As a doctor who specializes in cardiovascular disease, Warren D. Johnston, M.D., FACC, FACP, has had a ringside seat to trends in heart medicine. From his vantage point as Director of St. Joseph Heritage Pavilion Cardiology Group and Director of the St. Joseph Women’s Heart Center, he’s seen health trends that present major challenges, but many positive developments as well.
First, the good news
“Heart disease is going down,” he says, and he attributes this positive news in part to adults and teens smoking less. “Smoking is a huge risk factor for cardiovascular disease, and it’s the single most preventable risk factor. If you stop smoking, in five years your cardiovascular risk is reduced to the point where it’s as if you never smoked.”
Another big boost for heart health: Doctors now recognize that heart disease is different for women than it is for men. For instance, doctors now know that low cholesterol (the “good cholesterol”) is more predictive of heart disease in women than in men.
“Symptoms display differently in women—they’re more subtle,” Johnston says. “Women may get chest discomfort that radiates down the right or left arm, but they are more likely to have back pain, sweating, profound fatigue and nausea.” Women who take on the role of nurturer tend to delay visits to the doctor or the hospital when they have a heart attack.
Treating women differently
For many years, a pervasive belief among doctors that held that women didn’t really get heart attacks caused them to not order the same diagnostic testing for women as they did for men. “Women with positive stress test results were less likely to get coronary angioplasty, and [were] less likely [to be] studied for arrhythmias,” says Johnson. Before the 1990s, clinical trials often included just 15 percent women.
This has changed. Johnston is co-medical director of the Women’s Heart Center at St. Joseph, which offers specialized care for women with heart disease as well as heart health assessments, educational seminars and low-cost screenings.
Heart disease is the leading cause of death among women, according to the Centers for Disease Control. In 2009, it claimed the lives of 292,188 women.
“Back in the day, if you asked women what they thought they would die of, most thought it was breast cancer,” says Johnston, explaining the prevailing belief of the 1970s and ‘80s. “That perception is something we really have tackled and we have worked to educate people through public outreach and screenings.” Johnston also credits former First Lady Laura Bush for touring the country raising awareness about heart disease among women.
Less invasive surgery, faster treatment
Another positive: People who are diagnosed with heart disease are living longer—and Johnston believes this is because of quicker treatment. “Now we know that when someone has a heart attack, and undergoes angioplasty within 90 minutes, that can save a life. It’s the standard of care now—an ER door-to-balloon time of 90 minutes.” That’s the time it takes from a patient entering the ER to the time the balloon catheter starts opening up the artery. Heart surgery has gotten less invasive too; much more can be done via a catheter inserted in the groin and threaded up into the heart.
And today doctors know that anyone who is experiencing a stroke should get medication within a three-hour window. “We can dissolve the clot, which will diffuse the neurological hit that stroke imposes on that individual,” says Johnston.
Patients who have had heart surgery are encouraged to get up and move much sooner than in years past. “When I started as a doctor, heart attack patients were sent for bed rest for two weeks—we thought it was a good thing,” says Johnston. “If they died, it was often because they developed clots in the veins of their legs which traveled into their lungs. Now we get patients up and walking in 24 hours.”
The bad news—and a solution
On the negative side, more people are overweight today—and this is a significant risk factor for heart disease. “Obesity is an epidemic that is reaching into the grade schools,” says Johnston. In part because of this, diabetes, high blood pressure and high cholesterol also are on the rise. “All this will put you at higher risk for heart disease,” he says.
But obesity is preventable and it’s reversible. “Preventable risk factors include hypertension, high cholesterol, obesity, smoking, being sedentary and diabetes,” says Johnston. “We can treat many patients with lifestyle modification—diet, exercise, weight loss, as well as pharmaceutical therapies.”