Heart Health

What Cardiologists Want You to Know

Chicago-area cardiologists weigh in on preventing heart disease, understanding your risk, and the advances and challenges shaping cardiovascular care

Heart disease remains a major health concern, but there’s plenty people can do to reduce their risk. For this issue’s roundtable, local cardiologists share what they want people to know about protecting their hearts, from understanding family history to building healthy habits early in life. They also weigh in on emerging treatments and the challenges shaping cardiovascular care today.

What can individuals do to prevent heart and vascular problems?

Dana C. Johnson: The good news is that many heart problems are preventable. Keep your blood pressure, cholesterol, and weight within healthy ranges, stay active, avoid tobacco, limit alcohol, and treat sleep apnea if you have it. As an electrophysiologist, I would add that treating sleep apnea also protects your heart’s rhythm.

Sandeep Khosla: The best way to prevent heart and vascular disease is to know your risk factors and live a heart-healthy lifestyle. Don’t smoke, stay physically active, eat a healthy diet, maintain a healthy weight, and get adequate sleep. It’s also important to monitor your blood pressure, cholesterol, and blood sugar, and work with your healthcare provider to address any concerns early. 

Palak Shah: Most heart and vascular disease is preventable. No. 1: Stop smoking, vaping, or chewing tobacco. No. 2: Movement is important. The American Heart Association recommends 150 minutes of moderate (walking, dancing) or 75 minutes of vigorous exercise (running, swimming) weekly. No. 3: See a doctor. Several patients we see present with heart disease as early as their 40s and have never seen a doctor. You should be seeing a primary care physician at least once a year to ensure your cardiovascular risk factors are controlled (blood pressure, cholesterol, blood sugar). No. 4: Watch your weight. Your body mass index should be less than 25. No. 5: Finally, you are what you eat. As much as possible, eat natural foods (fruits, vegetables, fish, dairy, nuts, whole grains, legumes), and avoid items from the middle of the grocery store that are highly processed and filled with preservatives.

Gregory J. Mishkel: Start with the basics: Don’t smoke, exercise regularly, eat sensibly, and develop good sleep habits. Know your blood pressure, cholesterol, lipoprotein(a), and blood sugar. Discuss appropriate screening with your physician. Prevention works best when small changes become habits you can sustain.

If I have a family history of heart disease, what are my chances of developing it? Should I meet with a cardiologist before a problem arises?

Sandeep Khosla: A family history of heart disease can increase your risk, especially if close relatives developed heart problems at a younger age. However, it does not mean heart disease is inevitable. Knowing your blood pressure, cholesterol, blood sugar, and other risk factors can help you better understand your overall cardiovascular risk. If you have a strong family history, multiple risk factors, or concerns about your risk, a preventive cardiology consultation may be beneficial. The key is to focus on prevention before symptoms develop.

Palak Shah: Depending on the cardiovascular disease, a family history can significantly increase your risk. If your family member developed heart disease before age 50 for a man or 60 for a woman, you should consider being tested (coronary calcium score, ApoB-100 and Lp(a)) as early as age 30. Importantly, the role of testing and seeing a cardiologist is to identify strategies to prevent the disease from developing.

Dana C. Johnson: If heart disease runs in your family, sometimes it’s better to speak to your doctor about your risk rather than wait for symptoms, especially if a close relative had heart problems at a young age or a sudden cardiac event occurred. A conversation with a cardiologist, and sometimes genetic testing, can help you understand your risk early.

Michael Carr: The answer is different as it relates to congenital heart disease (CHD). The baseline risk for CHD is about1 in 100 births, but this number increases three- to sixfold if there is a primary family member with CHD, with some forms of cardiac disease conferring higher risk. Certain forms of electrical and acquired heart disease have a genetic component, and your provider can aid in the discussion regarding cardiac screening.

Gregory J. Mishkel: Family history raises risk, especially when relatives develop cardiovascular disease young, but genetics and environment both matter. Discuss it with your physician before symptoms develop, ideally in young adulthood. Polygenic risk scores may help refine risk assessment, but no test predicts your future with certainty.

At what age should people start focusing on good heart health? And why then?

Michael Carr: There probably isn’t a minimum age to start focusing on good lifestyle choices for long-term cardiovascular health. It should start with the basics of good nutritional choices and a focus on consistent physical activity in childhood, then build from there.

Palak Shah: We are all born with arteries that are free of plaque buildup and typically have normal blood pressure, cholesterol, and blood sugar levels. Then life happens; diet happens; exercise doesn’t happen as much as it should. The goal is to develop healthy heart habits as early as childhood; the sooner, the better. The risk of cardiovascular disease is cumulative. It grows as we grow; therefore, you might as well reduce risk early in your life.

Gregory J. Mishkel: Heart health starts in childhood, when habits take shape long before symptoms appear. When we’re young, it’s easy to assume that what we do today won’t catch up with us. Helping children build good habits is much easier than asking adults to undo decades of them.

Sandeep Khosla: American College of Cardiology and American Heart Association guidance emphasizes formal cardiovascular risk assessment in adults around age 40. But really, heart-healthy habits should begin early, ideally in childhood. They become especially important in young adulthood. Heart and vascular disease often develops gradually over many years before causing symptoms. Establishing healthy habits and managing risk factors early can significantly reduce the likelihood of heart attacks, strokes, and other cardiovascular conditions later in life.

Did Covid-19 change heart health?

Dana C. Johnson: It did. Heart inflammation and new rhythm problems, such as atrial fibrillation, occurred during and after Covid-19 infections. Some people also saw changes in their bodies’ automatic regulation of blood pressure and heart rate. One silver lining is that more people have started paying closer attention to their heart health.

How does extreme heat, as we experienced this past summer, affect heart health?

Sandeep Khosla: Extreme heat places added stress on the cardiovascular system, particularly for people with heart disease, high blood pressure, or kidney disease. Heat can lead to dehydration, electrolyte imbalances, and additional strain on the heart, increasing the risk of complications. During hot weather, stay hydrated, limit prolonged outdoor activity, and contact your healthcare provider if you experience symptoms such as chest pain, unusual shortness of breath, dizziness, or heart palpitations.

Dana C. Johnson: Heat can be hard on your heart! Dehydration and shifting electrolytes can trigger rhythm problems, and your heart works harder to help cool your body. If you are on heart medications or have an arrhythmia, stay hydrated, avoid the hottest hours each day, and pay attention to how you feel.

Michael Carr: In the pediatric population, even in those with cardiac disease, extreme heat plays less of a role as long as patients and families concentrate on adequate hydration and appropriate monitoring of outdoor activities. The concern arises when children and adolescents curtail their overall activity level due to high temperatures.

What new heart and vascular procedures are you most excited about?

Gregory J. Mishkel: I’m particularly excited about catheter treatments for leaking mitral and tricuspid valves, expanding options for patients who previously faced surgery or had no suitable intervention. Decisions should be made together by a heart team, including interventional cardiologists, surgeons, and heart failure specialists, with the patient’s goals guiding the recommendation.

Michael Carr: Continued innovations in imaging modalities to detect and monitor congenital heart disease and nonsurgical options for pediatric patients, combined with advances in congenital heart disease surgery, are incredibly exciting and will ultimately lead to continued improvement in long-term outcomes.

Palak Shah: I specialize in heart failure and heart transplantation. Although I joke around and tell most people that you don’t want to see me as a patient, if you need to see me because your heart is weak or you have heart failure, you should see me soon. We have several medications and devices that we can use to help your heart recover toward normal function. If your disease is advanced, we can offer lifesaving therapies, including a left ventricular assist device (LVAD) or heart transplant.

Dana C. Johnson: Electrophysiology is one of the fastest-growing fields in medicine, with technologies such as pulsed field ablation changing the way we approach heart rhythm disorders.  We can now treat rhythms like atrial fibrillation more safely and effectively with a minimally invasive, often same-day procedure, and potentially avoid lifelong medicines.

Sandeep Khosla: Cardiovascular care is advancing rapidly, with new minimally invasive treatments helping patients recover more quickly while avoiding major surgery. I’m particularly excited about catheter-based technologies that can treat complex coronary artery disease, as well as newer procedures, such as renal denervation for difficult-to-control high blood pressure. Advances in catheter-based treatment of pulmonary embolism are also improving outcomes for patients facing potentially life-threatening blood clots in the lungs. 

What does a practice in your specialty need to thrive in today’s healthcare environment?

Sandeep Khosla: Successful cardiovascular programs combine advanced technology with highly skilled, multidisciplinary teams focused on patient-centered care. Providing access to high-quality care, maintaining strong relationships with referring physicians, embracing innovation, and emphasizing prevention are all essential. Ultimately, the best outcomes occur when clinical excellence, teamwork, and community-based care work together to support patients throughout their healthcare journey. 

Gregory J. Mishkel: A thriving practice needs timely access, people with shared values, and an environment where anyone can speak up. Advanced practice providers and pharmacists are essential members of the team. Alongside traditional quality measures, patients’ reports of their symptoms, function, and quality of life should help shape how we practice.

Palak Shah: A thriving advanced heart failure program needs a true interdisciplinary team. At Northwestern Medicine, we have the depth of expertise across every specialty, from oncology and nephrology to transplantation and beyond, allowing us to care for the whole patient. Combined with access to leading-edge research and clinical trials, we’re able to offer innovative treatments that improve both quality of life and long-term outcomes.

Michael Carr: We need a consistent pipeline of dedicated providers to care for pediatric patients with congenital/acquired cardiac disease. We need researchers to ask questions and ultimately provide answers to improve the care we provide for children with heart disease. Last, we need more experts to care for the ever-increasing number of adults with congenital heart disease.

What do you see as the biggest challenge facing healthcare providers today?

Dana C. Johnson: Honestly, it is the administrative burden. Prior authorizations, paperwork, and shrinking reimbursement take time away from patients and slow the adoption of new technologies by the people who need them. I would love to see that streamlined so physicians can spend more time doing what matters most: caring for patients.

Palak Shah: Healthcare in America has several administrative hurdles related to insurance companies, pharmacy benefit managers, hospitals, physician groups, and regionalized Medicare and Medicaid products. As a result, we spend close to a trillion dollars a year on healthcare administration — about twice as much as other countries. Clinicians spend hours on documentation, prior authorizations, and inbox messages instead of with patients. Well-deployed technology, including AI, and team-based care models are essential to restoring time for patients.

Michael Carr: The continued focus on patient volume rather than optimization of clinical care is a significant concern. All patients deserve time with a provider to fully evaluate concerns and arrive at an optimal management plan. We need to increase the number of trainees choosing a career in primary care to improve overall care.

Gregory J. Mishkel: I think the biggest challenge is reaching more patients while keeping care personal. Staffing shortages, administrative demands, and fragmented care take time from patients. My job as a physician leader is to remove those obstacles and give our teams the support to do their best work.

Originally published in the Fall 2026/Winter 2027 print issue.