Prevention is the key to improving America's cardiovascular health
Cardiovascular disease is the leading cause of death in the United States and worldwide. After decades of decline in cardiovascular deaths, this progress has stalled, and rates are now on the rise. Risk factors such as obesity, type 2 diabetes, and metabolic syndrome are increasing, while lifestyle factors including lack of physical activity, unhealthy diet, smoking, excessive alcohol, stress, and lack of sleep also contribute to poor cardiovascular health.
Fortunately, cardiovascular disease is largely preventable, and identifying individuals at high risk can help enable an individualized treatment plan to ensure a long, healthy life.
How can I prevent heart disease?
Preventive cardiology is a specialized field that focuses on three key areas:
- Primordial Prevention: Encouraging a heart-healthy lifestyle from childhood to prevent the development of risk factors such as obesity, diabetes, and hypertension.
- Primary Prevention: Proactively managing key risk factors including high blood pressure, high cholesterol, and poor sleep to prevent the onset of a heart attack or stroke.
- Secondary Prevention: Reducing the likelihood of future cardiac events in individuals with existing cardiovascular disease through structured treatment and cardiac rehabilitation.
Studies suggest that if all U.S. adults achieved optimal cardiovascular health, 2 million cardiovascular events could be prevented annually. The American Heart Association’s Life’s Essential 8™ outlines key steps for maintaining cardiovascular health:
- Eat better
- Be more active
- Quit/don’t use tobacco
- Get healthy sleep
- Manage weight
- Control cholesterol
- Manage blood sugar
- Manage blood pressure
When should I see a preventive cardiologist?
Certain risk factors indicate a higher likelihood of developing heart disease. You should consider a consultation if you have:
- A personal history of cardiovascular disease, especially at an early age (before 55 in men, before 65 in women).
- A family history of heart disease.
- Conditions that can damage the heart, such as high blood pressure, diabetes, obesity, high LDL cholesterol, high triglycerides, or low HDL cholesterol.
- High levels of lipoprotein (a), which increases the risk of artery plaque buildup.
- Inflammatory disorders such as lupus, HIV, or inflammatory bowel disease.
- Coronary artery calcification detected on chest CT scans or an elevated coronary artery calcium (CAC) score, or Breast Arterial Calcifications seen on a mammogram.
- Unique women’s heart health risks, including high blood pressure during pregnancy, gestational diabetes, or premature menopause.
A preventive cardiologist can assess your personal risk and develop a proactive plan to protect your heart health.
Charles Amir German, MD, MS, FAHA, FASPC, is the Director of Preventive Cardiology and a preventive cardiologist at MedStar Georgetown University Hospital. Dr. German is at the forefront of preventive cardiology research and is a fellow of the American Heart Association and American Society for Preventive Cardiology. He is the first author of an article entitled “Defining preventive cardiology: A clinical practice statement from the American Society for Preventive Cardiology” which was published in the American Journal of Preventive Cardiology, Volume 12, December 2022.
As an expert in risk assessment, he begins every visit with a comprehensive evaluation of a patient’s risk factors to fully understand everyone’s unique circumstances. This includes novel biomarkers, blood testing and cardiovascular imaging. He then collaborates with them to develop a practical treatment plan, including lifestyle changes, medication, or other therapies. He is passionate about helping individual patients and impacting the general population with proven strategies for lowering risk factors for cardiovascular diseases, including heart attack and stroke.
Diagnostic testing and cardiac imaging
Diagnostic tests may include blood tests, advanced lipid testing, lipoprotein(a), genetic testing and other tests as indicated by your risk assessment.
Depending on the results of your medical history, family history and lifestyle factors, one of the following cardiac imaging exams may be ordered:
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Calcium score
A calcium score measures the amount of plaque in the coronary arteries to better assess a patient’s risk of heart attack and stroke.
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Exercise stress test
In this test, you will walk on a treadmill or ride a stationary bike while we monitor your heart rhythm, blood pressure and breathing. Wear comfortable clothing and walking shoes. You will wear sticky patches called electrodes on your chest, arms and legs to record your heart’s electrical signals and a cuff on your arm to monitor your blood pressure. You also may need to breathe into a tube to evaluate your oxygen levels. As you walk on the treadmill, the speed and incline of the treadmill will increase. Similarly, if you are pedaling a stationary bike, the resistance will increase. You will continue until you reach a target heart rate or you experience:
- Abnormal heartbeat
- Changes in your heart rhythm
- Chest pain
- High or low blood pressure
- Shortness of breath
When the test is over, you will be asked to rest until your heart rate and breathing return to normal. You can then return to your normal activities for the day. The appointment will take about an hour, but you will only be exercising for 10 to 15 minutes. Depending on the results of the test, additional testing, or a more advanced stress test, such as a nuclear stress test or stress echocardiogram, may be needed.
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Genetic testing
Genetic testing can be useful for heritable genetic cholesterol disorders, and can be considered in certain patients with a family history of cardiovascular disease or elevated cholesterol.
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Advanced lipid testing
These are specialized blood tests which can better predict heart attack and stroke beyond what is reported in the normal lipid panel.
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Lipoprotein (a)
This is a special, heritable type of cholesterol that is elevated in 20% of the population, that is an independent risk factor for cardiovascular disease.
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Nuclear stress test
A nuclear stress test, also known as a thallium stress test, may be recommended in addition to an exercise stress test. It will take two to five hours and include taking images of your heart before and after exercise. A very small amount of radioactive dye will be injected through an IV in your arm. Then we will take detailed pictures of the heart tissue with a special camera that detects the dye. These images can identify areas of the heart that have decreased blood flow.
After we take these images, you will proceed with the treadmill or bike stress test. Once that is over, another set of images will be taken. When the nuclear stress test is over, you should be able to return to your daily activities. You can help flush the dye out of your system by drinking extra water. The results of this test will help determine whether you need additional testing or treatment.
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Stress echocardiogram
This type of stress test helps us better assess the structures of the heart by doing an echocardiogram before, during and after a treadmill or bike stress test. For the echocardiogram, or echo, a technician will stick patches called electrodes to your body so we can monitor your heartbeat. They will then rub gel on the area to be tested and will press a device called a transducer against your chest. The transducer creates sound waves and picks them up as they bounce back from your heart. These sound waves will create detailed images of your heart. After these images are taken, you will begin the treadmill or bike stress test. You may be stopped at one or more points to take additional echo images. One last image will be taken when you have finished exercising.
The appointment will take about an hour, but you will only be exercising for 10 to 15 minutes. When the stress echocardiogram is over, you should be able to return to your daily activities. The results of this test will help determine whether you need additional testing or treatment.
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Coronary CT scan
CT angiography of the coronary arteries helps understand the total amount of plaque in the arteries that supply blood to the heart, while also determining the degree of blockage or narrowing.
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Echocardiogram
An echocardiogram uses high-frequency sound waves, called ultrasound, to create images of your heart. These images are more detailed than a standard X-ray, and there is no radiation involved in the test.
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Ankle-Brachial Index (ABI)
The ankle-brachial index (ABI) is a simple, non-invasive test to check for peripheral artery disease (PAD). This test compares the blood pressure measured at the ankle with the blood pressure measured at the arm. A low ankle-brachial index number can indicate a blockage or narrowing of the arteries in the leg. Physicians recommend this test for people who have leg pain while walking or have risk factors for PAD, such as smoking and atherosclerosis in other parts of the body.
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Carotid ultrasound
This is an ultrasound test to assess for plaque in the neck arteries which supply the brain.
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Cardiopulmonary stress test
A cardiopulmonary stress test, which is also called a cardiopulmonary exercise test (CPET) evaluates how the heart and lungs function during controlled exercise. The level of oxygen in the blood and how much air the lungs take in during the test are recorded. Physicians are then able to determine if the results are normal or abnormal and recommend follow-up treatment.
Treatments
Creation of your cardiovascular risk profile is the important first step in developing a plan to effectively treat any existing cardiovascular disease or decrease the likelihood of developing cardiovascular disease in the future. We work closely with other MedStar Health physicians, endocrinologists, sleep medicine physicians, OB/GYNs, and mental health professionals to manage disease and provide the most effective treatments.
Your treatment plan could include:
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Medications
Based on you and your family’s medical history, diagnostic tests, and imaging, we prescribe medications to lower your cholesterol, lower your blood pressure, or improve your heart’s pumping ability. We also manage statin side effects or offer alternative medications for patients who do not tolerate these drugs to control high cholesterol.
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Nutrition
You will receive a personalized assessment and recommendations on a heart healthy diet.
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Hypertension management
We specialize in treating patients with uncontrolled or resistant hypertension (high blood pressure) which is a major risk factor for developing atherosclerotic cardiovascular disease, kidney disease, heart failure, arrhythmias, and sudden cardiac death.
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Lipid management
We collaborate with patients to actively manage their cholesterol levels. Utilizing new and emerging markers of lipid related risk, we can determine the best medication regimens to treat patients diagnosed with dyslipidemias (abnormal levels of fat in the blood). Special attention is given to familial hypercholesterolemia which affects roughly 1 in 220 people and requires intensive lipid lowering therapy.
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Cardiometabolic health
Diabetes, pre-diabetes, insulin resistance, hypertension, overweight/obesity, high cholesterol and/or high triglyceride levels often occur together and are all risk factors for cardiovascular disease. While each one of these conditions increases risk, the combined effect can result in early onset of severe cardiovascular disease and events such as heart attack or stroke. We collaborate with MedStar Health physician specialists and other health professionals to prevent the onset of cardiometabolic disease and aggressively treat existing disease.
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Cardiac rehabilitation
MedStar Health's Cardiovascular Rehabilitation program is designed for patients recovering from heart disease or a cardiac event such as a heart attack or heart surgery. In addition, cardiac rehabilitation can help improve stamina in patients who have heart failure or a wide range of other cardiovascular conditions (e.g., chest pain, arrhythmia, cardiomyopathy, and others).
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Sleep disorders
Obstructive sleep apnea is common among patients at risk for cardiovascular disease, and we work closely with sleep medicine to identify and treat this sleep disorder.
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Smoking cessation
Smokers are two to four times more likely to have heart disease than non-smokers. When you stop smoking, your body begins to heal, and you will experience almost immediate decreases in blood pressure and heart rate. We refer patients to smoking cessation classes to address this important risk factor.
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Weight management
Excess weight can put strain on the heart, raise blood pressure, cholesterol, and glucose (sugar) levels. We work closely with the medical and surgical weight management program to optimally control this risk factor.
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Women and heart disease
Heart disease is the leading cause of death in American women, with 90% of women having at least one risk factor. The good news? It is largely preventable.
Preventive cardiology specialists can help women understand their unique risks and take steps to safeguard their heart health. Learn more about our Women’s Heart Health Program here.
Access to cardiovascular research and clinical trials
MedStar Cardiovascular Research Network offers patients access to groundbreaking clinical trials and innovative treatments. Participating in cardiovascular research helps advance heart disease prevention and treatment while providing potential access to new therapies.
Take Control of Your Heart Health Today
Don’t wait until symptoms appear. Schedule a consultation with our Preventive Cardiology specialists and take proactive steps toward a healthier heart.
Additional resources
“Defining preventive cardiology: A clinical practice statement from the American Society for Preventive Cardiology”
American Journal of Preventive Cardiology, Volume 12, December 2022.
Life's Essential 8 | American Heart Association
American Heart Association Life’s Essential 8™ - Your checklist for lifelong good health