Heart Talk - February 2019
Heart Attack Myths, Busted
Heart-healthy and Stroke-free Living with Eric A. Goulder, MD, FACC
If you think you’re too young — or too healthy — to have a heart attack, a recent cautionary tale published in The New York Times may change your mind. The article’s author, Trymaine Lee, never considered himself to be at risk for heart disease — until he suffered a near-fatal major “widow-maker” heart attack at age 38. “ ‘You hit the lottery,’ one of the cardiologists who saved my life told me,” wrote Lee, a physically fit nonsmoker with no family history of heart disease or early death. “The worst kind of lottery.”
The article also reports that rates of heart attacks have increased in younger adults. In a study of more than 28,000 people hospitalized for heart attacks between 1995 and 2014, 30% were between ages 35 and 54, with a 5% rise over that period in the number of younger heart attack victims. Here’s a look at common misconceptions about heart attacks — and the facts you need to safeguard the health of your most important organ.
Myth: If your cholesterol levels are normal, you won’t have a heart attack.
Fact: A national study of 136,905 people hospitalized for a heart attack found that nearly half had “optimal” levels of cholesterol and nearly 75% had levels that fell within recommended targets. The blood test these patients typically receive sounds comprehensive: Known as a “lipid profile” or “coronary risk panel,” it checks levels of total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides.
As we recently reported, according to this test and other standard methods of evaluating cardiovascular health during annual checkups, celebrity fitness trainer Bob Harper was the picture of health, yet suffered a massive widow-maker heart attack at age 52. A year later, the mystery of Harper’s seemingly inexplicable heart attack was solved when he received a $20 blood test that is not routinely used by American medical providers. It checks for a common, inherited cholesterol disorder: elevated levels of a blood fat called lipoprotein(a) or Lp(a). We wonder if Lee has been checked for this dangerous disorder, which triples risk for heart attacks, according to three studies of nearly 45,000 people. Elevated Lp(a) also magnifies risk for having heart attacks or strokes at a young age.
Myth: If you had a heart problem, it would be detected during your annual physical.
Fact: Lee’s article reports that heart disease was never mentioned during any of his annual checkups, so he never worried about it. In a recent study of 3,501 young heart attack survivors ages 18 to 55, nearly all of the patients had a least one risk factor and 64% had three or more. Yet only half of the patients knew they were at risk before their event! Even fewer reported that their medical provider had ever discuss risk modification, such as lifestyle changes that might have prevented their heart attack!
While we don’t know what technique, if any, Lee’s doctor used to evaluate his heart health, practitioners of standard care typically use “risk calculators” to estimate how likely their patients are to develop heart disease. However, a number of studies have shown that these calculators can be dangerously unreliable. For example, a 2015 study of more than 5,000 adults published in Journal of the American College of Cardiology found that most initial cardiac events do not occur in people considered at “high risk” based on these scoring systems. Lee would appear to be a case in point, since he reports that he does not have high cholesterol, high blood pressure, diabetes or any family history of heart problems.
Unlike standard care, the BaleDoneen Method does not rely solely on risk factor analysis. Along with checking our patients for a wide range of red flags for cardiovascular risk, we also use advanced laboratory and imaging tests to directly check each patient for hidden signs of arterial disease, which often causes no symptoms until it becomes severe enough to trigger a heart attack or stroke.
Myth: Root canals are a leading cause of heart attacks.
Fact: A recent video on Netflix that references the BaleDoneen Method as the premier cardiovascular prevention program in the country misrepresents our teachings about oral health, specifically root canals. The video also asserts that root canal treatment is one of the top causes of heart attacks and claims, falsely, that we advocate removal of root-canal treated teeth. In reality, we take no position for or against root canals. However, our method does place a strong emphasis on oral-systemic wellness as a key component of heart attack and stroke prevention. In fact, your dental provider can be a potentially lifesaving member of your heart attack and stroke prevention team!
A recent BaleDoneen paper published in the peer-reviewed journal, Postgraduate Medicine, identifies oral bacteria from periodontal (gum) disease as a contributing — and potentially treatable — cause of heart disease. Ask your dental provider to check you for gum disease, a chronic oral infection that affects about half of adults over age 30. Also discuss the best ways to improve and protect your oral health. We advocate that cardiovascular prevention patients be tested for high-risk bacteria, using diagnostic tests that measure oral pathogens through DNA analysis, including OralDNA, OraVital and Hain Diagnostics. We also recommend that root canals be evaluated with 3D imaging to make sure that no hidden infection goes undiagnosed and untreated.
Myth: If heart disease runs in your family, there’s not much you can do to prevent heart attacks.
Fact: As discussed more fully in the BaleDoneen book, Beat the Heart Attack Gene, about 50% of Americans carry genes that raise their risk for heart attacks and strokes, such as 9P21, often called “the heart attack gene.” For more than a decade, our method has used genetic testing both to identify people at genetic risk for heart attacks and also to guide personalized treatments to prevent them, such as a diet based on your DNA. Our evidence-based, precision-medicine approach has been shown in two recent peer-reviewed studies to effectively detect, prevent, stabilize and even reverse arterial disease, helping our patients avoid heart attacks and strokes.
Moreover, a large body of research shows that an optimal lifestyle can dramatically reduce your risk for heart attacks, even if you carry high-risk genes. For example, a recent study of nearly 500,000 people with genetic risk for heart disease found that among participants at the highest genetic risk, those who got the most cardiovascular exercise (such as jogging, biking, running, brisk walking or other aerobic workouts), slashed their risk for heart disease by nearly 50%! Conversely, physical inactivity kills nearly 5.3 million people prematurely each year, another recent study found. Talk to your healthcare provider before starting a new exercise regimen to make sure it’s right for you. For more research-based fitness news, also check out our blog post, “What’s the Best Exercise to Reduce Your Waistline & Heart Attack Risk?”
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