New do’s and don’ts about heart disease

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Having once been told I’m at very high risk for a heart attack, I’m no fool when it comes to cardiovascular disease. I read studies. I submit to bloodwork at least twice a year. I take my meds and have changed my diet. I see my cardiologist annually.

I also write about health, so I often look at cardiovascular disease from a less personal, more objective view. Still, I recently discovered while attending a symposium featuring dozens of the national top cardiologists that there’s much I didn’t know about heart disease – or realized my information was outdated.

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Here are some key points.

Don’t take low-dose aspirin if you haven’t had a heart attack. For years, doctors urged healthy older people to take 81 milligrams of aspirin daily, which studies had concluded would help prevent a first heart attack. “That thinking has changed recently,” said Carl Orringer, director of the Preventive Cardiovascular Medicine Program at the University of Miami Health System. Three large trials have showed either “mild or no cardiovascular risk reduction but a higher risk for gastrointestinal bleeding that counterbalanced any benefits.” On the other hand, if you’ve already had a heart attack or stroke, Orringer recommends a daily low-dose aspirin to prevent a recurrence. (Bernie Sanders, call your doctor!)

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Don’t waste your money on fish oil. I’ve got 200 capsules of fish oil in my medicine cabinet right now. According to a recent meta-analysis of many studies, over-the-counter (OTC) fish oil “failed to show clear evidence of cardiovascular risk reduction,” Orringer told me. Part of the problem is that OTC formulas don’t contain standardized amounts of the omega-3 fatty acids thought to reduce risk. A study published in the New England Journal of Medicine last year showed that a prescription form of omega-3, icosapent ethyl (brand name Vascepa), produced “highly significant additional risk reduction” for those with cardiovascular disease, diabetes or additional risk factors, Orringer says. The Food and Drug Administration recently approved icosapent ethyl/Vascepa for certain at-risk patients. Ask your doctor whether this is a good option for you.

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Make sure your blood pressure is taken correctly. At my last annual physical, the nurse took my blood pressure while chatting with me and as I sat with my legs dangling off the exam table. Wrong and wrong, according to guidelines revised in 2017. Among the rules: Feet flat on the floor, legs uncrossed. No talking for at least five minutes beforehand; no coffee, smoking or exercise for at least 30 minutes. Cuff on bare skin, not over clothes, with your arm at heart level and not lower. If your provider doesn’t follow these procedures, ask them – nicely – to try again in accordance with the new guidelines.

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Beware daylight saving time. I had no clue there was a possible relationship between the beginning of daylight saving time (this year on March 8) and heart attack risk. Virend Somers, a Mayo Clinic cardiologist, says “the loss of an hour seems to be associated with a higher risk of heart attack, especially on the Monday after.” What to do? Get an extra hour of sleep if you can on the night the clocks move ahead, which Somers says “may theoretically help mitigate this issue.”

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Younger women need to be aware of their risk. Counterintuitively, younger women are more likely to die of a heart attack than anyone else – right after the attack and up to one year.

American Heart Association statistics show that 26 percent of women will die within a year of a heart attack compared with 19 percent of men. Five years after a heart attack, almost half of women die, develop heart failure or have a stroke compared with 36 percent of men.

Martha Gulati, chief of cardiology at the University of Arizona College of Medicine, told me that younger (under 55) women “either don’t survive their heart attack or they don’t live long after” it for several reasons.

She explained they are less aggressively treated, with doctors less likely to recommend follow-ups or refer them to cardiac rehab. These women are more likely to be rehospitalized after a heart attack than any other group, but particularly their “same-aged male peers.” Gulati told me this is because “the medical community [has] ignored women’s hearts and we have not educated all physicians about their risk.” Reforms, she says, need to start in medical school, because “closing these gaps can save lives.”

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Get familiar with CPR, and don’t be squeamish about doing it. Women who experience cardiac arrest, when the heart abruptly stops are also less likely to survive these events than men. (About 80 percent of men will die vs. 92 percent of women when cardiac arrest occurs outside of a hospital.)

Bystanders are less likely to perform CPR on women, Gulati says, because “men are worried about touching a woman, unsure how to do CPR on a woman, or they think they will be sued if they touch or expose a woman.” They’re also afraid of hurting a woman, although Gulati emphasized that CPR requires sharp pressure and “if you don’t break ribs doing CPR, you probably aren’t doing it right.” Most injuries aren’t serious and heal relatively quickly, Gulati said; considering the alternative, this is by far the better outcome. Gulati wants to see CPR trainings take place on “woman-equins” not just mannequins: “We aren’t teaching it right if we don’t have some semblance to reality.”

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Make sure your gynecologist examines all of you, including your heart. Most gynecologists take what’s called “the bikini approach,” focusing on the breast and reproductive system, while practically ignoring the rest of the woman as part of women’s health, says Nanette Wenger, professor of cardiology at Emory University School of Medicine and one of the first doctors to focus on women and heart disease.

Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai Medical Center, says those annual exams should include preventive heart screening as well. That includes a personal and family history of heart disease, stroke, hypertension, diabetes and high cholesterol; bloodwork to measure triglycerides, cholesterol and sugar levels; and lifestyle interventions (including diet, exercise and tobacco habits). She worries that gynecologists have “implicit bias from outdated teaching that women are ‘protected’ from heart disease until elderly.”

Bairey Merz says studies suggest that women who are treated by female gynecologists tend to “have better outcomes including heart disease compared to male physicians.” But she’s quick to add that male doctors who work with female colleagues also had better patient outcomes when it comes to heart attacks, “suggesting it is not the sex of the physician, but the knowledge and attitude that can be learned.”

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New mothers need to recognize there can be a heart connection to postpartum deaths. While bleeding and infection account for the lion’s share of post-pregnancy deaths, 40 percent of those deaths have a cardio connection: general cardiovascular conditions, embolism, cardiomyopathy and preeclampsia/eclampsia. Nandita Scott, co-director of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital, says “more women are entering their pregnancy less healthy due to a rise in obesity and cardiovascular risk factors at younger age.” There are other risks, of course (more frequent multiples, increasing maternal age, more Caesarean sections), but the heart is key.

“We can reduce the maternal mortality by increasing awareness among patients and providers that this is an at-risk situation,” Scott says.

Of course, many tried-and-true cardiac health recommendations have not changed: Get enough exercise and sleep, keep your weight under control, and eat well, generally meaning lots of vegetables and healthy oils while avoiding red meat and ultra-processed foods.

The bottom line is that it’s important to stay informed and pro-active, as recommendations about health can change over time.