Heart
Some Statistics on the #1 Killer of Americans - Cardiovascular Disease
Cardiovascular disease is a class of disease that involves the heart and blood vessels. It is the leading cause of death for both men and women in the U.S.
According to the American Heart Association there are 83.6 million American adults who have 1 or more types of cardiovascular disease (CVD), which boils down to 1 in 3 adults.
Let’s try to relate those numbers to this room for now.
Look around the room. Look down your row. You can count off by 3s and hope you don’t get the unlucky number “3”. Let’s say the “1s” and “2s” are those without any cardiovascular disease, but the “3s” do have one or more types of the disease. In the U.S. adult population, out of approximately 100 “3s” (who don’t reverse their disease) one of them will die this year.
That sounds like your odds are pretty good – unless you happen to be number 100.
Over 787 million Americans die of a coronary event each year – or one every 40 seconds.
According to the National Center for Health Statistics, if all forms of major CVD were eliminated, life expectancy could rise by almost 7 years.
Cardiovascular disease includes a number of conditions affecting the structures or function of the heart. They can include:
• High Blood Pressure (HBP)
• Coronary artery disease (hardening or narrowing of the arteries) (CAD) atherosclerosis atherosclerosis
• Coronary Heart Disease (CHD)
• Chest Pain (Angina)
• Heart attack
• Abnormal heart rhythms or arrythmias
• Heart failure or Congestive Heart Failure
• Heart valve disease
• Congenital heart disease
• Heart muscle disease (cardiomyopathy)
• Pericardial disease
• Aorta disease and Marfan syndrome
• Vascular disease (blood vessel disease)
• Abnormal heart rhythms or arrythmias
• Heart valve disease
• Heart muscle disease (cardiomyopathy)
• Pericardial disease
• Aorta disease and Marfan syndrome
There are six cardiovascular diseases that are included in the 83.6 million Americans with one or more of them. The seventh category, congenital defects, is not included in these statistics.
The first CVD is something that might surprise you:
1. High Blood Pressure (HBP)– If your blood pressure is greater than 140/90 without medication you fall into this category. If a health care professional has told you at least twice that your blood pressure is high or if you are taking blood pressure medicine (antihypertensive medication), you also fall into this category. 33% of adults over 20 have HBP. (77.9 million)
The next CVD is:
2. Coronary Heart Disease (CHD) – This is a narrowing of the small blood vessels that supply blood and oxygen to the heart. It is also called Coronary Artery Disease. Coronary artery disease (CAD) is atherosclerosis, or hardening, of the arteries that provide vital oxygen and nutrients to the heart. (15.4 million American adults have CHD)
The third CVD is:
3. Actually having a heart attack (Myocardial Infarction (MI) – (7.6 million Americans have had a heart attack.)
Next is:
4. Chest pain (Angina Pectoris or Angina (AP) – (7.8 million American adults have had some form of chest pain.)
The 5th CVD is:
5. Heart Failure (HF) also called Congestive Heart Failure (CHF) – This is a serious medical condition in which the heart cannot pump enough blood to meet the body’s needs. The inability may result in fluid retention, which causes swelling, for example, in the legs, feet, or abdomen. (5.8 million Americans have CHF)
The 6th form of CVD is usually thought of in a different category, but it involves the blood vessels to the brain.
6. Stroke (all types) – Happens when the blood flow to the brain stops. (6.8 million American adults have had a stroke.)
The category called Congenital Cardiovascular Defects is not included in the 83.6 million who have CVD. These are defects in the structure of the heart and great vessels that is present at birth. (1 million) It affects about eight out of every 1,000 children. Congenital heart defects may produce symptoms at birth, during childhood, and sometimes not until adulthood. In most cases scientists don't know why they occur. Heredity may play a role, as well as exposure to the fetus during pregnancy to certain viral infections, alcohol, or drugs.
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Atrial Fibrillation - An Abnormal Heart Rhythm
What Is AF?
Atrial fibrillation (AF) is the most common heart arrhythmia in Western countries and occurs mostly in the elderly. AF produces a rapid and irregular heartbeat, during which the atria (the upper two chambers of the heart that receive blood) quiver, or fibrillate, instead of beating normally.
Because the rapid and irregular heartbeat produced by AF cannot pump blood out of the heart efficiently, blood tends to pool in the heart chambers. This increases the risk of blood clot formation inside the heart, which can then travel from the heart into the bloodstream. If the clot becomes lodged in an artery, it can cause a pulmonary embolism (a sudden blockage of a lung artery) or a stroke.
The mean age for AF diagnosis in men was 66.8 years versus 74.6 years for women. Data from a California health plan suggest that compared with whites, blacks, Asians and Hispanics have significantly lower prevalences of AF.
Risk Factors
Diet
A pacemaker catheter that has been passed through the vein in the groin
Obesity
Bedrest
Family history (having at least one parent with AF)
Fractures in the pelvis or legs
Giving birth within the last 6 months
Recent surgery (most commonly hip, knee, or female pelvic surgery)
Advancing age
European ancestry
Body size (greater height and BMI)
Left ventricular hypertrophy
Left atrial enlargement
Diabetes
Hypertension (high blood pressure) or treatment of hypertension
Presence of CVD (cardiovascular disease)
Hyperthyroidism
CKD (chronic kidney disease)
Heavy alcohol consumption
Data has suggested that moderate-intensity exercise (such as regular walking) was associated with a lower risk of AF. However, data from many studies suggested that vigorous-intensity exercise 5 to 7 days a week was associated with a slightly increased risk of AF.
A study of over 4600 patients diagnosed with AF showed that risk of death within the first 4 months after the AF diagnosis was high. AF is also associated with mortality in individuals with other cardiovascular conditions and procedures, including HF (heart failure), MI (heart attack), CABG (Coronary Artery Bypass Graft Surgery ), noncardiac surgery, stroke and sepsis (a life-threatening illness that can occur when the whole body reacts to an infection).
When standard stroke risk factors were accounted for, AF was associated with a 4- to 5-fold increased risk of ischemic stroke. Individuals with AF have an adjusted 2-fold increased risk of dementia. AF and HF (heart failure) share many risk factors and 40% of individuals with either AF or HF will develop the other condition.
Symptoms
Atrial fibrillation often causes no symptoms at all. When symptoms do occur, there may be palpitations (awareness of a rapid heartbeat), fainting, dizziness, weakness, shortness of breath and angina pectoris (chest pain caused by a reduced blood supply to the heart muscle. Some individuals with atrial fibrillation have periods of completely normal heartbeats.
Standard Treatments
Initial treatment focuses on finding and treating the underlying cause of atrial fibrillation. The majority of cases are caused by coronary artery disease and treatment may consist of lifestyle changes, medications that treat high blood cholesterol and hypertension and/or procedures such as angioplasty and coronary artery bypass surgery.
Atrial fibrillation due to thyrotoxicosis (an overactive thyroid gland) can be treated with medications or surgery, while fibrillation due to rheumatic heart disease may be treated by replacing damaged heart valves.
The arrhythmia (irregular heart rate) of atrial fibrillation can be treated with medications, such as diltiazem hydrochloride, digoxin or verapamil, which work to slow the heart rate. Another treatment option is electrical cardioversion, a procedure that delivers an electrical “shock” to the heart to restore normal heart rhythm. Although this procedure is effective in most cases, the rate of recurrence is high, and 50 to 75 percent of patients eventually develop atrial fibrillation again.
When medications are ineffective, catheter radiofrequency ablation or minimally invasive surgical ablation can sometimes be performed. In these procedures, an area of tissue in the atrioventricular node is destroyed to prevent the passage of excess electrical impulses from the atria to the ventricles. The result is often complete blockage of all electrical impulses. A pacemaker is then implanted to control the heart rate and rhythm.
In addition to the treatments described above, individuals with atrial fibrillation are often given medications to prevent blood clots that can lead to stroke, pulmonary embolism and other complications. Treatment usually consists of anticoagulant medications (blood thinners), such as aspirin and warfarin.
Conservative Treatments
According to many studies, the underlying cause of most cases of atrial fibrillation is closure of the small arteries to the heart muscle, due to the Western diet and lifestyle.
There are many controversies surrounding the proper treatment of people with atrial fibrillation. Digoxin is an inexpensive, highly effective, relatively safe, time-honored, generic medication. With the introduction of expensive beta-blockers and calcium antagonists over the past four decades, doctors were told digoxin was inferior for the treatment of atrial fibrillation. But, based on the research, digoxin is the drug of choice for this common condition.
When the heart rate is already normal or slow, there is no need for any medication to regulate the heart rate. In most cases, when rate control is needed, digoxin is prescribed first to slow the heartbeat. If this medication alone is inadequate, then a beta-blocker medication can be added. Calcium channel blockers are more dangerous and are not used in this method of treatment.
Conservative treatment does not usually recommend “cardioversion” with drugs or electric shocks to the heart because research shows this aggressive approach gives results that, at best, temporarily restore normal (sinus) rhythm, and there are significant risks and side effects from cardioversion. The vast majority of the published research papers recommend medications to control the heart rate, rather than cardioversion.
Because people with atrial fibrillation also have an increased risk of forming a blood clot in their heart, which can move to their brain and cause a stroke, the powerful blood thinner, Coumadin (warfarin) is prescribed. The most important complication of this treatment is bleeding; therefore, people with atrial fibrillation who are otherwise healthy, should not routinely be given Coumadin; for many, a baby aspirin daily may be a better choice.
In addition to the judicious use of medications, a healthy low-fat plant-based diet is prescribed for someone with this condition in order to improve the overall health and reduce the risk for strokes and heart attacks. In most cases, once the rhythm of atrial fibrillation occurs it is permanent and a change in diet will not convert atrial fibrillation to normal; it will only lower the risk of further heart damage or stroke.
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CVD, Inflammation and Periodontal Disease
What is the link between periodontal disease and heart disease? Medical doctors, research scientists, and dentists all realize that this is an important topic.
What is periodontal (gum) disease?
Periodontal disease is an infection of the gums and bone that surround and support the teeth. In its early stage, called gingivitis, the gums can become swollen and red, and they may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out.
What causes periodontal disease?
Periodontal (gum) disease comes from not brushing your teeth, from not getting them professionally cleaned, from smoking or from the trauma of a “bad bite” causing clenching and grinding (a bad bite). Periodontal disease can also be caused by inflammation going on in the body.
How do you treat periodontal disease?
A patient comes in every 3-4 months and the hygienist scrapes the tartar off the teeth, injects some medicine or bacteria-killing ozone and tells the patient to continue brushing and flossing. The patient then comes back 3-months later and he still has some bleeding points and the same ritual usually happens again.
This is a good way to increase your hygiene production, but think about it. How many of your patients have you actually cured of periodontal disease and been able to put them back on a 6-month recall?
If the disease is serious and there are large pockets around the teeth and bone loss, we may decide to refer these patients to a specialist called a periodontist who can surgically open the gum along the gum line, remove tartar and clean the area. If there is bone loss, granular bone graft material can be placed into the hole so the body can repair it. The gum is then closed with sutures.
How many of your patients are actually cured of periodontal disease by this treatment? Don’t you usually keep them on a 3-4 month recall going back and forth between the general dentist and the periodontist?
Beyond the Mouth
I realize that not taking care of your body can cause problems. If a patient smokes, if they get obese, if they get diabetes, if they seldom brush their teeth or get them professionally cleaned, they can obviously be in some trouble.
I'm venturing to ask you to think in a new direction - not about the latest gel or bacteria-testing scheme - but in something totally different.
As much as dentists want to believe in some complicated new technique, we are not going to cure a person’s heart disease or diabetes or likelihood of a heart attack through “curing” their periodontal disease.
What if you could show your patients that periodontal disease is just a window into their body and it may indicate that a number of other negative things are going on?
I bet if you surveyed your “perio” patients (who have come in for regular professional cleanings and have regularly brushed their teeth), you will find they are doing some other risky behaviors. You may find that they smoke. They may have elevated blood pressure or cholesterol. They may have a BMI >30. Their triglyceride level is probably >80.
Of course there is a connection between periodontal disease and heart disease! They both have the same risk factors.
I know as dentists and hygienists you are bombarded on a weekly basis with new products promising a cure for periodontal disease. Those marketers make it sound like if you cure a patient’s periodontal disease, you will also be curing his diabetes, heart disease or stroke risk, and if you don't cure their periodontal disease, they will continue to suffer those same diseases.
There are even expensive courses designed to help you find out if YOU are at risk of heart disease, stroke or diabetes. These courses subject you to a number of high tech tests and then promise that if you follow the proposed treatment plan, you will never have a stroke, heart attack or even diabetes. The only problem is that when they find you are possibly on the way to one of these diseases, they want to put you on a number of medications and a vigorous exercise program.
Chronic Inflammation
But, what about chronic inflammation you may ask? Did you know that perio and heart disease and diabetes and cancer all cause chronic inflammation in the body? Did you know that you can reduce or even eliminate chronic inflammation without medications and ozone treatments?
Think in a new way. There is so much good scientific evidence that a change in diet can do remarkable things. Your body doesn’t want to be ill and inflamed. Your immune system wants to cure you and make you well. But your body can’t heal itself as long as you are adding poisons such as tobacco smoke or overexposure of the skin to excess sunlight.
Over 75% of the chronic illnesses in developed countries are due to repeated injuries from the fork and spoon. Three or more times a day damaging quantities of fat, protein, cholesterol, and chemicals are ingested at the “dinner table.” The beef, chicken, cheese, refined flours, and sugars are sources of present day malnutrition.
There is much discussion these days in the scientific journals and the lay press about inflammation, foods, and chronic diseases, especially atherosclerosis, arthritis, and cancer. Populations of people who follow starch-based diets with fruits and vegetables show strong evidence of reduced inflammation in their bodies based on blood tests
These same people also have much less heart disease, arthritis, periodontal disease and cancer than do populations of people who consume diets high in animal (saturated) fats and trans fats. The foods themselves do not directly change these inflammatory markers. The elevations in these blood factors are the body’s response to the injury caused by the foods.
Go ahead and take that expensive training and find out how you can prescribe a number of expensive tests for your patients so they can find out if they are at risk for diabetes, heart attack or stroke.
But, there certainly are easier and cheaper tests that will show if you are at risk of disease.
Calculate your BMI. Find out your total cholesterol level, your triglyceride level, your CRP and your blood pressure. You can get these tests done through a local independent lab (if you don’t want to go to your MD) and the cost will be under $200. If any of them are high, you may need to change your habits rather than resorting to medications and surgeries.
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Tom's Letter, "From My Heart"
Thursday, January 31, 2013
I am 53 years old. Four days ago I was invincible. I could eat and drink anything and only exercise when I felt like it. I looked younger than I am and was reasonably fit without trying very hard. I had just sold my practice in Cincinnati and was ready to start Phase II of my like practicing with my wife Kathy Frazar in our dream practice in Houston.
We have an incredibly beautiful office and wonderful patients. Our Tesla electric car that we have waited for four years arrived last month. Our daughter started at TCU in the fall so we would have time for ourselves. We restarted our continuing education journey with a trip to Las Vegas two weeks ago to learn advanced neuromuscular dentistry.
We had the world by the tail...
Until Monday morning. I started the day making a temporary for a patient. Immediately started to feel "bad" - flu-like symptoms - hot and cold - nauseous - lethargic. I went into our massage room at the office and lay down. Thank God Kathy and I are a team as she covered all of our patients. At noon I had one of our team members take me home.
Off to bed. I lay there for four hours, listless. Didn't even have the desire to get something done on my iPad. Very unlike my type A self. I could feel my pulse racing. I knew something was very wrong. I started to doubt the flu. Kathy came home and took me to the "Doc in a Box" in Wesleyan Plaza.
They took my blood pressure and told me to go to the Emergency Room on Kirby immediately. My BP was near 200/100. The ER doc thought it was so bad that I was transferred to Methodist Hospital by Ambulance. I am thinking, "Come on guys, look at me, do I look like I need an ambulance? I am young and healthy."
Kathy asked that Dr. Robert Hust, a cardiologist who cared for her Mom, admit me. We "checked in" Monday night. I am writing this from my room Thursday morning. They will "check me out" soon. I have had a brain CT, a heart scan, a heart ultrasound, a liver and spleen ultrasound, an endoscopic ultrasound, a bold culture, and have had blood drawn at least 15 times. I am not complaining. I am in the best heart hospital in the world. Everyone knows who Dr. Michael DeBakey is.
I was totally ready to "check out" after the first heart ultrasound. It showed a regurgitation of my mitral valve. I was thinking, "Give me some pills and I will be fine."
Not so fast cowboy. They needed to know why I had developed this. I had a consult with a Hemotologist to rule out blood disorders, a consult with an Infectious Disease specialist to rule out infection on valves (which is what can happen after a dental visit or if you have an infected tooth or gums, for example).
By Tuesday night my head was spinning and reality was setting in. This could be serious. I could die during the open heart surgery they would need to do to replace my mitral valve. I know the odds are slim, but it does happen. My vain self was thinking about how I would look at the pool with a filet scar down the middle of my chest. I had not heard any results by bed time. Fortunately I had asked for a sedative to help me sleep that night. I had only slept one hour the night before. Hospitals are not conducive to sleeping.
Wednesday morning they sedated me and put an ultrasound tube down my throat to ultrasound my heart from right next door at the base of my esophagus. They wanted to see why my mitral valve was not sealing between beats. Was it due to the increased pressure? Was it damaged from infection? Did the fibers that open and close it stretch or cease to function?
After this test, I had an abdominal ultrasound because they found increased hemoglobin and decreased platelets in my blood. Turns out that was OK for now. I didn't need any other problems at this point.
Last night, well after nine, Dr Hust came by our room and told us he didn't think I needed valve repair or replacement at this time. I teared up and wanted to hug him. He could manage my condition with medication. I was not going to die! I would live the life I had always dreamed of with my dear Kathy, and see my children and parents for a long time.
Well, I guess I am far from invincible. I am further reminded of this as a nurse just checked my BP and it is 140/103. Still not out of the woods. Dr Hust will fine tune this with meds and I will work on it with diet and exercise.
I wrote this because I implore you as a husband, or wife (really directed at men, as you know you are the bad ones who die first) to do it for your children...
I dodged a bullet this time and am choosing to duck out from the gun fight.
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