Guest Column

Don't take heart health for granted

By M.P. Ravindra Nathan
Published February 25, 2008

February is American Heart Month and a good time to take a look at the health of the most vital organ in your body. Is it working well? Are you at risk for future problems and how can we prevent them?

First, a story from my personal experience. Ralph, only 65, was referred to my office for consultation because of an abnormal electrocardiogram (EKG). He had three short episodes of mild chest discomfort in the past month, which he thought was indigestion. Yes, the EKG showed some changes, so I advised him to get admitted to the hospital and have some tests before this got out of hand. He wasn't convinced, but finally relented. It turned out he had a severe blockage of one main coronary artery. With an angioplasty and a stent implant, he went home in three days, fully recovered.

In 2004, at the age of 58, former President Bill Clinton suddenly developed tightness in the chest while he was coming back from an extended tour promoting his autobiography, My Life. He had experienced similar symptoms before, especially on exertion, which he attributed to exhaustion. He consulted his cardiologist and soon had an angiogram that showed 90 percent blockages in two arteries. "I was a heart attack waiting to happen," he confessed. The story of Clinton's operation, although a media event, was a teaching moment for the entire nation.

In spite of all the advances in preventive care, the epidemic of heart disease continues unabated. An estimated 79.4-million Americans have some form of cardiovascular disease (CVD): heart attacks, strokes, angina, heart failure, etc. Many suffer from more than one type. Coronary heart disease (CHD), which affects more than 15-million Americans, is the leading cause of death in the United States and results in frequent hospitalizations and permanent disability. In 2008, the direct and indirect costs associated with CHD could surpass $150-billion.

The underlying cause of CVD is a process called "atherosclerosis," simply called hardening of the arteries. This means plaques are accumulating within the lining of your coronary arteries that supply blood to the heart muscle. These plaques consist of several blood constituents notably cholesterol, platelets and calcium. Some of them, so-called "vulnerable" plaques, are prone to rupture, leading to sudden heart attacks and deaths.

So, are you at risk?

For many people, the wake-up call comes too late. Heart disease can creep up without any warning. Hence, the question you should be asking is, "Am I a possible candidate for future heart problems? What can I do to prevent or at least postpone this dreadful disease?"

Physicians currently assess a person's risk for heart attacks, strokes, etc., on the basis of individual risk factors. For example, if you have high blood pressure, it would be considered a significant risk factor. Add a high cholesterol level and cigarette smoking to that, and the risk becomes higher. But a new assessment tool could gauge the risk of a range of future cardiovascular diseases at one time, according to several recent clinical studies. This global risk assessment, based on "Framingham Risk Score," can estimate better a 10-year CHD risk in men and women.

Here is how it works. A certain number of points are allotted for each of these health conditions according to its importance in an individual and the final count is tabulated. The conditions incorporated into this scoring system are: age, levels of total cholesterol, high-density (good) and low-density (bad) cholesterol, systolic BP, treatment for high BP, smoking, family history, presence of obesity/overweightness and presence of diabetes mellitus.

Among the top risk scorers, 60 percent of women and 49 percent of men developed CVD, suggesting that this risk scoring system has high predictive accuracy, as attested by several clinical studies. This simplified system also allows your doctor to estimate a quantitative prognosis in the examination room with a simple general prediction for future events.

Good health is the cornerstone for progress. Are you eating at least three servings of fruits and vegetables and doing regular workouts, as you are supposed to? And have you quit smoking? If not, the consequences can be quite costly. The Florida Medical Association wants you to know that "coverage of cardiovascular screening blood tests is provided as a Medicare Part B benefit. The beneficiary will pay nothing for the screening blood tests."

So, please, consult your doctor and find out your own risk for future heart disease. As Arthur Agatston, M.D., the famous preventive cardiologist and author of the popular bookThe South Beach Diet said, "Many high-risk patients can achieve astonishing turnarounds."

M.P. Ravindra Nathan is a Brooksville cardiologist. Guest columnists write their own views on subjects they choose, and do not necessarily reflect the opinions of this newspaper.

[Last modified February 24, 2008, 21:55:16]