You have more power over your heart health than you think. Here's what top docs wish everyone knew.
Cardiovascular disease is the number-one killer among men and women over 65, ahead of cancer and stroke. You probably already knew that.
Something you might not know: According to the American Heart Association, about 70 percent of men and women between 60 and 79 are living with some form of cardiovascular disease-whether they realize it or not. But that doesn't mean their fate is sealed.
"One big misconception is that it's not modifiable," says Evan Appelbaum, M.D., a cardiologist in Chestnut Hill, Massachusetts. "People feel like, 'It's in my makeup, it's in my genetics. And therefore, regardless of what habits of body or mind I partake in life, I'm not going to alter my risk that much,'" he says. "People underestimate the power they have not only in leading a long life, but it's really about the quality of life."
To help patients add more—and better—years to life, cardiologists like Dr. Appelbaum are shifting from practices that focus almost exclusively on treatment to holistic care that emphasizes preventive lifestyle measures to help lower risk of heart disease.
Here’s what he and other top cardiologists say most people need to know about heart health.
1. Small Chunks of Physical Activity Are Effective
It’s no secret that staying active is associated with better cardio outcomes, not to mention reduced risks of cancer, stroke, diabetes, and early death. That’s why the Centers for Disease Control and Prevention (CDC) recommends at least 150 minutes per week of moderate-intensity aerobic activity, like brisk walking.
But how you divvy up that 150 minutes is entirely up to you. "You don't have to do it in 30-minute workouts," says David Sabgir, M.D., a cardiologist in Columbus, Ohio. "I like 10-minute chunks. I encourage patients to walk five minutes away from their house or apartment, and then come back," he says. "So many people aren't doing anything. So it's a great way to get the ball rolling."
Dr. Sabgir's belief in the power of movement inspired him to create Walk with a Doc, a program that organizes free walks with a doctor who provides a health talk at the beginning of the exercise session. The organization has more than 320 chapters nationwide that walk together weekly, biweekly, or monthly. But even if you can't make it to one of these events, he says walking 10 minutes two or three times per day can get you results.
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2. Daily Pain Pills May Do More Harm Than Good
Knee and low back pain affect 20 and 28 percent of Americans, respectively, according to the CDC. And if you’re experiencing it every day, over-the-counter pain meds may seem like the godsend they’re advertised to be: Take these every day, the commercials say, and you’ll feel better fast.
But using these medications every day can raise blood pressure and actually increase cardiac risks, says Mimi Guarneri, M.D., an integrative cardiologist in La Jolla, California. That doesn’t mean you can’t take OTC pain meds when you need relief, but work on getting to the root of the problem.
"The analogy I always use is that if someone had a sick tree and the tree had sick fruit on it, would you cut off all the branches or would you fix the soil?" she says. "The ill-to-the-pill approach never gets to the underlying cause of the problem: What's going on in my soil?"
If you’re experiencing chronic pain or any of these six pains you should never ignore, see your doctor. Ask about appropriate treatments and preventive measures. The good news is movement can often help fix pain in the knees, back, hips, and shoulders.
3. There’s More Than Just “Good” and “Bad” Cholesterol
You likely already know about HDL (often called "good") and LDL (often called "bad") cholesterol levels, as well as your triglycerides. But there are additional cholesterol markers that can help determine your risk, Dr. Appelbaum says.
"There are subtypes of LDL cholesterol, or small particles," he says. "Based on their size alone, they actually carry an inherent risk. And there's a simple blood test that you add on that can parse that out."
Questioning your doctor about the tests he or she is performing can be intimidating-after all, they're the experts. To make yourself more comfortable and open a conversation, appeal to that expertise, Dr. Appelbaum suggests. Start by saying something like, "I've read about these other tests, like an LDL particle size test. Should I be doing something like that?" Or "I have a friend who has done that-what do you think about that, doc?"
Most physicians, Dr. Appelbaum says, will appreciate that they’re dealing with someone who is taking the time and effort to invest in their health. For more great tips to keep cholesterol in check, click here.
4. You Can—and Should—Ask About Additional Testing Options
Even if you're not showing symptoms of cardiovascular disease, certain tests can provide a deeper understanding of your heart risks and help your doctor recommend preventive steps. For example, a noninvasive test like a carotid ultrasound can look for plaque buildup. Also, a a cardiac CT scan can look for calcium buildup in the heart, which is an indicator of how much risk your cholesterol levels can pose.
As with the LDL particle size test, ask about these tests by involving your doctor in a conversation. "Come prepared with things you've read about, and then ask, 'What do you think?'" Dr. Appelbaum suggests. "I think that question, more than 'I'd like to have this test,' is an important way to engage them in a partnership."
Have questions about costs? Ask about that too. You can also check what Medicare covers here, or check with your health plan.
5. There’s No Such Thing as TMI
Tell your cardiologist about your health in ways that go beyond your heart. Your sexual health, for example, can provide an important window into your overall cardiovascular health.
"When someone has erectile dysfunction, or failure to have an adequate or any erection at all, what's causing that is blood flow," Dr. Appelbaum says. "Blood flow in the arteries of the penis can mirror what's going on in the arteries of the heart or brain. So while it may not seem related, telling your cardiologist about health issues in other areas may help them further understand your heart risk and what to test for."
Feeling shy? Know that doctors are prepared to talk about—and help you with—sensitive topics. Try making a list of your symptoms or concerns before your appointment, and then share the list with your doctor. Check out more tips to make the most of your doctor visit.
6. Count Your Sleep Apnea Risk Factors
Sleep apnea, a disorder that involves short pauses in breathing while you sleep, is a major risk factor for heart disease, Dr. Sabgir says.
"Sleep apnea is associated with atrial fibrillation, coronary artery disease, and high blood pressure," he says. It can also cause reduced energy, which many people think is just part of getting older. But when patients get relief from sleep apnea, many report feeling 20 years younger, Dr. Sabgir says. "No pun intended, but it really is a sleeping giant."
To assess whether you should ask your doctor about sleep apnea, remember the acronym STOPBANG, Dr. Sabgir says. It stands for the eight sleep apnea risk factors:
- Tired feeling
- Observed apnea, when your partner or someone else has seen you briefly stop breathing while you sleep
- Pressure, meaning elevated blood pressure
- Body mass index (BMI) greater than 30, a measure of your weight relative to your height
- Age over 50
- Neck size greater than 40 centimeters
- Gender, since males are at greater risk
If you have four or more STOPBANG risk factors, ask your doctor about a potential sleep study or other sleep apnea test, Dr. Sabgir says.
7. You Should Be Eating Less Than 20 Grams of Sugar Per Day
“Right now, we have a world that is eating way too much sugar,” Dr. Guarneri says. According to a study in JAMA Internal Medicine, most Americans consume 10 percent or more of their calories from added sugars—not natural sugars from things like fruit, but from sources like sugar-sweetened beverages, cookies, and the like. These added sugars can increase the risk for obesity, diabetes, and high blood pressure.
The study also found that those who ate 17 to 21 percent of their daily calories from added sugars had a 38 percent higher risk of death from cardiovascular disease compared to those who ate 8 percent of their daily calories from added sugars. For someone on an 1,800-calorie daily diet, 8 percent amounts to 144 calories, or about 36 grams of sugar.
Dr. Guarneri suggests aiming even lower: 20 grams per day. "That's an extremely low number if you start looking at food labels," she says. "You're going to get that in one can of soda. But it's a level that's been associated with a reduction in triglycerides, a reduction of fasting blood sugar, and improvement in diabetes."
Trying to cut back on the sweet stuff? Start with small changes, like choosing water with lime instead of sipping soda and making your own fruit-based yogurt instead of buying the fruit-on-the-bottom kind. For more tips, check out our simple rules of clean eating.