While the ongoing COVID-19 public health crisis dominates headlines nationally and locally, another more common disease remains America’s deadliest – heart disease.
Based on an aggregation of 21 scientific models, the U.S. Centers for Disease Control and Prevention estimates the novel coronavirus will have claimed the lives of between 129,000 and 145,000 victims nationally by July 11.
And while estimates of the annual total will undoubtedly continue to rise, heart disease alone accounts for nearly 650,000 deaths each year, according to CDC data.
Rahool Karnik, MD, a cardiologist at Abrazo Arrowhead Campus in Glendale, said this is nothing new.
“Heart disease, or more specifically, coronary artery disease remains the leading cause of death in the U.S.,” Dr. Karnik said. “It accounts for over 600,000 deaths annually or 1 in every 4 deaths. Every 40 seconds an American will have a heart attack (or myocardial infarction).”
He said the average age for a first heart attack is 65 for men and 72 for women.
Socioeconomic factors are a top indicator, with those making less than $25,000 having two-and-a-half times the risk of heart disease as those making more than $75,000 annually. Those who don’t complete high school are twice as likely to have the disease than those who graduate college.
Heart disease is a national problem, with more than $350 billion spent annually on treatment. However, along with increasing rates of disease, improvements in treatment and technology are leading to better outcomes, according to Dr. Karnik.
“The prevalence of coronary artery disease has been increasing. This is in part attributable to rising life expectancy along with the increasing prevalence of risk factors, such as obesity, diabetes, and hypertension,” he said. “However, treatment options have also improved. As a result, the death rate from coronary artery disease decreased by 31.8% in the decade from 2006 to, according to the most recent statistics.”
Data from CDC reveals more than 30 million, or 12.1%, of Americans, have been diagnosed with heart disease.
Arizona stands among the lowest states for the rate of death from cardiovascular disease, killing 361 per 100,000 people over age 35 based on data from 2017 and 2018. This ranks the state 9th lowest, ahead of only Puerto Rico, the U.S. Virgin Islands, Minnesota, Colorado, Massachusetts, Hawaii, Connecticut, and Alaska.
Ranging from 527 to 581 deaths per 100,000 people, the worst five states for heart attack death were Louisiana, Arkansas, Oklahoma, Alabama, and Mississippi. Only the Northern Mariana Islands and Guam --- with rates at 584 and 745 per 100,000 respectively --- had higher mortality rates among American states and territories.
Across Arizona, the lowest-ranked counties for mortality per 100,000 were Pinal (315), Coconino (331), and Santa Cruz (332); while the highest rates were in Gila (420), La Paz (425) and Mohave (536) counties. The mortality rate in Maricopa County was 351 per 100,000, according to CDC.
To prevent cardiovascular disease, doctors and other health experts offer a variety of approaches, including diet, lifestyle, and medical intervention. For some, the disease may be inevitable regardless of how they live, Dr. Karnik explained.
“Be aware of your family history,” he said. “A strong family history can place an individual at risk from genetic factors regardless of their healthy lifestyle choices.”
Other diseases, such as viruses, can also exacerbate heart disease, according to Dr. Karnik.
“It is also important to note that inflammatory, such as viral infections, can actually precipitate the cascade of events that lead to rupture of plaque in the arteries and then cause heart attacks,” he added.
Ben Franklin reputedly coined the axiom: “An ounce of prevention is worth a pound of cure.” And while the 16-to-1 ratio of prevention-to-cure value may not be scientifically proved, Dr. Karnik agrees with the Founding Father that prevention is crucial.
“It starts with primary prevention. It is much easier to prevent an event than it is to deal with the aftermath of one,” Dr. Karnik stated.
The CDC offers the following list of prevention measures at its website, cdc.gov:
Diet and exercise remain the top ways to keep the heart healthy, according to Dr. Karnik.
“Maintain a healthy diet --- I usually recommend a balanced diet with allowances for patients’ favorite items in moderation. I find this is highly sustainable as patients do not feel they’re deprived of the foods they like,” Dr. Karnik stated. “The diets that have been shown to have the heart healthiest benefits include the Mediterranean and DASH diets.”
Both the Mediterranean and the DASH diet --- which stands for dietary approaches to stop hypertension --- focus on eating whole grains along with fresh fruits and vegetables and lean proteins, such as chicken and fish, according to webmd.com.
Along with regular physical activity, finding out about other risk factors can also be crucial to maintaining heart health, Dr. Karnik said.
“A regular exercise regimen consisting of both aerobic and resistance exercises is also key and refraining from tobacco use is very important,” he stated. “Finally, regular visits with their primary care provider to assess for and manage their risk factors such as diabetes, hypertension, and cholesterol, are paramount.”
A troubling national trend has emerged as patients needing care for potentially dangerous conditions avoid treatment because they’re afraid of contracting COVID-19, Dr. Karnik said.
“I believe the coronavirus pandemic is receiving the attention it deserves as the public needs to be made aware of what steps to take in order to mitigate its impact,” he said. “However, it has also created a level of fear whereby patients may not seek appropriate medical care (hospital, primary care provider, cardiologist) for their other health issues because they are concerned about being exposed to the virus. It is important that they continue to seek appropriate medical care if they experience concerning symptoms.”
The American Heart Association echoed his concern, noting COVID-19 fears as a national problem preventing some from seeking help and explaining the urgency in a brief video posted on their website.
“Heart attacks and strokes don’t stay home. So, don’t avoid the ER out of anxiety. Don’t die of doubt. If you have an emergency, call 9-1-1. When seconds count, the hospital is the safest place to be,” the video stated.
According to information published at the website, while some heart attacks are sudden and intense, many times the symptoms start more slowly, with mild pain and discomfort — even if mild, the symptoms should not be ignored.
While individual experiences of heart episodes may vary widely, some typical symptoms include:
IMPORTANT: Anyone experiencing chest pain or shortness of breath should seek immediate medical attention.
Tareq Khawaja, MD, director of the cardiac catheter lab at Banner Del Webb in Sun City West, reiterated the need for prompt attention and treatment.
“The heart attack is what’s going to kill you,” Dr. Khawaja said. “Most people recover from the virus; but once you’ve had a heart attack, you don’t do very well. Unfortunately, I have seen patients who’ve delayed their presentation and ended up with complications from a heart attack.”
He said while the novel coronavirus certainly poses risks to anyone engaging in social settings, hospitals have carefully prepared to keep those being treated for the virus safely separated from everyone else coming to the hospital for the more “usual” reasons.
“We need to get the message out that just because there’s a possibility of the virus in the hospital, we’ve taken all the necessary precautions according to CDC guidelines in terms of separation, distancing, barriers and personal protection,” Dr. Khawaja said. “The patients are well managed and cared for. So, there should not be that apprehension about going there.”
Even beyond the risk of COVID-19 infection, some patients still may fear the hospital generally and put off treatment that can save lives and prevent long-term and permanent damage, Dr. Khawaja said.
“There is a perception about these kinds of procedures being very long and complicated and potentially high-risk,” he said. “But with the advent of the newer technologies we use, it comes down to the ability to miniaturize. All of the equipment we used a generation ago has become smaller, so you can still perform exactly the same quality procedure, but with better equipment, which is less likely to cause damage to blood vessels, ruptures of arteries, and that kind of thing.”
The doctor said many catheterizations that once required an insertion into the femoral artery near the groin can be completed through smaller vessels in the wrists, which makes the procedure less invasive and easier to recover from.
“That means the patient can stand up or wake up straight away after the procedure and walk around,’ Dr. Khawaja explained. “That kind of miniaturization, in order to deliver something through a tiny, little artery in the wrist, is because of the technology that’s allowed that to happen … all of those things have made the procedure much, much safer.”