By R. Mark Burke

Mark Burke, MD
Mark Burke, MD

Following is part two of a two-part column about heart disease prevention and treatment.

Among the many issues a cardiologist must deal with, the one most people understand is a “heart attack,” or myocardial infarction (MI), a sudden obstruction of blood flow to a portion of the heart, which if not relieved, can be fatal. Each year, 1 million Americans suffer a heart attack and about half of them do not survive. While most people understandably fear cancer, an MI and its consequences are worse, causing more fatalities and more incapacity and disability.

An MI is a result of coronary artery disease and sits on one end of a spectrum which ranges from silent to symptoms of angina (chest discomfort) to full-blown heart attack and death. Although the total number of heart attacks has declined over the years and has shifted to an older age group, the national surveys haven’t caught up with what I see in the office: an increasing number of younger people with elevated risks for coronary artery disease or even established coronary artery disease, some of whom, sadly, have already had a heart attack.

Although fewer people overall are having a heart attack, especially the worst types of MI (mostly because of “statins”: drugs which lower cholesterol), greater numbers are at risk for one. These same risks lead to a whole set of related problems, including dementia, cancer, stroke, gout, kidney failure, debilitating arthritis, severe back problems and more (the list is long). The reasons for this trend, for the most part, lie in changes in our lifestyle: people are not only eating too much (the biggest problem) and are consequently much heavier, but also eating too much of the wrong kinds of foods. They are, as well, not getting enough regular physical activity. Currently, less than one third of adults get the minimum amount of recommended physical activity.

I’ve avoided statistics in these columns, but, it is important to point out that the least fit and the most out-of-shape are 4.5 times more likely to die of heart disease, while people who maintain an active lifestyle are at 45% lower risk of developing any heart disease than their sedentary counterparts. These are big numbers, yet even though most people know that eating right and exercising are still the most powerful (and cheapest) medicines, fewer and fewer are able to follow the prescription.

One of the most common complaints I hear in my office is: “I know I’m overweight, but why am I short of breath? I never was before.” For most, the answer is, in fact, the extra weight and lack of exercise and everything that follows from that – though this is often not what people want to hear. In these situations, people are frequently looking for some external explanation and may have trouble accepting that the effects of being overweight are cumulative, adding up until they start causing symptoms. So, if the weight and lack of exercise are the problem, the corollary (the conclusion that follows from these facts) is that losing the weight and getting regular physical activity will improve things: so simple, so true, and yet, so very difficult to achieve.

The barriers to a healthy lifestyle are huge, though they are not insurmountable. They begin with who we are as a culture. We’re sedentary: we’re spread out geographically and have to drive everywhere to get anything. Our work is sedentary and we work too many hours compared with the rest of the world. When we get home, we’re so tired from long or unhappy work hours that we don’t or can’t do anything physical. We’ve got home stresses, family stresses, money stresses and health stresses, which only compound our inability to take care of ourselves. We’re too tired to make a good meal and we are supersized. Food is no longer served in reasonable portions. For most, a description of a good restaurant includes the size of the portions, bigger always being better. We’re used to eating too much, and if asked to eat a healthy portion, we feel cheated. We’ve got problems as a society and, consequently, as individuals. Many in our society are developing medical complications that rob them of the ability to perform even the simplest of modern human tasks: walking around a grocery store or up a flight of stairs, or down the driveway to get the paper without being out of breath and exhausted.

Making this problem even more difficult is that our own physiology doesn’t actually want to help out when we’re overweight. The brain won’t let a person lose weight easily; it tries to keep the weight at its current, unhealthy levels, which just adds to the issues I outlined above. Furthermore, being overweight and out of shape leads to even more issues with mobility and motivation and to a consequent decline in an ability to get needed activity. As people experience this decline, they become discouraged, angry and resentful, so they give up. A spiraling, vicious cycle develops that leads ever downward – unless the cycle is broken by a deliberate, meaningful change in direction.

The Dali Lama has reportedly said that in politics (as in life) change takes ten years. To the extent that it takes a long time, I think he’s right. As a cardiologist, charged with helping people towards a healthier lifestyle, I cannot and do not give up on whoever walks through my door, no matter how long it takes. Persistence, constant education and determination lead to success. And that success leads to a happier, healthier life.

Mark Burke, MD is a board certified cardiologist at the Center for Cardiovascular Health, a department of Brattleboro Memorial Hospital.