Heart Disease Prevention – A Primary Care Update

by Cristina Sciavolino- Day, MD

Heart disease continues to be the leading cause of death for both American men and women. According to the 2015 American Heart Association update (1), 1 in 7 deaths were caused by heart disease. There is a cardiac event every 34 seconds and someone dies as a result every 24 seconds. These numbers are sobering.

Even more troubling is the sharp rise in obesity among adolescent boys which is a leading risk factor for heart disease. This risk has improved with higher socioeconomic groups but worsened for lower ones. One could surmise that healthier food costs more and access to healthcare is easier to those with more financial means. With obesity comes a higher chance of having complications of diabetes, high blood pressure and cholesterol disorders.

Smoking is the second leading risk factor for the cause of death in the US. In fact, per the AHA, 33 percent of all heart disease related deaths may be attributed to smoking. Per the 2015 update, the number of people smoking has decreased. In 2013 the percentage of adult smokers has decreased from 24 percent to 17.9 percent and from 36 percent high schoolers smoking to 15.7 percent.

Media attention has helped. Some of the reduction in traditional cigarette smoking has been due to a shift to electronic cigarettes; however, their own safety is coming into question.

Prevention is key. Starting a proactive approach from a young age is essential. Avoidance of smoking is important. Follow a low fat diet rich in fruits, grains, vegetables and fish. Exercise with the family so children stay active as well. Fifteen percent of adolescents are felt to be inactive. Females are more likely to be the offenders. Perhaps if the family as a whole exercises more together, this would be addressed more. Exercise not only lowers weight which itself lowers both cholesterol and diabetes, it also helps to stabilize blood pressure.

Get your annual check-ups in order to get examined physically and get your risk factors assessed. Get your lab work done as advised by your physician. For average risk factors, your LDL should be less than 100, triglyceride less than 150, glucose less than 99 and vitamin D level above 40. If you have higher risk factors such as heart disease or diabetes, your LDL goal becomes stricter at less than 70. If you have medical conditions, optimize their control. Remember, many times, simple weight gain was the cause of the high blood pressure, high cholesterol or diabetes. As a result, weight loss may reverse it.

If you have strong risk factors for heart disease and are asymptomatic, speak to your primary care doctor about getting a calcium cardiac score done. It is a quick painless way to assess calcified plaque present in your coronary arteries. The Eisner study found that patients simply assigned to the cardiac scan imaging group had improvements in their blood pressures, cholesterol levels, waist size and risk scores compared to those not scanned with a cardiac score (2). Being more aware of their status helped with motivation compared to those not being scanned and informed. As opposed to screening, if the cardiac score is abnormal or if some mild symptoms occur, modern technology now exists that evaluates both large and small vessel heart disease. This is done via a cardiac pet scan which provides more information than regular nuclear stress tests. Cardiac pet scans are now available in Naples.

Prevention does save lives. I encourage you to take an active role in your health and fitness. Now that you know that adolescents are at an increasing risk, talk to your children. Encourage them to eat well and exercise. Do things as a family. Eat more fruits and vegetables. Schedule the annual check-up that you may have been putting off. Know what your test results are now that you know what the goals are. If you smoke, stop. Drink in moderation. We only have one life to live. Let’s make the most of it.

Dr. Sciavolino-Day is a primary care physician specializing in Internal Medicine at Coastal Physician Care. Her office number is 239.597.0143.

(1)AHA Statistical Update:Heart Disease and Stroke Statistics-2015 Update-A Report from the AHA- Circulation 2015;131:434-441

(2)Interpreting the Coronary Calcium Score-N.England J.Med 2012;366:1550-1551-April 19 2012