Heart disease, whether genetic in origin or brought on by poor lifestyle choices, can be preventable. But what are the factors that can move you from a tragic heart statistic to a healthy patient? Doctors agree early detection is essential; so are regular checkups and seeing a cardiologist if your primary care physician recommends it.
genetics
Running guru Jim Fixx, author of the bestseller The Complete Book of Running, lost his father to heart disease at age 43. Despite this forewarning and a healthy, active lifestyle, Fixx himself died at age 52 of a heart attack while running. Heredity trumped activity, but genetic predisposition doesn’t have to be a death sentence.
cardiac close calls
“It’s really dramatic how much we can reduce the risk of an event with cholesterol medicine,” says Dr. Stephanie White of SSM Health St. Mary’s Hospital. “That’s one of the main tools we have. The area of cardiology does a lot of research identifying risk factors for coronary disease,” White says. “Sometimes there’s a disconnect between identifying what those risk factors are and how we can modify them and prevent events from happening. That’s what’s difficult.”
Patients are at increased risk when a first-degree relative has had a heart attack at a young age, White says. Gender does not change the risk, but hypertension, diabetes, high cholesterol and smoking do.
Dr. Jennifer Silva, a Washington University pediatric cardiologist, sees a lot of patients with sudden cardiac death (SCD) brought on by abnormal heart rhythm or arrhythmia, typically an inherited tendency. “There are certain people who are at risk of sudden cardiac death,” she says.
When a child has a family history of SCD, genetic testing can determine what the child’s risk is, Silva says. Risk can be mitigated with beta-blockers to limit arrhythmias, and devices like defibrillators and pacemakers also help regulate rhythm. “Arrhythmic sudden cardiac death is not always 100-percent preventable in all patients, but certainly for the vast number of kids we’ve identified with these conditions, they are alive and well.”
Genetic testing is essential, she says, because data suggests 10 to 20 percent of infants who die of Sudden Infant Death Syndrome had an undetected arrhythmia.
can you lower your risk?
It’s complicated, the doctors say. “Hypertension runs in the family, just like coronary disease and the way you metabolize cholesterol,” says White. “Each of those can be a genetic component for developing heart disease.”
It’s possible to lower but not eliminate heart attack risk with aggressive treatment, such as cholesterol medicine, she points out. For patients with a family history of heart disease—particularly immediate family like parents and siblings—White recommends the atherosclerotic cardiovascular disease (AS CVD) test. “There’s a calculator that we plug in your blood pressure, cholesterol level, whether you have high blood pressure, and whether it’s treated. Then we can calculate your 10-year risk of having an event,” White says.
If that risk is very low, the next step is checking the coronary calcium score. If that score is higher than the 80th percentile for your age, White would prescribe cholesterol medicine to reduce the risk. “That’s the only thing we’ve found medication-wise that can actually reduce somebody’s risk of having a heart attack,” she says.
People with a family history of heart disease need to get regular checkups that include measuring BP and cholesterol levels. “Just because their blood pressure is good today, it doesn’t mean that patients won’t develop hypertension over time,” she says.
equipment
OK, so you’re determined to improve your exercise routine, or lack thereof. But when it comes to heart-healthy exercise equipment, how do you choose? Ethel Frese, DPT, associate professor of physical therapy and athletic training at Saint Louis University, can simplify the choices.
“The cheapest and easiest for most people is walking,” she says. “You just need a good pair of walking shoes.” But what if you work and can’t find a good time for outdoor walking? Or you’d like to combine your sweating with reading, TV watching or binging on your favorite FX series?
Treadmills are a good option for elevating the heart rate, whether walking or running, Frese says. Stationary bikes and elliptical machines also offer solid cardiovascular workouts, with the added bonus of being easy on the joints, she says. If you use a stair stepper, be careful not to lock or completely straighten your knees.
Weight training is good to incorporate into a fitness program, but it’s not necessarily the best cardio workout. To get a sustained cardiovascular workout with weights, do circuit training with no more than 30 seconds of rest between the machines. “That will give you some degree of cardio,” Frese notes.
Frese agrees with cardiologists that a minimum of 30 minutes a day, three days a week, of aerobic exercise is needed for heart health. And she reminds that older people or those with a history of heart disease should get doctor approval before starting an exercise program.
broken hearts
There really is something called Broken Heart Syndrome (BHS), and yes, it can kill you! But not if doctors have anything to say about it. It’s not common, but nonetheless you’ll want to know its signs and how to avoid it.
you can die of a broken heart
Broken Heart Syndrome (BHS), also called stress cardiomyopathy, happens more often in books and movies than in real life. “It’s unpredictable and rare,” says Dr. Harvey Serota, a cardiologist with St. Louis Heart and Vascular Cardiology. “In my whole career—I’ve been practicing 29 years— I see one every few years.”
It hasn’t even been in the medical textbooks very long. “It’s only been recognized as an entity the last eight years,” says Dr. Pat Cole, a cardiologist with The Heart Health Center. As you might have guessed, BHS is brought on by stress (the death of a loved one or sudden shock) and mimics a heart attack.
BHS entails all the things people complain about with a heart attack, like chest pain and shortness of breath, Cole says. It’s also associated with EKG changes and elevated biomarkers. “For all intents and purposes, it looks like a heart attack,” Cole says.
what causes BHS?
It is likely related to the body’s ‘fight or flight’ reflex to sudden stress, Cole says.“ The current theory is the body highly overproduces adrenalin or epinephrine, and that causes a direct problem with the heart muscle,” she explains. “We know this because patients who have come immediately to the ER and had their epinephrine levels measured have levels much higher than normal—as high as 40 times normal! So for whatever reason, your body is producing this overload of epinephrine or adrenalin.”
It is most common in older women, but it doesn’t happen often to anyone.“ We all live with stress every day,” Serota says. “I don’t think I would live my life worried about getting stress cardiomyopathy. It’s almost a surprise when the doctor finds it because we’re expecting (artery) blockage, and they don’t have it,” Serota says. Still, it’s serious. “Patients can end up in ICU in shock.”
treat & take it down a notch
Mending a broken heart involves betablockers to reduce rhythm problems, ACE inhibitors to improve the heart’s pumping, cholesterol and pain medicine, and possibly diuretics to get rid of the fluid. “We treat them as if they’ve had a heart attack, even though that’s not really what happened,” Cole says.
And, of course, your doctor will try to get to the bottom of what incited the incident in the first place. “Often it’s extreme emotional or physical stress,” Cole says. “Most of the time it’s a short, sudden event: an acute illness of a spouse, an accident, or physical stress.” Such episodes can also bring with them actual heart damage.
“There’s a huge psychological overlay to a diagnosis you didn’t have before,” Cole says. “In some cases patients want psychological counseling because of the diagnosis.” Fortunately, most people with BHS recover completely, with no permanent damage. “The good news is it’s almost always reversible,” Cole says. “Within a day or two to a week, everything goes back to normal. It’s nice to be able to tell patients, You’re going to be OK.”
prevention
If we’re looking for preventive measures, a lot of it comes down to good old-fashioned common sense. The cornerstones are diet and exercise, says Dr. Mark Vogel, a cardiologist with Mercy Clinic Heart and Vascular.
get serious
“In general, shortcuts don’t pay off in life,” says Dr. Michael Lim, a SLUCare cardiologist. “Find the willpower and make prevention part of what you do on a daily basis.” He suggests people start with determining their susceptibility. “We’re actually getting pretty good at trying to predict what somebody’s 10-year risk of having a significant heart event is,” he says. That involves checking blood pressure, cholesterol and weight, plus discussing family medical history. “Those things are very telling with respect to your risk,” Lim says.
In some cases, medication will be necessary, but improving diet is absolutely ground zero in heart health, the physicians agree. “The consensus in the cardiac world is you want to have a diet that emphasizes fruits and vegetables, fish and poultry, and low-fat dairy and decreases the amount of red meat, sugary foods and sugary beverages like soda,” Vogel says.
The other part of the equation is exercise. “Exercise absolutely complements diet,” Lim says. “The more you exercise, the lower your heart risk.” That doesn’t mean you have to run a marathon or climb Mt. Everest—just maintain a minimum of 30 minutes of steady aerobic activity three to five times a week. Your exercise of choice can be as simple as walking, swimming or bicycling. “Do it continuously, with a 5-minute warmup, 20 minutes of exercise and a 5-minute cooldown,” Lim advises.
the talk test
If you don’t have time to exercise daily, Vogel suggests a longer, more vigorous workout. The ‘talk test’ helps determine if the activity is intense enough. “If you can go 25 minutes and carry on a full conversation, that activity level is not vigorous,” he says. He reminds people that in order to decrease cholesterol and blood pressure, the American Heart Association recommends 40 minutes of moderate to vigorous activity three to four times a week.
“Think of the heart for what it is; it’s a big muscle,” Vogel says. “If you do aerobic, cardiovascular exercise, that muscle will be stronger.” Regardless of their diet and exercise, patients with risk factors like family history of heart disease, high blood pressure or high cholesterol should get screened for a coronary calcium score starting at age 40, Vogel advises. This involves a CT scan to get a two-dimensional view of the heart and arteries so cardiologists can look for calcium. The higher the calcium score, the higher the risk for heart disease. Mercy offers this screening for $130; visit mercy.net/stlheart. “If you adapt these measures, the overall benefits can be huge, in terms of your length of life and your quality of life,” Vogel says.
