Heart Disease:
Learn the Risk Factors, Warning Signs
Michael Cinquegrani, MD
Medical College of Wisconsin Cardiologist;
Associate Chief, Division of Cardiovascular Medicine
Named one of the "Best Doctors in America®" 2004 by
Best Doctors, Inc.
Genetics plays a role in heart disease — but it is not the whole story. Michael Cinquegrani, MD, lists many risk factors you can control and also goes over the heart disease warning signs. When it comes to treating heart attacks, he explains, there is a "night and day" difference between now and the not-so-distant past.
Q. What are the main kinds of heart disease?
In adults, heart disease has several basic forms. One is coronary artery disease, which is an atherosclerotic [narrowing and hardening] change in the coronary arteries that can lead to chest discomfort and can lead to heart attack. That's one bucket. The second bucket is heart disease related to high blood pressure that leads to disabling symptoms such as shortness of breath and heart failure. The third bucket would be heart failure. Arrhythmia is the fourth bucket. There's also another bucket called valvular heart disease [disease of the heart valves]. It's particularly important for older people.
Q. What are the risk factors for heart disease?
There are certain risk factors for the development of heart disease in adults that are common between the first three buckets. One is a genetic predisposition to have coronary disease. The second would be those things that you influence yourself — smoking, uncontrolled high blood pressure, diabetes and high cholesterol levels. Obviously, you can't do anything about your genetic heritage, but you can do things about modifiable risk factors. You can control your blood pressure, you can quit smoking, you can do things either with diet or with medications to reduce your cholesterol if it's too high, and you can keep your diabetes well controlled.
Diabetes is a big driver of heart problems. Weight loss is an important one for people who are overweight because it can reduce the severity of their diabetes and it can also reduce the severity of their hypertension. Smoking speaks for itself.
Q. What warning flags should you look out for?
If people notice that their exercise tolerance is diminishing, they can't do activities they used to because they're getting short of breath, or they notice they are waking from sleep short of breath — those can be signs that there is something wrong with their heart.
If they're getting any kind of chest discomfort, usually a pressure sensation, that may also radiate to the neck or the arms or the jaw or the back — that can be a sign that they have blockage in the arteries to the heart. If it's a new symptom, it's particularly worrisome.
Q. If the heart care of today is "10," how do you rate the care of twenty years ago?
If we're calling today's heart care a 10, twenty years ago would probably be a 7. Twenty-five years ago would have been a 4. In the very early 80s, we totally transformed how heart attacks were being cared for. The difference was night and day. We started understanding more about how heart attacks occur and how to influence the course positively by getting a blood vessel open either with medications or with angioplasty.
So today, when somebody comes in with a heart attack, he or she has a much better chance of leaving the hospital, lowering their risk of future heart attacks and lowering their risk of death from heart failure — and a much better chance of leading a normal life.