Dr. Sekar Kathiresan, Medical Director of the Cardiovascular Disease Prevention Center at Massachusetts General Hospital, discusses the risks for coronary artery disease and how a healthy lifestyle can mitigate some factors.
Coronary artery disease is a narrowing of the heart arteries. This narrowing happens because of cholesterol buildup that happens over several decades. The cholesterol buildup and the narrowing leads to sluggish blood flow to the heart.
As a result, you can develop symptoms like chest pain, shortness of breath, fatigue, pain in the neck, or pain in the back or jaw. Coronary artery disease puts you at risk for heart attack and for stroke.
Coronary artery disease is the leading cause of death in the United States among both men and women. Those who are particularly at high risk or those with a family history of heart disease, that is, if you have a father who has had a heart disease prior to the age of 55 or a mother prior to the age of 65, you yourself are about two-fold increased risk. But you can counteract this genetic risk by focusing on lifestyle factors like cholesterol, blood pressure, maintaining a healthy weight.
In addition, people that have multiple risk factors together like blood pressure, low amount of the good cholesterol or overweight, are particularly at higher risk for heart disease. So this clustering of risk factors puts people at increased risk. In addition, a factor like type-2 diabetes also puts people at increased risk.
There are four major ways to diagnose coronary artery disease – first is an EKG or Electrocardiogram. This records the electrical activity of the heart and can tell if a patient has had a heart attack. A second major way is called an exercise treadmill test and here, the patient exercises on a treadmill. This puts a stress on the heart and we can tell that there’s sufficient blood supply to the heart muscle because of this test.
A third major way is a CAT scan of the heart. With a CAT scan now-a-days you can directly look at the heart arteries and see if there are blockages. The last way is an invasive procedure called a coronary angiogram where dye is injected into the heart arteries and x-ray pictures are taken to see if there are blockages. Each of these procedures has its own strengths.
We at Mass General are focused on using the right procedure to diagnose coronary artery disease for the right patient. There are three major treatment options for coronary artery disease; first is lifestyle modifications. This includes eating better, maintaining a healthy weight, and regular physical activity.
A second major option is medications. These medications include statins to lower the cholesterol, and Aspirin to reduce your risk of a heart attack.
A third major option are procedures to relieve the blockage that may already exist and these procedures include coronary angiogram, an angioplasty and stent placement to relieve blockages, or bypass surgery to bypass the blockages. Early diagnosis and treatment is critical.
Among the reasons people may come to the Mass General Heart Center for their preventive cardiac care is a combination of both research and clinical care. On the research front, we are working actively to discover the genetic causes of both abnormal cholesterol levels and risk for heart attack. We have made many such discoveries in the last few years and these discoveries are improving our ability to diagnose patients at an earlier time point and, in the future, should lead to new medicines that reduce the risk of heart disease.
In the clinic arena, our heart attack prevention program focuses on both primary prevention and secondary prevention. By primary prevention we mean preventing a first heart attack. For example, patients with a family history of heart disease can be seen in our center where there’s a risk evaluation for the risk of heart disease, and then we make a set of recommendations to try to reduce that risk.
In terms of secondary prevention, we focus on patients who have already have one problem – one heart problem, and trying to reduce the risk of a second event. Specifically, the Cardiac Rehabilitation Program takes in patients who have already had a heart attack or bypass surgery and we work with them over a three-month time period to try to counteract their risk factors and reduce their risk.
About Dr. Sekar Kathiresan, M.D.:
Dr. Sekar Kathiresan graduated from North Allegheny High School in Pittsburgh, PA and received his B.A. in history summa cum laude from the University of Pennsylvania in 1992. He received his M.D. from Harvard Medical School in 1997. He completed his clinical training in internal medicine and cardiology at Massachusetts General Hospital.