According to the American Heart Association, heart disease and stroke remain two of the top killers of Americans. But local experts say there is cause for optimism. With advances in research and treatments, patients are living longer and ejoying a better quality of life.
[heart failure]
Dr. Toniya Singh, St. Louis Heart and Vascular:
Heart failure is a disease in which the heart is unable to pump blood at a rate essential for the requirements of the body during ordinary activity. The heart may be unable to pump efficiently because of blockages in the blood flow, problems with the valves in the heart or an inherited disorder. Heart failure also can be caused by the inability of the heart to relax normally and fill with blood, or by abnormalities in the electrical activity in the heart. Risk factors include: obesity, sleep apnea, high blood pressure, diabetes, hormonal imbalances, infections caused by various viruses, or vitamin deficiencies.
Heart failure most often presents with shortness of breath on exertion or even at rest, fatigue, and swelling in the legs. Early detection is the key in starting treatment and fixing all the conditions that led to the development of heart failure. The sooner heart failure is detected and treatment is started, the better the outcome. Keeping your weight, blood pressure, blood sugar and cholesterol under control will go a long way in preventing the problem, too.
Dr. Paul Hauptman, SLUCare:
Despite the ominous tone of the name ‘heart failure,’ people should be cautiously optimistic about this disease in this day and age. It’s a chronic condition that can be managed very successfully with a combination of medication and different devices. In fact, in some cases—especially in new presentations—patients can normalize with treatment. While there is currently no cure for heart failure, there are some exciting research advancements, including gene therapy and stem cell therapy.
Former Vice President Dick Cheney, for example, had his first heart attack at age 37. Over the years he has had multiple others, bypass procedures, stents and, most recently, a heart transplant. Still, at 73 years old, he’s alive and kicking. Cheney is just one example of the many people who are living longer and healthier lives with heart failure. It’s why I get up and go to work in the morning.
Some people will continue to have symptoms, though, despite optimal medical therapy. For them, there are still options, including left ventricular assist devices (LVAD), heart transplant and experimental approaches. Patients with late-stage heart failure may also choose to transition to palliative care to better manage their symptoms.
[heart disease in men and women]
Dr. Keith Mankowitz St. Luke’s Hospital:
High blood pressure or hypertension is the leading cause of stroke and a major cause of heart attacks. Recent research suggests that women are more at risk to die from hypertension-related cardiovascular disease than men. The perception by both patients and physicians that women are at substantially lower risk than men could explain the poorer outcome in women.
Hypertension is often called ‘the silent killer’ because it rarely causes symptoms, even as it inflicts serious damage to the body. Many people with high blood pressure don’t realize they have the condition. All women should have their blood pressure checked regularly. For hypertensive patients, achieving lower blood pressure goals can markedly reduce the chance of having a stroke or heart attack and can prolong life. However, approximately twothirds of treated hypertensive women are unable to control their blood pressure.
High blood pressure is more likely in people who have a family history of high blood pressure, heart disease or diabetes, are African-American, over age 55, overweight, not physically active, drink excessively, smoke, eat foods high in saturated fats or salt, use certain medications such as NSAIDs (ibuprofen, decongestants, etc.) and use illicit drugs such as cocaine. After age 65, black women have the highest incidence of high blood pressure.
Dr. Anthony Sonn, Mercy St. Louis:
There’s been a lot of focus on how heart disease affects men and women differently. In reality, though, there are many more similarities. Heart disease and stroke are among the top killers of both. Coronary artery disease is probably the most common cardiovascular disease for both. People experience many different symptoms emblematic of a heart attack that don’t necessarily differ because of gender. In general, some of the more common symptoms of a heart attack can be chest tightness, chest pain, shortness of breath, heartburn, nausea, light headedness, dizziness and palpitations. In the past, the misconception that women were less likely to have a heart attack led to poorer outcomes for women. Fortunately, greater awareness among physicians and the general public has helped improve outcomes for women.
One difference that does exist is the female hormones—estrogen in particular—that appear to provide some protective benefit in pre-menopausal women. A woman’s risk for heart disease increases after menopause when estrogen levels drop. However, there is no proof that hormone replacement therapy can offset the risk for heart disease and, in women with certain risk factors, it can actually have the opposite effect.
[statins]
SSM St. Mary’s Medical Center:
In November, the American College of Cardiology and the American Heart Association released new guidelines on the treatment of cholesterol in patients at high risk for cardiovascular disease. According to the guidelines, most Americans should first try to control their cholesterol through diet and exercise, except for four groups: people with very high LDL or ‘bad cholesterol’ over 190; patients who have been diagnosed with heart disease; patients between the age of 40 to 75 with Type 2 diabetes; and those over 40 who have a greater than 7.5 percent chance per year, over 10 years, of having a heart attack (doctors have a formula to calculate this risk). People who fall into these categories should start a statin immediately and also make healthy lifestyle changes.
For those with heart disease, statins can lower the chance of another event by 30 percent. And the newer statins are more aggressive, meaning patients can take just one pill per day. However, potential side effects include abdominal discomfort, diarrhea, liver problems, diabetes and muscle aches.
Dr. Michael Twyman, Des Peres Hospital:
Statins are not a cure for poor lifestyle. I recommend that most patients try for at least six months to lower their cholesterol through exercise and diet alone. This includes adding 40 minutes of moderate exercise daily, incorporating more vegetables and fruits, and reducing processed foods. If you’re not already exercising, start slow and work your way up to a longer, more intense workout. As a general rule, it should be slightly hard for you to hold a conversation while exercising.
People who have had a cardiovascular event in the past benefit the most from statin therapy. For patients who have had a heart attack, stroke, cardiac stent or bypass surgery, a statin will help reduce the risk of having another event. In addition to lowering cholesterol levels, statins have been found to lower inflammation levels, a key driver of cardiovascular disease and many other chronic diseases. And with generic options now available, statins are more affordable than in the past.
[stats]
787K men and women in the U.S. died from heart disease, stroke and other cardiovascular diseases in 2010, according to the American Heart Association
[stem cell therapy]
Despite enthusiasm over the potential use of stem cells to repair heart muscle, Dr. Gregory Ewald, associate professor of medicine at Washington University School of Medicine, says we may still be years away from having a reliable stem cell treatment that could be administered to most patients.
According to Ewald, researchers are working in a number of areas to determine how to best use stem cells in patients with damage caused by heart attacks or heart failure. “First, they’re trying to figure out which are the right stem cells best capable of doing the work,” he says. “Second, they need to figure out how to deliver the stem cells where they need to go and keep them there so they can repair muscle tissue. Third, they need to determine if the cells improve heart function measurably and make people feel better. So we’re still really in a learning phase.”
Ewald and Dr. John Lasala, associate professor of medicine at Washington University, are currently participating in a multi-site clinical trial to determine whether there’s a way to trigger the body to send stem cells to the damaged site in the heart. “We’re injecting a small DNA plasmid that contains a signaling molecule into areas of the heart that have been damaged by heart attacks in patients with heart failure,” Ewald explains. “That signaling material sends out a homing signal for stem cells. We think it will cause stem cells to come to the site of injury without actually having to harvest, prepare and inject the stem cells, which is pretty tedious work.”
[atrial fibrillation]
“Atrial fibrillation is a heart arrhythmia in which the heart beats rapidly and irregularly,” says Dr. Karthik Ramaswamy, director of the Arrhythmia Center at Missouri Baptist Medical Center. “It’s caused by short-circuiting in the electrical system of the upper chambers of the heart.”
Symptoms include heart palpitations, shortness of breath, exercise intolerance, chest discomfort, light headedness or feeling faint, Ramaswamy says. Some patients, though, are asymptomatic and only diagnosed with an EKG.
The incidence of atrial fibrillation increases as we get older; as many as 15 percent of individuals over the age of 85 have the condition. But it also can occur in otherwise healthy younger adults, Ramaswamy notes. “By itself, atrial fibrillation is not life-threatening, but it can lead to serious complications like blood clots, stroke and heart failure. Fortunately, there have been important advancements to treat atrial fibrillation and prevent stroke.”
Treatment for atrial fibrillation generally includes medications to control the heart rate and help get the heart back into rhythm. Other options include a cardioversion, which delivers an electric shock to the heart to restore rhythm, and catheter ablation, in which a catheter is inserted through a vein in the leg to the heart to find and destroy the problem areas. “Most important, we try to prevent strokes,” Ramaswamy says. “There are very effective medications, including blood thinners and anticoagulants.”
By Sara Savat
