Give your heart a head start by knowing — and reducing — your risks
Preventive medical advice sometimes feels like it’s changing as fast as the weather whirling outside your window. And that’s especially true when it comes to preventing heart attacks. Are eggs healthy to eat, or are they too cholesterol-laden to indulge in? Should you drink a glass of red wine a day, or eschew alcohol altogether?
Case in point: The longtime advice to take baby aspirin to lower the risk of heart disease changed in October 2021, when the U.S. Preventive Services Task Force issued a draft recommendation against using low-dose aspirin for the primary prevention of cardiovascular disease in people 60 or older.
Despite these changing recommendations, figuring out how to prevent heart disease is important, because heart disease kills — often.
Heart disease was the top cause of death in Illinois in 2020, with 27,466 deaths that year, followed by cancer and Covid-19, according to the Illinois Department of Public Health. Together, heart disease, stroke, and other cardiovascular diseases account for roughly one in three deaths in the U.S every year.
If you’re wondering what you need to do to prevent a heart attack, read on. Chicago-area doctors share the latest suggestions on this vital topic.
Low-dose aspirin
While some of the aspirin recommendations are changing, other aspects remain in place. Popping a “baby” (low dose, 81 mg) aspirin daily is still a good idea for people with a history of heart disease, but it’s no longer recommended for those without past heart disease.
“The recommendations for aspirin haven’t changed for those who have had a heart attack or other types of vascular disease. For those people, except for special circumstances, aspirin is still an important part of their treatment program,” says Stephen Devries, MD, preventive cardiologist and executive director of the educational nonprofit Gaples Institute.
But for people 60-plus who don’t have heart disease, low-dose aspirin may increase the risk for gastrointestinal or brain bleeds, without much prevention benefit. Also, under the new draft recommendations, people ages 40 to 59 who are at a higher risk of cardiovascular disease should talk to their doctor about whether taking low-dose aspirin is right for them.
“Newer therapies have emerged for prevention over the years that have reduced the importance of aspirin, including better therapies for blood pressure and cholesterol management,” Devries says. One of these therapies is inclisiran (Leqvio), which the Food and Drug Administration approved in 2021.
The drug helps block production of a protein in the liver to reduce the amount of LDL cholesterol in the bloodstream. People take an initial injection of the drug, a second injection three months later, and subsequent doses every six months.
Know your risks
Everyone’s risk for heart disease is different, so knowing your personal risk makes a difference. Things like diabetes, a smoking habit, or a family history of heart disease can ratchet the risk into uncomfortable territories.
“Genetics are very important, so a family history of heart attacks and strokes at a young age may increase your risk,” says Rina Verma, MD, a cardiologist with AMITA Health Alexian Brothers Medical Center in Elk Grove Village.
Risk-predictor tools and imaging studies, such as CT scans, can look at your heart health and determine whether you have risk factors for cardiovascular disease, says Gregory Mishkel, MD, chair of cardiology at NorthShore University HealthSystem.
“Today, physicians have access to more sophisticated cholesterol analysis and inflammatory markers that can inform individuals as to their risk of heart disease,” Mishkel says.
For instance, a high-sensitivity C-reactive protein test that measures inflammation levels in the body can also show risk of coronary artery disease. And a particle test can look at the type and size of LDL cholesterol particles to give more information about a person’s cardiovascular risk. “The small dense particles are more atherogenic [promoting plaque in the arteries] than the large fluffy particles,” Mishkel says.
Another test, a coronary calcium scan, uses a CT scan to measure calcium-containing plaque in the arteries and look for hardening of the arteries, which is a marker for underlying coronary artery disease.
“Increasingly, for patients who have chest pain, we now combine CT scanning with dye and can look inside the artery to determine the extent of plaque, how severe the blockage is, and the effects on blood flow,” Mishkel says.
Healthy habits
Once you know your risk, figure out which actions work best for you to lower the likelihood of heart disease.
As Devries points out, “We can’t escape the harm of a poor diet with technology.”
Studies have shown that the Mediterranean diet — which includes eating plenty of leafy produce, legumes, fruits, nuts, seeds, and herbs, plus seafood, poultry, and dairy in moderation — can help to significantly lower the chances of heart disease and stroke.
The upshot: an egg a day (or two egg whites) can be part of a heart-healthy diet, says the American Heart Association (AHA). Wondering about red wine? The flavonoids in it — which are also found in dark chocolate — can have a protective impact on the cardiovascular system. Still, the AHA recommends that women limit themselves to one drink a day and that men limit themselves to two drinks.
It’s also wise to get good control of diabetes and cholesterol. Doctors recommend eating a diet low in saturated fat and high in fiber from veggies, fruit, whole grains, and nuts. Weight loss and regular cardio exercise — even walking — is key.
And smokers — you guessed it — should stop smoking. The smoke ushers chemicals into the lining of the blood vessels and also significantly raises blood pressure. Nicotine narrows the blood vessels and makes the heart pump faster, upping blood pressure in a zip.
Tried-and-true approaches seem to go the distance when it comes to heart health. “A plant-based diet, regular exercise, and not smoking are some ways to modify your lifestyle to reduce your risk,” Verma says.
Devries suggests you ask yourself a few important lifestyle questions to make sure you’re keeping your heart healthy: “Are most of your meal plates, as well as your shopping cart, at least half-filled with vegetables and fruit? Are you eating too many packaged, ultraprocessed foods? Are you doing something active, even walking, for 30 minutes on most days? Have you found a strategy that works for you to help manage stress? These questions all point to simple ways that everyone can use to powerfully stack the deck in their favor.”
We heart that.
Originally published in the Spring/Summer 2022 print issue
Kathryn O’Shea-Evans is a freelance writer for The New York Times, Wall Street Journal, and many other outlets.
