You and Your Heart
Torrance Memorial doctors strive to be on the cutting edge of heart disease prevention and treatment. Here’s what they know now about CAD.
Heart disease is serious business in America. Coronary artery disease (CAD) continues to be the leading cause of death for both men and women in the United States. It also continues to be an area of medicine in which breakthroughs are constant.
Torrance Memorial Physician Network cardiologist Victoria Shin, MD, points to the ability to treat heart valve problems “that used to require high-risk open heart surgery. We can now do minimally invasive procedures such as TAVR. The technology has evolved, and the quality of the equipment we use has improved by leaps and bounds.”
Right now, though—even as doctors are quite excited about such developments—they also are being given new, stricter guidelines for blood pressure (BP) limits and cholesterol levels that could help reduce CAD in their patients.
“One of the big things that has come out of recent research is the more aggressive American Heart Association (AHA) blood pressure recommendations,” says Gaurav Banka, MD, a cardiologist with COR Healthcare Associates. “Previously anyone with a BP level higher than 140/90 was considered high risk; now the threshold is 130/80, with the recommendation for strict lifestyle changes and even medication to get that pressure down to 120 or lower.”
The first question, of course, is how does one lower their BP? “I always start with logical non-pharmaceutical, steps,” explains Dr. Banka. “More cardiovascular exercise and smaller portion sizes, which can lead to weight loss. Less sodium in the diet. And very conscious stress-reduction. Once a patient has tried those steps and hasn’t seen a significant reduction, then we turn to medication. And there are a variety of them, so we are able to personalize an approach—depending on the patient and their health conditions. A diabetic, for instance, will be prescribed something different from a non-diabetic.”
Whatever the medical approach, Dr. Banka stresses the need for stress-reduction. “We also try to personalize those recommendations,” he says, “by identifying the causes—work, family, physical and mental health—then finding the approach that works for each individual: exercise, yoga and meditation, reading, even knitting. I recommend patients look at classes offered by Torrance Memorial.”
New guidelines from the AHA also challenge the way doctors look at and use blood cholesterol levels. Torrance Memorial primary care physician and internal medicine doctor Ahad Shiraz, MD, explains: “In the past we were relying on the numbers to determine treatment for preventing heart attack and stroke. Anyone with a high LDL (bad) cholesterol level was placed on statins. Now we use an algorithm provided by the AHA—based on gender, age, medical history and lifestyle factors—that determines the 10-year risk factor for heart disease. You actually get assigned a rating of your 10-year risk, which your doctor then uses for your recommendations: lifestyle changes, daily aspirin for men over 45 and women over 55 are certainly all good ideas that should be discussed in the clinic with your doctor.
Steps to CAD prevention
There’s no doubt that preventing heart disease is a prime interest of cardiologists and other doctors, and most agree that regular exercise is the best weapon. “Yes, the more active you are, the better,” Dr. Shiraz agrees. “The minimum is 30 minutes of moderate aerobic exercise five times per week. Walking, for example, is considered moderate. Or 35 minutes three times a week of higher-intensity work like weightlifting, jogging or swimming. The point is to get the heart beating faster and building up a sweat. You not only strengthen your heart muscle, but you also rev up your metabolism, which is what keeps everything in check.”
“I recommend a combination of cardio and resistance exercise,” says Dr. Banka, “with an emphasis on cardio. I like my patients to monitor their heart rate and work at 50% to 80% of their max capacity. So many times patients say they exercise, but that can mean different things, such as getting on the bike and watching TV. That’s not the most effective way to work.”
And since being overweight and obesity are risk factors for heart disease, diet plays a significant role. “We recommend a simple, healthy diet,” Dr. Banka says. “Avoid refined carbs such as white rice and bread, sugar, processed foods that are high in salt, and red meat. We used to advise avoiding foods high in fat, but some peer studies have found that high fat intake is associated with lower mortality. My hypothesis is when you eat more fats, you tend to cut carbs, which is more important. Studies have found a higher association between high carbohydrate consumption and mortality.”
Dr. Shiraz agrees, although he doesn’t tell people to stop eating red meat. “I try to encourage moderation, increased fruit and vegetables, fish and chicken and an occasional steak. But fiber is important, because it cuts down the amount of cholesterol your body absorbs from food. Try for 25 to 30 grams every day, mostly from your diet. If your GI tract is regular, you don’t need fiber supplements.”
Heart Disease: He vs. She
Perhaps the most notable improvement in the field of CAD is the recognition of how crucial heart disease awareness is for women by doctors and researchers., says Dr. Shin. “Heart disease used to be considered a ‘man’s disease,’” she says. “Thankfully, with more research and more public education, that false paradigm is shifting. More women have died from CAD than from breast cancer, lung disease, Alzheimer’s and other diseases, but breast cancer gets most of the press.”
“More women than men die of heart disease,” she continues. And even though the typical onset of CAD for women lags behind men by about 10 years (20 years for clinical events such as heart attack and sudden death), the consequences are worse for women. “Among individuals with premature (under 50) heart attack, women experience a two-times-higher mortality rate. And among older patients (over 65), women are more likely to die within the first year after a heart attack.”
Why? “Studies suggest women with heart disease are treated less aggressively than men,” Dr. Shin answers, “both with medications once diagnosed and also with delay in diagnosis or delay in presentation by the patient due to the atypical nature of symptoms.” Fortunately that is changing, but certainly not as rapidly as many in the field would like.
“It’s not that the medical profession is innately sexist,” says Dr. Shin, “but rather the ability to accurately diagnose and treat is delayed due to a different set of risk factors, pathophysiology and presentations. More research that includes women needs to be pursued in the cardiology community.”
As Dr. Shin notes, 80% of heart disease can be prevented by reducing controllable risk factors such as hypertension, smoking, inactivity, type 2 diabetes and obesity. In fact, she says, “The impact of obesity on the development of heart disease appears to be greater in women than in men. Among individuals in the Framingham Heart Study, obesity increased the risk of heart disease by 64% in women, as opposed to 46% in men.” See “She and He,” at right, for other comparisons.
Bottom line for men and women: “Check with your primary doctor for the traditional risk factors—high blood pressure, blood cholesterol, diabetes—and ask for the 10-year risk assessment. Stop smoking, get daily exercise, lose weight and eat as healthfully as you can.”
Do you have questions about your heart health? Contact your primary care doctor; if you don’t have a doctor, call our physician coordinators at 310-891-6717.