February is a time dedicated to love and grand romantic gestures. And cardiologists everywhere want you to show yourself some love and schedule that heart screening. With American Heart Month upon us, Dr. Satish Chandraprakasam of Trident Heart and Vascular reminds us that while flowers and chocolates are nice, nothing says “I love you” like good cardiovascular health.

What does good cardiovascular health look like?  

Importance of maintaining good cardiovascular (CV) health is being emphasized in programs from the American Heart Association (AHA) that promote seven ideal cardiovascular health metrics (Life’s Simple 7) including:

• Not smoking
• Being physically active
• Having a normal blood pressure
• Having a normal blood glucose level
• Having a normal total cholesterol level
• Being at a desirable weight
• Eating a healthy diet

Photo courtesy of Satish Chandraprakasam

Why is cardiovascular disease so dangerous? 

The 2019 Heart Disease and Stroke Statistics update of the American Heart Association (AHA) reported that 48 percent of persons over 20 years of age in the United States have cardiovascular disease (CVD). In other words, 1 in 2 people have these cardiovascular conditions. The prevalence increases with age for both males and females.

Cardiovascular diseases (CVD) are estimated to result in 17.3 million deaths worldwide on an annual basis and remains the leading cause of death in the United States. Global trends are just as alarming with Central Asia and Europe having the highest rates of CVD mortality in the world.

CVD remains a silent killer in many ways.

Who is most at risk for developing CVD?

There are risk factors and risk enhancing factors that predispose to CVD. Risk factors include:

• Elevated blood pressure (hypertension)
• Elevated blood cholesterol (dyslipidemia)
• Diabetes mellitus
• Obesity (BMI >30) and overweight (BMI 25-29)
• Family history of heart disease
• Cerebrovascular disease, manifested by stroke and transient ischemic attack.
• Peripheral vascular disease, aortic atherosclerosis, thoracic or abdominal aortic aneurysm
• Elevated atherosclerotic heart disease risk score (ASCVD risk score)

Risk enhancing factors include:

• Metabolic syndrome – increased waist circumference, high triglycerides, elevated BP, elevated blood glucose, low HDL
• Chronic kidney disease
• Premature menopause in women
• Chronic inflammation – rheumatoid arthritis, lupus, inflammatory bowel disease
• South Asian race
• Elevated highly sensitive C reactive protein level, lipoprotein (a), apo B
• Abnormal ankle brachial index (ABI) – measure of peripheral blood flow
• Air pollution
• Chronic stress
• Sleep disturbances
• Sedentary lifestyle

What symptoms are associated with CVD? 

The common misconception among people is that CVD includes only heart disease, which in reality includes coronary heart disease (CHD), cerebrovascular disease, peripheral vascular disease (PVD), congestive heart failure (CHF) and hypertension.

Coronary heart disease (CHD) is manifested by heart attack or myocardial infarction (MI), angina pectoris or chest discomfort due to decreased blood flow to the heart and sudden cardiac death from cardiac arrest.

Cerebrovascular disease is manifested by stroke and transient ischemic attack (mini stroke). In the field, this stroke acronym is often used to alert patients and first responders to recognize stroke symptoms “BE FAST” which stands for:

BALANCE – loss of balance

EYES – vision impairment

FACE – asymmetry, drooping

ARMS – weakness, numbness

SPEECH – slurred, can’t get words out

TIME – act fast, door to needle to administer lytic therapy (clot blusters or thrombectomy)

Peripheral artery disease  (PAD) is manifested by intermittent claudication – lower extremity pain on walking, skin color changes, loss of hair or sensation and in extreme cases – non-healing leg ulcers, gangrene leading to loss of limb and death.

Aortic atherosclerosis and thoracic or abdominal aortic aneurysm – calcific enlargement of the abdominal and thoracic aorta and death from rupture or tear of the aorta.

Congestive heart failure (CHF) is manifested by shortness of breath, fatigue, puffy feet, weight gain, abdominal distension, facial puffiness and inability to lie flat at nighttime. This is due to the inability of the heart to maintain adequate cardiac output and meets the demands of the organs.

Hypertension is manifested by headaches, blurry vision, fatigue or can be completely asymptomatic before presenting as heart attack or stroke.

What are some easy ways to improve your overall heart health? 

Good cardiovascular health starts with screening for disease that increases the risk for heart disease. This should start as early as when you are in 20s. Thereafter, every 4 to 6 years, it is important to continue to keep watching for these risk factors and adopting heart healthy lifestyle changes and choices to remain free from heart disease. These include the “ABCDEFs” of good CV health:

Avoid smoking and use cessation techniques

Blood pressure control less than 130/80

Count your steps- move a lot more (30 minutes a day or 150 minutes of moderate intensity exercise)

Desirable body weight (BMI <25); Dietary changes

Eliminate risk factors- diabetes, kidney disease, inflammation, stress, sleep disorders

Fruits and vegetables; Fiber; Foods with a low glycemic index and low glycemic load; Monounsaturated Fat (avocado, olive oil) rather than trans fatty acids or saturated fats (refined oil, deep fried foods); Omega-3 Fatty acids such as fish oil

Some other considerations:

• Role of aspirin in primary prevention is controversial. We cannot adopt a “one size fits all” approach and hence it must be individualized according to the patient’s age and ASCVD risk score.
• Moderation in alcohol – red wine (<100 g/week) may be beneficial.

Overall, it’s the lifestyle choices that matters. It is important to adopt changes that you can sustain lifelong and not just short term.

Once at risk or diagnosed with heart disease, can you do anything to change your diagnosis or outcome? 

Yes, you can! While primary prevention is always better, it’s never too late for secondary prevention which is to prevent recurrent cardiovascular events after an index event. Please make sure you are following up with a cardiologist to keep a check on your risk factors, get regular testing for screening and diagnosing heart conditions and institute timely interventions if you are at risk or having them.

When is it time to see a specialist? 

Primary care physicians can start screening for risk factors for heart disease early, but one should seek a cardiovascular specialist consultation if they have symptoms of cardiovascular disease (CVD) or have multiple risk factors for CVD or a strong family history of heart disease. Signs and symptoms of CVD include chest pain or discomfort, shortness of breath upon walking, lying down or bending, leg puffiness, racing heart, dizziness or passing out spells or abnormal electrocardiogram and abnormal calcium scoring of the heart or aorta.

Why did you choose to specialize in cardiology? 

I chose cardiovascular medicine as I can treat and save my patients from life threatening conditions and get a great deal of satisfaction from seeing them get better right away. And I love what I can do for my patients and truly reflects our practice philosophy – LISTEN. CARE.  HEAL.

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