The good news is that heart disease is on the decline due to a number of factors, including better awareness in lay and medical communities, improved medicines, earlier treatment of risk factors and lifestyle modifications. We are headed in the right direction, but we can do better. Heart disease is preventable.
Reducing our risks
Risk factors for heart disease include obesity, high cholesterol, high blood pressure, smoking and diabetes. Unfortunately, both obesity and diabetes are on the rise. For patients with type 2 diabetes, 70 percent die of cardiovascular causes.
Inactivity and the standard American diet, rich in saturated fat and calories, also contribute to heart disease risk. The underlying culprit is atherosclerosis, fatty streaks in the arteries.
All of these risk factors can be overcome.
When medication helps reduce risk
Cholesterol and blood pressure medications have been credited to some extent with reducing the risk of heart disease.
In terms of lipids, statins have played a key role in primary prevention. Statins are effective at not only lowering lipid levels, but also inflammation levels that contribute to the risk of cardiovascular disease.
The Jupiter trial showed a 55 percent combined reduction in heart disease, stroke and cardiovascular disease mortality with statins in healthy patients — those with a slightly elevated level of inflammation and normal cholesterol profile.
Unfortunately, many on statins also suffer from muscle pain and cramps. Many patients’ goals when they see me is to ultimately discontinue statins by modifying their lifestyles. Lifestyle modification is a powerful ally.
Making lifestyle changes
The Baltimore Longitudinal Study of Aging investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five servings or more of fruits and vegetables daily with <12 percent saturated fat had a 76 percent reduction in their risk of dying from heart disease compared to those who did not.
The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet. These results are impressive and, to achieve them, they only required modest dietary changes.
The Nurses’ Health Study shows that these results are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Many times, this is the first manifestation of heart disease in women.
The authors looked at four parameters of lifestyle modification, including a Mediterranean-type diet, exercise, smoking and body mass index. The more lifestyle factors incorporated, the greater the risk reduction. There was a 92 percent decrease in SCD risk when all four parameters were followed.
Monitoring your risk of heart disease
To determine your progress, we use cardiac biomarkers, including inflammatory markers like C-reactive protein, blood pressure, cholesterol and body mass index.
In a study of high-risk participants and those with heart disease, patients implemented extensive lifestyle modification: a plant-based, whole foods diet accompanied by exercise and stress management.
The results showed an improvement in biomarkers, as well as in cognitive function and overall quality of life. The best part is the results occurred over a very short period to time — three months from the start of the trial.
Ideally, if patient needs to use medications to treat risk factors for heart disease, it should be for the short term. For some patients, it may be appropriate to use medication and lifestyle changes together; for others, lifestyle modifications are sufficient, as long as patients take an active role.
By focusing on developing heart-healthy habits, we can improve the likelihood that we – and those we love – will be around for a long time.