Sudden stress - whether it's from anger, a heat wave, or getting out of bed - can be the final "insult" that sets off a heart attack, stroke, or cardiac arrest. These events usually occur after cholesterol-rich plaque has festered for decades in arteries nourishing the heart and brain. The more important triggers include waking from sleep, heavy physical exertion, anger, natural disasters and war, weather, air pollution, infections, sexual activity, and overeating. Other triggers include grief, lack of sleep, mental and work-related stress, holidays, sporting events, and use of recreational drugs. Harvard Heart Letter July 2007 .

When most people are first diagnosed with cardiovascular disease (CVD), they are confronted with major lifestyle changes: stop smoking, lose weight, eat better, take medications and exercise. There is no doubt that lifestyle modification is difficult, because it takes time, education and support. A good cardiac rehab program provides all of these things. Experts on nutrition exercise and behavior change will help you understand the CVD process, identify hurdles to your success, and help to find ways to meet your health goals. Heart disease is a progressive condition caused by a variety of factors, many of which can be modified with appropriate medical and/or lifestyle change. Participants in cardiac rehab have a 25-30 percent reduction in risk of death from coronary artery disease. Cardiac rehab is a covered service by CMS (Medicare). Cleveland Clinic Heart Advisor February 2010.

Any kind of exercise is better for your heart than no exercise at all. Walking is often held up as the gold standard - most people can do it, it's easy on the body, and it doesn't take any special equipment or venue. More vigorous activities like running, tennis or swimming do even more for the heart. Swimming works the heart and lungs and uses the arms, legs, and other muscle groups in between improving muscle strength and flexibility. Water is easy on the joints and muscles, and swimming is often recommended for people with arthritis and other chronic conditions. If doing laps isn't your thing, there are excellent aquatic alternatives like walking or running in the water or water aerobics. Harvard Heart Letter May 2009.

Smoking makes the heart beat faster and harder, narrows blood vessels, increases blood pressure, lowers the level of HDL (good cholesterol), makes blood more likely to clot inside blood vessels, and contributes to the formation of artery-clogging plaque. Each of these increases the chances of having a heart attack or stroke or developing peripheral artery disease (poor circulation to the toes, legs, genitals, arms and fingers). Harvard Heart Letter August 2008.

During the depths of winter, the produce sections of most grocery stores may look bleak. Frozen produce is a solid choice for a healthful diet. Fruits and vegetables are usually picked ripe and flash frozen. In addition to capturing their flavor, the freezing process seals in nutrients. Frozen vegetables make an easy, nutritious addition to soups, stews, and casseroles. They can be eaten plain, gussied up as a side dish, or thawed and tossed into salads. Frozen fruit is terrific for making smoothies or pie, sweetening yogurt, and eating as a snack. Adding extra fruits and vegetables to our diet is a gift to your heart and the rest of your body. Harvard Heart Letter February 2010.

Chocolate's artery-opening activity is attributed to compounds called flavanols that are abundant in cacao beans, as well as in onions, apples, berries, beans, and some types of tea. Just because cacao beans contain flavanols doesn't mean that chocolate does. In fact, the bitter-tasting flavanols are traditionally removed. "Dutched" cocoa, which has been treated with alkali, has few active flavanols. Look for the least-processed chocolate you can find. Skip those that have been treated with alkali. Keep in mind that you don't need much, because the calories may far outweigh the benefit. Harvard Heart Letter February 2008.

Metabolic syndrome is a collection of risk factors that increase disease risk. People who have three of these risk factors are said to have metabolic syndrome: ?extra fat in the waist and abdomen (a waist circumference of 35 inches or larger for women, 40 inches or larger for men) ?inefficient use of insulin (fasting blood glucose level of 110 mg/dL or more) ?high blood pressure (130/85 mmHg or higher) ?low HDL (good) cholesterol (less than 50 mg/dL for women, 40 mg/dL for men) ?high triglycerides (150 mg/dL or more). If you want to eliminate metabolic syndrome, you have to exercise at a moderate to vigorous intensity for 45 minutes a day or more. Cleveland Clinic Heart Advisor March 2008.

Every drug can do both good and harm. Aspirin can prevent heart attacks and strokes, but it can also irritate the stomach and cause unwanted - and sometimes serious - bleeding. Recommendations from the U.S. Preventive Services Task Force emphasize working with your physician to weigh the benefits of aspirin therapy against the risk. Men 45 or older should take aspirin to prevent heart attack only if their risk level exceeds the hazard of aspirin. Women 55 or older should take aspirin to prevent stroke only if their risk level exceeds the hazard of aspirin. Recent research suggests that taking 75 to 81 mg of aspirin a day is just as effective and often safer than taking larger doses of 100 mg or more. Harvard Heart Letter June 2009 Cleveland Clinic Heart Advisor June 2009.

Media reports questioning the safety of statins are raising concerns about side effects such as muscle pain. Physicians worry that these reports will cause patients to stop taking the drugs. Statins are incredibly safe. They reduce the rate of heart attack and stroke, and save more lives than almost any other drug. The primary side effect of statins is myopathy (muscle pain, tenderness or weakness). Research shows the risk is small, similar with all statins, and dose related, (the higher the dose, the greater the risk of myopathy). Myopathy generally resolves over time and reverses when the statin is discontinued. Lowering the dose or switching statins may eliminate symptoms also. If you experience side effects from statins, it's important for you and your physician to determine your need to continue the therapy and at what level. The decision is particularly important for people with cardiovascular disease. Cleveland Clinic Heart Advisor June 2010.

Vitamin D is best known for helping the digestive system absorb calcium and phosphorus. That's one way it helps build and maintain healthy bones. But it does much, much more. Deposition of calcium in arteries, a process that stiffens arteries, is more likely to happen in people who are low in vitamin D which makes them twice as likely to develop heart disease. Several studies suggest that low vitamin D contributes to high blood pressure and heart failure. Sunlight is an efficient way to get more vitamin D. Only a few foods - salmon, tuna, sardines, milk and fortified cereals - can give you vitamin D. It makes sense to ask your doctor to test your vitamin D level, and to take a supplement if it is in the deficient or insufficient range. Getting 800 to 1,000 IU daily from supplements is a good goal. Harvard Heart Letter December 2009.

Sleep apnea, a nighttime breathing pattern of held breaths and explosive snores, is bad for the body and the heart. This pattern of sleep, breath holding, and waking to breathe again is hard on the sleeper (and his or her bed partner). It causes daytime sleepiness and has been implicated in automobile accidents and other mishaps. Sleep apnea can boost blood pressure, contribute to heart failure or make it worse, lead to atrial fibrillation, dull memory and thinking skills, and may even shorten life. If you have been told you sometimes stop breathing when you sleep, it is well worth getting checked for sleep apnea. Sleep testing is normally administered in a hospital or sleep center and overseen by a technician. Portable monitors are now available and have opened the door to diagnosing sleep apnea at home. Harvard Heart Letter September 2010.

Pericarditis is an inflammation of the pericardium, the thin, two-layered sac that surrounds the heart to help protect it from infection. Many circumstances can lead to pericarditis, ranging from a viral infection to a reaction to a heart attack or heart surgery to autoimmune diseases. The most indicative sign of pericarditis is a sharp chest pain that increases with breathing, particularly when lying down, that can be relieved by sitting up and leaning forward. Other symptoms include difficulty breathing, especially when lying down, a dry cough and pain in the back, neck or left shoulder. Of all the conditions that can afflict the heart, pericarditis is among the most unpredictable and least-understood. But in many cases, it's a short-term, self-limited problem that can be cleared up with anti-inflammatory medications. Cleveland Clinic Heart Advisor March 2010.

The kidneys are two bean-shaped organs in your lower back. Healthy kidneys clean toxins from your blood, filtering out waste products for disposal in urine, and returning clean blood to circulation with the right balance of chemicals to ensure that other organs function well. A prime beneficiary of these services is your heart. Its non-stop work demands a constant supply of blood to its muscles from your kidneys. When kidneys fail, it's like a heart attack launched from behind your back. Cleveland Clinic Heart Advisor February 2007.

An aneurysm is an enlargement of a blood vessel. Stretching the artery wall weakens it, heightening the risk that the aneurysm will rupture. In general, aneurysms smaller than 4 centimeters require no action other than regular observation, as long as it causes you no discomfort. Larger aneurysms have been treated with surgery. But today, stent grafts (artificial vessels propped open with wire mesh cylinders and inserted into the aorta) are undergoing evaluation for treating some smaller aneurysms. All aneurysm patients need to tame high blood pressure, break any tobacco habits and avoid heavy lifting, like shoveling snow. Cholesterol reduction may also be useful. Cleveland Clinic Heart Advisor February 2007.

Peripheral vascular disease (PVD) means you have atherosclerosis in the arteries of your legs. It is the result of the same process that puts fatty plaque in the arteries of the heart and neck, so yes, you might have heart disease, too. PVD is very important to diagnose, because having it increases the chance of having a heart attack or stroke by 500 percent. It is very important for people with PVD to keep their blood pressure and cholesterol under control to reduce this risk. Cleveland Clinic Women's Heart Advisor January 2007.

Walking has been shown to ease the leg pain that often accompanies peripheral artery disease (PAD). Walking improves the flexibility of arteries and blood flow throughout the body, which may well lower the change of having a heart attach or stroke, which is much higher in people with PAD. Supervised exercise is recommended, at least at first, for people with PAD who haven't been very active. Don't ignore daily physical activity like walking around the block and climbing stairs. The more you do, the more you fight the physical decline that often accompanies peripheral artery disease. Harvard Heart Letter March 2009.

Restless leg syndrome (RLS) is a disorder in which there is an urge or need to move the legs to stop unpleasant sensations. RLS can cause twitching and flexing leg movements during sleep. Researchers found that when RLS patients experience leg twitching, they also have spikes in their blood pressure readings, which could contribute to cardiovascular disease. The leg movements can occur every 20 to 40 seconds throughout the night, making such frequent blood pressure fluctuations dangerous. Scientists believe RLS is related to the brain's release of the neurotransmitter dopamine, because dopamine drugs can reduce the symptoms. Patients and doctors should take the diagnosis of RLS seriously and include cardiologists in any treatment plans. Cleveland Clinic Heart Advisor August 2007.