By Rhonda Alexander for Sun-Times Media
As an emergency room physician, Dr. Jamie Harlan sees at least three to five patients per shift with chest pain. To say heart disease is rampant in our society is an understatement.
“I think the population knows a lot more about it [heart disease] now, so they are more aware [and this] actually helps us,” said Harlan.
After working as an emergency room physician at Presence Saint Francis Hospital in Evanston for over three years, Harlan has seen the gamut. The good part about patients being more proactive about their symptoms, he said, is that they don’t sit around and wait as much. They take action by coming to the ER where tests can be done. This has resulted in earlier diagnosis and that helps doctors improve mortality rates.
According to the American Heart Association, heart disease is the number one killer for all Americans, yet the prevailing majority of Americans don’t see heart disease as their greatest health threat.
Heart disease is no longer a death sentence
Despite the fact that heart disease and the preceding symptoms are at epidemic levels, Dr. Mark Goodwin says the mortality rates for heart disease have declined over the last several years.
“There’s been a 25 percent decrease in the instance of death and morbidity from cardiovascular disease in the last 10-15 years,” said Goodwin, interventional cardiologist with Edward Hospital and Midwest Heart – Advocate Medical Group in Naperville.
Most likely, this is due to several factors – earlier detection being one of them; the number of different stress tests and imaging tests that are now available make it easier to diagnose heart disease at an earlier age.
Who does heart disease affect?
Coronary disease and stroke are the leading cause of death in South Suburban Cook County, according to Sandy Mickulich, Nurse Practitioner at Advocate South Suburban Hospital in Hazel Crest .
However, women are disproportionately affected. One in three women die of heart disease each year.
“Women tend not to access healthcare because they are the care givers,” said Mickulich.
She says women – even though they have chest pain or they have symptoms of heart disease – will not go and get help until it’s too late.
Mickulich sees the disease up close on a daily basis since she’s in the trenches everyday running Advocate’s South Suburban Heart Failure Clinic.
Dr. Goodwin notes that the face of heart disease also looks a lot younger than in previous years.
“It’s not uncommon for us to see people [with heart disease] in their 40s and even someone in their 30s,” said Goodwin.
Smoking – Don’t think you don’t have a chance because you smoke. It’s never too late to quit, which will greatly reduce your risk.
“If a patient stops smoking, they can significantly reduce their risk,” said Matthew Sorrentino, MD, FACC, FASH at University of Chicago’s School of Medicine in Chicago.
High Cholesterol – The build up of plaque that occurs as a result of the bad lipids in the blood narrows the arteries and can lead to a heart attack or a stroke.
“Bad habits accumulate over time like the plaque in our arterial walls … over time, we are more likely to develop heart disease,” said Jean Owen Alves, MS, RD, LDN registered nurse and nutritionist for the Rush Nutrition and Wellness Center in Chicago.
High Blood Pressure – Having high blood pressure can lead to complications such as PAD, peripheral artery disease, a condition caused by a narrowing of blood flow to the arms and legs. Complications such as chronic pain, ulcers, gangrene and even amputation of the feet and legs can result if the condition is left untreated.
Diabetes – Preventing type 2 diabetes begins with proper diet and exercise.
“Nutrition and physical activity are both key to preventing heart disease,” said Owen Alves.
She is a big proponent of prevention and believes prevention is always better than treatment.
Family History – Previous schools of thought always leaned on family history as a mitigating factor in whether or not you will “inherit” certain diseases, but Harlan emphasized that family history has two components to it.
“You have a genetic component … and also the psychosocial component, which is what we learn from our parents and family members,” said Harlan.
Harlan believes the psychosocial component is even harder to overcome than the genetic component because it involves unlearning behaviors that have become an innate part of our being.
Behaviors become a part of who we are. Once you learn something and it becomes a part of you, the motivation to unlearn bad behaviors often don’t come until near catastrophic events such as, heart attacks and strokes occur.
Is any demographic more at risk?
Even though the American Heart Association lists heart disease as the leading cause of death for African American women ages 20 and older, the consensus of those interviewed is split right down the middle on whether or not ethnicity plays a role in heart health. Statistical evidence suggests obesity, diabetes, whether or not you smoke, your exercise and nutritional habits as well as family history determines your susceptibility to heart disease.
However, since 63 percent of men and 77 percent of women who are non-Hispanic and African American have the obesity risk factor, the evidence leans in favor of ethnicity playing a role in having heart disease.
Prevention is key
Know your numbers – Knowing your lab values such as blood pressure, cholesterol, blood sugar, height, weight and BMI (Body Mass Index) goes a long way when it comes to having a healthy heart and knowing where you stand.
Diet – Goodwin believes this is primarily due to what we choose to eat. The ready fix available – although isn’t as easy as it sounds – is radical, yet simple, but will require intestinal fortitude that everyone can access.
“It’s like in life, that balance … the 80/20 rule … 80 percent of the time, we need to be making good, healthy choices,” said Goodwin.
He stressed that we have to realize that we can’t have pizza one day, a hot dog the next day and sausage the next meal, but going out to enjoy a nice meal with your family one night in a week is an occasion to indulge in occasionally. If overindulgence continues, that will undoubtedly create problems over time.
Don’t Smoke – This is self-explanatory and easier to cease – even though it can be an addiction – but is easier to simply quit altogether instead of having to maintain a delicate balance – as is the case in nutrition since everyone must eat to live.
Exercise – If patients are able and don’t have issues with lower extremities, exercising can be as easy as shopping.
“Grab a cart at Wal-Mart, pretend you’re shopping – you don’t have to – and just walk,” said Mickulich.
Family history – Family history matters, but that just means you have to be more diligent in a good lifestyle program to overcome genetics.
“Premature heart disease is usually the development of some sort of heart condition under the age of 60 in a parent or brothers and sisters,” said Sorrentino of the genetic component to family history.
Barriers to treatment
Knowing that you have access – no matter your financial or health insurance situation is one of the biggest challenges.
People are afraid they can’t afford things. Lower socioeconomic areas and underserved areas where individuals don’t have access to information about treatment, prevention and other components they need to arm themselves against heart disease creates barriers that don’t have to exist.
“Certain groups are possibly underserved and undertreated which creates a prevalence of heart disease,” said Sorrentino.
Connections to other major health issues
“[High cholesterol, obesity, heart disease, diabetes] … it’s all intertwined,” said Mickulich.
“But if you lose 10 percent of your body weight, you can decrease your blood pressure … and if you lose weight, you decrease your risk of developing diabetes.”
Another condition that may be overlooked when screening for heart disease is kidney disease.
Prakash Makam, cardiologist and medical director of the Peripheral Arterial Disease Center at Community Hospital in Munster, Indiana hasn’t noticed ethnic predominance, which has dominated the statistics in many studies due to the traditional carbohydrate-laden diet of some ethnicities such as the Hispanic and African American populations; but he’s quick to affirm that the presence of kidney disease makes some more prone to diseases related to poor heart health.
“People with kidney disease are prone to PAD … as it is a disease of the arteries,” said Makam.
When you mention the phrase, heart disease, it sounds like a subject that is complicated and difficult to understand, but it really isn’t.
In reality, heart disease boils down to the basics – most important – know your numbers. The second is to realize that a barrier such as financial hardship or lack of insurance doesn’t have to prevent you from taking care of your health. (Unless you take control and know your numbers … access healthcare, there’s just no way of knowing what’s coming down the road for you, so you have to take control of your own destiny.)
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