Cardiovascular disease, says Dr. Heba Wassif, is not just a concern "for old men," but is one whose development can be lessened early in life with awareness and lifestyle changes.
SPRINGFIELD - Want to keep your heart as healthy as possible as you age?
Baystate Health cardiologist Heba Wassif has some tips for you.
Restrict your intake of sugar, salt and fat, exercise daily and don't think of heart disease as a "topic for old men."
"It is a topic for everyone," said Wassif who joined Baystate Medical Practices - Heart and Vascular Program a year ago.
"A lot of young people think heart disease is a man's disease and not a woman's disease. Both men and women should think about heart disease. Young women should think about heart disease in order to prevent it in the future."
She adds that "the majority of the population has one risk factor or the other, meaning, for example, about 50 percent of men and women, between the ages of 55 and 64, have hypertension (high blood pressure).
"There are 18 million people in the U.S. who have hypertension alone; 10 percent of the population has diabetes, one third of the population is obese," Wassif said.
"So there are many sections of the population that would have risk factors for cardiovascular diseases and the main goal is to reduce the risk by controlling all these risks and dangers."
Wassif clarified that the use of the term cardiovascular disease, often used interchangeably with the term heart disease, refers to the fact that the circulatory system's "blood vessels are the ones causing the problem," while the term heart disease can refer to the heart itself.
"With heart disease we are also talking about the heart as an organ as the disease is not only a vascular disease, but also a valvular disease where people have a narrowing or leakage in the valves of the heart or weakness in the heart muscle that causes congestive heart failure, or inflammation in the lining of the heart known as pericarditis."
Wassif, who did her cardiology fellowship at Johns Hopkins University School of Medicine in Baltimore, and an interventional cardiology fellowship with additional advanced cardiology training at Brigham and Women's Hospital in Boston, is a non-invasive cardiologist.
She diagnoses patients through external tests, like electrocardiograms that measure the electrical activity of the heart and echocardiograms that give a visual image, or coronary calcium scans that can detect the presence of calcifications in the arteries of the heart.
These tiny specks of calcium are considered an early sign of coronary artery disease. Their detection can be used to determine a person's risk for a heart attack or other heart problems before the individual experiences any symptoms.
Treatment might include statin therapy, medications that reduce the amount of low-density lipoproteins in the blood.
These lipoproteins transport cholesterol, a substance made by the body and increased by the ingestion of certain foods, to cells for the production of hormones. An excess of this LDL cholesterol in the blood can cause the build up of a hard substance known as plaque. This build up can make it difficult for the heart to circulate blood, and cause a condition known as atherosclerosis. If some of the plaque breaks open and causes a blockage in an artery to the brain, it can cause a stroke; in an artery to the heart, it can cause a heart attack.
Plaque, which is formed from calcium, fat and other substances, can also build up in the renal arteries, causing chronic kidney disease, and peripheral artery disease if it occurs in arteries supplying blood to the pelvis as well as the legs and arms, where too little blood flow due to narrowing can cause claudication, or intermittent pain, during exercise.
There are procedures to dissolve clots, something done within hours of a heart attack, as well as catheter-based procedures to widen blocked arteries and, when a wire mesh or stent is inserted, to help prevent further blockages. More invasive procedures, like bypass surgery, graft healthy arteries or veins and use them to re-route blood around the blocked coronary artery.
The two numbers on a blood pressure monitor, as the American Heart Association explains, "tell you the amount of force pushing against your artery walls when the heart is contracting and when the heart is at rest." The top number on a blood pressure monitor is the systolic blood pressure; the lower, the diastolic. The systolic blood pressure shows the pressure that the heart generates to push the blood through circulation, while the diastolic blood pressure is the lowest the blood pressure gets just at the time the heart is about to start beating. The AHA says blood pressure for an adult age 20 or over should normally be less than 120 systolic and less than 80 diastolic. High blood pressure can damage vessels and organs if left untreated over time.American Heart Association
Diseases of the heart's four valves, which control blood flow, can be caused by a number of factors beyond an individual's control, including being born with heart defects.
Wassif notes that today's technology has made it possible for individuals, generally not considered ideal candidates for surgery because of age or health issues, to have their aortic valve replaced through a procedure known as TAVR.
In transcatheter aortic valve replacement, which is done at Baystate's Davis Family Heart & Vascular Center, a catheter is inserted into a blood vessel in the groin, or chest, and used to thread a replacement valve into the defective valve.
The traditional treatment for aortic stenosis, which is a narrowing of the valve's opening, is surgery where the chest is cut open, the heart placed on heart-lung bypass and the valve replaced.
Valve replacement surgery is most often done on the aortic valve and the mitral valve, both are on the heart's left side and control the flow of blood, enriched by oxygen from the lungs, through the heart and into the body.
Transcatheter mitral valve repair with MitraClip is being done to correct leakage of blood from the left ventricle backward in the left atrium for a condition known as mitral regurgitation in patients too sick for open heart surgery, and Wassif noted that TAVR is a procedure that continues to be streamlined and is being offered to a larger pool of patients as a less invasive option to open heart surgery.
Despite today's treatment options, Wassif said there is an increasing emphasis on prevention by both the federal government and organizations like the American Heart Association.
"It is as simple as that," said Wassif of the AHA's Life's Simple 7 checklist, which includes no smoking, of what to do for a healthy heart.
"It is based on studies we have that 80 percent of heart disease is preventable with adjustment of lifestyles," Wassif said.
"What is being recommended is simple. Moderate exercise - 150 minutes per week. If you are able to do more, that is great, but no one needs to run a marathon. It is whatever the person is capable of - walking, swimming. Or, if you are not able to exercise, then monitor your steps."
The list coincides with Wassif's advice for individuals to know their family history for heart disease, talk to their doctor about their risks for cardiovascular disease and to know what is normal for them in terms of their weight, cholesterol levels, and blood pressure as high blood pressure, or hypertension, can damage arteries.
"You need to know if you have people in your family who died young of cardiovascular disease. You need to be talking to a primary care doctor and/or a cardiologist to see what your risk is," Wassif said.
She added that "you can't do anything about your genetics."
"Your genetic composition is your genetic composition, but to know whether you have early heart disease, then you would be intervening earlier. You would be promoting a healthy lifestyle earlier or know if you would be a candidate for a statin," said Wassif, noting that a coronary calcium scan can be done to detect the presence of plaque in the arteries.
"If you have a family history of heart disease and you have a calcium score that is not zero, than you can be more aggressive as a non-invasive cardiologist in managing your risk because you have sub-clinical cardiovascular disease that you might not be aware of."
Sweet and red peppers, cherry tomatoes, diced zucchini, and small onions sauteed in extra virgin olive oil and plated with whole grain pasta makes for a heart healthy meal.Anne-Gerard Flynn photo
Wassif also points to the U.S. Department of Health and Human Services and U.S. Department of Agriculture "2015-2020 Dietary Guidelines for Americans."
"The U.S. government has new healthy guidelines. One of their biggest is sugar. Sugar should now be no more than 10 percent of your diet no matter what your caloric intake is. So, if you are an individual who needs 2,000 calories a day, than no more than 10 percent should be sugar. That is a huge change in these guidelines to reduce the sugar intake," Wassif said.
She adds lowering one's sugar intake lowers one risks for such diseases as type 2 diabetes.
Under the new guidelines, Wassif says that sugar intake would be about 12 teaspoons daily, and is about two teaspoons daily for salt. Excessive salt causes the body to store water which raises blood pressure and puts a strain on the heart.
Wassif has found many of her patients have trouble reading labels to keep within recommended guidelines. As a result, she would like to see a supermarket aisle with just low-salt or no-salt products.
"We have an Indian section, an Asian section and different sections for different flavors. There should be a section for low salt as well. People in the community, as well as our patients, would benefit from that" Wassif said.
"It is not that people are not trying to adhere to their diets, but we have to try to minimize the barriers they run into and one is the supermarket. They walk in and get lost. They don't know what to pick, what to choose."
Wassif said her patients are a "fairly even" mix of men and women, ranging in age from 20 to 90, with an average age of 60, and many initially see her because of chest pain.
"Not every chest pain means a blockage," Wassif said.
"There are patients who have chest pains but who don't have a blockage. The disease is not in the big blood vessels but in the smaller blood vessels that we usually can't see."
Wassif said she can use something called the pooled cohort equation to help predict an individual's 10-year risk for stroke and heart attack. The equation is sometimes used in combination with a calcium score to determine if a patient should be put on statin therapy to lower their cholesterol to recommended guidelines.
Wassif said women often have a higher risk for heart problems because of pregnancy and because they have higher rates of inflammation as well as depression, which is being increasingly seen as a contributing cause of heart attacks if not treated.
"There was the Nurses Study of 89,000 women that looked at women who had had cardiac events and 46 percent of them were related to poor and unhealthy lifestyles. This shows what we can do in our daily life to promote cardiovascular health," said Wassif of the study, initially undertaken in 1976, and funded by the National Institutes of Health, and now in its third generation.
Wassif noted that information from the Nurses Study II is supporting evidence of a link between migraines and increased risk for cardiovascular disease in women.
She recommends that women follow the advice of the American Heart Association and have an annual "Well-Women's Visit."
"As you do screening for many other diseases, consider looking into your heart health as well," Wassif said.
Heart disease is the leading cause of death in the U.S. for both men and women, and the leading cause of death worldwide. Asked if the heart is the body's most important organ, Wassif quipped, "It is to me!"
"It is an important organ as its has a lot of interaction with the other organs," Wassif added. "It is essential to the body's functions."
Born in Egypt and raised in the Persian Gulf, Wassif said her decision to enter medicine was influenced by a father who was a doctor, as well as by a mother who was a pharmacist and "lots of aunts and uncles who were doctors."
After graduating from the University of Cairo, she did an externship in cardiology at the Bristol (England) Royal Infirmary, and her anesthesiology externship at Abbott-Northwestern Hospital in Minneapolis.
Why the heart?
"It has always fascinated me, and I have always like reading EKGs," said Wassif, who is fluent in English, French and Arabic and speaks some Spanish.
"I could never think of any other organ that interested more - it has always been all about the heart for me."
Wassif does follow her own heart healthy advice in terms of both diet and exercise.
"I try to do 10,000 steps every day," said Wassif, a number the Centers for Disease Control and and Prevention and the American College of Sports Medicine say is achieved through 30 minutes of walking in addition to other daily activities. The CDC and ACSM recommend both aerobic and muscle-strengthening physical activities several days a week for both heart and bone health.
"Sunday I did 7,000 steps; Monday I did Zumba and yesterday a core class for strengthening," Wassif said.
She added, "I am always eating salads."
"I minimize my meat intake, and use very little or no salt. I eat lots of fruits and vegetables and I love fish, and that's easy living in New England!"
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