Features February 2013 Issue

Heart Disease Rates Declining, but There’s More to do to Stay Healthy

As February is American Heart Month, this is a good time to start making the changes that can help protect you and your heart.

The “Heart Disease and Stroke Statistical Update” for 2013 presents a combination of encouraging news in the treatment of heart disease, as well as sobering numbers of just how far the U.S. has to go in improving overall cardiovascular health.

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For example, the American Heart Association reports that between 1999 and 2009, the rate of deaths from cardiovascular disease (CVD) declined 32.7 percent. However, CVD still accounts for about one in three deaths in the U.S. And the biggest barriers to continued reduction in CVD deaths appear to be the growing prevalence of obesity and diabetes.

“The rise in obesity will turn back the clock,” says Cleveland Clinic cardiac surgeon Marc Gillinov. “We will lose all of our gains.”

And even among healthy baby boomers, the reality is that at least one in three will eventually develop heart problems or have a stroke, according to a separate report released by the Centers for Disease Control (CDC) in late 2012. The encouraging news there, however, is that older adults living a healthier lifestyle are more likely to delay the onset of cardiovascular problems by at least seven to 14 years.

“Age alone may be a risk factor for heart disease, so it’s important to control risk factors to delay the onset for as long as possible,” says Leslie Cho, MD, Director of Preventive Cardiology and Rehabilitation at Cleveland Clinic, and Editor-in-Chief of Heart Advisor.

Simple steps
While age and family history may be heart risk factors beyond your control, there are some important and relatively simple risk factors that can be managed with a little planning and commitment on your part.

And the first is to get on your feet and get moving. The value of exercise and fitness can’t be overstated when it comes to heart health. And even if you’ve lived a rather sedentary life, your body will respond if you increase the amount of physical activity in your daily routine.

“It’s never too late to start leading a healthy lifestyle,” Dr. Cho says. “Even a small amount of exercise every day can improve your blood pressure and cholesterol.”

If you take a statin for high cholesterol, improved fitness also increases your survival, according to a recent study in The Lancet. Researchers found that your odds of living a longer life with high cholesterol are better if you’re physically active, even if you don’t take a statin. However, they noted that following your physician’s recommended medication regimen is always advised.

The risks of not staying fit are also well documented. A recent European study found that declining fitness over a decade doubles a person’s risks for heart attack. And if you’ve already had a heart attack, exercise can still provide multiple benefits.

“In individuals after a heart attack, increasing exercise levels with exercise training improves life expectancy, too,” says Cleveland Clinic cardiologist Michael Rocco, MD. If you didn’t participate in cardiac rehabilitation after your heart attack or heart procedure, talk with your doctor about this life-changing program.

Eating for heart health
While a Mediterranean-style diet (rich in fruits, vegetables, whole grains, fish, nuts, a little olive oil, but with little red meat or sweets), is often considered one of the best heart-healthy eating plans, Dr. Cho says the details of the diet are less important than it be one that is low in saturated fats, low in sodium and small in portion size.

“A lot of people eat healthy food but sometimes just too much food,” she says. “It’s important to have moderation in your diet.”
She adds that it’s important to know what your goal weight is and try to reach that weight and maintain it throughout the year.

“Programs like Weight Watchers, which is essentially calorie counting, work,” Dr. Cho says. “Consulting a dietitian can also be very helpful. Breaking a lifetime’s worth of dietary habits is hard, but doable. It’s also important to eat the food you like and that you’ll make yourself, so you can have this diet for life.”

Better treatment benefits
While as a nation the U.S. needs to do a better job reversing the trends of obesity and diabetes, it’s worth noting that preventive care and medical treatments are improving.

A variety of blood pressure medications are helping people control hypertension and statins are making a big difference in reducing the prevalence of high cholesterol.

Dr. Gillinov says statins are among the biggest difference-makers in improving cardiovascular health, though he finds some reluctance among patients to start statin therapy. “Some people are afraid of statins,” he says. “Don’t be.”

As for blood pressure control, medication adherence is vital, as is frequent monitoring of your blood pressure. Dr. Gillinov says it’s important to know your blood pressure and work with your doctor to get it under control, even if that means trying different combinations of medications, and following your physician’s advice about diet and exercise.

“The biggest issue with blood pressure is that it doesn’t cause symptoms, unless someone has a heart attack or stroke,” he explains. “Just because you feel fine, doesn’t mean that your blood pressure is fine.Take your medicines. Keep salt intake low. Achieve your ideal weight and exercise.”

Dr. Gillinov adds that part of the reason CVD deaths are down is due to the advances in heart surgery. “We have more minimally invasive techniques, and we’re at the beginning of percutaneous valve therapies,” he says. “We’re just better at protecting the heart and getting people through.”