Understanding Heart Disease
An Interview with Dr. Edward Martin
Where does Oklahoma, or Tulsa to be more specific, rank in terms of heart disease-related deaths?
Dr. Martin: Heart disease is the leading killer of both men and women in the state of Oklahoma. The last detailed United States state rankings were from 2009 and showed that Oklahoma was 48 out of 50 states in cardiovascular deaths. The third worst. From a statewide standpoint, the last compiled statistics for Oklahoma were from 2004-2006. In those rankings, Tulsa County ranked 28 out of Oklahoma’s 77 counties for heart-related deaths. Oklahoma City was slightly better and ranked 25th. From an overall state perspective, heart-related deaths generally occurred more in the southeastern counties of Oklahoma and were lowest in the northwest counties.
What are the warning signs?
Dr. Martin: The most classic symptom for a heart attack is discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. However other symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. Other symptoms that may or may not occur include breaking out in a cold sweat, nausea or lightheadedness. As with men, a woman’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.
What is a person’s risk of having a heart attack or suffering from a heart-related condition?
Dr. Martin: The controllable risk factors that increase the risk of developing a heart attack or stroke are smoking, high blood pressure, high cholesterol, diabetes, overweight and obesity and physical inactivity. Additional risk factors include male gender and family history of heart disease. Multiple risk calculators exist to help the individual person calculate his or her own risk of having a heart attack or dying from coronary heart disease over the next 10 years. One of the better ones can be found at the American Heart Association (AHA) website at //www.heart.org/HEARTORG/ Conditions/HeartAttack/HeartAttackToolsResources/ Heart-Attack-Risk-Assessment_ UCM_303944_Article.jsp. But, in general, the greater the number of risk factors you have, the greater the risk; especially if the risk factors are not well controlled.
What screenings are important to help someone learn their risks and what can the doctors at Oklahoma Heart Institute do to help people manage those risks?
Everyone should know their risk factors, including your cholesterol, blood pressure, blood sugar and hs-CRP blood test for inflammation. At OHI, we offer inexpensive screening tests to evaluate carotid arteries, cardiac function, peripheral artery disease and your risk for abdominal aneurysm. We also offer a cardiac calcium score to measure arterial plaque buildup, which can cause blockages and heart attacks. All of the tests are painless and literally can save your life and prevent heart attack and strokes.
What local resources are available to help people facing heart disease?
Dr. Martin: Because of the internet, these days it is not as important as it used to be to have local resources available. A wealth of information can be garnered online. Multiple resources are available at the American Heart Association website at //www.heart.org/ HEARTORG/. There you’ll find information on diet, exercise, weight loss, nutrition, research, smoking cessation and much more. However local resources do exist. In Oklahoma, the following resources are available: The Oklahoma State Department of Health’s Heart Disease and Stroke Prevention Program has resources available at //www.ok.gov/health/Disease,_Prevention,_ Preparedness/Chronic_Disease_Service/ Heart_Disease_and_Stroke_Prevention_ Program/index.html. Smoking cessation help from the Oklahoma Tobacco Settlement Endowment Trust is available at 1(800) quit-now and at //www.ok.gov/tset/Programs/Helpline. html. Additional smoking cessation help Dr. Martin is a noninvasive cardiologist with specialty expertise in noninvasive imaging. He is Director of Cardiovascular Magnetic Resonance Imaging at Oklahoma Heart Institute and Hillcrest Medical Center. In addition, he is a Clinical Associate Professor of Medicine at the University of Oklahoma College of Medicine — Tulsa. Dr. Martin has specialty training in Nuclear Medicine, as well as additional training dedicated to Cardiovascular Magnetic Resonance Imaging. He completed his Cardiology Fellowship at the University of Alabama. Dr. Martin’s Internal Medicine Internship and Residency training were performed at Temple University Hospital in Philadelphia. He received his medical degree from the Medical College of Ohio. Dr. Martin completed his Master of Science degree in mechanical engineering at the University of Cincinnati and his Bachelor of Science degree in physics at Xavier University. He is a founding member of the Society of Cardiovascular Magnetic Resonance and is an editorial board member of the Journal of Cardiovascular Magnetic Resonance. Understanding Heart Disease By Elaine Burkhardt An Interview with Edward T. Martin, MD, FACC, FACP, FAHA Oklahoma Heart Institute 19 and resources can be found under the Oklahoma State Plan for Tobacco Use Prevention and Cessation at //www.ok.gov/health/ Disease,_Prevention,_Preparedness/Tobacco_ Use_Prevention_Service/. Tips on weight control, nutrition and physical activity can be found at Get Fit Eat Smart Oklahoma at //www.ok.gov/h3andhealthy/%3Ci%3EGet_Fit_Eat_ Smart%3C_i%3E_State_Plan/index.html. Finally, local hospital websites can be loaded with useful information on preserving heart health. Take a look at www.oklahomaheart.com
How can we all reduce our risks? Are there nutrition and exercise tips?
Dr. Martin: Certain lifestyle modifications can help you reduce your risk of developing coronary heart disease. Most are simple to start but require dedication to implement completely.
- Exercise. The AHA recommends 30 minutes of moderate exercise a day at least five days per week. Or 15 minutes per day of vigorous activity. A simple positive change you can make to effectively improve your heart health is to start walking. A walking program is flexible and boasts high success rates because people can stick with it.
- Reduce the amount of “bad fats” or saturated fats and trans-fatty acids in your diet. These fats are bad and raise the bad or LDL cholesterol levels in the blood. They are commonly found in animal meats and dairy products and in many baked goods, fried foods and snack foods.
- Eat more fish. At least two times per week. They provide omega 3 fatty acids, which may help prevent heart disease and heart arrhythmias. Omega-3 fatty acids are one of the “better fats”. These are the monounsaturated and polyunsaturated fats. You should try to replace the bad fats with the better fats. These fats are commonly contained in canola oil, olive oil, peanut oil, sunflower oil, avocados, many nuts and seeds and oily fish (salmon, tuna, mackerel, herring and trout).
- A heart healthy diet should include a variety of fruits, vegetables, grains, legumes, fat-free or low-fat dairy products, fish, poultry and lean meats.
- Reduce your salt intake. High-sodium diets are linked to an increase in blood pressure and a higher risk for heart disease and stroke. Americans on average consume 3,436 mg of sodium daily. Many experts now believe that lowering daily consumption to no more than 1,500 mg of sodium daily would be an effective way to prevent or lower high blood pressure.
- If you are overweight, lose weight. Losing as few as 10 pounds can lower your heart disease risk. Last year 32% of Oklahoma adults were classified as obese. That is having a Body Mass Index (BMI) of 30 or higher. BMI is a numerical value of your weight in relation to your height. BMIs are good indicators of healthy or unhealthy weights for adult men and women, regardless of body frame size. A BMI of less than 25 indicates a healthy weight. A BMI of less than 18.5 is considered underweight. A BMI between 25 and 29.9 is considered overweight. BMI calculators can be found at multiple websites. However The National Heart Lung and Blood Institute has many resources in addition to a BMI calculator at //www.nhlbisupport.com/bmi/.
- If you smoke, stop. Smokers are 4 times more likely to develop coronary heart disease. One in four Oklahoma adults, or 650,000 people, currently smoke. Smoking cessation is the most important lifestyle modification that one can make to reduce the risk of heart disease and stroke. If you can only make one change, this should be it.
If a person does have heart disease, what treatment options are available?
Dr. Martin: The treatment options will vary depending on the nature and severity of the coronary heart disease. The options will range from medical therapy to possibly angioplasty or heart stent to coronary artery bypass surgery. Once you have been affected with coronary heart disease. it is important to try and prevent it from getting worse to improve overall quality of life and extend survival. This is called secondary prevention. The goals for secondary prevention are:
- Complete smoking cessation.
- Blood pressure under 140/90 mmHg and under 130/80 mmHg in people with diabetes or chronic kidney disease.
- Exercise 30 to 60 minutes of moderate-intensity aerobic activity, such as brisk walking, on most but preferably all days of the week, supplemented by an increase in daily lifestyle activities (e.g., walking breaks at work, gardening, household work). High risk patients (e.g., recent acute coronary syndrome or revascularization, heart failure) benefit from medically supervised cardiac rehabilitation programs.
- Weight management with a Body Mass Index (BMI) between 18.5–24.9 kg/m2 and waist circumference less than 40 inches in men and less than 35 inches in women.
- Start dietary therapy. Reduce intake of saturated fat (to less than 7 percent of calories) trans-fatty acids, and cholesterol (to less than 200 mg dietary cholesterol per day). Add plant stanol/sterols (2 grams/day) and viscous fiber (more than 10 grams/day) to further lower LDL cholesterol blood levels. Increased intake of omega-3 fatty acids in the form of fish or in capsule form (1 gram/day) for risk reduction. For treating elevated triglycerides, higher doses are usually necessary for risk reduction.
- In diabetics HbA1c less than 7 percent.
- Aspirin therapy 75-162 mg/day in all patients unless contraindicated.
- Reduce LDL cholesterol levels to less than 100 mg/dL and ideally less than 70 mg/dL. These are the essential secondary prevention guidelines. Consult with your physician or cardiologist to individualize additional medical therapy and lifestyle changes.