How to stop heart disease long before any symptoms

Contents of the article

Millions of adults aged 20 years and older suffer from coronary heart disease. But experts say overall health doesn't have to be an inevitable part of aging.

Contents of the article

There are steps you can take to reduce your risk of developing cardiovascular disease, which is the leading cause of death worldwide. However, the most important thing is to start much earlier than you think.

Contents of the article

Contents of the article

“This disease in modern Western society develops at a very early age,” said Steven Nissen, a cardiologist at the Cleveland Clinic who has been a leading advocate of early prevention. In the United States alone, more than 900,000 people died from heart disease in 2023, equivalent to one out of every three deaths.

A growing number of cardiologists and public health experts agree that millions of people could be saved if the medical system changed the way it treats heart disease, focusing on identifying and treating atherosclerosis, or the buildup of plaque that narrows arteries over time before obvious signs or symptoms appear.

Contents of the article

“Unfortunately, most of our systems are set up to take into account that the moment you look for coronary artery disease is the moment someone tells you they have symptoms or the moment they have a heart attack,” said Rasha Al-Lami, who led a research team of more than two dozen experts from around the world that studied changes in the way heart disease is identified and treated. “This disease starts much earlier. There is a continuum. If we interrupt it much earlier, we can prevent similar events from occurring in people.”

What are the main causes of cardiovascular diseases?

Coronary heart disease is most often caused by the buildup of fatty substances, also known as plaque, in the arteries. Risk factors include high blood pressure, high cholesterol, unhealthy diet, lack of exercise, obesity and diabetes, and smoking.

Contents of the article

Contents of the article

One study found that more than 99% of people who had heart attacks, heart failure, and strokes had at least one of the four major risk factors for cardiovascular disease. These patients had “suboptimal” blood pressure, cholesterol or glucose levels, or were current or former smokers, according to a study published last month in the peer-reviewed Journal of the American College of Cardiology.

“People may have risk factors for the disease, but we can treat those risk factors,” said Al-Lami, professor of cardiology at the National Heart and Lung Institute at Imperial College London.

We apologize, but this video has failed to load.

Play video

What does treatment look like?

Although several treatment guidelines published by the American Heart Association and the American College of Cardiology focus on prevention, many cardiologists say more needs to be done to identify and provide early care for people at risk of developing cardiovascular disease.

Contents of the article

Heart experts agree that shifting focus to preventing plaque formation is critical. Researchers estimate that if risk factors that cause plaque buildup are eliminated by 2050, mortality rates from cardiovascular disease could drop by more than 80%, potentially saving 8.7 million lives worldwide each year, according to a paper published in the peer-reviewed journal Lancet earlier this year.

Current guidelines recommend aggressive treatment if a person's likelihood of having a coronary event, such as a heart attack, in the next decade is high enough, said Patricia Best, an interventional cardiologist at the Mayo Clinic in Rochester, Minnesota.

“Most of us want to live beyond 10 years,” Best said. “We need to start looking at younger ages and focusing more on lifetime risk rather than shorter-term risks of 10 to 20 years.”

Contents of the article

Because many cardiovascular risk assessment tools are designed for people with symptoms, early detection of atherosclerosis will require new screening strategies and changes in risk definitions, the researchers write in the Lancet paper. They also called for increased investment in research and development of new treatments that will prevent the onset or progression of the disease.

“We need to think about what to do with a 25-year-old who is obese and has cholesterol levels that are well above optimal,” said Nissen, who was not involved in the Lancet paper. “We need to think about their lifetime risk, not their 10-year risk. What are the chances that at 55 or 60 they'll have a heart attack or sudden cardiac death?”

Contents of the article

What can you do to help yourself and your heart?

“To improve your heart health, consider following the American Heart Association's checklist,” said Neha Pagidipati, a heart disease prevention expert at the American College of Cardiology.

The AHA's “8 Essentials” list includes:

• Eat better. Recommendations include whole foods, plenty of fruits and vegetables, lean protein, nuts, seeds, and using olive or canola oil for cooking.

• Quitting tobacco and vaping.

• Healthy sleep. For most adults, that's seven to nine hours of sleep each night.

• Weight management.

• Control cholesterol levels. LDL, or “bad” cholesterol, levels should be 100 milligrams per deciliter or lower, Nissen says.

Contents of the article

• Blood sugar management. If you have diabetes, pay attention to your hemoglobin A1C level, which should be below 5.7%.

• Blood pressure management. Most people should have blood pressure below 120/80, Nissen says.

“We now have all the strategies in place to take a holistic view of cardiovascular disease,” said C. Noel Bairy Mertz, professor of cardiology and director of the Barbra Streisand Women's Heart Center at Cedars-Sinai. “Why wait until they need a workaround? Plus, our holistic strategies are actually quite affordable.”

It's also important to know if you have a family history of heart disease, Nissen said.

Talk to your doctors about how best to reduce your risk. You may ask your doctor if you need to treat any potential risk factors, such as high blood pressure or cholesterol, with medications or lifestyle changes.

Al-Lami urged people to treat heart disease like cancer.

“People are very aware of what they need to do to reduce their risk of cancer, and they are very interested in early diagnosis,” she said. “I want the same thing to happen for coronary heart disease.”

Contents of the article