When it comes to diseases that claim the most lives annually, heart disease is the uncontested champion. According to the Mayo Clinic, it is the No. 1 killer of both men and women in the United States and is the leading cause of death in the entire world. For many people, heart disease is preventable.
Though the term "heart disease" encompasses a variety of conditions including congenital defects and abnormalities associated with viruses, the most common forms are heart attack and stroke, conditions caused by atherosclerosis — hardening of the arteries.
"Atherosclerosis or coronary artery disease is unfortunately very common for two reasons," says Dr. Frank Smart, a professor and chief of cardiology at LSU Health Sciences Center. "The first is genetics and the second is lifestyle. You can't do anything about genetics, but you can something about lifestyle."
A family history of heart disease — a first-degree male relative with a heart attack, stroke or blockage before age 60, or a first-degree female relative with any of these before age 65 — significantly increases one's chance of heart disease and need for early awareness and prevention, Smart says. However, doctors recommend all men adopt a heart-healthy lifestyle regardless of their genetic predisposition.
"It's easier to prevent heart disease than to treat it," says Dr. Carl "Chip" Lavie, director of cardiac rehabilitation and preventative cardiology at John Ochsner Heart & Vascular Institute.
Selling this message has proved challenging. As Americans develop increasingly sedentary lifestyles and opt for fat- and salt-laden fast foods, obesity (a major contributor to heart disease) has climbed to record levels nationwide. Lavie says 30 percent of adults in the U.S. meet the criteria for obesity; 70 percent are either overweight or obese.
In the South, where obesity rates are higher than in other areas, the need for prevention is even more pressing. According to the American Heart Association, the 13 states with the highest numbers of death from heart disease are all Southern. "The problem is a combination of things," Lavie says of the regional divergence. "Obesity is a problem by itself, but the food consumed in the South and socioeconomic factors, which add to the obesity problem, also play a role in the increased heart disease. A lot of this goes hand in hand."
Other risk factors include smoking, high levels of LDL or "bad" cholesterol, high triglycerides and low levels of HDL or "good" cholesterol, diabetes, hypertension or high blood pressure, physical inactivity and psychological stress, all of which can be controlled with proper care. In recent years, the number of male smokers has declined, and over the past several decades, incidents of heart disease have decreased, Lavie says, but that trend may be reversing.
"We're seeing indicators that the decrease (in heart disease) may be stopping, and the concern is that we'll see an increase in heart disease because of obesity," Lavie says. Along with the rise of obesity, a larger percentage of the population is diabetic, and a greater number of young people are being diagnosed with heart disease. Doctors say prevention must begin in childhood.
"There's more of a recognition that attention has to be paid to children to help them have a heart-healthy lifestyle for the future," says Dr. Robert Ascuitto, professor of clinical pediatrics and director of cardiology at Children's Hospital. "It's important to strive to achieve a heart-healthy life through good nutrition and exercise. Kids need to put aside the video games and get outside and run around."
While obesity is readily apparent, the heart disease that often accompanies it may not be as obvious. Typical warning signs are pressure in the chest, aching in the jaw, shoulder blade or either arm, and shortness of breath. More than a third of people with heart disease ignore the symptoms or don't see the doctor in time to treat them.
"Unfortunately, the presenting symptom in 35 percent of people is death," says Smart, who explains that women may ignore the symptoms because theirs are often not as recognizable as those experienced by men. Many men may fail to react due to a sense of immortality. "The idea that men are indestructible carries with them into middle age," Smart says.
On the other hand, men are more likely than women to go to the emergency room when experiencing a heart attack or stroke, and they're more likely to have a life-saving angioplasty or bypass surgery. Another way heart disease affects men differently than women is that men generally have an earlier onset of the disease. Doctors believe the presence of estrogen protects women from heart disease until they go through menopause.
"Women lag about 10 to 14 years behind men in developing heart disease, but after menopause, the gap between heart disease in women and men greatly narrows," Lavie says. "Although women live longer than men, their lifetime risk of heart disease is quite similar."
For heart disease patients, treatment guidelines are the same as those recommended for prevention: Don't smoke; perform exercises that raise your heart rate (like jogging, walking fast or swimming) for a minimum of 30 minutes a day most days of the week; take blood pressure medication if your blood pressure is high; regulate high cholesterol with diet and medication; minimize stress, and if you're obese, lose weight. People 40 and older should have their blood pressure checked every six months and their cholesterol checked every year (if it's high, check every six months), Smart says. If there's a family history of heart disease, screening should start in the 30s.
When drastic lifestyle changes are imperative, rehabilitation programs can provide the support many patients need. "(After) a heart attack ... the patient no longer falls into the category of primary prevention. They fall into secondary prevention or rehabilitative and we have established programs," Lavie says. "We refer them to cardiac rehabilitation and encourage them to attend." Patients take part in the program three times a week for 12 weeks and are provided with support by dietitians, nurses and exercise physiologists. "They work as a team for patients, and they're also ... cheerleaders for the patients," Lavie says. Camaraderie with fellow patients is another advantage of the program.
"One of the other benefits in addition to physical improvement is that there's significant mental improvement," says Dr. Gary Menszer, interventionalist and medical director of cardiac rehab at East Jefferson General Hospital. "A lot of patients who've had heart attacks or open heart surgery don't have confidence or a positive outlook. All those things can be improved with cardiac rehab." Patients can also use the hospital's Wellness Center for an ongoing exercise regimen and access to healthcare professionals. Ultimately, though, accountability for recovering from heart disease lies with the patient. "At some point in time, we are all responsible for our own health care and well-being," Smart says.
it's easier to prevent heart disease with a healthy lifestyle than to treat it.
Administered by exercise physiologists, dietitians and nurses, cardiac rehabilitation programs can provide the support many heart disease patients need.