Healthy heart message remains the same; how it’s delivered may need to change

Phyllis Jackson will not tell anyone to throw out their saltshaker, seeing as she is loath to give up hers.

She also will not demand that anyone get on a treadmill, considering that when it comes to exercise it is as though she is allergic to walking in place.

What she will suggest is cutting down on cold cuts, hot dogs and salty snacks. As for physical activity, she’s a fan of turning up the music as she cleans the house.

Aside from a recent recommendation from the American Heart Association that Americans get more sleep – seven to nine hours a night – and research into gender differences in cardiovascular health, the basic advice on heart health has not changed: Eat less fat and salt and eat more fruits, vegetables, and be more active.

“People get into patterns and patterns are hard to change,” said Jackson, a registered nurse and Community Wellness Project Manager at Common Ground Health.

How the message is delivered may be what needs to change.

“I think what we can do is just continue to say it and say it differently,” said Dr. Amole Ojo, an electrophysiologist with UR Medicine Cardiac Care.

“Just try to be more specific. Instead of ‘just lose weight,’ discuss with people how they can go about that.”

To be sure, many people have listened.

Deaths from cardiovascular disease have declined in the past decade, from an age-adjusted rate of 257 per 100,000 in 2000 to the age-adjusted 163 per 100,000 in 2018. The rate is far lower than the age-adjusted 588 per 100,000 in 1950.

Yet cardiology waiting rooms provide evidence that some people have yet to catch on.

Every 34 seconds, one person in the U.S. dies from cardiovascular disease, according to the Centers for Disease Control and Prevention. Heart disease remains – as it was in 1950 — the leading cause of death for men and women in most racial and ethnic groups. In 2020, one in every five deaths was from heart disease, which includes coronary artery disease and heart attack.

“We see a lot of people who don’t make those lifestyle changes,” Ojo said. “Some people may not listen until there’s a crisis. The heart attack is a wake-up call.”

Even though someone like Dr. Ojo can work on the immediate problem, the solution may not be a permanent fix. “Most of the time (the heart) doesn’t go back 100 percent to the way it was before.”

Cardiologists urge adults to know their blood pressure and their cholesterol — two key indicators of heart health and potential warning signs. They also encourage learning one’s family history to identify risk of heart disease or other conditions that can affect the heart.

Diabetes, obesity, inactivity and excessive alcohol use are risk factors for heart diseases for both sexes. But research in the past few years is showing gender differences in not just how heart disease presents in women, but also risk factors that may be particular to females.

“I always felt there was a difference,” said Dr. Uzma Iqbal, attending cardiologist and director for the women’s heart health and cardio-oncology programs at Rochester Regional Health. “But we always treated men and women kind of the same. It didn’t scientifically make sense to me because we have different hormones.”

Iqbal said women who have pregnancy-related issues such as high blood pressure, pre-eclampsia, gestational diabetes or who deliver pre-term babies may be at higher risk of cardiovascular disease in later years.

“It was initially thought that this was just during pregnancy and that was it; so they need to be aware and be monitoring their blood pressure and blood sugar because they’re more likely to develop those risk factors.”

Iqbal said these women may have gotten lost to follow-up and that efforts are underway to make ob/gyns aware of the long-term effects of these pregnancy complications.

Iqbal said the symptoms of heart disease also can be different in women. While some may feel the proverbial elephant sitting on their chest, others may get a tingling sensation or be short of breath or feel tired. Women who have heart disease may feel pain in their back.

“I’m more conscious of when a woman tells me, ‘Each time I am going up this flight of stairs, I get back pain,’’’ she said.

Iqbal said inflammation is believed to play a role in heart disease. Inflammation also plays a role in autoimmune diseases such as rheumatoid arthritis and lupus, which affect women more than men. Women who’ve undergone left-sided radiation for breast cancer also may have higher risk than the general population and should share this health history with their providers.

A treadmill stress test or coronary calcium score can give objective measures of heart disease risk.

The exercise test indicates the heart’s capacity to handle exertion. The coronary calcium score shows the amount of calcification in arteries of the heart.

“Someone who’s in their 30s should not have any calcium,” said Dr. Jonathan Rodriguez, cardiologist with Geneva General Cardiology Associates, part of Finger Lakes Health. “We have the data for different groups of people and can compare them to their peers and tell them, ‘You’re in the 50^th percentile and average for your age,’ or ‘You’re in the 95^th percentile and you have a lot of calcium for someone your age.’ Then we recommend there are things those people do or they get referred.”

Rodriguez said the tests are done when lifestyle or hereditary risks factors have been identified, but some people want reassurance.

“A lot of people come because they have friends who have had heart attacks and are concerned and kind of just want a more gets vigorous assessment what their risk might be.”

He said such tests should be reserved for people with known risk factors or for whom lifestyle changes have not worked.

But lifestyle changes don’t have to be drastic to have an effect.

Rodriguez said they can be as simple as cutting down on caffeine which, in excess, can contribute to arrhythmia, or trying recipes based on the Mediterranean or DASH diets, which focus on fresh or frozen foods and don’t eliminate entire food groups.

When Jackson conducts health screenings throughout the community, she coaches participants on adjustments to their eating and activity rather than dictate sweeping changes.

“I understand where they are and what little things are they willing to do,” she said. “You’ve got to keep remind them that you can’t do it overnight.

“I make it very personal,” she said.

When it comes to food, she tells how she managed to keep ramen noodles in her eating plan. “I love them. But I learned to make a casserole of ramen noodles and I substitute out what they use in the packet that comes with it with my own seasoning.”

The great-grandmother tells people she wants be involved in those children’s lives. “I do these things because of them. That really motivates me to do better. So you remind them of what’s important to them … and that they can do little things to help them be healthier for others as well as themselves.”

Patti Singer is a freelance writer in Rochester. Contact her at [email protected].