Heart Care Important Both Before and After Problems Occur

People need to take care of their hearts both before and after heart trouble starts, according to two new studies.

In the first study, reported in the journal Hypertension, researchers say that to avoid heart failure when you are ages 70 or 80, you must begin by keeping your blood pressure and weight under control when you are 50.

"We tested the hypothesis that higher levels of blood pressure and body mass index (BMI) in midlife would be powerful determinants of heart failure risk in later life," says lead researcher Dr. Ramachandran S. Vasan.

He proposed that the risk posed by preceding measurements would remain even after accounting for these risk factors measured later in life.

"This is exactly what we found," says Dr. Vasan, a senior investigator with the Framingham Heart Study and a professor of medicine at Boston University School of Medicine.

Body Weight, Blood Pressure Are Key

In the first study, an increase of about 20 points of systolic blood pressure at age 50 was associated with a 36 percent higher risk of heart failure up to 20 years later. Every one-point increase in BMI (a ratio of weight to height) at age 50 was associated with a 6 percent increase in the risk of heart failure, explains Dr. Vasan.

"The study highlights the importance of maintaining an ideal BMI and blood pressure over the life course of individuals," says Dr. Vasan.

For the study, Dr. Vasan's team collected data on 3,362 people who were part of the Framingham Heart Study who had routine examinations between 1969 and 1994. During follow-up, 518 people developed heart failure.

"The prevention of heart failure should begin early in life and should include screening for elevated blood pressure and BMI," says Dr. Vasan. "Failure to identify or treat such modifiable risk factors in early and mid-adulthood may result in the loss of opportunities to reduce the incidence of heart failure in later life."

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, says he agrees that keeping both your weight and blood pressure down will help you avoid the ravages of heart failure.

"The lifetime risk for developing heart failure in both men and women is one in five," says Dr. Fonarow. "However, heart failure can be prevented, and there are a number of modifiable risk factors for heart failure, including hypertension, obesity, and diabetes.

"Maintaining a healthy blood pressure and body weight is essential to reduce the risk of heart failure," he says.

The second study found that fewer than 20 percent of patients seek cardiac rehabilitation after a heart attack or coronary bypass surgery. The study results are published in the journal Circulation.

"It has been shown by many trials that cardiac rehabilitation reduced the risk for new coronary events, re-hospitalization, and mortality," says study leader Dr. Jose A. Suaya, at Brandeis University in Waltham, Mass.

"The main advantage of cardiac rehabilitation is to reduce mortality. Cardiac rehabilitation also improves functional capacity," says Dr. Suaya. "Patients can walk more without pain and improve their quality of life," he says.

For the study, Dr. Suaya's group collected data on 267,427 men and women, 65 and older, who had survived a heart attack or bypass surgery. The data were drawn from 1997 Medicare claims records.

In the year after hospital discharge, only 18.7 percent of the patients had at least one session of cardiac rehabilitation. Patients who underwent bypass surgery were more likely to seek rehabilitation - 31 percent - compared with heart attack patients - 13.9 percent.

More men had cardiac rehabilitation (22.1 percent) than women (14.3 percent). Age also played a role - patients 75 to 85 were less likely to go for rehabilitation, the researchers found.

In addition, patients with other medical conditions, such as diabetes, a previous stroke, congestive heart failure or cancer, were significantly less likely to seek cardiac rehabilitation, Dr. Suaya's group found.

There are many reasons why patients don't seek rehabilitation, the researchers say.

"Many doctors may be reluctant to refer patients to cardiac rehabilitation," says study co-author Donald S. Shepard, Ph.D., at Brandeis University. "In addition, patients may not know or ask about it."

More Rehabilitation Services Needed

Dr. Shepard also notes that many medical institutions do not promote the service, which typically includes exercise and advice on diet.

"It's not glamorous and, from the data we have, it is not very profitable," he says.

It may also be difficult for people to get to rehabilitation centers, notes Dr. Shepard.

"One of the findings in the study was that the closer you are, the more likely you are to use the service," he says. "Travel time and travel expense are things that reduce the use of the service."

Dr. Fonarow adds, "More needs to be done to ensure that eligible patients are effectively enrolled in supervised cardiac rehabilitation.

"The American Heart Association's 'Get With The Guidelines Program' is one example of a highly successful initiative to improve referral to cardiac rehabilitation after hospitalization for cardiovascular event or surgery," he adds.

Always consult your physician for more information.