Ask Dr. Casey: Cardiovascular Disease Prevention.
Hi Dr. Casey, I have a family history of cardiovascular disease. Is there anything I can do to help prevent it for myself?
- Pam H
Hi Pam,
I love this question that is geared towards prevention. When you consider the fact that the average human heart beats 80 times, every minute of everyday, for an average of 78 years (that’s an impressive 3 billion beats in a lifetime for all you mathematically include people out there), don’t you want to give this miraculous system every possible chance to continue doing so? I wish I could catch most of our population at age 25 to be able to discuss some of the preventive principles of cardiovascular disease. Or better yet, be able for these principles and mindset to be more easily ingrained into our cultural norms. Because the recipe we have right now is one for inducing cardiovascular disease, not preventing it. No matter the age, though, I always think that today is the right time to start thinking about or practicing preventive health strategies.
It may not come as a surprise that I do not have a magic supplement or pill for prevention of cardiovascular disease (CVD). In my opinion, there isn’t anything that is tantalizing or sexy to advertise, because CVD prevention is a day in, day out practice of habitual choices. In a first office visit with new patients, I am sure to go over what are called “determinants of health.” I discuss with patients what their sleeping quality, nutrition, movement, relationship fulfillment and feeling of being connected, stressors, blissors, hydration, smoking history, as well as alcohol and drug use. After all, as the name implies, these things help to determine your health. It’s the day-in, day-out habits that are a large part of the equation of health and prevention of disease on all fronts. Unless you have a family history of premature CVD, the majority of your risk profile comes down to your own health choices.
Paying attention to all of the determinants of health is important for prevention of CVD. For example, sleeping less than 6 hours per night has been shown to significantly increase the risk for CVD (1). What’s more, obstructive sleep apnea can cause high blood pressure and be a major contributor to adverse cardiac events. In the Harvard Longevity Study, the quality of relationships with others at age 50 was shown to be one of the single most important predictors of health 30 years later (2). As a Nutritional Sciences major for my undergraduate, I tell my patients that food is the medicine we take every single day, whether we think of it that way or not. And consuming a diet of unprocessed, whole foods has been shown to reduce CVD (gluten-free cookies don’t count). I won’t jump too deeply into the contentious topic of meat consumption for your question, but let’s just say I think moderation is the key that most Americans seem to struggle with (there’s so much more between the extremes of carnivore diet and raw vegan). And a fun fact that I think most don’t realize: consumption of more than 14 drinks for men or 7 drinks for women in a week can increase the risk for most diseases. Even though red wine once was the darling of news for prevention of cardiovascular disease, the tune has changed somewhat in recent years with studies showing that even in moderation it can have deleterious effects on CVD (3). Again, moderation and balance are the not-so-secret keys that just don't make catchy headlines or sell products. But it can do wonders for your longevity and health span.
I consider additional testing as another part of early detection and sleuthing for preventive health. While the standard lipid (cholesterol panel) is the current primary screening that insurances cover as a marker of cardiovascular disease, it certainly does not capture the whole picture. There are additional clinically useful markers that can help to paint a more complete picture of cardiovascular risk. For example, patients with a family history of cardiovascular disease, I will run what’s called Lp(a). This is known as the “heart attack” marker that is more genetic in nature, and helps put another lens on how intensively I need to monitor a patient's cardiac markers and to what degree of strictness for their daily health choices. There are a number of additional useful markers that I may utilize, including inflammatory markers of hsCRP and IL-6, which can lead to plaque formation. And for those with chronically high cholesterol, I will take a look to see if it is big and fluffy or small and dense, known as sdLDL. The latter is more likely to wreak havoc on arteries and contribute to plaque formation and eventual blockage. Plaquing of the arteries can lead to reduced blood flow, higher likelihood of hypertension, stroke, heart attack, etc. There are a number of other labs I will discuss with patients so they feel empowered to have some choice and knowledge about the testing that they get, too.
In short, prevention of cardiovascular disease takes a lifetime and is a daily habit - what you do on a daily basis counts. Just as one drop of water consistently falling over decades in your home can cause undesirable consequences and even total damage, so too can your choices when it comes to your health. In the end, there is no magic bullet or supplement. There are useful supplements for treatment (which is a whole other conversation), but if we are talking prevention, then it starts right now. Remember the 3 billion beats your heart will pump out without even conscious thought. I love how intentionally you are tuning in, Pam, to tending to your cardiovascular health.
Citations
Lao XQ, Liu X, Deng HB, Chan TC, Ho KF, Wang F, Vermeulen R, Tam T, Wong MCS, Tse LA, Chang LY, Yeoh EK. Sleep Quality, Sleep Duration, and the Risk of Coronary Heart Disease: A Prospective Cohort Study With 60,586 Adults. J Clin Sleep Med. 2018 Jan 15;14(1):109-117. doi: 10.5664/jcsm.6894. PMID: 29198294; PMCID: PMC5734879.
Mineo, L. (2017, April 5). Over nearly 80 years, Harvard study has been showing how to live a healthy and happy life. Harvard Gazette. https://news.harvard.edu/gazette/story/2017/04/over-nearly-80-years-harvard-study-has-been-showing-how-to-live-a-healthy-and-happy-life/
Biddinger KJ, Emdin CA, Haas ME, Wang M, Hindy G, Ellinor PT, Kathiresan S, Khera AV, Aragam KG. Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease. JAMA Netw Open. 2022 Mar 1;5(3):e223849. doi: 10.1001/jamanetworkopen.2022.3849. Erratum in: JAMA Netw Open. 2022 Apr 1;5(4):e2212024. PMID: 35333364; PMCID: PMC8956974.
