terms of weight loss under scientific scrutiny," he said.

Schulman has been comparing the Atkins low carbohydrate diet compared to the low calorie diet.

"For many years, cardiologists felt that these diets would be detrimental for heart patients, that they would increase heart disease," he said. "There was a highly controlled Atkins and Dean Ornish study. The Atkins diet was slightly more efficient in lowering cholesterol because it causes protein loss in short-term studies. Cholesterol levels were better in the Atkins and that translates to better heart levels. It lowers the levels of bad cholesterol and raises the levels of good cholesterol. But it has not been tested in the long-term. It is still being studied."

The American Heart Association recommends a low fat, low calorie diet to maintain heart health.

National policy, from the National Cholesterol Education Panel, recommends less than 30 percent of calorie intake should be from fat. There should be a balance of protein and carbohydrates and an appropriate calorie amount for one’s age and weight.

Most American diets have higher fat calories by 50 percent. Schulman said not everyone would have a dramatic change when trying to improve cholesterol levels. Improvement is usually in the 5 to 10 percent range, and no more.

"A low carbohydrate diet usually works better. But a lot of it is genetic and no matter what you do, you can’t reduce your cholesterol. In some patients, if you’re one of those with the bad genes, the diet is not going to help," he said.

"Some experts say, ‘in the U.S., we celebrate things with meals.’ Until you change that, there will be problems. We shouldn’t celebrate a birthday with an orgy of cake and cookies because everything is celebrated with that kind of orgy. To counteract that, it’s almost impossible; it’s swimming against the tide," he said.

Schulman said there are medications that work on the basic mechanisms of hunger, but every medicine has side effects.

"Aspirin would never get approved now. It causes bleeding and bruising but it reduces heart attack risk by 40 percent. Nothing comes for free," Schulman said.

He notes that in Scandinavian countries, during the deprivations of World War II when there was no beef, that heart disease decreased.

He said that diabetes can be improved through diet and that "a lot of adult diabetes is caused by obesity."

"Diet does play a role (but) it isn’t the only role. About half of the people decrease heart disease by diet, half from advances in medical science," he said. "Alcohol doesn’t have an effect in moderation, but excessive drinking can cause a toxic effect on the heart, which causes pumping action defects and rhythm dysfunctions. Red wine may have a potential antioxidant effect."

He said that exercise is good and that it increases the endorphins and neurotransmitters that promote a sense of well being.

"People are less depressed, they lose weight, and it increases the efficiency of the heart," said Schulman.

Schulman also recommends that people be active.

"People need to know what their blood pressure is; they need to know what their cholesterol is; they need to not smoke. As far as a low carbohydrate diet, the jury is still out on it. I recommend people cut down on carbohydrates. You don’t have to go bananas. You don’t have to cut out everything. A vegetarian diet is okay as long as the person gets good knowledge."

Schulman said that heart disease was thought to be a man’s disease, but it’s as much a woman’s disease as a man’s disease.

"One in 20 women will die of breast cancer. One in two-and-a-half women will die of heart disease. The mortal risk from heart disease is greater than a ten-fold factor. Heart disease in women is not decreasing; it is increasing."

Major dents in lifestyle would make a huge difference, according to Schulman. "But in the meantime, we have better drugs to improve cholesterol metabolism."