COVID aside, heart disease is still the deadliest disease, but advancements in medicine are showing the amazing impact of smart preventative measures. Learn from the experts what simple steps can help to delay or altogether prevent problems down the road.
With the exception of 2020, heart disease has been the leading cause of death in both men and women for decades. The Centers for Disease Control and Prevention reports that about 365,000 Americans die from heart disease annually – a rate of about 1,000 a day. That statistic was only surpassed in 2020 because of COVID-19, and it’s expected to reassert itself once the pandemic has subsided.
In order to both avoid and survive heart disease, it’s important to understand the dangers and focus on the elements of prevention.
Dr. Haroon Chughtai, a cardiologist with Beloit Health System, says it’s wise to recognize the earliest symptoms of heart disease, which he stresses can be different in men and women.
“In men, warning signs can be chest pain or shortness of breath with exertion,” Chughtai says. “But women may have a number of symptoms that include nonspecific chest discomfort, shortness of breath, fatigue, nausea and an overall feeling of unwellness. Symptoms in men are fairly straightforward, but we need to be more diligent in assessing women.”
Assessing impending heart disease includes checking for high blood pressure, high cholesterol and family history for heart disease – which are often the reasons why patients are referred to cardiologists.
“Usually, general practitioners treat rising blood pressure and high cholesterol levels with medications,” says Chughtai. “When those levels become too high or are not responding to the medications, then the patient is referred to me.”
Chughtai explains that cardiovascular disease is not one single disease, but rather a spectrum of diseases involving the heart and vascular system. So, treatment will depend on the areas of concern. While some conditions involve the heart exclusively, others include our vast network of arteries and veins.
“For example, blockages in the legs also impact risk of heart disease, and studies have shown higher risk of heart issues in patients with blockages in the legs,” Chughtai says. “Assessing overall cardiovascular health is the goal in patients referred to me, and there are various tools and tests available for this including stress tests, ultrasounds, CAT scans and angiograms.”
Chughtai adds that recent advances in cardiovascular medications have helped mitigate the damages of high blood pressure and cholesterol without many of the side effects that worried both doctors and patients.
“The cholesterol medications now do an excellent job, and they’re not as likely to create problems with the liver and muscles,” he says. “We have so many more options available now, compared to when cholesterol medications were first introduced.”
And as so many cardiologists stress, Chughtai adds that lifestyle and awareness of family history are essential in preventing or delaying heart disease.
“A healthy diet low in sugar and fat, and filled consistent exercise, rest, avoiding smoking and other good habits can go a long way toward keeping the heart and vascular system strong,” he says. “Knowing who in your close family has had heart attacks or heart disease is also essential to warding off trouble.”
Dr. Paul Christensen, a cardiologist who has treated patients with heart disease at OSF HealthCare Cardiovascular Institute for decades, agrees. He says experience has taught him that preventing or delaying heart disease depends on two vital factors: heredity and lifestyle.
“Knowing your family’s health history is essential,” Christensen says. “It’s the first question we ask when patients are referred to us. If a close family member, parents or grandparents, have had heart attacks or were diagnosed with high blood pressure before the age of 55, there is an extreme risk that the patient will also develop heart disease.”
Unfortunately, doctors cannot undo the risks of heredity, Christensen continues. But being aware of the risks helps cardiologists to prescribe medications and design lifestyle changes to mitigate them, and thus delay or prevent the disease.
“We also watch more closely for the very earliest symptoms, including rising blood pressure and high cholesterol levels, especially LDL,” he says. “Catching these symptoms and treating them early on can slow the progress of heart disease and prevent early damage to the heart and vascular system.”
Whether or not the patient is at high risk, changing to a healthier lifestyle at any age benefits not just the heart but the entire patient. Christensen points out that good nutrition, sufficient exercise and sleep, avoiding smoking, and managing stress can not only prevent or delay heart disease but also reduce the possibility of getting diabetes, COPD, cancer, obesity, sleep apnea and other conditions that impact the heart and other vital organs.
“Even taking good care of your teeth can help prevent heart disease,” Christensen adds. “Chronic inflammation and infections in the mouth can be harmful. They increase the level of hormones in the body, which in turn adversely affects the heart as well as other organs.”
Stress is another source of aggravation to the heart, he says. Reducing stress and getting adequate sleep and exercise can help the patient regain their normal body rhythms and lower blood pressure.
“Any level of exercise helps,” he says. “You don’t have to run a marathon, raise your heart rate or break a sweat. By simply walking daily on your lunch hour or leisure time, you can improve your odds of preventing heart disease.”
But cardiovascular disease doesn’t necessarily happen on its own, says Dr. Jeffrey Smith, a cardiac electrophysiologist at Mercyhealth for more than 25 years and department chairman of internal medicine at the University of Illinois College of Medicine-Rockford. Smith says a number of other diseases may directly affect heart health.
“A person with diabetes has as much risk of having a heart attack as one who has already had a heart attack,” Smith says. “Diabetes is what we call a heart attack equivalent. In these patients, the need to control cholesterol with a statin and take a baby aspirin is exactly like what a patient who has already had a heart attack must do.”
A healthy lifestyle that includes a diet low in sugar and fat, a good exercise regimen and abstaining from smoking or alcohol actually helps prevent both diseases.
“Smoking can cause hardening of the arteries and chronic obstructive pulmonary disease (COPD),” Smith says. “It puts increased strain on the right side of the heart that interacts with the lungs as well as swelling in the legs and atrial fibrillation (A-fib). We call this right-side heart failure. Alcohol abuse can weaken the heart or trigger A-fib as well.”
Smith adds that sleep apnea is another threat to heart health which, if untreated, can lead to congestive heart failure and atrial fibrillation. And cancer is another threat.
“Heart cancer and fluid build-up in the tissues around the heart are rare but do occur,” Smith says.
“Chemotherapy for non-cardiac tumors can weaken heart muscle while radiation therapy to the chest area can cause hardening of the arteries, which in turn can precipitate a heart attack.”
Uncontrolled high blood pressure carries many risks. High blood pressure causes strokes, heart attacks, kidney failure and congestive heart failure (weak heart muscle). Patients with congestive heart failure are at risk of not only severe shortness of breath but also sudden cardiac arrest, an abnormal heart rhythm in which the patient instantly collapses and dies.
“We cannot stress enough the importance of a healthy diet that is low in salt, sugar and fat,” Smith says.
Recovery from a heart attack plus treatment for heart disease also involves two additional vital elements: rehabilitation and education. Once heart disease is diagnosed, it’s essential for a patient to learn how to help themselves heal. Staying committed to an individually designed rehabilitation program can positively impact one’s chance of survival.
For Diane Bardell, team leader for FHN Cardiac Services in Freeport, helping patients help themselves is key.
“Education is a vital part of cardiac rehab,” Bardell says. “After the diagnostics, testing and treatments, patients come into rehab and learn about diet and exercise including yoga. We help them to heal. They are never going to be cured completely, but this will prevent future heart attacks and more.”
With more than 33 years on FHN’s nursing staff, Bardell has spent 23 years supporting cardiac patients. Not everyone who comes in for testing realizes the seriousness of their condition.
“One patient explained away chest pains as heartburn,” Bardell says. “A stress test led to a diagnosis of significant heart disease and bypass surgery. She then came to our cardiac rehab program. Another patient of about 50, who looked healthy and could walk a distance, was found to have severe blockages that required surgery.”
FHN provides all testing of the heart and vascular system. Stress testing and angiograms help Bardell and her team to evaluate the sorts of circulation problems that can be associated with heart disease, Bardell says.
Coronary and peripheral angiograms look for circulation problems to both the heart and legs.
“My main job is to manage the diagnostic tests,” Bardell says. “But it goes far beyond that to walking the patient through testing, treating, educating, monitoring and rehab. As a rural hospital, we are a contained service that provides total care within one unit.”
For FHN cardiac nurse practitioner Kristine Fosler, new or known patients need a multi-faceted treatment to get them back on track to improved health.
“The latest medications are a vast improvement,” she says. “For lowering bad or LDL cholesterol, we now have the option to prescribe PCSK9 inhibitors to help lower the levels under 70 in patients who cannot tolerate statins. They have fewer side effects and don’t require as many blood tests. In addition, patients with known heart disease are prescribed baby aspirin to help keep the arteries open. We also use beta blockers to offset the workload on the heart, helping it move blood around the body with less effort. In some cases, nitroglycerin is prescribed to treat angina (chest pain).”
Blood pressure is another key to improved heart health.
“In adults, we aim for blood pressure less than 130/80, while in elderly patients and certain populations, the goal is adjusted to less than 140/90,” she explains. “The difference in the older population is that they tend to be at a high risk for falls, and lower blood pressures often lead to imbalance issues.”
Taken as a whole, the concept of preventing and managing heart disease throughout a person’s life seems like an impossible challenge. Through starting off on the right foot and taking steps throughout life with regular physical examinations, a sound knowledge of family history and a healthy lifestyle, it is possible to live longer and, more importantly, with a higher quality of life than ever before.