Stopping Killers in their Tracks (Part One)
By Vicky L. Chappell, M.D., Texoma Cardiovascular Surgeons, Texoma LIVING WELL Magazine
The leading cause of death in the United States, for both men and women, is heart disease. This disease is responsible for approximately 600,000 deaths per year. The most common type of heart disease is coronary artery disease (CAD), which can lead to heart attack or acute coronary syndrome (ACS). It is important to understand your risk factors for CAD, including family history, diabetes, hypertension, abnormal cholesterol, and smoking. You should also be aware of the common symptoms, mainly chest pain or pressure. Keep in mind that symptoms do not always include chest pain. Women, elderly people, and people with diabetes are more likely to have symptoms other than chest pain, such as fatigue, shortness of breath, and weakness. If you have a heart attack, you are more likely to survive if you know the symptoms and get to a hospital as soon as symptoms start.
In a report from The Centers for Disease Control and Prevention, the preliminary death rate for heart disease decreased by 3.7% from 2008 to 2009. Three possible explanations for the decline in CAD death rates have been proposed: (1) primary prevention; (2) modern care for ACS; and (3) secondary prevention in those with known CAD. Clinical trials have shown substantial evidence to support each of these strategies for reducing new cases of CAD and even reducing death from CAD.
Primary prevention of CAD is focused on risk factor reduction. There have been major public health measures, such as reduction in cigarette smoking and promoting awareness regarding CAD. From the clinical aspect, the approach has been to address lipids, blood pressure and blood sugar. You can greatly reduce your risk for CAD through lifestyle changes and, in some cases, medication. However, primary prevention is not complete without routine follow up with your physician.
Modern care for ACS starts in the emergency department. Once the diagnosis of a heart attack has been made, expedience to definitive care is priority. This includes appropriate administration of medications and, often, coronary stents. The recommendation from the American College of Cardiology and the American Heart Association is that a heart attack be treated definitively within 90 minutes of the beginning of the event, called the Door to Balloon (D2B) Initiative. There are occasions when a cardiovascular surgeon may be consulted, either when multiple blockages are found or when a stent is not possible. Modern care does not stop after 90 minutes. Patient care requires a strong team approach from everyone, including physicians, nurses, and therapists. This team effort continues from the emergency room to the patient’s recovery in the hospital and at home.
Secondary prevention is directed toward patients who have already been diagnosed with CAD. Lifespan can be extended even if you have previously suffered from heart disease. It is still important to eliminate risk factors as much as possible with diet, exercise, and smoking cessation. Medications play a role in secondary prevention, or preventing a second heart attack. Close follow up with your physician may identify blockages, which need intervention before the onset of a heart attack or heart failure.
Coronary artery bypass grafting (CABG) surgery may be indicated when CAD progresses despite preventative measures, medications or coronary stents. The surgeons at Texoma Cardiovascular Surgery have a combined experience of over 45 years. Not only do we perform CABG both with and without heart-lung bypass (off-pump), we are accomplished at complex valve replacement and repair. Other cardiac procedures, such as Cox-Maze, for atrial fibrillation are available, including minimally invasive Maze for select patients. We employ the latest technology to deliver the highest standard of care for the people of Texoma.
The incidence of heart disease-related death is declining. We should be encouraged that there are things we can do to live longer, healthier lives. However, when advanced health care is needed, it can be found right here at home.
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- ACC/AHA Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction. Journal of the American College of Cardiology. 2004;44:671-719
- Kenneth D. Kochanek, et al. Deaths: Preliminary Data for 2009. National Vital Statistics Reports. 2011; 59(4).
- Russell V. Luepker, MD, MS. Decline in Incident Coronary Heart Disease: Why Are the Rates Falling? Circulation. 2008; 117:592-593.
Author Vicky L. Chappell, M.D. is a physician with Texoma Cardiovascular Surgeons located in Sherman, TX and can be reached at 903-868-4595.