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Mon, Dec. 09

Column: A new look at heart disease

When it comes to matters of the heart, many people believe they know how to maintain their health. Not so, say many cardiothoracic surgeons and cardiologists who now are urging a fresh look at this complex condition.

"Heart disease is caused by many factors, some that people can control and some they cannot," said Jose Torres, MD, Cardiothoracic Surgeon, The James Family Heart Center at Yavapai Regional Medical Center (YRMC). "I've performed heart bypass surgeries on triathletes in their 40s. The fact is that each of us processes cholesterol differently."

Dr. Torres advises not to assume that because you're following a healthy lifestyle - low-fat diet, regular exercise and not smoking - that your cholesterol levels are in check. People with high cholesterol are twice as likely to develop heart disease, according to the Centers for Disease Control and Prevention (CDC). Because of that, it's important to know your cholesterol level.

If you're in your 20s, Dr. Torres recommends a baseline cholesterol level so you and your physician can understand what's normal for you. Do you have a family history of high cholesterol? Then it's particularly crucial that you and your doctor track your level of the harmful cholesterol, known as LDL.

"Some people suffer from hyper cholesterol, which means they may metabolize cholesterol differently," Dr. Torres said. "Also, there's lots of research going on to understand the role inflammation plays in heart disease and heart attacks."

In 2013, the American College of Cardiology and the American Heart Association released new cholesterol guidelines - the first change in many years - aimed at reducing the risk of coronary artery disease. For people who have exhausted lifestyle efforts, the guidelines recognize the importance of therapies that lower the risk for heart disease rather than specific target cholesterol levels. This means your physician may not be as focused on specific lab numbers, but more on the effectiveness of therapy in preventing further heart disease.

Heart disease is progressive, but once it has begun, there are steps you can take to control it. In addition to addressing your individual cholesterol levels, Dr. Torres recommends not smoking.

"A huge number of the people who need heart surgery are smokers," he said. "If you smoke, stop now. Ask your physician to prescribe the nicotine patch, nicotine gum or find another way that will help you stop."

High blood pressure also contributes to heart disease so Dr. Torres advises that you make sure your numbers are in the healthy range. Optimal blood pressure is less than 120 systolic and 80 diastolic.

Open heart surgery - also known as coronary artery bypass graft (CABG) surgery - may be necessary for some people with heart disease. Residents of western Yavapai County and northern Arizona are fortunate to have access to experienced and highly regarded heart surgeons. Dr. Torres - who attended medical school at the University of New Mexico, Albuquerque and pursued a Cardiothoracic Surgery Fellowship at University of Iowa Hospitals and Clinics - notes that open heart surgery is among the safest of surgeries.

During CABG surgeries, Dr. Torres bypasses the heart's occluded arteries and creates new passages around the blockages for blood to flow to the heart muscle. Arteries or veins are taken from other parts of the body and used to reroute the blood around the clogged arteries. These are called grafts.

"Medicine has made great strides in protecting the heart during open heart surgery," Dr. Torres said. "Improvements in heart bypass machines have helped this. Also, surgical techniques keep getting better. One of the results is that we've reduced the number of days patients typically spend in the hospital following open heart surgery."

What are the outcomes of CABG surgery? The procedure:

• Improves the supply of blood and oxygen to the heart.

• Relieves chest pain (called angina).

• Reduces risk of heart attack.

• Improves ability to participate in physical activity.

While heart health is important year-round, February is a good time to reassess your heart health. For more information on heart health, visit the healthcare reference library at www.yrmchealthconnect.org.

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