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Mon, Feb. 24

Cardiovascular disease not just a numbers game - you must act

Heart disease is the leading cause of death in the United States. Stroke is not far behind. Together, heart disease and stroke are among the most widespread and costly health problems facing the nation today, accounting for more than $500 billion in healthcare expenditures annually.

Edward Ha, MD, is an interventional cardiologist - a heart doctor with a specific focus on evaluating and treating heart artery disease - at Yavapai Regional Medical Center. In addition to the interventional aspect of using catheter-based cameras to identify and repair heart artery blockages, Dr. Ha sees patients for chest pain, angina, shortness of breath, blood pressure management - the full spectrum of heart-related healthcare.

Dr. Ha says there are two primary aspects of a cardiologist's job. First is what he calls their "symptom complex" or quality of life.

"It's increasingly apparent that medicines, while they are good for treating symptoms, also have side-effects that can actually reduce a patient's quality of life. You have to strike a balance," the doctor says.

The other major concern Dr. Ha keeps in mind with patients is managing risk.

"You don't really feel high blood pressure or elevated cholesterol," Ha continues. "You don't really even know when you are at risk for a heart attack, because it doesn't give you a symptom. Yet some people are at higher risk for heart attack and some are at lower risk. The way we identify risk is not necessarily by how you feel but by evaluating risk factors to establish a risk level."

According to Dr. Ha, there has very recently been a significant paradigm shift within cardiology as to how risk is managed.

"In the past we would identify factors like cholesterol or blood pressure as things that needed to be managed but we would manage them separately. People have been told 'know your numbers. Know what your cholesterol level is,' and we'd prescribe medicines and dosages based on treating to those numbers, as discrete targets. That's no longer the case."

The American College of Cardiology (ACC), which governs the standards of practice for cardiologists in the U.S., has devised a risk calculator that takes into account a number of factors including cholesterol, smoking, age, gender, blood pressure, past cardiac history and the like. When a patient is found to be at a certain level of risk, the guidelines call for therapies appropriate to that overall level of risk.

According to Dr. Ha, no one element alone is a sure indicator of risk for heart attack. "People will say, oh, my blood pressure is 160 over 80, I have to get that down or I'm going to have a stroke or a heart attack. That's not really how those numbers work. It's far more nuanced than that.

"My best advice, is to exercise daily, follow an appropriate diet and talk to your doctor about evaluating your risk level. That's true for both men and women. Women get heart attacks and strokes as much as men do. In fact, heart disease is the number one killer of women.

"Based on what is known about heart care right now, medicines do have their place, but it's become increasingly apparent that in order for us to do something about the epidemic of cardiovascular disease that we face, we have to begin from a patient-centered point of view. Lifestyle is important. We know that. We have good research that points to that. We have to do more than just treat to the numbers."

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