Understanding heart health may help tame an often silent foe

UC cardiologist offers insight on risk factors and prevention of heart disease for heart month

About 647,000 Americans die from heart disease annually. That’s nearly one in four deaths, according to the Centers for Disease Control and Prevention. It’s the leading cause of death for women, men and people of most racial and ethnic groups in the nation.

February is American Heart Month, and the first Friday in the month is designated National Wear Red Day by Go Red for Women and the American Heart Association to call attention to the risk heart disease presents for women. It kills more American women than all cancers combined.

Dr. Hina Jamali, assistant professor of cardiovascular health and disease at the University of Cincinnati and UC Health cardiologist, provides some insight into this often silent killer of Americans.

What are the top risk factors for developing heart disease?

Jamali: Medically speaking, the main or most aggressive risk factors for cardiovascular disease — such as angina, heart attacks, strokes, mini-strokes, peripheral arterial disease, heart failure and atrial fibrillation — are diabetes, hypertension, high cholesterol and smoking. Thanks to extensive advanced research, we now have multitiered tools to calculate 10-year risks of heart disease in adults aged 20 years and older.

These tools incorporate several individualized details related to age; gender; family history; presence or absence of conditions like diabetes, hypertension or kidney disease; inflammatory conditions like rheumatoid arthritis, lupus or psoriasis or the use of nicotine products as well as some advanced biomarkers measured in the blood. This risk estimation can be done by your cardiologist or primary care physician when appropriate.

In simpler terms, however, it appears that most of the risk for cardiovascular disease is stemming from a poor lifestyle, which includes poor diet, lack of physical activity and exercise and substance use, including but not limited to tobacco and alcohol. Most of the risks are interlinked and create a greater and exponential danger to overall health as well as heart disease when present together. They are also associated with mental health diagnoses like depression, stress and anxiety that now are being linked to cardiovascular risk.

As a start for taking charge of reducing your cardiovascular risk, visit your primary care physician for annual preventive screening, incorporate a plant-based or Mediterranean diet into your life and strive for 20 minutes of daily moderate to vigorous aerobic and/or resistance exercise. Make a commitment to quit smoking and then seek out formal and informal support to quit smoking.

2020 Women in Cardiolgy group photo.

UC Women in the field of cardiology pose for a picture in support of National Wear Red Day in Care/Crawley Atrium. Photo by Colleen Kelley/UC Creative Services.

Does heart disease differ in women compared to men?

Jamali: Heart disease in women, particularly ischemic heart disease or disease related to narrowing of coronary arteries, presents in ways that differ from what we have seen in men during the past 20 years. The most prominent issue that came to light was the simple fact that healthcare professionals as well as patients themselves, were not looking for heart disease in women as diligently as they were looking for it in men. As a result, it was being underdiagnosed, or being diagnosed late, as well as being undertreated.

We now have studies showing higher prevalence of what we call “atypical symptoms” of heart disease in women compared to men. Chest pain remains the leading symptoms of ischemic heart disease in both sexes; however in women, the pain can be “different” and not a classic left-sided chest pressure-like pain. Instead, it can feel like a mid-back pain, throat pain, breathlessness or unusual and unexplained fatigue as well as upper abdominal pain (epigastric pain) with symptoms similar to those of heartburn. 

Psychosocial factors also play a role in these gender differences. Women take longer to seek health care and pay less attention to their health, which is likely linked to their social roles as mothers and wives. Also, the presence of depression and other forms of mental stress (anxiety, anger, work and marital stress) is higher in women than in men, and it can affect their health seeking behavior negatively as well as lead to poorer outcomes in the presence of heart disease.

What’s the link between heart disease and stroke?

Jamali: The heart and the brain, just like other vital organs of our body are all supplied by muscular walled blood vessels, called arteries. When disease strikes the arteries of one of these organs, it is generally assumed that you are at risk to develop or already have some disease in the arteries of other organs. Not all organs or body parts are affected equally. The disease affecting the arteries of the heart and brain is called “atherosclerosis” which is mainly abnormal inflammation and erosion of the artery wall due to damage from cholesterol buildup as well as from other toxins and disease like smoking and high blood pressure or diabetes.

Another important link between heart disease and stroke is that rhythm abnormalities like atrial fibrillation also increases the risk of stroke by a different mechanism. Atrial fibrillation can cause formation of clots inside one of the heart chambers, which increases the risk of stroke by dislodging from the heart and traveling to the brain. There are several ways to reduce the risk of stroke when you have heart disease. These are best discussed in detail with your cardiologist.

Do younger people really need to worry about heart disease?

Jamali: The demands and stresses of the modern American life weigh heavy on the health of more and more young adults as compared to maybe 50 years ago. Therefore, we are seeing heart disease affect adults in their 30s at times. It all depends on the individual and their risk factors, which include family history of premature cardiovascular disease (disease in a first degree family member before the age of 55 years in men and before the age of 65 years in women).

The current recommendations are that adults aged 20-39 years should get their cardiovascular risk assessed by their primary care physician or cardiologist every four to six years. Developing healthy lifestyle choices, especially related to nutrition and exercise, as well as staying away from smoking and substance abuse, can go a long way in reducing present and future risk of heart disease.

2020 Women in Cardiolgy group photo.

Clinicians pose in the UC College of Medicine to support National Wear Red Day. From left to right: Dr. Anisiia Doytchinova, Dr. Erica Pivato, Dr. Kelly Laipply, Dr. Karen Ohlbaum, Cara Hamre, Kate Romanowicz, Dr. Suzanne Bennett, Dr. Hanan Kerr, Dr. Hina Jamali, Kelly McCormick Kirk, Lauren Rankine and Dr. Florence Rothenberg. Photo by Colleen Kelley/UC Creative Services.

Is there a connection between good sleep and heart health?

Jamali:  A healthy and restful sleep has many benefits for the mind and body. Unfortunately sleep disorders are very common, sleep apnea and insomnia being the most common ones. They affect the duration as well as quality of sleep. Less than seven hours of nightly sleep or more than nine hours of nightly sleep can be of concern. Those suboptimal sleeping patterns are linked with an increase in cardiometabolic risks.

At the forefront is the effect of poor sleep on blood pressure as well as possibly caloric intake. Uncontrolled blood pressure or hypertension, along with obesity, are independent as well as synergistic risk factors for developing stroke, heart attacks and heart failure. If you suspect that you have a sleep disorder or poor sleeping habits, the first thing to do is to make sure you do not have hypertension by visiting your cardiologist or family physician. There, you can discuss further sleep health and related issues like obesity.

Featured image at top: Dr. Hina Jamali is shown in the UC College of Medicine. Photo/Colleen Kelley/UC Creative Services

Urban health is an important priority of UC’s strategic direction known as Next Lives Here. Among the goals is to engage the entire campus community in solving urban issues related to health and well-being, prevention, quality care, researching the next cure, equality in access and talent development.

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