Dr. Nelson Trujillo: “Heart disease can be prevented or even reversed.”

About 660,000 people in the United States die from heart disease each year—that’s 1 in every 4 deaths.

“Early detection is vital, because the development of heart disease can be slowed or even reversed by lifestyle changes and proper medical management,” said board-certified cardiologist Nelson Trujillo, MD, during a free health lecture on battling heart disease. “For the last 25 years, I’ve been seeing patients in the Boulder community. I’m going to share some things that you can do to keep yourself healthy and avoid ever meeting me.”

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Watch Dr. Trujillo’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. These include:

• Problems with the arteries surrounding the heart
• Problems with the heart sack or pericardium
• Problems with the heart valves
• Problems with the heart’s electrical system (an arrhythmia)
• Problems with the heart muscle function (usually caused by one of the above)

“In the United States, the most common type of heart disease is coronary artery disease (CAD). This is caused by the buildup of atherosclerotic plaque in the arteries surrounding the heart,” explained Dr. Trujillo. “CAD is what we think about when somebody says I've had a heart attack, or I have heart disease. It's not really the heart itself but the arteries surrounding the heart.”

He added, “Atherosclerotic plaque is made of fatty substances, cholesterol, calcium, cellular waste products and fibrin, which is a clotting material in the blood. Over time, plaque and inflammation can narrow and harden the arteries. It can even stop blood flow.”

This can lead to problems such as:

• Heart attack — loss of blood flow to areas of the heart
• Stroke — loss of blood flow to areas of the brain
• Peripheral artery disease (PAD) — loss of blood flow to the legs or arms

12 ways to prevent heart disease

Dr. Trujillo said that there are several ways to reduce your risk of developing CAD:

1. Quit smoking: See our smoking cessation resources.
2. Manage 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.
3. Lower 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.
4. Manage diabetes: This condition can damage blood vessels over time, leading to heart disease. An A1C test can measure your blood sugar levels. Target an A1C level of less than 7%.
5. Exercise (think “recess”): “My mantra is we need more recess,” Dr. Trujillo stated. “When we were all children, we never missed recess. It happened at 10 o'clock and at two o'clock. Just like those days, set aside time twice a day for 20 or 30 minutes to go outside, run around, kick a ball, throw a tennis ball or dance. Recess should consist of aerobic exercises, mind body exercises such as Tai Chi, and some strength building exercising.”
6. Reach and keep a healthy 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.
7. Eat a healthful diet: “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,” according to Dr. Trujillo.
8. Avoid heavy alcohol use: Heavy drinking is linked to a number of poor health outcomes, including heart conditions.
9. Address loneliness: Dr. Trujillo encouraged his audience “to regain your sense of community, whether that's going back to church, joining the rotary group or a book group, just regain that connection.” In fact, Dr. Vivek Murthy, the U.S. Surgeon General, released an advisory declaring loneliness a new public health epidemic in the United States. His report says that loneliness is as bad as smoking 15 cigarettes a day and has profound effects on mental health, increasing the risks of heart disease, stroke and dementia. 
10. Sleep. Sleep affects not only cardiovascular but all aspects of health. Less than 7 to 8 hours/night increases heart disease risk.
11. Nurture mental wellness: Many forms of mental health issues can affect heart disease. There’s the temporary state of depression or a more severe, clinical case. You can also have varying levels of anxiety that affect the heart.
12. Stress management. Dr. Trujillo said, “It’s clear stress does affect the heart." He then took viewers through a quick breathing exercise, which has been shown to lower blood pressure and reduce cardiovascular mortality:

• Start with your right index closing your right nostril.
• Slowly inhale through your left nostril.
• Slowly exhale through your left nostril.
• Pause briefly at the bottom of your exhale as you empty your lungs completely.
• Repeat this three times.
• Then close your left nostril with your left index finger, and repeat the steps above.
  
  Perform this exercise at least once per day.

Screenings 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. Trujillo warned. “Regular screenings help us treat the risk factor with lifestyle changes and medications, and serve as a wake-up call for avoiding heart disease or a life-threatening cardiac event.”

During an appointment, a cardiologist will do a physical exam and listen to your heart. Be ready to answer questions about your family history and your own medical history. Your cardiologist will want to know if your siblings, parents or others in your family have had heart problems. Depending on the information gathered during a physical exam and your medical history, a cardiologist might order an EKG (electrocardiogram).

Your health care provider might use a cardiac risk calculator to gauge how likely you are to develop heart disease. These cardiovascular risk assessments use personal health information to calculate a 10-year and lifelong risk of heart disease.

Your cardiologist can also order the following tests but other health care providers, such as your primary care physician, may order these tests as well:

• Coronary artery calcium scoring (HeartScan): Based on a CT scan, this looks for calcified plaque (calcium deposits) inside the heart’s major vessels. Measuring calcified plaque has proven to be a good predictor of future CAD. The score ranges break down as follows:
  • Zero: You have no calcified plaque. Your risk of having a CAD-related event is low — not zero — and the lowest among your age group.
  • 0 – 100: “If the score is between 0 and 100, we know that the risk is also low. In that range, we're able to use predominantly lifestyle changes to reduce the risk of heart-related events and lower plaque burden,” Dr. Trujillo stated.
  • > 100: Your chance of having a heart attack is moderate to high. Your health professional will want you to consider aggressive lifestyle changes and, possibly, start treatment with a statin to reduce your cholesterol levels.

• 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.

Click here to view/download slides shown during Dr. Trujillo's lecture.

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