Prof. Julian Halcox is cardiology specialist working for the NHS and at Sancta Maria Hospital in Swansea. He is a Professor of Cardiology at Swansea University and Honorary Consultant Cardiologist at Singleton and Morriston Hospitals. Prof. Halcox is considered an international opinion leader in the field of preventative cardiovascular medicine. He has recently led a major multidisciplinary review of cardiovascular disease prevention strategy in Wales. Here, he talks about the warning signs of coronary disease, how it can be identified and treated and what you can do reduce your risk of developing heart disease in the future.
Coronary disease can be considered a hidden health issue for many as the build-up of the fatty deposits that cause blockages in the coronary arteries can be a gradual process over several years. Patients are often unaware that their heart’s blood supply is being blocked or restricted in this way until a major event such as a heart attack brings this issue to the fore. Unfortunately fatalities and long-term damage are more likely to occur when heart attacks happen out of the blue.
So what are the main symptoms of coronary disease and when should you seek medical assessment? The most serious symptom is sudden severe chest pain, usually described as a feeling of heavy pressure or constriction, often accompanied by sickness and sweating. If you experience this for 15-20 minutes or more, you should seek emergency medical attention, as it could be a heart attack or a threat of one. Other symptoms that develop over time can include discomfort in the chest at times of exertion or emotional distress. This discomfort can often start in the middle of the chest and radiate to the neck, shoulder, arm and hand but will typically ease off after a few minutes of rest. Many patients liken this to indigestion and will ignore symptoms of heart disease but it is always worth seeing your GP if you have any concerns. Shortness of breath with exertion is also a cause for concern, particularly in older people and those with diabetes. Although a wider range of problems such as lung diseases, can cause breathlessness, I would recommend seeking medical attention if this symptom persists.
Certain factors can make a patient more pre-disposed to developing coronary disease than others, including increasing age and being male. Heart disease is the biggest killer of women, with the risk of developing coronary disease increasing more rapidly post-menopause and developing coronary disease 5-10 years later than men on average.
Smoking, low levels of physical activity, obesity – particularly around the hips and stomach and increased alcohol intake are all lifestyle factors that can increase a patient’s risk profile, at any time of their lives. These can lead abnormalities in lipids such a cholesterol and triglycerides in the blood which are indicative of cardiovascular disease.
A family history of heart disease can also increase your risk and would be a factor in considering early assessment for the disease. As well as genetic factors, shared behavioural patterns within families can contribute to the risk factor profile and consequent risk of heart attacks.
You don’t need to be in the dark when it comes to knowing about the health of your heart. If you are suffering with any of the symptoms outlined above, you have a known family history of coronary disease, or you are concerned about your lifestyle and how this is affecting your cardiovascular health then visit your GP. You will receive a cardiovascular risk assessment which will include a blood pressure check, a blood test to assess your cholesterol level and a discussion about your medical and family history. From there, if you are identified as being at high risk, a treatment strategy will be created for you for and you may need to take medication such as statins which reduce the harmful cholesterol carrying particles circulating in the blood and you may be advised to alter your lifestyle.
If after an NHS risk assessment shows that you are not a high-risk patient, but you are still concerned because of your age or family history then you could seek additional, more advanced tests, privately. At Sancta Maria Hospital in Swansea, we offer additional assessments that can provide peace of mind and allow for early treatment of developing coronary disease. For example, we can refer patients, for a test for the presence of plaque in the vessels that supply blood to the heart using an ultra-fast CT scan. Identifying the presence of plaque, before it has led to a significant blockage is an important early indicator that the disease process has begun, increasing the risk of eventually experiencing the clinical consequences of heart disease. This important information would not be picked up from a clinical examination, blood tests and an electrocardiogram (ECG). Known as a Coronary Artery Calcium or CAC test, the results can help to determine a more specific treatment plan for patients whose risk status was not previously clear. Private patients will have access to this test which is not available to NHS patients for screening purposes. We also offer more detailed testing on the lipid profile in the blood, characterising the levels and nature of good and bad cholesterol (lipoproteins). These types of assessments are being sought more frequently by patients in their 40s who are keen to obtain a greater understanding of their own personal risk and how to take the most appropriate and effective steps to prevent the development of coronary disease.
Although heart disease is one of the biggest causes of premature death in the UK, new research is helping us to understand more about the condition and new treatments are emerging. One such emerging treatment for people with a high risk of cardiovascular disease involves using short interfering ribonucleic acid, or RNAi, to silence specific genes that can beneficially influence lipid metabolism and plaque build up. Although in the late development stage, we are hopeful that many of our patients will benefit from this soon.
Asides from medical treatment for coronary disease, changes in lifestyle can improve your cardiovascular risk. Giving up smoking, reducing your alcohol intake and increasing your physical activity can all have a positive impact on your health and particularly your cardiovascular health. Adopting a Mediterranean diet, avoiding processed foods, sugars and other refined carbohydrates as well as changing your cooking methods to grill or bake rather than fry or roast can also help patients to lose weight, improve blood pressure and cholesterol levels and reduce their risk of developing type II diabetes. If you are at all concerned about your cardiovascular health then see your GP.