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Important Facts About Heart Health
Karen Wiarda, D.O. discusses heart health, the difference in heart disease presentation in women and men, and how best to counsel patients of the risk factors to be aware of and the ways to prevent heart disease.
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Learn more about Karen Wiarda, DO
Karen Wiarda, DO
Dr. Karen P Wiarda, DO, is a Cardiovascular Disease (Cardiology) specialist in Mattoon, Illinois. She attended and graduated from medical school in 2005, having over 14 years of diverse experience, especially in Cardiovascular Disease (Cardiology).Learn more about Karen Wiarda, DO
Transcription:
Melanie Cole (Host): Heart disease is the number one killer of men and women and is more deadly than all forms of cancer combined. Today we're talking about heart health and heart disease prevention with Dr. Karen Wiarda. She's a cardiologist with the Carle Foundation Hospital. Dr. Wiarda, tell us a little bit about the current state of heart disease today, the incidents and burden, and what's different about what we know about it now as compared to what we knew twenty years ago?
Dr. Karen Wiarda, DO (Guest): As mentioned, the burden is very high. There's an estimated 17.9 million people who die from cardiovascular disease, which accounts for 31% global deaths and 85% of those deaths are from heart attacks and strokes. Over three quarters of those deaths are from low and middle-income countries, and we know that if we can prevent heart disease by reducing behaviors associated with heart disease like tobacco and healthy diet, obesity, physical activity, and harmful alcohol use, that we can impact these numbers and dramatically improve them.
Host: What are some comorbid conditions that can either contribute to or be caused by heart disease? And while you're speaking about that, speak about those risk factors, because diabetes and these things, they all go together.
Dr. Wiarda: The greatest risk factor is genetics obviously, which we can't change, but the risk factors that we can change are high blood pressure, diabetes, hyperlipidemia, a known established cardiovascular disease as well, obesity, and an unhealthy lifestyle, and lack of activity.
Host: Those are all such important risk factors, and while they all tie in with heart disease, you mentioned that there's a genetic component. Is that something we would know? Is that something that doctors and providers should be asking? Is this part of a well exam?
Dr. Wiarda: It is important to be asked that question, but it's also important to make sure the answer is offered if it isn't asked. Genetics are the one thing you can't change when it comes to heart disease, but you can certainly affect the genetics by making the right choices.
Host: Tell us some of the latest ways to diagnose the presence or cause of heart disease. If we're getting our wellness exams, you're working with your primary care provider, you're getting your bloodwork done, what else is available to detect it, and are there some symptoms? And while you're speaking of symptoms, Dr. Wiarda, speak about how women and men exhibit and present these symptoms in a different way.
Dr. Wiarda: So in terms of detecting heart disease, certainly bloodwork is going to give you a better understanding of what your cholesterol level is. It'll also give your blood sugar and your hemoglobin A1C, which is looking at your blood sugar over long-term of three months. As well as your kidney disease, whether or not there's kidney disease present. The lab work will be able to tell you all that. An EKG can tell you if there's abnormalities with the conducting system that would suggest that you have problems with your coronary arteries potentially. Echocardiograms look at the structure of the heart, and they can tell you if you're functioning well, or whether or not you have valvular problems with your heart. And there's other imaging like coronary CTA calcium scores that can provide information about the burden of calcium in your heart, and then that allows you to talk about your risk. Another test that can be helpful is the level of inflammation in your heart or high sensitive CRP (c-reactive protein), and that can give you an idea of whether or not even with your cholesterol level, if the inflammation is high in your body and allow you to better treat the cholesterol to reduce your risk.
Host: While you're talking about inflammation, what about stress? Because we hear about cortisol, and stress, and inflammation, and that these are now big contributors to heart disease. Does stress contribute to heart disease, and is that something that we're learning as we see more women having heart disease, as more women are having these high levels of stress in the workplace that men used to have thirty or forty years ago?
Dr. Wiarda: Stress certainly plays a role in heart disease, and that's actually on multiple levels. So one, certainly with the release of cortisone and fight-or-flight hormones, as well as stress increases your blood pressure, stress can increase your blood sugar, stress can reduce the amount of sleep that you get, and so all of that stress increases your risk of heart disease. Additionally, women certainly- and how you deal with stress is also important, but also reducing stress with exercise, reducing stress with therapy could even potentially help, but it absolutely increases your risk of heart disease. And women, back to the additional question, women do present differently than men with symptoms of heart disease, and often the last symptom that women feel is chest pain. The more common symptoms for women are fatigue, just feeling tired, just feeling short of breath, they may have back pain, they may have jaw pain or abdominal pain, but typically the last symptom they have is chest pain. Your classic angina, which anyone can have, is substantial chest pain that radiates to the jaw, typically the left side, and down the left arm. However, you can just feel tired, you can feel nauseous, you can have abdominal pain. Women, and particularly diabetic women, can present strictly with fatigue, and that's it.
Host: I want to stick with this point for a minute, Doctor, because while women have these kinds of different symptoms, so many of those symptoms that you've described can mimic stress and anxiety or an orthopedic issue, so many other- heartburn, reflux. How do we know?
Dr. Wiarda: One, we know them by taking a good history. Two, by doing the appropriate exams like an EKG. Three, just by also looking at the risk factors. And so if someone has a family history, or they are diabetic, or have high blood pressure or high cholesterol and tobacco, which is a significant risk, then you will want to make sure that you probe and always sort of protect the heart first and then worry about the other symptoms later. But you really want to take a good history and you want to listen to your patient and make sure that you're not belittling their symptoms.
Host: What an important point. As we look to medicational intervention, for any of these comorbid conditions - high blood pressure, cholesterol, any of these things - what are some of the things you would look to first, and while you are telling us a little bit about the medications that you might use, is aspirin something that is being recommended for many people? Most people? Tell us who it's recommended for.
Dr. Wiarda: Well a daily aspirin can certainly prevent a clot-related stroke. It may increase your risk of bleeding; either hemorrhagic stroke, GI bleeding, any form of bleeding. And so a daily aspirin is actually something that you need to speak with your physician about prior to initiating. Because it has its benefit by interfering with the clotting action of the blood, it actually can reduce your risk of having a stroke or heart attack, but it can also cause the bleeding, so you want to talk to your doctor and determine whether or not your risk specifically are such that it's risk over benefit- risk is less than benefit. So the US Preventative Serve Task Force recommends that daily aspirin, ages fifty to fifty-nine who are not at increased risk of bleeding, have an increased risk of heart attack and stroke of 10% or greater over the next ten years. If they're age sixty to sixty-nine, they don't have an increased risk of bleeding and they're high risk of heart attack or stroke, 10% or greater over ten years, then they should talk to their physician. More research really is needed regarding the benefits of taking a daily aspirin, and the ages younger then seventy - between fifty and older than seventy - it is something that you need to speak with your physician specifically about. Certainly benefits but really it's just an ongoing discussion. The other question you asked is whether or not enteric coated aspirin is beneficial and what dose of aspirin. Typically 81 milligrams is the correct dose, specifically if you look at the guidelines for aspirin for atrial fibrillation, they say 325 milligrams. Generally speaking 81 milligrams is a dose that's appropriate even with coronary stenting. When it comes to enteric coated aspirin, there's been some evidence that suggests that it can actually increase the risk of ulcers and they aren't as effective because of the enteric coating being absorbed. So enteric coated aspirin isn't necessarily as beneficial as we once thought. The only other thing that you have to think about when you're taking aspirin is just the risk of additional bleeding with things like Plavix or some of the new NOAC medications for atrial fibrillation, stroke prevention, or blood clot prevention, as that increases the risk of bleeding further. Additionally, NSAIDs and other medicines that can increase the risk need to be evaluated and at least discussed.
Host: Where does exercise fit into this whole heart health tip? And while you're discussing that, dietary modifications when you're working with a patient, and what you would like providers to know about using their prescription pad to prescribe exercise and dietary modifications that can help prevent heart disease?
Dr. Wiarda: I think one of the most important things that people need to understand is if you don't use it, then you're going to lose it, and exercise is incredibly important, and that is for all ages. For substantial health benefits, you want at least 150 minutes or two and a half hours to 300 minutes or five hours a week of moderate intensity exercise, or 75 minutes which is about an hour and fifteen minutes, or 150 minutes, or two hours and thirty minutes a week of vigorous intense aerobic physical activity, or an equivalent combination of the two. So moderate activity versus vigorous activity, you want to at least have some difficulty having a conversation. That would be considered moderate physical activity. And you want to also vary up your activity. You want to do some muscle activity, some balance activity, some weights, so that you're doing not just cardiovascular, but you're actually benefitting multiple parts of your heart, multiple parts of your body as well. Balance is important, and so any physical activity, we need to get off the couch. Studies have actually shown that people are self-describing less in activity. The problem is with cellphones and with gaming, there's more than one hour of time spent doing that. So it's just really important to get out there, get exercising, and to make it better, to make it more fun, to make it more enjoyable, do it with friends. Do activities as a family, do activities in groups so that it makes it fun. Vary up your activity, all of that helps. In terms of diet, probably the three best cardiac prevention diets, certainly by World News and Report, are the Mediterranean Diet, the DASH Diet, and the Ornish Diet. Those are the healthiest in general. You want to reduce high fat diets, you want low fat, healthy fat diets, you want low carbohydrate, healthy carbohydrate, meaning fresh fruits and vegetables. You want healthy proteins, you want to reduce your whites and eat brown rice, brown bread, healthier bread, high fiber. Those are the diets that are really important.
Host: It's great information, Dr. Wiarda. Wrap it up for us with your best advice for heart health, and what you would like other providers to know about taking that good history, and helping their patients to get onto a heart healthier lifestyle.
Dr. Wiarda: I think the most important thing is just making sure that you really listen to your patients. When they walk in the door, it's important to understand their life stressors, their family stressors, how much they eat, what they eat. Don't just ask, "Do you eat a good diet?" Say, "What does a good diet sound like to you?" Be detailed about your questions and make sure that you understand their risk, make sure you understand their family history, make sure your patients understand the benefits of quitting smoking, and help them to quit smoking, and that they understand the benefits of reducing stress, and that we have social work available to help with stressors, and other providers, and make sure we use our other providers, make sure we use our dieticians, make sure we use our diabetes educators and our cardiac rehab. The resources are available, people just need to understand they're out there, and that we can help them access those support systems.
Host: Great information. Thank you so much, Dr. Wiarda, for coming on with us today and sharing your expertise, giving us your best advice about heart health. It's so important for everyone to hear. You're listening to Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle's sponsored educational activities, please visit www.CarleConnect.com. That's www.CarleConnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole, thanks so much for tuning in.
Melanie Cole (Host): Heart disease is the number one killer of men and women and is more deadly than all forms of cancer combined. Today we're talking about heart health and heart disease prevention with Dr. Karen Wiarda. She's a cardiologist with the Carle Foundation Hospital. Dr. Wiarda, tell us a little bit about the current state of heart disease today, the incidents and burden, and what's different about what we know about it now as compared to what we knew twenty years ago?
Dr. Karen Wiarda, DO (Guest): As mentioned, the burden is very high. There's an estimated 17.9 million people who die from cardiovascular disease, which accounts for 31% global deaths and 85% of those deaths are from heart attacks and strokes. Over three quarters of those deaths are from low and middle-income countries, and we know that if we can prevent heart disease by reducing behaviors associated with heart disease like tobacco and healthy diet, obesity, physical activity, and harmful alcohol use, that we can impact these numbers and dramatically improve them.
Host: What are some comorbid conditions that can either contribute to or be caused by heart disease? And while you're speaking about that, speak about those risk factors, because diabetes and these things, they all go together.
Dr. Wiarda: The greatest risk factor is genetics obviously, which we can't change, but the risk factors that we can change are high blood pressure, diabetes, hyperlipidemia, a known established cardiovascular disease as well, obesity, and an unhealthy lifestyle, and lack of activity.
Host: Those are all such important risk factors, and while they all tie in with heart disease, you mentioned that there's a genetic component. Is that something we would know? Is that something that doctors and providers should be asking? Is this part of a well exam?
Dr. Wiarda: It is important to be asked that question, but it's also important to make sure the answer is offered if it isn't asked. Genetics are the one thing you can't change when it comes to heart disease, but you can certainly affect the genetics by making the right choices.
Host: Tell us some of the latest ways to diagnose the presence or cause of heart disease. If we're getting our wellness exams, you're working with your primary care provider, you're getting your bloodwork done, what else is available to detect it, and are there some symptoms? And while you're speaking of symptoms, Dr. Wiarda, speak about how women and men exhibit and present these symptoms in a different way.
Dr. Wiarda: So in terms of detecting heart disease, certainly bloodwork is going to give you a better understanding of what your cholesterol level is. It'll also give your blood sugar and your hemoglobin A1C, which is looking at your blood sugar over long-term of three months. As well as your kidney disease, whether or not there's kidney disease present. The lab work will be able to tell you all that. An EKG can tell you if there's abnormalities with the conducting system that would suggest that you have problems with your coronary arteries potentially. Echocardiograms look at the structure of the heart, and they can tell you if you're functioning well, or whether or not you have valvular problems with your heart. And there's other imaging like coronary CTA calcium scores that can provide information about the burden of calcium in your heart, and then that allows you to talk about your risk. Another test that can be helpful is the level of inflammation in your heart or high sensitive CRP (c-reactive protein), and that can give you an idea of whether or not even with your cholesterol level, if the inflammation is high in your body and allow you to better treat the cholesterol to reduce your risk.
Host: While you're talking about inflammation, what about stress? Because we hear about cortisol, and stress, and inflammation, and that these are now big contributors to heart disease. Does stress contribute to heart disease, and is that something that we're learning as we see more women having heart disease, as more women are having these high levels of stress in the workplace that men used to have thirty or forty years ago?
Dr. Wiarda: Stress certainly plays a role in heart disease, and that's actually on multiple levels. So one, certainly with the release of cortisone and fight-or-flight hormones, as well as stress increases your blood pressure, stress can increase your blood sugar, stress can reduce the amount of sleep that you get, and so all of that stress increases your risk of heart disease. Additionally, women certainly- and how you deal with stress is also important, but also reducing stress with exercise, reducing stress with therapy could even potentially help, but it absolutely increases your risk of heart disease. And women, back to the additional question, women do present differently than men with symptoms of heart disease, and often the last symptom that women feel is chest pain. The more common symptoms for women are fatigue, just feeling tired, just feeling short of breath, they may have back pain, they may have jaw pain or abdominal pain, but typically the last symptom they have is chest pain. Your classic angina, which anyone can have, is substantial chest pain that radiates to the jaw, typically the left side, and down the left arm. However, you can just feel tired, you can feel nauseous, you can have abdominal pain. Women, and particularly diabetic women, can present strictly with fatigue, and that's it.
Host: I want to stick with this point for a minute, Doctor, because while women have these kinds of different symptoms, so many of those symptoms that you've described can mimic stress and anxiety or an orthopedic issue, so many other- heartburn, reflux. How do we know?
Dr. Wiarda: One, we know them by taking a good history. Two, by doing the appropriate exams like an EKG. Three, just by also looking at the risk factors. And so if someone has a family history, or they are diabetic, or have high blood pressure or high cholesterol and tobacco, which is a significant risk, then you will want to make sure that you probe and always sort of protect the heart first and then worry about the other symptoms later. But you really want to take a good history and you want to listen to your patient and make sure that you're not belittling their symptoms.
Host: What an important point. As we look to medicational intervention, for any of these comorbid conditions - high blood pressure, cholesterol, any of these things - what are some of the things you would look to first, and while you are telling us a little bit about the medications that you might use, is aspirin something that is being recommended for many people? Most people? Tell us who it's recommended for.
Dr. Wiarda: Well a daily aspirin can certainly prevent a clot-related stroke. It may increase your risk of bleeding; either hemorrhagic stroke, GI bleeding, any form of bleeding. And so a daily aspirin is actually something that you need to speak with your physician about prior to initiating. Because it has its benefit by interfering with the clotting action of the blood, it actually can reduce your risk of having a stroke or heart attack, but it can also cause the bleeding, so you want to talk to your doctor and determine whether or not your risk specifically are such that it's risk over benefit- risk is less than benefit. So the US Preventative Serve Task Force recommends that daily aspirin, ages fifty to fifty-nine who are not at increased risk of bleeding, have an increased risk of heart attack and stroke of 10% or greater over the next ten years. If they're age sixty to sixty-nine, they don't have an increased risk of bleeding and they're high risk of heart attack or stroke, 10% or greater over ten years, then they should talk to their physician. More research really is needed regarding the benefits of taking a daily aspirin, and the ages younger then seventy - between fifty and older than seventy - it is something that you need to speak with your physician specifically about. Certainly benefits but really it's just an ongoing discussion. The other question you asked is whether or not enteric coated aspirin is beneficial and what dose of aspirin. Typically 81 milligrams is the correct dose, specifically if you look at the guidelines for aspirin for atrial fibrillation, they say 325 milligrams. Generally speaking 81 milligrams is a dose that's appropriate even with coronary stenting. When it comes to enteric coated aspirin, there's been some evidence that suggests that it can actually increase the risk of ulcers and they aren't as effective because of the enteric coating being absorbed. So enteric coated aspirin isn't necessarily as beneficial as we once thought. The only other thing that you have to think about when you're taking aspirin is just the risk of additional bleeding with things like Plavix or some of the new NOAC medications for atrial fibrillation, stroke prevention, or blood clot prevention, as that increases the risk of bleeding further. Additionally, NSAIDs and other medicines that can increase the risk need to be evaluated and at least discussed.
Host: Where does exercise fit into this whole heart health tip? And while you're discussing that, dietary modifications when you're working with a patient, and what you would like providers to know about using their prescription pad to prescribe exercise and dietary modifications that can help prevent heart disease?
Dr. Wiarda: I think one of the most important things that people need to understand is if you don't use it, then you're going to lose it, and exercise is incredibly important, and that is for all ages. For substantial health benefits, you want at least 150 minutes or two and a half hours to 300 minutes or five hours a week of moderate intensity exercise, or 75 minutes which is about an hour and fifteen minutes, or 150 minutes, or two hours and thirty minutes a week of vigorous intense aerobic physical activity, or an equivalent combination of the two. So moderate activity versus vigorous activity, you want to at least have some difficulty having a conversation. That would be considered moderate physical activity. And you want to also vary up your activity. You want to do some muscle activity, some balance activity, some weights, so that you're doing not just cardiovascular, but you're actually benefitting multiple parts of your heart, multiple parts of your body as well. Balance is important, and so any physical activity, we need to get off the couch. Studies have actually shown that people are self-describing less in activity. The problem is with cellphones and with gaming, there's more than one hour of time spent doing that. So it's just really important to get out there, get exercising, and to make it better, to make it more fun, to make it more enjoyable, do it with friends. Do activities as a family, do activities in groups so that it makes it fun. Vary up your activity, all of that helps. In terms of diet, probably the three best cardiac prevention diets, certainly by World News and Report, are the Mediterranean Diet, the DASH Diet, and the Ornish Diet. Those are the healthiest in general. You want to reduce high fat diets, you want low fat, healthy fat diets, you want low carbohydrate, healthy carbohydrate, meaning fresh fruits and vegetables. You want healthy proteins, you want to reduce your whites and eat brown rice, brown bread, healthier bread, high fiber. Those are the diets that are really important.
Host: It's great information, Dr. Wiarda. Wrap it up for us with your best advice for heart health, and what you would like other providers to know about taking that good history, and helping their patients to get onto a heart healthier lifestyle.
Dr. Wiarda: I think the most important thing is just making sure that you really listen to your patients. When they walk in the door, it's important to understand their life stressors, their family stressors, how much they eat, what they eat. Don't just ask, "Do you eat a good diet?" Say, "What does a good diet sound like to you?" Be detailed about your questions and make sure that you understand their risk, make sure you understand their family history, make sure your patients understand the benefits of quitting smoking, and help them to quit smoking, and that they understand the benefits of reducing stress, and that we have social work available to help with stressors, and other providers, and make sure we use our other providers, make sure we use our dieticians, make sure we use our diabetes educators and our cardiac rehab. The resources are available, people just need to understand they're out there, and that we can help them access those support systems.
Host: Great information. Thank you so much, Dr. Wiarda, for coming on with us today and sharing your expertise, giving us your best advice about heart health. It's so important for everyone to hear. You're listening to Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle's sponsored educational activities, please visit www.CarleConnect.com. That's www.CarleConnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole, thanks so much for tuning in.