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Lifestyle choices lie at the core of disease prevention

Rochester Business Journal
August 17, 2012

 If John Bisognano M.D. could get people in a room, feed them a 1,500-calorie-a-day diet and make them exercise on a moving floor for 30 minutes each day, he says, they would not have to worry about their chances of getting heart disease.

Bisognano, director of cardiology outpatient services at the University of Rochester Medical Center, does not want to provide unrealistic dietary advice that people know they cannot follow. Instead, he suggests small changes consistent with the individual's previous lifestyle.
Heart disease prevention centers on lifestyle choices. Since more than 33 percent of the American population dies from heart disease, doctors say preventive measures are essential. Smoking is a big risk factor, and physicians suggest quitting or not picking up the habit. Eating a healthy, vegetable-rich diet helps fight obesity, a leading risk for heart disease. Exercise and reducing stress also aid in keeping heart problems at bay. 
Heart disease is a constellation of illnesses that include coronary disease, heart attacks, heart failure and weakened heart function. It is generally defined as an incident that leads to decreased function of the heart or decreased heart output.
In a 2012 statistical update, the American Heart Association projects that by 2030, 40.5 percent of the U.S. population will have some form of heart disease. Between 2012 and 2030, total annual direct medical costs are expected to soar from $309 billion to $834 billion.
Even with the staggering statistics, Gerald Gacioch M.D., chief of cardiology at Rochester General Hospital, says there are nine prevention measures that reduce the chance of heart attack by 90 percent.
"First is treating high blood pressure. Second is not smoking. Third is getting cholesterol under control. Fourth is (treating) diabetes. Fifth is avoiding obesity. Six is stress; it is a killer. Seven is modest alcohol intake. Eight is eating more veggies. And nine is exercise," Gacioch says.
He breaks down these nine factors into two categories, health and lifestyle. On the health side, Gacioch stresses getting high blood pressure under control: A third of Americans have high blood pressure.
"In my own personal case, I've had it since I was 35," Gacioch says. "I'm now 53. I have been on medicine for almost 20 years, so I'm not at any increased risk (for heart disease) anymore."
Blood pressure along with the other two health-related risks, cholesterol and diabetes, must be treated with medication and other therapies. Bisognano says drugs are well-established, have been around more than 25 years and have minimal to no side effects.
Daniel Williford M.D., a partner at University Cardiovascular Associates, says people often are apprehensive about treating high blood pressure because the disease does not show symptoms. They would rather ignore a diagnosis and have no physical symptoms than treat it and deal with side effects from the medications.
Joan Thomas M.D., chief of cardiology for Unity Health System, says she recommends a once-a-year blood panel for patients to ensure they do not have any of the health risks that could lead to heart disease.
In terms of lifestyle habits, Gacioch says smoking is a huge risk factor. Nearly 20 percent of Americans still smoke, even though it has been five decades since the surgeon general's warning about harmful effects was published, and he finds that shocking.
"If you smoke a pack a day, you are four times more likely to have a heart attack than someone who doesn't smoke. And even if you cut it down to half a pack, you are still twice as likely," Gacioch says.
Smoking is correctly associated with lung cancer, Bisognano observes, but far more people develop coronary problems, and smoking is the leading cause of heart disease.
Another key preventive measure, according to Gacioch, is the right diet and exercise program.
"The key for diet is veggies," he says. "Really stress to people that they want to be as plant-based as they can. The problem is too many calories coming in and not many calories going out. People eat too much carbohydrates."
In terms of exercise, he says one hour five times a week is a good standard to live by. Bisognano says younger individuals should be conscious of food intake and maintain a high level of physical activity.
Starting an exercise plan too quickly, however, can create problems, Thomas says. Injuries can stop patients from getting back to an exercise routine.
Bisognano has the same opinion about short-term, intensive diets.
"If the diet has a fixed period of time and focuses only on weight loss, they are doomed," he says. "It has to be a smaller but longer-term modification of their eating habits. You can't eat cauliflower for life."
Williford notes that a large number of people fall prey to various infomercials and advertisements that promote a supplement without scientific data or proof. He points to amino acid L-arginine, which some people have used in megadoses to lower blood pressure, though actually it is associated with a higher risk of heart attack.
Though prevention can lower risks for patients who have a genetic proclivity for heart disease, it does not eliminate the chance of a heart attack, Thomas cautions.
Bisognano agrees: "I think there is a certain set point that you start out at, but you can make things substantially better or substantially worse from that point with what you do. I find many long-distance runners in my practice are that way because they come from families with a history of heart disease."
Heart disease rates are going up because of the national obesity problem. Treatments for heart disease have improved so that people do better once they are diagnosed, but Thomas says that the number is still rising. Teaching children to lead a healthy lifestyle is the place to start preventing heart disease.
Says Bisognano: "Education in the middle school, the elementary schools is a good thing, but you also have to give people the tools to help themselves."
Megan Goldschmidt was a Rochester Business Journal intern.
8/17/12 (c) 2012 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email

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