Take it to hearth: advice from Indiana heart centers and updates on technology.

• Author: Held, Shari
• Position: HEALTH CARE

CARDIOVASCULAR DISEASE is the No. 1 cause of death in both men and women in the United States. This year more than 500,000 people will die of heart disease. Most of those deaths could have been prevented with a healthy lifestyle, including better diet and more exercise.

"The traditional risk factors are hypertension, diabetes, high cholesterol, smoking, obesity and family history," says Dr. Kiran Kareti, a cardiologist with Indiana Heart Associates who practices at The Indiana Heart Hospital in Indianapolis. "These risk factors usually account for 50 to 75 percent of all cardiovascular disease."

Smoking is the leading cause of heart disease. Indiana ranks second among the states when it comes to the number of adult smokers, and 10 when it comes to the percentage of obese/overweight adults.

For years drugs such a beta-blockers and ACE inhibitors have been used to treat high blood pressure and improve outcomes in patients with cardiovascular or coronary artery disease. Statin drugs such as Lipitor, Zocor or Crestor are used to lower cholesterol levels by slowing the body's production of cholesterol.

Recently they have been joined by a promising new class of drugs--cholesterol absorption inhibitors. Zetia is one of the first drugs in this class. "It now gives us two reliable and well-tolerated methods for successfully lowering serum cholesterol," says cardiologist Dr. Steven Orlow, medical director, cardiac catheterization for Lutheran Hospital in Fort Wayne. "With Zetia we have a completely different route that we can utilize in addition to the statins, to actually achieve even lower blood levels of cholesterol."

"There's really no reason in this day and age for people not to have their blood pressure controlled," says Dr. Elizabeth Ashworth, cardiac surgeon with Cardiology and Vascular Surgery Associates who practices at Columbus Regional Hospital's Heart Center "And the same goes for elevated cholesterol. There are a plethora of medications available now. If one medication doesn't work, another one will."

Riverview Hospital in Noblesville offers several programs to assist in the prevention of heart attack. "Wellness Wednesdays" offer screening for blood pressure, cholesterol and blood sugar along with tests measuring body fat. The "Get HeartSmart" program offers one-on-one evaluation and exercise and diet counseling. Riverview's Cardiac Rehab program is a medically supervised exercise program for people recovering from a heart attack or surgery or people with high risk factors.

"Cardiovascular fitness has been proven to be as strong as, or stronger, than medication or even bypass surgery in preventing heart attacks," says Kareti. "It is critical."

Fast equals better. For someone having a heart attack, door to balloon time (from arrival at the hospital to the time the patient receives care in the catheterization lab) is critical. The national standard is 90 minutes, and many Indiana hospitals have shortened that time considerably.

"What people really need to know is that heart attacks like you see on TV the gripping chest pain--is not always how it is," says Liz James, manager of cardiopulmonary rehab at Riverview Hospital and Riverview Health Park in Carmel, "especially if you are a diabetic or a woman. Diabetics don't feel pain like a non-diabetic person does. Their symptoms may be fatigue, just not feeling right, or shortness of breath," she says.

"Don't drive yourself to the hospital if you are having a problem," she cautions. "Technology-wise, ambulance transport is a lot more sophisticated that it used to be. Call 911, and you can minimize the damage from a heart attack."

Last November Riverview implemented...