Heart disease was the topic of a talk presented at the Senior Expo on Tuesday.
Dr. Jeffrey Michel, interim chief cardiology division Baylor Scott & White Temple division, talked about what is known about heart disease and what is not known. What can be done about heart disease and the things people believe will prevent heart disease, but don’t.
Much research has been done on heart disease over the past 100 years.
“There’s still probably more about the disease that we don’t know than what we do,” Michel said.
Heart disease affects 800,000 people in the United States each year. Sixteen million people in the U.S. have heart disease; 8 million have had a heart attack and 7 million have had a stroke.
“We consider stroke-heart disease because a lot of strokes are caused by blood clots forming in the heart and the same plaque buildup in the arteries of the heart are occurring in the arteries to the brain.
Heart disease can be any number of things and Michel focused on plaque and coronary heart disease.
In the past, it’s been called hardening of the arteries and it wasn’t clear if plaque was an actual disease, he said.
In 1980, it was finally proved that the clots forming in the plaque were causing heart attacks and death.
There are a number of causes that lead to plaque, obesity, hypertension, diabetes, pollution, tobacco, genetics and more.
“It’s a very complicated disease,” Michel
There’s a myth that heart disease is a modern disease, and that’s not true.
Ahmose Meryet Amon, an Egyptian princess, lived 3,500 years ago, died in her 40s and a scan showed she had plaque in her arteries.
Another myth is that people who eat right and exercise won’t have heart attacks.
Autopsies on whales that have washed on beaches have shown some of those deaths are the result of heart attacks.
“The whale is a mammal, but it’s hard to make a case that the whale was lazy or didn’t eat a healthy diet,” Michel said.
There are things in life that can be controlled to reduce the risks.
However, there are also non modifiable risks — age, sex, race and genetics.
Age is a major factor, he said.
Women have fewer heart attacks, are older when they have heart attacks, but have poorer outcomes, compared to men.
Modifiable risk factors include smoking, diabetes, hypertension, high cholesterol and kidney failure.
Lifestyle is important and can lower your risk of heart disease with some modifications — better diet, more exercise.
Smoking is a big risk, but that risk drops significantly once ceased.
“Smokers live on average 14 years less than nonsmokers,” Michel said.
E-cigarettes are a way to deliver nicotine without the smoke, assuming the smoke is what is causing the problem.
“We have to be cautious, we don’t know yet if they are safer,” he said. “It’s unregulated. People buy the cartridges and don’t know what’s in them.”
The risk factors Michel sees in the clinic are high blood pressure, high cholesterol, untreated diabetes and kidney disease.
Lifestyle has a risk factors – exercise, diet, work, stress and socioeconomic.
Statin therapy is the most effective medication and reduces heart attacks by treating elevated cholesterol, it’s also the most vilified drug in recent times.
Statins can cause joint and muscle pain.
Lowering blood pressure is effective in reducing heart attacks. Controlling diabetes plays a role.
In India and China, the migration of the population from rural to urban has an effect. In villages the rate of diabetes is 2 percent, in cities the rate is 25 percent.
“This is happening in real time,” he said. “The change in lifestyle factors have an impact.”
How heart attacks are treated has changed. Bypass surgeries were the norm for years and are being replaced by stents.
Bypass provides a lower risk for about 10 years, but it doesn’t cure the disease.
Stents can treat the symptoms, but if the stents are used after the plaque has formed the disease process is ignored.
“I’m a big fan of statins,” Michel said. “I think they work so well is because they are probably anti inflammatory.”
People receiving chemotherapy do better if they are on statins, he said. People going into surgery and given statins are less likely to have a heart attack during surgery
Aspirin works well when taken during a heart attack. It’s not as effective in preventing heart attacks.
Boiling down all the information into a simple message, Michel recommends exercising 150 minutes a week, and paying attention to blood pressure and cholesterol numbers.
We’re getting fatter and the incidence of heart attacks is dropping.
“We can do better and we can individually reduce our risk significantly,” he said.