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Waking up is darn-near cruel for us career-driven,
child-rearing, x-treme-hobbied Americans.
Waking up with swirling thoughts about the day ahead could even be hazardous to our health.
If you are among those persons who are at risk for cardiovascular disease, 6 to 9 a.m. is the most stressful time of day for the heart. That is when an attack and sudden cardiac death is a possibility.
"As you awaken, no longer in a relaxed state of sleep, your body's level of cortisol, a stress hormone, shoots up; so does your adrenaline, a hormone that is a powerful stimulant," explains Dr. Samuel Ward Casscells III. "Some people think about their day and worry about what will happen. That stress could evoke a serious event.
"Your rising blood pressure signals your body that it is time to get up. As more adrenaline is released, your heart rate increases. All of this stimulation could be a trigger for health problems," Casscells says, who is also the John Edward Tyson Distinguished Professor of Medicine (Cardiology) and Public Health at The University of Texas Health Science Center at Houston and vice president of Biotechnology.
Along with these physical awakenings, the arteries constrict and blood becomes more coagulable. That means there is more of a risk of clotting in the morning.
"Some of these responses to waking up are due to the body being dehydrated. It does not help that adrenaline can precipitate blood clots. We know from studies that taking an aspirin blunts much of that early morning risk. Beta blockers keep the adrenaline in check, further reducing risk," Casscells explains.
This series of events he describes happens in every body, but it is dangerous for those with cardiovascular disease - especially for those who have it and don't know it.
There are a lot of heart attacks in the winter, especially in cold climates. People get out from under a warm quilt and step into a cold world. Going outside to get the morning paper could start a domino effect in the body. The cold weather can induce the arteries to constrict.
Others have a drink of strong coffee. Caffeine stimulates the adrenaline and the blood pressure. This combination can trigger cardiac arrhythmias. So people with cardiovascular disease should drink decaffeinated coffee.
Regardless of the weather, heart attacks are more common on Monday mornings, in the winter, following a job loss, divorce, loss of a loved one - in other words, a stressful event.
"A bigger problem is people who are ignorant about risk factors," says Casscells. "A man, who has had high cholesterol, say at 300, is now taking a medication, such as Lipitor, Zorcor or Pravacor, to control it. He assumes that the drug will take care of it. He does not realize that the medication will not even begin working in his body for at least one year. Then, it takes six to seven years before his arteries will get cleaned out and his cholesterol returns to normal."
A person can also think that if he or she loses weight, anti-cholesterol drugs aren't necessary. That seems logical. Just because the numbers are down, however, the risk reduction does not begin for 12 months.
"What people do not realize is that these drugs are no substitute for diet. A Mediterranean-type diet reduces the risk faster and better. These drugs reduce your risk of a heart attack by 25 percent. It can be reduced much more by eating the right food," Casscells believes.
Exercise is great, but the person Casscells worries about is the weekend athlete. This person is generally out of shape, overweight, stressed, and has a diet that consists of too much food as well as the wrong foods.
"They go out to run or jog on a cold morning. They collapse and die," Casscells says. The de-conditioned body is simply too stressed and excited to cope with unrecognized heart disease.
The added risk to the body of illegal stimulants such as cocaine, amphetamines or performance-enhancing steroids catapults a person toward untimely heart damage or death.
Like one good blood pressure reading, a person can have a normal stress test and think that is a guarantee to good health.
"But stress tests can create a false picture. For a woman, I recommend the EKG stress test in combination with the ultrasound of the heart [called a stress echo.] You can watch the heart move as you exercise," Casscells advises and adds that a nuclear stress test is also accurate for women. This type of test uses a small amount of dye to image the heart before and right after exercise.
"Women and men can have a first-class stress test, and it will not show the blockages. The stress test does not turn abnormal until the arteries are 70 percent blocked."
For the person who wants to know if he or she will have heart disease 10 years in advance, Casscells recommends a CT scan.
People fail to realize the significant role stress plays in cardiovascular disease. "When a young man has a heart attack, he will be depressed and angry. If he is in denial, he will start exercising too soon, which will cause more damage, instead of letting the heart rest and heal," observes Casscells. "Studies show that women who have heart attacks almost always had a major psychological stress leading up to the event such as a divorce or job loss."
Know the risks and what is important: Being fit is more important than being thin; but the most important thing is eating the right foods. A healthy diet includes fruits, vegetables, fish, little meat, and no transfats.
Casscells' other advice to avoid heart attacks and strokes:
Visit http://www.americanheart.org to review heart, stroke and diet information.
UPDATED: 11-11-2004
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Cardiologist Samuel W. Casscells is the John Edward Tyson Distinguished Professor of Medicine at the UT Medical School.
See Dr. Casscells also at:
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