Heart Disease Awareness: Understanding the Risks & The Path to Prevention

February is Heart Disease Awareness Month and helps us to rededicate our resources to Coronary Heart Disease (CHD), the leading cause of death around the world. Although there is interest in screening for CHD, questions persist regarding the appropriateness, cost-effectiveness, and optimal approach to such screening. In my Podcast with Dr. Chung Yoon, we learned that testing for Lp(a) can help anticipate CHD in otherwise low-risk individuals, but the marker cannot otherwise be modified. It’s in your DNA.

Understanding CHD Screening vs. Risk Estimation

Screening for CHD should be distinguished from the estimation of risk for CHD. Both are performed in asymptomatic people and aim to improve outcomes with interventions if indicated. However, screening for CHD identifies existing disease rather than the likelihood of future events related to CHD.

The Role of Awareness in CHD Prevention

Throughout Heart Disease Awareness Month, a variety of educational campaigns are launched to inform the public about the nature of heart disease and its risk factors, which include:

• High blood pressure
• High cholesterol
• Smoking
• Obesity
• Physical inactivity
• Diabetes

These campaigns aim to educate people about the signs and symptoms of heart disease, such as chest pain, shortness of breath, and fatigue, encouraging them to seek medical attention promptly if they experience any of these warning signs.

The Challenge of Detecting CHD Early

The hardest part is finding patients before it’s too late. Symptoms of the disease often appear late. For women, the two most common symptoms of heart disease are fatigue and poor sleep—symptoms that many experience regularly. Under these circumstances, how do we anticipate or effectively screen for CHD? The first step is awareness.

CHD Screening: Who Should Be Tested?

Heart disease is the leading cause of death for women in the United States, which is why the first Friday of February each year is National Wear Red Day for Women. But should all women be screened every year, and if so, how?

High-Risk Groups for CHD Screening

Candidates for CHD screening are generally members of one or more "special populations," where a CHD event may pose unique or additional risks. These include:

• Pilots and Department of Transportation (DOT) drivers
• Asymptomatic patients with diabetes mellitus
• Those with a high estimated ASCVD+ score

Best Screening Methods for CHD

Screening should be tailored to the patient. If the candidate can exercise, an exercise test is the most appropriate and useful test for individuals at high risk of coronary heart disease.

According to UpToDate, the following tests are not recommended for CHD screening due to poor sensitivity and specificity:

• Resting 12-lead ECG
• 24-hour ambulatory ECG monitoring
• Blood tests (e.g., C-Reactive Protein) for diagnosing asymptomatic atherosclerosis and CHD

It is crucial to distinguish between risk estimation and screening, as they serve different purposes. However, the biggest challenge remains: How do we treat CHD once it is found?

Conclusion: The Importance of Heart Disease Awareness Month

Heart Disease Awareness Month is a crucial observance that highlights the importance of cardiovascular health and empowers individuals to take proactive steps in preventing heart disease. Through education, screening, lifestyle changes, and community support, this month serves as a catalyst for improving heart health and reducing the impact of heart disease on individuals and society.

By working together, we can make significant strides in combating this pervasive health issue and ensure a healthier future for all.

Written by Dr. Jeff Stone