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HHelp Warraich is a cardiologist at Duke University Medical Center in Durham, North Carolina. His medical training began in his native Pakistan, and this fall he will join the faculty at Brigham and Women's Hospital at Harvard Medical School and the VA Boston (Veterans Affairs medical facilities). In his book State of the heart, he looks at the history, science and future of heart disease and says it has become a neglected disease.
People are more likely to survive a heart attack today, but heart disease remains the deadliest in the world. Why is that?
Over the last few decades, we have gone from a heart attack from one almost certainly fatal diagnosis to one that the vast majority of patients can recover from. However, these advances mean that people live long enough to develop other conditions, including heart failure, a chronic condition in which the heart is unable to flow blood throughout the body.
What kills people today is a chronic disease. Unless we change our health care system so that it focuses on chronic diseases and we have lifelong patient contacts rather than waiting for them to get sicker, we will continue to have this shift.
What is the biggest advance in heart health in your opinion? went unnoticed?
Until recently, open heart surgery was the only way to treat a disease called aortic stenosis. The aortic valve is the last valve of the heart in which blood must flow in order to reach the rest of the body. As you get older, it begins to thicken and harden. This increases the pressure exerted by the heart to force blood to enter the body and can cause many strains on the heart.
But the last decade has seen the development of a new procedure called transcatheter aortic valve replacement (TAVR). Cardiologists are able to replace the valve with a minimally invasive procedure. They insert this valve into the veins of your leg and wrap it up to the heart. Recently, Mick Jagger completed this procedure and only a few days after returning to tour, he was dancing – you would not have a clue about having it done.
You suggest that one of the reasons people do not take heart disease seriously is that they think that it's their fault. How much does food contribute to the health of our heart?
For many patients, it's not something they control. For example, if a woman who gave birth develops postpartum cardiomyopathy, she could not have done anything to avoid it.
At the same time, there are many heart diseases for which you can reduce the risks by changing your lifestyle. In our modern lifestyle, we do everything in our power to hurt the heart: our daily activities are not very aerobic, the food we eat is highly processed, the salt we consume is much more than we we need and the stress we are experiencing is considerable. It seems that every fact of life has been designed to add fuel to this fire.
What steps do you take in your own life to maintain a healthy heart?
One thing I try to do is run maybe once or twice a week, although I could probably do more. The diet for which we have the best evidence is probably the Mediterranean diet. I am therefore using a lot more olive oil, nuts and healthy fats. This is something that I changed based on my reading of the evidence.
But an important factor in my risk is that I am a South Asian man and that South Asians are at an incredibly high risk of heart disease. This has not been much recognized until recently.
Research has badociated endurance sports with an increased risk of atrial fibrillation (ALie), a type of irregular heartbeat with which live 1 million Britons. Is there a chance that too much exercise is really bad for our heart?
What we have seen is that it is mainly a J-shaped curve: very little exercise is bad, and there is evidence that there is too much exercise. But I have rarely been in a situation where I asked a patient to reduce his amount of exercise. Our challenge is really to get people to exercise as much as possible. The benefits of exercise are so prevalent.
Do you think that totally artificial hearts will ever become a reality?
I think they could. But for now, we have done better with a mechanical pump sewn into the heart, called left ventricular badist device (LVAD). The experiences of these patients are unlike any other human being who has ever lived. Most of them do not have a pulse. Listening to their chest, you actually hear the pump running. If they lacked batteries, they could die, sometimes instantly. But they also represent the dawn of a new age. People have always planned that someday we would be transhuman, but that moment has already arrived. Patients with LVAD, who have tens of thousands of people around the world, are a living example.
Heart attacks are often lacking in women because they look different of those in men. What can we do to solve this problem?
A misconception that still persists for many is that heart disease is a human disease. Heart disease can occur later in women than in men because they have some protection against female hormones, but if you look at the whole life of your life, heart disease kills as many women as you do. # 39; men.
Not only are many women not paying attention to their hearts, this is also true of clinicians. Often, we mistakenly think that women with heart disease may have something else to do. We are better than a few years ago, but the road ahead is still long.
Do you foresee a future in which we all wear a heart monitor this inform to our doctors when something irregular happens to happen?
The Apple Watch is already receiving similar information, and there are other devices that are even more effective at evaluating the heart. So it is not just something that will happen in the future, but it is currently the subject of a thorough study. For me, this represents the democratization of the ECG. [electrocardiogram]. I think it's going to be very good for a lot of patients. But I'm also worried that this will create a lot of false alarms.
It also highlights the fact that heart disease is becoming more and more a disease of socially disadvantaged people. Affluent people can afford healthy lifestyles and healthier foods and have access to technologies to monitor their own health. Heart disease could go from a medical illness to an economic illness in which having heart disease becomes synonymous with poverty.
Can you die from a broken heart?
It's possible – but you'd be surprised at what's breaking people's hearts. This is a condition called Takotsubo cardiomyopathy, first reported by Japanese cardiologists who saw many mostly elderly women enter after emotional trauma to the weakened heart. The mortality due to this disease is the same as that due to a heart attack, so it must be taken seriously.
People traditionally thought that Takotsubo was the result of a divorce or death of a loved one. But any type of emotional overload can increase the risk, even the joy. Studies show that the most common cause of the syndrome is in fact work-related stress. The data show that work-related stress is really one of the factors of this heart disease epidemic.
What do you think will be the next big medical advance in our hearts?
We already have so many medications that can help you live longer and better. The question is, how do we make sure that all patients who benefit would get them and take them? So many patients with high cholesterol do not take any cholesterol medications. So many patients with heart failure could benefit from simple medications, but they do not take them.
What could define the next decades is not a revolutionary technology, but a reflection on how we can achieve the progress we already have for patients, not just in the UK or the US, but in the worldwide, in China, Pakistan and India.
• State of the heart by Haider Warraich is published by Ingram International (£ 29.99). To order a copy, go to guardianbookshop.com. UK free p & p on all online orders over £ 15
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