How Old is Your Heart?

Exercise. Eat healthy. Lose weight. Avoid high cholesterol foods.  Avoid trans-fats. Stop smoking. Drink in moderation. Avoid salt. Don't snort cocaine. Don't get diabetes or hypertension-- If you do get them, treat them.  Don't get fat. Dont get old. Exercise some more. No seriously, eat healthy.  And this time really stop smoking.....

The list goes on. What are the things we can do to stay heart healthy?  We've heard all the preaching from our doctors, from our loved ones, from the media and so on.  Everyone theoretically "knows" what are the healthy does and don'ts.  Half the time we try to consciously forget them, or simply ignore them, because hey... I feel just fine.  Why should I give up my post meal cigarette?  Why should I stop eating McDonalds? And you know what, Im just too lazy to go to the gym.  Because it's true, most of the time you can get away with it and be just fine... But sometimes, bad things can happen. Like a heart attack. Because hey, you never really know how old your heart is.

The funny things about risk factors for something like heart disease, is that they are not causative in everyone.  If you took 100 people, and half of them were smokers.  You would by virtue of what we know, see more heart attacks in the smokers than the non smokers.  But, if you compared all the smokers amongst each other, some of them would get coronary artery disease and heart attacks, but others would be just fine.  One guy smokes half a pack a day for 20 years and the other, 2 packs a day, and the lighter smoker may have a heart attack, or lung cancer, and the heavier smoker may not.  Why one and not the other? (Assuming there is an equal amount of other major coronary risk factors--which include diabetes, hypertension, age, male sex, high cholesterol, and family history)

So questions do arise.  One of them is: Hey do I take my chances and just screw it and live how I want to live?  The other more intelligent question is: Hey is there something else that will clue me in on whether or not I am going to be one of those people at risk for getting a heart attack?  The answer is probably yes there is, but the reality is we have no idea what it is.  But I can venture a guess....

Genetics.  It must be right? Actually it has to be. From personal experience, family history of early heart attacks is probably one of the most important risk factors for heart disease.  (That and probably diabetes..). But family history means your genetic line has some predisposition towards heart disease.  By medical standards, a family history is defined as a first degree relative who has a heart attack before 55 (for men), and before 65 (for women).  But it grows beyond that... Not everyone whose dad had a bypass surgery at age 48 will have heart disease, then again the guy whose parents had no heart disease may have a heart attack at age 45!  Obviously this is not common, and we have to treat populations based on probabilities and risk stratification, we cant just go looking for heart disease in every human being... But again, perhaps certain families, and even certain populations and ethnicities have a higher incidence of disease.  This I can tell you is certainly true.  There really have not been enough large scale studies across all the different ethnicities for the guidelines to tell us "hey, if you are Pakistani or from Trinidad, then you are at higher risk than the white folk".  But from my anecdotal experiences, I certainly to some degree take ethnicity into mind....

Let me give you an example from personal experience.  A decent chunk of the population I treat at one of my hospitals happen to be minorities, as we have a large territory of Queens that we treat..  Everything from hispanic, to a good chunk of South Asians and people of Indian decent.  One particularly prominent group we see are of Guyanese decent. I don't know if more Guyanese people just happen to come to my hospital and the Asians more often go to neighboring hospital, but I can tell you that I have seen so many patients of Guaynese decent who have terrible coronary disease, often at a very early age. I have seen people not only in their 40's, but in their 30's with heart attacks.  The youngest one I remember was 2 years back, when a 29 year old kid came in with a huge myocardial infarction.  Anyway, the reason I started on this topic to begin was because just today we saw a 36 year old pleasant lady from Guyana.  She had some chest pressure 3 days before while playing with her 1 year old daughter, and thought it was just some head cold. She finally saw the doctor today, and they saw an abnormal electrocardiogram suggesting she may have had a heart attack.  It must be just some false positive right? I mean she is 37 years old, how could she have a heart attack?  We performed a cardiac angiogram, and found a 99% blockage of her right coronary artery, and we found she definitely had damage to her heart muscle -- i.e. she had a heart attack.  Crazy!  She is only 4 years older than me, she has a new baby, but was otherwise healthy.  She had no family history of coronary disease.  But she was Guyanese, and from my 3 years working here, although I was certainly surprised, and upset by it, I was not shocked, because it's not the first time I seen it in a Guyanese person.  I told her she had a near total blockage of her artery and had a heart attack, and we had to put a stent in to fix it. But she would be fine, but would have to be on medicines for the rest of her life.  All she asked me was "Can I still have another baby"?   That is something we don't usually here in cardiology given the average age of our population....

There is something in the genetics of certain people.  People of certain lineages and families.  But often of certain ethnicities as well, including South Asians, and especially those of Guyana and Trinidad.  Of course my view is biased.  I am in cardiology, and I only see those that have suspicion of or have true disease.  Maybe our population of Guyanese are somehow all related! There are probably tons of Guyanese and Indian families out there who never get heart disease... But there is certainly those that do.  Some of these cases we find a problem, like a certain type of cholesterol abnormality, or a strong family history.  Usually we talk about High LDL cholesterol (or bad cholesterol) .. But many times we see patients of Indian descent and Guyanese as well who have not so bad LDL's, but very low HDL's (or good cholesterol).  This may be worse than having high bad cholesterol. And of course a lot of these patients end up getting diabetes and hypertension at younger ages too.   So there are sometimes different things to look at and to target in terms of one's health and risk factors.  But occasionally, (albeit not commonly) like this lady today, you have someone who has no family history, a slightly low HDL, and if I saw her in the office, by guidelines, I would just recommend dietary modifications and no other meds, not even an aspirin.  However she came in with a heart attack. All I could think of was her ethnic descent as an explanation...  She may have ben 36, but her heart was more like 76.

So what does this mean for you? What can one do?  I am not saying if you are Guyanese, then get an angiogram at age 30.  It was just an example (probably of many potential others) to illustrate that genetics are important, and we can't control everything.  So, the only thing we can really do is what I said before.... Which is live healthy, eat healthy, get your cholesterol and sugar and blood pressure checked at least yearly to screen, don't smoke, if you drink--drink in moderation, and exercise regularly. This should start early, even in your late 20's and early 30's.. Because getting into these habits early on will stick to you later on after you pass age 45, which is when age itself becomes a risk factor and it never hurts to get a head start.  And I will say if you have a true family history of early heart disease, take things even more seriously.  Because genetics you can do nothing about.  All you can do is control the things you really have control of... And you can never truly know hold old your heart is....

The girl did fine by the way.. We put a stent into her right coronary artery, and she will have to be on medications for a while, but she will still be able to have her second baby.  However she will maintain a 35% risk of heart failure in the future, and a 6% of chance of dying suddently.  Though she is lucky, because a small portion of heart attacks end with a fatal arrhythmia, causing sudden death.

Comments

[Nsingh]

Came across your post from a a Google search. I'm also Guyanese and heart disease claimed many of my family members.

A couple years back my 49 year old (Indo Guyanese) uncle suffered a heart attack and as a result died a year later. During a hospital (Queens) visit, his cardiologist noted to us the exceptionally high rates of heart disease and within the Indo Guyanese community.

[ali]

It really is crazy yet curious how rampant heart disease is in Guyanese. Though I wonder if it is as evident among the Guynese community at large.. Of course my view is a selection bias of just those who I see come through the cardiac department, and we see many from Queens (I guess thats where a large community is) But clearly they present at a younger age and of a unique metabolic and cholesterol profile. I wonder if Guyanese people see this among their own communities or are aware of it? People often attribute it to diet, but it is obviously not the diet that causes a 30 yr old have a heart attack...

We even joke that when anyone Guyanese comes to the hospital with chest pain, we throw all risk factors and predictors and other things out the window and assume they truly will have coronary artery disease (blockages in the arteries) and would cath them sooner than later... After all all we know about heart disease was studied in mostly whites anyway..

[Nsingh]

Yes, the community is aware of this but not much is done to change lifestyle and habits. Diabetes is rampant also. I spoke to a 61 year old family member a couple days ago who is a heavy smoker and found out he has diabetes for the past 16 yrs. I mentioned to him the obvious dangers of smoking and he replied,"I've been smoking since 9 years old and I don't believe in scare tactics" !

I really can't explain why a 30 year old would have clogged arteries, but maybe its a rare exception. However, for those over 45 the rate is just relatively astronomical. I don't think your views are bias at all.

I've been told in Guyana in the 60s & 70s most people used coconut oil (coconuts are abundant in Guyana) because it was very cheap. Maybe this is one of the factors that explain the high heart disease rate for 50+ year old Indo-Guyanese.

I do think smoking is a main factor still. About 3/4ths of the older males in my family are or were heavy smokers.

[ali]

It is definitely a lot to do with genetics, because I have seen a handful of people under 40 yrs old come in with a heart attack.. Inevitably they all have low HDL's as well... So diet may not help, but genetics is def a player.