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Written By Kevin Kerfoot / Reviewed By Ray Spotts
As chief of cardiovascular medicine and executive director of the Heart and Vascular Center at Wake Forest Baptist Medical Center, David Zhao, M.D., still brings a decidedly low-tech instrument a stethoscope with him when he sees patients. And he stresses that traditional qualities such as expertise and teamwork are essential in making the most effective use of what technology can provide. These days, having access to new technologies and treatments is essential to provide enhanced or improved care to the community, Zhao said. But skill, knowledge and experience, collaboration and technology together are the keys to better outcomes and better quality of life for patients.Zhao works with a team of more than 50 expert physicians and surgeons plus other specially trained professionals who employ the most advanced devices and methods available to prevent, diagnose, treat and manage the full spectrum of heart and vascular conditions. While fully immersed in a world of cardiac MRI scanning, miniature wireless pacemakers, left atrial appendage closures, ventricular assist devices and transcatheter aortic valve replacement surgery, their belief is that high-quality cardiovascular care isnt just about the latest medical products and procedures.
Technology, Expertise And Collaboration
Expertise and collaboration are especially important in cardiovascular care as most of the advanced treatments - especially those addressing structural heart conditions - require the participation of different specialists, including interventional cardiologists, electrophysiologists, heart surgeons, vascular surgeons and anesthesiologists. These are complex procedures that call for a lot of teamwork by people with varied skills and experience, Zhao said.
Thats especially true with the cardiac procedure of last resort, transplantation. Wake Forest Baptists heart transplant program is not one of the largest in terms of volume, performing 12 a year, but it has a 100 percent success rate and is one of only eight heart programs in the country to receive the highest score awarded by the Scientific Registry of Transplant Recipients, a national database of organ transplantation statistics.
Initiatives aimed at preventing heart and vascular problems need to involve collaboration across multiple disciplines, Zhao said. There are so many factors that can contribute to cardiovascular disease that dont specifically involve the heart. And a lot of those vary greatly from person to person, so you have to look at this from many perspectives.
Individualized Prevention And Prediction
Thats why the Heart and Vascular Center has teamed with Wake Forest Baptists Diabetes and Endocrinology Center and the Sticht Center for Healthy Aging and Alzheimer's Prevention to develop a program in cardiovascular, metabolic and brain health that will provide patients with individualized prevention and prediction models.
Weve joined together because the prevention part is shared by all three areas, Zhao said. What we do is collect and analyze a combination of information - genetics, blood tests, scans, body mass index, family history, lifestyle habits - and put it all in one package so we can say to the patient your risk of having a heart attack or developing diabetes in X number of years is X, and heres what you can do to reduce that risk by X percentage. It is very individualized.
There is a high-tech element to this type of personalized, or precision, medicine, and Zhao has no doubt that digital technologys role in health care will only become even more extensive over time. Computers can already do many of the things that we do better and more quickly, he said. The cell phone and other devices will be much more involved in your health than they are now, and they can and will be programmed with personalized information.
Regarding cardiovascular care, Zhao believes that advances in imaging technology will have the most significant impact. Our imaging capabilities have improved greatly over the years, from still pictures to moving pictures to 3-D images, but cardiac imaging is making the transition from illustrating anatomy to showing functionality what the heart looks like when its working, he said. This completely changes how we can use images to assess, guide and monitor treatments, and as the technology evolves it will revolutionize how we diagnose, treat and prevent diseases.
Spotting Cardiovascular Disease At An Earlier Stage
Screening methods for cardiovascular diseases such as heart attacks and strokes could be improved by measuring different biological signposts to those currently being tested, a study led by researchers from King's College London suggests. Published in theJournal of the American College of Cardiology, the study could allow doctors to better predict the development of cardiovascular disease at an earlier stage.
The research explored the role of a family of proteins called apolipoproteins. Currently, the main focus is on apolipoprotein A1 (apoA1), the main component of high-density lipoproteins (HDL) or good cholesterol, and apolipoprotein B (apoB), which is present on low-density lipoproteins (LDL) or bad cholesterol. For the first time, researchers have used a technology called mass spectrometry to measure an unprecedented number of apolipoproteins in a population-based study and discovered that another group of apolipoproteins might complement the signposts of good and bad cholesterol: apoE, apoC2 and apoC3.
These apolipoproteins are associated with very low-density lipoproteins (VLDL) and predominantly linked to another type of fat called triglycerides. ApoE, apoC2 and apoC3 have shown a stronger association with cardiovascular disease than apoA1 and apoB, suggesting that currently some of the most predictive apolipoproteins are not measured in patients who may be at risk of cardiovascular disease. The study identified apoC3 as a prime therapeutic target for lowering VLDL, which might reduce excess cardiovascular risk related to high VLDL.
The findings could lead to a change in the way patients all over the world are screened for cardiovascular disease. It could also pave the way for more personalized treatments. "We directly compared the association of a broad panel of apolipoproteins to new onset of cardiovascular disease over a 10-year observation period, and found that while apoB was predictive, other apolipoproteins, namely apoE, apoC2 and apoC3, were even better, says lead author of the study Professor Manuel Mayr from King's College London. "These unexpected strong associations of VLDL-associated apolipoproteins with cardiovascular disease provide support to expanding the current measurements of apolipoproteins and to the concept of targeting additional apolipoproteins to reduce risk."
Unhealthy Diets Linked To More Than 400,000 Cardiovascular Deaths
Eating a diet lacking in healthy foods and/or high in unhealthy foods was linked to more than 400,000 deaths from heart and blood vessel diseases in 2015, according to an analysis presented at the American Heart Association's Epidemiology and Prevention / Lifestyle and Cardiometabolic Health 2017 Scientific Sessions. Eating more heart-healthy foods, and less foods with high amounts of salt and trans fats, could save tens of thousands of lives in the United States each year.
"Low intake of healthy foods such as nuts, vegetables, whole grains and fruits combined with higher intake of unhealthy dietary components, such as salt and trans-fat, is a major contributor to deaths from cardiovascular disease in the United States," said Ashkan Afshin, M.D., M.P.H., M.Sc., Sc.D., lead study author and acting assistant professor of global health at the University of Washington's Institute for Health Metrics and Evaluation in Seattle. "Our results show that nearly half of cardiovascular disease deaths in the United States can be prevented by improving diet."
The new analysis was designed to pinpoint how diet impacts heart and blood vessel disease; it relied on 1990-2012 data from the National Health and Nutrition Examination Survey, food availability data from the Food and Agriculture Organization of the United Nations as well as other sources.
Looking at U.S. cardiovascular deaths in 2015, researchers found less-than-ideal dietary choices - both a lack of healthier foods and an excess of less healthy foods - played a role in the deaths of an estimated 222,100 men and 193,400 women. Researchers also evaluated the degree to which leading dietary risk factors were linked to cardiovascular disease deaths:
- low intake of nuts and seeds (11.6 percent);
- low intake of vegetables (11.5 percent);
- low intake of whole grains (10.4 percent); and
- excess salt (9 percent).
The team's systematic approach in quantifying how diet can contribute to heart disease deaths, and in defining the healthiest diet to prevent it, are the research's key strengths.
The Foods That Protect Against Cardiovascular Disease
According to the American Heart Association, heart disease is the leading global cause of death; 2,200 Americans die each day from heart disease. Wholesome nutrition is a major factor in combating plaque build-up in coronary arteries, which results in the most common type of heart disease - coronary artery disease. The AHA encourages limiting sugary drinks, sweets, fatty or processed meats, solid fats, and salty or highly processed foods to maintain a heart-healthy diet. The American Heart Association emphasizes the importance of eating a healthy dietary pattern that is rich in fruits, vegetables, nuts, beans, whole grains, low-fat dairy products, fish, poultry and limited in fatty or processed red meat. The association also suggests limiting sugary soft drinks, salt (sodium), saturated and trans fats.
The Centers for Disease Control and Prevention suggests that a poor diet among diabetes, obesity, physical inactivity and excessive alcohol use is one of the most influential lifestyle choices that put people at a higher risk for heart disease. Americans are advised by organizations such as the CDC and the AHA to consume more fruits and vegetables and less sodium and sugar.
Eating fresh fruits and vegetables cooked using a low-fat method are great for heart health, says Carleton Rivers, RDN, assistant professor in the Department of Nutrition Sciences in the University of Alabama at Birmingham School of Health Professions and program director of the UAB Dietetic Internship. Choose vegetables that have a rich color like dark leafy greens, sweet potatoes, squash, carrots and zucchini. Just be sure not to substitute fresh fruits with 100 percent fruit juice or dried fruit.
Fruit juice and dried fruit are high in sugar and may be more easily consumed in a greater amount than a whole piece of fruit. Fruit juices also lack the fiber needed to control blood sugar. Rivers says fiber and protein are important. Fiber is important for gastrointestinal motility, blood sugar control and lower low-density lipoprotein (LDL) cholesterol. Fiber is great for appetite control because it can fill you up and keep you feeling fuller for longer. Protein is needed to build and maintain muscles and can be found in a variety of sources such as lean meats cooked using a low-fat method, such as baking.
The AHA and CDC advise cooking meals at home to have a healthy, balanced diet, and Rivers agrees it may be easier to eat healthy when one cooks or prepares meals at home. Many restaurants add butter and salt to improve the taste of dishes, she said. This of course increases the calorie amount for a meal. Before going to a restaurant, look up the nutrition facts for the menu items you think you would want to eat, then make a decision based on which menu items are lower in calories, saturated fat, sodium and sugar.
As much as the AHA and the CDC encourage a heart-healthy diet, Rivers says a cheat day is okay every now and then to allow yourself to have a little bit of what you are craving to help prevent derailing from a diet all together. Your favorite piece of chocolate or guacamole and tortilla chips are what Rivers recommends as two heart-healthy treats to have on those cheat days.
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Written By:
With over 30 years of writing and editing experience, Kevin Kerfoot writes about health, nutrition, skin care and oral hygiene for Trusted Health Products’ natural health blog and newsletters.
Reviewed By:
Founder Ray Spotts has a passion for all things natural and has made a life study of nature as it relates to health and well-being. Ray became a forerunner bringing products to market that are extraordinarily effective and free from potentially harmful chemicals and additives. For this reason Ray formed Trusted Health Products, a company you can trust for clean, effective, and healthy products. Ray is an organic gardener, likes fishing, hiking, and teaching and mentoring people to start new businesses. You can get his book for free, “How To Succeed In Business Based On God’s Word,” at www.rayspotts.com.
