Southern Regional Meeting 2017, New Orleans, LA, February 11-13 ...
To Prevent Heart Attacks, Doctors Try A New Genetic Test
Despite the high hopes for the new tests, there are many questions.
Some critics say that a focus on treating younger people is misplaced because they may not comply with taking a statin or another drug for the rest of their lives. It can be difficult for young people to focus on possible threats to their health decades in the future, and some of Dr. Rader's patients have put off even getting polygenic risk tests after he recommends them.
The real need, these critics say, is with the huge group of older people who need cholesterol-lowering treatment but are not getting it, or who are abandoning their prescriptions. In one study, about 40 percent of people 65 and older who had a heart attack and need lipid-lowering medications for the rest of their lives stop taking statins within two years.
Others, like Dr. Rita F. Redberg, a cardiologist at the University of California, San Francisco, the editor at JAMA Internal Medicine and a critic of the overuse of statins, is concerned that polygenic risk scores could introduce new problems.
"There is a lot of downside to labeling people with a disease," she said.
The label, she added, "inexorably leads to tests and a search for treatments." And, she said, "because the person, who now has become a 'patient,' is asymptomatic, more tests and possible treatments in most cases will not make the person feel any better."
People can go from thinking of themselves as healthy to thinking of themselves as someone with a disease. "Now, whenever they experience the common aches, pains and twinges of life, they wonder if it is because they have this 'disease,'" Dr. Redberg said. "And they may then go to the doctor or even emergency room for things they would not have previously. And that also will lead to more tests and procedures, with their attendant risk of harms."
Taking Care Of Your Heart Health In Your 20s, 30s, 40s, 50s, And 60s
One in every five women dies from heart disease in the United States, per the Centers for Disease Control and Prevention (CDC). The risk increases with age, but there are ways of treating your heart right in your younger years.
"Heart health choices that you make when you are young will affect your life in later years," says Joyce Oen-Hsiao, MD, cardiologist at Yale Medicine in Connecticut. "If you start following a healthy, active lifestyle when young, you will be more likely to maintain that healthy and active lifestyle as you get older."
Prevention is key, says Christine Jellis, MD, cardiologist at Cleveland Clinic in Ohio. "When we think about prevention, it's all about setting ourselves up for success in the future." Consider this: 80 percent of heart disease is preventable, according to the American Heart Association (AHA). What can you do to beat the nation's No. 1 killer? Follow this decade-by-decade guide to keep your heart healthy.
Your 20s and 30s: Lay the Foundation for Good Health What's Happening NowDuring your prime years, you're less likely to have artery-clogging cholesterol buildup, thanks to plentiful amounts of estrogen. This powerful hormone helps keep arteries flexible and blood cholesterol levels low, according to the AHA.
Still, if during pregnancy you develop high blood pressure, preeclampsia (pregnancy-induced high blood pressure), or gestational diabetes (pregnancy-related diabetes), or if you give birth preterm (before 37 weeks), then you're at increased risk for cardiovascular disease, later in life, according to Cleveland Clinic. "Having preeclampsia shows that there is twice the risk of developing heart attack, stroke, or blood clots within 5 to 15 years after pregnancy," Dr. Oen-Hsiao says.
If you had gestational diabetes, according to the CDC, you have a 50 percent chance of later developing type 2 diabetes, which can also increase the risk of heart attack.
While preeclampsia or other pregnancy complications don't guarantee heart problems later in life, Dr. Jellis says it's good to know if you are part of a group that should be more proactive about your heart health.
What to Do NowSee a primary care physician. If you developed high blood pressure, preeclampsia, or gestational diabetes, or gave birth preterm, see a primary care physician after your baby is born (not just an ob-gyn). You may even want to see a cardiologist.
Even if you have never been pregnant, says Jellis, "everyone should have a primary care physician or provider: somone who they check in with on a regular basis, so that they are updated with the latest data and evidence as to what [they] should be doing."
Eat to beat heart disease. Jellis suggests eating a Mediterranean-style diet, which is loaded with fruits, vegetables, whole grains, lean protein such as fish, and healthy unsaturated fats like olive oil. Since you've got time on your side, developing healthy lifelong eating habits in your twenties and thirties can help keep your arteries clear.
Fit in fitness. Try putting in at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week, the AHA recommends. They also suggest adding weight training to your fitness routine. "We don't have to take up powerlifting," says Jellis, "but there is good data to show that resistence or strength training is important and is something that a woman can integrate early in her life."
Give up harmful habits. Picking up habits that can do considerable harm to the body, as well as the heart, like cigarette smoking and drinking too much alcohol isn't worth it. Before it becomes a lifelong habit, quit smoking and keep drinking to a minimum — to no more than one drink a day, the AHA says.
Your 40s: Keep Track of Your Health Metrics What's Happening NowUnless you enter menopause in your forties, your risk of heart disease generally remains low throughout this decade. Still, if you've got a family, maybe even parents to look after, and a busy work schedule, it's easy to let your health slide. It may also be a good idea to ask your family members about their health history. If your family has a history of heart disease, your chances of developing the same are higher, according to the CDC.
Women in their forties must often juggle a lot of responsibilities, says Jellis, but even though you are premenopausal and at a lower risk of cardiovascular disease, you still need to optimize your health and avoid as many risk factors as possible.
What to Do NowKeep close tabs on your numbers. Get yearly checkups so you can track important numbers, such as blood pressure, fasting blood glucose, body mass index (BMI), and cholesterol. If your LDL "bad" cholesterol, blood pressure, or other risk factors aren't where they should be, work with your physician to take steps to improve them. For example, change your diet, exercise more, or take medication to lower your blood pressure or cholesterol if your doctor recommends it.
According to StatPearls and the AHA, here's an overview of the numbers you need to know and the goals to shoot for.
Although many providers still use BMI as a measurement for obesity, it doesn't always give the full picture, according to the National Institutes of Health, and a waist circumference greater than 35 inches in women can also point to an increased risk of heart disease. If your numbers are out of the normal range, your provider can work with you to take action.
Continue (or start) exercising. "Women whose lives were 'too busy' to exercise consistently in their thirties should try to start back to a good exercise regimen to try to reduce their risk of plaque formation," says Oen-Hsiao. As women age, she adds, the arteries and heart can stiffen, which can add to increased blood pressure, but consistent exercise can keep your arteries more flexible and lower this important number.
Your 50s: Kick Your Health Plan Into High Gear What's Happening NowAfter menopause, the risk of heart disease rises. A study published in 2022 in The Journal of the North American Menopause Society suggests severe menopausal symptoms may provide clues to your future cardiovascular health. In the study, the more severe the menopausal symptoms, the more likely subjects were to develop heart problems later on.
With the loss of estrogen, blood pressure tends to go up, as do LDL cholesterol and triglyceride levels, while HDL cholesterol tends to decline, setting the stage for artery-clogging atherosclerosis. But, says Oen-Hsiao, "keeping risk factors, like cholesterol, blood pressure, and blood sugars down will help to prevent coronary artery disease."
What to Do NowConsider hormone therapy. Where providers used to make generalized recommendations on hormone therapy, says Jellis, "this has evoled over time and now we really advise women to seek guidance from their provider or from an endocrinologist, because it is based on an individualized approach." In general, menopause replacement therapy is based on your personal risk factors and level, Jellis explains.
Assess your heart disease risk. Even if you feel fine, you can still have heart disease that's not yet causing symptoms. Plugging in your age, cholesterol, blood pressure, and other details into the AHA's online risk calculator will estimate your 10-year risk of heart disease.
Depending on your results, the AHA provides recommendations you can discuss with your physician. They may recommend preventive treatment, such as aspirin or statin medication. A statin helps shrink arterial plaque, according to the American College of Cardiology, preventing or delaying cardiovascular symptoms or events.
Ask about a low-dose noncontrast CT scan of your heart. This test measures calcified plaque deposits in your arteries and gives you a calcium score. From this score, "you can calculate the percentile rank of a person based on their gender, ethnicity, and age that will give you a ranking of your cardiovascular risk," says Jellis. These results can be helpful, because it can highlight patients who are at higher risk than first thought, she notes. It can also encourage people to follow their treatments more closely, or to take additional treatment if needed.
Your 60s and Older: Keep Up the Good Work What's Happening NowThe risk of heart attack is higher now. Between the ages of 60 to 79, about 78 percent of women have heart disease, according to a study review published in 2019 in the Journal of Cardiovascular Development and Disease. The good news is that you still have the power to reduce your risk of heart attack and stroke.
What to Do NowKeep your provider in the loop. At this point in life, Jellis recommends regular checkups with your health provider. "Your provider can look at the cumulative effect of the risk scores and be proactive about treatment," she says. "If your calcium score is high, your provider may be more inclined to put you on more therapies and be aggresive about that risk factor targeting." The more your provider knows about the state of your heart health, the more they can do to help.
Watch your risk factors. The numbers you started tracking in your forties — cholesterol, blood pressure, fasting blood glucose, weight, and BMI — can mean even more now since the probability of a cardiac event like a heart attack or stroke is greater, according to the 2019 article in The Journal of Cardiovascular Development and Disease. Do what you can to stay in the ideal ranges. Keep working with your doctor to develop a personal treatment or prevention plan to manage your risk factors. Follow up as often as recommended to make sure any medical interventions, such blood pressure medication or a statin, are working.
Don't ignore sneaky symptoms. If you have symptoms of heart disease, such as angina (tightness, pressure, or discomfort in your chest when you're exercising or stressed), see your doctor. Seeking prompt medical treatment can help head off a heart attack. The AHA reports heart attack symptoms in women can be different from men. While chest pain is still common, many women often report other symptoms like nausea, vomiting, back pain, or jaw pain when experiencing a heart attack. If you feel concerned at all about any symptom, seek medical help right away.
Understanding The Signs Of A Heart Attack In Women
© (Getty Images) Senior woman feeling pain at home Heart disease is the leading cause of death for women in the United States. In 2020, it was responsible for about 1 in every 5 female deaths in the U.S., according to the Centers for Disease Control and Prevention.
However, according to a survey from the American Heart Association, only about half of women surveyed recognize that heart disease is the No. 1 killer in the U.S., with major disparities in awareness among Black and Latino women.
Heart disease is the main cause of a heart attack, yet heart disease can be prevented.
"About 80% of all heart disease can be prevented," says Dr. Kate Elfrey, a board-certified cardiologist with The Heart Center at Mercy in Baltimore, Maryland.
Gaps in awareness, however, mean many women are still at risk of suffering a heart attack. Understanding the symptoms and risk factors associated with a heart attack is important to ensure you seek treatment quickly and can take steps to reduce and prevent your chances of having heart problems in the future.
What Is a Heart Attack?A heart attack is a severe cardiac condition in which there is a sudden problem with or interruption of blood flow to the heart.
"There are arteries that lay on top of the muscle of the heart, and they supply blood flow to the heart muscle so that it can pump appropriately," Elfrey says. "When you have a buildup of plaque and cholesterol that becomes severe to the point where it has obstructed the artery, that's when you'll have a heart attack."
The most common cause of heart attacks is a blockage in one or more of the major arteries feeding the heart. The plaque buildup will block the artery, preventing that territory of the heart muscle to not get adequate blood flow, which ultimately leads to pain, discomfort and other symptoms that come with a heart attack.
Symptoms of Heart AttackCommon signs and symptoms of a heart attack include:
"The hallmark signs and symptoms (are) like what we see in the movies," Elfrey says, describing it as a crushing chest pain, where the individual grabs their chest or makes a fist and holds onto their chest.
Someone experiencing a heart attack may describe the feeling as an elephant sitting on their chest. The pain may feel like an excruciating, severe squeezing sensation, explains Dr. Daniel Hermann, an interventional and structural cardiologist and director of structural cardiology at Memorial Hermann Memorial City Medical Center in Houston.
Heart Attack Symptoms in WomenSigns of a heart attack in women can present much more subtly than heart attack symptoms in men. In addition to the symptoms listed above, these include:
All of these signs can be more prominent in women than the classic chest pain symptom. For women, maybe their chest pain is less prominent, or sometimes completely absent, Hermann says.
When to Seek Emergency CareIf you have an acute onset of symptoms and experience severe chest pain, profuse sweating and extreme dizziness, call 911.
"The faster you can get to the hospital so that we can see if you really are having a heart attack is very important," Elfrey says, adding that, in a sudden severe cardiac event, there's about an hour and a half window from when you begin experiencing symptoms to the time doctors can treat the heart attack in order to preserve heart function.
Because women's heart attack signs are often much more subtle, it can be challenging to know when they're experiencing a serious cardiac event and at what point they should seek emergency care.
If you live an active lifestyle and notice unusual changes, that's a big warning sign. For example, Elfrey says, if you go out for a one-mile walk every day and notice you're more fatigued or can't walk up a hill you typically can without stopping and taking a break, that change could signal a heart attack.
If you aren't feeling quite right – like feeling short of breath walking to the bathroom – the sooner you can get to the hospital the better.
"The most important thing is to listen to your body," Elfrey says. "Don't take anything for granted. Don't say, 'It's probably just stress,' or 'It's probably just indigestion.' Don't take the risk when it comes to the heart."
Risk Factors for Heart Attack in WomenThere's no evidence that shows that one risk factor leads to a higher risk of heart attack in men or women, Elfrey says.
Risk factors for heart attack in men and women include:
These risk factors can increase the buildup of plaque or fatty material in your arteries, which can lead to a heart attack.
Stress is often ignored as a risk factor, Elfrey says. Whether it's work-related stress or family issues, this creates physical stress on our body.
"Our bodies kind of go into that fight-or-flight mode, and our cortisol levels will elevate, or go up high, so that we're able to sustain and function at a higher level of breath," Elfrey says.
Though cortisol secretion is necessary to cope with stress in the short term, prolonged and/or excessive secretion of the hormone can promote inflammation inside the body. Increased inflammation due to stress can trigger premature plaque building in the heart arteries, which contributes to the heart attack process, Elfrey says.
Elfrey also points out that, though risk factors don't necessarily differ from men to women, women often take on the caretaker role in the household. This may add to more stress, causing many women to internalize stress and not take proper care of themselves to manage stress levels.
"In women, we need to pay close attention to how stress is affecting our bodies," she says.
Preventing a Heart AttackNo matter your family history, there are several ways to keep heart disease at bay.
"We see a lot of people that are concerned because of family history, and they feel like they've been dealt a bad hand," Hermann says. "You have a lot of power to modify your risk profile."
Some of the best ways to prevent a heart attack and heart disease are to:
Heart disease can be prevented. The key is building a great relationship with your physician and being able to listen to your body and ask questions, Elfrey says.
Ask about heart disease screeningElfrey sees many patients who aren't having any symptoms but just want to come in and have a risk assessment.
"They want to go over their risk factor profile, and that's what saves lives," she says.
There's a simple noninvasive test that you can do, called a coronary calcium score, that looks for calcium buildup in your heart and heart arteries. It identifies how much risk you have of having a coronary heart problem.
The test is a non-contrast CT scan that essentially takes an X-ray of your heart and heart arteries.
"We've found so many people that are completely asymptomatic that are walking around with a very high plaque burden and not knowing anything about it," Hermann says. "It's important to discuss with your physician whether it's appropriate to have it or not."
Control known risk factorsIf you have known risk factors for heart attacks, such as high blood pressure, high cholesterol or diabetes, it's crucial to keep these factors in check. Your health care provider can help identify your risk factors and how to best control them.
Eat a heart-healthy dietEating a balanced diet that promotes heart health can help reduce your risk of cardiovascular disease. Look to follow an eating plan that emphasizes heart-healthy foods such as vegetables, fruits, whole grains, lean poultry and fish.
Get movingMen and women benefit from being more physically active, losing excess weight and following a heart-healthy diet. Adults should aim for at least 150 minutes of moderate-intensity physical activity – such as biking, swimming or a brisk walk – and two days of muscle-strengthening activity per week, according to the Physical Activity Guidelines for Americans from the U.S. Department of Health and Human Services.
Avoid smokingSmoking increases the risk of having a heart attack far greater for women than men. Avoiding certain things that are known to lead to heart disease – such as smoking – can decrease your risk, Hermann says.
Manage stress levelsWe are all affected by stress differently, but it's important to recognize stress as a major risk factor so that you can learn how to manage those symptoms.
Copyright 2023 U.S. News & World Report
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