Heart of the Matter

According to the Centers for Disease Control and Prevention, heart (or cardia) disease is the leading cause of death for both men and women in the United States. It is responsible for about one in four deaths, or 610,000 lives lost annually.

Every year, about 735,000 Americans suffer a heart attack, but studies show only 27 percent of Americans recognize the major symptoms or know to call 911 when they occur. This may be why nearly half of all cardiac deaths occur outside of a hospital.

There are many kinds of heart disease, the most common of which is coronary heart disease, a disease of the arteries of the heart and their resulting complications, such as angina (chest pain, caused by reduced blood flow to the heart muscle due to blocked or narrowed arteries), atherosclerosis (thickening of the artery walls due to plaque) and heart attacks (when the heart’s supply of blood is stopped). The more general term for them, ischemic heart disease, refers to any condition caused by narrowing of the arteries.

Other types of heart disease include hypertensive heart disease, in which high blood pressure can overburden the heart; inflammatory heart disease, in which the heart muscle, membrane surrounding the heart or inner lining of the heart becomes inflamed; rheumatic heart disease, caused by one or more attacks of rheumatic fever, which damage the heart; congenital heart disease, when someone is born with malformations of the heart’s structure; and heart failure, a chronic condition that occurs when the heart’s muscle becomes too damaged to pump blood adequately.

While people may not always recognize the signs and symptoms of heart disease, American are becoming more familiar with factors that put them at risk for developing it: high blood pressure, high cholesterol, smoking, diabetes and prediabetes, being overweight or obese, being sedentary, having a family history of early heart disease, not eating healthfully and getting older.

While nothing can be done to prevent a genetic predisposition to risk, there is much people can do to reduce their other risk factors, says James T. Willerson, MD, President of the Texas Heart Institute. “Don’t smoke,” he says. “Be on a good, low-cholesterol diet, manage your weight and be sure your blood pressure is well-controlled.”

There are many medications for lowering blood pressure if it’s too high. Diuretics help rid the body of excess sodium and water. Beta-blockers reduce the heart rate and how hard the heart is working. ACE inhibitors help blood vessels relax and open up, thereby lowering blood pressure. These are just some of the medications available.

Dr. Willerson also recommends using diet, exercise and, if necessary, medication to keep low-density lipoprotein (LDL, the bad cholesterol) under control. LDL, the most important type of cholesterol for predicting heart disease, should be kept under 100 mg/dL. People with persistently high levels of LDL cholesterol are often given drugs called statins to bring those levels into the target range.

Another type of heart problem that occurs as people age is atrial fibrillation, or afib, an irregular heartbeat that can lead to blood clots, stroke, heart failure and other complications. When this occurs, it feels as if the heart is skipping beats or banging against the chest wall, and can cause nausea or light-headedness.

If sustained over several weeks, a very rapid heartbeat can injure the heart, says Dr. Willerson, so arrhythmia medications, such as amiodarone and beta-blockers, are used to bring the heartbeat back to a slower, regular rhythm. To prevent blood clots, Dr. Willerson also gives patients blood thinners.

And once a patient has recovered? What does life after a cardia episode look like?

“It means correcting all the possible contributions that led to that heart attack or stroke,” says Dr. Willerson. “Lowering your blood pressure, if it’s been uncontrolled. Losing weight. Keeping LDL as far under 100 mg/dL as possible. It means taking aspirin and other medications to prevent blood from clotting. If you’ve had a heart attack, you may need to undergo a procedure to have your arteries unblocked. It means never smoking, not taking drugs, getting rest and avoiding stress.”

“All of these are important,” he says.