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Educate and Empower Your Patients About Heart Health

by Angela Johnson, MPH (PCOM - Chicago)

Coronary heart disease (CHD) is the number one cause of death among women and men in the United States?1-2 Estimates suggest that every 29 seconds someone in the United States suffers from a coronary event, and every 60 seconds someone loses their life as a result. According to the American Heart Association, in 2003 one in every five deaths was associated with CHD, causing an estimated 479,305 fatalities.3

To help raise awareness about this and other heart-related issues, the American Heart Association has designated February 2006 as "American Heart Health Month." CHD, sometimes referred to as ischemic heart disease, "is atherosclerosis of the coronary arteries. Atherosclerosis is when the arteries become clogged and narrowed, restricting blood flow to the heart. Without adequate blood, the heart becomes starved of oxygen and vital nutrients it needs to work properly."2 Researchers now believe that fat begins depositing in the blood vessel walls before our teen years, and as we continue to age the fat continues to build, causing injury to the blood vessel walls. As the heart attempts to heal the injuries within the blood vessels a cascade of reactions occur, including the release of chemicals. This makes the walls sticky and susceptible to other substances sticking and eventually forming a material called plaque. This is the substance that continues to build and cause a narrowing of the arteries.

A coronary heart disease symptom can include cardiac arrest, back or arm pain, especially on the left side, palpitations, dizziness, light-headedness, fainting, weakness or irregular heartbeat. Silent ischemia is when no coronary heart disease symptom occurs, yet an electrocardiogram and other tests show evidence. In this case, arteries may be blocked 50 percent or more, without causing a coronary heart disease symptom.

Unfortunately, there are several factors that increase our patients' risk of CHD that are uncontrollable. These include family history of CHD, male gender, age (65 years and older), and menopause in women. Fortunately, there are other CHD risk factors that are controllable, and a few are outlined below:

Tobacco smoking - Smoking is the largest CHD risk factor, making smokers twice as likely to have a heart attack as non-smokers; and two to four times more likely to die suddenly. The good news is that three years after quitting, the risk of death is the same as for someone who has never smoked. 5

High blood pressure - According to the American Heart Association, about 65 million people 20 years and older have high blood pressure (which is now defined as prehypertension: 120-139/80-89; stage 1 hypertension: 140-159/90-99; stage 2 hypertension: 160 and above/100 and above). In 2003, death rates per 100,000 were 14.9% and 49.7% for white and black males, respectively; and 14.5 and 40.8% for white and black females, respectively.6 Despite efforts to identify, educate, and treat people with hypertension, an estimated 31% of hypertensive people do not know they are hypertensive. 7
High blood cholesterol - Experts recommend keeping cholesterol levels to 200 mg/dl or lower. When levels start climbing between 200 - 239 mg/dl, this is considered borderline high, and anything above 240 mg/dl is high.5

Physical Inactivity -- Being physically inactive is thought to significantly increase one's risk of heart disease. Experts recommend that people of all ages engage in 30 minutes of physical activity of moderate intensity (such as brisk walking). "In a 1993 study, 14 percent of all deaths in the United States were attributed to activity patterns and diet. Another study linked sedentary lifestyles to 23 percent of deaths from major chronic diseases. For example, physical activity has been shown to reduce the risk of developing or dying from heart disease, diabetes, colon cancer, and high blood pressure. On average, people who are physically active outlive those who are inactive."7 For more information about this, visit http://www.mayoclinic.com/health/high-blood-pressure/HI00024

Diet and Nutrition - A heart healthy diet is an important preventative tool. "There is evidence that plant foods play a role in preventing atherosclerotic heart disease. Plant foods provide dietary fiber that help lower blood cholesterol and antioxidants that help in lipoprotein oxidation. On the other hand, consumption of saturated fat, dietary cholesterol, and red meat have been shown to increase the incidence of heart disease."5 For more information on a heart healthy diet, visit http://www.mayoclinic.com/health/heart-healthy-diet/NU00196.

Stress -- Often called the "fight or flight" response, stress occurs automatically when a situation one is experiencing is deemed threatening. As soon as this response happens, a series of mechanisms go off in the body, kind of like an alarm system, telling your adrenal glands (which are situated on top of the kidneys) to release hormones (e.g. cortisol and adrenaline) into your bloodstream. It is this rush of hormones in the system that prepares the body for "fight or flight" (e.g. making your heart and breathing rates increase; your vision to become more acute, etc). Stress, in and of itself is not always a bad thing. However, when stressful situations pile up, and the body is not given a chance to recover (e.g. relaxation techniques, exercise, etc), over time the stress-response "can disrupt almost all your body's processes, increasing your risk of obesity, insomnia, digestive complaints, heart disease and depression." 8 Stress is a CHD risk factor that is difficult to avoid, but people should make every effort to learn stress management techniques.

In our clinics, patients are incorporating TCM into their health-care for a wide-variety of reasons. Even though I've only been an intern for four weeks, I've observed and assisted over the past two to three years and have realized that many of the above "controllable" factors are real issues for many of our patients. My challenge for all of us is to make a commitment this February, during "Heart Health" month, to educate our patients about their own heart health, utilize the vast knowledge and skills we have learned in the classroom and clinic, and most important, empower our patients to be a part of their own wellness and healing in 2006.

About the Author:

Angela Johnson holds a Master of Public Health and is in her fourth and last year at PCOM - Chicago. In addition, Angela is part of an integrative medicine education and research team at Rush University Medical Center, Chicago, IL.

References:

Yale New Haven Health. (2006). Heart resource page. Citing reference [www]. Accessed January 23, 2006. Available at http://yalenewhavenhealth.org/HealthNews/heart.htm

WebMD. (2004). Heart disease: coronary artery disease. Citing referece [www]. Accessed January 23, 2006. Available at http://www.webmd.com/content/pages/9/1675_57851.htm?printing=true

American Heart Association (2005). Heart attack and angina statistics. Citing reference [www]. Accessed January 23, 2006. Available at http://www.americanheart.org/presenter.jhtml?identifier=4591

Medline Plus. (2004). Medical encyclopedia: coronary heart disease. Citing reference [www]. Accessed January 23, 2006. Available at http://www.nlm.nih.gov/medlineplus/print/ency/article/007115.htm.

New York State. Department of Health. Coronary heart disease. Citing reference [www]. Accessed January 23, 2006. Available at http://www.health.state.ny.us/nysdoh/heart/aboutchd.htm

American Heart Association (2005). High blood pressure statistics. Citing reference [www]. Accessed January 23, 2006. Available at http://www.americanheart.org/presenter.jhtml?identifier=4621

United States Department of Health and Human Services. (2002) Physical activity fundamental to preventing disease. Citing reference [www]. Accessed January 23, 2006. Available at http://aspe.hhs.gov/health/reports/physicalactivity/index.shtml.

Mayo Clinic. (2005) Stress: why you have it and how it hurts your health. Citing reference [www]. Accessed on January 23, 2006. Available at http://www.mayoclinic.com/print/stress/SR00001/METHOD=print

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