Dr. Kevin Most: Heart health
When you think of February what color do you think of? What shape? 99% of people will say Red and a Heart. It is amazing how a single day in a month can impact how we think. Is there another month that you can think of the equates the same thoughts? The closest one will come up with is July with Red, White and Blue and a flag, but this is only in the United States. Valentine’s Day is an international holiday and is known around the world as a day of love. For many this equates to a box of chocolates, red roses and a card sharing how important a loved one is in your life.
The great thing about the timing of this discussion is that those of you who have forgotten that this Thursday is Valentine’s Day
In the healthcare world we take the advantage of the overall impression of the month to promote Heart Health. We all need to know and understand the basics of heart health, what can we do, what should we do to make sure that our heart works as well as possible. The heart in very simple terms is just a pump, that pushes blood to the lungs to get oxygen and then to the rest of the body to bring oxygen to the body. Obviously it is so much more important and complex. As a pump we need to make sure it is pumping at the correct rate and that it is pumping at the right pressure. It has to make sure it is as efficient as it possibly can be and oh yeah, it can’t stop or rest at any time under normal circumstances.
Would it surprise you if I told you that 48% of all adults in the US have some type of heart or blood vessel disease. 48% of us have had a heart attack, stroke, angina ,high blood pressure, abnormal heart rhythms or narrowing of the arteries. This is sad news as we really need to make an impact here as heart disease is still the number 1 killer in the United States. We thought we were making an impact on heart disease after we saw a decline in heart related deaths for a few years, however that trend has reversed and again we saw an increase as we start to approach 900,000 deaths a year attributed to heart disease.
Some important statistics to get your attention
- In the US someone dies from heart related illness every 30 seconds.
- Cardiovascular disease claim more deaths than all forms of cancer combined
- We have over 1 million Heart attacks a year in the US alone, with a cost of over $200 billion
- We still have 6% of children aged 12-17 smoking regularly, with 15% of adults still smoking
- 73% of High School students do not get the Heart Association recommendation of 60 minutes of exercise daily
- 40% of American adults have Cholesterol levels over 200 mg/dl, the goal is under 200
- 24 million in the US have been diagnosed with diabetes with another close to 8 million living with it but not diagnosed
- Using the new guidelines almost 50% of US adults have High Blood Pressure (2017 goal is 130/80 from the previous 140/90)
- 1 in every 6 healthcare dollars is spent on cardiovascular disease
We discussed in the past the impact of high blood pressure on your heart as well as other organs in the body including your kidneys, eyes and brain. In 2017 we made a change in the definition of high blood pressure which added millions to the list of those with high blood pressure. The old definition of high blood pressure was 140/90, in 2017 we adjusted that to 130/80 or higher. This has not only raised awareness but has pushed doctors to be more aggressive when treating patients. This was done as high blood pressure is the largest risk factor for both heart attacks and strokes. The sad thing is we know about the bad things that can impact our heart health and yet we don’t do much individually. Would it surprise you if I told you 80% of heart disease can be prevented by controlling blood pressure, diabetes and cholesterol levels as well as stop smoking. Those simple things can help us decrease the number of individuals who suffer from heart disease.
We all have seen ads on cholesterol lowering medications and blood pressure medications, but would it surprise you to know that estimates are that close to ½ of the individuals who need these medications actually take them. There are over 80 million individuals in the US who would benefit from a stain drug. In this group 55% are taking a statin, 46% report making lifestyle changes, 36% are doing both taking a statin and changing lifestyle and 35% report they are doing nothing, a sure course to disaster. Statin drugs in the past were considered expensive and with bad side effects, they are now generic and low cost as well as having a much better side effect profile. Personally my daily statin has brought my cholesterol down from over 300 to under 150.
So, why don’t we do a better job. One is the slow progression of the disease. Things we do in our youth and young adulthood impacts us decades later. This may be dietary, it may be exercise, it may be a smoking habit, there are many things we do as young adults that we need to change. We also struggle with a concept called the social determinants of health. How can we expect individuals to eat fresh fruit and vegetables daily, when they can’t get them easily or they are too expensive. How do the vegetables compete with the dollar menu at McDonalds or other cheap foods that are loaded with fat and sodium. Heart disease continues to be the number 1 cause of death and 850,000 die every year yet we do not see it as an emergency.
What we have done instead of addressing the issue is to build a huge pharma industry that has allowed us to continue our bad dietary habits and in turn attempt to correct it with a pill. The work of the pharmaceutical companies is great, the advancement of statin drugs has certainly made an impact on individuals cholesterol levels. Medication for diabetes and high blood pressure have certainly saved and extended lives. The advancements with dosing have allowed us to make it simple for patient s and makes compliance much easier. I am not sure what the tipping point will be for this issue but in the mean time we can continue to appreciate what healthcare companies are doing.
One of the biggest and simplest things that has occurred is the technology of accurate BP monitoring that can be done at home. In the past a single reading in the doctor’s office was what we got. If the numbers were ok, great , if they were a little high, we might watch them. If they were high we would check them a few more times before labelling the individual as having hypertension. Now it is much different, patient have their own monitors at home and many are expected by their physician to take their blood pressure at least once a week. Those numbers are then sent to the physician so he now has accurate and frequent data which allows them to make adjustments in real time before a disaster. A blood pressure reading coupled with a weight will often allow a doctor to change medications make recommendations in real time and decreasing the need to go to the ER or hospital
The health of any pump is based on how well we take care of it. The heart is no different. The actions we take today will make sure that it works better and longer in the future. One thing we are well aware of and is well publicized is the impact cholesterol has on our heart. The blood vessels that bring oxygen and nutrients to the heart muscle cannot be blocked, they must have good blood flow. When they do not, due to blockage from cholesterol plaques breaking free and causing blockage, the heart muscle does not get what it needs and we have what is called a “heart attack”.
There is a big spectrum of heart attacks, from a simple short time decreased blood flow to a full blockage. The first results in a “minor heart attack” the second often will result in death. It is important we know the signs of a heart attack and get care as quickly as possible, every minute of an untreated heart attack kills more heart muscle and makes it work less efficiently in the future as heart muscles cells do not repair
Before we discuss the signs to look for, let’s make sure we have one point clear. Heart attacks occur in both women and men. Many think of the classic heart attack as a man clutching his chest with difficulty breathing, well heart disease also occurs in women and in fact it is the cause of death in 1 out of every 4 women. So as we discuss the signs remember we are not just talking about men. Women will often have the exact same symptoms although some may be subtle and not overlooked.
Heart Attack Symptoms
- Chest pain often described as a pressure in the chest.” It feels like an elephant is sitting on my chest”
- Indigestion or Heartburn
- Shortness of Breath, feeling like you can’t catch your breath. We expect this after exercise but not out of the blue
- Left arm pain, the pain may actually be coming from the heart but the brain is being told it is the left arm
- Back or jaw pain
These symptoms may worsen during or after exercise as the body is asking for more oxygen and blood flow yet the pump is suffering and not working well. When pushed the heart is not getting what it needs and thus the symptoms show, letting us know that our heart is not working as it should. Women should not overlook these symptoms and if you were a smoker or have a family history of heart disease take them seriously and ask about your heart.
Just like any pump it has valves and holding areas. The pumps are essentially one way valves which allows blood to flow out and prevents it from flowing back into the heart. You all have probably you know who has had a bad valve and needed it replaced. The advancement in valve replacement is amazing it has gone from essentially “open heart “ surgery to surgery done thru a blood vessel in your leg, where a new valve is fed thru a tube and placed over the old faulty valve, and you go home in one day. Compared to the old way of open heart where the patient would be in the hospital for a week.
Advancements have been made in the screening for heart disease with CT scans showing calcium deposits in your heart blood vessels, stress testing is more accurate, treating abnormal heart beats with a procedure replaces lifetime medication in many and the impact of having defibrillators in common public areas makes sure we have the most important treatment close to the patient and easy to use for anyone. These advances help slow or treat the disease but they don’t stop it.
Now all is not bad news, studies have continued to show that dark chocolate and red wine have some cardiac benefits. Dark Chocolate that is 70% Cacao is best, it has antioxidants, it can increase blood circulation, lower blood pressure, lower cholesterol levels and overall lower your risk of both heart and stroke issues. Red wine has many of the same characteristics which provide similar benefits but it only is found in red wines due to resveratrol which is not seen in white wines.
So as you are looking for that last minute Valentine’s gift think about red wine and dark chocolate, it is a win win for all involved.