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Healthcare Experts Zero In On Heart Disease Prevention, Treatment

Cardiovascular Disease Still The No. 1 Killer For Men And Women– And The Costliest

By Sean Belk - Staff Writer

February 14, 2012 - With fewer people smoking and more advanced medicines available, the rate of deaths attributed to heart disease has declined sharply over the last few decades, according to national health statistics.

But, local cardiologists and healthcare professionals say there’s no denying the fact that heart disease is still the leading killer in the United States for both men and women and remains the most expensive burden on America’s healthcare system.

Dr. Fernando Mendoza, an interventional cardiologist for Los Alamitos Medical Center,
conducts a carotid intima-media thickness (IMT) test on a patient. The test assesses a
person’s risk for heart attack or stroke noninvasively without the use of radiation.
(Photograph by the Business Journal’s Thomas McConville)

Although milestones in research, technological advancements and educational outreach have reduced the prevalence of heart disease and stroke among today’s population, rising health problems such as obesity, hypertension (high blood pressure), and diabetes, among other risks, pose new challenges for maintaining a healthy heart.

Every February, a wave of advertisements, programs and events during “American Heart Month” reminds us that more progress needs to be made in the public’s awareness of the risk factors of heart disease, and the fact that, if treated early, the onset of this costly, silent killer may be prevented.

There are about 7.5 million Americans living with cardiovascular disease today, according to the latest statistics from the American Heart Association (AHA). The AHA lists the leading risk factors for heart disease and stroke as: family history and genetics; smoking; high blood cholesterol; physical inactivity; being overweight or obese; and diabetes.

Between 1998 and 2008, the number of deaths in the U.S. attributed to cardiovascular disease declined 30.6 percent, according to the latest statistical update by the AHA. That’s good news; however the burden of the disease is still high, accounting for one in every three deaths in the United States. Controlling the traditional risk factors remains an issue for many Americans.

“We’ve certainly made some tremendous impact, but we haven’t tackled the problem completely,” said Dr. Khiet Hoang, an interventional cardiologist and associate medical director of the Coronary Care Unit at the Long Beach MemorialCare Heart & Vascular Institute. He said the center conducts more than 450 cardiac surgeries, 3,500 coronary catheterization lab tests, and 1,500 noninvasive procedures to treat and diagnose heart disease every year.

Although common, heart disease is largely preventable, he said, which is why it’s important to get screened for risk factors before ever having to undergo treatment or be admitted to the emergency room for a heart attack or a stroke. “In the business of heart attacks, time is important in terms of saving muscles, which will then save heart function and prevent heart failure in the future,” Hoang said.

Knowing Your Risk Factors

Aside from the rapid growth in medicines to treat risk factors such as high cholesterol and blood pressure, another reason for the decrease in heart disease is that fewer people are smoking today than decades ago.

Since the advent of federal warnings and smoking bans in public areas, there’s been a steady decline in smoking since the 1960s. For many, quitting smoking significantly decreases the risk for heart disease, and people are likely to see an “immediate impact” from smoking cessation, Hoang said.

Smoking is one of the top risk factors for cardiovascular disease because it causes inflammation, hardening and stiffening of the lining of the blood vessels in the brain, the heart and throughout the body, leading to increased risk for stroke and heart attack, he said.

Smoking also increases the chance for peripheral arterial disease, a plaque build up in the arteries that obstructs blood flow to the head, organ and limbs. This can cause pain when walking and eventually lead to amputation. “Smoking is dangerous and something that we really have to preach and encourage our patients to stop and stay away from,” Hoang said.

Although coronary heart disease was once thought to be a problem affecting primarily men, recent research and studies show that women are just as vulnerable to the risk factors.

Dr. Henry Van Giesen, an interventional cardiologist and medical director for Cardiac Rehabilitation and the Women’s Cardiac Health and Research Center at Long Beach Memorial Medical Center, said heart disease is the No. 1 cause of death for women, above breast and lung cancers. “Most people recognize that, if you look at the statistics out there, heart disease is the leading cause of death for both men and women in this country,” he said.

Women tend to display slightly different symptoms than men and they also develop heart disease later in life, possibly due to elevated hormone levels during menopause, Van Giesen said. He added that the rate of occurrence of heart disease in women post menopause eventually catches up to men’s incidents, typically when women are in their 50s.

The most common symptoms of heart disease among women are: chest pains; palpitations or the feeling of heart skipping; fatigue; shortness of breath; and poor exercise capacity, Van Giesen said. Also common among women are hypertension, diabetes and high cholesterol. For men, symptoms include: chest pains, often described as an “elephant sitting on your chest;” discomfort in the neck or arm; shortness of breath; indigestion; or jaw pain.

Aside from yearly health check ups, Van Giesen recommends that men should start getting screened for heart disease by at least age 45, while women should start getting checked no later than age 55.

In addition to their own insurance plan and personal doctor, women can visit the Women’s Cardiac Health and Research Center at Memorial Medical Center, which currently provides screenings for as low as $55 along with other heart care, even for women who have no prevalent symptoms.

The center, which was partly developed to establish a database for women’s heart cases, offers a comprehensive cardiovascular evaluation that includes an electrocardiography test, checking blood lipid levels, including high and low density lipoprotein, and blood sugar. A score is given to determine a person’s risk for heart disease over the next 10 years.

The Women’s Heart Screening Program at Community Hospital of Long Beach also provides heart disease screenings for women, costing only $20 for a one-hour screening.

Claudia Keller, executive director of the Los Angeles Chapter of the AHA, said awareness of women’s heart health has increased from less than 20 percent of women to upwards of 60 percent since the association began its campaign in 2004 to educate women about the risk factors of heart disease.

While there’s still more progress to be made, she said, “We have made tremendous headway over the last decade in letting women know, not only what their risk factor is for heart disease, but how to manage the risk factors and how to lead a healthy life,” she said.

In Los Angeles County, mortality rates from heart disease and stroke for both men and women decreased significantly over the past decade, according to the latest statistics from AHA officials. However, heart disease mortality remains 12 percent higher in L.A. County than for the U.S. as a whole.

Health factors in at-risk urban areas, such as South L.A., East L.A. and parts of Long Beach show heightened incidents of obesity, hypertension, high cholesterol, poor nutritional choices and lack of exercise, Keller said. The AHA also points out that risk factors linked to family history and environment are higher among certain ethnic groups, such as diabetes being disproportionately higher among African American and Hispanic individuals.

Whether these traits are tied to environmental issues or personal health factors is still unclear, she said. But Keller added that, “We do know that poor areas, where people don’t have access to healthcare are harder hit by cardiovascular disease than in areas where access to healthy food, access to healthcare and access to information is much more available.”

Ron Arias, director of the City of Long Beach Department of Health and Human Services, said the city has been working to address cardiovascular risk factors in underserved areas of the city by taking such actions as being one of the first cities in the state to ban smoking in public areas and, more recently, implementing healthy eating standards in schools.

He said higher risk factors, such as obesity, smoking and diabetes, seen in predominantly low-income areas, are primarily caused by lack of higher education, family history and less access to healthy sources of food. Smoking is still prevalent among about 12 percent of the population in the city and Los Angeles County, Arias said.

The health department is now hoping to turn around those statistics through promoting physical activity and increasing educational awareness about all of the primary risk factors of heart disease, said Dr. Mauro Torno, the Long Beach health department’s interim health officer.

“The common denominator is addressing all of the issues in a holistic global approach that we have programmed here at the health department, aimed at promoting healthier eating, smoking cessation, decreased weight and encouraging physical activity,” he said. “There has been a down trending in the prevalence of heart disease and morbidity over the years and a good portion of that ... is due to more education and more rigorous attacks on risk factors at the community level.”

Ways To Stay Heart-Healthy

A major emphasis of American Heart Month is promoting preventative measures people can take to avoid heart disease later in life, and making these measures a daily routine all year round, said healthcare experts.

Dr. Amar Kapoor, director of cardiology at St. Mary Medical Center and president of the Heart Mind Body Institute, has formulated a program of prevention, involving detoxification, reversal diet, lifestyle optimization, meditation and “heart yoga.”

He said today’s society is bombarded by unhealthy processed foods and environments that promote bad eating habits, less physical activity and new forms of stressors that all greatly increase a person’s chance of developing heart disease and sudden cardiac death.

“Despite our absolutely sophisticated technology, diabetes is going up, high cholesterol is going up and there is an epidemic in obesity,” Kapoor said. “It is all related to our dietary indiscrecions and being loaded with new stress, which we cannot evaluate by measuring in any lab.”

The heart is also tied to the brain, which is why it’s important to consciously work on meditation and yoga to reduce stress that medications are often unable to alleviate. Studies show that negative thoughts develop negative hormones, which can increase cortisol levels and blood pressure, he said.

“The heart is a living, breathing, thinking, emotional organ, not just a pumping organ,” Kapoor said. “If you relax and meditate and get the negative thoughts out of your stream of thinking, you become a nice, peaceful person inside ... The mind is such a powerful weapon that you can train it for your benefit or it can become burdensome.”

Daily exercise and physical activity is also important for preventing heart disease and stroke, said Dr. Douglas J. Killion, the medical director and chief of staff for Kaiser Permanente’s South Bay Medical Center, which serves 200,000 member patients in the local region. “If you can get out and walk 20 minutes a day, you’re being very friendly to your heart,” he said. “We can recommend that to all individuals of all ages.”

Dr. Steven Forman, an interventional cardiologist for Los Alamitos Cardiovascular, a private medical practice working in conjunction with Los Alamitos Medical Center, said people who exercise regularly are generally less heavy and, therefore, have less chance for high blood pressure and diabetes.

To maintain a healthy heart, he recommends a “low fat, low cholesterol diet” of mainly chicken, fish, fruits and vegetables, and to avoid saturated red meats and junk food.

“If you don’t smoke and you eat right and exercise, the likelihood that you’re going to wind up in a cardiologist’s office or in the hospital with a heart attack is going to be significantly lower,” he said. Killion said getting screened and treated early on for risk factors is also imperative to reducing the high healthcare costs associated with heart disease. According to the AHA, the total direct and indirect cost of heart disease and stroke in the United States was estimated at about $297 billion in 2008, mainly due to prolonged hospital visits, surgeries and required home care, costing more than any other diagnostic group.

Prevention is one of the major focal points of federal healthcare reform, Killion said, hoping it will help increase the availability of doctor visits and screenings by opening up access to health insurance to more people and cutting down on emergency visits related to heart disease. “Whatever can be done on the preventive side can have long-term cost savings for society,” he said.

From an overall economic standpoint, Killion said spreading the importance of heart health awareness among both private and public sector employees is vital to a productive society. “The more employees can be kept healthy with diet, nutrition, being screened and treated for any of these conditions ... leads to a more healthy and productive workforce,” he said.

Advancements In Treatment

Treatment for men and women who live with heart disease also continues to be a key focus in the medical field. Dr. Fernando Mendoza, a cardiologist at Los Alamitos Medical Center, said the chances of surviving from heart disease today has increased significantly over the last 20 years due to advancements in treatment.

There are a number of tests that can now more accurately diagnose heart disease symptoms in the body. Common tests include echocardiograms and treadmill stress tests.

Another such test is called a C-reactive protein, or CRP, test, which measures the amount of a protein in the blood that correlates to levels of inflammation in the body. High levels of CRP may be a sign of infection or long-term heart disease.

A carotid intima-media thickness test measures cholesterol by conducting an ultra-sound in the neck arteries that reflects what’s going on in all arteries, including the heart’s, Mendoza said. Such tests, he said, assess a person’s risk for heart attack or stroke noninvasively and without the use of radiation seen in other coronary tests. There also has been more focus on, and advanced treatment for, atrial fibrillation, a condition affecting the rate or rhythm of the heartbeat, Mendoza said.

Forman, who is currently representing Los Alamitos Medical Center in a statewide, three-year research study on cardiac interventions, said that cardiac CT scans are now far more advanced than former angiograms or X-ray tests of blood vessels.

With advancements in treatments such as angioplasty, valve replacements and stents (used in treating coronary blockages), fewer patients go through the dangers of bypass surgery, Forman said. Additionally, he said, some patients exhibiting varicose veins can now be treated with a radio frequency procedure known as ablation instead of surgery.

Long Beach Memorial Care Center has long been recognized as a leading medical institution for heart disease related studies and research. The hospital’s heart and vascular institute currently has 15 ongoing research trials, with some involving clinical trials for new medicines, Hoang said.

One research trial, known as the ALERTS study, includes investigating the safety and effectiveness of a new implantable device, known as the AngelMed Guardian System, designed to provide patients with early warnings of a possible heart attack. So far, 19 patients have participated in the study since it started in 2009, he said.

On a national level, the AHA is considered the second largest source of funds for cardiovascular research after the National Institutes of Health. The AHA spent $132 million on research in 2009, and nearly $5 million in heart research was spent last year through the Los Angeles division alone, according to AHA statistics.

“We help fill in the gap and we help make sure that the research funding stream stays strong,” Keller said. “But, we always urge the federal government to earmark more dollars to cardiovascular disease because it is the No. 1 killer in America ... There’s all kinds of opportunities to not only take care of your own heart health, but to promote health and wellness in the community, because everybody benefits from everybody else being healthier.”

For more information on heart health resources and events during American Heart Month, visit www.heart.org or call the AHA Los Angeles Chapter at 213/291-7000.