Heart Disease Awareness

February is American Heart Month, a time to raise awareness of heart disease and the best ways we can all better take care of our hearts.    

Heart disease – also known as cardiovascular disease – is the number one killer of women and men, responsible for one out of every five deaths in the United States.  In 2021, about 695,000 Americans died from heart disease – that’s one person every 33 seconds. 

Heart disease is also a top cause of disability, leading to diminished quality of life and lost productivity.  It has a tremendously negative economic impact – heart disease costs about $240 billion a year in the U.S., when factoring in cost of health care, medicine and workforce impact. 

These are sobering statistics, to be sure.  But there is also good news to share.  Advances in medicine, including the detection of health conditions that lead to heart disease, as well as treatment of those conditions, have made a positive impact.  Increased knowledge about how to reduce heart disease risk has empowered more people to better take control and improve their heart health. 

“Many of the causes of heart disease – as well as the health problems that lead to heart disease, such as high cholesterol and hypertension – are interrelated,” explains Dr. Scott Ewing, a cardiologist in Fort Worth.  “For example, you can reduce your risk of multiple conditions, including high cholesterol, hypertension, diabetes and obesity by eating better and getting more physical activity.”

Types of Heart Disease

Heart disease includes several specific conditions.  These are among the most common:

Coronary Artery Disease

Coronary Artery Disease (CAD) is the most common form of heart disease and is often the root cause of heart attacks and other heart problems.  CAD was responsible for more than 375,000 deaths in 2021. 

CAD occurs when plaque – deposits of cholesterol and other substances – build up in the coronary arteries, the arteries that supply blood to the heart.  When blood flow to the heart is impeded over a long period of time, the heart becomes weakened and heart failure can result.  If blood flow is completely cut off, a heart attack will result.  CAD can also cause blood clots, which may lead to stroke.

Heart Attack

In the time you have been reading this article, someone in the United States has had a heart attack.  Each year, more than 800,000 Americans suffer a heart attack.  About one in five of these are “repeat” heart attacks, meaning the person has had at least one heart attack in the past.

Also known as a myocardial infarction, a heart attack occurs when a portion of the heart suddenly receives inadequate blood flow.  The longer the heart goes without the required amount of blood flow, the greater the damage that will be done to the heart. 

Since time is of the essence, everyone should recognize the signs of a heart attack and know when to seek immediate medical attention:

• Chest pain or discomfort
• Pain or discomfort in the jaw, neck or back
• Feeling weak, light-headed or faint (this is more common in women)
• Pain or discomfort in arms or shoulder
• Shortness of breath

If you or someone around you suddenly begins to experience one or more of these symptoms, call 911 immediately.  The sooner you seek and receive medical attention, the greater your odds of recovering from a heart attack.

Cardiovascular-Kidney-Metabolic Syndrome (CKM)

In 2023, the American Heart Association identified a new cardiovascular condition, cardiovascular-kidney-metabolic syndrome (CKM).  CKM observes the linkage between diabetes, obesity, heart disease and kidney disease.

It’s been well-known for years that diabetes and obesity are major risk factors for developing heart disease.  A CKM diagnosis may help guide a patient’s treatment for conditions such as kidney disease or obesity with the goal of preventing heart disease down the road. 

Other Forms of Heart Disease

Angina: Angina is chest pain caused by reduced blood flow to the heart. 

Arrhythmia: Arrhythmia occurs when the heart beats irregularly.  Arrhythmia increases the risk of blood clots and stroke.

Atherosclerosis:  This is the narrowing of the arteries as a result of plaque buildup. 

Cardiomyopathy: This condition results from the stiffening or enlargement of the heart muscle, which can cause inadequate blood pumping. Cardiomyopathy can result from many factors, including genetic ones.  Uncontrolled high blood pressure is a key risk factor for this condition. 

Heart failure: Heart failure – also called congestive heart failure (due to the buildup of fluids in the lungs, limbs and liver) – results from the gradual weakening of the heart muscle.  The heart is still beating but no longer pumps blood correctly.

Peripheral Arterial Disease (PAD):  When the arteries that supply blood to the arms and legs narrow or stiffen as a result of atherosclerosis, the blood and oxygen flow to the limbs can be diminished or even blocked.  This can lead to numbness, tingling and pain in the legs and arms. 

The Three Buckets of Heart Disease Risk Factors

“There are numerous risk factors for heart disease,” explains Dr. Sam Nassar, a Fort Worth cardiologist.  “These risks can basically be sorted into three buckets:  the ones we can’t control, medical conditions we can mitigate through medicine and lifestyle adjustments and lastly, lifestyle factors.” 

Bucket 1: Risk factors we can’t control:

• Family history:  Genetics plays a role in many health conditions, including heart disease.
• Age:  The older we get, the greater our risk of heart disease. 

Bucket 2: Medical conditions that lead to heart disease that we can manage or prevent:

High cholesterol

Cholesterol is a waxy, naturally-occurring substance in our bloodstream.  Our bodies need some cholesterol to help build healthy cells and aid in the digestive process. 

Cholesterol is transported through the bloodstream by what are known as lipoproteins.  There are two types of lipoproteins, low-density (LDL) and high-density (HDL). LDL is often referred to as “bad cholesterol” and HDL as “good cholesterol.”

LDL cholesterol is bad for us because it contributes to the buildup of plaque in the arteries, which can lead to coronary artery disease, angina and heart attack.  Keeping LDL levels in check is very important for heart health. 

Conversely, the higher your HDL is, the better.  HDL transports cholesterol and fat through the blood and to the liver, so they can be eliminated from the body. 

Triglycerides, a type of fat found in the blood, can also be harmful to cardiovascular health if they are too high.

A cholesterol screening, a simple blood test that measures cholesterol and triglyceride levels, will determine if your levels are in the normal range.  Everyone should receive cholesterol screenings periodically: 

Screening for High Cholesterol

• Children between the ages of 9-11
• Young adults between the ages of 17-21
• Adults every 4-6 years, if no history of heart disease
• Adults with a history of heart disease should visit with their physician about how often to be screened. 

If your LDL levels are elevated, you may be able to bring them down by making dietary adjustments.  Eating less saturated fat, the type of fat found in meat and dairy, can help improve cholesterol levels.  Trans fats, also known as partially hydrogenated vegetable oil, are found in many processed baked goods, such as cookies and doughnuts, as well as some fried foods.  Trans fats are considered to be the worst type of fat to consume, as they raise LDL cholesterol while reducing HDL levels. 

In addition to dietary adjustments, HDL levels can be elevated through regular exercise.  If diet and exercise are insufficient to bring cholesterol levels into a healthy range, your physician may prescribe a medication known as a statin.  Read our companion article this month for a deep dive on statins (link).

High blood pressure

Also known as hypertension, high blood pressure can also be influenced by genetics.  Like cholesterol, there are things we can do to reduce risk.

Hypertension is referred to as a “silent killer” – it usually produces no noticeable symptoms, but left untreated, can result in severe damage to the heart.  A blood pressure reading, which is two numbers, measures the force of blood against the arteries:

• Systolic (upper number): when the heart beats
• Diastolic (lower number): when the heart is resting, in between beats

Blood pressure readings can be classified as:

• Normal: Less than 120/80 mm Hg;
• Elevated: Systolic between 120-129 and diastolic less than 80;
• Stage 1: Systolic between 130-139 or diastolic between 80-89;
• Stage 2: Systolic at least 140 or diastolic at least 90;
• Hypertensive crisis: Systolic over 180 and/or diastolic over 120

Elevated blood pressure can damage the arteries over time.  It also makes the heart work harder to pump blood, causing extra strain and possible damage to the heart.  The root cause of high blood pressure is usually unknown and is a condition that often develops gradually with age.  However, there are known risk factors that contribute to high blood pressure, including too much salt and too little potassium in a diet, as well as excessive alcohol consumption and tobacco use.  As with cholesterol, if diet and exercise are insufficient to bring blood pressure into a normal range, your physician may prescribe medication. 

All adults should have their blood pressure checked by a medical professional periodically: 

• Ages 18-39: every three to five years.
• Ages 40 and older: every year.

Diabetes & prediabetes

Sustained levels of high blood sugar leads to prediabetes and eventually, diabetes.  Genetics may play a role, but we can also reduce our risk for these conditions.

Diabetes is a disorder of the metabolism, meaning the body is not properly using the food it is consuming.  Under normal circumstances, our liver breaks down carbohydrates into glucose, also known as blood sugar.  The liver releases the glucose into the blood stream.  Meanwhile, the pancreas, a gland located near the stomach, produces insulin, which is a hormone that helps the body’s cells absorb the sugar in the blood.  Our cells then use the glucose for energy.  If a person’s cells are unable to absorb enough glucose, blood sugar levels rise.  This can lead to diabetes. 

Your doctor can check your blood sugar level with a simple blood test, and there are several things that can be done to lower it if it’s too high.  Some foods should be avoided or eaten only in moderation.  This includes certain carbohydrates, such as white flour products like bread and pasta, as well as white rice.  Sugary drinks, including soda and fruit drinks, can also cause blood sugar levels to spike.  Getting regular exercise and remaining hydrated are important keys to keeping blood sugar levels in check.

All adults should have their blood sugar levels checked periodically: 

• Men and women age 45 and older, every three years
• Men and women ages 19-44, if overweight or obese
• Women who have had gestational diabetes

Overweightness and obesity

Some people are predisposed to weighing more, which can make losing weight challenging.  Yet, there are steps that people can take to shed pounds and reduce their risk of heart disease.  This includes diet and exercise, as well as medical interventions if necessary, such as prescription medication and weight-loss surgery. 

Bucket 3: Negative lifestyle factors that increase risk for heart disease

• Smoking & vaping:  Smoking is a known risk factor for heart disease.  Vaping is also unsafe.
• Stress:  Too much prolonged stress is hard on the heart. 
• Lack of sleep: Not getting enough sleep increases stress, can lead to weight gain and disrupts your body’s natural repair process. 
• Excessive alcohol consumption: Too much alcohol contributes to high blood pressure and weight gain.
• Unhealthy diet: Eating too many fried, processed, sugary or fatty foods is bad for your heart health and leads to weight gain.
• Sedentary lifestyle: Sitting for extended periods of time contributes to multiple health conditions that lead to heart disease. 

Heart Disease Risk Matrix

Here’s a condensed version of the above:

Living a Heart-Healthy Life

As you can see, heart disease and many of the conditions that lead to heart disease are greatly influenced by the decisions we make throughout our lives.  So how can you best protect your heart?  Let’s count the ways:

1. Don’t smoke or vape!
2. Get 7-8 hours of sleep per night.
3. Reduce your stress so it doesn’t harm your physical and mental health. 
4. Get moving!  We should get a minimum of 150 minutes of moderate-intensity aerobic physical activity per week, in addition to doing strength exercises twice a week.  Read more in our January article on physical activity and exercise.
5. Eat right:
   • Eat more fruit, vegetables, whole grains, lean meats and fish.
   • Eat less refined sugar and flour products. 
   • Eat less meat heavy in saturated fat. 
   • Watch your overall calorie intake and ensure you are not eating portions that are too large. 
   • Drink plenty of water. 
   • Check out our recent article, Eating Better in 2024, for additional healthy, heart-friendly eating tips. 
6. See your primary care provider! Go for a checkup once a year – even if you are feeling fine – to make sure you are up to date on all your necessary screenings like cholesterol, blood sugar and blood pressure.

“By taking proactive steps to protect our hearts, we can substantially reduce our risk of heart disease, says Dr. C. Brooks Smith, a family medicine physician in Granbury.  “And, when lifestyle choices are not sufficient by themselves, we have a variety of treatments available to help people manage their heart disease risk factors and live longer, healthier lives.”

So, this February, do your heart a favor: go see your doctor if it’s been a while and get your recommended screenings checked off your to-do list.  Your heart will thank you later!

This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians. 

This article contains information sourced from:

New type of heart disease identified links obesity, diabetes and kidney disease (nbcnews.com)

Heart Disease Facts | cdc.gov