A Healthy Heart

Preventing, Detecting, And Treating Coronary Artery Disease

by Dr. Michael B. Finkelstein, M.D., F.A.C.P., A.B.H.M.
posted on July 31st 2010

The statistics related to heart disease are frightening. It is the leading cause of death in the United States, killing one in five people. But here is the good news: Prevention efforts and treatment advances have made a difference. Between 1950 and 1999, the death rate from heart disease fell by almost 60% and is still falling. 

If you keep up with the latest research on heart disease, it’s easy to be overwhelmed or confused about what puts you at risk and how you can protect yourself. Sometimes it seems as if every year scientists either identify a new risk factor for heart disease or revise the advice about an established one. To some degree, this reflects the way that science progresses and the extraordinary effort under way to understand what causes heart disease. But where does this leave you as you try to figure out how to reduce or avoid your risk for heart disease? 

Your first focus must be prevention. It is becoming clear that 80%–90% of the people who develop coronary artery disease have at least one major controllable risk factor. Most of these risk factors can be eliminated or, at least managed, if you take the appropriate steps to protect yourself. (see “Recognizing and reducing risk factors,” below). To be clear, while many doctors may be knowledgeable in this area, their primary focus may be on the early detection and treatment of heart disease as well as the medical management of these risk factors, e.g. treating elevated cholesterol with medication. As important as this is to take immediate care of yourself once a diagnosis of heart disease has been made. In addition, there are non−medicinal approaches that may be of equal or greater value. Thus, if necessary, you may need to go outside of the medical mainstream to learn about and address the lifestyle factors that contribute to heart disease. 

However, the fact remains, it is critical to make yourself available to the medical technology and other means to lessen your risk. So, the second focus, after you begin taking better care of yourself, is for you to learn all you can about improvements in diagnosis and treatment so that you are aware of your options and can talk with your doctor about them. One of the most exciting advances in cardiology is the development of improved technology that enables doctors to take better pictures of the heart and arteries. The hope is that these techniques and others, still in development, will provide a noninvasive way to diagnose heart disease, thus sparing people the risks involved in angiography and other procedures. 

And it’s not just technology that is changing. Advances in management and a better understanding of how to fine−tune treatment for each individual can also save lives. Information and choices abound. As you consider your options, remember that with heart disease, as in most areas of medicine, one size does not fit all. Work with your doctor as well as other individuals who can help you with your lifestyle choices to determine how best to protect yourself. This way you will not be putting all your eggs in one basket. Your heart health is far too important to ignore. This report should help you to develop a personalized strategy for your own heart health. 

Recognizing and reducing risk factors

The most common risk factors for heart disease are the following: unhealthy levels of cholesterol (and other lipid particles in the blood), diabetes, hypertension (high blood pressure), cigarette smoking, family history (genetic factors) and stress. 

The first three (lipids, diabetes and hypertension) are controllable by diet and lifestyle, e.g. adequate levels of activity and the way we manage stress. Similarly, one can stop smoking by choice, but this is hard to do if stress isn’t managed as well. And while we can’t change our family history, it seems that the inherited tendency we might have can be lessened if we manage the other factors carefully. As you can then see, these are all related. Thus, a lifestyle commitment to the prevention of heart disease is the most unifying strategy. Proponents of “integrative medicine” would further suggest that the combination of lifestyle management with sound medical care (e.g. neither too little nor too much medical/technological intervention) would make the most sense and have the best results. 

Once these risk factors are identified, one needs to address them effectively. As mentioned, a unified approach is not only the most efficient, but is the most effective. First, one needs to get the proper information about diet and commit to adhering to a diet that works, e.g. is smart from a heart health and whole health point of view, but fits into one’s lifestyle. Second, activity is a must. This is different in some respect than the usual prescription for exercise. I believe incidental daily activity, e.g. sufficient amount of walking or a hobby like gardening is more than adequate. To be clear, the focus should be on daily and it needs to be enough (probably on the order of 30 minutes at least). 

Managing stress is perhaps the biggest challenge. However, the good news is that with a managed diet and consistent exercise you can keep it in check. Beyond this, it is important to eliminate the unnecessary stress in your life and do better job managing the “stuff” you can’t get rid of. Strategies abound for this work, though it is not in the purview of this article to address them here. Suffice it to say, this is an important topic and deserves full consideration and effort. It would be rare that a person could maintain good health for an extended period with a significant and ongoing undercurrent of stress in their lives. Not only are there clear consequences, from a medical point of view, but all quality of life measures, including one’s honest answer to the simple question, “are you happy?” are dependent on keeping stress from getting the best of us. The bottom line is that we need to do some basic analysis; in part this is our own introspection of our inner world and the reality of our lives, as well as an honest assessment of our choices and habits. 

The second component is to have a relationship with a doctor who is supportive of this work and can provide you with the baseline screening, follow up, and, when necessary, medical treatment for risk factors that are persistent even after you put forth your “best effort.” Combined, this integrated approach will serve you best. 

To make one final point: I see far too many people relying on their doctors to bail them out, e.g. favoring the second component and not seriously addressing the first. Once again, the primary focus of your efforts to reduce your risk for heart disease should be prevention; and most of that, at least at the beginning, is up to you. The best news of all is that when you take care of your heart, you will also be taking care of your lungs, liver, kidneys, intestines, brains, and all the other important components of your life.

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