Chances are high that every American has come face to face with heart disease in some form. It’s the number one killer in both the United States and the world, so even if you aren’t personally affected, you probably know someone who is. On the bright side, however, there are plenty of ways to prevent heart disease by taking care of this vital organ in your day-to-day life.
As 2022 kicks into full swing, we’re bringing you an abundance of information on heart health that might inform your New Year’s resolutions. Of course, healthy habits aren’t something to adopt for a few weeks and then abandon when February rolls around– staying on top of heart disease requires a lifelong commitment.
Sounds intimidating? It certainly doesn’t have to be. Rather than endless kale salads and daily two-hour gym sessions, maintaining good health is about moderation, self-awareness, and finding a balanced lifestyle that works for you. Washington’s natural beauty also makes it easier to de-stress through regular exercise that doesn’t feel like a punishment.
To learn more about heart disease awareness and prevention, I spoke with Dr. Nicole Jackson, a cardiothoracic surgeon with PeaceHealth St. Joseph Medical Hospital in Bellingham. We covered everything from family history to common myths and even the multitude of medical resources available here in the North Puget Sound region.
BY THE NUMBERS
Overall, “heart disease” is a general term. The World Health Organization defines heart disease as “a group of disorders of the heart and blood vessels,” and this includes everything from coronary artery disease (which affects blood vessels supplying the heart) to cerebrovascular disease (affecting blood vessels supplying the brain) and congenital heart disease (or heart problems caused by birth defects).
Heart disease was behind 32% of all global deaths in 2019, and roughly 659,000 people in the United States die from it every year. To break those numbers down further, that’s 1 in 4 overall deaths nationwide– and one person dies from heart disease every 36 seconds.
According to Washington State’s latest available statistics, 11,859 individuals died of heart disease in 2019, and heart disease is second only to cancer in terms of cause of death.
- About 18.2 million adults age 20 and older (~6.7%) have coronary artery disease (CAD)
- About 2 in 10 deaths from CAD happen in adults less than 65 years old.
- Someone has a heart attack every 40 seconds in the U.S.
- 30.3% of Washington residents have high blood pressure
- Out of 100,000 people, 44 died of a heart attack in Washington between 2017 and 2019
Dr. Jackson says the most common disease she sees as a heart surgeon is coronary artery disease (CAD). CAD is the most common cause of heart disease in North America, and it affects 18.2 million of American adults ages 20 and older (6.7%).
CAD occurs when plaque builds in the walls of the arteries that supply blood to the heart and other parts of the body. For some patients, a main symptom is angina (or chest pain and discomfort), which occurs when plaque-narrowed arteries struggle to supply blood to the heart and body. For others, the first symptom of CAD is a heart attack.
The second most common condition Dr. Jackson sees is aortic valve disease. It occurs when the aorta (the body’s main artery) and the left ventricle (or lower chamber of the heart) malfunction.
“It’s degenerative and most commonly found in older folk in the 70s-80s age range, but [patients] can be younger,” Jackson says.
There are two main types of aortic valve disease: Aortic regurgitation (when blood leaks back into the left ventricle) and aortic stenosis (when the aortic valve is narrowed). Aortic valve disease can also be congenital, meaning it is caused by a defect present from birth.
According to Dr. Jackson, the third most common issue is arrhythmia, which the American Heart Association (AHA) defines as any change from the normal sequence of electrical impulses. Arrhythmias cause abnormal heart rhythm, and someone with an arrhythmia might feel a fluttering, a pause, or change in their regular heartbeat. Some arrhythmias cause lightheadedness and are barely noticeable. Others, however, can be serious and even life-threatening.
There are two forms of arrhythmia: Bradycardia (when the heart rate is too slow, or less than 60 beats per minute) and tachycardia is (when the heart rate is too fast, or more than 100 beats per minute). Doctors can determine where in the heart an arrhythmia stems from by using electrocardiograms (ECGs).
5 MYTHS ABOUT HEART HEALTH
Myth #1: Patients with heart disease always have recognizable symptoms
Heart disease symptoms aren’t always straightforward; according to Dr. Jackson, symptoms can be nebulous and non-specific. It’s important to pay attention to them regardless.
“That shouldn’t be dismissed, especially for people with a family history of heart problems,” Jackson says. “People go through the process of seeing their doctors, and sometimes it can take a little while to get honed in on what [a symptom] is, or at least bring it up as a consideration that it could be the heart.”
Myth #2: Longtime smokers won’t reduce their risk for heart disease by quitting.
No matter how long you’ve smoked, your risk goes down as soon as you stop. According to Harvard Medical School, heart attack risk drops 50% after a year of quitting smoking; in 10 years, it will be as if you never smoked at all.
Myth #3: If you’ve had one heart attack, you won’t have another.
“Sometimes people think that if you’ve had one event, you’re fixed and nothing’s going to happen in the future,” says Jackson. “These things can still progress and change as we age.”
Within just five years, one in five heart attack survivors are readmitted to the hospital for a second one. It’s crucial to take medications as prescribed and make appropriate lifestyle changes.
Myth #4: Quick-fix diets and trendy supplements can lower risk of heart disease.
“All the time you see these diet fads, pills, and gimmicks, but in general I think the most successful people are the ones that make it a habit,” says Jackson. “With diets, people often lose weight but then they gain it right back, which is not necessarily great for you.”
Dr. Jackson confirms that maintaining good heart health is all about moderation; for example, she still enjoys steak, but only a few times a year as opposed to once a day or even once a week. She also notes that food preferences may shift in response to dietary changes. The body will adapt to lower salt levels– but it needs to be a sustainable habit, not a crash diet.
Myth #5: Heart disease is inevitable if it runs in your family.
“There are certainly things you can do to catch it before it causes a problem, or to minimize the risk,” Jackson says. “The American Heart Association put out recommendations which I wholeheartedly endorse. Regular exercise– ideally three to four times a week, at least moderate to vigorous exercise, where you’re really getting a sweat and getting your heart rate up– helps a ton. Not only does it help with your heart health, but if you ever do have to see a surgeon and have to undergo anything, you’re going to be so much better off.”
Dr. Jackson notes that other AHA recommendations include not smoking and eating a healthy diet. These are positive habits for everyone, but especially for those with a history of heart disease.
Genetics can’t be modified, but risk factors tied to lifestyle absolutely can be. For additional information and resources, visit the AHA’s website at heart.org.
WHO GETS HEART DISEASE?
Risk factors for heart disease include unhealthy cholesterol levels, high blood pressure, diabetes, obesity, and family history. Lifestyle also plays a major role, and those who are physically inactive, use tobacco, or drink alcoholic beverages are at a higher risk for heart disease.
Although risk increases as people get older, heart disease can happen at any age– and the rate of occurrence among young people is rising.
Perhaps you’ve heard that heart disease is statistically more common in men. This is marginally true, but women are also at risk; in fact, 1 in 5 women die from heart-related issues in the U.S. Beyond this, 1 in 16 women aged 20 and older (6.2%) have coronary heart disease.
Dr. Jackson notes that women more commonly present with atypical symptoms such as nausea, GI upset, and vomiting– even in the absence of angina.
“They don’t have that classic, sudden, severe chest pain or worsening pain with exertion that you hear more often with men,” Jackson says. “They certainly can have those symptoms, but it is less common.”
As a result, women are usually diagnosed later than men– and this results in a poorer prognosis. Women’s symptoms can be subtle and easier to miss, especially if a physician is looking for “classic” heart attack symptoms. Jackson notes that it’s especially important for women not to dismiss these symptoms, connect with a good primary care physician, and alert their doctor of any family history.
Heart disease doesn’t discriminate, and it’s the number one killer of people across most races and ethnicities in the U.S. However, mortality rates for cardiovascular disease are 30% higher for Black patients when compared with the overall American population. This is in part due to disparities in the control of risk factors, as well as complex barriers that affect access to diagnosis and care. In November of 2020, the American Heart Association (AHA) issued a presidential advisory addressing structural racism as a fundamental driver of health disparities.
In theory, we know how to eat healthy: Plenty of fruits and veggies, balanced meals, calorie control, and a low sugar and salt intake. In practice, healthy eating isn’t always straightforward.
Sodium is known to put stress on the body and lead to hypertension, and packaged and prepared foods are the source of more than 70% of the sodium that Americans consume.
This doesn’t just apply to obvious culprits such as pizza or chips; for example, a slice of bread may contain 200 milligrams of sodium or more. Even foods that purport to be healthy, natural, or organic may have high sodium contents. The daily recommended amount is just 2,300 milligrams of sodium– but the average daily intake for Americans is 3,400 milligrams.
The acting commissioner of the Food and Drug Administration (FDA), Dr. Janet Woodcock, has acknowledged that it’s unrealistic to expect that improvements to the American diet will come from mass behavior change alone. In October of 2021, the FDA released a statement urging the food industry to reduce the amount of added sodium in processed foods by 12% over the next two and a half years.
In the meantime, it’s important for consumers to check the sodium contents of processed foods and seek out low-sodium alternatives when possible. If Americans lowered sodium intake to recommended levels, the AHA estimates it could prevent 450,000 cases of cardiovascular disease and save $40 billion in healthcare costs over the course of 20 years.
Limiting processed foods also helps people maintain or achieve a healthy body weight. This is important because obesity is a risk factor for heart attacks, high blood pressure, Type 2 diabetes, and high cholesterol levels. To build a heart-healthy diet, start by practicing portion control, eating two to three cups of vegetables a day, upping fiber intake, and consuming more heart-healthy fats (such as nuts or olive oil) in place of animal fats.
MOVE YOUR BODY
The AHA recommends 150 minutes of moderate-intensity aerobic exercise per week (such as brisk walking, ballroom dancing, or gardening) or 75 minutes of vigorous activity (such as running, hiking uphill, or swimming laps)– or a combination of both.
This means that being physically active doesn’t have to look like grinding away in the gym every day of the week. To make lasting lifestyle changes, the key is to find an activity that you enjoy enough to stick with. Luckily the natural beauty of the Pacific Northwest makes it a great place to get active– and stay that way.
“Bellingham is fantastic for its network of trails and parks,” says Jackson. “Most people from the Northwest are used to the rain and just need an appropriate coat for getting outside and staying active that way. I like going down to the waterfront, going to Larrabee State Park for hiking, and during the snow season, getting out and skiing or snowboarding with my family.”
The benefits of the great outdoors go beyond the physical: Stress levels are linked to heart disease, but spending time outside is shown to boost feelings of wellbeing and lessen anxiety. Still, whether you’re in the gym or on a hike, getting active can help you feel better in more ways than one.
“[Exercise] is good mental therapy as well– you get your natural endorphins going,” says Jackson. “Meditation, mindfulness, things like that can certainly help the overall stress in your body which can lead to excess inflammation in general. It’s good practice to exercise for physical health as well as mental health.”
So, if you– like millions of other Americans– have a family history of heart disease, when should it become a concern?
When talking to Dr. Jackson, I used the example of a loved one whose mother has a hereditary heart condition. This person is relatively young, but his mother started experiencing issues earlier than average. How worried should he be?
“If his mom’s [having problems] at 60, then maybe when he’s in his 50s it’s worth considering a screening,” Jackson says. “It’s not the same as other guidelines where there’s an age cut-off. If you know your family history and when [relatives] first started having problems, very often– and especially for folks with similar lifestyles– it’s usually a similar age frame if not a little bit earlier. ”
Yet again, lifestyle plays a significant role. Dr. Jackson notes that, if a person’s relative has experienced heart problems in relation to factors such as Type 2 diabetes or tobacco, then that person should bear this history in mind and take extra precautions. This means not smoking, eating a healthy diet, and getting plenty of physical activity.
AT THE DOCTOR
Many heart disease patients will require care beyond their primary care physicians. Treatment is unique to each individual and constantly evolving– but patients in the North Sound area are in great hands.
“Every step of the way, year by year, it’s about being able to fine-tune and improve what we do,” says Jackson. “So outcomes are better and better, and expectations for those outcomes get higher.”
For heart disease patients needing specialized care, PeaceHealth has heart clinic locations in Bellingham, Sedro Woolley, and Anacortes. Their team of more than 50 heart specialists cares for upwards of 15,000 heart disease patients annually.
PeaceHealth is also on the cutting edge when it comes to minimally invasive treatments. For example, procedures such as the Mitraclip and transcatheter aortic valve replacement (TAVR) treat heart valves and provide some patients with less invasive treatment alternatives. In addition, the Watchman procedure helps to prevent blood clots caused by atrial fibrillation (a form of arrhythmia), allowing patients to potentially avoid a lifetime of blood thinners.
WHAT CAN I DO RIGHT NOW?
If you’re concerned about heart disease, you can assess your level of risk at peacehealth.org/hearthealth. It’s also important to keep an open line of communication about your lifestyle and family history with a primary care physician. If you notice symptoms such as unusual tiredness or shortness of breath, bring them up with your doctor– no matter how small they may seem.
“[Doctors can] check things like cholesterol panels and lipid profiles to see if there’s something to be done with diet or medication,” says Jackson. “The primary goal is highlighting what risk factors could be modified.”
Whether or not you have ever been affected by heart disease, prioritizing good habits– in regards to both physical and mental health– is the best form of preventative medicine.
“I really strongly advocate for getting out, being active, and trying to make long and steady habit changes in diet,” Jackson continues. “If anything ever does come up in terms of the heart, you’ll be in better shape to handle it.”