How to Avoid a Heart Attack

By Mika Ono

As a cardiologist, Erminia "Mimi" Guarneri knows a lot about heart attacks, or "cardiovascular events," as she likes to call them. Much of her understanding of heart disease can summed up by two questions she asks patients in the emergency room: "What have you eaten in the last two hours?" and "Did you just have a fight with someone?"

It's amazing how revealing these answers are, according to Guarneri, who spoke at the La Jolla, California, campus of The Scripps Research Institute on May 30 as part of the employee Lunch & Learn seminar series.

Path to a Different Medicine

Guarneri, now medical director of The Scripps Center for Integrative Medicine, came gradually to a view of heart disease that encompasses not only cholesterol and triglyceride scores, but also lifestyle and emotion.

Guarneri, who earned an M.D. from the State University of New York, Brooklyn, completed an internship and residency at the New York Hospital/Sloan Kettering Memorial Hospital, Cornell University, and received cardiology training at New York University, first came to Scripps Clinic in 1994. There, she learned how to perform a procedure called stenting, which is used to restore blood flow to the heart muscle.

At first, Guarneri was delighted with the results. But over time, she began to notice the limitations of the technique—and of cardiology in general, as usually practiced.

First, there were the patients who came back five years after a stenting procedure with repeat blockage. Somehow, they weren't able to sustain lifestyle changes. Then, there were the statistics about the runaway incidence of heart disease in the United States—according to 2004 statistics from the American Heart Association, more than 79 million Americans have some form of cardiovascular disease. "I felt like I was mopping up the mess," Guarneri says.

Moreover, the popularity of complementary and alternative medicine was growing at a tremendous rate, some statistics showing that twice as many people visited alternative medical providers as primary care physicians. Why?

According to Guarneri, complementary medicine was offering something that Western medicine was lacking. Complementary medicine focused on underlying causes, rather than on treating symptoms. It appealed to people's desire to feel good, rather than relying on their fear of dying. It gave people a sense of control, rather than delegating the decisions to the physicians. And it emphasized quality of life, rather than quantity.

Guarneri's response to these issues has been to try to draw on the best of both worlds—the evidence-based approach of the West (her talk was peppered by citations from the scientific press on inflammation, immunology, endocrinology, and epidemiology) with some of complementary medicine's greatest strengths—an emphasis on prevention and patient empowerment.

"I'm a firm believer in Western medicine," she says. "It is really good at acute care. If you get hit by a truck, you don't want aroma therapy." At the same time, she notes, "I was taught no nutrition in medical school."

So if you end up in the emergency room with a heart attack, Guarneri will use the latest high-tech offerings from Western medicine to keep your heart beating. But her hope is she'll be able to spread the word about staying well so she'll never see you there.

Tips on Staying Well

For those who aren't cardiology patients and don't want to be, Guarneri's practical recommendations include advice that you might have heard before, but probably need to hear again:

• Pay attention to portion size. Portion size has expanded greatly over the past decades. As one of Guarneri's examples, in 1957 a typical serving of popcorn at the movies was three cups and 170 calories. Today, it is 16 cups and 900 calories.

• Eat more healthy food. Guarneri equates "healthy" with an "anti-inflammatory diet," including green leafy vegetables, fruits such as berries, non-fat yoghurt with active cultures, soy (including tofu and miso) and other beans, vegetables such as pumpkins, tomatoes, and carrots, and nuts such as almonds and walnuts (in moderation). Also recommended are cold-water fish, certain spices (turmeric, rosemary, ginger, red pepper), and tea.

• East less unhealthy food. Falling into the category of foods to avoid are fatty meats, cream, and butter—even one fatty meal can set you back, according to Guarneri, impeding vascular reactivity for six hours—and "anything white," including sugar, pasta, rice, and bagels, which are high-glycemic foods that cause insulin levels to spike. Also on the do-not-eat list: anything that contains transfat or high fructose corn syrup.

• Exercise. Guarneri recommends 40 to 60 minutes of aerobic exercise every day, plus muscle strengthening three times a week. "No diet is healthy without exercise," she says, pointing out that exercise reduces the incidence of heart disease by 50 percent—results yet to be matched by any pill.

• Consider fish oil supplements. The American Heart Association recommends one gram of fish oil for anyone with heart disease. Fish oil, which is high in omega-3 fatty acids, has been shown to reduce triglyceride levels and have other beneficial effects.

• Manage your stress. "Stress is an important piece of the puzzle," Guarneri says. Anger is particularly toxic—often much more so to the person who becomes angry than the person on the receiving end. While you can't control stressful "initiating events," you can control your response and perception. Yoga, meditation, support groups, and spirituality are all practices that can help improve your response to and perception of stressors. Guarneri, who recently published a book, "The Heart Speaks: A Cardiologist Reveals the Secret Language of Healing" (Touchstone, 2007), recommended the audience go to Scripps Center for Integrative Medicine to check out the list of exercise, support, and yoga and meditation classes there.

Stress management resources for Scripps Research employees also include a yoga class held on the La Jolla campus's Immunology building, East Conference Room, on Thursdays from 11:15 AM to 12:15 PM (except for the first Thursday of the month), and other sports groups (see Sports@Scripps).

In addition, the Office of Counseling & Psychological Services, which arranges the ongoing Lunch & Learn seminar series, offers free, confidential counseling to employees and their families. See http://www.scripps.edu/services/counseling/ or call x4-7297 for more information.

Send comments to: mikaono[at]scripps.edu

"Stress is an important piece of the puzzle."

—Mimi Guarneri