Healthy Lifestyles and Managing Heart Disease Risk

Physical therapists and other healthcare professionals can and should play a role in educating patients on the value of healthy behaviors.

Some heart disease risk factors are beyond patients' control. Healthcare professionals can help them mitigate the ones that aren't.

There is no shortage of scary heart disease statistics.

• It's the leading cause of death for men, women, and people of most racial and ethnic groups in the United States.
• One person dies every 34 seconds of heart disease.

• Heart disease is the cause for one out of every five deaths in the U.S. on an annual basis, and, overall, approximately 697,000 Americans die from heart disease each year.

Physical therapists and other healthcare professionals can and should play a role in educating patients on the value of healthy behaviors, as well as encouraging them to embrace these healthy habits.

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Identifying heart disease risk factors

Many factors can increase or decrease a patient's risk for heart disease. Heredity plays a significant role; for example, familial hypertrophic cardiomyopathy and familial hypercholesterolemia are commonly inherited conditions.

Lifestyle choices also impact a patient's level of risk, says Teri Dreher, RN, iRNPA, CCM, CEO, and owner of NShore Patient Advocates.

"The biggest risks for heart disease fall into the areas that you cannot do anything about (heredity) and those that you can do something about, such as diet, exercise, smoking and maintaining a generally healthy lifestyle."

Remaining too sedentary for too long, for example, takes a significant physical toll, says Dreher.

"Blood pools and gets sluggish, and it is more likely that fatty deposits will settle in coronary arteries that feed the heart muscle, eventually becoming plaque and narrowing the blood flow to the heart," she says.

"Once those arteries get narrowed enough - think of old, rusty pipes in a house - a clot or piece of the plaque may break off and block blood flow. Everything 'downstream' gets starved for fresh oxygenated blood and dies. The dead heart tissue will stop pumping and the heart will be weakened."

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Contributing factors

The Society for Cardiovascular Angiography and Interventions has outlined some of the biggest contributing factors to heart disease, including:

• Smoking causes blood vessels to constrict, increases blood pressure and cholesterol levels, deprives the body's tissues of oxygen, damages blood vessels' inner lining, enables plaque to grow inside of arteries and increases the likelihood of dangerous blood clots.
• High cholesterol. High levels of LDL cholesterol, or bad cholesterol, increase the build-up of plaque in the arteries and heart. But it's also unhealthy to have low levels of HDL, and the target LDL cholesterol level for individuals with coronary artery disease is 100 mg/dL or below. The target HDL cholesterol level is above 40 mg/dL for men and above 50 mg/dL for women.
• Blood pressure above 140/90 mmHg for long periods of time can damage the blood vessels, increasing the likelihood of cholesterol plaques forming, and causing the artery walls to become thicker and stiffer, and less able to expand and contract with changes in activity and physical demands.
• Being overweight or obese puts stress on one's heart and makes controlling high blood pressure more difficult. Overweight individuals are more likely to develop cardiovascular disease, and obese patients are at even greater risk.
• Physical inactivity weakens muscles and makes it tougher to control other heart disease risk factors, such as blood pressure, cholesterol levels, diabetes and obesity. A lack of physical activity also raises the difficulty of managing stress, which research has linked to a greater chance of developing heart disease.

Providing education and encouragement

Patients can't do much about their age, gender and family history. The risk of cardiovascular disease goes up with age. For example, just as men are more likely to develop cardiovascular disease than women. Around age 45, 10 out of every 1,000 men develop signs of heart disease. By age 55, the risk doubles, to roughly 21 out of every 1,000 men.

Likewise, an individual's risk nearly doubles if a parent or sibling developed heart disease relatively early in life (before age 55 for men and age 65 for women, according to SCAI).

Education and mitigation

What can healthcare professionals do to help their patients mitigate risks?

"We should encourage prudent diets, exercise, stress management and avoidance of tobacco products," says Michael Miyamoto, MD, a cardiologist at Mission Hospital in Mission Viejo, Calif. "For those with medical conditions, it is our job to manage these as effectively as possible. This takes a combination of healthy lifestyles and, where needed, medical therapy."

"While complete prevention of all atherosclerosis might be unrealistic, our goal is to aggressively minimize it. This means reducing actual disease events, such as heart attacks and strokes."

Education is indeed fundamental, either in the form of counseling or providing educational materials, adds Robert L. Quigley, MD, D.Phil, Senior Vice President and Regional Medical Director, Americas Region, International SOS Assistance, Inc.

"Patients can bolster their by regular physical exams with laboratory testing. This creates metrics for the patient to follow and take ownership of," says Quigley.

"It's all about the patient having the information to take control of their own life. Heart health and heart disease prevention are a lifelong journey that includes changing one's lifestyle and behavior," says Quigley. "While patients can't change their genetics, they can adjust their lifestyle and diet."