Heart Health Center

Dr. Sinatra's Healthy Heart Program

• Step One: The Healthiest Diet of All
• Step Two: Supplements for the Heart
• Step Three: Exercise — Just Do It!
• Step Four: Reduce Your Emotional Risk Factors

Step One: The Healthiest Diet of All

After a great deal of research, I've concluded that the best overall diet is the Pan Asian Modified Mediterranean (PAMM) Diet. There's a remarkable amount of research to back up this healthy and delicious approach to nutrition. It's good for your heart and will help protect you against breast cancer and osteoporosis. And best of all, it's not really a "diet": it's a lifestyle choice.

Moderate Carbohydrates, More Protein and Healthy Fats

What is a PAMM diet? In a nutshell, it encourages eating cold-water fish such as salmon and halibut; "healthy fats" such as olive oil and low-glycemic carbohydrates such as garlic and onions, plus plenty of fruits, vegetables, soy, and nuts.

The overall percentage of each lines up something like this: 25–30 percent protein; 25–30 percent healthy fats; and 45–50 percent carbohydrates. This is a moderate-carbohydrate diet with slightly more protein than is often recommended.

Note: Like many cardiologists, I used to recommend low-fat, high-carbohydrate foods to my cardiac patients. I was caught up in the low-fat, high-carbohydrate craze that swept across the country ten years ago. Boy, was I off the mark! In fact, I was so wrong that I wrote a book, Lower Your Blood Pressure in Eight Weeks, in which I highlighted the PAMM diet.

Instead of eating large chunks of meat, Mediterranean people flavor their sauces with meat. And at most meals, they eat fiber-rich fruits and vegetables teeming with phytonutrients and packed with vitamins, carotenoids, flavonoids, polyphenols and monounsaturated fats crucial to well-being and cardiac health. Their diets are naturally rich in omega-3 fatty acids, coenzyme Q10 and the minerals potassium, calcium and magnesium. The same holds true for Pan Asian people, who eat lots of fish, soy, vegetables, and nuts.

Lose Weight, Gain Energy, Fight Disease

The PAMM diet can support more even blood sugar and insulin levels while giving you more energy and helping find your ideal weight or body mass. My patients report that they consistently feel better, experience a better quality of life, and—according to the literature—enhance their resistance to diseases such as coronary heart disease and cancer.

Take a look at these important benefits of the PAMM diet:

1. Cold-water fish such as salmon and halibut contain an abundance of beneficial essential fatty acids, omega-3 oils that reduce arterial clotting and inflammation. They are also excellent sources of coenzyme Q10, an energy-boosting nutrient.


2. High in low-glycemic legumes such as lentils and chickpeas. These foods slow the release of sugars into the bloodstream, helping to prevent excess insulin release leading to hyperinsulinemia and its related health concerns, including poor heart health, obesity, high blood pressure, and high LDL: "bad" cholesterol.


3. Offers a cornucopia of fresh fruits and vegetables teeming with phytonutrients—carotenoids, flavonoids and polyphenols—associated with a lower incidence of heart health problems, vision problems, and more.


4. Lower in dairy and excessive quantities of meat, thus less methionine, an amino acid precursor to homocysteine, which is formed without adequate B-vitamin support.


5. Rich in root vegetables such as garlic and onions, two terrific heart healers noted for their blood pressure–lowering and antioxidant effects.


6. High in vitamin C, vitamin E, magnesium, zinc, and L-glutathione—key antioxidants necessary to control free radicals; vitamin E is especially important for cardiovascular health.


7. Low in saturated fat, creating less arterial plaque.


8. High in fiber, further helping to stabilize blood sugar by slowing the absorption of carbohydrates and supporting a healthy lower bowel.


9. High in olive oil, far healthier than margarine, which contains trans fatty acids.


10. Soy products such as soy milk, soybeans, and tofu are rich in antioxidants that can reduce cancer risk.


11. May include small amounts of red wine, a rich source of quercetin, which prevents the deposit of arterial plaque.

Now that you're aware of the multiple benefits of my PAMM diet, here's how to apply it:

Decrease your intake of:

• Processed foods containing refined white flour and sugar, such as breads, cereals (corn flakes, frosted flakes, puffed wheat, and sweetened granola), flour-based pastas, bagels, and pastries


• Foods containing hydrogenated or partially hydrogenated oils (which become trans fatty acids in the bloodstream), such as most crackers, chips, cakes, candies, cookies, doughnuts, and processed cheese


• Starchy, high-glycemic cooked vegetables, such as potatoes, corn, and carrots


• Processed canned vegetables (usually very high in sodium)


• Processed fruit juices, which are often loaded with sugars. (Try juicing your own carrots, celery, and beets instead, or other fruit and vegetable combinations.)


• Red meats and organ meats


• Oils such as corn, safflower, sunflower, peanut, and canola


• Dairy products such as whole milk, high-fat cheese, and whole-milk yogurt

Increase your intake of:

• Oatmeal and higher-fiber pastas made with spelt or Jerusalem artichokes instead of semolina flour pasta. Go to my Pasta á La Sinatra recipe.


• Slow-burning low-glycemic vegetables such as asparagus, broccoli, kale, spinach, cabbage, Brussels sprouts, and legumes such as lentils, soybeans, and chickpeas.


• Onions and garlic


• Herbs such as rosemary, ginger, and turmeric


• Grapefruit, cherries, peaches, plums, dried apricots, rhubarb, pears, and apples; cantaloupes, grapes, and kiwifruit are suitable; however, they contain more sugar. Note: if you take any medications, do not consume grapefruit products.


• Protein such as fish, especially fatty, cold-water fish like salmon, mackerel, and sardines; shellfish. You may flavor your sauces with small amounts of lamb, lean beef, chicken, or turkey. And eat up to six eggs a week.


• Soy products like tofu, soybeans, tempeh, and soy milk


• Extra-virgin olive oil and sesame oil on salads or for cooking


• Nuts and seeds, including raw walnuts, almonds, and flax


• Low-fat cottage cheese, feta cheese, and small amounts of grated Parmesan

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

Step Two: Supplements for the Heart

While books have been written about the following nutritional supplements and more, here are some of your key nutritional allies to promote a healthy heart and cardiovascular system. I encourage you to expand your horizons when it comes to nutritional supplements, and read and learn all you can in this rapidly evolving field.

Vitamin E Tocotrienols Carotenoids Lutein Magnesium Calcium B-Vitamins & Folic Acid

Vitamin C Coenzyme Q10 L-carnitine Alpha Lipoic Acid N-acetylcysteine (NAC) Oligomeric Proanthocyanidins (OPCs) L-arginine

Vitamin E: One of Your Heart's Best Friends

Study after study has confirmed my long-held conviction that vitamin E acts like a loyal bodyguard as it promotes healthy cell membranes.

Recommended dose: For women, take 200 IU of vitamin E a day. Men need 400 IU per day. In addition, women with hot flashes or night sweats can increase the dose to 400 to 600 IU a day.

When you're out shopping for vitamin E, look for one of the newer generation of products that contain mixed tocopherols, including alpha and gamma fractions, and tocotrienols, a group of related compounds. These do an even better job than standard vitamin E products of promoting healthy cells and healthy cholesterol levels.

Note: If you take the blood thinner Coumadin, don't take more than 200 units of vitamin E per day because a combination of the two could promote excess blood thinning and the remote possibility of bleeding.

Tocotrienols: New Kids on the Block

These compounds have demonstrated vitamin E–like activity, with added benefits in protection from serious heart problems: they help lower cholesterol (standard d-alpha-tocopherol does not), and there's evidence that tocotrienols provide greater antioxidant protection against lipid peroxidation than standard vitamin E.

Tocotrienols can be purchased in health food stores as a single supplement or as part of a mixed-tocopherol vitamin E product.

Recommended dose: 40–80 mg per day

Colorful Carotenoids

Consumption of fresh fruits and vegetables has long been associated with promoting heart and eye health. But it can be a challenge to consume the five to nine recommended servings per day. That's why it makes sense to take out the additional "insurance" in supplements.

Look for a special supplement or read the label to find a mixed carotenoid complex within your multivitamin, including alpha carotene, beta carotene, gamma carotene, xeaxanthin, cryptoxanthin, lycopene, and lutein.

Recommended dose: Strive for a carotenoid complex total of up to 10,000 IU per day.

A Word About Beta Carotene:

Beta carotene is an extremely important player in promoting heart health. More than 200 studies have confirmed that foods rich in flavonoids, carotenoids, and other antioxidants can reduce risk of numerous health conditions, including heart health and a stronger immune system.

I do not recommend that you take high-dose supplemental beta carotene alone, but get it in combination with your diet. In fact, it's best to combine a good diet with some supplements, like my basic antioxidant formula.

Lutein: The French Paradox Explained

When news broke a few years back that red wine seemed to protect the French from heart health problems, some of you may have stocked up on Cabernet or Beaujolais. But there's a healthier and less expensive way to protect your heart and your eyes, and that is found in a carotenoid called lutein. This antioxidant nutrient is found in most fruits and vegetables, most abundantly in spinach, kale, and collard greens. Scientists believe that it promotes healthy cholesterol levels and ultimately heart health.

Recommended dose: Take at least 6 mg a day. Lutein supplements are available in health food stores, pharmacies, and grocery stores.

Magnesium: Unsung Hero of Cardiovascular Health

Magnesium is essential for healthy heart function. It is crucial to produce the high-energy bonds that drive the energy machinery of your cells.

More specifically, magnesium:

• Helps maintain proper smooth muscle function in your blood vessels.
• Helps shuttle potassium and sodium into and out of cells, maintaining proper membrane balance (homeostasis).
• Acts like a calcium channel blocker to stabilize cardiac conduction, heart muscle, and vascular membranes.
• Magnesium deficiencies can lead to muscle weakness and tremors (spasms) and a host of cardiovascular problems ranging from high blood pressure to arrhythmias.

Calcium: The Other Half of the Dynamic Duo

Calcium is important, too, because of its synergistic relationship with magnesium. Although most people associate calcium deficits with poor bone health, low levels can also increase your vulnerability to high blood pressure. But you must be careful about the amount of calcium you take. More than 2,000 mg of calcium per day can cause your kidneys to excrete magnesium!

Recommended dose: Take 1,000 mg daily of calcium in conjunction with 500 mg daily of magnesium. Postmenopausal women are often advised to take 1,500 mg of calcium, which is fine, but most of you will be able to make up the difference in your diet with 1,000 mg.

I like calcium in softgel form because of its rapid disintegration time (six minutes or less) and better bioavailability. In people with poor digestion, solid calcium tablets may pass through the digestive tract intact and out of the body. Choose a calcium formula that contains mixed compounds such as citrate, carbonate, aspartate, and gluconate in combination with a similar magnesium complex. For more on my recommendation, click here.

B-Vitamins & Folic Acid: Starring Roles for Your Heart

Recently, a national survey showed that only 45% of women between the ages of 20 to 29 have a folate intake that achieves 100% of the RDA. This means that slightly more than half of women in this age group have low intakes of folic acid, which in turn increases their risk of having a child with serious—and fully preventable—birth defects.

Here's what else researchers at the Harvard School of Public Health in Boston found:

• An intake of folic acid and B6 above the current RDA (180 mcg of folic acid; 1.6 mg B6) could significantly lower a woman's risk of serious heart problems.
• Women who typically consumed 400 mcg folic acid and 3 mg of B6 daily—significantly above the current RDA—were half again as likely to suffer from serious heart problems than those who consumed the lower levels.

Recommended dose: Although you can get folic acid and B6 from food, including green leafy vegetables, beans, legumes, oranges and orange juice, diet may not give you all that you need. I've always believed that a higher dose of folic acid, as well as other B vitamins, is the antidote for reducing high homocysteine. Make sure you're getting what you need in your multivitamin: See Daily Nutrient Program.

Vitamin C: Still the All-Around Antioxidant Champ

Vitamin C, also known as ascorbic acid, is one of the best-known antioxidants. Vitamin C promotes heart, immune, bone, and joint health as well as healthy mood.

Recommended dose: Take 500 mg daily. In addition, eat foods rich in vitamin C, such as broccoli, tomatoes, strawberries, and citrus fruits such as pink grapefruit and oranges.

Note: If you have high iron (ferritin) levels, be careful about megadosing with vitamin C. Vitamin C enhances the absorption of iron, and too much iron (which can be determined by a blood test) is a risk factor for heart disease.

Coenzyme Q10: Energy on Call

More than 100 clinical studies at major universities and hospitals have documented the actions of coenzyme Q10. I have long considered CoQ10 a wonder nutrient because of its ability to support heart health.

The heart is one of the few organs in the body to function continuously without resting; therefore, the heart muscle (myocardium) requires the highest level of energetic support. And any condition that causes a decrease in CoQ10 could impair the energetic capacity of the heart, thus leaving the tissues more susceptible to free radical attack.

Dietary sources of CoQ10 come mainly from beef heart, pork, chicken livers, fish (especially salmon, mackerel, and sardines).

Recommended dose: Take 30–120 mg of water soluble Q-Gel per day.

L-Carnitine: Fuel for the Heart

While CoQ10 sparks the energy within the cells, L-carnitine is like a shuttle, bringing fuel into heart cells to be burned as energy. I've observed some dramatic effects in my patients teaming up these two nutritionals; in fact, they have changed the way I treat heart health.

Recommended dose: Take 250–500 mg L-carnitine fumarate two to four times daily. Start at the low end of the dosage scale and work up until you achieve the effect desired. Both L-carnitine and coenzyme Q10 may require fine-tuning to obtain the optimal therapeutic blood level and symptom relief, especially if you have a compromised heart.

Alpha Lipoic Acid: Antioxidant With a Twist

Alpha lipoic acid is considered a universal antioxidant because of its ability to promote healthy stress levels and conserve other important antioxidants such as vitamins C and E and coenzyme Q10.

And because it's fat and water soluble, alpha lipoic acid is readily dissolved and distributed throughout all the tissues and cells of your body, including the brain, where it readily crosses the blood/brain barrier to protect neural tissues.

As you age, your stores of lipoic acid decline. Sure, you can get some of what you need from food; but, unfortunately, the best dietary source of lipoic acid is red meat, which often contains high levels of saturated fats, hormones, insecticides, pesticides, and radiation. As a result, it's far better and safer to get this antioxidant in supplement form.

Recommended dose: Take 50–100 mg of alpha lipoic acid daily.

N-acetylcysteine (NAC): Free Radical Fighter

N-acetylcysteine (NAC) also helps raise levels of L-glutathione, one of the most potent free radical scavengers around. Teaming up with vitamin C to form glutathione peroxidase, glutathione supports red blood cell function. This sulfur-containing compound has been shown to promote healthy endothelial cells that line your coronary arteries and keep blood flowing smoothly by producing various chemical substances, which cause blood vessels to relax.

Recommended dose: Take at least 100 mg daily and up to 600 mg.

Oligomeric Proanthocyanidins (OPCs): Bioflavonoids With Clout

You've probably heard about the benefits of red wine, green tea and grape juice. All are in the family of oligomeric proanthocyanidins (OPCs). These free radical scavengers are quickly absorbed into the bloodstream where they cross the blood/brain barrier. They show great promise in supporting healthy circulation, including blood vessel elasticity, blood stickiness, clotting, plaque buildup, blood pressure, and vein integrity. In addition, they may promote eye health.

Recommended dose: Take 30–60 mg daily.

L-arginine: Supercharged Amino Acid

The amino acid L-arginine is gaining favor as an essential nutrient to promote heart health. It is thought to be the primary source for the production of nitrogen molecules involved in maintaining the elasticity of blood vessels. Research has also shown that L-arginine may be helpful for people with high cholesterol and for men who suffer from impotence.

Good sources of L-arginine include nuts, especially almonds and peanuts. You can also find L-arginine in meat and, to a lesser degree, in dairy products—but since I'd rather see you limit your intake of these foods, L-arginine capsules can be purchased in health food stores as an amino acid supplement.

Recommended dose: Take 2–3 grams at bedtime.

How to Pick a Good Multivitamin

When shopping for a "multi," here are the overall ranges of  "the basics" that I recommend. Please note that I'm not a proponent of mega dosing.

7,500 IU mixed carotenoids (beta-carotene, lycopene, lutein, zeaxanthin, beta-cryptoxanthin, and alpha-carotene), and vitamin A (palmitate)
200–400 IU vitamin E (mixed tocopherols, gamma tocopherol, tocotrienols)
400–500 mg vitamin C
200–400 IU vitamin D
1,000 mg calcium
500 mg magnesium
50–100 mg potassium
100–200 mcg selenium
400–800 mcg folic acid
10–20 mg vitamin B1 (thiamine)
10–20 mg vitamin B2 (riboflavin)
10–40 mg vitamin B3 (niacin)
40 mg vitamin B6
200 mcg vitamin B12
25–50 mg vitamin B5 (pantothenic acid)
10–20 mg zinc
100–200 mcg chromium picolinate
10–40 mg quercetin
200–500 mcg vanadium
1–2 mg manganese
1 mg copper
75–150 mg iodine (kelp)
75–150 mg molybdenum
50 mg inositol
25–200 mcg biotin

The following superantioxidant nutritionals can further promote heart health. These include:

• Coenzyme Q10
• L-carnitine
• Lutein
• Alpha lipoic acid
• Proanthocyanidins
• N-acetylcysteine (NAC)
• L-arginine

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

 

Step Three: Exercise—Just Do It!

Exercise. I can't think of another lifestyle modification with such immediate and long-lasting benefits for your health and well being. Even simple exercises strengthen your heart and circulatory system, build stamina, and improve your state of mind.

Top ten reasons to exercise

1. Your heart will love you for it. Your heart will become more efficient, maintaining the same level of output with fewer beats per minute.
2. Your blood pressure will go down.
3. You'll minimize your risk for stroke.
4. You'll increase your muscle strength and restore your range of motion (flexibility).
5. You'll rev up your metabolism and burn calories, thereby losing weight.
6. You'll beat depression. Exercise releases endorphins and triggers release of the neurotransmitter serotonin, which lifts your mood.
7. Your blood sugar will go down, improving your body's regulation of insulin.
8. You'll age more gracefully and look and act younger than your years.
9. You'll fall asleep more quickly and sleep more deeply, improving your concentration and your memory.
10. You'll feel more amorous. Exercise not only increases your growth hormones, it improves your self-image, making you feel better about yourself.

Aerobic Movement: The Foundation

Did you know that 30 minutes of exercise will keep your metabolic rate up for another hour? So the longer you exercise, the greater the benefits.

You don't need a lot of fancy equipment. Nor do you need to join a health club. Just put on a pair of comfortable lace-up shoes and start walking.

If you haven't been active for a while, start out easy—just 10 minutes a day. (Please consult with your doctor before you initiate any exercise program.)

Your goal should be to add five minutes a week to your walking regimen, building up to 30 minutes total, five days a week. If you can devote more time to exercise, 45 to 60 minutes a day, so much the better!

Walk with friends to make it fun. If the weather is bad, head over to your local mall and get moving!

I'm a big fan of dancing. It's great exercise and reduces stress at the same time. You don't have to work up a sweat or push yourself until you're out of breath. Find your own rhythm and "go with the flow." Dynamic exercise enhances well being and puts a spring in your step. Add a bit of stretching and yoga and spice it up with a bit of weight training to create a great exercise session.

Here's one way to get started: put on your favorite music, warm up with a good stretch and some deep-breathing, then walk for 10 to 15 minutes. Mix it up with some free weights, finish with a little yoga and stretching, and cool down.

Weight Training: Tone and Strengthen

I wholeheartedly endorse adding weights to your exercise regimen to promote a healthy heart and bones.

Not only does strength training increase endurance, it can promote healthy blood pressure and cholesterol levels and enhance your sense of well being.

Some researchers believe that strength training may also reduce subsequent cardiac events and the risk of sudden death.
And for those who are frustrated with the limitations heart disease has imposed upon their active lifestyle, strength training is a way to fight back. Many of my cardiac patients have discovered that they don't have to sit in the rocking chair for the rest of their lives!

Exercise Safely

Be alert to warning signs that you may be doing too much exercise. If you experience any of the following, stop immediately:

• Lightheadedness or dizziness
• Palpitations
• Shortness of breath (unable to carry on a conversation)
• Jaw pain
• Arm tingling or numbness
• Tight feeling in the lungs (bronchospasm)

Whatever form of exercise you choose, learn to listen to your body and be aware of any symptoms that come up during exercise or up to an hour afterward. If you feel ill, stop exercising and rest. If symptoms persist after three to five minutes of rest, seek medical attention immediately.

Thinking About Running?

I'm often asked about the health benefits of jogging. I advise against strenuous exercise like jogging or running, especially if you're just starting an exercise program. Studies have shown a connection between heart attacks and sudden exertion.

Conversely, moderate exercise has been shown to reduce the long-term risk of coronary artery disease. The Nurses Health Study found that women who walked briskly at least three hours a week achieved results equivalent to jogging or aerobic dancing.

Step Four: Reduce Your Emotional Risk Factors

Withheld and denied emotions, social inhibition, and lack of social support were identified as predictors of coronary heart disease in a study published in The Lancet of Feb. 17, 1996. The findings confirmed some of my own research in the area of negative emotions.

Through years of conducting Healing the Heart workshops, I observed that sadness and a negative outlook on life, along with an inability to cry or express anger, correlates strongly with an increased risk of developing heart disease.

And because they withhold their emotions more than women do, men are particularly at risk. These observations led me to explore alternative methods of addressing—and even shifting—these personality factors.

How to Unlock Armored Emotions

• To increase energy flow, you must first learn how to breathe fully. Do this by taking deep breaths in through your nose, and feeling the air fill your lungs. Then, slowly exhale through your mouth, allowing yourself to sigh. Breathing deeply can put you back in touch with your body, bringing emotions to the surface. Your body becomes more alive, increasing your energy, vitality, and passion for living.
• When deep breathing is first stimulated, don't be surprised if it triggers crying, the body's way of discharging sadness and hurt. Deep sobs allow energy bound by stress to be released from the thoracic cavity, freeing the grip of muscular tension on your heart. A good cry also enhances oxygen to the cells and stimulates the release of biochemicals to the brain that encourage relaxation.
• Learn to say "No" and mean it. Sometimes, I encourage patients to kick and shout to release long-suppressed hurts and anger. Using your voice and expressing negativity, jutting out the jaw and making a fist, and even using upper arm motions such as striking out or hitting pillows can loosen tension in the body, particularly the upper back and neck.
• Laughter is potent medicine for the heart. When you laugh with your whole heart, the depth of your breathing increases, releasing trapped energy from your chest, diaphragm, and even your groin muscles. Laughter releases endorphins and DHEA, hormonal markers of health and well being. Let yourself go every now and then, and feel free to be silly and uninhibited.

Begin Shifting Your Attitude

With the support of a psychotherapist or other skilled coach or trainer, you can learn to bring up suppressed emotions such as anger and fear without a sense of abandonment or humiliation. When you're "in touch" with yourself, you're in touch with your body and your emotions. You can gain insight into how persistent beliefs that long ago shaped your personality may no longer serve you.

The good news: Your "personality" is not carved in stone. Therapies such as Bioenergetic Therapy can unlock long-held emotions and defenses, especially if you are prone to bouts of hostility or rage.

Your health, and especially your heart health, is directly related to your capacity for emotional growth, self-expression, and willingness to be supported with a vibrant social network. Without these crucial "life support" systems in place, as life goes on, you'll be more vulnerable to isolation, alienation, heartbreak and serious health risks.

Tap Into These Powerful Emotional Healers

1. Spirituality and prayer. More physicians and healthcare providers are discovering that spirituality can be a healing tool. In a conference at Harvard Medical School, research showed that people who attend church or pray regularly have lower rates of heart disease, hypertension, and suicide.
2. Scientific evidence suggests that faith, religion, and/or belief in God lowers death rates and increases health, specifically reducing anxiety, depression, anger, and blood pressure. Double-blind studies worldwide have shown that people who are prayed for by others have higher survival rates and fewer complications from heart surgery.
3. Meditation and relaxation. Relaxation is characterized by an absence of physical, mental, and emotional tension. Researchers have identified relaxation as the vehicle with the highest potential for "opening the door to change" by reconnecting the body, mind, and spirit.
4. Bioenergetic therapy uses the language of the body to heal the problems of the mind. Alexander Lowen, M.D., the founder of Bioenergetic Therapy who taught me for three years, offers a body-mind approach that has a liberating and positive effect on emotional, physical and, psychic health. Bioenergetic therapy goes beyond "talk." The therapist may use specific body positions to first encourage deep, free breathing to release emotional expression. For example, men and women with heart disease often have a high, inflated chest that rarely moves freely, even with conversation.
5. Other types of therapy such as gestalt which strives for an understanding of conscious, "here and now" behavior, and cognitive behavioral therapy (CBT), which looks at your beliefs and expectations—are also excellent interventions for the cardiac patient.

Anger: Self-Quiz

When you're in touch with your anger, you'll be able to release it more effectively and move on. How do you know if you have some anger that you need to look at? The following quiz will help you. Answer yes or no to each question candidly.

• Do I ever become hostile and impatient to the point of interrupting others?
• Do I have "looks that could kill"?
• Do I ever strike out verbally or physically?
• Do I sometimes flare my nostrils or hold my breath when I am upset?
• Do I "stuff" my negative feelings, blame myself, or become depressed?
• (For women): Do I feel that it would be unfeminine to show my anger?
• (For men): Do I feel that "real men" show their anger?

If you responded "yes" to one or more questions, you probably have some unresolved issues surrounding anger, hostility, or rage. If you have uncontrolled, suppressed anger in the form of rage, beware: This can be hazardous to yourself and others. Most of us are reluctant to give in to our rage out of fear that we may lose control and hurt someone. This is where one-on-one supportive psychotherapy is not only helpful, but therapeutic.

To learn more about Dr. Sinatra's top recommendation for heart health, click here.

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