Monday, March 16, 2009

Healthy, Low-Fat Soup: Recipes and Tips

Healthy, Low-Fat Soup: Recipes and Tips


One of the best "light" dinner options when the weather is cold is soup! Just pair a big bowl of soup with a wheat roll or some wheat crackers, and call it a meal. I always have some favorite canned soups in my pantry so anyone in the family can serve themselves some soup in l5 minutes. But there's something to be said for slowly simmering a homemade pot of soup over the stove until the flavors meld together perfectly. From chicken matzo ball soup to hearty lentil soup, it can really hit the spot on a cold day or night. Read on for some healthy and low-fat soup recipes, as well as tips on how to make any soup recipe lighter.

Soup for Supper

Can soup suffice as supper? If you are accustomed to eating light at night -- or if this is something you're moving toward -- a bowl of soup can definitely work as a satisfying evening meal.

Here are three reasons why:
It's almost impossible to slam down a bowl of soup. You have to eat slowly and enjoy each spoonful.
The high liquid content of most soups does a great job of filling your stomach.
If the soup or stew is high in fiber (from beans, vegetables, and/or whole grains), it will also help add bulk to your meal and thus help you feel full longer.

Light and Low-Fat Soups

As long as the soup you're slurping is broth- or tomato-based, you usually can't get into too much trouble, calorie-wise. A cup of broth, by itself, is about 25 calories with 1 to 2 grams of fat. A cup of tomato juice is about 40 calories and 1 gram of fat.

But with a cream-based soup, all bets are off. One cup of light whipping cream (in liquid form) is about 700 calories and 74 grams of fat, while 1 cup of half-and-half is 315 calories and 28 grams of fat. Wowza! Switching to whole milk in your creamy soup recipes is sounding a "whole" lot better now, isn't it?

One cup of whole milk is about 150 calories and 8 grams of fat. Using whole milk will usually give your soup the creamy taste and texture you desire, but without all the excess calories and fat. The lower-fat options for "cream" like whole milk, low-fat milk, and fat-free half-and-half are more sensitive to high heat, so avoid boiling and add them to the soup toward the end just to warm.

Here's a chart of the calories, fat, saturated fat, cholesterol, and fiber found in soup base ingredients so you can compare them for yourself:
Ingredient 1 (cup) Calories Fat (g) Sat. Fat (g) Cholesterol (mg) Fiber (g)
Light whipping Cream, liquid 698 74 46 265 0
Half-and-half 315 28 17 89 0
Whole milk 150 8 5 33 0
Stewed tomatoes, Canned 66 0.4 0 0 4
Tomato juice 41 0.1 0 0 2
Chicken/beef broth 25 1 0.5 ~2 0.5


4 More Tips for Low-Fat and Healthy Soups

Here are four more tips to help you keep your soup recipes low fat and healthy:
If your soup recipe calls for meat, choose leaner cuts whenever possible, like skinless chicken or turkey breast, pork tenderloin, or sirloin steak trimmed of visible fat. If the recipe calls for sausage, substitute a less-fat turkey sausage (such as turkey polska kielbasa links). Remember that you can usually get by with half as much as the recipe calls for.
When using fresh herbs, add them toward the end of cooking or stir them in right before serving. Some fresh herbs even work well sprinkled on as a garnish. Add dried herbs in the beginning or middle of cooking so they have plenty of time to rehydrate and give off their flavor.
If the soup recipe calls for stirring in butter at the end of the cooking process, just don't go there. If it calls for sauteing vegetables in butter in the beginning, just use a tablespoon of olive oil or canola oil instead. If you need more moisture as the vegetables are browning, add in a couple of tablespoons of water, wine, or broth.
Pump up the fiber in your soups by adding beans when possible and use whole grains like barley, brown rice, wild rice, or whole wheat blend pastas instead of refined grains.

3 Healthy, Low-Fat Soup Recipes

Here are three new light and nutritious soup recipes to try this winter!

Moroccan Lentil Soup/Stew

1 large onion, chopped (about 1 1/2 cups)
1 tablespoon minced garlic
1 teaspoon minced fresh ginger (or 1/2 teaspoon ground dried ginger)
1 tablespoon olive or canola oil
6 cups low-sodium chicken or beef broth (water can also be used)
1 1/2 cups red lentils, dried
15-ounce can garbanzo beans, rinsed and drained
14.5-ounce can diced tomatoes (tomatoes and any juice), low sodium if available
3/4 cup diced carrots
3/4 cup chopped celery (about 3 medium stalks)
1 teaspoon garam masala (a spice blend)
1 1/2 teaspoons ground cardamom
1/2 teaspoon ground cayenne pepper
1/2 teaspoon ground cumin

6 tablespoons fat-free sour cream (optional garnish)
Add onions, garlic, ginger and olive to a large nonstick saucepan and cook over medium-high heat, stirring often (about 7 minutes). Add the broth, lentils, garbanzo beans, diced tomatoes, carrots, celery, garam masala, cardamom, cayenne pepper, and cumin.
Bring stew to a boil, then lower heat to simmer, cover saucepan, and continue to cook until lentils are soft (about 1 to 1 1/2 hours.)
Ladle about a third to a half of the soup into a large food processor or blender and pulse to briefly puree. Pour soup puree back into the pot and stir. Serve each bowl with a dollop of fat-free sour cream, if desired.

High Cholesterol Risks: Top 2 Dangers

This is the way to decrease cholesterol. for busy people.

High Cholesterol Risks: Top 2 Dangers
There are usually no symptoms of high risk cholesterol.

A lot of people don't take the risks of high cholesterol very seriously. After all, one out of five people have high cholesterol. A staggering 50% of Americans have levels above the suggested limit. Could something so common really be a serious health risk?

Unfortunately, yes. Cholesterol is a direct contributor to cardiovascular disease, which can lead to strokes and heart attacks.

"Despite all of the amazing medicines and treatments we have, cardiovascular disease is still the number one cause of death and illness in our society," says Laurence S. Sperling, MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, Ga.

The World Health Organization estimates that almost 20% of all strokes and over 50% of all heart attacks can be linked to high cholesterol.

But if you've been diagnosed with high cholesterol, don't despair. The good news is that high cholesterol is one risk factor for strokes and heart attacks that you can change. You just need to take action now, before your high cholesterol results in more serious disease.
All About High-Risk Cholesterol Numbers

When it comes to high cholesterol risks, it's tough to keep the details straight. We might have a vague idea of whether our cholesterol is "good" or "bad," but we forget the actual numbers by the time we get to the parking lot outside our doctor's office. So it may be worth reviewing the basics.

Cholesterol is a fat-like substance circulating in your blood. Some of your cholesterol comes from the foods you eat. But the bulk of it is actually made in your own body, specifically in the liver. Cholesterol does have some good uses. It helps produce new cells and some hormones. But an excess of it in the bloodstream can lead to trouble.

There are two types of cholesterol: LDL cholesterol and HDL cholesterol.
LDL is also called "bad cholesterol" -- Sperling suggests that you think of the "L" as standing for lousy. LDL cholesterol can clog your arteries, increasing the risk of heart attack and stroke. Most people should aim for a level of less than 100 mg/dL. However, people who already have heart disease may need to aim for under 70 mg/dL.
HDL is "good cholesterol." Imagine the "H" stands for healthy, Sperling suggests. This type of cholesterol attaches to bad cholesterol and brings it to the liver, where it's filtered out of the body. So HDL cholesterol reduces the amount of bad cholesterol in your system. You should aim for 60 mg/dL or higher.
Triglycerides are not cholesterol but another type of fat floating in your blood. Just as with bad cholesterol, having a high level of triglycerides increases your risk of cardiovascular problems. Aim for a level of less than 150 mg/dL.

So although we all talk about high cholesterol risks, the term is a little misleading. What we really mean is high levels of bad LDL cholesterol and triglycerides and a low level of good HDL cholesterol.

What about total cholesterol, which is the sum of your LDL and HDL? While anything under 200 mg/dL is still considered the target, most experts don't focus on the number. It doesn't mean all that much. "Someone can have a total cholesterol of under 200 -- which is lower than average for Americans -- but still have unhealthy levels of HDL or LDL," says Sperling.

Drugs Before Stents for Stable Heart Disease

This is the best way to understand that can cancel the heart attack.

HealthDay ReporterLatest Heart News
Drugs Before Stents for Stable Heart Disease
Aging Baby Boomers May Swamp Cardiac Care
New Test Seems to Spot Deadly Heart Condition
Neck Size Linked to Heart Risk
Ankle Blood Pressure Test May Spot Heart Risks


THURSDAY, March 12 (HealthDay News) -- Treating people with non-acute heart problems should start with drug therapy, not invasive techniques such as angioplasty or implanting stents, because there is no difference between the two approaches in outcomes, a new study finds.

There has been an ongoing debate over whether initial treatment of people with non-acute heart problems should be with drugs or whether it would be better to open blocked heart arteries with a catheter -- called percutaneous transluminal balloon coronary angioplasty -- with or without a bare-metal or drug-coated stent, a wire mesh tube used to prop open an artery.

"In the short run, angioplasty procedures among stable patients can improve symptoms but are not lifesaving," said Dr. David J. Moliterno, chief of cardiovascular medicine at the University of Kentucky's Gill Heart Institute.

"To improve life span takes more than a few minutes in the catheterization laboratory," he said. "Rather, a lifetime of change is usually needed."

The report was published in the March 14 issue of The Lancet, in advance of an American College of Cardiology meeting in Orlando, Fla. Moliterno wrote an accompanying editorial in the journal.

For the study, a team led by Dr. Thomas A. Trikalinos, from the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, identified 61 clinical studies that compared medical therapy, or drug treatment, with angioplasty and stents. The trials included a total of 25,388 people. The researchers documented deaths, heart attacks and cardiac bypass surgeries, and repeated procedures after initial treatment.

They found that angioplasty and either bare-metal or drug-coated stents did not result in fewer deaths or heart attacks compared with medical therapy.

"The reason for the similar outcome is likely that these hardest endpoints occur at a relatively low rate among stable cardiac patients when followed for a short period of time and are more affected by risk factor and lifestyle modifications," Moliterno said.

People with stable coronary artery disease, he said, should not expect angioplasty, with or without use of a stent, to affect mortality or the occurrence of a heart attack.

"Rather, regardless of whether a patient requires angioplasty for symptoms, all patients should continue, as a primary treatment, to focus attention to aggressive risk factor modification," Moliterno said. "In other words, it's not just about the current severe blockages but about the underlying pathology causing the blockages."

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said he agrees that invasive procedures should be reserved for people with unstable cardiac problems.

"Percutaneous coronary interventions have been demonstrated to substantially improve clinical outcomes in patients with ST segment elevation, acute myocardial infarction and, in select groups of patients, with unstable angina and non-ST segment elevation acute myocardial infarction," Fonarow said. "Percutaneous coronary intervention is evidence-based, guideline-recommended therapy for these indications."

Though angioplasty might reduce symptoms in some people with stable coronary artery disease, he said, no individual study has demonstrated a comparative reduction in the number of heart attacks or deaths.

"This new meta-analysis demonstrates that balloon angioplasty, bare-metal stents and drug-eluting stents do not improve the clinical outcomes of death or myocardial infarction compared to medical therapy," he said.

Most people with stable coronary artery disease "are better off with initial treatment with optimal medical therapy, reserving percutaneous coronary intervention for those patients with persistent symptoms despite optimal medical therapy," Fonarow said.

Another report in the same issue of The Lancet found that, after two years of follow-up, bioabsorbable polymer drug-eluting stents, which are reabsorbed by the body, were safe and effective.

None of the 30 people who participated in the study died or needed further treatment of the stented artery during those two years, and there were no new blockages of the artery caused by the stent, the researchers found.

Biodegradable stents were developed to eliminate problems with metal stents, which can cause new blockages and can interfere with magnetic resonance imaging.

"All these findings need to be confirmed in larger studies, but this or similar devices could become of paramount importance for the restoration of vascular integrity in the treatment of flow-limiting plaque," the authors concluded.

The way to cut cholesterol

High Cholesterol: Stocking a Heart-Healthy Kitchen
Heart-healthy foods are essential to a heart-healthy diet.

If you want to eat a heart-healthy diet but are not sure what foods you should buy, check out this heart-healthy kitchen essentials guide. From fruits and vegetables to whole grain goodness, learn what foods to keep on hand.
Fresh Fruits & Vegetables

Fill your fridge with seasonal fruits such as berries, oranges, apples, pears, and grapes, and vegetables such as bell peppers, broccoli, kale, cauliflower, tomatoes, dark leafy greens, celery, eggplant, zucchini, and squash.
Dairy and Dairy Alternatives
Skim or 1% milk
Soymilk (plain, unsweetened, vanilla, or chocolate)
Low - or nonfat buttermilk
Nonfat half-and-half or nonfat creamers
Nonfat or reduced-fat cheese (bricks, slices, or shredded)
Soy-based cheeses (bricks, slices, or shredded)
Nonfat or light cream cheese
Nonfat or 1% fat cottage cheese or ricotta cheese
Nonfat or 1% fat yogurt (includes fruited, vanilla, or plain)
Soy-based yogurts
Nonfat sour cream
Egg substitutes, egg whites
Meat, Poultry, Fish & Meat Substitutes
Skinless, boneless chicken or turkey breasts and tenders
Skinless, white breast meat ground chicken or turkey
Pork tenderloin, trimmed of fat
Lean ground beef such as ground round or ground sirloin (Note: When buying beef, look for words like "round" or "loin" and choose lean cuts -- the less marbling, the lower the fat content.)
Assorted fish: salmon, mackerel, tilapia, trout, herring, tuna
Tofu silken, soft, firm, or extra firm
Tempeh
Seitan
Frozen Foods
Frozen vegetables and vegetable blends without added sauces, gravies, and added sodium
Frozen fruits without added sugar (for example, frozen blueberries, strawberries, or raspberries)
Frozen soybeans (edamame)
Frozen vegetarian burgers, sausage patties, or links (For example, Boca Burgers, Yves, Morningstar Farms or Gardenburger)
Reduced-fat and sodium vegetarian chili, burritos, and entrees like Amy's Organic and Health Valley.
Fats, Cooking Oils
Assorted cooking oils (olive, canola, walnut, grapeseed, peanut, and sesame)
Non-fat cooking sprays (for example, Spectrum Naturals, Pam)
Baking fat replacements (for example, pureed prunes, applesauce, or Smucker's Baking Healthy)
Non-hydrogenated shortening (for example, Spectrum Naturals)
Trans-free liquid or tub margarine (for example, Promise Activ, Benecol, Fleischmann's Light, Smart Balance)
Reduced-fat or nonfat salad dressings
Herbs, Seasonings & Spices

Here are some delicious seasonings to take the place of salt.Allspice Basil Bay Leaves Black pepper
Caraway seeds Cayenne Chili powder Chinese five-spice
Cinnamon Cloves Coriander Cumin
Curry powder Dill Garlic powder Ginger, ground
Italian seasoning Marjoram Mint Nutmeg
Onion powder Oregano Paprika Parsley
Red pepper flakes Rosemary
Assorted sodium-free Mrs. Dash seasonings

Sweeteners
Splenda, Equal, Nutra Sweet, Sugar Twin, and Brown Sugar Twin (sugar substitutes)
Sugar free or "light" maple syrups
Honey
Brown rice syrup for a sweetening alternative to use when baking
Pantry Essentials

Snacks
Assorted raw nuts and seeds (almonds, walnuts, sunflower seeds, sesame seeds)
Dried fruits
Whole-grain breads, tortillas, pitas
Whole-grain, trans-fat free crackers (such as Health Valley whole wheat crackers, Kashi TLC crackers, Reduced Fat Triscuits, Fat Free Rye Crisp, Wasa)
Baked, trans-fat-free tortilla chips
Brown rice cakes, popcorn cakes
Whole-grain pretzels (such as Snyder's oat bran or honey wheat)
Plain popcorn or light microwave popcorn

The Important of Meditation

When Your Doctor Orders Cholesterol-Lowering Medications


You’ve just left your doctor’s office with a prescription for a statin medication to help lower your cholesterol. But you may be nervous. You’ve heard that you’ll have to take this cholesterol-lowering medication for the rest of your life. And your doctor noted that statins, like all medicine, can cause side effects.

Why should you take a statin? Can’t you just improve your cholesterol levels by eating right and exercising? The answer is yes -- and no. Healthy cholesterol and triglyceride levels look like this:

Total cholesterol: less than 200 mg/dL

HDL (“good” cholesterol): 40 mg/dL or more for men, 50 or more for women

LDL (“bad” cholesterol): less than 130 mg/dL

Triglycerides: less than 150 mg/dL

Many people can get their cholesterol and triglyceride levels into these healthy ranges through a combination of a healthy diet and an active lifestyle. But for many others, these lifestyle changes help, but are not enough.
Measuring the Benefits of Statins, Diet, and Exercise

“Lifestyle changes certainly are the cornerstone of cholesterol reduction,” says Michael Miller, MD, director of the Center for Preventive Cardiology at the University of Maryland Medical Center.

Exercising, eating a healthy diet, and losing weight can result in:
A 5% to 10% reduction in LDL cholesterol
A 10% to 30% reduction in triglycerides

But for those with very high LDL cholesterol or triglycerides, those lifestyle measures may be insufficient. “If your lipid levels are way out of whack, for example, reducing your LDL by 10% may not get you down to a healthy level,” Miller says.
Statin medications act quickly and can help reduce LDL or “bad” cholesterol by up to 50% or more.
Statins also help increase HDL or “good” cholesterol by up to 15%.

If you’re making healthy lifestyle changes at the same time, says Miller, you should see major changes in your cholesterol levels within two to four weeks after beginning lipid-lowering therapy.

“Statins are very simple: you take them once a day, and their effects are quite profound,” says Patrick McBride, MD, MPH, director of the preventive cardiology program and the cholesterol clinic at the University of Wisconsin School of Medicine and Public Health.

“Not only do statins improve your cholesterol levels, but they reduce your risk of heart attack, stroke, and cardiovascular events. They’re one of the great success stories of modern medicine,” says McBride.

Most recently, the JUPITER trial showed that statins can also slash the risk of heart attack nearly in half for people with normal cholesterol but high levels of a protein associated with inflammation.
Statin Side Effects and Other Worries

What about side effects from taking statins? It’s true that any medication comes with side effects. Side effects most commonly seen with statins are headache, GI tract upset, muscle and joint aches, or rash. Very rarely, patients may experience muscle or liver damage.

Cholesterol, ther risk,

High Cholesterol Risks: Top 2 Dangers
There are usually no symptoms of high risk cholesterol, yet the dangers are very real -- even fatal.
By R. Morgan Griffin
WebMD Feature
Reviewed by Brunilda Nazario, MD

A lot of people don't take the risks of high cholesterol very seriously. After all, one out of five people have high cholesterol. A staggering 50% of Americans have levels above the suggested limit. Could something so common really be a serious health risk?

Unfortunately, yes. Cholesterol is a direct contributor to cardiovascular disease, which can lead to strokes and heart attacks.

"Despite all of the amazing medicines and treatments we have, cardiovascular disease is still the number one cause of death and illness in our society," says Laurence S. Sperling, MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, Ga.

The World Health Organization estimates that almost 20% of all strokes and over 50% of all heart attacks can be linked to high cholesterol.

But if you've been diagnosed with high cholesterol, don't despair. The good news is that high cholesterol is one risk factor for strokes and heart attacks that you can change. You just need to take action now, before your high cholesterol results in more serious disease.
All About High-Risk Cholesterol Numbers

When it comes to high cholesterol risks, it's tough to keep the details straight. We might have a vague idea of whether our cholesterol is "good" or "bad," but we forget the actual numbers by the time we get to the parking lot outside our doctor's office. So it may be worth reviewing the basics.

Cholesterol is a fat-like substance circulating in your blood. Some of your cholesterol comes from the foods you eat. But the bulk of it is actually made in your own body, specifically in the liver. Cholesterol does have some good uses. It helps produce new cells and some hormones. But an excess of it in the bloodstream can lead to trouble.

There are two types of cholesterol: LDL cholesterol and HDL cholesterol.
LDL is also called "bad cholesterol" -- Sperling suggests that you think of the "L" as standing for lousy. LDL cholesterol can clog your arteries, increasing the risk of heart attack and stroke. Most people should aim for a level of less than 100 mg/dL. However, people who already have heart disease may need to aim for under 70 mg/dL.
HDL is "good cholesterol." Imagine the "H" stands for healthy, Sperling suggests. This type of cholesterol attaches to bad cholesterol and brings it to the liver, where it's filtered out of the body. So HDL cholesterol reduces the amount of bad cholesterol in your system. You should aim for 60 mg/dL or higher.
Triglycerides are not cholesterol but another type of fat floating in your blood. Just as with bad cholesterol, having a high level of triglycerides increases your risk of cardiovascular problems. Aim for a level of less than 150 mg/dL.

So although we all talk about high cholesterol risks, the term is a little misleading. What we really mean is high levels of bad LDL cholesterol and triglycerides and a low level of good HDL cholesterol.

What about total cholesterol, which is the sum of your LDL and HDL? While anything under 200 mg/dL is still considered the target, most experts don't focus on the number. It doesn't mean all that much. "Someone can have a total cholesterol of under 200 -- which is lower than average for Americans -- but still have unhealthy levels of HDL or LDL," says Sperling.

Heart Attatch, deases, heart problem

What is a heart attack?


A heart attack (also known as a myocardial infarction) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and chest pressure sensation. If blood flow is not restored to the heart muscle within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is eventually replaced by scar tissue.

Approximately one million Americans suffer a heart attack each year. Four hundred thousand of them die as a result of their heart attack.

What causes a heart attack?

Atherosclerosis

Atherosclerosis is a gradual process by which plaques (collections) of cholesterol are deposited in the walls of arteries. Cholesterol plaques cause hardening of the arterial walls and narrowing of the inner channel (lumen) of the artery. Arteries that are narrowed by atherosclerosis cannot deliver enough blood to maintain normal function of the parts of the body they supply. For example, atherosclerosis of the arteries in the legs causes reduced blood flow to the legs. Reduced blood flow to the legs can lead to pain in the legs while walking or exercising, leg ulcers, or a delay in the healing of wounds to the legs. Atherosclerosis of the arteries that furnish blood to the brain can lead to vascular dementia (mental deterioration due to gradual death of brain tissue over many years) or stroke (sudden death of brain tissue).

In many people, atherosclerosis can remain silent (causing no symptoms or health problems) for years or decades. Atherosclerosis can begin as early as the teenage years, but symptoms or health problems usually do not arise until later in adulthood when the arterial narrowing becomes severe. Smoking cigarettes, high blood pressure, elevated cholesterol, and diabetes mellitus can accelerate atherosclerosis and lead to the earlier onset of symptoms and complications, particularly in those people who have a family history of early atherosclerosis.

Coronary atherosclerosis (or coronary artery disease) refers to the atherosclerosis that causes hardening and narrowing of the coronary arteries. Diseases caused by the reduced blood supply to the heart muscle from coronary atherosclerosis are called coronary heart diseases (CHD). Coronary heart diseases include heart attacks, sudden unexpected death, chest pain (angina), abnormal heart rhythms, and heart failure due to weakening of the heart muscle.

Atherosclerosis and angina pectoris

Angina pectoris (also referred to as angina) is chest pain or pressure that occurs when the blood and oxygen supply to the heart muscle cannot keep up with the needs of the muscle. When coronary arteries are narrowed by more than 50 to 70 percent, the arteries may not be able to increase the supply of blood to the heart muscle during exercise or other periods of high demand for oxygen. An insufficient supply of oxygen to the heart muscle causes angina. Angina that occurs with exercise or exertion is called exertional angina. In some patients, especially diabetics, the progressive decrease in blood flow to the heart may occur without any pain or with just shortness of breath or unusually early fatigue.

Exertional angina usually feels like a pressure, heaviness, squeezing, or aching across the chest. This pain may travel to the neck, jaw, arms, back, or even the teeth, and may be accompanied by shortness of breath, nausea, or a cold sweat. Exertional angina typically lasts from one to 15 minutes and is relieved by rest or by taking nitroglycerin by placing a tablet under the tongue. Both resting and nitroglycerin decrease the heart muscle's demand for oxygen, thus relieving angina. Exertional angina may be the first warning sign of advanced coronary artery disease. Chest pains that just last a few seconds rarely are due to coronary artery disease.

Angina also can occur at rest. Angina at rest more commonly indicates that a coronary artery has narrowed to such a critical degree that the heart is not receiving enough oxygen even at rest. Angina at rest infrequently may be due to spasm of a coronary artery (a condition called Prinzmetal's or variant angina). Unlike a heart attack, there is no permanent muscle damage with either exertional or rest angina.

Atherosclerosis and heart attack

Occasionally the surface of a cholesterol plaque in a coronary artery may rupture, and a blood clot forms on the surface of the plaque. The clot blocks the flow of blood through the artery and results in a heart attack (see picture below). The cause of rupture that leads to the formation of a clot is largely unknown, but contributing factors may include cigarette smoking or other nicotine exposure, elevated LDL cholesterol, elevated levels of blood catecholamines (adrenaline), high blood pressure, and other mechanical and biochemical forces.

Unlike exertional or rest angina, heart muscle dies during a heart attack and loss of the muscle is permanent, unless blood flow can be promptly restored, usually within one to six hours.



While heart attacks can occur at any time, more heart attacks occur between 4:00 A.M. and 10:00 A.M. because of the higher blood levels of adrenaline released from the adrenal glands during the morning hours. Increased adrenaline, as previously discussed, may contribute to rupture of cholesterol plaques.

Approximately 50% of patients who develop heart attacks have warning symptoms such as exertional angina or rest angina prior to their heart attacks, but these symptoms may be mild and discounted.