Best Doctors 2014: Beat Makers

Ticker Tips

Though heart disease is the nation's No. 1 killer, it's also very preventable, says Dr. Grace Cater, a cardiologist at MetroHealth Medical Center. She offers advice on ways to keep your heart healthy.   //John Hitch

Don't be salty » To keep your blood pressure and risk of heart disease down, 2 grams of salt a day are all you should have. "You can buy an Italian seasoning, which adds a lot of flavor but without the sodium," she says.

Work it out » Cater encourages moderate workouts, where you can still carry on a conversation without being short of breath. She suggests "a minimum of 2 1/2 hours a week, in at least 10-minute increments." Try a mix of doubles tennis and bike rides over flat terrain.

Word of mouth » Cater says to use free apps such as MyFitnessPal to track what you eat. "It's amazing when you start tracking your meals, you realize there is that much sodium or that much sugar in it."

Track stars » When exercising, make sure not go above "70 to 85 percent of your maximum heart rate," says Cater. The formula to find your max is 220 minus your age, and can be tracked with a $40-$70 wrist monitor.

Just say 'om' » "Stress can cause a surge of adrenaline in the body and cause a heart attack," Cater says. When times are tough, think about striking a pose. "Yoga is very important because it relaxes the body and decreases mental stress."

Smoke out » Using an electronic cigarette can help wean you off your habit. "That is good, but you still need to get off the e-cigarette," Cater says, since studies of the substitute are still underway. "We really don't know what the long-term effects are on the heart."

Numbers Game

With more than 75 million Americans dealing with high blood pressure, there's a good chance you may already be a whiz at decoding your numbers — the top digits measure the pressure in your arteries when your heart beats, while the bottom ones gauge pressure between beats. For those trying to keep below the recommended 140/90, a new set of guidelines released earlier this year by a national hypertension committee is raising concern. The new suggested threshold of 150/90 relaxes the guidelines for when medication is necessary to treat hypertension, but could also potentially put patients at greater risk for heart attacks and strokes. Dr. Daniel Simon, University Hospitals' chief of cardiovascular medicine, shows us how these modifications could affect you and what you can do to adjust.   //Jennifer Keirn

Go figure.
"[It] used to be everybody was hypertensive over 140/90," Simon says. "These recommendations say that if you are elderly [defined by some as 60, others as 80] you don't need drug therapy under 150/90."

Speak up.
Consensus in the medical community might take another year or two. So talk to your doctor about it in the meantime. "Be your own advocate for blood pressure control," he says. "It's so easy to check your pressure. There's no reason not to."

Get healthy.
"If you are between 140/90 and 160/100, start with lifestyle modification first," he says, including exercise, weight loss and a low-salt diet high in calcium, fruits and veggies.

Good to know.
This committee's research says the target blood pressure for those with diabetes and kidney disease doesn't have to be as low as previously thought, says Simon, with treatment now recommended over 140/90.

Drug Effects

For more than 20 years, doctors have been telling us to reduce our low-density lipoproteins — known as the bad cholesterol — to lower our risk of heart attack and stroke.

With the goal of keeping those troublesome numbers under 70, many doctors have prescribed a multitude of medications to help patients win the fight.

But the way drugs are doled out is changing. Last November, the American Heart Association and the American College of Cardiology updated their guidelines and advised doctors to consider multiple patient factors such as race and lifestyle before deciding what cholesterol-fighting methods to prescribe. In many cases, patients were taking statins — drugs which help lower cholesterol by inhibiting an enzyme that helps produce it — unnecessarily or at a higher dose than needed.

Now doctors are trying to avoid putting patients on other lipid-lowering drugs if they're on a statin. The idea, says Dr. Michael Hughes, a cardiologist in Summa Health System, is that statin drugs have a multitude of effects and those other drugs may not be needed.

"It is a guideline, not a mandate, and I think that is very important," Hughes says. "Physicians, for many years, have been hammered to get the LDL as low as possible."

The new guidelines may result in more patients with cardiovascular disease being on an intensive statin therapy.

"The net effect will probably be more people on drugs, but they should be on less drugs," Hughes says. "We have really good drugs to treat these people with."   //Matt Tullis

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