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Monday, September 23, 2019

Start when you are young... continue when you are older.

How can we prevent heart disease?

When it comes to preventing heart disease, the ideal is to establish good heart health habits when you are young. This is because the body becomes accustomed to its habits eating, exercise, heart output. It “pre-adapts,” if you will. I try to ingrain this in my patients who are in their 30s. It’s never too early to start acting in ways that keep the heart healthy.

Why exercise?

Being sedentary is the worst thing you can do to your heart. I am a huge proponent of exercise. It’s one of the most important things you can do for your heart health and your overall health, as well. And it’s something that you can modify throughout your life. You don’t need a fancy gym. You can walk, swim, dance, garden, and lift objects and do push-ups at home. No matter how busy you are, if you want to keep your heart healthy, you have to make room in your life for exercise.

The American Heart Association recommends 150 minutes of moderate intensity aerobic activity or 75 minutes of vigorous aerobic activity per week, or, preferably, a combination. It can be as simple as a 15-minute walk–rest–walk back, five days a week.

I’m from the Orthodox community, and when it comes to exercise, I offer this analogy to my patients who are also Orthodox. “Take prayers. Things can be going completely crazy at home, but when it is time for prayers, you stop and do them no matter what.” That’s how exercise needs to be. We all find time for the things that are most important to us, and exercise needs to be on that list for all of us.

Why is family history important?

Everyone should be aware of his or her family medical history, as it can significantly influence your health and risk factors. If you have a family history of premature heart disease, it is important to take your heart health seriously and see a cardiologist.

In my practice, I am very data driven. I don’t put people on medication lightly. In fact, I try to avoid medication. That is why assessing cardiovascular risk is so important. Cardiologists have a variety of tools to determine a patient’s risk for heart attack and stroke. With this information, patients and their cardiologists can make better-informed decisions. A few of the tools are:

Cardiac risk calculator

The American College of Cardiology/American Heart Association risk calculator (for patients who have not had a heart attack or stroke) is used to calculate a person’s risk for heart disease and stroke. Based on that risk factor, we can start a conversation and consider how this person is eating and exercising, and whether a cholesterol-lowering medication is a good idea.

Coronary calcium score

A coronary calcium score, obtained from a non-invasive CT scan of the heart, can help a cardiologist determine a patient’s risk category and how best to treat that person. For example, should we be more aggressive in our treatment?

The scan can indicate if plaque is building in a patient’s coronary arteries. It can be especially useful for younger patients with a strong family history of early heart disease and can contribute important data for decision-making.

For example, a 39-year-old male patient whose brother has had a heart attack and whose father and uncle both died young from heart attacks might benefit from a coronary calcium score. While the test is not currently covered by insurance, it can be worth the investment for its usefulness in assessing risk and in recommending lifestyle modifications and treatment plans.

Other tests, such as advanced lipoprotein tests, can further help determine a patient’s risk. The bottom line is that understanding your risk is critical to having the right dialogue with your doctor and coming up with the best plan for heart health.

Want to sleep better at night?

Don’t ignore your symptoms. I volunteered with a local EMS ambulance for 14 years, beginning when I was 18 (and continuing when I was a doctor starting out in my practice). I always told patients, “It’s better to spend one night in the hospital and be safe rather than sorry.” The message here is that when it comes to your heart, it is better to act if you are experiencing symptoms rather than wait and find out that more could have been done to help you.

It’s a myth that there’s no reason to see a cardiologist until you are in your 50s. There is no set age to see a cardiologist. It’s never a bad idea to get an expert opinion, especially if you have a family history of heart disease. Don’t ignore symptoms, and don’t be afraid to come in for a consultation. In my practice, we listen and individualize care. I always tell my patients, whether they are 34 or 94, “We’re here if you need us. Just call.”

If you’re worried about your heart, see a doctor. It can give you the reassurance that everything is ok so you can sleep at night.

By Dr. Joseph Shatzkes, Englewood Health


Joseph Shatzkes, MD, is a preventive and general cardiologist with Englewood Cardiology Consultants in Englewood and a member of the Englewood Health Physician Network.