Prevention
How to Avoid Heart Problems

When it comes to helping you avoid heart disease, your cardiologist is skilled in two forms of prevention:

Primary Prevention and Screening
1. What is Primary Prevention?
2. How do I know if I am at risk for Coronary Artery Disease (CAD)?
3. What can I do to prevent CAD?
4. What additional tests are available to pick up the problem before it is serious?

1. Primary Prevention refers to the prevention of heart problems before they occur. This is in contrast to secondary prevention which refers to preventing the progression of heart problems or recurrence of heart attacks in people who have already been diagnosed or treated for the condition. Examples of secondary prevention include:

1. prescription medicines to lower cholesterol, reduce angina (chest discomfort) or heart attacks;
2. procedures such as angioplasty and/or stents to relieve a blockage in the coronary artery; or
3. placement of an internal defibrillator (a special type of pacemaker) to prevent or treat cardiac arrest.

The majority of cardiac disease could be prevented BEFORE it occurs. The practice of primary prevention focuses on helping people determine what their level of risk is for contracting the disease and teaching how to make lifestyle changes to further minimize the risk.

2. The major risk factors for the development of CAD include: hypertension, being overweight, inactivity/lack of exercise, high cholesterol, diabetes, smoking, and having a first degree relative (parents or siblings) who developed CAD before 60-65 years old.

With the exception of family history and in some cases, diabetes, for the most part all other risk factors for CAD would be drastically reduced.

3. Cigarette smoking is the number one preventable cause of death in this country. It is the number one cause of heart attacks in people under the age of 50 years old. Yet, by stopping, your risk goes down to normal within three years. A variety of smoking cessation tools are available including medications and counseling. This can be discussed with your doctor or visit smokefree.gov on the web.

Obesity is defined as being 20% greater than your ideal body weight. About 1/3 of Americans are considered obese and the rate has nearly doubled in the past two decades. Obesity is likely responsible for 85-90% of all adult cases of diabetes, 50-75% of cases of hypertension on 33% of the cases of cardiovascular disease.

Between 50-75% of Americans are considered sedentary, lacking physical activity of 20 minutes or more three times a week.

About 25% of American adults are believed to have an elevated cholesterol (>200mg/dl). About _ the cases of CAD are related to high cholesterol.

All the above risk factors are preventable. Research has shown that programs using lifestyle modification including cigarette cessation, diet and exercise can reduce the risk of developing heart problems by almost 75%!

4. Recently, newer technologies and blood tests have been introduced to help screen for the early development of CAD. To name a few:

1. high resolution carotid IMT study (which measures the thickness of the artery wall);
2. EBCT (a special CAT scan of the heart arteries to measure the build up of calcium in the coronary arteries);
3. high sensitivity C reactive protein (a blood test measuring inflammation of the artery) and;
4. homocystiene (an element in the blood associated with premature hardening of the arteries and blood clots). Various forms of stress testing are available to detect coronary disease before further problems arise.

Secondary Prevention
Secondary prevention refers to preventing the progression of heart problems or the recurrence of heart attacks in people who have already been diagnosed or treated for the condition.

Examples of secondary prevention include:

Medication - Your doctor may prescribe medicines to lower cholesterol, reduce angina (chest discomfort) or minimize heart attack risk.

Procedures - Angioplasty and/or stents to relieve a blockage in the artery and maintain proper blood flow.

Defibrillator Placement - A defibrillator is a special type of pacemaker that can prevent or treat cardiac arrest.