February is Heart Health Month
- Primary Care
Little Changes Can Make A Big Difference
By Dr. Cindy Ripsin
Over the past three decades, the rate of heart disease has improved but is still the leading killer of men and women in the United States.
What is heart disease?
Many conditions cause diseases of the heart. Some are born with (congenital heart disease), and some happen during our lifetime. The main killer of Americans, coronary heart disease or coronary artery disease, happens over time and often can be prevented by careful attention to risk factors.
The heart is a muscle that pumps blood. The smooth exchange of blood between the heart and lungs and out to muscles and organs of the body can only happen if the heart has its own healthy blood supply. The heart is surrounded by coronary (“coronary” = “heart”) arteries, which provide the heart with its own oxygen-filled blood supply. Narrowing of any of these arteries will reduce the blood flow to parts of the heart, much like a beaver dam slows the downstream flow of water in a river. When the narrowing of an artery gets so severe that it blocks blood flow, the part of the heart relying on that artery for its blood supply will stop pumping. This is what causes a heart attack. When the heart attack is severe, it can cause sudden death. Half of all people with heart disease die suddenly from their first heart attack. When the blockage is less severe, it can still cause parts of the heart muscle to die, so the heart will no longer pump as strongly as it once did.
How can we keep our hearts and the hearts of the people we love as healthy as possible?
The most important risk factors for early heart disease are smoking, high cholesterol, high blood pressure, and diabetes.
Smoking is one of the biggest causes of heart disease. At least half of all smokers already have evidence of narrow coronary arteries, even if they haven’t yet had a heart attack. The good news is that two years after a smoker quits, their chance of having an early heart attack is greatly reduced. Nicotine is a highly addictive drug, and quitting can seem impossible, but there are ways to make quitting a little easier. So, if you smoke, work with your doctor to make a plan for quitting.
Cholesterol is made up of several different fractions. The most important fraction for heart health is the LDL cholesterol, sometimes called “bad” cholesterol. Food high in saturated fat is converted to LDL cholesterol in the body. LDL then gets deposited into the lining of the arteries, creating fatty plaques that narrow arteries and slow, or even stop, blood flow. These fatty plaques also increase inflammation in the heart, and inflammation is an important risk factor for early heart disease.
Saturated fat is any fat that is solid at room temperature. Butter, lard, and the fats in meat are good examples of saturated fat. Breakfast meats like bacon, ham and sausage, chorizo, and deli meats are loaded with saturated fat, and they are also very high in sodium which can raise blood pressure, so limiting or avoiding these foods can help prevent the buildup of fatty plaques in the heart.
Each time the heart pumps, the force is felt on the heart walls and within the body’s main blood vessels. That force is called blood pressure. When blood pressure is higher than ideal, the heart needs to pump harder to push the blood through the blood vessels, which puts a strain on the heart over time. High blood pressure can directly decrease the ability of the heart to pump. It can also put pressure on the fatty plaques within the blood vessels and cause the plaques to break and clog the artery, causing a heart attack or stroke. High blood pressure is called "The Silent Killer" because people often have no ill effects from having high blood pressure but then can die of a sudden heart attack or stroke. Blood pressure is expected to increase during exercise, but when it is higher than ideal when we’re resting quietly, it means we are putting a daily, unhealthy strain on our heart. The most accurate way to check your blood pressure is at home while resting quietly. The American Heart Association recommends checking blood pressure at home and sharing those readings with your doctor. They have even sponsored a multi-million-dollar program to teach people how to accurately take blood pressure in the home.
There are two types of diabetes: Type I and Type II. People who have Type I diabetes make no insulin at all. In Type II diabetes the body makes insulin, but the insulin doesn’t work well. When we eat or drink, insulin acts like a key to open the cells and allows the energy from the food to enter. In people with Type II diabetes, the insulin is like a rusty key; it eventually works to open the cells, but it takes longer than it should, so blood sugar builds up and can damage the large and small blood vessels.
People with Type II diabetes have a very high risk of having early heart disease. For women, the rate is three and a half times higher, and for men, it is two times higher than people without diabetes. The damage to the heart and blood vessels from diabetes begins even in people with prediabetes. People with family members who have diabetes and people who have excess body fat around their midsection, so-called central obesity, are at much higher risk for diabetes. But the good news is that healthy weight loss combined with healthy eating can prevent someone with prediabetes from getting Type II diabetes. Prediabetes is the condition in which the insulin is starting to malfunction. If you aren’t sure if you or your loved one has diabetes or prediabetes, talk to your doctor. A simple blood test can give you the answer you need to manage this important risk factor.
The blood test is called hemoglobin A1C and it can tell your doctor if you have diabetes or prediabetes. It measures the average blood sugar over the past three months by checking to see how saturated the blood cells are with sugar:
When the hemoglobin A1C is less than 5.6% this is considered normal.
When the hemoglobin A1C is between 5.7% and 6.5% this is in the range of prediabetes.
Once the hemoglobin A1C reaches 6.5% this is diabetes.
If you’ve never been tested, talk to your doctor and find out your number.
So, like millions of Americans, you and your loved one might have already been told you have extra body weight or even already have diabetes or prediabetes, and you need to lose weight and change your diet to prevent your first heart attack. It can be so overwhelming to hear this. Like many others, you might have already tried to lose weight, but “nothing ever works.” Feelings of frustration and shame can make these challenges even more difficult. Keep in mind that a journey of a thousand miles begins with a single step. Choose very small changes that you can make on a permanent basis. Adding very small changes together over a long period is far more successful than trying to make even a single large change. Talk with your doctor about partnering with you and/or your loved one to make a plan for change.
Dr. Cindy Ripsin is a board-certified family physician with over twenty years’ experience caring for patients of all ages. She is the medical director for Boundless Health.