Heart Health

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heart Health

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February 2013 | IM 91

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Understanding Heart Disease Learn how you can combat this widespread condition

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he statistics are heartbreaking. As the leading cause of death of both men and women in the United States, cardiovascular disease claims the lives of approximately 600,000 people per year, according to the Centers for Disease Control and Prevention. Not only that, but 935,000 Americans experience heart attacks each year, and of those nearly 1 million cases, 610,000 are first-time occurrences, while the other 325,000 are repeat offenders.

by Julie Young 92   IM | February 2013

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Innovation, healing and health start here.

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HEART HEALTH SPECIAL ADVERTISING SECTION

Heart Disease Risk Factors

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here are several factors that increase one’s risk of coronary heart disease and having a heart attack, according to the American Heart Association. Based on extensive clinical and statistical studies, these risks include major factors that cannot be changed, some that can be modified, and other contributors that increase one’s chance of developing heart disease at some point in his or her life.

Risk factors that cannot be changed include:

• Age. Approximately 82 percent of those who die from coronary heart disease are 65 or older.

• Gender. Studies show that males have an increased risk of being diagnosed with heart disease than women. Even though the post-menopausal years increase a woman’s risk of death from heart disease, it’s still not as great as a man’s risk.

• Heredity (including ethnicity). Children who have parents diagnosed with heart disease are more likely to develop heart disease themselves. African Americans are at a greater risk for high blood pressure than Caucasians, which puts them at a higher risk for coronary heart disease along with other ethnicities, such as Mexican Americans, Pacific Islanders, Native Americans, and some Asian Americans.

Risk factors that can be controlled include:

• Tobacco use. Smokers are two to four times as likely to develop heart

disease than non-smokers. Tobacco is a powerful risk factor for sudden cardiac death in patients with coronary heart disease.

• High cholesterol. When cholesterol rises, so does the risk of coronary heart disease. Coupled with other risks, such as tobacco or high blood pressure, the risk increases even more.

• High blood pressure. This condition increases the heart’s workload, which causes it to work harder and become thick and stiff. As a result, the heart muscle will not work properly and will ultimately increase the chances of stroke, heart attack, kidney failure, or congestive heart failure.

• Physical inactivity. Moderate to vigorous activity accomplished in regular intervals will help keep the blood flowing and the heart strong.

• Obesity. Like high blood pressure, excess weight increases the heart’s

workload and raises a body’s blood pressure and cholesterol, which all contribute to the development of heart disease. Losing just 10 pounds can make a big difference to your heart.

• Diabetes. Diabetes seriously increases one’s risk of heart disease even

when blood glucose levels are under control. According to the Heart Association, at least 65 percent of people with diabetes die of some form of heart or blood vessel disease. Persons who are obese or overweight should lose weight to keep blood sugar in control.

Other factors that contribute to your risk of heart disease include stress, your diet, and alcohol consumption. Individuals can assess their risk of having a heart attack or coronary heart disease within the next 10 years by visiting the American Heart Association’s Heart Attack Risk Calculator at heart.org.

Heart disease is a serious condition to say the least—it accounted for more than 13,000 Hoosier deaths in 2009, according to the Indiana State Department of Health.

So what conditions fall under the umbrella of heart disease, and what are the major risk factors that contribute to the weakening of the heart muscle? How can you manage your risk factors, and if you’ve already been diagnosed, what is the most effective way to manage heart disease?

Local cardiologists weigh in on what causes a total eclipse of the heart and what you can do about it.

The many forms of heart disease Dr. Michael Ball, FACC, cardiologist at St.Vincent Heart Center of Indiana, says there are two main categories of heart disease: arterial and structural.

The most common form of heart disease is coronary artery disease, which can cause heart attacks, angina, heart failure, and arrhythmias. Caused by a buildup of plaque deposits in the arteries, CAD narrows the passageways inside the arteries and prevents the heart muscle from getting the blood that it needs.

“There are a number of risk factors that increase one’s risk for CAD, including diabetes, hypertension, high cholesterol, smoking, and obesity,” he says. “In the medical community, we emphasize hearthealthy living in order to keep those risks under control before that plaque ruptures and a myocardial infarction [heart attack] occurs.”

The second type of heart disease results from structural problems within the heart muscle. This can be any abnormality or defect in the heart muscle, valve, or electrical system of the heart.

They can be congenital problems (present at birth) or can be acquired over time.

Congenital problems include ventricular or atrial septal defect, also known as a hole in the heart; coarctation of the aorta, in which a small portion of the aorta becomes narrowed; and tetralogy of fallot, a rare condition caused by four heart defects at birth.

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Know your numbers.

As the President & CEO of Fifth Third Bank, Central Indiana, numbers are a part of my everyday life. I am constantly thinking about the bank’s customers and the numbers that are important to them. It wasn’t until I attended a Go Red luncheon in February that I began paying attention to the numbers most important to me and my health.

I made a commitment that day to become more educated about my heart health. Knowing my numbers has empowered me to manage my heart disease risk factors, and with my doctor’s help I have lowered my chance for heart disease.

Heart disease is the #1 killer of women, but with education and awareness you can manage your risk.

Join me in taking the Go Red Heart Checkup by going to:

goredforwomen.org Warmest Regards,

Nancy Huber President & CEO Fifth Third Bank, Central Indiana

©Fifth Third Bank 2012. Member FDIC

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HEART HEALTH SPECIAL ADVERTISING SECTION

Risk Factors By the Numbers Here’s a look at how Indiana stacks up when it comes to heart disease risk factors, according to the Indiana State Department of Health. Numbers are from 2011.

Adults who reported having high blood pressure

33 %

66 %

Adults who reported having high cholesterol

40 %

Adults who smoked cigarettes

25.6 %

HEART HEALTH PROFILE

American Heart Association February is American Heart Month, a time when the American Heart Association puts special emphasis on its Go Red For Women campaign. Beginning its 10th year, Go Red For Women was started in 2004 to raise awareness among women that heart disease is their No. 1 health threat, claiming more lives than all forms of cancer combined.

Go Red For Women has focused on gender-specific research and establishing genderspecific guidelines for prevention and treatment.

The results have been encouraging on all fronts.

Since 2004, 23 percent more women are aware that heart disease is their leading killer. In addition, women that engage in the Go Red For Women movement have made healthy behavior changes: • 54 percent started exercising • 61 percent began eating healthier • 43 percent had their cholesterol checked • 37 percent lost weight Go Red has flourished in Indianapolis due to the longtime support of St. Vincent Heart Center. Take control of your heart health, and find out more about the movement at goredforwomen.org.

Adults who who were considered overweight or obese

Adults with coronary heart disease who also had diabetes

31.9 %

Valve disorders are typically classified in two ways: stenotic, in which a valve does not open properly, and incompetent, in which the valve leaks. Ball says there are also electrical issues that can affect the heart muscle and result in an abnormal beat, which is one of the causes of sudden death and may require a pacemaker to regulate. There are also structural diseases that inflame the walls of the heart muscle itself and can cause damage to the inner workings and outer layers of the heart.

What are the risks?

There are a number of factors that increase one’s risk for heart disease, including family history, the presence of diabetes, hypertension, high cholesterol, obesity, and smoking. Dr. Dave Kovacich, FACC, managing partner, Franciscan Physician Network Indiana Heart Physicians, and cardiologist with Franciscan St. Francis Health, says the CDC recently issued a report stating that only 3 percent of the population has optimum cardiac health. The good news for the other 97 percent is that there are steps

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HEART HEALTH SPECIAL ADVERTISING SECTION

Foods for the Heart The Academy of Nutrition and Dietetics recommends these foods as part of a heart-healthy diet:

• Omega-3 fatty acids: salmon, tuna, olive oil, or flaxseed

• Beans: black, kidney, or red beans • Nuts: almonds or walnuts • Whole grains: brown rice, oatmeal, or whole-grain pasta

• Vegetables: spinach, broccoli,

asparagus, tomatoes, or red bell peppers • Fruits: blueberries, oranges, cantaloupe, or papaya

HEART HEALTH PROFILE

Fifth Third Bank Dear Friends, It is our distinct privilege to be a member of the communities where we do business.

As a publicly traded company, we appropriately make our key business decisions with our shareholders and customers in mind. But that’s just part of the story.

We are committed to operating our business in a socially responsible way. That’s why we also thoughtfully consider the impact our business decisions have on individual people. We’re not just a company providing necessary financial services. We’re also the employer of over 1,000 people in Indiana and a provider of health and retirement benefits. We are a philanthropic entity. We are a company with the means to support and elevate economies and causes. Beyond that, we are parents, grandparents, and children—members of families just as you are.

And because of all of those things, we support Go Red For Women and the American Heart Association. We care about all individuals in our community, and we want each person to understand their own personal heart disease risks. Be curious about your health, know your numbers, and take action.

For the betterment of our community, Nancy Huber President & CEO Fifth Third Bank, Central Indiana

they can take to reduce their risk of heart disease.

“Fast food has become a way of life for people, and no one is as active as they could be,” Kovacich says. “As a result, you have people becoming more and more obese, putting them at risk for diabetes and hypertension and other conditions that contribute to heart disease.”

The first step is to have a frank discussion with your primary-care physician regarding your family history and any concerns you may have about your health.

If any of the classic heart disease symptoms have presented themselves, such as chest pain, shortness of breath, nausea, or chronic fatigue, it’s important that those are addressed.

Dr. Nan Oscherwitz, a cardiologist with Community Health Network, says physicians use a number of tests to diagnose heart disease in a patient before a life-threatening incident occurs, including EKGs, ECGs, and stress testing, along with chest X-rays and lab results.

Oscherwitz says an ECG is often the first place to start, followed by further testing if needed.

“But it’s important to note that none of these are 100 percent perfect,” she says.

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Menu Makeover

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our diet plays an important role in your heart health.

When cooking at home, it’s generally easy to prepare heart-healthy meals. Dining out, however, is a whole different story. We’re all familiar with the abundance of calorie-, fat-, and sodium-heavy entrees in America’s restaurants. Even dishes we presume are good for us often include ingredients that increase the unhealthy

factor.

You don’t have to avoid restaurants altogether, though. Just be sure to bring with you these healthy-eating tips from the American Heart Association.

• Look for these key words: steamed, broiled, baked, grilled, poached, or roasted. Foods prepared in these

methods will typically be healthier than foods that are served fried, au gratin, crispy, scalloped, pan-fried, sautéed, buttered, creamed, or stuffed.

• Choose entrees that feature seafood, chicken, or lean meat. If you order meat, remove all visible fat and ask that the skin also be removed from the chicken.

• Choose a baked potato over french fries, but have it with vegetables or fat-free or low-fat sour cream or margarine instead of butter, full-fat sour cream, or cheese.

• Hold the mayonnaise and other calorie-heavy sandwich sauces, like “special sauce.”

• Steer clear of high-sodium foods—including any food that’s served pickled, in cocktail sauce, smoked, in broth or au jus, or in soy or teriyaki sauce.

• Be selective at salad bars. Choose fresh greens, raw vegetables, fresh fruits, garbanzo beans, and reduced-fat, low-fat, light, or fat-free dressings. Avoid cheeses, marinated salads, pasta salads, and fruit salads with whipped cream.

• Ask for butter, cream cheese, salad dressings, sauces, and gravies to be served on the side so you can control how much you eat.

HEART HEALTH PROFILE

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If something is noted on a report, physicians will prescribe medications to help control conditions, such as high blood pressure and cholesterol, that contribute to the onset of heart disease.

Ultimately, though, it is up to the patient to adhere to a healthy diet, get enough exercise, and give up the vices that intensify their risks.

However, not everyone is proactive about their health, and sometimes heart disease is only diagnosed after a heart attack occurs. Ball with St. Vincent says symptoms of a heart attack include the traditional chest pain, shortness of breath, or chronic fatigue, but can also be stomach problems, nausea, and other vague symptoms that can easily be mistaken for something else.

“Symptoms can present themselves

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HEART HEALTH SPECIAL ADVERTISING SECTION

Keeping tabs on the rate and regularity of your pulse can clue you in to any hearthealth conditions.

HEART HEALTH PROFILE

St. Vincent Heart Center With Life’s Simple 7®, you can learn your risk for heart disease and find ways to reduce that risk today. Take steps in these areas to improve your heart health: Get Active Try to get at least 30 minutes of moderate physical activity daily.

Lose Weight Know your calorie needs and track your intake. It’s a matter of balancing calories in with calories out.

Manage Blood Pressure Try to control your stress, reduce your sodium intake, and limit alcohol.

Eat Better Stock your kitchen with healthy foods and track what you eat by keeping a journal.

Stop Smoking Talk with your healthcare provider or look for a quit-smoking program today. decrease Blood Sugar Reduce consumption of simple sugars, such as soda, candy, and sugary desserts.

Control Cholesterol A diet that is high in fiber and low in cholesterol helps keep cholesterol levels controlled.

Visit BestHeartCare.com today to learn more.

differently in men than in women, and reports have shown that it is often found later in women than in men, but it just depends,” Ball says. “Sometimes women will minimize their symptoms, but it doesn’t change how we treat the condition.”

Dr. Irmina Gradus-Pizlo, associate professor of medicine at the Indiana University School of Medicine and the medical director of the Advanced Heart Care Program at IU Health, says that many patients assume the symptoms of a heart attack should be excruciating, but in most cases they are more like subtle discomforts. Some people do not notice the warning signs at all.

“In fact, about 30 percent of people who we know to have had heart attacks in retrospect cannot recall any symptoms at all,” she points out. “Others report some discomfort.”

Pass or fail Managing heart disease is a three-fold process that not only requires a change in a person’s lifestyle but also pharmaceutical help and surgical intervention.

Bypass surgery and stinting can help

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results in a condition that, according to the National Heart, Lung and Blood Institute, affects 5.8 million people in the U.S.: heart failure.

“Heart failure is worse than cancer,” says Dr. Waqas Ghumman, FACC, director of heart failure for Community Health Network. “Heart failure occurs when a dinged-up heart doesn’t pump enough blood to meet the needs of the body. It’s not the same as a heart attack. It’s worse.

I like to use the analogy of a horse pulling a cart. A healthy horse can pull a cart, but when it has a broken leg it becomes exponentially harder for him to pull the cart.

As more weight is added to the cart, the more you run the risk of that horse losing another leg or two, making pulling that cart impossible.”

Ghumman says when the heart can’t push blood forward, it backs up, causing swelling in the legs and abdominal region and a shortness of breath in the patient.

As a result, the heart muscle grows bigger and weaker, and once diagnosed, patients are lucky to be alive in five years—provided they follow their physician’s advice to the letter. That can mean cutting out salt, watching their liquid consumption, taking their medications, or undergoing specialized surgical procedures. Those can include bypass surgery; heart valve repair or replacement; cardiac resynchronization therapy, also called biventricular pacing; and implantable cardioverterdefibrillators.

“Despite the word ‘failure’ in the condition, it’s not like the horse is dead, and it can’t regrow its legs, but it does have the chance to get better,” Ghumman says.

“It’s a balancing act.”

Medications, such as aspirin, beta blockers, and ACE inhibitors, can help control and manage the risk factors of heart disease.

reroute and assist blood flow through the arteries, while medicines such as aspirin, beta blockers, clot busters, and ACE inhibitors can help control and manage contributing risk factors.

“There are a number of medicines that come into play when someone is diagnosed with heart disease,” Gradus-Pizlo says. “Some of them have been on the market for decades, and others are newer.

The beat goes on They may leave with prescriptions that will keep blood pressure and cholesterol under control, and there may be additional medications involved if one endured a surgical procedure designed to help keep the stints and bypasses open.”

When a heart has been working overtime in order to keep blood flowing throughout the body, it may become weaker and develop a backup, which

Ball says the take-home message for individuals is that if there is a change in the way they feel, get it checked.

“It will save your life,” he says. “Once that plaque ruptures and you have a heart attack, you have a very small window of opportunity (less than 90 minutes) to get that artery opened and unblocked. Making those lifestyle changes and seeking help ahead of time can be the difference between life and death.”

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