A Patient's Guide to Heart Disease
Low Levels Of Biomarker Could Predict Heart Disease Risk In Older Women
Cardiovascular diseases (CVDs) are conditions that affect the circulatory system — the heart, arteries, veins, and capillaries. They are the leading cause of death worldwide, with the World Health Organization reporting that they are responsible for 17.9 million deaths each year.
Identifying those at risk is an effective way of preventing premature death from CVD, and new findings from the Karolinska Institutet in Sweden may point toward one way of identifying women at higher risk of CVD.
In this latest study, published in the Journal of the American College of Cardiology, they investigated the effects of IgM anti-PC in postmenopausal women.
They found that higher levels of the antibody protected the women against CVD, and low levels were associated with both atherosclerosis and heart attack (myocardial infarction/MI).
"This study found an association in women between levels of an antibody against phosphorylcholine (a component of cell membranes and lipoproteins that may mediate chronic blood vessel inflammation and resulting atherosclerosis), and future cardiovascular disease. This finding is quite novel and could represent a marker that could be used to help assess someone's risk of developing heart disease."
— Cheng-Han Chen, MD, board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA
Although it is commonly thought that heart disease affects more men than women, the Centers for Disease Control and Prevention (CDC) report that it is the leading cause of death for women in the United States. It can occur at any age, but hormonal changes following menopause increase the likelihood of coronary artery disease — the build-up of plaques in the arteries that can lead to heart attack.
In this latest study, researchers measured the levels of IgM anti-PC in 932 women from the Swedish Mammography Cohort, to determine whether there was a link between this anti-inflammatory antibody and CVD. The women had a mean age of 67, and no history of heart disease.
All the women filled out questionnaires about their health, lifestyle, and diet at the time of enrollment in the study. Researchers calculated their body mass index (BMI) and recorded whether they had diabetes, high blood pressure, or high cholesterol.
From blood samples taken after a 12-hour fast, the researchers assessed their levels of IgM anti-PC. They then divided the women into 5 equal-sized groups, based on their level of IgM anti-PC. The lowest group had a mean level of 20±6 U/mL, the highest had a mean of 161±96 U/mL of IgM anti-PC.
They followed up with the participants for 16 years until December 31, 2020, or until one of the following events — composite CVD, ischemic heart disease, myocardial infarction, ischemic stroke, or death.
Of the 932 women in the study, 113 developed composite CVD, 69 developed ischemic heart disease, 44 had heart attacks, and 50 had ischemic strokes.
The women with the highest levels of IgM anti-PC had a 73% lower risk of CVD than those in the group with the lowest levels. The reduction was most evident in the risk of ischemic heart disease and heart attack (MI).
Lead author Johan Frostegård, Professor of Medicine, Institute of Environmental Medicine, Head of Unit of Immunology and Chronic Disease, Karolinska Institutet, explained the findings to Medical News Today:
"I think CVD and atherosclerosis are inflammatory conditions where immunity is central. Here's a hypothesis about this: where anti-PC is in focus, we described several potential mechanisms, anti-inflammatory and increasing clearance of dead cells and also inhibiting oxidized low-density lipoprotein deleterious effects."
"Women have higher anti-PC than men and get CVD later in life. I think the findings could be highly significant for both prevention and treatment among women," he added.
The team behind this study is currently working on a more extensive study with both men and women to determine what level of anti-PC can be used to determine CVD risk.
"Larger prospective studies would be needed to both confirm this finding and to determine the levels of the antibodies that provide risk discrimination."— Cheng-Han Chen, MD
In a study in wild brown bears, Frostegård and his team found that hibernating bears have very high anti-PC levels, and do not seem to develop atherosclerosis or CVD, despite high levels of obesity before hibernation. This finding, together with other research, has led him to suggest that immunization might be a way to increase anti-PC levels in people whose levels are low.
"If there's a vaccine to raise anti-PC, those with lower levels could be more eligible [for] vaccination."
He suggested that the vaccine could be given in middle age, or possibly earlier as atherosclerosis builds up slowly, and that it might also be useful against other diseases characterized by chronic inflammation.
However, Chen sounded a note of caution:
"It is too early to know whether the anti-PC antibodies provide a direct protective effect on developing heart disease, or whether it is simply a marker of future risk. Vaccines that raise the levels of anti-PC antibodies would only be useful in the former case."
What Is Heart Disease? Everything You Need To Know
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What Is Heart Disease?Heart disease is a type of cardiovascular disease that affects the heart's structure and function. Several different heart conditions fall under the umbrella term for heart disease. The most common type is coronary artery disease, in which plaque builds up in the arteries and blocks blood flow to the heart, potentially leading to heart attacks or heart failure.
According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States in men and women. Nearly 650,000 Americans die from heart disease annually. Young adults make up a growing percentage of cardiovascular disease events, with heart attack rates increasing by two percent every year in people under age forty. (Learn more about How to Lower Blood Pressure.)
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Types of Heart DiseaseThere are several different types of heart disease and symptoms corresponding to each type.
They include:
Coronary artery disease
Heart arrhythmias
Cardiomyopathy
Heart valve disease
Heart failure
Pericarditis
Endocarditis
Congenital heart disease
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Coronary Artery DiseaseCoronary artery disease, or coronary heart disease, is the most common type of heart disease. It occurs when fatty deposits called plaques build up in your arteries, making them thicker-walled, harder, and narrower — a disease process known as atherosclerosis. These fatty deposits contain cholesterol, waste products, calcium, and proteins like fibrin.
These plaques can suddenly and unpredictably rupture, leading to sudden and severe blood flow blockages that can prevent the heart muscle from receiving enough oxygen and nutrients due to limited blood supply. When this happens, part of the heart muscle can stop functioning or even die. This event is called a myocardial infarction or heart attack, and can lead to permanent heart damage or be fatal. According to the American Heart Association, men tend to develop coronary artery disease at a younger age than women.
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Heart ArrhythmiasHeart arrhythmias refer to problems involving the heart rate or heart rhythm that result from abnormal electrical activity in the heart. Arrhythmias can cause your heart to beat too rapidly (tachycardia), too slowly (bradycardia), or irregularly.
Arrhythmias can sometimes cause relatively mild symptoms like palpitations, irregular heartbeats, or lightheadedness.
Unfortunately, more severe arrhythmias can result in complete failure of the heart to pump blood and sudden cardiac death if the normal electrical activity of the heart cannot be quickly restored by medication, CPR, or immediate defibrillation (administering electrical shocks to reset the heart's electrical circuit). These types of severe arrhythmias are often the cause of death when someone has a fatal heart attack.
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CardiomyopathyCardiomyopathy refers to a diseased heart muscle. The disease makes it difficult for the heart to pump blood throughout the body. Over time, cardiomyopathy causes the heart muscle to become rigid, enlarged, or weak.
There are several distinct types of cardiomyopathy:
Dilated cardiomyopathy. This common type causes the heart chambers to dilate.
Hypertrophic cardiomyopathy. Certain genes or other causes result in thickening of the heart chamber walls.
Restrictive cardiomyopathy. This rare type causes scar tissue to replace normal heart muscle.
Stress-induced cardiomyopathy. Also known as "broken heart syndrome," this type of cardiomyopathy is induced by emotional stress.
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Heart Valve DiseaseHeart valves open and close to allow blood to flow through the heart. When these valves become damaged, your heart has to work harder and may not work as well. There are a few different ways your heart valves can malfunction, leading to poor circulation and extra stress on the heart that can ultimately lead to heart failure.
Heart valve diseases include:
Stenosis. Stenosis causes your heart valves to narrow or harden, limiting blood flow and putting extra stress on the heart muscle because it needs to squeeze harder to move blood forward.
Regurgitation or leaky valve. Regurgitation occurs when a valve doesn't close properly, leading blood to flow backward or leak into the heart chamber in between heart contractions.
Atresia. Artesia is a condition in which a heart valve doesn't fully open. This is usually considered a congenital heart disease, which means it's present from birth.
Rheumatic heart disease. Rheumatic heart disease occurs when the heart valves have been damaged by rheumatic fever. It typically arises from inadequately treated strep throat and is the most common acquired heart disease in people under 25.
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Heart FailureHeart failure is a scary term, but it doesn't indicate a non-beating heart. It means the heart muscle isn't pumping blood efficiently enough to meet the demands of the body.
Heart failure causes the heart to overcompensate — it grows larger, develops more muscle, and may pump faster to supply blood to the body adequately. These measures may help temporarily, but over time, the heart grows weaker, causing symptoms like fatigue, breathing issues, and mental fog. Most people who develop heart failure have another heart condition, such as coronary artery disease, heart valve disease, or cardiomyopathy.
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PericarditisPericarditis refers to inflammation of the thin sac surrounding the heart. The most common symptom is sharp chest pain, which is felt in the middle or left side of the chest or sometimes in the shoulders.
Numerous types of infections, including bacterial, fungal, or viral, can cause pericarditis. The condition can also develop after a heart attack, heart surgery, or radiation treatments. Some autoimmune disorders, such as scleroderma, lupus, and rheumatoid arthritis, may also contribute to pericarditis.
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EndocarditisWhen a person has endocarditis, it means the thin inner lining of their heart and heart valves is inflamed. It's usually caused by bacteria in the bloodstream and can lead to symptoms like fever, fatigue, rapid heartbeat, and body aches.
Endocarditis is usually treated with antibiotics. The condition can be life-threatening if left untreated.
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Congenital Heart DiseaseCongenital heart disease refers to heart problems that you're born with, like holes in the heart, malformed valves, and others.
Some examples of congenital heart disease include:
Pulmonary stenosis. This is a type of heart valve disease in which the pulmonary artery, the vessel connecting the heart to the lungs, is too narrow or thick.
Atrial septal defect. An atrial septal defect is a hole between the two upper chambers of the heart.
Ventricular septal defect. A ventricular septal defect is a hole between the two lower chambers of the heart
Tricuspid atresia. The tricuspid valve is located between the right atrium and the right ventricle. If you have tricuspid atresia, the valve doesn't have an opening, which blocks blood flow between the atrium and the ventricle.
However, this list is not exhaustive. There are many other types of congenital heart disease. Sometimes, these issues resolve on their own without treatment, and other times they are life-threatening and require surgery.
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Symptoms of Heart DiseaseSome people don't experience heart disease symptoms. They only find out they have a heart condition after experiencing a heart attack or heart failure, or when heart disease is diagnosed on a test like an echocardiogram or cardiac stress test.
Heart disease symptoms depend on the type and severity of the heart disease but generally may include:
Chest pain (angina)
Shortness of breath
Lightheadedness
Heartburn
Heart palpitations (fluttering feelings in the chest)
Extreme fatigue
Fainting
Nausea
Swelling of legs, feet, ankles, abdomen, or neck veins
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Early Warning Signs of Heart DiseaseSome warning signs of heart disease may include:
Chest pain or shortness of breath during activity or while at rest
Chronic coughing or wheezing
Sudden weight gain
ED (we'll talk more about this later)
Tiredness that interferes with daily activities
Weakness in legs
Poor appetite
Nausea
Brain fog or memory loss
Fainting
Rapid or irregular heart rate
(Learn more about ED.)
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Symptoms of a Heart AttackA heart attack, or myocardial infarction, occurs when blood flow to the heart is suddenly blocked. This medical emergency is often the result of coronary artery disease.
Often, heart attack symptoms are immediate and intense, and other times they develop gradually. The longer you wait to get treatment for a heart attack, the greater the damage to your heart muscle.
Signs you are having a heart attack include:
Chest pain, pressure, or discomfort in the center or left side of the chest that lasts for more than a few minutes
Weakness
Lightheadedness
Shortness of breath
Cold sweat
Discomfort in the back, neck, or jaw
Pain in one or both arms
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What Causes Heart Disease?The causes of heart disease depend on the type you have. For instance, unhealthy lifestyle habits can contribute to the plaque buildup that leads to coronary artery disease. But congenital heart disease is determined by your genes or how you developed in the womb.
Lifestyle habits like poor nutrition and smoking, genetics, other diseases, and aging can all play a role in the development of heart disease.
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Lifestyle HabitsThere is extensive evidence showing that lifestyle habits can contribute to heart disease. The primary lifestyle habits associated with heart disease include:
Poor diet. A diet high in refined grains, added sugars, salt, and saturated fats can raise cholesterol, increase inflammation, and contribute to plaque buildup in the vessels. A poor diet also raises your risk of obesity, making the heart work harder to pump blood throughout the body.
Lack of exercise. Physical inactivity is the fourth leading risk factor of death worldwide. It plays a role in heart disease by contributing to weight gain and obesity, promotes inflammation, and increases the risk of blood clots.
Smoking. The chemicals in cigarette smoke harm the entire body, including the heart and blood vessels. This damage makes you more prone to plaque buildup in the arteries. A 2021 study by Northwestern researchers found that smokers were more likely to die from cardiovascular diseases like heart attacks, strokes, and heart failure, than lung cancer.
Excessive alcohol use. Binge drinking is associated with a higher risk of heart disease. Studies show that alcohol weakens the heart's ability to contract and pump blood. Binge drinking has been shown to cause arrhythmias, such as atrial fibrillation. Long-term heavy drinking can also cause alcohol cardiomyopathy, which involves damage to the heart's structure, cells, and tissues.
Stress. Temporary stress might help you meet a deadline or avoid danger, but chronic stress can hurt your heart. Studies reveal stress induces inflammation within the arteries and disrupts endothelial function (your blood vessels' ability to regulate blood flow) by increasing heart rate and blood pressure. These changes can lead to atherosclerosis, blood flow blockages, and cardiovascular events.
Sleep. Research shows that sleep disorders and sleep deprivation are linked to increased inflammation throughout the body, which can raise your risk of heart disease. Lack of sleep can also contribute to unhealthy lifestyle choices like poor nutrition and stress, which can contribute to obesity, high blood pressure, and other cardiovascular risk factors.
Dental health. Keeping your teeth clean isn't just a good way to banish bad breath and stay on your dentist's good side – it can also protect your heart. Studies show there's a link between heart disease and periodontal disease, a condition characterized by gum inflammation and tooth damage.
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GeneticsIn addition to congenital heart defects, heart disease can develop over time if it runs in your family. According to a 2020 study, cardiac disorders like arrhythmias, cardiomyopathy, and high cholesterol that can cause coronary artery disease can be caused by genetic variations or mutations that are sometimes passed down from your parents.
But the risk of developing heart disease isn't just based on your genetic code. The study also pointed out that families share lifestyle and environmental factors that can contribute to the development of heart disease.
While genetics can double or even triple your heart disease risk, poor dietary habits, smoking, having excess weight, and other diseases like diabetes can also play significant roles.
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DiseasesSome diseases that seem unrelated to your heart at first glance can actually contribute to the development of heart disease. This can happen because many chronic diseases cause systemic inflammation or other metabolic processes that can result in structural or functional damage to blood vessels or the heart itself.
They include:
In some cases, medications used to treat other medical conditions have been shown to cause heart disease and cardiovascular events like heart failure. These drugs include anthracyclines (a drug used in cancer treatment) and nonsteroidal anti-inflammatory drugs (NSAIDs), although these events are rare.
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AgingResearch from the National Institute on Aging suggests that aging can alter the heart and blood vessels. Arteries may become thick and stiff, contributing to limited blood flow and high blood pressure. The heart's electrical system can change, leading to irregular heartbeats. And heart chambers can become enlarged, causing the heart to fill too slowly.
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Risk Factors for Heart DiseaseBased on what we know about the causes of heart disease, there are numerous risk factors. The good news is that many of them are modifiable or even avoidable.
Risk factors include:
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Complications of Heart DiseaseIf left untreated, heart disease can lead to various complications, including:
Heart attack
Cardiac arrest
Chronic fatigue
Weakness
Stroke
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Heart AttackWhen your heart muscle is suddenly deprived of oxygen because a plaque on one of the blood vessels to your heart ruptures, you may experience a heart attack. This event, characterized by symptoms like chest pain, weakness, and shortness of breath, can damage the heart muscle permanently and may be fatal.
According to the American Heart Association, someone in the U.S. Has a heart attack every 40 seconds.
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Cardiac ArrestWhen the heart suddenly stops pumping, it's known as cardiac arrest. This medical emergency deprives the brain and other vital organs of blood and oxygen and can cause death within minutes without immediate attention. Nine out of 10 people who have a cardiac arrest outside of a hospital do not survive.
People experiencing cardiac arrest lose consciousness, stop breathing, become unresponsive, and have no pulse.
Arrhythmias are the main cause of cardiac arrest but can be triggered by other cardiac events such as heart attacks. Other risk factors include coronary heart disease, heart valve disease, and congenital heart defects.
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StrokeA stroke occurs when blood flow to the brain becomes blocked or if there is sudden bleeding in the brain. This medical emergency can result in brain damage, disability, or even death.
Symptoms of a stroke can include weakness, numbness, or paralysis on one side of the face or body, sudden and severe headaches, vision problems, and trouble speaking.
Certain heart diseases, such as atrial fibrillation or congenital heart defects, can predispose to strokes if they are not treated appropriately. Other strokes are not directly caused by heart disease but are related to blood vessel disease (e.G., carotid artery stenosis).
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Conditions Related to Heart DiseaseIf you have heart disease, your risk of developing other health conditions may also be increased. These include:
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AneurysmsAneurysms are balloon-like bulges that form within arteries damaged by atherosclerosis, the same process that causes coronary artery disease. Aneurysms can predispose to strokes or other types of embolisms. They can also sometimes rupture, especially when they become large, causing rapid and often catastrophic internal bleeding.
Aortic aneurysms are a serious type of aneurysm because they form in the aorta, the main artery of the body. They can happen within the chest or just below it in the abdomen, and when they become large, they cause symptoms like chest pain, back pain, and shortness of breath.
Your chance of having an aneurysm is higher if you have hardened arteries, high blood pressure, or high cholesterol.
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Peripheral Artery DiseaseSimilar to coronary artery disease, peripheral artery disease (PAD) involves the narrowing and hardening of blood vessels due to plaque buildup. Since PAD is also a result of atherosclerosis, it often occurs in patients who also have coronary artery disease.
Hardening and narrowing of the affected blood vessels that carry blood from the heart to other body parts can affect the legs, feet, arms, and hands.
The most common signs of PAD include cramping, fatigue, and pain in the leg or buttock muscles. This pain may go away when you're resting.
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EDED occurs when you have trouble getting or keeping an arousal long enough to have satisfying intimacy.
Studies show ED is often the first indicator of cardiovascular disease in men. The arteries that bring blood to the privates can be damaged by atherosclerosis, just like the coronary arteries that bring blood to the heart. Since the arteries to the privates are smaller than the arteries to the heart, symptoms of atherosclerosis tend to show up earlier in the privates than the heart. The clogged arteries make it difficult for blood to rapidly fill the privates during arousal, limiting the ability of the privates to get and stay firm. Men experience that as ED.
In one study of 2,000 men without known heart disease that examined ED as a possible predictor of cardiovascular risk, subjects with ED experienced more than twice the number of cardiovascular events than men without ED.
Though none of the 2,000 men had a history of heart disease or stroke at the beginning of the study, 115 men with ED had or died from cardiac arrest, heart attack, or stroke after nearly four years.
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Diagnosing Heart DiseaseWhether you have a family history of heart disease, you've been noticing symptoms like chest pain or shortness of breath, or you've developed related symptoms such as ED, it's always a good idea to make sure your heart is healthy or strong.
Your healthcare provider can run several tests to diagnose heart disease, as well as gather information on your family history, lifestyle, blood pressure and other factors that will help them estimate your risk of heart disease.
These tests include:
An electrocardiogram (ECG or EKG). This test evaluates and records your heart's electrical signals to check if your heart rhythm is irregular (too fast, too slow, or uneven). If the ECG doesn't provide enough data, you may be asked to wear a Holter monitor, a device that records your heart's rhythm over a few days.
Echocardiogram. This noninvasive imaging test uses sound waves to collect pictures of the heart. It allows your healthcare provider to check how your blood flows through your heart's valves and chambers.
Coronary calcium scoring/CT. This scanning procedure measures how much calcium is in your arteries to see how much plaque buildup you have.
Cardiac catheterization. This more invasive procedure involves placing a thin tube into a blood vessel to evaluate your heart valves. Your healthcare provider may also use dye to check if your arteries are narrowed or blocked.
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Heart Disease TreatmentTreatments for heart disease vary depending on the specific type and severity of the disease. They may involve various combinations of medication, surgery or other procedures, and lifestyle changes to improve heart function and prevent disease progression.
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MedicationMedications for heart disease include:
ACE inhibitors. Angiotensin-converting enzyme (ACE) inhibitors relax muscles in blood vessels to lower blood pressure. They're typically prescribed for heart failure, high blood pressure, and heart attacks.
Antiplatelet agents and dual antiplatelet therapy. These drugs, which include aspirin, prevent blood clotting in patients with various types of heart disease.
ARBs and ARNIs. Angiotensin 2 receptor blockers (ARBs) and angiotensin receptor-neprilysin inhibitors (ARNIs) reduce blood pressure by keeping your blood vessels from constricting. They're usually prescribed for heart failure and high blood pressure. ARNIs can also reduce sodium retention.
Beta-blockers. Beta-blockers slow the heart rate, lowering blood pressure and making the heart beat less forcefully. They're prescribed to treat and prevent heart attacks, high blood pressure, and chest pain.
Blood thinners. Anticoagulants, sometimes called blood thinners, prevent blood clots and are typically prescribed after heart attacks or strokes.
Calcium channel blockers. These drugs relax blood vessels by impeding the movement of calcium into the heart's cells.
Cholesterol medications. Since high cholesterol is a major risk factor for heart disease, cholesterol-lowering medications like statins are among the most important treatments for heart diseases that involve atherosclerosis, like coronary artery disease. Statins lower bad cholesterol and thereby decrease the number of fatty deposits in your arteries to prevent plaque buildup that leads to blockages and heart attacks.
Antiarrhythmic medications. Prescribed for heart failure and arrhythmia, these drugs work on the heart's electrical system to improve heart function and decrease the risk of arrhythmia.
Diuretics. These drugs prevent the heart from working too hard by ridding the body of excess fluid and sodium.
Vasodilators. These drugs, such as nitrates, are strong relaxing agents for the muscle in blood vessel walls. They are used to increase blood flow to the heart.
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SurgeryHeart surgery may be performed during a heart attack or if other treatment methods don't work. Some surgeries, like coronary artery bypass grafting, which reroutes blood flow, are major and involve longer recovery time. Others, like percutaneous coronary intervention, are less invasive.
During heart surgery, your healthcare provider might repair or replace heart valves or other structures, implant medical devices that support your heart's function, or even replace a severely damaged heart with a healthy heart from a donor.
Heart surgery types include:
Coronary artery bypass grafting (CABG). Also known as heart bypass surgery, CABG is a type of open heart surgery that improves blood flow to the heart. During the procedure, a surgeon connects healthy blood vessels from one part of the body to blood vessels above and below the blocked artery.
Percutaneous coronary intervention (PCI). This minimally invasive surgery for coronary artery disease involves your surgeon placing a stent inside a blocked artery to restore blood flow.
Heart valve procedures. During a heart valve procedure, your surgeon will either repair or replace a faulty valve to improve blood flow. Replacement valves may come from a donated human heart or animal or be a manufactured mechanical valve.
Surgery for congenital heart defects. Surgery for congenital heart defects depends on the type you have. A surgery can help repair holes in the heart, replace a valve, widen blood vessels, or in severe cases, replace the heart entirely through heart transplant surgery.
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Lifestyle Changes to Prevent Heart DiseasePrevention of cardiovascular disease is one of the most important things you can do to prolong your life. Prevention efforts generally involve lifestyle modifications, understanding your own cardiovascular risk, and sometimes taking preventative medications like statins if you are at high risk.
Here are some lifestyle tips to improve your heart health:
Follow a healthy diet. Eat plenty of vegetables, fruits, and whole grains, and limit your intake of salt, added sugars, and saturated fats.
Exercise. Get at least 150 minutes per week of moderate-intensity physical activity.
Maintain a healthy weight. A higher BMI is associated with an increased risk of heart disease. In addition to a healthy diet and regular physical activity, your healthcare provider may suggest other methods of losing weight to protect your heart, such as weight loss medication.
Stop smoking. If you smoke and already have heart disease, quitting reduces your risk of cardiac death, heart attacks, and death from other chronic diseases. If you don't smoke, don't start.
Manage your stress levels. Practicing mindfulness, talking to a therapist, and maintaining a healthy work-life balance are just a few ways to control your stress before it wreaks havoc on your heart.
Limit how much alcohol you drink. You don't have to stop drinking if you enjoy it. Just don't overdo it. Moderate alcohol use can actually be cardioprotective by improving HDL (good cholesterol). Try to limit your alcohol intake to two drinks or less per day.
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Understanding Your RiskAnother way to prevent heart disease is to assess your current risk. Fortunately, there are tools that make this a lot easier, such as the ASCVD Risk Estimator Plus from the American College of Cardiology.
The tool evaluates your estimated 10-year and lifetime risk of developing heart disease based on factors like age, sex, race, cholesterol levels, blood pressure, hypertension treatment status, diabetes status, and whether or not you're a smoker.
The risk estimator also offers customized recommendations to help you create a plan to lower your risk of heart disease based on the data you provided.
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Medications That Support Your HeartPatients at high risk for cardiovascular disease-related medical events should strongly consider taking a statin to reduce their bad cholesterol and lower their future risk of a heart attack or stroke. There is also emerging evidence that men who take phosphodiesterase-5 inhibitors for ED, like tadalafil (the active ingredient in Cialis®), appear to be at lower risk for heart attacks, strokes, and death than men with similar health who do not take ED medications.
Duel-action medication containing both a statin and phosphodiesterase-5 inhibitor, like Hims Intimacy Rx + Heart Support, can be especially useful in men with ED who want to proactively lower their future cardiovascular risk and treat their ED at the same time.
The medication includes the active ingredients in Lipitor® (atorvastatin) and Cialis (tadalafil), which help lower cholesterol and improve blood flow, respectively. However, this drug is not suitable for everyone, including those taking nitrates for heart disease. Find out if you're a good candidate.
Though it can feel like a daunting subject, you're not powerless against heart disease. You can do so much right now to improve your heart health, starting with something simple like what you eat for lunch. Remember, taking early action is critical. If you're noticing unusual symptoms you think are related to heart disease, call your healthcare provider today.
This article originally appeared on Hims.Com and was syndicated by MediaFeed.Org.
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More from MediaFeedGlobal Stroke Burden Continues To Rise, With Climate Change Gaining Influence
Even as stroke rates have come down around the world, an aging population has continued to push the total burden in terms of absolute numbers ever higher, which threatens to overwhelm the healthcare system over the coming decades.
That's one of the key takeaways of the latest stroke update from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study, published last week in the Lancet Neurology.
In addition, the link between stroke and climate change-related factors—like ambient temperature and air pollution—appears to be getting stronger, lead author Valery Feigin, MD, PhD (National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand), and colleagues report.
The GBD Study is the only project that provides information on the burden of stroke across all countries and territories, as well as trends over the last 30 years, Feigin told TCTMD. "Without that study," he added, "any healthcare planning, resource allocations, and priority settings are not really evidence-based, so regular updates of these estimates are absolutely crucial for public health."
The continuing rise in global stroke burden indicates that approaches to managing the problem need to change, including by moving away from common risk-based efforts that have the medical community focusing on individuals deemed to be at highest risk, he argued.
"Priority should be given to primary prevention," Feigin said. "We're always kind of reacting to the situation. We need proactive actions, and this is prevention. That's the only way we can stop a rise in the burden and eventually reverse it."
The Key Role of Environmental Factors
Prior GBD analyses have shown that the prevalence of cardiovascular diseases, including stroke, increased steadily between 1990 and 2019, with an overall slowing of the decline in CVD-related mortality—and increases in some parts of the world—over time. Moreover, a previous stroke-related analysis with data through 2019 demonstrated that stroke remained the second leading cause of death in the world behind ischemic heart disease. Feigin and his colleagues subsequently projected large increases in stroke-related mortality and disability-adjusted life-years (DALYs)—a measure encompassing years at full health that are lost—by 2050.
In their current paper, the investigators provide an update on the situation using data gathered through 2021 from 204 countries and territories. In addition to stroke events, they examined changes in 23 individual risk factors and six risk clusters (ie, air pollution, tobacco smoking, and behavioral, dietary, environmental, and metabolic factors) across 21 GBD regions and sociodemographic index quintiles.
There is no country in the world where the burden in absolute terms is going down. Valery Feigin
Not surprisingly, Feigin said, stroke burden continued to rise on a global scale, even as rates of new and prevalent cases, deaths, and DALYs stayed on the decline in most areas. In 2021, there were an estimated 11.9 million new stroke events (up 70.2% from 1990), 93.8 million stroke survivors (up 86.1%), 7.3 million related deaths (up 44.1%), and 160.5 million related DALYs (up 32.2%) worldwide.
The heaviest impact was felt in low- and middle-income countries, which accounted for 83.3% of incident cases, 76.7% of prevalent cases, 87.2% of fatal cases, and 89.4% of stroke-related DALYs.
Stroke was bumped from second to third on the list of overall causes of death (after ischemic heart disease and COVID-19) and from the third- to the fourth-leading cause of DALYs (behind COVID-19, ischemic heart disease, and neonatal disorders).
More unexpected data came in the form of the most influential risk factors for stroke, Feigin said. High systolic BP was still at the top, accounting for 56.8% of stroke-related DALYs, but coming in second and third were ambient particulate matter pollution (16.6% of DALYs) and smoking (13.8% of DALYs). Although both of those were important contributors in prior analyses, they hadn't been ranked as highly, Feigin noted.
Moreover, the updated data indicate that extreme high ambient temperatures are having a profound impact on stroke burden, adding to prior studies showing the importance also of extreme cold temperatures.
"These findings are in line with research showing that rises in ambient temperature (including heat waves) and climate change are associated with increased stroke morbidity and mortality," the authors write. "Because ambient air pollution is reciprocally associated with the ambient temperature and climate change, all of which synergistically influence cardiovascular disease (including stroke) occurrence and overall health, the importance of urgent climate actions and measures to reduce ambient air pollution cannot be overestimated."
Redoubling Primary Prevention Efforts
The current approach of screening for individuals at highest risk of stroke and focusing management efforts on them—and spending less time on lower-risk individuals—is clearly not working to reduce burden around the world, Feigin said, noting that most people who have cardiovascular events would be deemed to be at low or moderate risk.
He pointed to a 2021 report from the World Health Organization (WHO) that concluded that screening for CVD risk and CVD risk factors has had no impact on lowering CVD morbidity and mortality in the general population. In some cases, in fact, such efforts may increase mortality, the WHO said.
"That's one of the reasons I believe we are failing in primary prevention of stroke and cardiovascular disease, and that needs to be changed," Feigin said.
Last year, a World Stroke Organization-Lancet Neurology commission, which Feigin helped lead, offered potential solutions to reduce the global burden of stroke, with recommendations covering four main areas—surveillance, prevention, acute care, and rehabilitation. To raise funding for these efforts, they advise taxing unhealthy products.
"That's what we need to be implementing as fast as we can across the globe if you want to change the situation," Feigin said, adding that the public health community needs to recognize that after age 70, neurological events overtake cardiac events in terms of prevalence.
If greater attention isn't paid to stroke, he said, "the whole health system will be at risk because we only have an increase in the burden. There is no country in the world where the burden in absolute terms is going down."
In an accompanying editorial, Simiao Wu, MD, PhD, and Ming Liu, MD (both from West China Hospital, Sichuan University, Chengdu, China), say "the GBD estimates, although sometimes incomplete or inconsistent, help to fill the data gap and raise awareness and inform the direction for current practice and future research."
They add, "We hope that GBD analyses will continue to provide timely health data and inform action in the battle against stroke at the global, regional, and national levels."
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