By Darrel C. Gumm, MD, FACC, FSCAI, HeartCare Midwest
A useful way think of heart disease is to think of the heart as a house. Generally problems occur in one of three major areas: electrical, structural, or plumbing. If the heart disease is electrical in nature, then it is related to the conduction system of the heart. If the heart disease is structural in nature, then this is related to problems with the heart muscle itself or with the heart valves. Imagine a house with walls that were weak, or doors that would not open all of the way, or windows that would not close. Finally, if the problem is with the plumbing of the heart, then that is related to the vascular system (blood vessels) of the heart.
A problem in any one of these areas, may affect the other areas. Problems with the plumbing or vascular system can have devastating effects on both the structural and electrical systems of the heart.
The buildup of plaque in the arteries of the heart is the basic cause of vascular heart disease. The process is often referred to as atherosclerotic cardiovascular disease and is abbreviated ASCVD. The vast majority of heart attacks are related to this condition.
Several risk factors contribute to ASCVD. Some of these risk factors are modifiable and some cannot be changed. The non-changeable risk factors are primarily family history or genetic factors. I will occasionally remind my patients that you can change your Levi’s but you can’t change your genes (and yes, they usually groan like you did just now).
The modifiable risk factors are important to recognize and even more important to address if you have any of them. There are five well-recognized risk factors: body weight, tobacco use, elevated blood pressure, elevated cholesterol levels, and controlling diabetes.
The first step in assessing the situation is to know your numbers. Everyone should know generally what their blood pressure runs, what their cholesterol levels are, what their fasting blood sugars are, what their body weight is, and what a more appropriate weight would be for them. Your primary care physician can help determine if all you need is lifestyle modification or if medication is required.
Lifestyle modification is a very simple first step and something that everyone can begin right now. One of the first steps is to drop the harmful habits for heart health. First on that list is to stop all tobacco use. The next step is to reach a healthy weight. Patients often ask me what they should weigh, and I usually say to them, with a smile, “Make your first goal whatever it says on your driver’s license.” Regular exercise also is very important. The target should be to shoot for 30 minutes five times a week. We can all immediately begin to focus on a more nutritious diet. A diet that is higher in fiber and lower in such things as fat and sodium is a great first step. Adding more fresh fruits and dropping the starches in your diet can also be a very easy goal. Alcohol consumption should be moderate, no more than one drink a day for women and no more than two drinks a day for men (and no, you cannot save up all week and then have seven drinks on Saturday). Adopting heart healthy behaviors are also brain healthy. In fact, these behaviors can reduce the incidence of heart attack and stroke by more than 80 percent.
Now how about a few tips to help make things stick? First of all, set realistic and measurable goals. Create a detailed plan for how to make it happen. Call a friend or a relative to do activities with you. Hold each other accountable. Measure your progress over time. If you have a smart phone, you may already have a pedometer just waiting to be activated. If not, get a pedometer and start counting steps. Don’t just “walk more,” but get 10,000 steps in every day without fail. Finally, be patient. Studies show that most people quit after the first three weeks. Try making a 3-month commitment. You will be much more likely to achieve your goal. It is also important to remember that you will have greater success in modifying habits if you can pick just one behavior to change at a time. Once the first good habit has been established, then move on to the next.
Understanding the process of vascular heart disease, what increases your risk of developing this problem, and what you can do now to prevent it or further modify is extremely important. Knowing your numbers and working with your primary care physician to get in the right zone will serve you well for years to come.
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