OBI Heart Check is a program to help individuals identify potential risk factors for heart disease. Heart Check identifies seven major areas which involve potential risk factors leading to the development of heart disease. It is hoped that individuals who participate in the Heart Check program will seek appropriate medical attention if risk factors are identified by the Heart Check program. The Heart Check program is part of the overall philosophy of the Oklahoma Blood Institute which "helps Oklahomans stay healthier". When risk factors are found, the Oklahoma Blood Institute will recommend that the information be furnished to the individual’s family physician for further review and evaluation. Heart Check is not a substitute for regular visits with the person’s family physician, but is meant to be an additional way of helping the person identify cardiac risk factors.

 
Heart disease and specifically coronary artery disease is a serious problem in Oklahoma with Oklahoma ranking in the top five states in the USA. It is now clear that identification of risk factors as soon as possible and with immediate evaluation and treatment can lead to a significant reduction in heart attacks, strokes, and early death.
 

The seven major areas involved in the Heart Check program are outlined in Table I. Tests performed are outlined in Table II.

TABLE I
CARDIAC RISK FACTORS
  1. Smoking, Diet and Exercise
  2. Diabetes
  3. High Blood Pressure
  4. Abnormal Cholesterols
  5. Iron Overload
  6. Elevated Homocysteine
  7. Chronic Inflammation
   
TABLE II
TESTS TO BE PERFORMED
  1. Blood Pressure
  2. Hemoglobin A-1C
  3. Total Cholesterol and HDL-C
  4. LDL-C and Triglycerides (must be fasting)
  5. Serum Ferritin
  6. Serum Homocysteine
  7. C-Reactive Protein
These seven cardiac risk factors will be summarized in the following paragraphs.
1. Smoking, Diet and Exercise
  A. Smoking
    It is clear, and has been clear for years, that smoking is destructive to the human body. It significantly increases the risks of many cancers and clearly accelerates the aging process and the development of coronary artery disease as well as pulmonary disease. Clearly, if you smoke, stop and if you don’t smoke, don’t start. Smoking cessation programs are available through many health agencies and easily accessible today.
     
  B. Diet
    Clearly a diet that is rich in fruits, vegetables, whole grains, nuts, and oily fish such as salmon, can significantly reduce the rate of development of atherosclerosis (hardening of the arteries) as well as high blood pressure. Soy based products contain isoflavones felt to be beneficial to the heart. The elimination of saturated fat found in the fatty red meats, full fat dairy products, and some of the tropical oils should be reduced and replaced with monounsaturated oils such as olive oil and polyunsaturated omega 3 oils found in oily fish and canola oil. Some of the worst fats are called "trans fats" which are hydrogenated vegetable oils that can increase the "bad" cholesterol or the low density lipoprotein cholesterol (LDL-C) and lower the "good" cholesterol or high density lipoprotein cholesterol (HDL-C). All nuts including walnuts and peanuts are good for the heart with peanuts being especially high in folic acid as well as mono and polyunsaturated fats.
     
  C. Exercise
    Exercise on a regular basis is one of the most important factors in the prevention of heart disease. Although vigorous exercise which accelerates the heart rate is especially good, 30 minutes of brisk walking or its equivalent each day can achieve the same benefits as more vigorous exercise. Exercise can help reduce the bad cholesterol (LDL-C) and elevate the good cholesterol (HDL -C).
   
2. Diabetes Mellitus
 

HbA1c (Hemoglobin A1c) Diabetes Test

  A blood test called the hemoglobin A-1C (glycosylated hemoglobin) will be performed by OBI as a potential screening test for diabetes mellitus, commonly known as "diabetes". An abnormal hemoglobin A1C test indicates that an individual has had higher than normal blood sugar levels over the prior 3-4 weeks. If this blood test is abnormal the recommendation will be for the individual to have further evaluation by their family physician.
     
  Type II diabetes, when unrecognized and untreated, leads to accelerated development of cardiovascular disease and subsequently to diabetic retinopathy (retinal eye disease and blindness), diabetic nephropathy (kidney disease possibly requiring dialysis) and heart attacks, strokes, and peripheral vascular disease (decreased blood flow to extremities especially the lower extremities). Early identification of diabetes with early treatment can significantly reduce the risks of all diabetic complications. Diet, medication and exercise all play a critical role in the control of diabetes.
   
3. High Blood Pressure
  BP (Blood Pressure) Test
  Blood pressure will be checked by OBI personnel on all individuals participating in the Heart Check program.
     
  The old standard of acceptable blood pressure has been a systolic (top number) of 140 mm of mercury over a diastolic blood pressure (lower number) of 90 mm of mercury. Newer data suggests that a systolic blood pressure less than 130 with a diastolic less than 80 is better and less apt to lead to the production of coronary artery disease, strokes, or peripheral vascular disease. In the case of individuals with adult onset diabetes, the blood pressure should be below 130 systolic and 80 diastolic in order to prevent diabetic kidney disease. Again, diet, exercise, cessation of smoking, weight reduction, and appropriate medications can lower the blood pressure to normal levels and prevent or reduce the subsequent development of accelerated cardiovascular disease.
     
 
Systolic / Diastolic
<130 / <80
  Desirable
130-135 / 80-85
  Borderline elevation
136-140 / 86-90
  Mildly elevated
>140 / >90
  Elevated
     
4. Abnormal Cholesterols and Triglycerides
  FCHO (Total Fasting Cholesterol), FHDL (High Density Lipoproteins), LDL (Low Density Lipoproteins), and TRIG (Triglycerides) Tests
  The cholesterols are the most important of the fats in the blood and are comprised of the high-density lipoprotein-cholesterol (HDL-C), the low-density lipoprotein-cholesterol (LDL-C), and the very low density lipoprotein-cholesterol (VLDL-C). Cholesterol breakdown will be measured through blood tests performed by the Oklahoma Blood Institute. The total cholesterol is the sum of all cholesterols in the blood (Total Cholesterol = HDL-C + LDL-C + VLDL-C). HDL-C is known as the "good " cholesterol and LDL-C and VLDL-C are known as the "bad " cholesterols .
 
  The total cholesterol should be below 170 mg/dl. A total cholesterol below 140 mg/dl may even help in reversing some of the effects of cholesterol induced atherosclerosis (hardening of the arteries). The normal level for HDL-C is greater than 40 mg/dl. For LDL-C the normal level is less than 100 mg/dl and for VLDL-C the normal level is less than 35 mg/dl. Another blood fat known as triglycerides is also linked to the development of coronary artery disease. The normal level of triglycerides is less than 150 mg/dl.
     
  The total cholesterol and the HDL-C can be performed on a non fasting blood sample. The LDL-C and triglycerides must be performed on a blood sample obtained from at least a fast of 12-15 hours, which means that the individual cannot eat anything except to drink water during that 12-15 hour time period, otherwise the test results are invalid. OBI can perform the total cholesterol and the HDL-C on a blood sample obtained from a non fasting individual. If the total cholesterol is below 170mg/dl and the HDL-C is above 40mg/dl, then the LDL-C and VLDL-C will most likely be within normal limits. The point to remember then is a high HDL-C and a low LDL-C is the most beneficial scenario. The triglycerides are a different series of fats which are also linked to the development of coronary artery disease. Elevated triglyceride levels are frequently seen in diabetics and pre diabetics.
     
  Diet is a critical factor as is exercise and cessation of smoking in the management of healthy cholesterol and triglyceride levels. For those individuals who are unable to lower their total cholesterol and triglycerides through these previously mentioned measures there are a number of medications that can be prescribed by a physician. A major category of medications used to lower total cholesterol and specifically lower LDL-C and possibly raise HDL-C are called "statin" drugs. Statin drugs are prescribed under a variety of names which include Lescol, Lipitor, Mevacor, Pravachol, and Zocor.
     
5. Iron Overload
  FERR (Ferritin) Test
  The Blood Institute will perform as part of Health Check a test called serum ferritin to evaluate the total amount of iron accumulated in a person’s body.
     
  There are a number of conditions which can lead to excessive absorption and storage of iron in the body with deposition of the iron in critical organs such as the pancreas, liver, heart, lungs, and joints as well as other tissues and organs. The end result is serious and potentially fatal disruption of the function of these organs with the heart being one of the critical organs that can be involved. A condition called Hereditary Hemochromatosis (HH) is found in approximately one out of every 400 Caucasian Americans. These individuals have inherited two genes for HH. Although not all of these individuals will develop serious complications, many of the men and some of the women with HH will ultimately develop serious organ involvement and cardiovascular disease. In addition, one out of every 10 Caucasian American carries one gene for HH and may have some increased iron absorption and excessive storage of iron.
     
  If the serum ferritin test performed by OBI is elevated, then the individual may need further evaluation by their family physician or by a hematologist or gastroenterologist to rule out liver disease (cirrhosis) or pancreatic disease (development of diabetes). The most effective way to remove iron from the body is by donating blood, since red blood cells contain major amounts of iron. Individuals who donate blood can significantly reduce the risk of iron overload. In addition to heart disease, iron overload can lead to the development of diabetes, cirrhosis of the liver, and possibly liver cancer.
     
6. Elevated Homocysteine
  HOCY (Homocysteine) Test
  Homocysteine is an amino acid found normally in small amounts in the blood and when elevated may increase the deposits of LDL-C in the arteries of the heart. Elevated homocysteine called hyperhomocysteinemia is inherited and, if present, can easily be treated by taking 800-1600 micrograms of folic acid or folate along with some Vitamin B12 and pyridoxine (Vitamin B6) on a daily basis.
     
 

The Blood Institute will perform a test called a serum homocysteine to determine if the levels are elevated.

If an individual has an elevated homocysteine level, the recommendation will be to eat more foods containing folic acid, such as green leafy vegetables and peanuts as well as taking folic acid, B12, and Vitamin B6.

     
7. Chronic Inflammation
  CRP (C-Reactive Protein) Test
  There are a number of proteins in the blood, including C-Reactive Protein which may become elevated in anyone who has a chronic inflammatory condition. The elevation of these proteins may lead to increased deposits of LDL-C in the coronary arteries and the development of coronary artery disease.
     
  OBI will perform the test called C-Reactive Protein and if elevated, the individual should be evaluated by their physician to find out what kind of inflammatory process is present and how to reverse or reduce the inflammatory process to reduce the level of the inflammatory proteins.
     
The Heart Check Program will help individuals identify cardiac risk factors by making individuals aware of the issues related to: (1) Smoking, diet and exercise, (2) measurement of an individual’s blood pressure, (3) the performance of a series of blood tests necessary to define other cardiac risk factors. All test results will be mailed and made available through OBI’s web site (www.obi.org) through a special confidential web based test reporting system which will allow the individual to track all test results indefinitely.
     
The primary purpose of Heart Check is to provide a program to help reduce heart disease to individuals participating in the Heart Check program.

 

This site is best viewed using IE 4.0+ and a screen size of 800x600 pixels.
©Copyright 2005.  All rights reserved.

Sylvan N. Goldman Center Oklahoma Blood Institute, 1001 N. Lincoln Blvd., Oklahoma City, OK 73104 (405) 297-5700

OBI is not responsible for the privacy statements, policies or content of other websites you may link to from this site.