Molly Ware, MD, on Battling Heart Disease

About 1 in 5 American deaths each year are a result of heart disease, making it the leading cause of death for men and women in the U.S. In fact, heart disease claims more lives each year than all forms of cancer combined.

“The good news is that heart disease can be prevented and controlled,” said BCH cardiologist Molly Ware, MD, during a free online health lecture.

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 Watch Dr. Ware's lecture on "Battling Heart Disease"

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What is Heart Disease?

​“The term ‘heart disease’ refers to several types of heart conditions. In the United States, the most common type of heart disease is coronary artery disease, which can lead to heart attack,” said Dr. Ware. Coronary artery disease is caused by the buildup of plaque in the heart’s arteries. It’s sometimes called ischemic heart disease.

Several diseases and conditions also fall under the umbrella of heart disease. These include:

• Problems with the heart valves
• Problems with the heart rhythm (an arrhythmia)
• Problems with the heart muscle function (usually caused by one of the above)

Six Numbers You Need to Know

Dr. Ware said that one way to stay on top of heart disease is to understand your risk factors and critical health numbers. The six important numbers one should know include:

1. High blood pressure: Even if treated, high blood pressure can damage your heart as well as increase your risk for stroke. While it can fluctuate with exercise, stress or sleep, try to keep your blood pressure below 120/80 mm Hg.
2. High cholesterol: This is considered a risk because it can build up on the walls of the arteries. LDL cholesterol levels should remain below 100 mg/dL, while HDL levels should be 50 mg/dL or higher for women, and 45 mg/dL or higher for men.
3. Non-HDL cholesterol: This is calculated by subtracting your HDL level from your total cholesterol number. Keep your non-HDL below 130 mg/dL.
4. Triglycerides: This is a type of fat that can contribute to the hardening of arteries. Optimal triglyceride levels are less than 150 mg/dL.
5. Diabetes: This can damage blood vessels over time, leading to heart disease. An A1C test can measure blood sugar levels. Target an A1C level of less than 7%.
6. Excess weight: Extra weight makes your heart work harder and can have negative impacts. Body mass index (BMI) is a good indicator of healthy weights. It's a measure of your weight in relation to your height and is calculated in conjunction with your waist circumference. A BMI between 18.5-24.9 (kg/m2) and waist circumference under 35 inches indicates a healthy weight.

Additional risk factors for heart disease include:

• Smoking
• Family history of early heart disease
• Chronic kidney disease
• Age of more than 55 years for women, age of more than 45 for men
• Sedentary lifestyle/lack of exercise

Other links to heart disease include:

• Low vitamin D levels
• Obstructive sleep apnea
• HIV infection
• History of chest radiation and certain chemotherapies
• Gout
• History of pregnancy complications: high blood pressure, pre-eclampsia, gestational diabetes
• Polycystic ovarian disease

Screening Tests Can Be a Wake-Up Call

“Sometimes heart disease is silent, and people don’t even know they have it until they experience a heart attack, heart valve problems or irregular heartbeat,” Dr. Ware warned. In fact, almost two-thirds of those who experience sudden cardiac death have no previous symptoms. “Regular screenings help us treat the risk factor with lifestyle changes and medications. They can be a wake-up call about the threat of heart disease or a life-threatening cardiac event.”

Dr. Ware described some of the newest screening tests for assessing heart health:

• Coronary artery calcium scoring: Based on a CT scan, this looks for plaque buildup inside the heart’s major vessels. It is helpful for people who have borderline risk factors.
• Lipoprotein testing: Lipoprotein, or Lp(a), is a particle in your blood that carries cholesterol. Elevated levels of lipoprotein have been shown to increase the risk of atherosclerosis, the buildup of fatty deposits in the wall of arteries.
• Measures of inflammation: A hs-CRP test measures the level of C-reactive protein in your blood, which tends to be elevated when there’s inflammation in your body, including within the arteries. However, this test is nonspecific and elevated levels of CRP might occur for any type of inflammatory condition.
• Carotid artery thickness: This is measured through an ultrasound exam and looks at the plaque buildup in the arteries of the neck, serving as a predictor of plaque buildup within the arteries of the heart.

The 4 Proven Pillars of Heart Health
How do we prevent things like heart attack? “It’s actually pretty simple. Nutrition, exercise, sleep and taming your stress are things we can do to not only prevent heart disease but other chronic diseases as well. These are known as The Pillars of Health,” explained Dr. Ware. “You can't really get on a path to health without addressing all four of these.”

1. Nutrition: Eat a Mediterranean-style diet. Dr. Ware described a Nurses’ Health Study that followed more than 125,000 people for eight to 14 years to assess the relationship between fruit and vegetable intake and adverse cardiovascular outcomes.
   
   “The study showed that increasing fruit and vegetable intake reduces cardiovascular risk,” said Dr. Ware. “In other words, reach for vegetables and fruit. Also eating a varied diet that's rich in lean protein, whole grains, good fats – for example, avocado or nuts instead of potato chips or sweets – is the best way to protect your heart.”
    
2. Exercise: “We need to be as active as possible during our day,” stated Dr. Ware. “Check with your doctor, then go for it! At least 30 minutes of moderate activity MOST days of the week. Some is better than none. More is better than less.”
   
   Strength training has a big role in building lean muscle, which promotes metabolism and helps with bone density down the road.
    
3. Sleep. Sleep affects not only cardiovascular but all aspects of health. Less than 7 to 8 hours/night increases heart disease risk. Poor sleepers tend to gain weight and have worse physical and mental performance, more inflammation and increased risk of depression.
    
4. Stress management. “It is clear stress does affect the heart. Heart attacks are less frequent in the summer. It’s probably because people are taking time off, getting out more to exercise, and spending time with family and friends."
   
   She added, “Personally, a few minutes of meditation daily has dramatically improved my stress level, beyond what I thought. I was pleasantly surprised, and that’s just a few minutes a day.”

If you wish to understand your risk factors for heart disease or to be screened, schedule an appointment with Molly Ware, MD by calling 303-442-2395.

Click here to view/download a PDF of slides shown during this lecture on Battling Heart Disease.

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