One out of every five Americans has some form of heart disease. Literally millions of cases could be prevented if people had better information about the best prevention and treatment strategies.

Despite the abundance of health information reported in the media, many people are endangering their health because they are still ill-informed about key aspects of heart disease. To learn about the most common misconceptions regarding heart disease, we spoke with Barry L. Zaret, MD, one of the country's leading specialists in cardiovascular health.

Misconception 1: High cholesterol is the main risk factor for heart attack.

Fact: While high cholesterol does increase risk, recent studies show that elevated levels (3 mg per liter or higher) of C-reactive protein (CRP), a protein that circulates in the bloodstream, may have an even stronger link than high cholesterol to heart attack and stroke.

Everyone has at least a small amount of CRP in the bloodstream. At higher levels, it indicates the presence of inflammation—possibly caused by an underlying bacterial or viral infection that may damage the linings of blood vessels and promote the development of atherosclerosis.

Every patient with a high risk for cardiovascular disease—smokers and/or those with a family history of heart disease, for example—should have a high-sensitivity CRP blood test. This test, unlike the standard CRP test, distinguishes between inflammation due to cardiovascular disease and other inflammatory conditions, such as arthritis. The high-sensitivity CRP test is particularly important for patients who have had a previous heart attack or who have unstable angina (chest pain caused by lack of blood to the heart). An elevated CRP level in these patients indicates a very high risk for heart attack—even if cholesterol levels are normal.

Misconception 2: All adults should take a daily aspirin.

Fact: Daily aspirin therapy is often recommended for patients who have an elevated heart disease risk due to family history, smoking, obesity, diabetes and atherosclerosis. Studies show that it can curb heart attack risk in men by more than 40%.

For women, the evidence is less clear. New research indicates that women who take aspirin are more likely to experience gastrointestinal upset or bleeding problems than men. Although research shows that in women age 46 or older aspirin protects against stroke, it does not reduce heart attack risk in all of these women. Aspirin has been shown to lower heart attack risk only in women age 65 or older, whether or not they have risk factors for the disease. 'Women of any age who smoke or have a family history of heart disease or other risk factors may benefit from aspirin therapy. The standard recommendation for women is 81 mg daily.

There's no evidence to suggest that aspirin helps prevent a heart attack in healthy women who are under age 65. For these women, not smoking, controlling body weight, getting regular exercise and maintaining a healthful diet are the best ways to guard against the development of heart disease.

This also is true for men age 64 and younger who are healthy and have no risk factors for heart disease. However, men age 65 or older, even if healthy, should take 81 mg of aspirin daily to protect against heart disease.

Misconception 3: The greatest danger of smoking is lung cancer.

Fact: Lung cancer is obviously a concern for smokers, but the risk for cardiovascular disease is actually higher. Of the approximately 440,000 premature deaths caused annually by smoking, the majority are due to cardiovascular disease, according to the Centers for Disease Control and Prevention.

Smoking increases levels of carbon monoxide in the blood, which damages artery linings and promotes atherosclerosis. It appears to lower HDL "good" cholesterol and increase blood levels of fibrinogen, a substance in the blood that promotes clotting.

Good news: One year after quitting, the risk for heart disease drops to one-half that of current smokers—and within 15 years becomes about the same as for someone who never smoked.

Misconception 4: Exercise is dangerous if you've already had a heart attack.

Fact: Heart attack patients especially benefit from regular exercise. An analysis of 22 different studies that followed more than 4,000 patients for three years found that the death rate among patients who participated in a cardiac rehabilitation program that included exercise was 20% to 25% lower than among those who didn't exercise.

Heart patients who exercise have increased endurance, fewer chest or leg pains and improved heart function. Regular exercise also lowers blood pressure, raises HDL cholesterol and lowers resting heart rate.

Patients who have heart disease or have had a heart attack, or those who have been sedentary should get a thorough checkup before starting an exercise program. This should include a treadmill stress test, which evaluates blood flow to the heart. Once your doctor determines that it's safe to exercise, aim for 30 minutes at least three to five days a week. Aerobic exercise—fast walking, swimming, etc.—provides the most benefits for heart patients. If you've had a heart attack or other cardiac event, start your exercise routine at a rehabilitation center, if possible. Ask your cardiologist to recommend one near you.

Misconception 5: Reports saying that chocolate is good for the heart are mostly hype.

Fact: The cocoa beans used to make chocolate are extremely rich in flavonoids, plant compounds that appear to relax small blood vessels and lower blood pressure. Some of the flavonoids in cocoa also appear to inhibit the ability of platelets to form clots in the arteries.

Harvard researchers recently studied residents of Kuna (an island off Panama), who drink an average of three to four cups of cocoa a day. (They consume even more cocoa in other foods) Hypertension among these people is almost nonexistent—until they leave the island and forgo their cocoa-rich diet. At that point, their rates of hypertension and heart disease rise.

Of course, there is a downside. The high levels of fat and sugar in chocolate can lead to obesity and elevated blood sugar. But one to two small squares daily of dark chocolate that's at least 70% cocoa and low in added sugar does appear to be good for the heart.

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