Heart disease is the leading cause of death for men, women, and people of most ethnic and racial groups in the US. In 2021 1 in every 5 deaths was from heart disease.

Too often the first presentation of heart disease is with sudden death. Sadly, many times people are not aware that they have a heart problem or cardiovascular disease. Even though statistics have improved, cardiovascular disease remains the number one killer in the United States today, higher than cancer deaths. According to the CDC thousands of people die from heart disease every day in the United States. The disease affects both men and women and, as the presentation is atypical in many women, it escapes early recognition and treatment.

The cardiovascular tree consists of the heart as the pump that pushes blood into the vascular tree of arteries, capillaries, and veins. The arteries and capillaries allow the exchange of nutrients and provide the cells with what they need to make energy. The veins bring the deoxygenated blood back to the heart from where it is sent to the lungs for oxygenation and back to the heart to send it out into the vascular tree. And the cycle repeats itself several times in a minute and thousands of times in a day to make the body function optimally. The rate and rhythm of the heartbeat change constantly on demand when we rest, exercise, sleep, and are excited or nervous.

Any problem along this path constitutes cardiovascular disease. It includes narrowing or blockage of blood vessels that cause heart attack or stroke. The common types of heart disease include coronary artery disease, heart failure, arrhythmia, or heart valve disease. Patients present with symptoms of chest pain, shortness of breath, fatigue, or palpitations. Early detection and treatment are crucial in treatment, prevention of complications, and improving outcomes. The goal is to improve both health span and life span.

The common causes of heart disease are poor lifestyle choices like physical inactivity and smoking, genetic factors, diabetes, hypertension, hyperlipidemia, and being overweight and obese. Cholesterol is part of every cell of the body and is essential for life. Cholesterol is required to produce hormones like progesterone, testosterone, estrogen, and cortisol. It also makes bile salts that digest food, and it synthesizes the fat-soluble Vitamin D. Cholesterol is fat-soluble and must be carried in the blood by lipoproteins made up of lipids on the inside and protein on the outside. Low-density lipoproteins LDL and high-density lipoprotein HDL are the two main types involved in cholesterol transport. The levels of these lipoproteins are indicators of heart disease. High LDL levels can cause plaque buildup and atherosclerosis. As atherosclerosis progresses and is complicated by inflammation it tends to cause narrowing of the blood vessels therefore obstructing blood flow. Over time this obstruction can progress and lead to blockage of blood flow. This presents with different symptoms depending upon which part of the body is affected. For example, in the heart, it presents as angina or a heart attack. In the brain, it presents as a mini stroke a TIA, or a stroke if a large artery is blocked. In the peripheral arteries, it causes numbness and weakness and is diagnosed as peripheral arterial disease.

Early diagnosis and treatment are the key to preventing morbidity and mortality.

Diagnosis of heart disease

Often the patient does not know or understand the extent of their problem and has a specific idea of what they can do to prevent worsening of disease and death. At Longevity Medical Clinic we say, “If you don’t measure you don’t know”.

Blood tests and coronary calcium scores can be done to determine the extent of heart disease. The lipid profile is one simple blood test that has been offered for a long time. However, the information provided by the basic lipid panel is inadequate. It provides values for Total cholesterol, Triglycerides, LDL cholesterol, HDL cholesterol, and Total cholesterol and HDL ratio. This information is inadequate as all LDL particles are not equal.

There is more information that can be gleaned easily from an expanded version of this simple test. We use the Cleveland Heart Lab to provide this useful information. The more expanded panel provides details about the patient’s risk of heart disease, inflammation in the lining of the blood vessels, the risk for plaque rupture, the number and size of the LDL and HDL, and carrier molecules like Apolipoprotein B, which is responsible for transporting cholesterol and other fats in the bloodstream. It plays a crucial role in the regulation of lipid metabolism and delivery of cholesterol to the cells in the body and is a better predictor of cardiovascular risk than LDL cholesterol. Early detection and management of elevated apolipoprotein B level play a crucial role in preventing and delaying the progression of atherosclerosis and reducing the risk of cardiovascular events. The marker lipoprotein(a) is an independent marker for heart disease. Especially in individuals with a family history of heart disease and normal LDL levels, it warrants aggressive management to reduce risk factors and treatment to reduce risk for heart disease. Additionally, we check the anti-inflammatory Omega 3 and proinflammatory Omega 6 values and their ratio in this panel.

The coronary calcium score is a quick CT scan that detects old, calcified plaque in the blood vessels of the heart. The location and amount of blockage detected are important markers for treatment and prognosis.

Other tests done to detect heart disease are out of the scope of our practice. They should be recommended and performed by your cardiologist. These include Echocardiogram, Stress test, angiogram, cardiac MRI, CT angiogram, and Holter monitor.

Prevention of Heart disease

Early detection is the key to diagnosis and treatment. Many steps can be taken to help prevent the progression of cardiovascular disease. The goal is always to improve health span and life span. Some of the things that will help reduce the risk for a cardiac event include the following:

Regular physical activity. The recommendation is at least 150 minutes of moderate activity or 75 minutes of vigorous activity every week.

Stop smoking. Tobacco smoke has harmful chemicals that damage blood vessels and increase inflammation in the lining of the blood vessels increasing the risk for heart disease.

Controlling obesity and overweight. An increase in body composition changes the hemodynamics of heart function and increases the risk of heart failure and heart disease.

Optimize Blood pressure. High blood pressure makes the arteries stiff and narrow and reduces blood flow thus increasing the risk for heart disease. Controlling high BP with diet and lifestyle modifications and medications reduces the risk of heart disease.

Normalize Cholesterol. Know your cholesterol numbers, not just total cholesterol and LDL cholesterol but Apolipoprotein B and lipoprotein (a), and reduce them to the ideal range, with lifestyle modifications and medications.

Manage Diabetes. The metabolic abnormalities caused by diabetes increase heart disease. Keeping diabetes under control will reduce the risk for progression of heart disease.

Improve diet. Diets high in saturated fats, trans fats, sodium, and added sugars are linked to increased risk for heart disease.

Conclusion

Heart disease is one of the most common causes of disease and death in the United States. Early diagnosis and treatment can alleviate morbidity and improve the quality of life for patients. At Longevity Medical Clinic we treat the normal but undesirable changes of aging which can help you lead a more fulfilling life.

Citations/References

https://www.cdc.gov/heartdisease/facts.htm

https://www.nhlbi.nih.gov/health/heart/physical-activity/tips

https://www.nhlbi.nih.gov/health/heart/smoking

https://www.cdc.gov/bloodpressure/about.htm#:~:text=serious%20health%20problems.-,Heart%20Attack%20and%20Heart%20Disease,Chest%20pain%2C%20also%20called%20angina

https://www.ahajournals.org/doi/10.1161/01.CIR.100.10.1132#:~:text=Kim%20W%20(2017)%20The%20Characteristics,Pharmacological%20Research%2C%2010.1016/j

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193#:~:text=Diabetes%20is%20associated%20with%20an,can%20damage%20or%20destroy%20nerves

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503652/#:~:text=Obesity%20is%20associated%20with%20an%20increased%20risk,can%20affect%20hemodynamics%20and%20alters%20heart%20structure

https://pubmed.ncbi.nlm.nih.gov/35583875/

https://www.cdc.gov/genomics/disease/lipoprotein_a.htm

https://www.cdc.gov/heartdisease/risk_factors.htm

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/heart-disease-and-food

https://www.ahajournals.org/doi/pdf/10.1161/ATVBAHA.107.155853

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8540246/