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Johns Hopkins Health - Understanding your Heart

Winter 2010
Issue No. 7

Understanding your Heart

Date: January 24, 2010

Separate fact from fiction when it comes to your ticker- and help yourself live longer

cartoon heart
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Shakespeare once said that “a light heart lives long.” While that’s true, a healthy heart lives longer.

Unfortunately, healthy hearts still elude about 70 million Americans, nearly a quarter of our population. High blood pressure, heart disease and stroke are responsible for more than 6 million hospitalizations, and the cost of having a bad heart runs well into the hundreds of billions annually.

“It’s not a pretty picture,” says Johns Hopkins cardiologist Roger Blumenthal, M.D. “But we can take steps to improve it.”

Among those first steps is dispelling some of the existing misperceptions about heart health, including that heart disease can’t happen to you. The numbers make it clear that it’s not true, yet most people are loathe—or simply uninformed about how—to learn more about this essential organ.

‘It’ Factors
Where it relates to heart disease, the key to knowing your heart is all about understanding risk factors. These can be preventable or unpreventable risk factors, says cardiologist Pamela Ouyang, M.D.

“Age and family history are risk factors you can’t do much about,” she says. “If your mom or dad had heart attacks or died as a result of heart disease at a relatively young age, then you’re automatically at greater risk than the average person.”

It also means you need to be even more vigilant about the preventable—or controllable—risk factors such as high blood pressure (hypertension), cholesterol, diabetes, smoking and obesity.

“We all need to watch for the preventable ones,” Ouyang says. Most people don’t realize that they can’t feel hypertension, she notes. “You simply can’t know what your blood pressure is unless you have it checked.”

Knowing your numbers and having your blood pressure and cholesterol checked regularly will help you keep those risk factors in balance. Conditions such as diabetes increase your risk for heart disease, too. Although most people who have been diagnosed with diabetes understand this, it’s the people who remain undiagnosed who may be walking hazards or fatalities waiting to happen. And unless you’re experiencing symptoms of diabetes such as thirst or frequent urination—and you tell your doctor—it’s not usually picked up until you have a blood test screening.

Then there’s obesity. On the rise and showing little evidence of abating anytime soon, obesity is the perfect storm for an unhealthy heart. Associated with a treacherous trifecta of high blood pressure, high bad cholesterol and diabetes, obesity is heart disease’s best friend.

Probably the single most preventable risk factor for heart disease, though, is smoking. On that front, there’s good news, Ouyang says.

“We’re actually seeing a decrease in heart disease deaths due to smoking,” she explains. “That’s probably due to the success of anti-smoking campaigns and laws, as well as workplace changes that have been implemented.”

Not a ‘Man’s Condition’
Besides misperception and lack of good knowledge about risk factors, the notion remains that heart disease is a “man’s condition.” That, combined with the fact that most women think that breast cancer is more of a risk than heart disease, makes it lethal for women.

Women are actually eight times more likely to die of cardiovascular disease than they are of breast cancer. And Ouyang notes that women are just as likely as men to develop cardiovascular disease later in life because of increased high blood pressure. Even more concerning is that women often ignore sensations of pain that could indicate heart problems.

“You might think women would be more attuned and more likely to visit their doctors,” Ouyang says. “The truth is that they’re more likely to ignore the possibility that the pain is from the heart when it occurs because they’ve been told in the past it’s not cardiac pain.”

The Right Measures
Although this information may seem daunting, Blumenthal is adamant that you can work with your doctor to assess your heart risk and take measures—whether lifestyle changes or medication management—to prevent heart disease. And that’s true whether you’re an average person or someone with significant risk factors.

Basically, says Blumenthal, who directs the Johns Hopkins Ciccarone Preventive Cardiology Center, the traits that help determine your risk for a heart attack over the next 10 years are age, total cholesterol, HDL (good cholesterol), LDL (bad cholesterol), blood pressure and smoking history. But he takes it a step further by also considering stroke and heart failure risk.

“There’s a false sense of security if you just look at risk associated with heart attack and it’s low,” he explains. “Looking at stroke and heart failure makes it a much more thorough assessment.”

Other new assessments include imaging that can determine how hardened your arteries have become because of calcium buildup, simple protein blood tests and calculating your heart age. Blumenthal says these can refine a person’s risk and offer a better picture for his or her future.

“It means working with your doctor,” he explains. “You can decide whether you go on lifelong aspirin therapy or more aggressive cholesterol-lowering therapy. Or whether you just need to do a better job motivating yourself to improve your lifestyle habits.”

And, lifestyle really is the cornerstone, Blumenthal notes. The family member who smoked, drank and never exercised until he was 90 years old is a rare exception. It’s also not a foregone conclusion that just because someone in your family had a heart attack or stroke that your own days are numbered.

“Most of us just need to pay better attention to our hearts,” he says. “It all matters.”

The Way to a Woman’s Heart?
Heart disease shows up differently in women than in men, says cardiologist Pamela Ouyang, M.D.

  • Women may have the traditional heart attack symptom of chest pain, but may also have less typical symptoms such as difficulty breathing and back pain.
  • Major risk factors for heart disease, such as smoking and diabetes, can be more damaging for women than for men.
  • For menopausal women, prevalence of hypertension significantly increases, and by more than 70 percent for women in their 70s. High blood pressure increases the risk of heart attack, heart failure and stroke.
  • After menopause, higher cholesterol makes women more susceptible to blocked coronary arteries.
  • Women smokers, especially young female smokers, are more at risk than men to develop heart disease.
  • Women who have diabetes or high blood pressure during pregnancy are at risk for developing those cardiovascular risk factors later in life.

Young Athletes Beware
What’s behind the sudden heart deaths of young, otherwise healthy, athletes? It’s rare but usually attributed to an inherited—and undiagnosed—condition called hypertrophic cardiomyopathy.

“It’s the No. 1 cause of heart-related sudden death in people younger than 30 and occurs most frequently in young athletes,” says cardiologist Theodore Abraham, M.D., director of the Johns Hopkins Heart Hype Program.

Young people—or anyone for that matter—should be concerned about these symptoms while exercising, especially when there is a family history of heart disease:

  • Lightheadedness or fainting
  • Chest pain
  • Unusual shortness of breath

In addition to the recommended yearly physicals required for athletes participating in sports, Abraham also recommends screenings for high-level athletes, those participating in intense sports and those who have family histories of heart disease.

Prevention ABCs
How do you keep track of important points about heart disease and prevention? Cardiologist Roger Blumenthal, M.D., uses this ABC system for his patients:

Aspirin, Assessment

  • Speak to your doctor and decide if you should be on aspirin or another medication to lower your risks.
  • Assess risks, including using the Framingham score for risk of heart attack.

Blood Pressure

  • Normal blood pressure is less than 130/80. Optimal is less than 120/80.

Cholesterol and Cigarettes

  • National guidelines are used to determine who qualifies for cholesterol-lowering medications.
  • Develop a plan for smoking cessation and reducing secondhand smoke exposure.

Diet, Diabetes Prevention/Management

  • Measure your waist circumference to help determine your risk for diabetes. Women, if your waist circumference is greater than 35 inches, or men, greater than 40 inches, you are at a greater risk.


  • Walk a minimum of 5,000 steps a day (two miles of total walking), but strive for 10,000 steps to reduce risk factors associated with heart disease.

Family History

  • Family history of heart disease may compel your doctor to be more aggressive with management of the risk factors.

For more information on heart disease prevention, diagnosis and treatment, visit For appointments and consultations, call 877-546-1872.