As we undertake this new monthly column focused on heart and vascular health, I need to report that heart disease continues to be the leading cause of death in the United States.
However, advances in recent years including lifestyle changes, better medications, less invasive procedures and public education of both patients and health care providers are helping those with the disease to live longer and preventing it from developing in many other people.
It is a good time to consider these advances as we enter the New Year and to think about resolutions related to our health. The best treatment for heart disease is preventing it in the first place. High blood pressure, elevated cholesterol, smoking and inactivity are all risk factors for developing heart disease that can be modified. Using phone-based apps, your health care provider can estimate your 10-year risk for cardiovascular disease.
Recommendations have gotten stricter in terms of evaluating patients for elevated blood pressure so steps can be taken earlier to manage those at risk for cardiovascular disease.
Guidelines issued three years ago by the American Heart Association and others recommend health care providers assess a patient’s risk for cardiovascular disease on both their current blood pressure measurement, taken on two occasions, as well as their 10-year risk for cardiovascular disease.
The guidelines now define normal blood pressure as 120/80; elevated, 120-129/80; stage 1, 130 to 129/80-89; and stage 2, 150/90.
Recommended treatments, especially for those with stage 1 hypertension (high blood pressure), involve lifestyle changes, such as lowering salt intake and engaging in some form of heart healthy exercise, such as a 30-minute brisk walk five times a week. Beyond that, there are a variety of well tolerated drugs that can be used to lower blood pressure.
Drugs that are effective in managing or preventing heart disease include statins that can lower cholesterol and therefore reduce an individual’s risk for heart attack or stroke. Some cardiologists prescribe a low-dose aspirin daily for individuals who have had a stroke or heart attack. While smoking rates in the country and Massachusetts are on the decline, Springfield is estimated to have an adult smoking rate 58 percent higher than that of the rate statewide.
Understanding different types of heart disease and potential treatments is important for everyone, so they can be aware for themselves and loved ones.
Heart attacks come in different types. Some are referred to as “STEMI,” that is, ST-elevation myocardial infarction. These events involve the complete blockage of a heart artery caused by the formation of a blood clot in the artery that supplies blood to the heart, as well as partly by the buildup of cholesterol. They are most often addressed through what we call “early treatment” with a special “clot buster” medication or angioplasty, which can save heart muscle and lives. Angioplasty involves threading a wire with a balloon up from the arm or leg to the artery of the heart, expanding the balloon to push the blockage in the artery out of the way, then placing a stent to keep the artery open. Delivering these lifesaving treatments is very time dependent, the first step of which is identifying who needs the treatment and then alerting the team of practitioners who deliver the treatment. Baystate Medical Center recently partnered with General Devices to pilot an application that paramedics can use to transmit such real-time information to its emergency department so the catheterization lab can prepare for an angioplasty, if needed, even before that patient’s arrival. This is extremely important as quick medical attention is key in limiting damage from a heart attack. Our cardiac catheterization laboratory treats some 350 STEMI cases each year. Thankfully, these heart attacks are on the decrease today thanks to fewer smokers and the use of statin drugs.
Heart disease extends beyond heart attacks. The heart contains valves that sometimes stiffen or leak to the point that they need to be repaired or replaced. Traditionally, this has required open heart surgery. Improvements in technology have now allowed in the majority of cases for replacement of the aortic valve to be done without opening the chest. Our cardiac surgeons and cardiologists, working side by side, can perform a procedure called “TAVR,” in which the aortic valve is replaced through a small incision in the groin. For a small number of patients, they can repair a leaking mitral valve as well through the insertion of a catheter into the groin area. I expect that this will expand to many more patients in the near future as new technologies emerge.
Abnormal heart rhythms are another type of heart disease. Atrial fibrillation is a very common condition in which the heart beats irregularly. This can be treated with medication and sometimes a procedure called ablation. Atrial fibrillation is associated with an increased risk of stroke, so many patients are treated with blood thinners to reduce this risk. Not all patients can take blood thinners. For some of the patients who cannot take blood thinners, there is a procedure in which a device called “Watchman” is implanted in the heart to reduce the risk of stroke.
Congestive heart failure is another common heart condition. Heart attacks and high blood pressure are common causes of congestive heart failure. Most patients are treated with medicine, but some patients with advanced heart failure benefit with a ventricular assist device — essentially a pump which is connected to the heart to assist it in pumping blood to the body. This and other treatments for advanced heart failure are available through the Baystate Advanced Heart Disease Clinic.
While there is much that can be done today to manage cardiovascular disease, the best approach, as I mentioned earlier, is to prevent it. Each of us can work toward this goal by maintaining a healthy body weight, getting enough sleep and exercise and seeing our health care provider for regular checkups. We will discuss more in-depth on prevention in our next column in February during Heart Month.
Dr. Aaron Kugelmass is vice president and medical director of the Heart & Vascular Program at Baystate Health.