It is estimated that greater than 80% of men and women over age 50 have arteriosclerosis (hardening of the arteries with cholesterol containing plaque). Up to 50% of women and 35% of men will eventually die of heart disease. Our mission at Copeman Healthcare is to prevent or delay the onset of heart disease and to protect against death or disability if you should ever experience a cardiac event.
There are many types of heart disease and generally they become more frequent with age. Modifiable risk factors can help reduce cardiac events and your health team has likely already discussed many of these with you in your annual risk assessment. This article addresses the two most prevalent risks and what can be done to guard against them.
1. ISCHEMIC HEART DISEASE
Also known as coronary artery disease, this is the most prevalent form of heart disease. It is caused when arteries become damaged with cholesterol containing plaque. Left untreated this condition can lead to a heart attack or heart failure as the heart can no longer function well as a pump.
Smoking, high blood pressure, cholesterol, elevated blood glucose, a sedentary lifestyle and many other factors can cause inflammation of the arteries. The injured arteries allow cholesterol to migrate into the lining and wall where it is then stored. This limits blood flow, causes hardening of the arteries and makes them more prone to rupture. These issues can be reduced or eliminated with proper lifestyle modification and medical management. For example, plaque can be removed or stabilized to reduce a person’s risk of heart attack.
Ischemic heart disease is considered a preventable degenerative disease that is a result of a modern urban lifestyle. Genetics will play a role but often these risks can be mitigated.
What are my Options?
If you believe you’re at risk, speak to your healthcare team and consider additional tests to establish your true risk. The arteries in your neck can be examined by ultra-sound in a process known as CIMT. Your coronary arteries can be examined by CT scan to obtain a calcium score (used to indicate plaque buildup) or a CT angiogram can be used to look inside your arteries for plaque that may be causing obstruction of blood flow.
Follow the suggestions of your health professional. Don’t smoke and keep an eye on your blood pressure, blood glucose and cholesterol. Eat a healthy diet, get moving, and if prescribed, be sure to take your medications. 25 years of studies have proven statin drugs such as Crestor, Lipitor and others are safe and effective. These drugs will help reduce your risk by up to 35%. Other medications such as ASA can be used if you are at high risk or have had a cardiac event.
2. CONDUCTION DISORDERS (rhythm disorders)
As the heart ages, or is damaged by high blood pressure, excessive alcohol, smoking, high glucose, genetics and/or other factors, the nervous system becomes damaged. This leads to irregular heartbeats called palpitations.
The most common conduction disorder is atrial fibrillation which occurs in 8% of people over age 80, and causes 30% of their strokes—many of which are preventable. It is a condition where the upper chambers called atria are beating in a disorganized fashion out of sync with the lower chambers called the ventricles. This can last for a few seconds or can be permanent. Some people are unaware they have this; others have severe symptoms of weakness and heart palpitations.
The main cause of atrial fibrillation is poorly controlled hypertension (high blood pressure). Alcohol can also be a cause and in almost all people aggravates an existing condition. Those with atrial fibrillation are at 4-5 times increased risk of stroke because the irregular heartbeat can cause a clot to form in the left atrium which can then fragment, migrate, and obstruct blood flow to the brain. Therefore, all people with atrial fibrillation require clot protection. ASA is used for younger people who typically run lower risk of stroke and Warfarin is considered the standard of care for older patients or those with other risk factors such as diabetes. This can be evaluated with an online calculator called CHAD2.
Newer, improved drugs are now available to prevent stoke in patients with atrial fibrillation. They are more expensive than Warfarin but reduce risk of unwanted bleeding and require no monitoring. In Canada, two new drugs are Pradax and Xarelto (and more are coming). They are taken orally once or twice a day and reduce stroke risk as well or better than Warfarin. They do not have any food or drug/drug interactions and reduce the risk of a serious bleed better than Warfarin.
Please consult your health team for protective strategies to help you mitigate your risk of heart attack and stroke.
Let’s be aware and prevent heart disease and stroke today Copeman Healthcare offers programs for hypertension, diabetes prevention & management, and brain health.