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Health Information Heart Disease

Looking out for no. 1

Beating the nation’s top killer — heart disease

When Dean Roupas was in his early 30s and his doctor told him he had high cholesterol — a condition that put him at risk for a heart attack — Dean downplayed the news and refused medication. Cholesterol-lowering drugs, in his opinion, were for guys his father’s age.

But what Dean didn’t fully consider at the time — as so many Americans don’t — was the full picture of his heart disease risk. Family history in particular made his danger more real.

Dean’s father, John, as well as an aunt and an uncle, all had bypass surgery in their early 50s. And Dean’s grandfather died of a heart attack when he was just 64.

With a family tree ripe with heart disease, it appeared that Dean was headed for catastrophe. And that’s what he heard when he ended up at his doctor’s office with chest pain and was referred to Steven Feinstein, MD, a preventive cardiologist at Rush University Medical Center. But, Feinstein added, there was still time to change course.

Heading off trouble

In many ways, Dean was lucky because his chest pain ultimately pushed him to the doctor. Often, buildup of fat and cholesterol in the arteries — or atherosclerosis, the cause of the main type of heart disease — is less obvious.

Many people have no warning signs until they have a heart attack. Others have warning signs but ignore them, not associating the symptoms with heart disease.

What can’t be ignored is that heart disease is the nation’s No. 1 killer. And what shouldn’t be ignored is that it’s often preventable.

Heeding the signs

Chest pain similar to the pain Dean experienced can be an obvious warning sign of heart disease. When you have pain that’s new or different than pain you’ve had before, you should have it evaluated.

“If it comes on suddenly and is severe, that’s an emergency — it could be a sign of a heart attack,” says Jeffrey Soble, MD, a cardiologist at Rush. “If it’s mild or vague, it still could be an important problem, and you need to address it in a timely fashion. That means calling your doctor to find out if you need to be seen quickly, as opposed to scheduling an appointment in a month or two. It’s the kind of thing that you want to take care of immediately.”

But be aware that, while chest pain is a significant symptom of a heart attack for both women and men, many women don’t experience chest pain during a heart attack. They are somewhat more likely than men to experience some of the other warning signs, particularly back or jaw pain and nausea or vomiting.

Another significant warning sign of heart disease is shortness of breath, with or without activity. Lack of adequate blood flow to the heart can cause fluid to back up in the lungs, making breathing difficult, explains Soble. Other possible signs of heart disease include the following:

  • Heart racing or heart palpitations
  • Swelling of the lower legs and ankles
  • Dizziness or fainting spells
  • Extreme tiredness
  • Nausea

These signs can indicate problems including heart failure (a condition in which blood is not pumped efficiently) or atrial fibrillation (a problem in which the heart’s two upper chambers quiver instead of beating appropriately).

Additionally, people who have had a stroke or stroke symptoms need aggressive risk-factor modification and evaluation for coronary artery disease by a physician.

A condition in which atherosclerosis blocks blood flow to your extremities, known as peripheral vascular disease, can also indicate coronary artery disease. This condition, sometimes signaled by pain in the calves when walking, is particularly problematic because blocked arteries in one part of the body frequently mean there are blocked arteries in the heart.

Recognizing risk

However, there’s more to be aware of than warning signs.

“By the time you’ve had symptoms, you already have advanced atherosclerosis,” Soble says. That makes knowing your risk factors — and working with your doctor to protect yourself — crucial.

In addition to family history of the disease, risk factors include the following:

  • Increased age
  • Smoking
  • Physical inactivity
  • Having diabetes, high blood pressure or high cholesterol
  • Being overweight — particularly if you have an apple-shaped body with a large belly

Research indicates that women who smoke and take birth control pills or use a birth control patch also have an increased risk of heart attack and stroke.

A winning strategy

If a doctor diagnoses heart disease, sometimes he or she recommends immediate treatment, such as bypass surgery or angioplasty. Other times, medication may be the initial treatment.

In either case, lifestyle changes, such as exercising regularly, quitting smoking, and eating a diet low in salt and saturated fat, are important. Those steps can also help prevent the disease.

Change for the better

Feinstein recommended exercise and a new diet for Dean — a diet he’s grown to enjoy. Today he consumes very little sugar, few carbohydrates and no meat, except fish. Salmon, vegetables, blueberries, strawberries and nuts, such as almonds, are among his foods of choice. It’s quite a change for a guy who wasn’t known as a picky eater. “If you threw it in front of me, I would eat it,” Dean says.

What made it easier for Dean was that Feinstein emphasized positive, proactive steps he could take to protect himself and told him what he should be eating, rather than what he shouldn’t.

Though he also takes medication, Dean credits Feinstein and the lifestyle changes he’s made for the dramatic improvement in his cholesterol levels and his significant weight loss and renewed energy.

But Dean hasn’t done it alone. He also brought his dad along for the trip — literally and figuratively. John accompanied Dean to his first appointment to give Feinstein the full picture of the heart disease in his family, but he was so impressed that he too became Feinstein’s patient.

“I went in there to give him my tale of woe and see what he could do for my son, and he turned around and helped me,” says John, who wholeheartedly started the same diet Dean did the very day they saw Feinstein in early 2004. He’s since lost six inches from his waist and seen stellar improvement in his cholesterol levels. His golf swing has even improved.

Some people consider the diet excessively strict and offer sympathy to the Roupases. But according to the father and son, the transformation was easy, and there’s no need for anyone to feel sorry for them. It’s good food, and their current lifestyle certainly beats the alternative.

“When the doctor told Dean, ’You’re going to look just like your dad; look at the scar on his chest. You’re going to get that too if you continue doing what you’re doing,’ that hit home with him,” John says. “And it hit home with me, because I don’t want to see my son go through what I went through — having open-heart surgery.”

Since Dean and John are business partners, they see each other every day. They say the support and encouragement they give one another makes things easier. Perhaps more important, they offer proof that, while heart disease can be a family affair, so can prevention.


  • If you’ve experienced warning signs of heart disease or have risk factors, call (888) 352-RUSH (7874) for a referral to a cardiologist at Rush.

Heart and Cardiovascular Care at
Rush University Medical Center

At Rush University Medical Center in Chicago, Illinois, cardiologists, cardiovascular surgeons, researchers and nurse specialists work in teams to address the full scope of heart problems, whether common or complex.

Working in state-of-the art facilities, using some of the world’s most sophisticated technology, these experts are on the leading edge of diagnosis, treatment and discovery. From preventive measures to heart transplantation, they are helping to revolutionize heart care.

For more information about cardiovascular services at Rush visit our Heart & Vascular Programs home page.

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