Heart Disease and Stroke Prevention: Here's How

Coauthored by Bowen Jiang and and Anand Veeravagu, M.D.

This Valentine's Day, show your loved ones how much you care by focusing on matters of the heart! In addition to greeting cards, flowers and chocolates, let's spend some time educating our loved ones about how to prevent heart disease and stroke. In doing so, we may just give them the best gift of all -- a longer and healthier life.

Heart disease has been the leading cause of death in the U.S. since the 1920's. Stroke, a condition caused by a sudden shortage of oxygen and nutrient delivery to the brain, ranks third. In 2010, heart disease and stroke claimed the lives of more than 750,000 Americans. Those who survive acute attacks of these diseases can experience significant complications; stroke, for instance, also ranks first as the leading cause of long-term disability among American adults. Moreover, heart disease, once considered only a man's illness, is in fact the leading cause of death among women. According to the Women's Heart Foundation, when adjusted for age and other factors, the mortality risk from cardiovascular illness is 1.7 times higher in women as compared to men.

Thanks to biomedical research and public health advances, the death rates from heart disease and stroke have been reduced by 60 percent since the 1950's. Medications for high blood pressure and cholesterol have played a significant role in lowering these rates, as has the decline in tobacco use. The Centers for Disease Control and Prevention (CDC) hails the reduction in mortality from heart disease and stroke as one of the most significant public health achievements of the 20th century. Yet, even today, more people still die from these two diseases annually in the U.S. than from cancer, Alzheimer's, diabetes and kidney disease combined. Furthermore, stroke incidence is rising dramatically among young and middle-aged Americans while declining in older people. This alarming shift in the age burden of disease may be linked to the obesity epidemic in the U.S., which is a major risk factor for stroke. A recent study presented at the American Stroke Association conference reported a 51 percent increase in strokes among men 15 through 34 years old, and a 17 percent increase among women in this age group.

These disturbing statistics are all the more tragic since both heart disease and stroke are largely preventable. In fact, according to the National Stroke Association, 80 precent of heart disease and stroke can be prevented by simply lowering the risk factors for these diseases. The following are some important risk factors that, when addressed successfully, will reduce the risk of developing heart disease or experiencing a stroke:

Smoking is the leading cause of preventable death in America. Each cigarette contains 2,000 to 4,000 noxious chemicals that cause direct damage to blood vessels, decrease the amount of oxygen delivered to the heart, and increase the risk of developing deadly blood clots. Create a plan to quit smoking and use supportive resources for encouragement! There are medications that can help, too. Not smoking is one of the very best things you can do to ensure a healthier future.

People with excess body fat, particularly around the waist, are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases blood pressure, raises cholesterol and triglycerides in the blood and lowers HDL levels (good cholesterol). Being overweight or obese also increases the chances of developing diabetes. Although losing weight may be difficult, remember that even a five to 10 pound weight loss could significantly reduce your risk of heart disease and stroke.

Lack of Physical Activity
An inactive lifestyle may predispose you to coronary artery disease, the type of heart disease that can progress to deadly heart attacks and strokes. Regular, aerobic exercises not only burn fat, but also release natural chemicals such as endorphins and vasodilators that maintain healthy blood vessels. Find physical activities that you enjoy and plan to exercise at least five times a week for 30 minutes a day.

High blood pressure
High blood pressure causes the heart to work harder to pump blood, placing strain on the organ. The high pressure flow directly damages blood vessels, making them more vulnerable to plaque formation. Steps that can be taken to reduce hypertension include limiting sodium intake, monitoring blood pressure regularly, engaging in physical activity and talking with your doctor about the need for medications.

In diabetes, the body either doesn't make enough insulin or becomes less sensitive to insulin, leaving too much sugar in the blood. The excess sugar can build up in blood vessels and damage peripheral nerves. Successful control of blood sugar through diet, exercise and for some, with medications, reduces the risk for heart disease and stroke.

Elevated Cholesterol
Too much cholesterol in the blood can lead to atherosclerosis, or the build-up of thick, fatty plaques that clog up arteries. Plaques that completely occlude a coronary artery can lead to a heart attack. Likewise, pieces of the plaque can break off and travel to the brain, causing a stroke. To reduce this risk factor, eat foods that are low in saturated fats and cholesterol, exercise regularly, and maintain a healthy weight and BMI. (Click here to calculate yours.)

Another important step in prevention is to consult your doctor about taking aspirin. The U.S. Preventive Services Task Force recommends that men ages 45 to 79 take a daily aspirin to prevent heart attacks and women ages 55 to 79 use aspirin to reduce the risk of ischemic strokes. The latest results from the Nurses' Health Study, a 30-year-long examintion of nearly 80,000 women, suggests that women who regularly take low- to moderate-dose aspirin are 25 percent less likely to die of any cause, 38 percent less likely to die of heart disease or stroke and 28 percent less likely to die of colon cancer compared with women who do not regularly take aspirin.

Early Detection
While reducing these risk factors is crucial to prevention, it is also important to seek medical care if you experience the signs and symptoms of a heart attack or stroke. A heart attack can be sudden and intense, but in most cases can start rather slowly, with mild discomfort. Women may have a different symptom presentation than men with more fatigue and indigestion.

Seek immediate medical care if you or someone you know is experiencing these symptoms:

Chest discomfort: The discomfort could be pressure, squeezing, fullness, or a crushing pain. Usually lasts more than a few minutes.

Discomfort in other parts of the body: Symptoms include pain or discomfort in the arms, back, jaw or stomach.

Shortness of breath often accompanies chest discomfort, but doesn't have to be present.

Other symptoms include a cold sweat, nausea, severe indigestion, sense of impending doom and light-headedness.

For stroke, a useful acronym to remember is "FAST."

Face: Ask the person to smile. Does the face droop?

Arms: Ask the person to raise both arms. Does one arm drift downwards?

Speech: Ask the person to repeat simple phrases. Is the speech slurred or disjointed?

Time: If you or your loved one experiences these symptoms, call 911 immediately.

Other warning signs of stroke may include sudden numbness or weakness on one side of the body, confusion, trouble walking, severe headache or difficulty seeing in one or both eyes.

Timing is everything in heart attacks and stroke, as early detection of symptoms determines the type and degree of treatments. For instance, the clot busting drug tPA will only be effective within three hours of having a stroke. Not surprisingly, studies reveal that patients who receive tPA live longer and have fewer long-term disabilities than those who did not receive this medication. One of the most cost-effective and life-saving measures in modern medicine is the role of aspirin during a heart attack. According to the American Medical Association, if you suspect you are having a heart attack, chewing one adult, non-buffered aspirin immediately may reduce mortality by 20 percent. However, if you or someone you know is experiencing a stroke, do not take or administer aspirin. This is because not all strokes are caused by blood clots and an intracerebral hemorrhage may also present with stroke-like symptoms. It is thus imperative that your physician be consulted to determine what is right for you, both in terms of prevention as well as in an emergency.  

New scientific advances in the treatment of heart disease and stroke have reduced mortality while also improving quality of life. Preventive measures including dietary changes and physical activity, along with medications that lower blood pressure and cholesterol, have reduced the risk factors for heart disease in many people. Others who have severe heart disease can now be treated using endovascular techniques, where stents are placed into the coronary arteries through a catheter instead of with open heart surgery. In the acute treatment of stroke, clot busters can be administered directly to the site of blockage or systematically, thereby improving outcomes. Today, neurosurgeons can remove some clots using a corkscrew shaped retrieval system, thus restoring blood flow to the brain instantaneously.

Looking to the future, increased investments are needed in basic science and clinical research to advance the prevention and treatment of these deadly diseases. Another important step forward is to be a savvy health consumer -- to learn about how to prevent these conditions by reducing risk factors, entering into a partnership with your physician to promote better health and to know the warning signs so that immediate action is taken if symptoms should occur.

Together, let's make the elimination of heart disease and stroke one of the most significant public health victories of the 21st century!

For more information, please visit:
National Stroke Association
American Heart Association
Mayo Clinic

Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington Post. She is the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, Chair of the Global Health Program at the Meridian International Center, and Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four Presidents, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. She is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association and was recently named a 2010 Rock Star of Science.

Bowen Jiang, a Soros Fellow, is a second-year medical student at Stanford University School of Medicine. He served as a Health Policy Fellow at the Center for the Study of the Presidency and Congress in Washington, D.C.

Anand Veeravagu, M.D. is a resident in neurological surgery at Stanford University Medical Center and a fellow of the National Institutes of Health. He specializes in cerebrovascular surgery and has developed molecular therapeutics for malignant brain tumors.