Healthy Lifestyles and Managing Heart Disease Risk

Some heart disease risk factors are beyond patients’ control. Healthcare providers can help them mitigate the ones that aren’t. 

There are no shortage of scary heart disease statistics. 

It’s the leading cause of death for men, women and people of most racial and ethnic groups in the United States. 

One person dies every 37 seconds of heart disease. 

Heart disease is the cause for one out of every four deaths in the U.S. on an annual basis, and, overall, approximately 647,000 Americans die from heart disease each year. 

Of course, healthy behaviors can help your patients lessen their chances of being one of them. And healthcare professionals should play a pivotal role in educating patients on the value of those behaviors.   

Identifying the risk factors

There are multiple factors that increase patients’ risk for heart disease. 

Heredity certainly plays a role—familial hypertrophic cardiomyopathy and familial hypercholesterolemia are commonly inherited conditions, for example. 

Of course, there are also lifestyle choices one makes that affect their level of risk, says Teri Dreher, RN, iRNPA, CCM, CEO and owner of NShore Patient Advocates. 

“The biggest risks for heart disease fall into the areas that you cannot do anything about (heredity) and those that you can do something about, such as diet, exercise, smoking and [maintaining] a generally healthy lifestyle.”

Remaining too sedentary for too long, for example, takes a significant physical toll, says Dreher. 

“Blood pools and gets sluggish, and it is more likely that fatty deposits will settle in coronary arteries that feed the heart muscle, eventually becoming plaque and narrowing the blood flow to the human’s pump, the heart,” she says. 

“Once those arteries get narrowed enough—think of old, rusty pipes in a house—a clot or piece of plaque may break off and occlude blood flow; everything ‘downstream’ gets starved for fresh oxygenated blood and dies. The dead heart tissue will stop pumping and the heart will be weakened.”

Heart disease is typically associated with unhealthy behaviors such as smoking or lack of exercise, exacerbating factors such as stress, and medical conditions like diabetes, high cholesterol and high blood pressure.

And while these are undoubtedly important variables in determining one’s heart disease risk, there are others that we’re just beginning to understand, says Michael Miyamoto, MD, a cardiologist at Mission Hospital in Mission Viejo, Calif. 

“The role of genetics is being studied, for example,” he says. “Having an immediate family member who has had a cardiovascular event raises one’s risk, but what gene or genes are involved in this increased risk remain unclear.”

It’s also likely that small increases in risk from multiple genes are involved, says Miyamoto, adding that CT scans have found evidence of atherosclerosis in ancient humans, “demonstrating that even pre-modern populations had hardening of the arteries, suggesting that humans may have an inherent predisposition to vascular disease.” 

Providing education and encouragement

Patients can’t do much about factors such as their age, gender and family history. 

And, with age, for example, the risk of cardiovascular disease goes up. Men are more likely to develop cardiovascular disease. And their likelihood begins to increase around age 45, when 10 out of every 1,000 men develop signs of heart disease, according to The Society for Cardiovascular Angiography and Interventions. By age 55, the risk doubles, to roughly 21 out of every 1,000 men. 

Likewise, an individual’s risk is nearly doubled if a parent or sibling developed heart disease relatively early in life (before age 55 for men and age 65 for women, according to SCAI). 

The list of behavior-influenced risk factors, many of which Dreher and Miyamoto outlined above, is much longer (see sidebar). Naturally, the goal of healthcare providers is to help patients mitigate these risks as much as possible. 

One of the most critical ways that healthcare professionals can achieve this goal is to educate and urge patients to engage in healthy behaviors and carefully manage the conditions that might increase their heart disease risk, says Miyamoto. 

“We should encourage prudent diets, exercise, stress management and avoidance of tobacco products,” he says. “For those with medical conditions, it is our job to manage these as effectively as possible, using a combination of healthy lifestyles and, where needed, medical therapy.”

Providers must also help patients determine their individual risk, by assessing risk factors and evaluating based on symptoms, adds Miyamoto. 

“While complete prevention of all atherosclerosis might be unrealistic, our goal is to aggressively minimize it, so that it doesn’t cause actual disease events, such as heart attacks and strokes.”

Education is indeed fundamental, either in the form of counseling or providing educational materials, adds Robert L. Quigley, MD, D.Phil, Senior Vice President and Regional Medical Director, Americas Region, International SOS Assistance, Inc.

“This can be bolstered by regular physical exams with laboratory testing that creates metrics for the patient to follow and take ownership of,” says Quigley. 

“It’s all about the patient having the information to take control of their own life. Heart health and heart disease prevention are a lifelong journey that includes changing one’s lifestyle and behavior. While genetics can’t be changed, lifestyle and diet can, and those can be facilitated through education.”

References

  1. Heron, M. Deaths: Leading causes for 2017. Accessed May 12, 2020 [https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_06-508.pdf]
  2. Fryar CD, Chen T-C, Li X. Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999–2010. Accessed May 12, 2020 [https://www.cdc.gov/nchs/data/databriefs/db103.pdf] 
  3. The Society for Cardiovascular Angiography and Interventions, 2017. Accessed May 14, 2020. [http://www.secondscount.org/heart-condition-centers/info-detail-2/risk-factor-modification-2#.Xr7eeWhKjIU]

SIDEBAR

Controlling What You Can

Following guidelines for heart-healthy living can reduce patient risk of heart disease. The Society for Cardiovascular Angiography and Interventions provides an overview of some of the biggest contributing factors and how they impact the body. For example:

Smoking causes blood vessels to constrict, increases blood pressure and cholesterol levels, deprives the body’s tissues of oxygen, damages blood vessels’ inner lining, enables plaque to grow insider of arteries and increase the likelihood of dangerous blood clots. 

High cholesterol. High levels of LDL cholesterol, or bad cholesterol, increase the build-up of plaque in the arteries and heart. But it’s also unhealthy to have low levels of HDL, and the target LDL cholesterol level for individuals with coronary artery disease is 100 mg/dL or below. The target HDL cholesterol level is above 40 mg/dL for men and above 50 mg/dL for women.

Blood pressure above 140/90 mmHg for long periods of time can damage the blood vessels, increasing the likelihood of cholesterol plaques forming, and causing the artery walls to become thicker and stiffer, and less able to expand and contract with changes in activity and physical demands.

Being overweight or obese puts stress on one’s heart and makes controlling high blood pressure more difficult. Overweight individuals are more likely to develop cardiovascular disease, and obese patients are at even greater risk.

Physical inactivity weakens muscles and makes it tougher to control other heart disease risk factors, such as blood pressure, cholesterol levels, diabetes and obesity.

A lack of physical activity also raises the difficulty of managing stress, which has been linked to a greater chance of developing heart disease.

Reference 

  1. The Society for Cardiovascular Angiography and Interventions, 2017. Accessed May 14, 2020. [http://www.secondscount.org/heart-condition-centers/info-detail-2/risk-factor-modification-2#.Xr7eeWhKjIU]

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