DEFEND A MATTER OF THE HEART

WRITER: RICHARD T. BOSSHARDT, M.D., FACS

It is not our largest muscle but arguably it’s our strongest. It is certainly the most critical. It has held a unique place in human history and culture. Even primitive cultures recognized its importance and ascribed to it such human attributes as courage, strength of character, and love. Its symbolic representation is celebrated every year on Valentine’s Day. It is, of course, the human heart.

Weighing an average of 10 ounces, the human heart is a dynamo, beating an average of 70 times per minute over our lifetime. Over the course of a year, the heart pumps over 600,000 gallons of blood. This workhorse is not immune to problems, however, and heart disease is the leading cause of death worldwide.

Most heart disease comes in the form of what is called ischemic heart disease. A network of blood vessels, called coronary arteries, supplies the heart muscle. In ischemic heart disease, a narrowing of the arteries restricts the flow of blood through these vessels, reducing their ability to supply the heart muscle with needed nourishment. If narrowing reaches a critical point, patients begin to experience symptoms including sharp, dull, pressurelike or crushing chest pain.

When the degree of ischemia reaches a critical point, the heart muscle begins to die. This is a heart attack, medically known as a myocardial infarction, or MI for short. If enough heart muscle dies, you die.

The underlying cause of narrowing of the coronary arteries is the gradual deposition of cholesterol and calcium within the walls of the arteries, a process called atherosclerosis. Risk factors include smoking, high blood pressure, diabetes, elevated blood levels of certain fats and cholesterol, obesity, a sedentary lifestyle, and a family history of heart disease.

Atherosclerosis was once thought to be primarily a disease of aging but this concept was shattered during the Korean War. The war produced a large number of casualties, providing an opportunity to perform an unprecedented number of autopsies on young men mostly in their 20s. To their astonishment, physicians discovered a large proportion of these otherwise healthy young men had significant atherosclerosis in their coronary arteries. They realized the process actually starts relatively early in life, even though it may not manifest clinically until decades later. This underscored the importance of preventative measures early.

Another misconception about atherosclerosis is it is primarily a disease of men, because most heart attacks seem to occur in men. However, with age, the occurrence of heart disease in women rapidly catches up in late middle age, especially after menopause, until it is equal with men. It seems that female hormones protect and delay development of atherosclerotic heart disease. In women, symptoms of heart disease tend to be less typical than for men. As a result, it is often less readily recognized, which can delay the diagnosis.

Once atherosclerosis occurs, it not reversible. Currently, treatment of it involves two approaches. One is angioplasty, whereby the surgeon passes a thin catheter through a puncture in the groin, into a large vein, and all the way into the heart and a coronary artery. The tip is then pushed into the area of blockage and a small balloon at the tip of the catheter is inflated, breaking up the plaque and restoring blood flow. If this is the only procedure, narrowing of the artery can re-occur quickly in most cases. To prevent this, a small, coiled, spring-like device called a stent is left in that part of the artery to act like a scaffold to support the blood vessel wall. Stenting has become extremely common, and most cases of atherosclerosis are now treated in this fashion. Unfortunately, not all patients are candidates for this type of treatment, and even with stents, reoccurrence of narrowing can occur.

The other approach is coronary bypass surgery, a major operation with real risks. In this operation, veins are harvested from the leg and sewn onto the heart, diverting blood around the blocked arteries. Coronary bypass surgery has been refined to the point where success is the rule and long-term results are good. My own father had four vessels bypassed in his 60s and nearly 30 years later, the bypasses were still functioning.

However, both angioplasty and coronary bypass surgery are expensive procedures.

The popular saying, “An ounce of prevention is worth a pound of cure,” has become a cliché precisely because it is true, and never more so than in medicine. The financial cost of treating heart disease alone in the U.S. in 2010 was over $100 billion dollars. And this does not include the cost of lost productivity in the workplace and the human cost in lives lost before their time due to heart disease.

Everyone can lower their risk of heart disease. Perhaps first is to stop smoking or, better yet, never start. Make sure to take care with diet. The worst foods for increasing the risk of heart disease are refined sugar (especially high fructose corn syrup), unbleached flour, saturated animal fats, and transfats.

Also, keep your weight in line with what is recommended for your height. Your body mass index (you can find numerous sites to calculate this online) should be around 25. And don’t forget to exercise regularly.

Unfortunately, you can do everything right and still have elevated cholesterol, high blood pressure, and other risk factors that you cannot control, such as a family history of heart disease. In such a case, you can reduce your risks by following the recommendations of your primary physician for treatment of these risk factors.

In all the discussion surrounding the future of health care, we should acknowledge that reducing the incidences of heart disease just may be the single most important thing we can do individually, and as a nation, to reduce health care costs.