Knowing and controlling your risk factors for heart disease

Heart disease is the leading cause of death in the United States. Heart disease develops at a younger age in African Americans, and mortality from heart disease is higher in African Americans than in White Americans. 

Coronary artery disease is the most common type of heart disease. Coronary artery disease occurs when the main blood vessels to the heart become blocked or damaged. When the blood vessels to the heart are blocked, the heart is not able to receive enough oxygen-rich blood in order to pump effectively. 

Blockages in the blood vessels are caused by the progressive buildup of plaque over years, or by inflammation and clot formation that can occur suddenly. A partial blockage in a blood vessel can cause the symptoms of coronary artery disease, and a complete blockage can cause a heart attack.

Symptoms

The most common symptoms of coronary artery disease are chest discomfort and shortness of breath. This chest discomfort is often described as a pressure, or squeezing, in the center of the chest. Often, the chest discomfort associated with coronary artery disease is brought on by exertion or activity, and is relieved by rest. 

Chest discomfort can radiate to the arm, neck or jaw, and can be associated with shortness of breath, sweating and nausea. In women, symptoms of coronary artery disease can be slightly different and can include discomfort or pain in the shoulders, indigestion or heartburn.  

A heart attack can occur when the blood flow through an artery is suddenly and completely blocked. The blockage is often due to a clot in a blood vessel. The symptoms of a heart attack are similar to the symptoms of coronary artery disease, but are usually more severe, and last longer than a few minutes.

 An untreated heart attack can cause permanent damage to the heart muscle and can be life-threatening. If you think you are having symptoms of a heart attack, it is very important to seek immediate help and call 911. 

Risk factors 

The risk factors for coronary artery disease include high blood pressure, cigarette smoking, diabetes, lack of exercise, obesity, high cholesterol, and having a family history of heart disease.  Risk factors for heart disease are more common and often poorly controlled among African Americans. 

The disparities in heart disease outcomes are due to many factors including differences in access to health care or health insurance, as well as differences in access to healthy foods, safe neighborhoods, nutritious food, and exercise options. Coronary artery disease often develops over decades. Therefore, you might not notice a problem until you have a significant blockage.  

Diagnosis and treatment

Based on symptoms and risk factors, your doctor may suspect coronary artery disease and then order additional tests to make a diagnosis. 

• An electrocardiogram (ECG) can measure the electrical activity in your heart. 
• A stress test may involve walking on a treadmill and images of your heart in order to determine if your heart receives enough blood with physical activity. 
• An echocardiogram is a heart ultrasound that allows your doctor to observe the structure and pumping function of the chambers of the heart. 
• A cardiac catheterization is a procedure where a tube is moved through blood vessels up to your heart and a special dye and Xray are used to create detailed pictures of the coronary arteries. Blockages can be fixed or opened up with balloons and stents during a cardiac catheterization. 
• Severe coronary artery disease can be treated with coronary bypass graft surgery, where a surgeon uses other blood vessels from your chest, leg or arm to create new pathways to deliver blood to the heart. 

Prevention

You can take simple yet powerful steps to prevent coronary artery disease by knowing and controlling your risk factors. Coronary artery disease can be treated with lifestyle changes. Blood pressure, cholesterol and blood sugar can be controlled with diet and exercise. 

Aim to eat a heart-healthy diet of lean proteins, fruits, vegetables and whole grains while avoiding processed foods and sugars. Increase physical activity to 30 minutes of moderate activity most days of the week. Try to maintain a healthy weight and avoid tobacco. 

Medicines can be used to prevent and treat coronary artery disease by lowering blood pressure, reducing cholesterol, and preventing blood clots. Heart-healthy lifestyle choices can improve your overall health and reduce the risk of getting coronary artery disease. 

Make your health a priority. It is never too late to start. 

Mosi Bennett, MD, Ph.D. is a board-certified heart failure and transplant cardiologist with the Minneapolis Heart Institute at Abbott Northwestern Hospital. He completed his undergraduate work at the University of Pennsylvania. He went on to attend medical school and graduate school at the Johns Hopkins University School of Medicine in Baltimore, Maryland. He completed his Internal Medicine residency at Johns Hopkins Hospital, and then cardiovascular disease and heart failure fellowships at the Cleveland Clinic.