Atrium Health Wake Forest Baptist doesn’t just treat cardiovascular disease. It’s one of the few healthcare systems in the country that has cardiologists dedicated to the prevention of cardiovascular disease. The Preventive Cardiology Program focuses on identifying and mitigating cardiovascular risk before it leads to serious complications.
To celebrate American Heart Month, we asked Dr. Michael Shapiro, Director of the Center for Preventive Cardiology at Wake Forest Baptist, to answer some of the most frequently asked questions about maintaining heart health and preventing heart attacks.
What do you wish more people knew about maintaining good heart health?
As a cardiologist, I used to find that lack of awareness was the big problem – that people didn’t get enough information about how to keep their heart healthy. In recent years, however, it’s more about misinformation. Mythology circulates very efficiently through social media and other channels. There’s a lot of misunderstanding out there – especially due to the diet wars – and in some ways, that’s even worse than a lack of awareness.
How should people get accurate information about keeping their heart healthy?
Speak to your primary care provider. They’re very good sources of reputable, good information about heart health. You don’t necessarily need to see a cardiologist to learn how to manage your blood pressure, cholesterol, blood sugar and weight. You can have conversations with your primary care provider to learn all of that. If you do want to go online for information as well, I’d suggest the Mayo Clinic website and WebMD as two good sources.
What role does heart imaging play in preventing heart attacks?
One of the most helpful tools we have in preventive cardiology is coronary artery calcium scoring. This is a simple, noninvasive CT scan that allows us to detect whether plaque has already begun to build up in the arteries of the heart — often years before symptoms develop.
Calcium scoring doesn’t tell us everything about plaque, but it gives us a clear and reliable measure of whether atherosclerosis is present. For people without symptoms, it’s the primary imaging test we use to better understand cardiovascular risk and guide prevention decisions. I often describe it as a way to look beneath the surface and see whether heart disease has already started, even when someone feels well.
In certain situations, more advanced imaging may be appropriate. For example, coronary CT angiography can be useful when someone has symptoms or when other test results are unclear. That type of scan provides more detailed information, but it is not used as a routine screening test for people who don’t have symptoms.
When imaging helps us identify risk earlier and more accurately, it allows us to tailor prevention strategies to the individual. That might include lifestyle changes, starting or adjusting medications, or sometimes reassurance when risk is low. The goal is always the same: to intervene early and reduce the chance of a heart attack before it ever happens.
We hear a lot about cardiovascular disease. What is cardiovascular disease, exactly?
It’s actually a whole suite of conditions. There are three main classes of cardiovascular disease. There are diseases of the arteries, such as coronary disease of the heart. There are diseases of the heart muscle, such as heart failure. And there are diseases of the electrical system or conduction systems, such as arrhythmias.
When people use the term “cardiovascular disease,” they usually refer to coronary artery disease because that’s the most common and lethal condition. It kills more people around the world than anything else. While we started to see improvements over the past four decades, we’re unfortunately starting to see an increase in cardiovascular mortality, largely due to the twin epidemics of obesity and diabetes. Coronary artery disease is the leading cause of heart attack.
Can someone be at risk for a heart attack, even if they don’t feel symptoms?
Yes. Even if someone doesn’t feel any symptoms, they still may be at risk of a heart attack. Half of people who have a heart attack will experience typical symptoms first. They’ll say something like, “Every time I go up a flight of stairs or every time I walk four blocks, I get chest pressure.” Then they’ll come into our office for stress tests, maybe the stress test is positive, maybe a blockage is found, and maybe they’ll get a stent or bypass surgery, go on medications, and change their lifestyle. Even though that sounds like a bummer, that’s actually the better-case scenario.
The worst-case scenario is the other half of people who will have a heart attack but will not experience any symptoms. All of a sudden, they’ll have an unheralded heart attack, or worse, sudden cardiac death. That’s why it’s important for everyone to learn about heart health, and not to wait until they think they have reason to worry.
If someone doesn’t have symptoms but has concerns about their heart health – perhaps they have a family history of heart problems -- how can they learn about their risk?
Their primary care provider may recommend a screening test for coronary disease that can detect calcium build-up in their coronary arteries. It’s like a mammogram for the heart. If the test reveals a risk, we can suggest lifestyle recommendations or think about some preventive medicines.
The good thing about heart disease is that we have effective strategies to mitigate risk, which is exactly why we screen for it. There are good things we can do to dramatically lower a person’s risk, and the sooner we get started, the more they’re going to work.
How can someone reduce their risk for cardiovascular disease?
The main categories include a high-quality diet, regular physical activity, weight management and tobacco cessation. But it’s hard to ask people to do everything at once. What if someone feels overwhelmed and they want to start somewhere? First, if they smoke, they should start a smoking cessation program to help them stop smoking. If they don’t smoke, they should start by adding physical activity.
People can be scared to see a cardiologist because they’re worried that we’re going to tell them to do all these horrible things, like we’ll tell them to run five miles a day, eat blueberries and leaves and sticks. It’s not like that at all! The truth is, what wins at the end of the day is low- to moderate-intensity physical exercise. If you can go for a walk for 45 to 60 minutes most days of the week, that’s the way to go for cardiovascular health.
What message would you like people to understand about cardiovascular disease?
This is a disease that is preventable. We can’t say that for most diseases. We know the recipe, so to speak, but it’s a matter of finding people who are at risk and finding them at the right time. The earlier we can find these patients, the more good we can do for them. It’s the reason why I love what I do: It’s all about saving people from ever having a heart attack in the first place, which is a beautiful thing.
How healthy is your heart?
Complete a short heart health assessment to find out if you are at increased risk of developing heart problems.
In addition to Dr. Shapiro, Megan Broman, PA-C, and Nigella Siegl, NP-C, are among the advanced practice providers (APPs) leading this effort, working closely with patients to prevent heart disease.
For questions or more information, 336-716-WFHV (9348).
