610,000 Americans die from heart disease each year. With figures of that magnitude it is imperative to take steps toward optimal cardiovascular health. Because everyone is at risk of heart disease, cardiologist Jonathan Finkel, M.D. with Crozer-Keystone Health System stresses the importance of heart screenings at an early age paired with a healthy lifestyle.
The bottom line on healthy eating
Dr. Finkel frequently sees patients who know they need to maintain a healthier lifestyle but do not understand what constitutes a heart-healthy diet. To make matters worse, oftentimes fad diets and clean eating trends make it difficult to figure out what should or shouldn’t be consumed.
Eat a balanced diet that includes:
- lots of fruits and vegetables
- moderate amounts of lean protein such as beans, nuts, fish, and poultry
- whole grains such as whole grain bread, brown rice, and whole wheat pasta
- limited red meat and fried foods, and
- no processed foods containing high levels of salt
Yes, young people can have heart attacks
Although it’s more common in patients over 60, it’s entirely possible to suffer a heart attack earlier in life. Dr. Finkel regularly sees young patients who assume they are healthy and don’t feel the need to check their blood pressure or cholesterol levels. Because many young people may be asymptomatic, Dr. Finkel highly recommends screenings to identify undiagnosed “hypertension, high cholesterol, or familial hypercholesterolemia, which if left untreated can cause heart attack in the late 20s and 30s.”
For patients under the age of 40 without symptoms, getting blood pressure measured every two years (if blood pressure is less than 120/80) is recommended along with having cholesterol levels checked every 4-6 years from age 20 and over. Unfortunately, genetics and age play significant roles in the risk for heart disease so the frequency of screenings should be tailored to each patient’s risk factors.
Assessing the risk for heart issues
“Screening for heart health is really screening for cardiovascular risk factors: hypertension, diabetes, obesity, high cholesterol, smoking and family history,” shares Dr. Finkel. “Those are the things we look for in someone without symptoms to get a sense of their general risk.” Age and sex are also factors in risk assessment, with men having an increased likelihood over women. That's not to say that if you meet these criteria that you will get heart disease, it’s that your odds are higher than someone who does not check all the boxes.
“There are risk scoring systems that incorporate these things and can give you an estimated risk percentage of having a [cardiovascular] event in the next ten years,” informs Dr. Finkel. Additionally, doctors routinely look out for metabolic syndrome. “Metabolic syndrome has five criteria: waist circumference, high triglycerides, fasting glucose levels, cholesterol levels, and high blood pressure. Any combination of three of these constitutes metabolic syndrome, which puts you at higher risk for heart disease, diabetes, and stroke.
When risk is uncertain, more advanced tests can be used to further evaluate patients such as coronary calcium score, high sensitivity CRP, and an ankle brachial index (ABI) to help your doctor assess your cardiovascular health.
Beyond coronary disease, there are also heart-related conditions such as atrial fibrillation, which is an irregular heart rhythm that puts individuals at a higher risk of stroke. Abdominal aortic aneurysm is another condition where an abdominal artery enlarges and ruptures, and is often fatal. Long-term rhythm monitors can be used to screen for atrial fibrillation, and ultrasound is performed in select patients – primarily men over 65 with a history of smoking – to screen for aortic aneurysms.
How do we manage patients at risk?
The best way to lower your risk of heart disease isn’t as simple as avoiding one negative habit. Rather, it’s by committing to living an overall healthy lifestyle. This includes “healthy eating habits, avoiding obesity, regular exercise, not smoking, and routine screening for high blood pressure, diabetes, and high cholesterol ” shares Dr. Finkel. “Unfortunately, you could live a healthy life and still get heart disease, but if you live an unhealthy life your odds are much higher.”
In addition to lifestyle, cholesterol medicines called “statins” have been shown to decrease the risk of heart disease in patients who are diagnosed as high risk based on age, sex, cholesterol level and blood pressure, as well as patients with diabetes. “These medicines are generally safe and very well tolerated, and are currently the best medicine we have to help decrease the risk of heart attack and stroke, but do not take the place of healthy living,” shared Dr. Finkel.
What to do if you’re experiencing symptoms
Symptoms of heart disease include exertional chest discomfort and shortness of breath. If you experience symptoms, visit your family doctor or even a cardiologist. These physicians can offer more advanced screening tests, such as EKG, echocardiogram, stress test or a cardiac CT scan to assess your cardiovascular health.
Additionally, symptomatic patients need to cut out smoking, engage in exercise, and eat a healthy diet.
The bottom line
Healthy living and appropriate screenings are the cornerstones to preventing heart disease. See a primary care doctor regularly, especially if you are experiencing symptoms that may be related to heart disease. Certain patients may benefit from statin medications, not as a substitute but as an addition to healthy living, but this should be a personalized discussion between you and your doctor.