Lower extremity arterial disease in patients with diabetes: a contemporary narrative review
5 Things That Impact Heart Health
To maintain a healthy heart, researchers say people should focus on diet and exercise, limit alcohol, manage stress, get enough sleep, and more.
To maintain a healthy heart, individuals should focus on diet and exercise, quit smoking and limit alcohol, manage stress, get enough sleep, and schedule regular medical checkups.Image Credit: udra11 - stock.Adobe.Com
February celebrates American Heart Month to raise awareness of heart health, as heart disease is the leading cause of death in the US for men, women, and most racial and ethnic groups.1 Heart disease caused 702,880 deaths in 2022, accounting for 1 in every 5 deaths.2
Additionally, heart disease cost the US about $252.2 billion from 2019 to 2020. Coronary heart disease is the most common type of heart disease, affecting about 1 in 20 adults aged 20 years or older.
Several medical conditions and lifestyle choices increase the risk of heart disease. By identifying, reducing, or abstaining from these risks, individuals can improve their heart health and mitigate potential health risks.
1. Diet and ExerciseFollowing a heart-healthy diet and regular exercise can reduce risk of heart disease or other cardiovascular-related issues.3 Limiting consumption of processed foods, added sugars, salt, and nontropical vegetable oils can reduce the risk of heart complications. Doctors and dieticians recommend a diet rich in fruits, vegetables, whole grains, nuts, fish, and limited dairy products for heart health.
Additionally, regular exercise can lower blood pressure, reduce the risk of diabetes and inflammation, and help maintain a healthy weight.4 Exercise works similar to β-blockers, slowing the heart rate down and lowering blood pressure overall. Combining aerobic exercise (eg, jogging, swimming, or biking) with resistance training (eg, moderate weightlifting) can benefit heart disease prevention.
Exercise benefits both healthy individuals and those with heart disease by improving myocardial perfusion, increasing high-density lipoprotein cholesterol levels, reducing stress on the heart, and improving cardiovascular function, a study found.5 A 4-month diet or exercise intervention program reduced cardiovascular risks in individuals with metabolic syndrome. Several previous studies have investigated the effects of diet and exercise on cardiovascular health, determining that diet, exercise, or a combination of both significantly impacts heart health.
2. Quit Smoking and Limit Alcohol ConsumptionExcessive tobacco and alcohol consumption can increase the risk of cardiovascular diseases.6 Smoking cigarettes increases the risk of cardiovascular disease in a dose-dependent manner with more tobacco use leading to greater disease risk. Smoking introduces chemicals that damage the heart and the blood vessels.7 Even occasional smoking can cause this level of damage, posing a greater risk to women who use birth control pills and people with diabetes. Smoking specifically increases the risk of peripheral artery disease, which, in turn, increases the risk of coronary heart disease, heart attack, and stroke.
Consuming 3 or more alcoholic drinks per day increases the risk of ischemic stroke, and heavier drinking increases the risk of myocardial infarction.6 People who consume 3 to 5 drinks per day have a roughly 50% higher risk of developing high blood pressure. Excessive drinking can cause abnormal heart rhythms, damage the heart muscle, and lead to heart attack, stroke, and palpitations.8 Higher alcohol consumption can also increase the chances of developing high blood pressure, type 2 diabetes, and obesity, all of which are risk factors for heart disease.
3. Manage StressChronic stress can increase negative impacts on heart health.9 Stress initially affects emotional and psychological well-being, but prolonged stress can lead to persistent physical symptoms.
Researchers, in a study published in The Lancet, wrote that a relationship between neural tissue activity and subsequent cardiovascular events suggested the brain's salience network, bone marrow, and arterial inflammation together form an axis that could accelerate the development of cardiovascular disease.10 Brain images revealed a link between areas involved in fear and stress and cardiovascular disease episodes.
The National Heart, Lung, and Blood Institute recommends practicing meditation, talking to a professional counselor, or seeking support from community or family to manage chronic stress.11 Relaxation techniques include breathing exercises, guided imagery, autogenic training, and progressive relaxation.12
4. Get Enough SleepInadequate sleep or insomnia puts patients at higher risk of cardiovascular disease.13 Studies have shown that insomnia can increase the stress hormone cortisol and alter the body's stress response. Short sleep periods or disrupted sleep patterns can increase blood pressure and inflammation, thus increasing the overall risk of cardiovascular diseases.
In addition, obstructive sleep apnea is a breathing disorder linked to heart disease, obesity, diabetes, stroke, and high blood pressure.14 Disturbed respiration reduces the amount of oxygen flowing in the blood, which can worsen the effects of sleep apnea on heart health.
Experts suggest developing relaxation strategies, establishing a consistent sleep schedule, and avoiding sleep disruptors like caffeine before bed to improve sleep quality. Additionally, strong sleep hygiene can create a foundation for better sleep, making it easier to obtain the necessary quantity and quality of sleep.
5. Annual ExamsRegular medical exams from your primary care provider can reduce the risk of heart disease.15 Physicians often conduct routine tests and screenings that can detect heart issues and warning signs, preventing more serious complications.
Heart disease risk factors often lack obvious signs or symptoms, and some patients remain unaware of their conditions for years before they worsen. Some symptoms of a potential heart problem include chest pain, dizziness, heart palpitations, nausea, fatigue, fainting spells, shortness of breath, and headaches. Patients should communicate any potential symptoms of heart disease to their physician, who can then run further tests and develop a plan to optimize the patient's heart health.
During regular exams, doctors assess heart health by checking body mass index, blood pressure, pulse rate, and oxygen saturation level, as well as listening to the heart rhythm. Doctors can use cholesterol tests, complete blood counts, comprehensive metabolic panels, fasting glucose tests, and creatinine blood tests to assess heart health. While an electrocardiogram is not part of a standard exam, a doctor may order this test for more detailed information on the heart's functioning. Overall, regular exams can reduce the risk of heart disease, particularly through screenings and tests that detect heart issues and warning signs early, before serious complications arise.
Patients should inform their physician about risk factors like advancing age or a family history of heart disease, as physicians can provide potentially lifesaving interventions beyond patients' self-management capabilities.
References
Can Atherosclerosis Be Reversed? Here Are 3 Things To Know About Coronary Artery Disease
Prior to 1990, many assumed that once cholesterol plaques form in the arteries causing atherosclerosis, it was not reversible.
While this is true for plaques that have calcified, what about plaques in the beginning stages prior to calcification that are "soft and mushy?" Sorry, they were believed to be fixed in place as well. In other words, all atherosclerotic plaques, regardless of the progression, are irreversible.
Thankfully, Dr. Dean Ornish, a medical pioneer and visionary, came along and changed everything. The change was triggered by his disenchantment with his role as a medical "fixer." He was tired of performing bypass surgery over and over again on the same patients and finally realized that he was working on the wrong end of the pipeline. A cartoon that depicts a spigot spewing water into a sink that is overflowing, and doctors working feverishly to mop it up, captures his frustration. It was time to turn off the spigot!
As Ornish contemplated the situation the following thought occurred to him: If a set of circumstances is known to cause atherosclerosis (clogging of the arteries), would getting rid of those same circumstances merely stop progression of the process, or it is possible to reverse the process?
What is the Ornish Reversal Program?By age 65, you're at greater risk for heart disease, a heart attack and other related conditions.
To find out, he decided he would conduct research. But he soon discovered that going against the establishment and questioning long held dogma is not easy. In fact, his idea was viewed as foolish, because medical experts assumed beyond a doubt that atherosclerosis, once it gains a foothold in the arteries, is permanent and irreversible.
Ironically, this assumption was made without ever being investigated.
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Undaunted by skepticism, Ornish proceeded with a group of patients awaiting coronary artery bypass surgery who underwent a radical change in lifestyle. All their meals were specially prepared vegan, they took long walks every day, engaged in relaxation exercises and learned to handle stress better through meditation and counseling sessions. They also did yoga and tai chi, several quit smoking, etc.
At the end of one year, Ornish proved the impossible as his program successfully reversed atherosclerosis.
Why don't we invest in preventing chronic diseases?Heart attacks are the leading cause of death in the United States, with 600,000 people dying annually of heart disease.
With all this good news, it raises the question: If the Ornish Reversal Program is so great, why isn't everyone who is at high risk for heart disease doing it?
The simple answer is that it requires commitment, dedication, discipline, and the willingness to make major lifestyle changes. Unfortunately, while the typical American adult is at high risk of heart disease (the number one killer in the U.S.), very few are willing to change, especially if it entails any discomfort or inconvenience.
Why not?
In fairness, they have been lulled into thinking all is well because they don't have symptoms that would alert and alarm them. Unfortunately, chronic diseases work "behind the scenes" for years, destroying the body, and only when the process has gotten very advanced and is life threatening do indications of a problem surface.
More: Should the government regulate food ads like it did cigarettes to stem childhood obesity?
My analogy of termites destroying your home is appropriate. Destruction from termites can reach a critical stage before you know there is a problem. I know this firsthand as the stairs to my back deck collapsed from termites, and there was no indication of a problem until I stepped on them.
Unfortunately, human nature requires something obvious and strong to stimulate change. This means if we have a chronic disease that has been progressing for years, we ignore it because we can. Then when things get so bad that the body cannot hide the disease any longer, the problem erupts as a heart attack or stroke, seemingly "from out of the blue." It's a harsh blow when our health is lost, but at least it inspires us to finally take action. Unfortunately, too often it's too late.
Can statin drugs helps reserves atherosclerosis?In addition to substantial changes in lifestyle, there may be additional help in reversing atherosclerosis. We know that statin drugs are effective in lowering the concentration of LDL (bad cholesterol) in the bloodstream. In the past, an LDL no higher than 100 mg/dl was the cutoff standard, but this is way too high. Experts now tell us to reduce LDL below 50 mg/dl. At this level the clogging process should slow and possibly stop, which is a highly meaningful change. And taking the LDL even lower may possibly reverse clogging.
However, decreasing LDL to a very low level likely will require a hefty daily dose of a statin drug which can cause unwelcome side effects in some patients. A lesser dose may accomplish the same desired effects if it is accompanied by a healthier lifestyle. This is my story as a modest statin dose on my vegetarian diet reduced my LDL to below 50 mg/dl.
Thus, my advice is, to decrease heart disease risk substantially and at the same time avoid potential side effects from a hefty statin dose, take a lesser dose and ease into an "Ornish-like" lifestyle. Although you may not be able to follow the Ornish plan perfectly, you will benefit greatly from whatever efforts you invest.
More: Is it really harder for women to lose weight? Yes. Here's what to know
Let me emphasize that whatever you do, don't wait for symptoms as it may then be too late. As a starting point, take a look inside your heart arteries and quantify your degree of clogging. Preventive cardiologist, Dr. Henry Sadlo, advises all folks middle aged and above to have a coronary calcium scan. CCS tests are readily available, risk free, painless and inexpensive. And they save lives because what you find may be sufficient motivation to take action, especially when it comes to your lifestyle. Ask your doctor to guide you to testing.
Reach Bryant Stamford, a professor of kinesiology and integrative physiology at Hanover College, at stamford@hanover.Edu.
This article originally appeared on Louisville Courier Journal: Can atherosclerosis, coronary artery disease be reversed?
Raising Awareness For American Heart Month
February is often linked to hearts, love, candy, roses and the color red. But there is also a more serious side to the month — as serious as a heart attack.
American Heart Month is observed every February and it's intended to raise awareness about heart disease.
"Heart disease is the leading cause of death in the United States due to high prevalence of risk factors including high blood pressure, diabetes, obesity and high cholesterol," said Dr. Yaqoob Mohyuddin, Associate Chief, Division of Cardiology – LVH-Hazleton. "In addition, low physical activity and smoking can increase the likelihood of developing heart disease. We have an aging population and with increasing age incidence of heart disease increases."
Finding out that heart disease is the leading cause of death for all Americans may have people worried about how much they could be at risk. There are modifiable and nonmodifiable risk factors at play but there is a lot that can be done to decrease the chances of getting it.
"Factors such as age, family history and gender can't be changed," Mohyuddin said. "Men are usually at high risk, however, women have a higher risk of developing heart disease after menopause. In addition, certain groups such as African Americans or South Asians have higher risk of developing coronary heart disease. Some of the other factors that are modifiable include smoking, high blood pressure, diet and physical activity."
In a traditional sense, heart disease refers to a buildup of plaque in the arteries which can lead to a myriad of problems, such as angina, shortness of breath or a heart attack — the most well-known heart problem.
"A heart attack occurs when there is an obstruction to blood flow in one of the arteries of the heart. Due to the obstruction or blockage, blood is not provided to that particular area of the heart with results and a myocardial infraction which is damage or death of the heart tissue," Mohyuddin said.
In order to reduce the risk of a heart attack or heart disease it is imperative to maintain a healthy weight and diet, stay physically active, manage blood pressure and stress, get adequate sleep and quit smoking.
"Patients who have a strong family history of premature heart disease, uncontrolled high blood pressure or difficult to control cholesterol could certainly see a cardiologist. Patients who have established heart disease such as coronary heart disease, valvular heart disease or congestive heart failure usually follow-up with a cardiologist," Moyhuddin said.
The Zoll LifeVest is a wearable defibrillator that monitors a person heart. (Submitted) Dr. John Ellis, of Northeastern Pennsylvania Cardiology Associates in Plains Twp., said Heart Month is a good reminder to get yourself checked out.
"I think people need to know about heart conditions," Ellis said. "Patients can help themselves by going to the doctor. I just think people need to be cognizant of their health."
Ellis said he likes to practice "interventional cardiology," a specialty that diagnoses and treats heart and blood vessel conditions using catheters to avoid open heart surgery.
Ellis also outfits some patients with the LifeVest by Zoll, a wearable defibrillator that detects certain life-threatening rapid heart rhythms and automatically delivers a treatment shock to restore a person's normal rhythm.
The device has saved the lives of his patients, he said.
Staff writer Bob Kalinowski contributed to this report.
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