Despite improvements in prevention and treatment, heart disease remains the country's No. 1 killer.
Exciting discoveries have been made when it comes to cardiac care and reducing heart disease. Less-invasive procedures are being used, tools are refined, the number of outpatient procedures are increasing and heart transplants are having a higher success rate. Advancements also involve more preventative health measures and improved treatment.
Nonetheless, heart disease remains the nation’s No. 1 killer, with more than 800,000 people dying every year, which translates to one in every three deaths. It is the leading cause of death in both men and women, a status it has held since 1920, according to the Centers for Disease Control and Prevention.
Heart Health Hacks
Despite improved awareness of the need for a healthy diet and more exercise to prevent heart disease, local cardiologists say they are seeing an upward trend in the numbers of patients with heart issues due, in part, to two overriding factors—a sedentary American lifestyle, including a poor diet, and an aging population.
Recognition for an improved lifestyle has definitely increased, says Dr. Talal Attar, an interventional cardiologist and an assistant professor of clinical internal medicine at the Ohio State University Wexner Medical Center.
“There is so much more focus on diet and exercise than we have ever seen, and we’re making progress on combating tobacco use, although we are not where we want to be,” he says. “Unfortunately, the counter to all of that is we are losing the battle with obesity and diabetes.”
Diabetes increases the risk factors and the likelihood of developing heart disease. In turn, the chances of provoking a heart attack or stroke and being overweight or obese can affect people’s ability to manage their diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Meanwhile, as baby boomers age, physicians are seeing an uptick in the number of patients, says
Dr. Gary Ansel, the system medical chief for vascular services at OhioHealth.
With an average lifespan of 78.8 years, Americans are living longer than ever. By 2050, a group that will be 65 and older is projected to include about 84 million people, almost double that same age group’s estimated size of 43.1 million in 2012. With many older people experiencing multiple chronic diseases, the challenge of providing adequate health care is called “monumental” by the National Institutes of Health.
Obesity rates top 40 percent for both men and women who are age 65 to 74, according to the CDC. Meanwhile, the American Diabetes Association estimates that the percentage of Americans age 65 and older with diabetes, both diagnosed and undiagnosed, is estimated to be more than 25 percent, or about 12 million people.
“An increase in patients we’ve seen in the last
10 years will continue because the population is getting older and getting sicker,” Ansel says. “Many older people are more sick than they were in the past, not only due to age, but also obesity and diabetes.”
With the numbers looking grim, experts have focused on cardiology studies in many areas, including prevention. Compelling discoveries have been made in the past few years to treat cardiovascular disease before it creates additional health issues, says Dr. Kavita Sharma, a cardiologist and lipidologist with OhioHealth.
“These discoveries are really impactful and put even more of a focus into prevention and how we want to do things earlier in life,” says Sharma, who as a lipid specialist is certified in the prevention of cholesterol (lipid) disorders. “These findings can help people avoid organ damage, heart attacks and strokes caused by heart disease.”
Heart and blood vessel disease includes numerous problems, many related to a process called atherosclerosis, during which plaque builds up in artery walls that supply blood to the heart and other parts of the body. Plaque comes from deposits of cholesterol and other substances in the artery, which in turn narrows the inside of arteries over time, leading to partially, or totally, blocked blood flow.
If a clot forms, it blocks blood, and that leads to a heart attack or stroke. Heart disease is the cause of 43.8 percent of all U.S. deaths, followed by stroke (16.8 percent) and heart failure (9 percent), according to the American Heart Association. The first sign of a clogged artery for many people is a heart attack, according to the CDC.
While sedentary lifestyles, poor diets and smoking cause many of these problems, high cholesterol can also be inherited from family members through a disorder known as familial hypercholesterolemia, called FH, which leads to aggressive and premature cardiovascular disease.
Diet and lifestyle, while important, are not the cause of high LDL, the so-called bad cholesterol, for people who have FH. With FH, genetic mutations make the liver incapable of removing excess LDL and people often show cholesterol levels that are “off the charts,” Sharma says. FH often goes undiagnosed and is the most common cause of premature cardiovascular disease, she says.
About 1.3 million people in the U.S. have FH and more than 90 percent of people with it have not been properly diagnosed. If just one parent has the condition, a child has a 50 percent chance of inheriting it. Left untreated, men have a 50 percent higher chance of getting a heart attack by age 50, while untreated women have a 30 percent higher chance of a heart attack by age 60, according to the FH Foundation.
Typically, patients with high cholesterol are treated with statin drugs, which help. The Food and Drug Administration has recently approved two relatively new medications, Praluent and Repatha, that inhibit this FH mutation and significantly lower LDL. These medications are game changers, Sharma says.
“These drugs have lowered heart attack and stroke risks for people, and they’ve dropped LDL an additional 60 percent beyond what statins have done,” she says. “And with early cholesterol management, people can push out the time they begin to see high LDL levels to near-normal ages, and their heart attack risks can go to near-normal levels, too.”
One major roadblock is the medicines’ cost, which is about $14,000 per year. Insurance companies have been reluctant to approve reimbursement for these medications, with insurers saying costs should be closer to $2,000 to $6,000 a year.
“Pharmaceutical companies say with rebates and negotiations, it is coming closer to the lower costs and recently the rates of insurance company approval have been improving,” Sharma says.
Despite the best preventative measures and new medications available, people continue to experience heart attacks and heart failures.
In the past, heart failure and heart attacks have required long hours of invasive surgery and extended hospital stays. But the development of new devices and procedures are changing old ways. To that point, in September the Ohio State University Wexner Medical Center became the first in the country to test a new device to help patients with advanced heart failure.
A failing heart is unable to adequately pump blood to the body, causing a buildup of fluids and increasing pressure in the heart and lungs. About 6 million people in the U.S. experience heart failure, with 800,000 new cases per year.
The OSU device, a shunt shaped like an hourglass, in September was woven through a catheter placed in the patient’s groin and moved between the two upper chambers of the heart, which created an open path to divert blood that was built up. After the surgery, the patient went home the next day.
This development, along with many others, comes from the findings of more than 200 clinical trials focused on heart and vascular disease at the hospital. Much of the work there involves physicians from multiple disciplines, says Ayesha Hasan, section director for Advanced Heart Failure and Transplant Cardiology at the OSU Wexner Medical Center.
“That recent work involved three or four specialists,” Hasan says. “We always tell patients they receive more personalized care because of our multidisciplinary approaches.”
Currently, Hasan is studying stimulation of the phrenic nerve, linked to the diaphragm and breath control, for treating sleep apnea and its relationship to heart failure.
“Apnea is associated with heart failure and high blood pressure and, if untreated, can lead to heart arrhythmia,” she says. “Treating one absolutely helps the others because 60 to 70 percent of patients with heart failure have some type of sleep apnea.”
Meanwhile, another growing trend in medicine is the creation of ambulatory surgery centers, known as ASCs, which conveniently allow outpatient care, including the offering of some heart procedures.
ASCs have come about due to major advances in anesthesia, pain management and surgical techniques, says OhioHealth’s cardiologist Ansel.
“The whole trend for medical, especially with cardiovascular disease, is to be much less invasive, including procedures through a patient’s wrist blood vessels,” he says. “Now we can do procedures in these outpatient facilities, which are so much safer now and less traumatic for the patient.”
Hospital or not, less invasive remains a focus. Blood clots are dissolved with medicine, physicians replace heart valves through tubes without opening a patient’s chest and miniature pumps hooked on a belt have replaced large machines to keep one’s heart ticking.
Even treatment of an aortic aneurysm today, which once required a hospital stay of up to 10 days, has the patient home the day after the procedure.
“Now it is like replumbing a pipe and is done through small leg punctures,” Ansel says. “Many went to a nursing home for recovery, but now it is almost like outpatient treatment.”
With the CDC currently calculating that about 735,000 Americans each year will have heart attacks, studies will certainly continue and more improvements will come. Meanwhile, for the 525,000 people this year who are expected to experience their first heart attack—or the 210,000 people who may have a repeat episode—care and prevention are important: don’t smoke, eat healthy, sit less and lead an active lifestyle.
Keys to Success
While advanced science continues to make strides in the field of cardiology, the formula for avoiding heart problems remains uncomplicated: eat healthy and exercise.
Those recommendations are standard, basic, simple and effective, says Dr. Talal Attar, an interventional cardiologist at the Ohio State University Wexner Medical Center.
Nonetheless, obesity and diabetes wreak havoc on a person’s body, and it’s difficult sometimes for people to make those connections to heart diseasse.
“If you know what food bothers your stomach, you won’t eat it, but you can walk around with your sugar levels above normal and you won’t know about it,” he says. “There is no instant feedback, and that makes it harder to be compliant.”
As for alcohol, the debate has gone back and forth, but drink only in moderation: one drink per day for women and two for men. Drinking any amount above those levels can create more harm than good, Attar says.
Overall, to lower heart disease risk, most cardiologists and health organizations advise to:Control blood pressure and cholesterol levels Maintain a healthy weight Manage diabetes and other health challenges Eat more plant-based food than meat Don’t smoke Limit alcohol Manage stress Get enough sleep