Since 1963, each February is designated American Heart Month by presidential proclamation in order to renew our commitment to fighting cardiovascular disease by increasing public awareness. Yet heart disease is still the leading cause of death in America. “Despite all the information available regarding cardiovascular risk and prevention, the prevalence of risk factors such as elevated blood pressure and cholesterol in the United States remains high,” says Dr. Denise Janosik, associate professor of medicine in the division of cardiology at Saint Louis University and medical director of the SLUCare cardiology practice in University Club Tower.
A report published in a major cardiology journal last fall noted that while death rates from heart disease have decreased in the last 25 years, the decline is slowing and may even be reversing among middle-aged Americans. Similarly, although the American Heart Association (AHA) already met its goal of a 25 percent reduction in heart disease deaths from 1999 through 2010, the improvement is attributed largely to new treatments rather than prevention.
Janosik thinks the biggest public misconception about heart disease is that it occurs suddenly. “Most people who have heart attacks have some identifiable risk factor that makes their event fairly predictable,” she says. She sees smoking cessation and controlling blood pressure, cholesterol and diabetes as the keys to reducing heart disease. “If I could recommend only one behavior, it would be to balance your energy intake with your energy expenditure,” she adds. “It sounds ridiculously simple, but too many people get hung-up about which diet they should follow or which exercise club to join when all they really have to do is eat less and move more.”
To help people make heart-healthy lifestyle choices, Janosik directs a 12-week SLUCare program titled LIVEWell that focuses on nutrition, exercise, stress management and motivation. The AHA estimates that about 770,000 people in the United States will have their first heart attack this year, and about 430,000 will have a recurrent attack. To improve the chances of survival, time is of the essence, says Dr. Richard Bach, director of the cardiac intensive care unit at Barnes-Jewish Hospital.
“Don’t tough out the symptoms,” he says. “If you feel chest pressure or have shortness of breath, even if you think it’s probably just indigestion, don’t delay, call 911. Symptoms of a heart attack can be subtle but still very dangerous. Unless it’s very obviously something else, assume it’s the heart until proven otherwise.” During a heart attack, at least one coronary artery is blocked, decreasing blood flow and oxygen to the heart. If blood flow is not quickly restored, the heart muscle suffers permanent damage. “In the last 25 years of research and experience, we’ve learned that if the artery is reopened within a few hours, we can save all or some of the heart muscle,” Bach says.
In general, the best way to ensure this happens is to undergo a cardiac catheterization as soon as possible, he says. The procedure uses a catheter threaded into the artery to clear the blockage and keep the vessel open, usually by inflating a small balloon inside the artery to open it and then placing a stent, a small mesh tube that buttresses the artery walls. “Once this is done, pain usually resolves and the heart stabilizes,” Bach says. “This has changed the landscape of heart disease treatment in the last 20 years.”
Many area hospitals have special protocols in place designed to decrease time between a patient’s arrival in the emergency room and completion of cardiac catheterization. In many cases, the treatment is provided within an hour. Using this rapid-response protocol, Barnes-Jewish Hospital was one of 17 in the nation and the only hospital in the state to report heart attack mortality rates below the national average, according to the national Hospital Quality Alliance.
To decrease the risk of future heart attacks, patients are admitted to the cardiac care unit for short-term monitoring and placed on a long-term medication regimen. “If treatment is rapid, the prognosis is often quite good,” Bach says. “People can go back to their routine and live a healthy lifestyle, which improves their prognosis even more.”
The St. Louis branch of the American Heart Association sponsors a variety of events and initiatives, including local Go Red for Women events and Start! St. Louis, a walking fitness and nutrition program.