Dr. Said Alsidawi, a Mayo Clinic cardiologist, says the problem is that many people don't even know they have it because they have no symptoms. And in many cases, the first presentation is sudden cardiac death. 

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Hypertrophic cardiomyopathy is a genetic condition that causes the heart muscle to thicken, making it harder to pump blood and sometimes causing an irregular heart rhythm.

"So right now, what we think in the United States, we've only diagnosed 1/7 of the people who have hypertrophic cardiomyopathy. So we're trying to increase the awareness in the community about this disease," says Dr. Alsidawi.

He says patients are born with a genetic mutation. The disease can start at a young age or later in life — many times with no symptoms. 

"We know the patients that we lose to this condition, the majority of them are young, active and athletes. So high-level athletic exercise can put you at higher risk of sudden cardiac death," says Dr. Alsidawi.

He says it's important to seek medical attention if you have any symptoms, especially with exertion, "including shortness of breath, chest pain, lightheaded, dizzy or passing out."

If diagnosed, the good news is hypertrophic cardiomyopathy can be treated with medications, surgery, implanting a defibrillator that monitors the heart or, in severe cases, heart transplantation.  

Additional resources:

• Sex and race disparities found in management of patients with hypertrophic cardiomyopathy in the hospital
• Mayo researchers create, test AI to improve EKG testing for hypertrophic cardiomyopathy

The post Mayo Clinic Minute: Know the warning signs of hypertrophic cardiomyopathy appeared first on Mayo Clinic News Network.

Proton beam therapy, traditionally used to treat cancer, is now bringing new hope to patients with life-threatening heart rhythm disorders. A clinical trial is harnessing this precise radiation treatment to target the specific area of the heart causing the irregular rhythm, providing a less invasive, potentially transformative solution. Tune in to the latest episode of Tomorrow's Cure to explore this innovative approach and its promise for revolutionizing heart rhythm treatment.

The podcast episode features Dr. Konstantinos Siontis, cardiac electrophysiologist and associate professor of medicine at Mayo Clinic in Rochester, Minnesota; Dr. Amanda Deisher, radiation oncology medical physicist, assistant professor of medical physics and researcher at Mayo Clinic's Comprehensive Cancer Center in Rochester; and Dr. William Stevenson, cardiac electrophysiologist, professor of medicine and director of the Cardiac Arrhythmia Clinical Research Program at Vanderbilt Heart and Vascular Institute. Together, they discuss a groundbreaking new approach to treating heart arrhythmias.

Proton beam therapy is a form of radiation treatment that uses a precise beam of protons to deliver targeted radiation. Now, a clinical trial is exploring the use of proton beam therapy to treat ventricular tachycardia (VT).

"Ventricular tachycardia is a type of fast heart rhythm that we see in people who have almost any type of heart disease. It can be an old heart attack, heart valve surgery or cardiomyopathy, which is a group of diseases that affect the heart muscle," says Dr. Stevenson. "What's common to many of these things is that they'll produce an area of scar in the heart. If you have an area of scar in your pumping chambers, it's almost like having a little electrical circuit in that scar. When the right thing comes along to trigger it off, it goes each time around the circuit as a heartbeat, and it can cause episodes of sudden rapid heart action, which are ventricular tachycardia."

Treatment of VT aims at restoring normal heart rhythm and can include medication, use of a defibrillator and catheter ablation. Unlike catheter ablation, proton beam therapy is completely noninvasive and can be delivered directly to the target in the heart.

"The idea of targeting any-size lesion in the middle of the patient without having to put the patient under anesthesia or any sort of access to veins or chest cavity, sounds like it's right up our alley," says Dr. Deisher.

The clinical trial using proton beam therapy to treat VT offers promise for patients who continue to battle the condition despite previous treatments.

Dr. Siontis discusses the results of the study thus far, "I certainly think that there were some patients who benefited from radiation with protons when everything else that we did for them, including multiple catheter ablation procedures and medications, had failed. I think adding noninvasive options generates a broad spectrum of options for patients who have the most difficult arrhythmias." To learn more about this innovative work, explore the new episode of Tomorrow's Cure. The podcast is available on all audio platforms, including Apple Podcasts, Spotify and Amazon Music. Episodes also feature a video component, which can be viewed on Mayo Clinic's YouTube channel.

Related Article:

• (VIDEO) Using proton beam therapy on the heart

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February is Heart Month in many countries

LONDON — You may have heard that people who feel faint should sit with their heads between their knees, but is that true? And how can you tell whether you or someone else who has fainted should go to the emergency department or perhaps even see a cardiologist? Elijah Behr, M.D., a cardiologist at Mayo Clinic Healthcare in London, explains five things it is important to know about fainting.

Fainting or blacking out, also known as syncope, is a temporary loss of consciousness due to insufficient blood flow to the brain.  

There are different types of syncope

Vasovagal syncope is the medical term for the most benign kind of fainting, simple fainting without a serious underlying cause, Dr. Behr explains. This type of fainting is common.

"In some people, if they have a drop in blood pressure from emotional distress, pain, illness or dehydration, for example, or just generally have a low blood pressure, any provocation causes a reflex in the heart," Dr. Behr says. "Rather than the heart speeding up and pumping more forcefully to maintain the blood pressure, it starts to slow down. The blood pressure drops, the heart rate slows further, and the heart can pause for many seconds; sometimes close to a minute for some people who have more severe fainting episodes."

Usually with this type of fainting, the person falls to the floor, blood pressure returns to the brain and the person starts to recover. However, if someone faints in a vulnerable location or vulnerable position, it can be dangerous to that person and others, Dr. Behr notes.

The syncope that most concerns healthcare professionals is cardiac syncope, blacking out due to an underlying heart disease such as a heart rhythm abnormality, or arrhythmia, he explains.

"This is usually a more abrupt loss and return of consciousness than in simple fainting. If you're older, you're more likely to have underlying heart disease that you may or may not be aware of. That's one of the reasons to be more concerned about loss of consciousness in older individuals," Dr. Behr says. "Young people can also have heart diseases that can cause cardiac syncope that may be a warning sign of something more serious to come, so it is important to investigate it."

Others for whom a blackout can be a warning sign of a serious heart problem include people with a family history of inherited heart problems, unexplained deaths or premature sudden deaths; people whose fainting is related to exercise; and people whose fainting is associated with heart palpitations or the heart feeling like it's racing away, he adds.

Before a simple faint, you might experience one or more signs that you should sit or lie down

"There will be a sensation of lightheadedness. There may be a sensation of nausea or buzzing or ringing in the ears," Dr. Behr says. "Some people describe tunnel vision — their vision closing in on them before they actually pass out — and some may actually lose vision but still be aware, not lose consciousness completely, and then recover. Other typical signs include feeling sweaty and clammy."

Some people get about a half-hour of warnings before fainting; some people may get 30 seconds, he adds.

What to do if you faint or someone else does:

• Check that the person is breathing and has a pulse. If not, call for emergency help, and if you know how to provide cardiopulmonary resuscitation, initiate it.
• If the person is still breathing and has a pulse, ensure they are lying flat, and their airway is open using the recovery position and call for help.
• If you feel like a faint may be coming on, position your head lower than your heart: for example, between the knees.
• Rest after coming out of the faint.
• Drink water after the faint, adding electrolytes if you have them.

"If your blood pressure is getting low and you're getting those symptoms, it means the blood doesn't get into your brain, and if your heart is trying to push the blood to your brain against gravity, then it's struggling. You really need to get your head level or below your heart so the blood pressure gets back to the brain, and that will avert all the symptoms and the vicious cycle that ensues," Dr. Behr advises. "Get your head between your knees or lie down and put your head down and your feet up in the air, depending on where you are and what is feasible to do."

Getting up and walking around straight away is probably the worst thing to do, he warns.

"Your blood pressure will drop further, and you’ll feel worse, and collapse and fall and injure yourself," Dr. Behr says. "The best thing is to stay where you are and get flat, and when you're feeling better, drink some water, maybe with some electrolytes if you're dehydrated. For general preventive measures, we advise most people who have fainted to drink more water and to sometimes add a bit of salt to their food, because generally they're running a low blood pressure."

Sometimes, getting hydrated and adding salt to the diet may not be enough. Occasionally people need to take medications to improve blood pressure control and increase blood pressure to prevent fainting episodes, Dr. Behr says.

When to seek medical help

"If somebody has had simple fainting with the clear precipitants that I described, it is best to have a chat with your GP (your primary care physician) to talk about it. Particularly if it's a first onset of symptoms, it's best not to ignore it," Dr. Behr says. "Often people go to the emergency department after a first faint, which I think is very fair to do and I would encourage."

If someone has had simple faints before, the circumstances that bring them on are typical for them and they have been evaluated by their primary care physician or a cardiologist before, they may not need to go to the emergency department every time, he adds.

The more concerning situations are older people having faints where other conditions may also be having an effect, people who are having recurrent faints despite keeping well hydrated, if there has been an injury due to a faint, and if the blackout comes on abruptly and with other signs that there may be an underlying cardiac condition.

"We need to make sure that they are treated and that something else isn't being missed," Dr. Behr says. "Also, sometimes faints can look like seizures. They can cause fitting activity, and differentiating a seizure and epilepsy from fainting requires involvement of a cardiologist and neurologist."

If you faint at the sight of blood, you may be able to condition yourself not to

"It's very common, but it can be surmounted by various means," Dr. Behr says.

For example, cognitive behavioural therapy (CBT) may help, he suggests. In CBT, you work with a mental health counselor such as a psychotherapist or therapist to become aware of inaccurate or negative thinking, so you can view challenging situations more clearly and respond to them more effectively.

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About Mayo Clinic Healthcare
Mayo Clinic Healthcare, located in London, is a wholly owned subsidiary of Mayo Clinic, a not-for-profit academic medical center. Mayo Clinic is top ranked by U.S. News & World Report in more specialties than any other hospital for a reason: quality of care. Mayo Clinic Healthcare is the U.K.'s front door to that unparalleled experience. Visit Mayo Clinic Healthcare for more information.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

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Dr. Regis Fernandes, a Mayo Clinic cardiologist, says triglycerides provide the body with energy from food. High levels can indicate signs of other conditions, like diabetes or prediabetes, that can increase the risk of heart disease and stroke.

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Triglycerides, the main kind of fat in your body, store extra energy from the food you eat. 

"It's an energy source. It's like a little battery used for energy. But too many triglycerides can also cause heart disease," says Dr. Fernandes.

People who are overweight, in general, have high triglyceride levels and good cholesterol levels that are low.

"They may get heart disease not because their LDL is high, they get heart disease because the HDL is low and the triglycerides is high," he says.

And this is significant for people in their 30s and 40s.

So what can you do? Reducing simple carbohydrates, such as refined sugars and flours, can help lower your weight and improve your cholesterol and triglyceride levels. And you can back that up with exercise.

"One of the best ways to lower triglyceride levels is to exercise. Also, exercise helps to lose weight. And when you lose weight, your triglycerides improve a lot," says Dr. Fernandes.

Tips to lower triglcyerides 

• Aim for 30 minutes of exercise most days.
• Cut sugar and refined carbs.
• Lose weight and focus on reducing calories.
• Choose healthier fats like olive oil and fish that are rich in omega-3.
• Limit alcohol, which can be high in calories and sugar.

Medications, including statins, may be prescribed if lifestyle modifications don't help.

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The stethoscope, one of the most iconic symbols of medicine, was invented over 200 years ago. Today, artificial intelligence is revolutionizing this essential tool, empowering doctors to detect cardiac disease at its earliest stages with greater precision. Discover these groundbreaking advancements on a new episode of Tomorrow's Cure.

The podcast episode features Dr. Demilade Adedinsewo, cardiologist, and Jason Bellet, co-founder of Eko Health. Together, they discuss innovative and lifesaving technology that is transforming heart health.

The AI-powered digital stethoscope, developed by Eko Health, captures electrocardiogram (ECG) data and heart sounds. This advanced tool enhances the detection of peripartum cardiomyopathy, a serious yet treatable condition that weakens the heart muscle during pregnancy or postpartum.

"There is a diagnostic gap when it comes to how do we identify a high index of suspicion and how we make it to that diagnosis," explains Dr. Adedinsewo. "Also, we do not have a simple, noninvasive screening test that is safe for mother and the baby."

Recognizing a weak heart pump caused by pregnancy is crucial because its symptoms — shortness of breath when lying down, swelling in the hands and feet, weight gain, and rapid heartbeat — can easily be mistaken for normal pregnancy-related conditions.

"We really believe that this technology has the ability to improve access to early detection, which then can inform the patient to go to a cardiologist on a more expedited timeline and get the advanced care they need," Bellet says. "If we can just detect heart murmurs that much better or AFib that much better in the physical exam, we can then get those patients referred into cardiology faster, get the echocardiogram and, hopefully, get the treatment they need earlier."

This technology holds immense potential to revolutionize the healthcare field.

"Our vision is to create a pipeline of algorithms such that when you put the stethoscope on the chest in a future physical exam, we'll be able to take those 15 to 30 seconds of heart sounds — and eventually lung sounds — and analyze them for a host of conditions, really turning that wellness visit that we all know with our provider that can be 15, 30 or 45 minutes into a really powerful early detection opportunity," Bellet says.

To learn more, check out the latest episode of Tomorrow's Cure wherever you get your podcasts. To see a complete list of episodes and featured experts, visit tomorrowscure.com.

Related Articles:

• Clinical research shows AI-enabled digital stethoscope can detect pregnancy-related heart disease
• Pregnancy-related heart failure is under-detected; AI-enabled stethoscope helped doctors diagnose twice as many cases
• Spotlight on early detection of 3 heart diseases using ECG-AI

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ROCHESTER, Minn. — Heart surgery is a serious and invasive medical procedure, and that can be intimidating for a patient. A new study published in Mayo Clinic Proceedings suggests that virtual reality (VR) can be an effective tool to reduce preoperative anxiety in older patients undergoing their first open-heart surgery. While much of the research to date using VR involved younger patient populations, these research findings suggest that immersive VR was effective and well tolerated in older patients. These reductions in anxiety are particularly significant given the known link between preoperative anxiety and negative postoperative outcomes, including increased pain, reduced activity and higher medication use. 

"This research represents a step forward in improving the patient experience and potentially using this approach to optimize postoperative recovery," says Jordan Miller, Ph.D., a cardiovascular disease researcher at Mayo Clinic and senior author of the study.  

Joseph Dearani, M.D., and John Stulak, M.D., both cardiac surgeons at Mayo Clinic involved with the study, emphasize the importance of emotional state before and after cardiac surgery. "We currently offer music and massage therapy after cardiac surgery because we know what a negative impact high anxiety has on recovery from surgery. Our team is now exploring broader implementation of VR — which can be used at any time and place, inside or outside the hospital — throughout the surgical episode to further evaluate its impact on clinical outcomes." 

Unlike traditional anti-anxiety medications, which can have drawbacks such as increased difficulty placing the tube that helps a patient breathe during surgery and a longer time to remove the tube after surgery, VR offers a nonpharmacological alternative. The study also highlights the potential of VR as a flexible tool, with the tablet-based option providing a viable alternative for patients susceptible to VR-induced motion sickness. 

The research included 100 participants who were scheduled for open-heart surgery. Each patient wore a monitor to record vital signs and completed a standardized, clinically validated anxiety test before and after the VR intervention on the day of surgery. The test asked them to rate their current state with 20 questions related to feelings ranging from calm to upset. Participants rated each feeling on a scale of 1 to 4, with 1 being "not at all" and 4 being "very much." 

Half of the participants were assigned to a VR tablet and the other half to immersive VR goggles while they waited in the holding area prior to surgery. The VR provided a 10-minute nature experience with guided breathing as they viewed trees and a waterfront that changed through four seasons. The tablet played a video of the content seen by patients in VR, while people who used the immersive VR headset were able to look all around and identify environmental features, which helped them advance through the scene. Both interventions reduced the pulse rate of participants, but they did not affect respiration rate or oxygen levels. 

Overall anxiety scores decreased an average of 2 points with the tablet treatment and 2.9 points with the VR goggles. Additionally, the researchers note that the scores improved considerably in up to seven of the anxiety-focused questions with the tablet and VR goggles. Several of those responses specifically represent a more positive outlook change from their previously negative feelings — a finding that has the researchers feeling optimistic about the abilities of VR to make surgery less stressful for patients.  

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.  

Media contact: 

• Terri Malloy, Mayo Clinic Communications, newsbureau@mayo.edu 

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ROCHESTER, Minn. — It’s not unusual to have one or more family members with some form of heart disease. Nonetheless, some people may not even know they have heart disease until they experience a heart attack or stroke or are diagnosed with heart failure. Despite the prevalence of heart disease, many people are still unclear about how genetics can impact heart disease and, most importantly, what they can do to lower their risk. Stephen Kopecky, M.D., a cardiologist at Mayo Clinic, explains how you can improve your heart health, even if your family has a history of cardiovascular problems.

Heart disease is a broad term that describes several conditions impacting the heart's structure and function. The most common type of heart disease is coronary heart disease typically caused by plaque buildup in and around the artery walls on the heart. But you may also have heard of heart valve disease, heart muscle disease (cardiomyopathy), conditions involving the heart's electrical system, or congenital heart disease. The exact symptoms depends on the type and severity of the disease.

Lifestyle factors — encompassing how much you move, what you eat, how well you sleep and more — play the biggest role in your heart health, Dr. Kopecky says. But circumstances you can’t control — namely, your genetics and family history — also impact your risk of heart disease.

Congenital heart disease, for example, is thought to run in families — meaning the condition may be passed down, also called inherited, from parent to child. Other research indicates that some genetic conditions, such as Down syndrome and certain types of muscular dystrophy, may be linked to cardiovascular conditions.

Family history may have a hand in heart disease that develops later in life as well. Though the exact numbers range, research consistently indicates that people with a family history of coronary artery disease, for example, have a significantly higher risk of developing the condition themselves. Similarly, people from families with two or more premature heart-related deaths have a three times higher risk of developing cardiovascular disease themselves before age 50.

Understanding your family history is an important piece of the puzzle, according to Dr. Kopecky. But it’s equally important not to blow genetic risk out of proportion. Genetics account for 20% to 30% of your risk, Dr. Kopecky says. But positive habits such as regular exercise and a healthy diet can impact your genes much more drastically.

“Certain good lifestyles can ‘turn off’ the bad genes and ‘turn on’ the good genes,” Dr. Kopecky explains. “We see patients in our prevention clinic with very high cholesterol, genetically determined. We know that if they have a good lifestyle, starting early in life, it lowers their heart attack and stroke risk.” In other words, Dr. Kopecky says the day-to-day, year-over-year habits you make to protect your heart health are oftentimes much more impactful than the genetic lottery.

There’s no magic or any one routine that will prevent heart disease and its more serious complications such as heart attack and stroke. By now, most people know it’s the small, consistent choices in all parts of life that add up in big ways.

“If you have genetic risk factors, it’s more important to have a healthy lifestyle,” Dr. Kopecky says. “I tell patients frequently: You have a new part-time job called ‘your health’.”

To get started, consider the following strategies:

• Incorporate a variety of nutritious foods. When making choices for meals and snacks, emphasize fresh fruits, vegetables, legumes and whole grains. Limit overly sugary, salty and processed foods that can raise blood pressure and cholesterol.
• Move as much as you can. For adults, the Centers for Disease Control and Prevention (CDC) recommends a minimum of 150 minutes of moderate activity every week. Exercise can help lower blood pressure, decrease cholesterol levels and maintain a heart-healthy weight. To get started, Dr. Kopecky recommends incorporating as much movement into your day as possible — and making time for light strength training and interval workouts as often as you can. Gardening, walking and taking the stairs all count!
• Prioritize sleep. Dr. Kopecky says getting enough quality sleep is critical for your heart health and overall quality of life. To ensure you’re well rested, Dr. Kopecky recommends consistently going to bed and waking up at the same time. “Don’t set an alarm to wake up. Set an alarm to go to sleep or get ready to go to bed,” he adds. “You shouldn’t need an alarm to wake up unless you’re traveling. Just wake up on your own.”
• Quit smoking and avoid alcohol. Heart attacks are more common in people who smoke. If you use any tobacco products, quitting as soon as possible helps lower your risk of heart disease. Similarly, it’s a good idea to limit your alcohol intake or avoid alcohol altogether.
• Lean on your healthcare team. If you have a family history of heart attack or heart disease — especially in first-degree relatives such as parents or siblings — or are unsure of your risk, talk with your healthcare team. Your care team also can help you determine the best plan for protecting your heart health.

Though it can seem overwhelming to make so many changes, just remember: Dr. Kopecky says nothing you do is ever too little or too late. When it comes to your heart health, you may find that positive reinforcement is a much more powerful motivator than shame or fear. Even small changes can compound and help protect your heart health, so do what you can as often as you can and celebrate the successes along the way.

For more information about heart health, please visit Mayo Clinic Press and MayoClinic.org.

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact: 

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

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DEAR MAYO CLINIC: I am in my 30s and overweight, but I thought I was too young to worry about cholesterol. I just learned my cholesterol is high. I know diet and exercise are important. Do I need medication? 

ANSWER: Cholesterol is a type of fat in our blood. Our bodies need a small amount of cholesterol to build the structure of cell membranes, make certain hormones and help with metabolism, such as producing vitamin D. The catch: We don't need too much cholesterol. 

Atherosclerosis, also known as narrowing of the arteries, happens when cholesterol builds up and blocks blood flow. This buildup is called plaque, which can clog arteries and can burst, leading to a blood clot. Atherosclerosis can cause heart problems such as chest pain (angina) or heart attack. It also can lead to problems in the brain, including transient ischemic attack, stroke, peripheral artery disease in the legs or arms, and even kidney failure.

Cholesterol and triglycerides are types of lipids. They travel in our blood by attaching to proteins. Adults 20 and older should ask their healthcare team about their lipid profile and how to interpret the numbers. 

• Low-density lipoprotein (LDL) cholesterol: We call LDL "bad" cholesterol. Below 100 milligrams per deciliter (mg/dl) is optimal for healthy people in the absence of coronary artery disease. If you have heart disease, your LDL should be below 70 mg/dl. Treatment decisions to reach appropriate levels need to be based on personal risk factors.

• High-density lipoprotein (HDL) cholesterol: We call HDL "good" cholesterol. It absorbs cholesterol in the blood and brings it to the liver, which flushes it from the body. For females, it should be above 50 mg/dl. For males, it should be above 40 mg/dl.

• Triglycerides: Triglycerides are a type of fat we use for energy. If you have too high of a triglycerides level, it can cause heart disease. Less than 150 mg/dl is optimal. 

• Total cholesterol: This is the sum of LDL and HDL cholesterol plus 20% of triglyceride levels. A total cholesterol level below 200 mg/dl is desirable.

Some people who are overweight may get heart disease not because their LDL is high but, rather, because their HDL is low and their triglycerides are high. That relationship can cause heart disease as much or even more than just high LDL cholesterol. These lipid abnormalities are significant for young people in their 30s or 40s who are overweight. Their triglyceride levels increase, and their HDL lowers. They're becoming prediabetic. Their LDL is staying the same, but they're still heading to heart disease. 

Treating high cholesterol depends on individual risk. The higher the risk — for example, with someone who already had a heart attack — a higher percent of reduction is needed. Medication to lower cholesterol can reduce LDL by about 60% to 65%. Lifestyle changes can reduce LDL by 10% to 15%. 

Several medications can help manage lipids. Discuss options with your healthcare team.

The body's ability to handle cholesterol is genetically determined. Genetic disorders that raise cholesterol levels are common. Familial hypercholesterolemia usually is caused by a genetic mutation preventing the body from clearing cholesterol. People with the condition are more likely to require medication to reduce their cholesterol levels. 

For people with genetic disorders that expose them to elevated cholesterol since birth, heart disease can happen at a younger age. So we start treating their high cholesterol with medication at a young age. 

Beyond medication, lifestyle modifications help manage lipids:

• Limit meat and dairy intake; they have saturated fat, which raises LDL cholesterol.
• Consume more fish, soluble fiber, fruit and vegetables. 
• Avoid diets high in carbohydrates, particularly refined carbs like sugar and white flour. They raise the blood sugar level quickly, raising triglycerides. Reducing simple refined carbohydrates helps lower triglycerides and weight because you store less fat. 
• Control your weight. It lowers your triglycerides and improves your HDL levels. 
• Exercise about 150 minutes of aerobic activity a week at a moderate intensity. Moderate intensity means you must breathe through your mouth. If you're breathing through your nose, that is low intensity. Exercise prevents cholesterol from building up, but it doesn't change LDL concentration levels. You must burn about 2,000 calories a week to lower LDL concentration. However, exercise helps lower triglyceride levels and maintain weight loss. 
• Do strength training at least twice a week. It helps your cardiovascular and muscular systems. Not everything we do to prevent heart disease is about cholesterol. 

The National Heart, Lung and Blood Institute recommends people get their first cholesterol screening between ages 9 and 11, and repeat it every five years. For men 45 to 65 and women 55 to 65, cholesterol screenings should occur every one to two years. Over 65? Test annually. More frequent testing may be needed for people who have or are at risk for coronary artery disease. — Regis Fernandes, M.D., Cardiovascular Medicine, Mayo Clinic, Phoenix

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Dr. Jesse Bracamonte, a Mayo Clinic family medicine physician, says it's important to seek medical advice if the condition persists. Getting evaluated can help identify and treat any underlying health conditions.

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Sometimes, cold feet simply mean you need warmer socks. But if your feet are always cold, no matter the weather, it might be something more.

"Anything from circulatory problems, not having adequate blood flow, heart condition problems, immune or autoimmune conditions such as like having thyroid disease, and sometimes nerve or neuropathic problems. Having nerve disorders can cause cold feet," says Dr. Bracamonte.

Where to start? He offers a few immediate steps.

"Warm socks, lifting your feet, staying hydrated, diet, nutrition is really important. Exercise is important. And, obviously, if you smoke, don't smoke," he says.

If your feet remain to feel cold but are not cold to the touch, it might be time to see your healthcare team.

"There are certain tests that it can easily be done to ensure that you have no circulatory issues, and a few blood tests may be warranted just to make sure you have no autoimmune issues or even signs of anemia," Dr. Bracamonte says.

Related posts:

• Tapping regenerative sciences to unlock mysteries of peripheral neuropathy
• Mayo Clinic Minute: What may be causing your hands and feet to tingle

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The average heart beats 100,000 times per day, circulating blood and oxygen throughout the body.

Dr. Demilade Adedinsewo (DEM-eee-LAH-day Ah-day-deen-SHAY-wo), a Mayo Clinic cardiologist, says that to keep the heart healthy, there are eight behaviors and numbers to keep in check.

Let's start with sleep.

"Seven to eight hours of sleep at night is recommended for ideal cardiovascular health," says Dr. Adedinsewo. "Fewer hours or poor-quality sleep can lead to physical symptoms that impact the rest of your body, including your heart."

In addition to sleep, it's important to:

• Maintain an appropriate weight.

• Keep blood glucose, blood cholesterol and blood pressure within range.

• Avoid smoking and secondhand smoke exposure.

• Follow an eating plan rich in nutrients, such as the Mediterranean or DASH diets.

• Exercise.

"Get at least 150 minutes of moderate-intensity physical activity every week," says Dr. Adedinsewo. "This does not necessarily have to be split up 30 minutes, five days a week, even though that's an easy way that we think about it. Really, every little thing that you do adds up."

Related posts:

• Mayo Clinic Minute: Do you practice good sleep hygiene?
• Mayo Clinic Minute: Heart disease in African American women
• Mayo Clinic Minute: How to jump-start your workout

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