Get to the Heart of the Matter

Heart disease is the No. 1 cause of death for both men and women in the United States, claiming approximately 1 million lives annually, according to the Heart Foundation. 

Now is the best time to take control of your heart health, regardless of age or family history. Leading cardiologists from Cincinnati’s healthcare networks share expert advice for maintaining a healthy heart. 

The preventative power lies in lifestyle modification. “There’s nothing magical about prevention and reduction of cardiovascular disease,” says Kami Tehrani, DO, a cardiologist at St. Elizabeth Heart & Vascular Institute. “At least 80 percent of heart disease is preventable and risks can be drastically reduced by adopting a healthier lifestyle.” 

A healthier lifestyle doesn’t equate a strict regimen, but rather a balance of increased activity and better food choices. Experts agree that sedentary habits are a breeding ground for numerous ailments, including vascular issues.  

“My 90-year-old patients are healthy because they’re active; physical activity is incredibly important,” says Simon C. Jung, MD, a cardiologist with the TriHealth Heart Institute. “Incorporate several different exercises you enjoy, like cycling, walking, swimming and hiking – it’s about being all-around active.” 

The American Heart Association (AHA) recommends a minimum 30 minutes of moderate-intensity aerobic activity at least five days per week or at least 25 minutes of vigorous aerobic activity three days per week. Two days a week of muscle-strengthening activity has shown additional health benefits. 

This is not the time for all-or-nothing thinking, either – any exercise is better than none and everyone has to start somewhere. Approximately 250,000 deaths per year in the United States are attributable to a lack of regular physical activity, as outlined by the AHA. Exercise is one of the most effective and safest ways to prevent chronic illnesses, including heart disease. 

Children, and certainly their parents, also need to understand the importance of adequate exercise. The American Academy of Pediatrics states the daily recommendation of physical activity for children ages 6 and up as 60 minutes. 

“Sometimes people confuse that recommendation with what adults consider 60 minutes of exercise, but for a child it means active play,” says Nicolas L. Madsen, MD, MPH, University of Cincinnati Department of Pediatrics at Cincinnati Children’s Hospital Medical Center. “Playing tag, climbing on a playground structure or going to soccer practice – all those minutes count and they don’t have to be consecutive.” 

A study conducted by the New England Journal of Medicine revealed that switching to a Mediterranean diet could prevent about 30 percent of heart attacks, strokes and deaths from heart disease. The menu for a Mediterranean diet consists of nuts, legumes, fruits, vegetables, fish and plenty of olive oil.     

Similarly to physical exercise, minimal changes in an individual’s diet can have a significant impact on heart health. “A realistic approach in our society is to control portion size, limit intake of saturated fatty acids, simple carbohydrates and completely remove trans fatty acids from our diet,” says David G. Babbitt, MD, a cardiologist with Mercy Health Physicians. 

Nutrient-rich foods should be selected over fat, trans fat, sodium, red meat, sweets and sugar-sweetened beverages, according to the AHA. A healthy diet emphasizes fresh fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes and non-tropical vegetable oils. 

“Eat well, remember (author) Michael Pollan’s seven-word dietary advice: ‘Eat food. Not too much. Mostly plants,’ ” says Charles Hattemer, MD, professor of clinical medicine at UC College of Medicine. “Consider the powerful effects of becoming truly healthy.” 

Another important component of vascular health includes awareness of risk factors and understanding what they mean. “The risk for heart disease can be determined by a number of well-defined factors, including a family history, high blood pressure, diabetes, elevated cholesterol, weight and level of physical activity,” says Richard C. Becker, MD, Chief, Division of Cardiovascular Health and Disease; Director UC Heart, Lung and Vascular Institute. “Based on risk calculated by a primary healthcare provider, efforts and at times medications, can be recommended to lessen the chance of a heart-related event such as a heart attack.” 

Robert O’Donnell MD, UC Division of Cardiovascular Health and Disease, says the primary health physician is on the front line of prevention. “A thorough history and physical examination will help stratify patients into different risk groups. Labs such as a fasting lipid panel will further classify patients.” 

According to the World Heart Federation, the leading risk factors in terms of global deaths from cardiovascular disease (CVD) include raised blood pressure (13 percent), tobacco use (nine percent), raised blood glucose (six percent), physical inactivity (six percent) and obesity (five percent). 

The majority of CVD is caused by risk factors that can be controlled, treated or modified. Modifiable risk factors include hypertension (high blood pressure), tobacco use, raised blood glucose (diabetes), physical inactivity, unhealthy diet, cholesterol/lipids and being overweight. 

There are, however, some risk factors that cannot be changed. Individuals in high-risk categories are strongly advised to receive regular check-ups in order to track  issues. High-risk categories include advancing age, gender (men are at greater risk of heart disease than pre-menopausal women) and a family history of CVD. 

Additionally, congenital (present at birth) heart defects are the most common types of birth defects. Nearly one in 100 babies are born with a heart defect in the United States each year, according to March of Dimes. About one-third of those cases are severe enough to require some sort of surgical intervention during their first year of life to ensure survival. 

“Fortunately, medical advances in the last three to four decades have been so great that the fatal diseases have turned into conditions that patients can live with for a lifetime,” says Dr. Madsen. “Some anatomical conditions may not be able to be reversed, but with a healthy lifestyle, the child can go on to live a ‘normal’ life.” 

Dr. Madsen says children born with congenital heart defects present a challenge, but also an opportunity to significantly impact the course of a patient’s future. “Most of the time we meet our patients as newborns due to birth defects, so we have the ability to follow them throughout the years, watching them grow and eventually lead successful lives. That’s very fulfilling. We want to ensure not only survival, but also a high quality of life for this population.” 

The future of cardiovascular medicine is constantly evolving as more research is conducted and breakthrough treatments are created. For cardiology experts, however, one of the most rewarding aspects would be a rich partnership between physicians and patients. 

“I hope to see patients take more control of their care and not rely on medications,” says Joel B. Forman, MD, a cardiologist with The Christ Hospital. “We make hundreds of decisions each day and have the ability to steer toward healthy choices. A passive approach to healthcare doesn’t work.”     

Patrick Lytle, DO, a cardiologist with Kettering Health Network, agrees. “From a preventative standpoint, I would love to see people become more active in their health and really start participating in it. We need more of a partnership in every branch of medicine.”