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Heart DiseasePreventive MedicinePrimary Care

Our Strategy for Your Cardiovascular Protection

By September 27, 2010February 21st, 2020No Comments

A well-functioning heart and blood vessels are central to your overall health and longevity. Many major diseases, such as high blood pressure, high cholesterol, diabetes, and cigarette smoking have severe adverse effects on those organs. And normal aging produces slow but real damage to those vital organs.

What can your physicians do to help you preserve healthy cardiovascular function for as long as possible?

First, Dr. Isselbacher and I encourage each of you to pay serious attention to your self-care. This includes eating a generally healthy diet (heavy on vegetables and salads, lighter on carbs and meats), doing at least modest excercise, and staying away from obviously harmful habits such as smoking.

Second, we are assiduous about checking you for high blood pressure, cholesterol issues, and diabetic tendencies.

Blood pressure problems may arise simply because your parents or grandparents had that problem, but also can be promoted by overweight and too much salt intake. Hypertension is relatively easy to control with medication, but it is also critical that it be controlled. Your normal blood pressure should approximate 120-130/80-85. If it doesn’t, we offer you appropriate medications to get your pressure to healthy levels.

Cholesterol problems are heavily dietary, in this country, but may be genetic. Most people with high total cholesterol and “bad” cholesterol (LDL) have that abnormality based on their dietary intake, especially too much saturated fat from dairy and general animal sources. But medical life is complex, so some people have high LDL more from genetic reasons, despite reasonable diets. Eventually, you and your doctors decide whether you need a medication (especially statins, such as simvastatin, Lipitor, and Crestor) to regulate and reduce your LDL to healthy levels.

Diabetes is directly relevant, but even more complex. Diabetes arises from your parents and your genes, but also from your diet, weight, and perhaps other factors. If you are mildly diabetic, your cardiovascular risk is much higher at any given blood pressure and cholesterol level. So controlling what you can control, especially diet (but cutting back on unnecessary carbs especially) and weight, is vitally important. We work hard to educate each of you with this propensity.

Third, we test and apply rational medical technology for your benefit. Clearly we do the basics, such as check your blood pressure, your weight, your blood sugars (and long-acting blood sugars through the A1c test), and your cholesterol profile. We remeasure those results after appropriate interventions. In addition, we may ask you to get a stress test to evaluate the functional capability of the heart. We may suggest you get a cardiac calcium score, which comes from a chest CT scan to ascertain the amount of calcium deposited in the walls of the coronary arteries (a reasonable, but not fully proven, proxy for the amount of plaque in those critical arteries). We also may suggest an ultrasound of the carotid arteries, to look for the development of plaque in the vessels that provide the brain.

We certainly might suggest a consultation with a cardiac specialist if something about your data were uncertain or worrisome. And on occasion we suggest a patient get a more invasive test such as cardiac catheterization (but that is not so much a preventive evaluation as an intervention for high-risk patients).

To summarize, we are assiduous about doing our best to help prevent the development of cardiovascular disease. Your participation is vital. Eating a healthy diet, keeping your weight to a reasonably trim level, not smoking (easy for most everyone now), and enjoying at least a modest degree of exercise, all contribute to minimize your risk of developing important cardiovascular or cerebrovascular disease. Your doctors will supplement your own efforts by those diagnostic tests and therapeutic interventions mentioned above.

Finally, if you do your part to minimize cardiovascular risk, and we do ours, the results in recent years are dramatically better than before. We see far fewer heart attacks and strokes than even 15-20 years ago. People can live longer and healthier lives without impairment. It is worth your while to pay attention. Your doctors are completely attuned to preventive strategies for cardiovascular disease. And they really work.

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