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10
HEALTHY LIFE
HEART & STROKE
May 1-2, 2013
By KARA HANSEN MURPHEY
Pamplin Media Group
F
or 50 percent of people with heart dis-
ease, a heart attack or cardiac death
is the first symptom. But there are
some red flags to watch out for, as
well as ways to reduce your risk.
When people say “heart disease” they are
usually talking about coronary artery dis-
ease, which develops when fat accumulates in
the walls of the arteries and, over time, can
restrict how much blood gets to the heart
muscle, said Dr. Michael
Shapiro, medical director
of Oregon Health & Sci-
ence University’s heart
disease prevention pro-
gram.
Someone with a block-
age forming in their heart
arteries might experience
chest pain or pressure
when exerting themselves
through exercise or under-
going emotional stress.
Angina, also sometimes
described as a heaviness of the chest, is typi-
cally felt below the breastbone. Sometimes it
radiates from the middle of the chest down
the left arm, possibly causing numbness,
swelling or a tingling sensation in the left
hand. Pain also might radiate from the jaw.
Some people feel nauseous, vomit or become
sweaty. Shortness of breath and fatigue are
additional signs.
“These are all classic symptoms,” Shapiro
said.
He said women are less likely to have symp-
toms but, when they do, they tend to more
commonly feel jaw, abdominal or chest pain.
“What gets us very concerned is if there’s
an abrupt change with symptoms, where the
pain comes on more
easily, lasts longer
or doesn’t go away,”
Shapiro said. “Or if
it comes on with
rest, or if an individ-
ual who never had
these before, all of a
sudden has these
symptoms, that’s a
sign of heart at-
tack.”
Know the risks
While many peo-
ple with heart dis-
ease don’t have ad-
vance warning,
health care provid-
ers can help assess
your risk.
Doctors have
long understood
that diabetes, elevated blood pressure, high
cholesterol and smoking cigarettes are com-
monly associated with heart disease. Obesity
also increases risk, while exercise decreases
it.
Men 45 and older and women 55 and older
are at a higher risk of developing heart dis-
ease. That age gap might be explained by es-
trogen production, Shapiro said, which ap-
pears to be somewhat protective, delaying the
appearance of coronary artery disease in
women.
Doctors can count these factors and plug
them into an algorithm to score how likely
someone is to die from a heart attack or heart
disease in the coming years. This approach to
assessing risk, however, has some limitations
despite its longstanding success.
“It underestimates risk in younger individ-
uals and in women,” Shapiro said.
For that reason, doctors sometimes per-
form more advanced screening tests, using
blood tests that go beyond the standard cho-
lesterol check or taking a picture of a per-
son’s heart arteries to identify individuals
who might be developing heart disease with-
out experiencing any conventional symp-
toms. National guidelines recommend
screening for adults age 20 and older.
“We can identify individuals who may not
have any symptoms at all. ... The thought is, if
we intervene early enough we may be able to
prevent the adverse consequences of this dis-
ease,” Shapiro said of the more advanced
screening methods. “If we can identify people
at risk before they have their event, we can
go a long way in either delaying their event
or preventing it from happening at all.
“If we wait for symptoms, we’ll only help
half of the people. That’s why screening
makes sense.”
Prevention is key
The good news is that many risks can be
mitigated through lifestyle changes such as
diet, exercise and weight management, or
medication — even if you already have some
plaque built up in your arteries.
“Fortunately, in individuals who lead a
healthy lifestyle and have good control of
their risk factors ... you don’t necessarily
need to make those plaques go away,” Shap-
iro said. “What you need to do is stabilize
those plaques, to make them less vulnerable
to rupture and less inflamed.”
The program at OHSU employs a physi-
cian’s assistant who provides patients with
lifestyle counseling, including making exer-
cise and dietary recommendations, and of-
fers smoking cessation counseling.
In all but about 5 percent of people with
heart disease, the condition is preventable,
Shapiro said.
“For the vast majority of people this is a
lifestyle disease, and if they’re developing
good lifestyle habits at a relatively young age,
they’re likely not to get into trouble,” he said.
“Anybody who is concerned about heart dis-
ease can certainly work with a provider who
has experience or interest in this area to
come up with a custom-made approach for
that individual to determine what their risk
might be, and, if it’s higher, then we’d like to
come up with a plan to drastically reduce the
risk.
“It’s far easier to prevent this disease than
to treat manifestations of it.”
■
Many factors can
be controlled to prevent
coronary disease
Know warning signs,
RISKS OF HEART
DISEASE
SHAPIRO
Smarter phones
Cellphones and mobile devices do a lot
more than connect people in different
places. These days, they’re increasingly
used as tools to track personal health,
including cardiac health.
Dr. Michael Shapiro of the heart disease
prevention program at Oregon Health &
Science University is enthusiastic about the
ways new technology might reshape health
care.
“We’re just on the tip of the iceberg here,”
he said. “The reality is, in the next five years,
we’re going to see an explosion in technolo-
gy. ... People are going to be able to have all
of this health information and be able to
track their own progress, to use that feed-
back, and share it with their providers.”
Documenting so much information will
allow doctors to provide more personalized
medical care and make better recommenda-
tions, he said.
Additional applications provide education
about general health or help people respond
to medical emergencies.
A few apps already out there:
■
Heart Health Mobile, by the Marshfield
Clinic, recently won The Million Hearts Risk
Check Challenge, a government-sponsored
competition that called on developers to
create mobile applications that help people
reduce their heart disease risk by managing
factors such as blood pressure and choles-
terol. Heart Health Mobile allows users to
enter height, weight, cholesterol and blood
pressure readings. They can track their prog-
ress over time and share it with physicians.
■
Cardiio is an app that works with the
cameras on iPhones and iPads, recording
light reflected from our face to measure your
heartbeat.
■
AliveECG requires the special AliveCor
Heart Monitor, essentially a case that trans-
forms your phone into a portable electrocar-
diogram, and it’s among programs being
used in a new heart health study involving
up to a million people.
Based at the University of California, San
Francisco, the new effort has been com-
pared to the Framingham Heart Study, an
ongoing 1940s initiative that helped develop
much of what we know about cardiovascular
disease risk factors today. The UCSF study
will arm people with mobile apps to mea-
sure heart rate, blood pressure and pulse
rate and transmit the information to a data-
base to improve prevention and treatment of
heart disease.
■
PulsePoint, developed by Tualatin Valley
Fire & Rescue, alerts subscribers who indi-
cate they are trained to provide CPR when
someone is in cardiac arrest nearby.
■
Pocket First Aid & CPR, from the American
Heart Association, provides instructions,
including videos, for a variety of emergency
situations, including cardiovascular emergen-
cy care.
WHAT TO CHECK
AND WHEN
■
According to the
American Heart
Association, blood pres-
sure should be checked
at least every two years
and more often if you
have high blood pressure.
Cholesterol and triglycer-
ides should be looked at
least every five years
starting at the age of 20.
They should be checked
more often if you have
other cardiovascular risk
factors, including if you’re
older. Starting at 45
years old, your blood glu-
cose level should be
checked at least every
three years.
DREAMSTIME PHOTO