Heart Disease Basics
Is heart disease an epidemic in the U.S.?
If an epidemic is something that affects the majority of the population, then there's no question that heart disease is an epidemic in the US. Heart disease is the number one killer of Americans, both men and women, and the unfortunate thing is that much of that heart disease epidemic could in fact be prevented. On the other hand, that's good news, because it means that we can do better in the future.
What are the most common types of heart disease?
Heart disease can affect any part of the heart and it's blood vessels. The most common kind, of course, is coronary artery disease (or atherosclerosis) affecting blood flow through the coronary arteries. But heart disease can also affect the heart muscle, it can affect the heart valves, it can affect the large vessels that come out of the heart – like the aorta, with aneurisms, and it can, in fact, affect even the sac around the heart, called the pericardium – a sac that has both a lining right on the heart and a larger sac around that can be affected by inflammation; causing pain in the chest that's a form of heart disease, but a much less serious form initially. The heart can also be affected by infections – so that the heart valves, for example, can be affected by what's called endocarditis: an infection of the heart valves with bacteria and that can actually destroy some of the heart valve tissue, resulting in leaky valves.
What is "coronary heart disease"?
Coronary heart disease is any disease that affects blood flow through the coronary arteries. The coronary arteries are the arteries supplying the heart. They come off of the aorta here, right at the top of the heart. And actually, because they spread out over the heart, they were thought to look sort of like a crown. So they're called coronary arteries, or the word "corona" or "crown," all come from the same place. They branch out over the heart and they send out little branches, not only over the surface of the heart, as here, but actually diving down deep into the heart muscle, where they bring oxygen through the blood to supply every cell throughout the heart. So every cell that's doing all the work of pumping is supplied by blood flow coming through the coronary arteries.The coronary arteries can increase this flow enormously when we exercise. So if we do anything that raises our blood pressure and heart rate, like running down the block, or for that matter, emotional work--having an argument with someone, getting up and giving a lecture--blood flow through the heart is needed to increase. And in fact, these arteries can greatly expand; they can open up and let more blood flow through.
What's the difference between "acquired" and "congenital" heart disease?
Congenital heart disease refers to structural problems with the heart that are present at birth. They can affect various different parts of the heart. For example, people are commonly aware of things like holes in the heart, where between two heart chambers there's actually a perferation. Sometimes very tiny, sometimes something that will close up over a few days or weeks, but sometimes something that needs to be closed itself with surgery over a period of time. There can be problems with the heart, the heart vessels, with the large vessels in particular that come out of the heart. There can be problems with the heart valves, some of which cause problems early in life, even in infancy, and others in which you can see the abnormality in the heart valve early but it doesn't really cause any problem for twenty or thirty or forty or fifty years. Acquired heart disease, on the other hand, means that the heart starts out being as perfectly healthy as we can determine and later on something occurs; arterial schlorosis, athira schlorosis, cholestorol deposits, hardening of the arteries, those are all terms that people use to refer to the process of choronary artery disease. Infectious problems affecting the heart valves would be an acquired heart disease. So one can have either problems you're born with, problems you acquire, and of course, the genetic predisposition to having a problem is present at birth in all of us. So in a sense, we all have those predispositions when we're born, and they make us more or less likely to develop acquired heart disease later.
Do men develop heart disease younger than women?
Men develop heart disease a little earlier than women by about a decade, so the incidents of heart attack in women is delayed by about ten years. Now, we don't actually know why that is. We used to think we had a simple answer in that women go through the menopause and after the menopause their incidents of heart attack certainly goes up, but in fact replacing estrogen as we did in trials of hormone therapy, what we used to call hormone replacement therapy, in fact didn't benefit women in terms of preventing heart attacks and preventing the development of coronary artery disease. So, it seems clear that there are multiple factors. In any case, when women start to catch up, they really do catch up. Although they start a little later, by the time they get to their late seventies and early eighties women in fact are dying of heart disease at a considerable rate. Wpmen are having heart attacks at a rate that is equivalent to and then surpasses the rate of men's heart attacks. In fact in this country, more women die of heart disease every year than men equating to more than four hundred and fifty thousand women a year with men amounting to a little over four hundred thousand this year.
Is heart disease genetic?
Heart disease, as is true for many diseases, is in some ways genetically determined. So we're all born with predispositions to one disease or another. We're more likely, for example to have high blood pressure, or diabetes, or high cholesterol. Things do run in families, and heart disease clearly runs in families as well. That doesn't mean that everyone in a family that has heart disease, will have heart disease, because genes express themselves differently in each individual. But, it does mean that if you're in a family that has heart disease, particularly if that heart disease is seen early, that is if heart disease is seen at an age less than fifty-five in men or less than sixty-five in women, then you do have to be concerned about that genetic predisposition to heart disease, and you do want to do everything you can to reduce all the modifiable heart disease risk factors. Change all the things that you can change, to do the best you can to protect yourself from heart disease. Fortunately, there's a great deal more that we can do for people who have a family history of heart disease than we used to be able to. So even if someone in your family has had heart disease, our ability to prevent heart disease, and to treat heart disease if it occurs, have tremendously advanced over the years. So that we can do much better for people with heart disease now then we could in the past.
What are "arteries"?
It's important to know what blood vessels we are talking about when we talk about heart disease and blood vessel disease and people often don't know what the terms mean. Arteries are the blood vessels that take blood away from the heart to the tissues. Arteries supply the tissues. So when the heart pumps blood out, it pumps it out through the largest artery, the aorta, and then into many other arteries: arteries to the kidneys, arteries to the muscles, arteries to the stomach, arteries to the heart itself. Arteries then break down into tinier little branches, just like a river has tiny branches and those arterioles actually are right down in the tissue providing the blood supply.
What is "plaque"?
The reason we talk about plaque and arteries together is that plaque, cholesterol deposits, atherosclerosis, and hardening of the arteries; those all mean the same thing. Plaque forms in arteries and can obstruct flow through the arteries, and that plaque is formed when cholesterol levels in the blood are too high and the cells within the arteries actually take up that cholesterol. It gets changed chemically and the artery lining, the areas right under the very innermost lining of the artery, are actually stimulated to grow so that the artery not only has cholesterol in it, but in some of these blood cells it actually has excess growth. As a result the opening in the artery becomes narrower and narrower, sort of as if you had boiler scale in a pipe. In addition, that innermost lining stops functioning as well, so its not as slick and shiny and smooth as it used to be, and blood is more likely to clot in that area. Those clots can then go to other places in the brain or in the heart and cause serious damage.
How does having a heart condition affect the rest of my body?
Let's talk first about coronary artery disease, or athersclerosis, is a disorder that's wide spread. So, if you had narrowings in the coronary arteries, you almost certainly have athersclerosis in other blood vessels as well. If you have them in the arteries going to the brain, they can certainly lead to strokes. If you have them in the blood vessels going to the kidneys, they can, in fact, make high blood pressure worse and affect kidney function. If you have them in the blood vessels going to the legs, they can affect the blood flow there, so that you have pain when you walk, or you may even have poor enough blood flow that amputations are needed. The eyes can be affected, one can become blind if blood vessels are affected by athersclerosis. So, heart disease, of the kind, that we call athersclerosis or coronary disease is often associated with problems in blood vessels in the rest of the body. Now, if the heart disease isn't related to athersclerosis, but is one of the many other forms of heart disease, then the primary way in which that affects the rest of the body is by the heart's function, and whether the heart is able to pump blood around sufficiently, so that it can supply the needs of the body, when you exercise or do physical activity, or really any sort of activity. If there is a disease causing a problem with the heart that also affects other parts of the body, like diabetes, or systemic lupus, then you can have affects both in the heart and other parts of the body, actually caused by the other disorder itself.
How is coronary heart disease treated?
If you have coronary heart disease, if you have been found to have it, if the diagnosis has been made, you need to be working with your health care professional to make certain that whatever was the event that led him to understand that you have coronary heart disease doesn't happen again. If it was a heart attack or an episode of angina, we need to be doing all the preventive things that we can do to keep you safe and have you live a long and healthy life. We can do that now because we have many, many different ways to treat the risk factors that would make you likely to go on and have a second heart attack or a stroke or a complication. So working with your health care provider can give you a very long and healthy life, one that people in decades before this really never had the chance to have.
What are the possible treatments for coronary heart disease?
The treatment of patients with coronary heart disease should always start with lifestyle. That is we do the things we can do in terms of diet and physical activity to reduce our risk factors for coronary heart disease in simple ways, because those are important even if we are giving other treatments for coronary heart disease as well, that we might think of as more effective. We want to do those lifestyle things to treat coronary heart disease because they're an important base. And these treatments for coronary heart disease will include discussions with your physicians about what you should eat, what you shouldn't eat, things like saturated fat. And in addition, what exercise is appropriate, what physical activity you can and should do. And your doctor will want you to be physically active too treat coronary heart disease. In addition your doctor will certainly prescribe medications as treatments for coronary heart disease. There is a set of medications that have all been demonstrated in separate large trials, to show that they can prolong life when used to treat people with coronary heart disease. Now of course, prolonging life; letting you live a long and healthy life is our ultimate goal. We also want your quality of life to be good. So we don't want you to have symptoms from your coronary heart disease, if we can avoid it. Some of the medications are used to treat symptoms of coronary heart disease, but many of them are actually to prolong your life. And sometimes, other procedures are needed to treat symptoms of coronary heart disease. So, angioplasty, coronary by-pass surgery, other procedures that will help open the arteries, and provide more blood flow to the heart are sometimes needed depending on your particular circumstances.
