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Health and Wellness: Matters of the Heart

Each February, our country turns its collective cognizance toward American Heart Month and National Wear Red Day. These public health education campaigns help raise awareness surrounding heart disease, which remains the leading cause of death in the United States.

Dr. Moe Zafarani — a cardiovascular physician at Aurora Medical Center in Oshkosh and at Aurora Health Center in Neenah — says heart disease remains a significant health issue in Northeastern Wisconsin, reflecting the broader trends in the state and the country.

As he notes, heart disease is the leading cause of death in Wisconsin, including Northeastern Wisconsin, accounting for approximately 22% of all deaths in 2022.

Dr. Ameer Kabour, medical director of ThedaCare Cardiovascular Care, says manifestations of heart disease can include high blood pressure; heart attacks and hardening of the arteries, leading to heart attacks; rhythm problems including atrial fibrillation; weakening of the heart muscle, leading to heart failure; and heart valve malfunction.

He says precursors of heart disease in men and women can include high blood pressure, high cholesterol, smoking, diabetes, sedentary lifestyle, chronic kidney disease, peripheral arterial disease, age, unhealthy diet, and family history of heart disease.

Dr. Stephen Serio, Prevea Health vascular surgeon at the Prevea Oconto Falls Medical Services Building and at the Prevea Allouez Health Center, adds that while there are many disease processes that affect our hearts, similar ailments can also affect other parts of the circulatory system, which directs blood flow to our brains, kidneys, and legs, as well as other locations.

Stent implantation for supporting blood circulation into blood vessels – 3d illustration

“Unchecked, these conditions may unexpectedly present as sudden, serious health emergencies,” he explains. “Examples include a myocardial infarction, otherwise known as a heart attack, or strokes resulting from atherosclerotic plaque involving the carotid arteries in the neck, or even catastrophic bleeding from an aneurysm of a blood vessel in the abdomen or chest.”

“The symptoms of the conditions can vary between women and men, although there are some commonalities,” Dr. Zafarani furthers. “Both men and women can experience silent or asymptomatic heart disease, and symptoms can vary in severity and frequency as the disease progresses. Men may experience more sweating, and women may have more nausea during a heart attack.”

Over time, says Dr. Serio, other disorders of the vascular system may present slowly and gradually worsen. These conditions include claudication, or progressive pain in the legs and calves experienced with prolonged walking, caused by blockages in the arteries in the legs, and venous insufficiency that results in varicose veins and swelling of the legs.

“These disorders may eventually advance to become serious ailments, such as wounds and sores that are difficult to heal,” he says. “If the wounds are left untreated, they can lead to amputation of the limbs. There are many professionals who manage heart disease, and vascular surgeons are specially trained experts who diagnose, evaluate and treat these conditions.”

The risk factors that exist throughout Northeastern Wisconsin communities

There are contributing factors for those of us living in Northeastern Wisconsin that make it of particular concern. As Dr. Zafarani points out, high rates of obesity and being overweight are prevalent in Wisconsin, with approximately 67% of Wisconsinites obese or overweight.

“This significantly increases the risk of heart disease,” he says. “Hypertension and high cholesterol are common in Wisconsin, affecting 32% and 36% of the adult population, respectively. These conditions are major risk factors for heart disease.”

Dr. Kabour says that in addition to weight management, smokers should quit smoking – a person’s heart attack risk drops by 50% just a year after smoking cessation.

“In our area specifically, although we continue to see a large number of patients diagnosed [with] the condition, we are making progress,” adds Dr. Kabour. “We are having meaningful, individualized conversations with our patients and their families. Our goal is to continue to educate our community as to how best to protect against heart disease. This continued education and awareness will lead us toward better patient outcomes and, we hope, help reduce the heart disease rates in our communities.”

Dr. Kabour says improving patient outcomes also goes beyond traditional health care to help communities and individuals thrive. Estimates show that 80% to 90% of health outcomes stem from what happens outside the walls of hospitals and clinics.

“That’s why it’s crucial to address non-medical health factors, often called, ‘social determinants of health,’” he states.

Examples of social determinants of health include safe housing, transportation, and neighborhoods; racism, discrimination, and violence; education, job opportunities, and income; access to nutritious foods and physical activity opportunities; polluted air and water; and language and literacy skills.

“As a population health organization, ThedaCare is dedicated to helping address these social determinants of health,” he adds. “We can make heart disease less of a concern for our region when we take steps to reduce the number of contributing factors that often lead to a heart disease diagnosis.”

New, less invasive technology allows for quicker recovery 

In the treatment of heart disease, new technology has emerged and benefitted patients over time. There are several noteworthy technologies over the last two decades, according to Dr. Kabour. Medicated stents enable enhanced treatment for heart blockages, with far fewer patients needing open heart surgeries, while transcatheter aortic valve replacement (TAVR) is used to fix heart valves using a minimally invasive procedure. Patients have also benefitted from the discovery of new medications, including some for cholesterol and heart failure.

The increased availability of automated external defibrillators has also improved outcomes, he says.

“When properly used, these devices help patients of cardiac arrest (heart stoppage) by checking the heart rhythm and administering an electric shock to the heart as needed to restore a normal rhythm, saving them from sudden death,” he explains.

Dr. Zafarani says the coronary CT angiogram plays a critical role in diagnosing blockages in arteries in the correct population subset, and we are fortunate in this region to have this technology.

“For example, in Oshkosh, Aurora’s coronary CTA program was recently awarded for quality by Heartflow – only 18% of the hospitals worldwide achieve this distinction,” he continues.

From a wider perspective, the adoption of less invasive treatments is an advantage for patients during treatment and in their recovery.

“This makes the treatment of these blockages in the coronary blood vessels and other vessels much less hazardous and has allowed patients to recover quicker and with less risk for complications,” Dr. Serio explains. “Every year new techniques become available that are able to treat increasingly complex patterns of disease with the use of a balloon or stent inside of the blood vessel, thus avoiding a large incision that would be required for a major surgery.”

In the wake of COVID-19, new concerns emerge

For those who contracted the virus during and following the COVID-19 pandemic, cardiovascular specialists have noted a strong connection between COVID-19 and heart inflammation, known as viral myocarditis, explains Dr. Kabour.

“This can result in areas of muscle scar, potential weakening of the heart muscle, and lead to abnormal heart rhythms,” he states. “These events can cause ongoing issues of chest pain, shortness of breath, sensations of high heart rates, feeling very lightheaded and very fatigued. In significant cases, the heart rhythm changes can be life-threatening if the degree of muscle weakness and scarring is significant.”

Dr. Zafarani says symptoms could be related to the heart or other factors, such as prolonged inactivity and convalescence.

“Severe COVID-19 can exacerbate existing heart conditions, although the effects on preexisting heart disease are not yet fully understood,” he states.

And, as Dr. Serio adds, COVID-19 has health implications that affect many of the vital systems of our bodies, so it’s important to have an open dialogue with your provider about what you’ve experienced.

“During the COVID pandemic, patients were found to have increased risk of heart attack and stroke,” he says. “We now see that patients who have had COVID-19 are at increased risk for cardiovascular events, such as a stroke, heart attack or blood clot. Those who have had a severe COVID infection are at four times the risk for a serious cardiovascular event, as compared to those patients without a history of COVID.

“This makes screening for heart disease even more important when discussing general health concerns with primary care providers,” he adds.

Education & communication with your provider are keys to improved heart health

Many of us likely have lifestyle or hereditary concerns that may be contributing factors to heart disease. Vascular screening has been shown to identify diseases early, and save lives, stresses Dr. Serio.

“Studies performed after implementing a screening protocol for abdominal aortic aneurysms (AAA) for patients during their ‘Welcome to Medicare’ appointment found that the risk for death related to AAA was reduced 44%,” he says.

“Emergency operations, which carry a much higher risk than elective procedures, decreased by 50%,” he adds. “Keeping in mind that vascular disease can affect many areas of circulation in our body, it is recommended that certain at-risk individuals participate in screening.  Most insurance providers, as well as Medicare, offer these services free of charge. As part of our commitment to our community with Prevea Health, we are offering these screening services at convenient locations near your home.”

There are certainly many other factors within our control in the prevention of heart disease as well, says Dr. Zafarani. It’s good advice for maintaining a healthy lifestyle overall.

“Heart disease prevention is possible through a combination of lifestyle changes, dietary adjustments and medical guidance,” he explains. “Limit foods high in saturated fats, trans fats, cholesterol, sodium and sugar. Aim for at least 40 minutes of moderate to vigorous intensity physical activity per day for three to four days a week.

“Maintain a healthy weight to reduce the risk of heart disease — losing even 5% to 10% of body weight can make a significant difference,” Dr. Zafarani continues. “Limit alcohol, avoid smoking, and be aware of your cholesterol numbers. Get adequate sleep and learn to manage your stress.”

“Heart disease can be preventable, and it takes a concerted and educated effort to reduce one’s risk,” adds Dr. Kabour.

For more information regarding heart disease, visit: thedacare.org/cardiovascular; prevea.com/medical-services/vascular-care and prevea.com/medical-services/cardiology; and aurorahealthcare.org/services/heart-vascular/world-class-care.

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