Heart disease kills nearly one in three Americans, but many of its causes are easily preventable. Learn how some simple habits can make a big difference.
We often hear stories about the dangers of heart disease and “sudden” heart attacks. But the truth is, they aren’t sudden. The underlying factors that cause heart attacks and disease may be present for years. A variety of health conditions and poor habits contribute significantly to heart disease, which is the most common killer of Americans. While there are some factors that we can’t control, the good news is that many causes of heart disease are within our power to control and treat.
An Essential Organ
The heart is an amazing organ that keeps blood flowing throughout the body, says Dr. David S. Bromet, FACC, chief of cardiovascular medicine at Presence Saint Joseph Hospital in Elgin.
“It’s the hardest-working muscle in the body,” he says. “It beats about 100,000 times a day and pumps 4.5 liters of blood every minute around the body.”
Over time, adverse health conditions and an unhealthy lifestyle can damage the heart.
“Heart disease kills nearly one in every three Americans,” Bromet says. “Every single day, nearly 2,600 people die from cardiovascular disease – an average of one death every 33 seconds.”
It’s a frightening situation. More Americans die from heart disease than from cancer, chronic obstructive pulmonary disease (COPD), accidents, diabetes, influenza or pneumonia. Many die before age 65. So how do you assess your risks?
First, it’s important to be aware of the underlying conditions that can lead to heart disease and congestive heart failure.
“Here’s what I tell people when I talk about preventing or postponing heart disease: Start with cholesterol,” Bromet says. “LDL is bad cholesterol that has a tendency to increase the risk of heart disease because it’s a major component in plaque that can clog arteries. The blockage can lead to heart attacks and strokes.”
LDL’s cousin, HDL, is a good cholesterol that helps to carry some of the bad cholesterol out of the body.
“Unmonitored, uncontrolled high blood pressure is another worry, as are diabetes, obesity and a sedentary lifestyle,” Bromet says. “Bad habits such as smoking, drug abuse and overindulgence in alcohol also take a toll on the heart, over time. Then there’s family history and genetics. Unfortunately, these last two are things we cardiologists can do nothing about.”
Patients who weigh 10 to 30 percent more than their normal body weight are two to six times more likely to develop heart disease, Bromet says. Smoking raises a patient’s blood pressure and decreases HDL (good cholesterol), while also damaging arteries and blood cells.
“Cigarette smoke contains more than 4,000 chemicals,” Bromet says. “About 200 of them are actually poisonous.”
And then there’s diabetes. Poorly controlled diabetes leads to a two- to three-times higher risk of heart attacks and strokes.
“A diabetic is more likely to die of a heart attack than a non-diabetic,” Bromet says. “The risk of sudden death from a heart attack for a diabetic is the same as that of someone who has already had one heart attack.”
An active lifestyle can help to prevent or postpone heart disease, Bromet says. A 12-year study of 707 retired men in Hawaii found that the mortality of retired men is cut in half if they walk more than two miles daily.
“People who are inactive run as great a risk of having a heart attack as those who smoke, have high blood pressure or have high cholesterol,” Bromet says. “Regular exercise not only reduces the development of diabetes and prevents strokes, but it also lowers blood pressure by as much as 20 percent.”
Of all the risks to heart health, diabetes is one of the greatest concerns, and often isn’t diagnosed early enough to prevent damage to the heart.
Dr. Wendell Malalis, an endocrinologist and colleague of Bromet’s at Presence Saint Joseph, says the basic interaction between diabetes and the heart lies in the way the disease affects the metabolic system.
“Insulin resistance and obesity are two of the factors that can lead to cardiovascular disease,” Malalis says. “Inadequately controlled diabetes increases the fatty acid in the blood stream. If a patient has a problem maintaining an appropriate blood glucose level over time, it can lead to higher LDL cholesterol and plaque deposits in the arteries surrounding the heart.”
Malalis says studies have proven that managing diabetes well can help a patient to prevent or minimize cardiovascular disease. Diabetic patients usually have blood tests every three months to determine their A1C level, the means by which doctors measure average blood glucose levels over a three-month time period. Patients can no longer “cheat” by eating properly only during days leading up to a test.
“What we want to see in patients with diabetes is an A1C of 6.5 to 7.0,” Malalis explains. “In elderly patients, we are a little more flexible because of the higher risk of too-low blood sugar, or hypoglycemia. We don’t feel sorry so much about keeping the A1C below 7.0 as much as we are concerned with their weight, blood pressure, cholesterol and triglyceride levels, and other vital statistics.”
For too many diabetic patients, when blood glucose is not well-controlled over a period of time, the plaque build-ups in the arteries cause blockages that trigger heart attacks and strokes.
“This is why so many diabetics experience chest pains and come into the hospital with symptoms of an impending heart attack,” Malalis says. “Angiograms indicate the need to open these arteries with stents, but at the same time, the dye used to see where the blockages are is also very hard on the kidneys. In some cases, this can lead to early stage renal failure. If the patient’s kidneys are already compromised, the worst-case scenario is that they suffer renal failure and will need to go on dialysis.”
While there is no way to predict whether diabetes eventually will cause congestive heart failure, Malalis says that focusing on target goals for blood pressure, cholesterol and A1C levels significantly reduces the risk of complications that lead to heart disease.
Controlling Blood Pressure
A healthy blood pressure is an important part of preventing heart disease. As people age, high blood pressure, also known as hypertension, becomes an increasing concern, says Dr. Douglas Tomasian, an interventional cardiologist with Centegra Hospital-McHenry.
“Certain lifestyles put patients at higher risk,” he says. “Too much salt in their diets, family history, inactivity and obesity are just a few of the causes. In terms of prevention, limiting salt intake, caffeine and alcohol use can be helpful, as well as avoiding tobacco products. Maintaining an active lifestyle with regular exercise has been shown to reduce blood pressure as well as cardiac events.”
Although blood pressure often climbs with age, hypertension may occur in very young patients, too, and even in children.
“All patients should have their blood pressure checked on a regular basis,” he says. “Hypertension is an important, but modifiable, risk factor for coronary heart disease and stroke.”
A target blood pressure for older patients is less than 140 systolic over 85 diastolic, Tomasian says. When those numbers begin to creep up, it may be time to consider starting medications to help hold down the pressure.
There are many safe and effective types of blood pressure medications, including beta blockers and angiotensin converting enzyme (ACE) inhibitors. In cardiac patients, several of these medications benefit the heart beyond lowering blood pressure.
“Two classes of drugs in particular are frequently used in cardiac patients,” Tomasian says. “Beta blockers are often prescribed after the patient has suffered a myocardial infarction, or heart attack. These medications have real benefits in the phases after a heart attack. They allow the weakened heart to recover while slowing the heart rate, and can reduce the risk of future heart attacks.”
Cardiologists measure the heart’s effectiveness by an “ejection fraction.” In an average, healthy person, the heart pumps about 65 percent of the blood within its chambers with every beat. Thus, the average person’s ejection fraction is 65. But when a person suffers congestive heart failure or has a heart attack, the ejection fraction can drop, often steeply. With appropriate medication, therapy and lifestyle changes, the heart can rebuild its function.
ACE inhibitors also are used for the treatment of hypertension and congestive heart failure. These medications work by relaxing the blood vessels, which lowers blood pressure and decreases oxygen demands, Tomasian explains. ACE inhibitors also are useful in treating kidney disease caused by uncontrolled diabetes.
“Beta blockers and ACE inhibitors, along with other medications, may be prescribed to meet each patient’s specific needs,” Tomasian says. “They’re usually tolerated well and have few side effects.”
An Integrated Balancing Act
It may come as a surprise to learn that lung diseases, including COPD, can have a direct effect on the development of heart disease. The relationship between the heart and lungs during the exchange of oxygen is an interdependent one. The same habits and conditions that can harm the lungs, especially smoking, can directly affect the heart, says Dr. Anand Soni, a cardiologist practicing at Northwest Community Hospital in Arlington Heights.
“There are a lot of commonalities,” he says. “When a person suffers from COPD, oxygen levels decline in the blood. That results in the heart having to work harder to provide this vital element to the rest of the body. This can then trigger symptoms of chest pain in those patients who have underlying coronary artery disease. It can also provoke congestive heart failure.
“The best way to address this problem is to optimize COPD treatment, using the appropriate inhalers and supplemental oxygen, if it’s indicated,” Soni adds. “We work closely with our pulmonary colleagues to determine how each patient should be treated.”
Diabetes and renal disease, or kidney failure, also may contribute to the development of congestive heart failure and coronary artery disease.
“In cases of advanced renal failure, urine output can decrease significantly,” Soni says. “This leads to an accumulation of excess fluids in the body. This fluid can settle in the lungs, abdomen and legs. This can be difficult to treat in those patients who have a weakened heart, or ‘cardiomyopathy.’”
The best way to avoid heart disease is to ensure that each patient receives maximal risk factor modification.
“This includes taking medications consistently and exactly as the doctor prescribes,” he says. “It also means quitting smoking, having a well-balanced diet and getting regular exercise.”
Change Your Habits
Following the doctor’s orders may decrease your odds of developing heart disease and help you to prevent other diseases as well. The interrelationship among the cardiovascular system, lungs and kidneys is such that what’s good for our hearts is good for the rest of our bodies, too. It’s never to late to take up those healthy habits.