On the Cutting Edge of Heart Disease Prevention & Treatment

WRITTEN BY PEG MOLINE

Coronary artery disease (CAD) affects millions of Americans each year as the leading cause of death for both men and women. However, it is an area of medicine with many breakthrough treatments and technology.

Torrance Memorial Lundquist Lurie Cardiovascular Institute 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 (transcatheter aortic valve replacement ). The technology has evolved, and the quality of the equipment we use has improved by leaps and bounds.”

While doctors are excited about these technology developments, they also have other methods such as 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 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 130 mm Hg or lower.”

The first question is how does one lower their BP? “I always start with lifestyle, nonpharmaceutical steps,” explains Dr. Banka. “More cardiovascular exercise and smaller portion sizes, which can lead to weight loss. Less sodium, caffeine and alcohol in the diet. Stress reduction is also important. 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.”

Whatever the medical approach, Dr. Banka emphasizes the importance of lowering stress. “We try to personalize those recommendations,” he says, “by identifying the causes—work, family, physical and mental health—and find an approach that works for each individual.”

Guidelines from the AHA also challenge the way doctors look at and use blood cholesterol levels. Torrance Memorial Physician Network primary care physician 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.

There’s no doubt preventing heart disease is a prime interest of cardiologists and other doctors, and most agree regular exercise is the best weapon. “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 -- strengthening your heart muscle and revving up your metabolism, which is what keeps everything in check.”

“I recommend a combination of cardio and resistance exercise,” says Dr. Banka. I like my patients to monitor their heart rate and work at 50% to 80% of their max capacity.”

Since being overweight and obesity are risk factors for heart disease, diet also 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 and red meat. Studies have found a higher association between high carbohydrate and red meat consumption and mortality.”

Dr. Shiraz agrees, “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.”

Do you have questions about your heart health? Contact your primary care physician. If you don’t have a doctor, call our physician coordinators at 310-891-6717.

It’s important to know a few key numbers and what they mean. Here is some advice on how to interpret your results—and goals to improve your overall heart health.

LDL—or low-density lipoprotein—is commonly known as “bad cholesterol.” LDL transports the cholesterol that blocks your arteries, putting you at risk for heart attack, stroke and other problems. Ideal number: below 100 m/dL

HDL—or high-density lipoprotein—is often called “good cholesterol.” HDL is effective at removing the bad cholesterol from your arteries, helping prevent blockages and other possible complications. Ideal number: above 45 gm/dL for men and 55 mv/dL for women.

This form of lipoprotein can raise your risk for heart disease, especially if you’re a woman. It is the most common fat in your body and can be affected by diet and medications. Ideal number: below 150 mg/dL

Your BMI is calculated by dividing your weight by your height and is used to estimate the amount of fat your body carries. It can help doctors determine if your weight is dangerously low or excessively high, which could put you at risk for heart issues and other health problems.

This is how forcefully your blood flows through your vessels. When it’s too high, it can lead to serious issues such as heart attack, heart failure or stroke. Eating healthy, getting regular exercise and managing stress can help keep your blood pressure in a healthy range. Ideal number: below 120/80

If your numbers for any of these indicators are in an unhealthy range, treatment options can improve them. It is important to speak with your primary care physician about your options, which could range from lifestyle changes to medication.