The latest discoveries, techniques and strategies for heading off heart disease.
As a doctor who specializes in cardiovascular disease,
Warren D. Johnston, MD, Fellow of the American College of Cardiology, Fellow
of the American College of Physicians, has had a ringside seat to trends in heart medicine. From his vantage
point as chair of the Department of Cardiology at
St. Joseph Heritage Medical Group and Director of the Women’s Heart Center at
St. Joseph Hospital, Orange, he’s seen health trends that present major challenges, but many
positive developments as well.
First, the good news
“Heart disease is going down,” he says, and he attributes this
positive news in part to adults and teens smoking less. “Smoking
is a huge risk factor for cardiovascular disease, and it’s the single
most preventable risk factor. If you stop smoking, in five years your
cardiovascular risk is reduced to the point where it’s as if you
Another big boost for heart health: Doctors now recognize that heart disease
is different for women than it is for men. For instance, doctors now know
that low cholesterol (the “good cholesterol”) is more predictive
of heart disease in women than in men.
“Symptoms display differently in women—they’re more subtle,”
Johnston says. “Women may get chest discomfort that radiates down
the right or left arm, but they are more likely to have back pain, sweating,
profound fatigue and nausea.” Women who take on the role of nurturer
tend to delay visits to the doctor or the hospital when they have a heart attack.
Treating women differently
For many years, a pervasive belief among doctors that held that women didn’t
really get heart attacks caused them to not order the same diagnostic
testing for women as they did for men. “Women with positive stress
test results were less likely to get coronary angioplasty, and [were]
less likely [to be] studied for arrhythmias,” says Johnson. Before
the 1990s, clinical trials often included just 15 percent women.
This has changed. Johnston is co-medical director of the Women’s
Heart Center at St. Joseph Hospital, Orange, which offers specialized
care for women with heart disease as well as heart health assessments,
educational seminars and low-cost screenings.
Heart disease is the leading cause of death among women, according to the
Centers for Disease Control. In 2009, it claimed the lives of 292,188 women.
“Back in the day, if you asked women what they thought they would
die of, most thought it was breast cancer,” says Johnston, explaining
the prevailing belief of the 1970s and ‘80s. “That perception
is something we really have tackled and we have worked to educate people
through public outreach and screenings.” Johnston also credits former
First Lady Laura Bush for touring the country raising awareness about
heart disease among women.
Less invasive surgery, faster treatment
Another positive: People who are diagnosed with heart disease are living
longer—and Johnston believes this is because of quicker treatment.
“Now we know that when someone has a heart attack, and undergoes
angioplasty within 90 minutes, that can save a life. It’s the standard
of care now—an ER door-to-balloon time of 90 minutes.” That’s
the time it takes from a patient entering the ER to the time the balloon
catheter starts opening up the artery. Heart surgery has gotten less invasive
too; much more can be done via a catheter inserted in the groin and threaded
up into the heart.
And today doctors know that anyone who is experiencing a stroke should
get medication within a three-hour window. “We can dissolve the
clot, which will diffuse the neurological hit that stroke imposes on that
individual,” says Johnston.
Patients who have had heart surgery are encouraged to get up and move much
sooner than in years past. “When I started as a doctor, heart attack
patients were sent for bed rest for two weeks—we thought it was
a good thing,” says Johnston. “If they died, it was often
because they developed clots in the veins of their legs which traveled
into their lungs. Now we get patients up and walking in 24 hours.”
The bad news—and a solution
On the negative side, more people are overweight today—and this is
a significant risk factor for heart disease. “Obesity is an epidemic
that is reaching into the grade schools,” says Johnston. In part
because of this, diabetes, high blood pressure and high cholesterol also
are on the rise. “All this will put you at higher risk for heart
disease,” he says.
But obesity is preventable and it’s reversible. “Preventable
risk factors include hypertension, high cholesterol, obesity, smoking,
being sedentary and diabetes,” says Johnston. “We can treat
many patients with lifestyle modification—diet, exercise, weight
loss, as well as pharmaceutical therapies.”
(This story originally appeared in OC Catholic, July, 2015)