Heartily Optimistic

ropping dead of a heart attack. It may seem like an unpredictable and random strike of lightning, but in most cases that’s not how it works. Instead, disease of the arteries, called atherosclerosis, is like a slow-moving storm gaining strength for decades and composed of factors like genes and life choices. And if you know your own, medicine now responds with several high-tech and holistic methods to not only predict whether you might have a heart attack or stroke but also to prevent one–to allow for your last heartbeat to peacefully conclude a long, healthy life.”It is really a good time in terms of health care for heart disease, says Patrick McBride, co-director of UW Hospital and Clinics’ Preventive Cardiology program. “Compared to a lot of other health issues we have excellent treatments available that can reduce risk and death. I’ve watched a lot of people who would have died prematurely in the past live full, long lives. High-quality, functional lives.”McBride and his colleagues hope to help stop this disease in its tracks and perhaps even reverse it. That’s right, reverse it. Even if you’re overweight. Even if you’re a smoker. Even if you inherited genes for high blood pressure or high cholesterol. Medicine now offers proven approaches that can assist in stopping smoking–which in three years nearly erases any heart-related effects–and lowering cholesterol, blood pressure and weight through improved diet, exercise and, when necessary, drug therapy.It starts with knowing your risk factor statistics. Medically speaking these are perhaps the most important things you could ever know about yourself. And if you don’t know all of them you’re at a serious disadvantage when it comes to preventing death by heart disease, the number one killer of men and women in the United States. Thinking that you’re fine because your grandmother lived to ninety is a ruse. As is simply hoping that while your brothers both had heart attacks, odds are you won’t. This disease is not about luck of the draw; it’s about assessing risk and developing a plan that may lengthen and improve your life.For a best estimate of your future risk, you must know your total and “good” (HDL) cholesterol levels, triglyceride level and your blood pressure. These factors are added into an equation that also includes your age, sex, whether you smoke and if you are taking blood pressure medications. Additionally, medical conditions such as coronary artery disease, peripheral vascular disease, diabetes, your waist circumference (measured at the hip bones) and whether there is a history of heart disease in your family finish off the complete risk assessment. Once you know this information you’re ready for the next step.”It’s at www.heartdecision.org and it’s a tool I built,” notes Jon Keevil, a UW–Madison cardiologist and self-described blend of “engineer, computer programmer and preventive specialist.”While a medical resident Keevil developed an interest in better assessing risk for heart disease. Using data from the Framingham Heart Study–which for decades has tracked people in the town of Framingham, Massachusetts, while searching for contributing factors of the disease–Keevil developed heartdecision.org. The diagnostic, risk-assessment program taps into decades of data from Framingham. So while the mantra “know your numbers” is thrown around, here’s where important meaning is attached to them.At heartdecision.org you can enter your risk factor statistics, click “update report,” and your risk assessment is generated along with a series of recommendations. First is a graph that plots your risk for heart attack or death across a range of ages. Just above your current age is a box with a percentage. This percentage is your ten-year risk of having a heart attack or dying. Age is the number-one predictive factor; so as you age your risk is higher simply because you’re older. If you are young and your risk appears low, look right of your current age on the graph and see what your future risk holds. Finally, below the graph is a summary interpretation of your results as well as recommendations.”It’s very rare that people know their Framingham score,” Keevil continues. “Depending on what you find at the website, you may want to talk to your primary care provider.”This is particularly true if you don’t know or don’t understand one of the necessary numbers, if you don’t meet one or more of the cholesterol goals listed or if your ten-year risk is above ten percent. The results from the website may aid in this discussion. Depending on the risk factors present, further testing may be useful to better clarify your situation.One place that the UW Preventive Cardiology program seeks to learn more is in a room at the rear of the UW Research Park and UW Clinical Sciences Center clinic where people undergo a test that helps determine the agedness of their arteries, their “vascular age.” The carotid IMT test uses ultrasound to measure the thickness of the artery walls inside the neck–the intima media thickness, or IMT–while looking for plaques, deposits in the arteries linked to heart attack and stroke. The test is incredibly illuminating, noninvasive, safe, accurate and relatively cheap–as in less than $300 and covered by most Madison insurers with a doctor’s referral.”Carotid ultrasound involves looking for early plaques in the carotid arteries–the arteries that supply the brain with blood–to see if there’s early blood vessel damage there. We think about the carotid arteries as a window to the coronary arteries. And we know that if you have plaques in your carotid arteries or your walls are thicker than they should be you’re at about a threefold increased risk of having a heart attack or stroke,” explains James Stein, director of preventive cardiology at UW Hospital, and a pioneering expert in carotid IMT testing.”We tell them the age at which the thickness of their arteries is ‘normal.’ That’s their vascular age. So if you’re forty years old and your arteries are in the ninety-fifth percentile, that’s terrible, but they may not understand it means that ninety-five percent of people have less thick arteries than they do. When you tell them that they have the arteries of a seventy-five-year-old, that captures their attention!”The carotid IMT test is one of many options that depend on each individual’s situation. For some, other tests may include a coronary calcium scan for example, a test that helps to show the amount of calcium plaques present in the arteries of the heart, something the ultrasound test does not do. But regardless of the test, these doctors stress the importance of recognizing the holistic nature of disease prevention and the high level of support and science that goes into this type of treatment.”When people come to our prevention clinic they’ll see a doctor, they’ll have a follow-up with an advanced practice nurse, a dietitian and an exercise physiologist. If necessary we do smoking cessation as well as stress management,” explains Stein.Thus this is really about overall wellness and the possibilities of living healthier. It means rather than crashing on the couch after work, taking a brisk thirty-minute walk instead. Or shifting from a diet high in fat, sugar and salt to one with more whole grains, fruits, nuts and vegetables.”When you think about the chronic diseases–heart disease, cancer, stroke, diabetes, arthritis–guess what? Weight control, physical activity, not smoking, that’s what makes all the difference,” McBride explains.So while it’s impossible to predict if and when lightning will strike, the storm cloud of atherosclerosis is dissipating. Yet out of everyone who has heart disease, half don’t find out until they have a heart attack, and about a third of those die. And if you are reading this article and have no idea of your numbers or risk, you’re ignoring some of the most important and easily adaptable advances in the history of medicine.”We have many outstanding treatments available that will significantly reduce risk of heart disease,” McBride says. “And if people identify risk we can make a big difference in preventing the disease in the first place.”John Morgan is a freelance writer who enjoys sharing stories about the environment, health, wellness and more in hopes of connecting the general public with important advances in science.