Heart Disease (Cardiovascular Disease)

Heart Disease Risk can be Reduced With Lifestyle Changes to Control Risk Factors

Heart disease is the leading cause of death in the United States—for both men and women. Heart disease affects people of all ages and ethnic backgrounds. Now is the time to check your heart health and reduce your risk of heart disease -- before you develop heart disease symptoms.

Your heart is an organ about the size of your fist that pumps blood to all the muscles and organs of your body. When healthy, this amazing organ adjusts its workload quickly and efficiently, pumping slowly as you sleep and speeding up as you exert yourself. When you have heart disease, however, your heart becomes weaker with each beat pumping less blood than a healthy heart.

Coronary artery disease (coronary heart disease) is the disease of the heart’s blood vessels called arteries. These arteries, located on the heart’s surface, supply the heart muscle with the blood it needs to function. If these blood vessels become clogged or narrowed by the buildup of fatty deposits called plaque (this process is called atherosclerosis), the heart cannot receive enough oxygen and becomes damaged. Too little blood flow to the heart results in angina (chest pain). When the blood flow is drastically reduced, a heart attack occurs. Heart disease also is related to two other serious ailments: high blood pressure and stroke.

Heart diseases are any disorder that affects the heart’s ability to function normally. Heart disease includes heart attack (acute myocardial infarction), congestive heart failure, arrhythmias, angina and others.

Heart Disease Prevention

Lifestyle and nutrition choices can protect you from heart disease—or at least reduce your risk. A variety of risk factors—some you can control, others you cannot—can increase the likelihood of cardiovascular disease, including the following.

  • Smoking. If you don’t smoke, don’t start. If you do smoke, quit. Smoking causes as many deaths from heart disease as from lung cancer. Women who smoke are two to six times more likely to have a heart attack than a nonsmoker, because smoking causes the heart vessels to become narrower. The more cigarettes you smoke, the higher your risk of heart attack. Heart attacks also are more severe and deadly in smokers. Quitting smoking will greatly increase your health.

  • High blood pressure/hypertension. If your blood pressure is 140/90 or higher, your risk of heart disease is increased. A normal blood pressure level is around 120/80. If you are close, lower levels usually can be reached through lifestyle changes such as losing excess weight, regular exercise, a healthy low-sodium diet and limited alcohol intake. If high blood pressure is severe, medication can help.

    In the United States, about 1 in 3 adults has high blood pressure. About 25% of people with high blood pressure are unaware that they have it.

    About 25% of American adults have prehypertension. People who are diagnosed with prehypertension (blood pressure ranges from 120 - 139/80 - 89 mm Hg) are at increased risk of developing high blood pressure.

  • High blood cholesterol. The body makes all the cholesterol it needs, so any extra cholesterol or fat in the diet causes plaque buildup inside blood vessels. Once again, a low-fat diet, exercise and losing weight can reduce your cholesterol.

    A blood test is used to measure cholesterol levels. A person’s total cholesterol level is determined from calculations and measurements of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides. Standard total cholesterol goals for adults are:

    • Less than 200 mg/dL is desirable
    • Between 200 - 239 mg/dL is considered borderline
    • Over 240 mg/dL is considered high
  • Overweight/obesity. More than half of American women ages 50 to 59 are overweight. Being overweight increases the risk of coronary heart disease even with no other risk factors. Obesity is particularly hazardous when it is part of the metabolic syndrome, a pre-diabetic condition that is significantly associated with heart disease.

  • Diet. Diet plays an important role in the health of the heart, especially in controlling dietary sources of cholesterol and restricting salt intake that contributes to high blood pressure.

  • Physical inactivity. Lack of regular aerobic exercise—exercise that increases your heart rate—is a major risk factor of heart disease. Brisk walking, swimming and weight lifting are three types of aerobic exercise. Try to work up to 20 minutes of daily activity.

    • According to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.
    • The American Heart Association recommends that individuals do moderate exercise for at least 150 minutes per week, or 75 minutes per week of vigorous exercise.

A few simple rules are helpful as you develop your own routine.

  • Don't eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

  • Diabetes. If you have Type II diabetes, weight reduction and exercise can reduce your risk of heart disease. People with diabetes often have high blood pressure, high cholesterol and are overweight, increasing their risk even further. Diabetes also doubles the risk of a second heart attack in women but not in men.

    • According to the U.S. Centers for Disease Control’s National Diabetes Fact Sheet 2011, nearly 26 million American adults and children have diabetes. About 79 million Americans aged 20 years and older have pre-diabetes, a condition that increases the risk for developing diabetes.

Heart disease risk factors that you cannot change include the following.

  • Age. Being over age 55 is a risk factor of heart disease.

  • Heredity. Family history of early heart disease (having a mother or sister who has been diagnosed with heart disease before age 65 or a father or brother diagnosed before age 55).

  • Race. Black women have a greater risk of heart disease and stroke than white women. One reason is that black women tend to have higher average blood pressure levels than white women.

  • Gender. Women in the United States have higher risk of heart disease. In fact, the risk is three times greater at age 65 than at 45, because women develop heart disease at an older age than men, and women tend to live longer.

Knowing your increased risks will help you control them and prevent further complications.

Heart Disease Warning Signs

If you have any of the following symptoms, you should talk with your doctor. If treated, the outlook is good. Without treatment, however, the heart disease symptoms may recur, worsen or even lead to a heart attack. See your doctor immediately if you have any of the following.

  • Mild or severe chest pain, tightness or pressure
  • Chest pain or shortness of breath during physical activity such as climbing stairs
  • Relief of chest pain after a short rest
  • Nausea, sweating, dizziness or difficulty breathing

Heart Disease Testing

Many tests that help doctors diagnose coronary heart disease are non-invasive and painless.

  • Electrocardiogram (also called an ECG or EKG). Records the heart’s electrical activity as it beats. This can show abnormal heartbeats, muscle damage, blood flow problems and heart enlargement. Electrodes attached to your skin transmit this activity to a machine that prints a report for your doctor to read.

  • Exercise stress test (treadmill test). Records the ECG during exercise, usually while you walk on a treadmill or ride an exercise bicycle. This test determines whether your heart is getting enough oxygen during physical activity. Electronic sensors attached to your body connect to an ECG machine. Women who cannot exercise because of arthritis or other medical conditions can have a stress test without exercise in which they are given a drug that increases blood flow.

  • Echocardiography. Uses ultrasound to produce sound waves that bounce off the heart, creating pictures that show heart size, shape and movement.

  • Thallium stress test. This nuclear scan assesses heart muscle contraction as blood flows through the heart. A small amount of radioactive material is injected into a vein, usually in the arm, and a scanning camera then records how much is taken up by the heart muscle.

  • Coronary angiography (or arteriography). Displays blood flow problems and blockages. A specially-trained cardiologist threads a thin, flexible tube (catheter) through an artery of an arm or leg up into the heart. A dye that shows up on an X-ray is injected, and the heart and blood vessels are filmed as the heart pumps. The picture is called an angiogram or arteriogram. An angiogram helps diagnose heart disease in people who are experiencing angina or who have abnormal results from stress tests or an echocardiogram.

Heart Disease Treatment

Today, new medicines and technology provides you with more options than ever in the treatment of heart disease.

Medications—A healthy lifestyle will improve your overall heart health, but you also may need medication, especially if you have chest pain or new lifestyle changes are insufficient to correct your blood pressure or blood cholesterol levels. Your doctor may prescribe one medication or a combination to find what works for you. It may take adjustments to find the right medication or even the right amount of a medication, so be sure to tell your doctor about any side effects. Types of medications may include the following.

  • ACE inhibitor. Stops the body’s production of a chemical that causes blood vessels to narrow. It also prevents hormones from raising your blood pressure.

  • Antiarrhythmic drugs. Used to correct irregular heart beats (arrhythmias).

  • Anticoagulants, antiplatelet agents, thrombolytics (blood thinners). These drugs lower the risk of blood clots forming in the heart and arteries.

  • Aspirin. An anticoagulant that prevents blood cells from sticking together and forming clots. Some doctors prescribe daily low doses of aspirin (50–81 mg) as a preventive drug.

  • Beta blockers. Slows the heart rate and can reduce high blood pressure. Used to treat angina.

  • Calcium channel blockers. Relaxes blood vessels so that blood can flow more freely; used for high blood pressure and chest pain.

  • Digitalis. Improves the heart’s ability to contract and is used primarily to treat congestive heart failure or arrhythmias (disturbances in the heartbeat). This has been used to treat heart disease for more than 200 years.

  • Diuretic. Decreases fluid in the body, thus reducing the volume of blood that the heart has to pump.

  • Nitrate (including nitroglycerine). Remember movies where someone fainted or needed that little white pill placed under their tongue? That pill was a nitroglycerin pill, which widens blood vessels and eases chest pain.

Special Procedures—If you have heavy plaque buildup in your arteries, you may need a special procedure to open an artery and improve your blood flow. Three procedures can ease severe chest pain or clear major blockages in blood vessels.

  • Coronary angioplasty, also called “balloon” angioplasty. A thin tube is threaded through an artery in your groin to the narrowed heart vessel, where a tiny balloon at its tip is inflated. The balloon flattens the buildup and stretches the artery, improving blood flow. The balloon is then deflated and removed, along with the tube.

  • Coronary atherectomy. A thin tube containing a cutting device at its tip that shaves the plaque, which is then removed through a catheter.

  • Bypass surgery for heart disease. When blockages are too long or too hard for angioplasty, coronary artery bypass graft surgery—better known as bypass surgery—may be necessary. This surgery is open heart surgery. You are placed on a special heart-lung machine so that surgeons can stop your heart long enough to sew a piece of blood vessel taken from another part of your body onto the narrowed artery. This makes a “bypass” around the blockage. Sometimes, more than one bypass is needed. On average, a bypass requires a few days in the hospital and several weeks of recuperation at home.

The Heart Lung Vascular Institute and the Center for Women & Infants Health offers physicians that can evaluate each person’s individual risk of developing heart disease. Click here for more details on Women’s Heart Health.

To make an appointment with a doctor, call 865.305.6970

If you possess the heart disease risk factors previously mentioned, you are an excellent candidate for the Heart Lung Vascular Institute’s Cardiovascular and Pulmonary Fitness Program.