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Ask the Expert

Be Heart Smart

Keith Horvath, M.D.

February is American Heart Month and there is no better time to become heart smart. According to the CDC, heart disease is the leading cause of death for both men and women in the U.S., claiming approximately 600,000 lives each year – that’s one out of every four deaths. Dr. Keith Horvath, chief of cardiothoracic surgery at the NIH Heart Center at Suburban Hospital, talks about the importance of being heart smart at every age.

What is heart disease?

Heart disease can be divided into three categories:

  • Coronary artery disease is the most common type of heart disease. It occurs when plaque builds up in the arteries that supply blood to the heart.
  • Valvular heart disease includes such conditions as mitral valve regurgitation, the leaking or backflow of blood between the upper and lower chambers of the heart, and aortic valve stenosis, a narrowing that causes an obstruction to blood flow.
  • Heart failure occurs when the heart can’t pump enough blood to meet the body’s needs. Heart failure can result from multiple heart attacks or long-standing valve disease.

 
When does coronary artery disease begin?

Contrary to what many believe, coronary artery disease is not necessarily a disease of aging. People have heart attacks in their 20s and 30s. In fact, plaque buildup begins in children as young as 5 and 6 years old. This is not your grandfather’s disease.


What are the risk factors for coronary artery disease?

Risk factors for coronary artery disease include:

          High Blood Pressure

          High Cholesterol

          Cigarette smoking and excessive alcohol use

          Obesity

          Diabetes

          Physical inactivity

          Age (older than age 55 for men, age 65 for women)

          Family history of premature heart disease (men under age 55 or women under age 65). There is definitely a genetic predisposition to heart disease, which is why it’s so important to know your family history.

 

Why should I worry about obesity?

Obesity in this country is an epidemic and is worsening over time. About 61 percent of adults, or an estimated 108 million adults, in the U.S. are overweight or obese, a condition that substantially increases their risk for hypertension, high cholesterol, type 2 diabetes, stroke, coronary heart disease, osteoarthritis, gallbladder disease, sleep apnea and respiratory problems, and endometrial, breast, prostate, and colon cancers.

 

Does stress play a role in heart disease?

Both stress and depression play a role, and they tend to go hand-in-hand. What’s more, people who are stressed tend to relieve that stress by engaging in activities that also increase their risk for heart disease, such as smoking, drinking, and overeating.

 

What can I do to lower my risk factors?

Some risk factors can be mitigated through lifestyle changes. There is a time component to the development of cardiovascular disease. It takes time to gain weight, to develop high blood pressure, and for plaque to form. You are never too young to make positive lifestyle changes, including adopting healthy eating habits and exercising.

High blood pressure and high cholesterol are consistent risk factors for heart disease. Fifty million people in the U.S. have high blood pressure and the majority of these individuals either don’t know they have this risk factor or their high blood pressure is not controlled. The benefits of lowering blood pressure alone include a reduction in stroke incidence, heart attack, and heart failure. Monitoring your blood pressure and cholesterol levels is easy to do and is a simple way to control your risk factors.

Following a healthy diet also doesn’t have to be difficult. Cut out high-fat foods in favor of high-fiber, low-salt, and low-sugar alternatives. Eat a variety of fruits and vegetables and drink water instead of high-calorie drinks. And watch portion sizes with both food and drink. Portions today are significantly larger than they were 30 years ago. Larger portions are not heart-healthy.

Finally, if you smoke, quit now, and if you don’t smoke, don’t start.

 

How does exercise benefit the heart?

Along with helping to control weight and lower cholesterol levels, regular physical activity boosts energy; helps counter stress, anxiety and depression; increases resistance to fatigue; and improves your ability to fall asleep and sleep well. Any patient who has been diagnosed with high blood pressure and/or high cholesterol would benefit from regular exercise. Start with just 30 minutes at least three times per week and work up from there.

And get your children moving too.  With computers, video games and cell phones, children are more sedentary than ever. Encourage your kids to be more physically active and model good health habits for them is a great start.


What are the warning signs of a heart attack?

Warning signs of a heart attack include:

  • Chest pain or discomfort
  • Pain or discomfort in the jaw, neck, back, shoulders or arms
  • Feeling weak, light-headed, faint or nauseous, or breaking out in a cold sweat
  • Shortness of breath

 

Do men and women present with the same symptoms?

In the past, women didn’t present as the “classic case” for a heart attack. They would come into the ER with chest pain or pressure and they would be treated for heartburn or reflux. ERs around the country have been addressing this problem for many years.  Women serve more often as caregivers, so they may put off the medical interventions they need and their conditions go undetected until they are bigger problems. Women are just as likely as men to have a heart attack. They must pay attention to their symptoms!

 

What types of treatments are available for coronary artery disease?

Treatments for coronary artery disease include:

  • Medication and lifestyle changes.
  • Angioplasty. This procedure opens narrow or blocked coronary arteries and often involves the placement of a stent, a small mesh tube, which is inserted in the artery to keep it open. Advances in angioplasty include the development and use of drug-eluting stents, which slowly release medication around the mesh tube to prevent the growth of scar tissue that can lead to recurrence of the blockage.
  • Coronary bypass surgery. This treatment option is most often recommended when three or more arteries are affected by narrowing or blockages.

Two recent trials demonstrated that even in the era of drug-eluting stents, there are some patients who would benefit more from coronary bypass surgery than from angioplasty. Patients in these trials who underwent bypass surgery demonstrated significantly better outcomes than those who underwent angioplasty. Patients shouldn’t be afraid of bypass surgery. It’s important to ask your doctor about all your options before deciding on the right treatment for you.

 

Are there any new treatments on the horizon?

Through our partnership with the National Heart, Lung and Blood Institute, the NIH Heart Center at Suburban Hospital is conducting laboratory and clinical research on the diagnosis and treatment of heart disease.

One of these studies uses stem cells to stimulate new blood vessel growth in the heart. By selecting out a specific subset of stem cells, allowing them to grow, and then injecting them back into the heart, we have been able to stimulate the growth of new blood vessels and to improve heart function.

Recently, the FDA approved a clinical trial and we are now conducting this study on heart patients. The patients in the study have end-stage coronary artery disease and have exhausted all other medical and surgical options. They have shown improvement in their heart muscles following the stem cell procedure. Our hope is that within the next two years, this procedure will be available to those individuals with heart disease who have been told that there is nothing more that can be done for them conventionally.


To learn more about cardiovascular research trials at Suburban Hospital, go to http://www.suburbanhospital.org/Research. To find out more about the stem cell trial, call Research Nurse Mandy Murphy at 301-896-3775.

                                                                                         

Meet Dr. Keith Horvath

Title:  Chief of cardiothoracic surgery for the NIH Heart Center at Suburban Hospital and Director of the Cardiothoracic Surgery Research Laboratory at the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

Training:  University of Chicago Medical School.

Surgical Training: Brigham and Women's Hospital in Boston.

 

Dr. Horvath's clinical investigation interests include mitral valve repairs and aortic surgery.

 

Dr. Horvath’s office is located at Suburban Hospital, 8600 Old Georgetown Road in Bethesda. The phone number is 301-896-7610.



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