An Ounce of Prevention for Heart Disease

COVID aside, it’s still the leading cause of death among Americans, but a with the right combination of preventive measures and healthy habits, it’s possible to put off this deadly disease.

For the first time in decades, heart disease is not the leading cause of death, but don’t celebrate just yet. Last year, COVID-19 deaths surpassed heart disease deaths – but experts expect this to be an anomaly. The grim statistics about heart disease remain sobering.

Asim Zaidi, MD, Cardiology

“In the United States, heart disease is the leading cause of death,” says Dr. Asim Zaidi, cardiologist for Northwestern Medicine in Huntley. “One American dies every 36 seconds from heart disease. About 650,000 Americans die from heart disease each year – that’s one in every four deaths.”

Of those deaths, more than 365,000 are caused by coronary artery disease, the most common form of heart disease. Coronary artery disease is caused by blockages of plaque in the blood supply to the heart.

So, how do we turn around these horrific numbers? It makes a difference to know your risks and maintain a healthy lifestyle.

“There are generally five risk factors to developing heart disease,” Zaidi says. “High blood pressure, high cholesterol, diabetes, smoking and a family history.”

This latter factor is an especially important clue for physicians. If a first-degree family member (a parent, sibling or child) has had a heart attack at an early age, say in their 40s or 50s, as opposed to later in life, the patient is more at risk, Zaidi says. When such a history is present, it’s important to be aggressive in treating the earliest signs of elevated blood pressure and/or cholesterol, he adds. This usually is handled by the patient’s general practitioner. If someone’s risk factors fail to respond in these early stages, they’re referred to a cardiologist for advanced treatment.

Diagnosis of heart disease is based 80 percent on history and 20 percent on clinical examination, Zaidi explains. Blood tests, electrocardiograms, stress tests and angiograms are used to help determine the stage of the disease.

“The second-most important risk factor is lifestyle,” Zaidi says. “Poor nutrition, lack of sufficient exercise, smoking and substance abuse all contribute both to the onset and the difficulty of treating heart disease.”
Zaidi identifies sugar as one of the most harmful elements, primarily because it can contribute to the development of diabetes.

“Sugar is a natural food, but its presence in nearly everything we eat is not natural. Added sugar may make up as much as 10 percent of a processed food product,” he says. “A serving of regular soda may include as much as 9 teaspoons of sugar.”

When asked about their diet, most of Zaidi’s patients describe it as not good. They ingest too much salt, fat and sugar. Sadly, they recognize the problem but don’t know how to change their habits.

“We talk to them about a 1,500-calorie diet, and then they go out to lunch with no clear idea that what they ordered is exactly what they should not be eating,” Zaidi says. “On average, it takes three months or more of nutrition education before they begin to correct their diets.”

Complicating this new lifestyle is the fact that healthier foods tend to be more expensive and require more work to prepare.

“The trick is to start children on healthier diets at an early age,” Zaidi says.

Smoking, of course, is an ongoing issue. Zaidi confirms that the effect of smoking on the lungs and the arteries has a direct impact on the heart.

“Smoking prevents sufficient oxygen levels in the lungs,” he says. “The heart has to work harder to absorb enough oxygen to circulate throughout the body. This puts additional stress on the heart and can lead to weakened muscles. Smoking also increases the rate at which plaque forms in the arteries. It can also contribute to a higher incidence of stroke and the need to amputate limbs because it encourages the formation of blockages in the blood supply. Nicotine addiction is hard to beat, but 80 to 90 percent of patients quit cold turkey after being told they’ve had a heart attack.”

Stress is yet another factor that directly affects your heart.

“Stress is harder to modify because it’ s a natural part of living,” Zaidi says. “It raises blood pressure and increases heart rate.”

Exercise and adequate sleep go a long way toward controlling stress.

“Take time out from the stressful routine as much as possible,” he says. “Break the stress cycle by taking walks, eating healthier foods and getting plenty of rest. This will help to ease the adverse effects of stress on the heart.”
While lifestyle choices such as smoking and a poor diet can impact your heart directly, they may also impact it indirectly. That’s because other medical problems can further complicate heart conditions. As we age, our odds of having other diseases that adversely affect the heart increase.

“It can be a vicious cycle,” says Dr. Rina Verma, cardiovascular disease specialist at AMITA Health Alexian Brothers in Elk Grove Village.

Dr. Rina Verma, AMITA Health

Perhaps one of the easiest examples to recognize is the link between diabetes and heart health. Diabetes, which can be caused by poor diet, is referred to as a heart disease equivalent by many cardiologists, Verma says.

“Uncontrolled diabetes creates high glucose levels in the blood, which in turn inflames and damages the walls of arteries,” Verma explains. “This leads to plaque buildup and blockages which can cause reduced blood flow to the heart muscle and leave patients vulnerable to heart attacks.”

Cardiologists can see these blockages in CAT scans and angiograms. Prescription medicines can help to control blood sugar and cholesterol levels, but it’s also important for patients to be educated on how to modify their diet and exercise, stop smoking and embrace other positive lifestyle changes. If they develop symptoms that point to a heart blockage, Verma adds, interventional treatments such as a stent may be required.

“Another example of lifestyle leading to a worsening heart condition is smoking and chronic obstructive pulmonary disease (COPD),” Verma says. “Damage in the lungs from smoking can lead to increased pressure in the lungs, which in turn can lead to increased pressure on the right side of the heart, as this heart chamber pumps blood into the lungs to renew oxygen supplies. This increased pressure can cause right-sided heart failure. Also, lower oxygen levels in the blood from COPD can put extra stress on the heart, further causing heart damage.”

Other habits, such as excessive alcohol intake, can also cause heart conditions, Verma says. High amounts of alcohol consumed over a prolonged period of time can become a toxin to the heart muscle. This can lead to weakening of the heart and heart failure. She adds that excess alcohol may also predispose patients to atrial fibrillation (A-fib), an irregular heart rhythm which can cause a rapid heart rate and lead to palpitations.

“This condition causes blood to pool in heart chambers, which can lead to blood clots and strokes,” Verma adds. “The risk of having a stroke with atrial fibrillation is not the same for everyone. The older you are and the more medical problems you have, such as hypertension and diabetes, the greater your risk of stroke.”

Prescribed blood thinners can reduce the risk of stroke.

“We used to prescribe Coumadin for this purpose, however there are newer blood thinners that are prescribed much more frequently today,” she says. “These newer agents don’t require constant blood tests and dietary restrictions.”

Poor diet choices can also lead to high blood pressure, which can further cause heart damage. Verma says untreated high blood pressure can cause stress on the heart arteries, leading to inflammation and plaque buildup, thus causing stress on the heart muscle. This can lead to thickening of the heart muscle, which can affect the way the heart muscle relaxes. Verma adds that a disorder in muscle relaxation can lead to congestive heart failure.

“What is also important is that lifestyle and diseases which may predispose patients to heart disease are the same conditions that can predispose patients to stroke,” Verma says. “If you have plaque in the heart arteries, there is a good chance you have plaque in the major arteries that supply the brain. Plaque in these arteries can cause blockages which reduce oxygen supply to the brain.”

Interestingly, Verma adds, not only can medical conditions have an effect on heart health, but their treatments may also impact the heart. Verma says that newer medical treatments for diabetes appear to have a positive effect on preventing heart attacks, stroke and congestive heart failure. This is directly opposite to some of the treatments used for cancer.

“Certain chemotherapies can weaken the heart muscle, which may lead to heart failure. Also, depending on where it is used, radiation therapy has been seen to affect the heart by causing scarring of the heart valves,” Verma says. “Earlier radiation treatments were more likely to be given in substantially higher doses. Today, newer techniques are used to help minimize this risk.”

And now a new threat to the heart has cardiologists concerned. “It’s too early to know the full effects of COVID-19 on the heart,” Verma says. “But we have seen it cause arrhythmias (abnormal heart rhythms) and, like other viruses, it has also been shown to cause scarring of the heart muscle. We have also seen COVID-19 predispose patients to blood clots. Blood clots have been seen everywhere, but specifically in the lungs, legs and heart arteries – which can be life-threatening.”

Negative lifestyle choices and the medical problems they cause have a direct impact on cardiovascular health, Verma says.

Ideally, a life without fear of heart disease begins in childhood, with parental guidance, education and the establishment of healthy habits.

Of course, it’s never too late to make changes that will benefit one’s heart health and help to ward off other diseases in the process. By starting immediately to modify and eliminate adverse habits, Americans can live longer and healthier lives. And while it may not be possible to overcome every challenge to the goal of preventing heart disease, it is possible to postpone disease onset. Plus, once heart disease is diagnosed or a patient has a heart attack, the vast advances in medical treatment can not only prolong life but also help to improve its quality.