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Most people know that heart disease is linked to diet and exercise—two lifestyle factors often considered to be within a patient’s control. Yet heart disease remains the No. 1 cause of death in the U.S. for every sex, race, and ethnicity.
How is that possible when heart-health advice is seemingly everywhere? Doctors and researchers have a few thoughts:
- Some people may not fully understand how eating and exercise affect their health.
- Risk factors beyond diet and exercise may not be as well-known or understood.
- Knowledge alone isn’t enough to remove barriers outside a person’s control.
As a cardiologist and the board president for the Eastern States region of the American Heart Association (AHA), my goal is to meet patients where they are in their understanding of heart health. I often use two analogies to explain how cardiovascular health is whole-body health:
Consider the gas you put in your car. If you use diesel instead of gasoline, the car will break down and stop working. Like a car, your body needs a specific type of fuel to work properly. And your heart is at the center of the system that delivers nutrients from that fuel (or a lack thereof) to the rest of your body. Please don’t treat your car better than your body!
Think of your body as a house. Your circulatory system is the plumbing. After 50 years or so, the pipes might not be squeaky clean, but they also likely won’t need repairs if waste has been handled properly. But imagine running grease through those pipes for 50 years—the pipes will clog and cause significant problems. In your body, the “grease” is a buildup of risk factors that contribute to heart disease, from lifestyle behaviors to underlying health conditions.
Providing this context helps patients visualize the important role their heart plays in overall health. But a few common risk factors require a deeper discussion about specific actions patients and providers can take to improve heart health.
Related reading: Who’s at Risk for Heart Disease
1. Health disparities.
Until the last few years, conversations about heart disease were usually limited to specific behavioral and health risks and recommendations. But another very important question is beginning to be answered: What societal limits are preventing certain populations from reducing their risk of heart disease?
As medical providers, we can tell people to eat healthier and exercise more all day long. But what is a patient to do if they can’t access heart-healthy foods or they live in a neighborhood where they don’t feel safe walking outside?
For example, a recent study found that Black people living in neighborhoods with a history of redlining (denying mortgage loan services to residents in certain areas based on their race or ethnicity) had much poorer heart health outcomes than other ethnic groups living in the same or similar neighborhoods. And pregnant women living with adverse social risks—such as economic, family, and housing instability—have higher rates of heart disease risk factors. Solving healthcare disparities like these requires collaboration between many systems within a community.
In January 2021, the AHA announced a four-year effort to address and eliminate health equity barriers, including a high blood pressure program focused on health outcomes in racial and ethnic minority groups.
MedStar Health has also dedicated research to health equity and recently partnered with local food banks to provide fresh, healthy food and nutrition education to people who need it most. Our social work services are continually improving and expanding to support patients before, during, and after their hospital appointments.
2. Diabetes.
People who have diabetes are twice as likely to develop heart disease as people who don’t. Chronically high, uncontrolled blood sugar will damage your blood vessels and decrease blood flow to and from your heart.
The AHA recently published a scientific statement alerting patients and doctors that many patients with Type 2 diabetes are not adequately managing their heart disease risk factors. According to the report, fewer than 1 in 5 of these patients who were not diagnosed with heart disease had healthy levels of blood sugar, blood pressure, and cholesterol.
We consider a diabetes diagnosis to be a pre-heart disease diagnosis. With this mindset, we partner closely with our patients and their primary care doctors to control diabetes-related risk factors, such as high blood sugar, and consistently monitor their blood pressure and cholesterol values.
One way to start reducing your risk of Type 2 diabetes and heart disease is to minimize the simple carbs in your diet, such as white bread, rice, potatoes, pasta, white (enriched) flour-based products, sodas, and juices. I also recommend eating plant-based foods (no meat) at least three days a week. Plant-based foods, such as fruits, vegetables, beans, and nuts, have long been linked to heart health.
Related reading: Why Processed Foods Are Not Good for the Heart
3. High blood pressure.
When it comes to high blood pressure (hypertension), many patients tend to focus on the numbers (readings over 130/80) instead of the downstream effects. The higher your blood pressure, the harder your heart must pump. This constant exertion can eventually cause artery damage and reduce blood flow to your heart.
Especially in Black patients, high blood pressure leads to congestive heart failure. Compared to other racial and ethnic groups, this population has the highest rate of heart failure—and the worst clinical outcomes.
Talk with your primary care provider about your risk of high blood pressure and get your blood pressure checked regularly. Medication can help lower blood pressure, and lifestyle modifications are important: limit alcohol, eat less salt and more plant-based foods, exercise regularly, and achieve a healthy weight.
Related reading: A Delicate Balance: Control High Blood Pressure to Reduce Stroke Risk
4. Smoking.
Most patients associate smoking with lung cancer. So, many are shocked when we tell them it’s also the second-leading cause of amputation due to gangrene and peripheral arterial disease—reduced blood flow from the heart to the rest of the body. Diabetes is the leading cause.
Smoking increases the amount of plaque in the blood. Plaque can build up in the arteries and restrict blood flow to and away from the heart. With less blood flowing to their limbs, patients often experience cramps in their legs after walking a certain distance and have to stop and wait for it to go away; this is almost like a recurring heart attack in the legs.
Left untreated, tissues in the affected limbs can die, resulting in amputation. Talk with your doctor about how MedStar Health can help you stop smoking.
5. Sleep apnea.
Patients with sleep apnea stop breathing during sleep due to an obstructed airway. The condition is often recognized by a patient’s partner due to a common symptom—loud snoring.
Ongoing loss of air flow triggers the release of stress hormones over and over again, which can eventually cause high blood pressure, stroke, or atrial fibrillation (an irregular heartbeat).
A neck size of 17 inches or more in men and 16 inches or more in women increases the risk of sleep apnea. If you often snore loudly or have other symptoms of a sleep disorder, such as constant sleepiness, frequent headaches, or difficulty staying asleep, talk with your doctor about sleep testing and treatments.
6. Stress.
The effects of stress on the heart can be difficult to monitor and manage, depending on what triggers it. Long-term stress can cause inflammation and high blood pressure. It also can lead to coping mechanisms that increase the risk of heart disease, such as overeating, avoiding exercise, smoking, and not sleeping enough.
Stress can be triggered by mental health disorders and external factors, such as work, family, or fears related to the political or environmental climate. For example, a recent study found that stress related to the COVID-19 pandemic has increased incidences of stress cardiomyopathy, a condition that mimics symptoms of a heart attack but doesn’t actually cause one. Heart function eventually recovers, but if this cycle continues, it can weaken the heart muscle.
Talk with your doctor about ways to manage stress and improve your mental health. Many treatments are available, such as medication, talk therapy, and lifestyle changes.
If challenges within or outside your control are preventing you from achieving optimal heart health, talk with your doctor. Your heart affects your overall health and our goal is to help you live a longer, more enjoyable life.
