Awareness has increased for coronary heart disease. Individuals more easily recognize the symptoms and know the importance of managing factors such as high cholesterol and hypertension.
Though awareness may be higher, patients still aren't necessarily taking all of the steps needed to protect the health of their heart.
When asked whether patients are more aware, Dr. John Higgins, an associate professor of medicine at The University of Texas Health Science Center at Houston (UTHealth) Medical School and director of exercise physiology at the Memorial Hermann Sports Medicine Institute, gave a perplexing answer.
"Yes, and no," he said. "The 'yes' part is that we're able to diagnose people's problems better. We're able to tell them what their risk factors are and set them up on a plan to fix those.
But on the 'no' side, the rate of obesity has gone up in this country. We have a lot of people in the south and the midwest who are obese and have diabetes and other associated problems."
Defining heart disease
Coronary heart disease occurs when the blood vessels that supply blood and oxygen to the heart narrow. It is usually caused by plaque that builds up in the walls of arteries leading to the heart, which causes them to narrow, but could also be prompted by the hardening of the arteries, according to the National Institutes of Health.
The U.S. Centers for Disease Control and Prevention reports that 17 million worldwide die of cardiovascular disease, especially due to heart attack and stroke. In the U.S. it is the leading cause of death for both men and women.
The risk of heart disease increases with age and is more likely to affect men as compared to pre-menopausal women. After menopause both genders remain at a similar risk. Genetics can play a role in determining who is most susceptible, and certain ethnicities such as Mexicans, American Indians, Hawaiians, blacks and some groups of Asians are at an elevated risk.
However many of the risk factors are manageable such as diabetes, high cholesterol and hypertension. Failing to maintain a healthy weight or exercise, and smoking also are controllable risk factors. Cocaine use, chronic kidney disease and narrowed arteries in other parts of the body can also lead to a heightened risk.
Before being diagnosed, may patients experience symptoms such as chest pain or notice that they are out of breath more often or have less energy.
Heart disease is usually identified through a physical exam that often includes an EKG and blood testing, though a variety of scans and tests are used to diagnose heart disease. An exercise stress test may be needed to make a diagnosis.
Common treatment includes medication to treat hypertension or high cholesterol, or other drugs. In some instances an artery opening procedure called angioplasty with insertion of a stent to prop the blood vessel open could be needed. Some patients also require coronary artery bypass surgery.
An epidemic
Cardiovascular disease deaths have actually declined in recent years, yet the number is still high. According to a report from the American Heart Association, in 2007, the most recent statistic available, 252 Americans for every 100,000 in the population suffer from heart disease.
This equates to 2,200 Americans who die from cardiovascular disease every day. Each year about 785,000 will have a new coronary attack, and another 470,000 will have a recurrent attack. About 795,000 strokes occur each year, the American Heart Association reports.
An update to that report in 2011 in part blames the obesity epidemic, noting that 34 percent of American adults are overweight. A prevalence of diabetes, partly related to obesity, and a lack of exercise among youth, also were pinpointed as contributors. About 32 percent of individuals between the ages of 2 and 19 are currently overweight.
For patients this can translate into premature heart disease that appears much earlier expected. Doctors generally don't expect to find patients with heart disease until they are in their 50s or 60s.
"We're now seeing obese people with coronary disease in their 30s and 40s," said Dr. Higgins. "I think we're doing a better job, but we've got all of these people and children who are obese which is leading to a whole generation of early heart disease."
Changing your lifestyle
One of the easiest ways to lower your chance of developing coronary heart disease and stroke, or to protect from future heart events, is by making simple lifestyle changes.
Though healthy eating, especially a diet rich in fruits and vegetables, and physical activity may be two of the easiest changes to make, they are often the most difficult for patients to make.
"Lifestyle changes are the toughest. They are always a tough thing. Taking a pill is an easier thing to do, " said Dr. Higgins.
Even if patients have trouble changing their diet completely, he suggests they can begin receiving benefits by reducing the amount of fatty foods consumed, choosing lean meats and adding fruits and vegetables to every meal. In addition to lowering the risk of heart disease, added fruits and vegetables boost fiber and help lower cholesterol, which also can aid in reducing the risk of heart attack and stroke.
"As far as exercise, that's probably one of the best things you can do. It raises good HDL cholesterol, helps better control diabetes and leads to weight loss and better insulin control," he said. "I recommend they exercise most days of the week. Aerobic exercise has been shown to be one of the most beneficial for those with coronary disease or for preventing coronary disease."
Aerobic exercise includes activities such as running, swimming and bicycling. Using an indoor treadmill or elliptical trainer are other options.
Making such changes can result in a significantly reduced risk of a heart attack or dying. Patients who exercise regularly have a 12 percent lower chance of a heart attack and a 25 percent reduced risk of death, Dr. Higgins said.
Additional protection
Diet and exercise, while effective, aren't the only way to lower cardiovascular disease risk. Controlling hypertension, high cholesterol and diabetes can aid in heart protection. In many cases that may mean medication combined with a healthier lifestyle.
Dr. Higgins also suggests a daily glass of red wine because it is believed to increase the good cholesterol while offering other benefits to the body. For those that do not drink alcohol, he said concord grape juice also can provide benefits. Quitting smoking is also essential to protecting the heart.
Dr. Higgins said that for each modified risk factor a patient can reduce their risk by 5 percent to 10 percent, which can be substantial if numerous lifestyle changes are made. As an example, eating healthier, exercising regularly, managing hypertension, quitting smoking and having a glass of red wine each day could reduce cardiovascular risk by up to 50 percent.
Modifying these risks is key for individuals with a family history of heart disease, or older patients. Men over the age of 45 and women older than 55 are at an increased risk of coronary heart disease.
"There are some unlucky people with a high genetic predisposition," said Dr. Higgins. "For them it is especially important to do as many preventative things as they can."
