Physical Activity and Your Health

According to the Centers for Disease Control and Prevention (CDC), 60% of Americans are not meeting the recommended levels of physical activity. Fully 16% of Americans are not active at all. Overall, women tend to be less active than men, and older people are less likely to get regular physical activity than younger individuals.

In a recent article published in Circulation: Journal of the American Heart Association, researchers from the Harvard Medical School released data from the 10-year Women’s Health study that showed moderate exercise reduced the risk of heart disease by 27% to 41%. the study was performed on 27,055 participants.

The mechanism of benefit was shown to be largely due to the reduction of LDL (bad cholesterol), raising HDL (good cholesterol) and reducing inflammation.

It is well-known that inflammation leads to the release of molecules called cytokines that can cause damage to the blood vessels in the heart and throughout the body. Cholesterol tends to deposit at these damaged sites, leading to plaque. the damaged vessels containing increased cholesterol deposits are the sites where platelets attach to blood vessels. These clumps of platelets can break off and completely block the blood vessel as it narrows downstream. In the coronary arteries, this leads to an acute heart attack; in the brain, it causes either a major or a minor stroke.

As little as two hours of brisk walking every week was sufficient to lower the risk of major cardiac events dramatically. Can you imagine that if all you do is walk briskly for 17 minutes daily, your risk of heart disease will go down by 40%? Regular physical activity is defined as about 30 minutes of moderate activity (preferably all days of the week) can reduce the risk of heart disease. One can lower your chances of having a stroke, colon cancer, high blood pressure, diabetes and other medical problems.

If you’re also trying to manage your weight and prevent gradual, unhealthy weight gain, try to get 60 minutes of moderate to vigorous-intensity activity on most days of the week. At the same time, watch your calorie intake. Take in only enough calories to maintain your weight. I often counsel my patients to eat no more than 350 calories a meal four to six times a day. Most of our bodies cannot metabolize more than this amount so large meals that many of us are used to will cause us to store weight and develop fatty tissue.

I often share the following scenario with my patients:

Patient A – Eats two large meals daily of 750 calories each – totalling 1500 calories.

Patient B – Eats five small meals of 300 calories each about 2-3 hours apart – totalling 1500 calories.

Q: Who will lose weight?

A: Patient B

By eating only the calories the body can burn, patient B will likely lose weight coupled with regular physical activity. Unfortunately, Patient A is unable to burn the extra 450 calories they eat at each meal and that totals 900 extra calories daily. 1 pound is about 3500 calories. In about 4 days, a person can gain an unwanted pound of weight eating this way and it can be exacerbated if they are physically inactive.

Another example: A 200 pound person who keeps on eating the same amount of calories, but walks briskly each day for 1.5 miles, will lose about 14 pounds in one year. Staying active will also help to keep the weight off. Second, you can eat fewer calories and be more active. This is the best way to lose weight, since you’re more likely to be successful by combining a healthful, lower-calorie diet with physical activity.

For example, a 200 pound person who consumes 250 fewer calories per day, and begins to walk briskly for 1.5 miles each day will lose about 40 pounds in one year.

As you can see, about 2/3 of weight loss is attributed to diet, but we need physical activity to help us stave off medical problems including heart disease.

Heart Disease

Heart disease occurs when the arteries that supply blood to the heart muscle become hardened and narrowed, due to a buildup of plaque on the arteries’ inner walls. Plaque is the accumulation of fat, cholesterol and other substances. As plaque continues to build up in the arteries, blood flow to the heart is reduced. Heart disease can lead to a heart attack. A heart attack happens when a cholesterol-rich plaque bursts and releases its contents into the bloodstream. This causes a blood clot to form over the plaque, totally blocking blood flow through the artery and preventing vital oxygen and nutrients from getting to the heart. A heart attack can cause permanent damage to the heart muscle. Some people aren’t too concerned about heart disease because they think it can be cured with surgery.

This is a myth. Heart disease is a lifelong condition. It’s true that certain procedures can help blood and oxygen flow more easily to the heart. But the arteries remain damaged, which means you are still more likely to have a heart attack. What’s more, the condition of you blood vessels will steadily worsen unless you make changes in your daily habits and control other factors that increase risk.

You have control.

Physical inactivity is one of several major risk factors for heart disease that you can do something about. The others are:

• Smoking. People who smoke are up to six times more likely to suffer a heart attack than non-smokers, and the risk increases with the number of cigarettes smoked each day.
• High Blood Pressure. Also known as hypertension, high blood pressure increases your risk of heart disease, stroke, kidney disease, and congestive heart failure.
• High Blood Cholesterol. High Blood Cholesterol can lead to the buildup of plaque in your arteries, which raises the risk of a heart attack. Starting at age 20, everyone should have their cholesterol levels checked by means of a blood test called a “lipoprotein profile”. You can lower high blood cholesterol by getting regular physical activity, eating less saturated fat and trans fat, and managing your weight. In some cases, medication is also needed.
• Overweight. If you are overweight or obese, you are more likely to develop heart disease even if you have no other risk factors. Ask your doctor to help you determine whether you need to lose weight for your health. The good news: Losing just 5-10% of your current weight will help to lower your risk of heart disease and many other medical disorders.
• Diabetes greatly increases your risk for heart disease, stroke, and other serious diseases. Ask your doctor whether you should be tested for it. Many people at high risk for diabetes can prevent or delay the disease by reducing calories as part of a healthy eating plan, and by becoming more physically active.

Taking Precautions

Some people should get medical advice before starting, or significantly increasing physical activity. Check with your doctor first if you:

• Are over 40 years old and not used to moderately energetic activity.
• Currently have a heart condition, have developed chest pain within the last month, or have had a heart attack. (Also see the section, “After a Heart Attack”)
• Have a parent or sibling who developed heart disease at an early age.
• Have any other chronic health problem or risk factors for a chronic disease.
• Tend to easily lose your balance or become dizzy.
• Feel extremely breathless after mild exertion.
• Are on any type of medication.

While physical activity can strengthen the heart, some types of activity may worsen existing heart problems. Warning signals include sudden dizziness, cold sweat, paleness, fainting, extreme breathlessness, or pain or pressure in your upper body. These symptoms may occur during, or just after, an activity. Ignoring these signals and continuing your activity may lead to serious heart problems. Instead, call your doctor right away.

Overall, it is best to get regular comprehensive evaluations to help understand how best to incorporate the right type of exercies in your life to help reduce your risk of heart disease and other illnesses.

Vincent Caracciolo, MD, FACC
First Coast Heart & Vascular Center, PA

Dr. Caracciolo Interview with WSOS

Dr. Caracciolo Interview with WSOS

Dr. Caracciolo had an interview with St. Augustine’s 99.5 WSOS radio.

Listen to Dr. Caracciolo’s interview with WSOS

 

Peripheral Arterial Disease (P.A.D.)

What is P.A.D.?

P.A.D. is short for Peripheral Arterial Disease. People have P.A.D. when the arteries in their legs become narrowed or clogged with fatty deposits, or plaque. The buildup of plaque causes the arteries to harden and narrow, which is called  atherosclerosis . When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced. Some people call this poor circulation.

P.A.D. occurs most often in the arteries in the legs, but it also can affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys and the stomach. When arteries that supply the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.

 

The good news is that like other diseases related to the arteries, P.A.D. can be treated by making lifestyle changes, by taking medicines, or by undergoing leg artery angioplasty or vascular surgery, if needed. And you can live well with P.A.D.

 

Is P.A.D. serious?

P.A.D. is a serious disease commonly affecting Americans over the age of 50. The hardened arteries found in people with P.A.D. are a sign that they are likely to have hardened and narrowed arteries to the heart and the brain. That is why people with P.A.D. have a two- to six-times greater chance of death from a heart attack or a stroke.

When the blood flow to the legs is greatly (or severely) reduced, people with P.A.D. may have pain when walking. P.A.D. may cause other problems that can lead to amputation of a toe, foot or a leg. People with P.A.D. may become disabled and not be able to go to work. As time goes on, they may have a very poor quality of life.

Who is at risk for P.A.D.?

The chance of having P.A.D. increases as you get older. People over age 50 have a higher risk for P.A.D., but the risk

is increased if you:

• Smoke, or used to smoke
• Have diabetes
• Have high blood pressure
• Have abnormal blood cholesterol levels
• Are of African American ethnicity
• Have had heart disease, a heart attack or a stroke
• Have a family history of P.A.D., heart attack or stroke.

What are the warning signs or symptoms of P.A.D.?

P.A.D. develops slowly over many years. In the early stages, most people with P.A.D. have no symptoms. Only about one out of four people with P.A.D. actually feel typical symptoms of P.A.D. in their leg muscles (known as “claudication”, defined below). By that time, their arteries may be so clogged or hardened that they are not getting enough oxygen to supply their leg muscles.

The most common signs of P.A.D. include one or more of these problems:

•  Cramps, tiredness or pain in your legs, thighs or buttocks that always happens when you walk but that goes away when you rest. This is called claudication.
•  Foot or toe pain at rest that often disturbs your sleep.
• Skin wounds or ulcers on your feet or toes that are slow to heal, or that do not heal.

Sometimes, people ignore their leg pain and think it is just a sign that they are getting older. As a result, many people with P.A.D. do not know they have it and do not get treatment. It is important to discuss any leg or thigh pain you may be having with your health care provider since it may be a warning sign of a serious disease such as P.A.D.

How do I find out if I have P.A.D.?

If you think you have P.A.D., see your health care provider and talk about any symptoms you are having and go over your medical history and your risk factors for P.A.D. Your provider will examine the pulses in your feet and legs. If your provider finds those pulses are weak and thinks you may have P.A.D., your provider may order a test called the ABI, which stands for ankle-brachial index .

The ABI is the best test for finding out if you have P.A.D. It uses sound waves to find out if there is reduced blood flow in the arteries. It also compares the blood pressure in your ankles with the blood pressure in your arms. P.A.D. also can be diagnosed by other tests that measure blood pressures in the leg (segmental pressure), toe pressures (toe-brachial index or TBI) or artery blood flow (with ultrasound).  Other more sophisticated tests can be performed such as PVR ( pulse volume recordings), CTA ( Cat scan) , magnetic resonance angiography (MRA) or catheterization or angiography.

 

How is P.A.D. treated?

P.A.D. can be treated with lifestyle changes, medicines and surgery, if needed. Since people with P.A.D. are at high risk for heart attacks and stroke, they must take charge of controlling their risk factors related to cardiovascular disease.

These life-saving steps will help to prevent and control P.A.D.:

•  Get help to quit smoking and set a quit date now.
•  Lower your blood pressure to less than 140/90 mmHg or less than 130/80 mmHg if you have diabetes or chronic kidney disease.
• Lower your LDL (bad) cholesterol to less than 100 mg/dl or to less than 70 mg/dl if you are at very high risk for a heart attack or stroke (if you smoke, have diabetes or have chronic kidney disease).
• Manage your blood glucose to reach an A1C level of less than 7 and practice proper foot care if you have diabetes.
• Talk to your doctor about taking antiplatelet medicines such as aspirin or clopidogrel (Plavix)  to prevent clotting.
• Follow a healthy eating plan to control your blood pressure, cholesterol and blood glucose (for diabetes).
• Get regular exercise such as walking for 30 minutes at least 3 or 4 times per week.

If you have pain or cramps in your legs, ask your health care provider about an exercise program that will help improve your symptoms. If possible, get a referral to a special P.A.D. exercise program.

For most people with P.A.D., these life-saving steps may be enough to slow down the disease and even improve any symptoms. If needed, your health care provider can refer you to a specialist for procedures or surgery to treat arteries that are severely blocked. These procedures often help people with P.A.D. to improve symptoms and to avoid losing a foot or leg.

Remember:

Finding and treating P.A.D. early can help keep your legs healthy, lower your risk for heart attack or stroke, and save your life and limbs.

Our board certified interventional cardiologists and vascular specialists have an extensive experience with interventions to treat simple to complex  vascular blockages in any vascular bed or organ including carotids ( neck arteries),  arms , kidney arteries, stomach or intestinal arteries, leg arteries as well as heart arteries.   Our experts use simple balloon angioplasty, stents to more complex atherectomy devices, laser catheters, and clot buster catheters to remove clots or cholesterol plaques.   If you wish to make an appointment with our doctors, please contact us at (904)-423-0010 or visit our web site (www.firstcoastheart.com) for our 8 locations or phone numbers in three counties.

Recommended website
Vascular Disease
Pad Coalition