Art of the Heart

Taking care of yourself will keep you and your heart in tip-top shape.

It seems as if medical experts are always thinking up new ways to scare us with statistics and warnings about smoking, drinking and not eating so much tiramisu. But facts are facts: Cardiovascular disease (CVD) is the leading cause of death for both men and women in the United States. The latest numbers from the American Heart Association (AHA) indicate that about one in every three Americans has some form of CVD.

So whatever your age, there’s no better time than right now to take your health to heart.

Breaking down the heart

CVD isn’t a single disease. Rather, it’s an umbrella term that covers a host of ailments—coronary artery disease, congestive heart failure, cardiac dysrhythmia and others—that ultimately affect the heart. We all know to see the doctor if something feels off, uncomfortable or painful. But CVD can manifest in unexpected symptoms, such as pain in an unusual location, indigestion, weakness or neurological symptoms.

It can also be asymptomatic, meaning you might not know something is going wrong until it actually goes wrong. In fact, anywhere between 20 and 60 percent of nonfatal heart attacks are considered “silent.” “That means whatever symptoms a person may or may not have at the time, they weren’t bad enough to cause them to seek medical attention,” says Dr. Steven Stricker, physician in chief at Kaiser Permanente, Napa-Solano Area.

The first step toward combating CVD is knowing what your body is up to. Though some medical organizations put high blood pressure, or hypertension, under that same umbrella, Stricker calls it “more of a risk factor than an illness.” Regardless, hypertension affects an estimated 72 to 73 million people in the U.S., and can indicate a greater risk of heart disease. Left untreated, it can also lead to heart or kidney failure, vision problems, heart attack or stroke.

The smaller fix

Medical therapy and treatment of any kind, including that for CVD, is implemented for two reasons, says Dr. Andrew Wong of Cardiology Consultants of Napa Valley: “First, if there is a life-, limb- or function-threatening condition. Second, to improve quality of life.”

Sometimes lifestyle changes alone don’t achieve the desired goals and need to be combined with medication, Wong says. He describes a hypothetical heart attack patient with a low-density lipoprotein (LDL) cholesterol number of more than 200. “Let’s say our goal is to decrease their LDL to under 70. With the best diet and a vigorous exercise program, the best one can hope to achieve may be a one-third reduction, perhaps down to 120. Medicines are then used to make up the difference.”

It will be up to you and your doctor to find the right medication. “Just like every automaker must have their own SUV, many drug manufacturers will have their own statin, beta blocker, etc.,” Wong says about the hundreds of cardiac drugs available.

As with any lifestyle change, consistency is key. “If your doctor thinks you need medications, try them out,” Stricker says. “Chances are you will have no side effects, and you will gain peace of mind when you see your numbers improve.” He adds that there are less costly, generic versions of nearly all the existing brand-name drugs, which will provide the same benefits.

The bigger fix

An estimated 1.2 million inpatient angioplasty procedures and more than 450,000 inpatient coronary bypass procedures are performed annually in the U.S., according to the AHA.

Angioplasty—a better-known term for percutaneous coronary intervention (PCI)—helps a patient avoid surgery by opening up narrowed, clogged arteries using stents, balloons and other devices, Stricker explains. “Because PCI has become more effective in recent years, fewer patients require surgery than before.” But, he adds, “Surgery is recommended when we can’t fix a life threatening situation any other way. So if your physician says that surgery is better for you, go for it, because the surgical techniques keep improving.”

The choice of procedure depends on the individual. “Some anatomy is best served by performing surgery, whereas others may be more approachable with PCI,” Wong says. While shown to be effective in saving lives at immediate risk, studies have shown that PCIs performed on a nonemergency basis on low-risk patients with coronary artery disease tend to provide little benefit in terms of reducing mortality. But “angioplasty can reduce the amount of angina [chest pain], and thus improve a patient’s quality of life.”

Bypass surgery is the most common cardiac surgery, but surgical risk doesn’t necessarily increase if a patient undergoes a double or more extensive procedure versus a single-vessel bypass. “If you already have the hood open, is it that much riskier to change all the spark plugs rather than just two?” Wong says. However, “The more extensive the disease, the higher the risk is for the patient regardless of the approach taken.”

The best fix of all

There’s a lot you can do toward fighting heart disease. Losing weight if needed and being more active may significantly improve cholesterol levels and blood pressure, Stricker says. Even so, he adds, there are some people with healthy lifestyles who, due to genetic factors, still have high cholesterol levels and blood pressure, and may also need to take medication. He cautions that being on medication is “no reason to get lazy. Pills alone will not put years on your lifespan if you don’t work on the weight and exercise at the same time.”

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[Sidebar]

Consider the female risk factor

One separate-but-equal cause for concern is the notion that heart disease is primarily a male problem. In actuality, women edge out men, 53 percent to 47 percent, in overall deaths from cardiovascular disease. There are reasons contributing to this misconception. Female hormones provide some protection from heart disease, so “premenopausal women have substantially less cardiovascular disease compared with their male counterparts,” says Dr. Andrew Wong of Cardiology Consultants of Napa Valley. With the onset of menopause, there tends to be a catch-up effect. “Women also have traditionally been undertreated by doctors,” he explains. “Their symptoms are more atypical, which means there is a higher chance for misdiagnosis or at least a delay in diagnosis.”

Although there are no specific “female heart attack symptoms,” studies have shown that afflicted women may be more likely than men to feel discomfort or pain in their shoulder region, shortness of breath or symptoms that mimic that of indigestion, such as nausea, vomiting or an upset stomach. If in doubt, call your doctor or visit your emergency room. Better to be turned away with an antacid than to leave heart damage untreated.

Dr. Steven Stricker, physician in chief at Kaiser Permanente, Napa-Solano Area, recommends checking out the American Heart Association’s Go Red campaign, which takes place in February. “It is equally if not more important that women address cardiac risk factors—smoking, weight, blood pressure, cholesterol, activity levels, diabetes—and look for symptoms of heart disease, rather than be falsely confident that only men are likely to get it.”

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