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Monday, June 3, 2019

Cardiovascular Disease: Time to “man-up” and take action against this killer

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“Serious as a heart attack!” This is a phrase we have all heard, so let’s look at what it means here in Shreveport. According to the latest data (2016) from the Centers for Disease Control and Prevention (CDC), cardiovascular disease (CVD) remains the leading cause of death in the United States, yielding 840,768 deaths accounting for one in three deaths in men and women. The Shreveport area is at a lower risk of cardiovascular death and stroke than the rest of Louisiana. Is it time for us to celebrate? Not just yet as we are still at greater risk than many other U.S. cities.

Unfortunately, one out of every two patients learn for the first time that they or someone they know has cardiovascular disease when they experience a stroke or sudden death. You cannot count on the typical “elephant sitting on my chest” symptoms to jar you into realizing you have a heart problem. If you have shortness of breath when walking or doing daily chores, an arm or jaw ache when walking, find that you are more tired than usual with everyday activity, or have indigestion with exertion, you may have blockages in your heart arteries. If your legs cramp when walking, you may have blockages in your leg arteries, placing you at higher risk of stroke or heart attack.

Who is at risk? Everyone, but some more than others. If you have diabetes, elevated blood pressure, actively smoke, do not exercise regularly, have elevated cholesterol or have a close relative (men younger than age 55 and women younger than age 65) who had a heart attack or stent, you are at increased risk. The more of these medical problems you have, the more at risk you are. African-American men are twice as likely to die from cardiovascular disease as white men. Women are more likely to die from cardiovascular disease than from cancer, and are less likely to know that they have cardiovascular disease.

One-third of cardiovascular deaths can be prevented, and six out of 10 preventable deaths are in individuals younger than 60 years old. Knowing your risk is easy, but you have to do your homework. You should ask about your blood sugar (HgA1C) number, blood pressure (top and bottom numbers), and cholesterol (HDL and LDL numbers). Unfortunately, one-third of us under the age of 65 do not know these numbers. Once you know your numbers, visit www.cvriskcalculator.com to find out your risk number. If it is greater than 7.5, you should discuss how to lower your risk with your medical provider. If you do not know the numbers, visit your health-care provider or look for community education events that offer these tests – often for free.

There are now noninvasive tests to determine if you have narrowing arteries, although exercise tests are still excellent tests. CT scans are being increasingly used to measure the flow in the arteries to see if it is abnormal. Using data gathered from the CT scan, HeartFlow creates a color-coded, three-dimensional model of your coronary arteries and calculates how much any blockages are limiting blood flow. Most blockages found using elective testing can be treated with medications alone. Medications are available to decrease your risk of having a heart attack or stroke and have played a key role in decreasing the risk of dying from heart disease by nearly 20% over the last 10 years.

If you develop chest pressure or other symptoms at rest and they last longer than 15-20 minutes (Doc, am I having a heart attack?), call 911 – do not drive yourself to a hospital. EMS teams can quickly evaluate and determine if you need immediate attention. An interventional cardiologist through a procedure called angioplasty — threading a thin tube (catheter) into the blocked coronary artery and expanding it by inflating a small balloon – can quickly clear a clogged artery. Most people undergoing angioplasty will also have a stent installed to help keep the blood vessel open.

To decrease your risk of having heart and blood vessel disease, stop smoking and exercise regularly. If you have diabetes and need to improve your blood sugar numbers, eat a balanced diet, decrease your bad cholesterol, be physically active and limit stress. And men, don’t be among the one-third of adult men who have not had a lipid profile in the past five years as it is crucial to have blood work done every four to six years starting at age 35. Also, consider a coronary-artery calcium scan, which is a noninvasive test that looks inside the coronary arteries to find actual plaque. It is the best way to get a handle on your overall plaque risk, or “plaque burden.”

I know what you are thinking: “I’m overwhelmed by this information.” Please do not stress. There are excellent resources on the America Heart Association’s website, www. heart.org. Another resource at your fingertips can be found by typing “ASCVD” into a web browser, then clicking on the American College of Cardiology’s ASCVD Risk

Estimator Plus and entering numbers for your age, cholesterol (HDL and LDL), and blood pressure. You will also answer several yes/ no questions to receive a report on your risk of developing atherosclerosis in the next 10 years. If you score 7.5% or higher, talk to your doctor about how to lower your risk.

So, “man-up” and take action to prevent and reduce cardiovascular disease. Let’s work together to make Shreveport one of the healthiest cities in Louisiana and the United States!

Steven Bailey, MD, is chairman of the Department of Internal Medicine at LSU Health Shreveport. He specializes in interventional cardiology and cardiovascular disease. For more information or to make an appointment, call 318-626-0050.

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