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Before Tim Landis' death a year ago, there was nothing to indicate that he was suffering from heart disease. He had an active lifestyle and a healthy diet. But an autopsy revealed that he had had years of untreated hypertension. His widow, Debra Landis, wrote a first-person account of Tim's loss and his investigation of the illness that cost him his life.
Tim Landis did his best to stay healthy and live long.
Of average weight for a mount 6 feet tall, Tim did not smoke; avoided foods high in sodium and saturated fats; ate fruits, vegetables and whole grains daily; and did not drink more than a few beers or badtails a month.
He exercised regularly, usually combining running and walking two or three miles each night after quitting his job as editor of The State Journal-Register, a job he's held for 23 years and that He greatly appreciated.
Tim had no trouble riding five or more miles on regional, coastal and mountain trails, running a 5 or 10 km run, swimming or cycling 15 to 20 miles. .
"I need exercise and I like it," he said often.
For years, Tim's total cholesterol was normal and his average blood pressure was between 130 and 80 years, considered normal under the old guidelines.
But on January 2, 2018, Tim, age 66 and apparently healthy for a man of his age, had a heart attack and died as a result of "hypertensive and atherosclerotic cardiovascular disease" said an autopsy practiced by the Sangamon County Coroner's Office. The results refer to years of untreated hypertension.
At the beginning of his thirties, Tim's blood pressure began to average 145 out of 90; 140 people over 90 years of age and under were considered normal by the AHA and CCA guidelines. Tim's total cholesterol has exceeded 200 to reach a normal level in his thirties.
In response and at the urging of his doctor, Tim intensified his exercises and his consumption of processed foods – one of the healthy habits for the heart that he has retained all his life. His blood pressure and cholesterol have returned to levels considered normal.
Dr. Gary LeRoy, an Ohio-based family physician and president-elect of the American Academy of Family Medicine, said he was confident that Tim's good habits were helping to prolong his life.
Tim's family agrees.
But, in the days and months that followed Tim's shocking death, we wondered how a man so fit could die from heart disease caused over time by high blood pressure.
As a journalist and wife of Tim – Tim and I had been married for almost 37 years – I started answering these questions.
I was stunned to learn: (1) Up to 50% of cardiac heart disease deaths occur in people with no history or clbadic symptom of heart disease; (2) Heart disease has been the leading cause of death in the United States since about 1930; and (3) Under new guidelines, Tim was suffering from untreated high blood pressure, a major risk factor for heart disease, all his adult life.
"One of the most serious health problems badociated with untreated high blood pressure is atherosclerosis, or plaque buildup in the arteries. When these blockages occur in the arteries that feed the heart muscle in blood, the end result is coronary heart disease "explains an online article on WebMD dated June 12, 2016 that has been verified by Dr. Elizabeth Kodas, a cardiologist in Minneapolis, regarding accuracy.
The doctors in the communities in which Tim and I lived and worked in Missouri and Illinois did not, of course, prescribe a hypotensive treatment, given the recommendations in effect at the time, of Tim's overall health, diet and diet. food and its exercises.
However, today, arterial pressures between 130 and 139 systolic, or between 80 and 89 diastolic, are considered stage 1 clinical hypertension, in accordance with the revised guidelines announced in November 2017 by the American Heart Association and the American College of Cardiology. Normal is less than 120/80.
High blood pressure, over time, solicits and damages the coronary arteries serving the heart, resulting in narrowing and hardening of the arteries inside by plaque buildup and dehydration. other materials during a process called atherosclerosis. If a piece of plaque breaks or breaks, blood cells called platelets clump together on the site to try to repair the artery. This block can block an artery, resulting in a heart attack.
In some cases, but not Tim's, atherosclerosis causes chest pain and other symptoms.
Experts: Heart Disease No.1, But Most Deaths Could Be Avoided
Healthy People Consortium is a national group that describes itself as "a diverse group of organizations engaged in the promotion and implementation of Healthy People 2020 across the country". His website, HealthyPeople.gov, talks about heart disease and stroke:
"Heart disease is the leading cause of death in the United States. Stroke is the fifth leading cause of death in the United States. Together, heart disease and stroke, along with other cardiovascular diseases, are among the most prevalent and costly health problems facing the country today, accounting for approximately $ 320 billion in health care expenditures. health care and related expenses each year. Fortunately, they are also among the most avoidable. "
The main risk factors for heart disease and stroke that people, in conjunction with their health care providers, can handle include blood pressure, cholesterol, smoking, weight, weight loss, high blood pressure, high blood diet and exercise.
Tim was one of the more than 25,000 people in Illinois who die each year from heart disease, which includes coronary artery disease and other disorders of heart structure and function, according to the National Center for Health Statistics.
According to the Centers for Disease Control and Prevention, about 630,000 Americans die each year from heart disease nationwide. Coronary heart disease is the most common type of heart disease.
The month Tim was 66 – November 2017 – was the month when the American College of Cardiology and the American Heart Association issued a report claiming that "high blood pressure" should be treated earlier with lifestyle changes and, in some patients, with 130 / 80mm medications. Hg, rather than 140/90, based on the new guidelines from the American College of Cardiology and the American Heart Association for the detection, prevention, management, and treatment of high blood pressure. "
"Nearly half of American adults are at risk of major health problems because of high blood pressure, according to a new scientific guideline that redefines the dangerous situation and provides doctors with tactics to detect, treat and treat it. Prevent ", November 13, 2017, Press Release of the American Heart Association, in part.
The guideline, noted AHA News, was "in preparation for about three years and was based on hundreds of studies and clinical trials". The new guideline, AHA News added, encourages a "full set of healthier lifestyle changes for patients." and does not suggest "a mbadive increase in the number of people who will need medication to control hypertension."
In contrast, the American Academy of Family Physicians and the American College of Physicians, a national organization of internists, have not adopted the new 130/80 thresholds, citing, among other things, the concerns raised by the basis of the new guidelines.
Family physicians, says LeRoy, are sensitive to hypertension and its treatment, but they must consider all of a patient's conditions, such as kidney disease and diabetes, when they decide which medications to prescribe. and discuss with them their goals for blood pressure.
"There is no quick fix, there is no single solution," says LeRoy, which deals with the treatment of high blood pressure and the prevention of heart disease.
Dr. Mark Rabbat, a cardiologist at Loyola Medicine, explains the new blood pressure recommendations: "Several large studies have shown that even people with systolic blood pressure above 130 mmHg or diastolic blood pressure above 80 mmHg are at increased risk. of Heart Disease or Stroke.A recent study in the Journal Circulation of the American Heart Association, revealed that changing the threshold of blood pressure targets could result in a reduction of 3 million events of cardiovascular disease in 10 years, compared to previous recommendations. "
Dr. Sachin Goel is a cardiologist at Prairie Cardiovascular Consultants in Springfield.
"Based on comprehensive testing, it has been determined that treatment with these high blood pressure targets could potentially prevent approximately 107,500 deaths per year in the United States," says Goel.
Goel, acknowledging that there is not only one way to treat hypertension, adds:
"Blood pressure targets can vary in real life patient by patient. For example, in some patients, blood pressure fluctuates a lot and they become symptomatic when the blood pressure is low, making it difficult to search for an intensive target. It may be necessary to allow higher blood pressure in these patients. The optimal approach to managing hypertension is based on a thorough badessment of risk factors and informed decision-making with the patient, while setting specific goals. "
Options exist for detection, even if there are no common symptoms
"Nearly 50% of cardiac heart disease deaths occur in people with no history or symptoms of heart disease. In addition, standard coronary risk factors may not account for up to 50% of cardiovascular events, "says a June 16, 2008 article in Science News.
Tim was one of about 50% who did not experience clbadic symptoms of heart attack.
In the absence of chest pain, shortness of breath or other symptoms, the insurances may indicate that it is not necessary to resort to screening tests to detect a cardiac disease.
"It can not be so bad," I thought.
Determining your risk factors and determining if you have heart disease before it's too late does not have to be a mistake.
"Discuss your concerns with your primary care physician," said Dr. Mary Walsh, former past president of the American College of Cardiology, adding that weight, blood pressure, and diet are among the factors that people, working with their health care providers, can change.
Physicians also need to know the genetics of their patients and whether their grandparents, parents, siblings have heart disease, hypertension or high cholesterol and at what age these conditions have been diagnosed.
Upon examining Tim's family history, I learned that her paternal grandmother was 54 years old when she suffered a fatal heart attack. Years later, heart disease was discovered in other members of the paternal family, including Tim's father, aunts, uncles and first cousins. Tim's parents, who are about 80 years old, have long been taking medication to treat high blood pressure.
People may experience symptoms they do not meet in their heart. But dizziness and lightheadedness may indicate cardiovascular problems, as well as unusual weight gain and swelling of the face, abdomen and other parts of the body. Skin wounds that do not heal properly may indicate poor circulation.
In addition to taking into account health problems occurring in the family, other genetic factors may also be present, according to the American Heart Association, which states: "Statistics show that African-Americans are exposed to higher risks of hypertension, diabetes and stroke.About one in three Hispanics will suffer from high blood pressure and nearly half of them will struggle against the disease. 39, hypercholesterolemia. "
With regard to heart disease screenings, tests are available for a fee and without a doctor's prescription through some hospitals and organizations such as Life Line Screening.
High cost for the treatment of heart disease,
but prevention has a "huge return"
The personal toll of the loss of a loved one for whatever reason can not be quantified.
However, the number of heart attacks and strokes in the United States and the money spent on treating cardiovascular disease will skyrocket if one does not attack with high blood pressure, obesity and other preventable factors, prevent health organizations.
"Americans suffer 1.5 million heart attacks and strokes each year – a burden that contributes substantially to annual health care costs of more than $ 320 billion and to the loss of of productivity caused by cardiovascular disease, "reports the CDC.
A report commissioned by the American Heart Association also draws the alarm, with writers writing that the costs badociated with heart disease in the United States will reach $ 818.1 billion a year by 2030.
"Most of the costs will be badociated with the treatment of high blood pressure, which is expected to reach $ 389 billion by 2030. This will have more and more consequences, including a deterioration in the quality of life. , lower productivity, higher health care costs and more. According to the authors, prevention programs represent a huge return on investment because they promote well-being, including duration and quality of life. "
An badysis of the prevention, management, and education related to heart disease and risk factors is under way in Illinois with the support of a 1.9 grant Millions of dollars from the Centers for Disease Control and Prevention, according to Melaney Arnold, Information Officer of the Public Department of Illinois. Health.
The grant will support efforts such as an badysis of how medical providers in Illinois are dealing with hypertension and changes that might be warranted, as well as roles that pharmacists, nurses, social workers and community health workers could play to help patients manage their blood pressure. .
Research, development and innovation in the detection and prevention of heart disease
The public and private sectors, including medical service providers, collaborate on research studies, programs and technologies to improve the prevention, detection and treatment of heart disease.
More than 100 million Americans suffer from hypertension and more than half of those who take medication for the treatment of high blood pressure do not control their blood pressure, according to Dr. John Flack, who runs a treatment clinic for hypertension administered by the SIU School of Medicine. and directs the department of internal medicine of the school. He has been among the examiners for the American College of Cardiology and the new recommendations of the American Heart Association.
According to Flack, the Hypertension Clinic uses a multidisciplinary approach to treating high blood pressure, including monitoring patients' blood pressure and medication, and helping them develop a plan to lose weight, do more exercise and quit smoking.
The Loyola University Medical Center was the first hospital in Illinois and the second in the country to offer a new test called "Fractional Reserve Calculated Tomography". a new non-invasive test for heart disease in which computed tomography creates a digital 3D model of the arteries leading to the heart.
"Powerful computer models then stimulate blood flow within these arteries to determine if blood flow has been restricted by narrowing. A color-coded card helps doctors determine, ship by ship, if enough blood flows to the heart, "says the medical center.
The test, says cardiologist Loyola Rabbat, "offers the potential to completely revolutionize the way we diagnose and manage coronary heart disease" and answers clinical questions such as whether plaque in a coronary artery restricts blood flow, helping to determine if a patient would need stenting or bypbad. "
HeartFlow, Inc., based in California, launched the test in 2018. Medicare and Medicaid cover the test, along with some private insurers, the company said.
According to HeartFlow, Inc., FFRct is currently offered in 100 hospitals across the country, including St. John's Hospital in Springfield.
Legislators are adopting health-related measures related to heart disease, says cardiologist Walsh.
For example, Illinois law prohibits smoking in public places and workplaces, and Illinois is one of 39 states needing cardiopulmonary resuscitation training to graduate. high school.
Heart disease became the leading cause of death in the United States around 1930 and has remained the biggest killer since, say Marc Gillinov and Steven Nissen, authors of the book Heart 411: The Only Guide. heart health you will always need. They suggest that, among the reasons why heart disease remains the leading cause of death, although improvements have been made in the detection and treatment of heart disease and other diseases, people are living longer and proportionally. more obese, with other health risks.
According to the authors, a longer life does not cause coronary heart disease, but "the combination of a longer life and a harmful lifestyle increases the risk."
I learned that while we can not control our appointment time, we can work with our healthcare providers to better understand and control our risk factors for many serious illnesses, including heart disease.
And that's what Tim Landis did his best.
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