Heart Health: Prevent Heart Attacks with Early Detection and Proactive Action

Welcome to the deep dive. Today we're uh really plunging into something vile, maybe even a bit surprising. We're digging into this core idea. What if the way we think about the biggest health threat out there, what if it's all wrong? Because, you know, the science, it seems to suggest we should be tackling heart disease with well, the same kind of urgency, the same proactive approach we use for cancer.

Absolutely. And the scale of this, it's it's really quite staggering when you look at the data the science has uncovered. I mean, heart disease isn't just a major killer. It is the number one killer in the US anyway. Just think in 2022 over 941,000 Americans died from cardiovascular disease. And globally, it's like someone dies from it every 1.7 seconds. It's relentless. But here's the statistic that uh really stops you in your tracks. It underscores why just waiting for symptoms is so dangerous. Over half, more than 50% of people who have a heart attack had absolutely zero symptoms beforehand. None.

Wow. Over half. That really um that really changes things, doesn't it? It makes you ask Okay, if the stakes are this high, why are we so often just waiting, waiting for symptoms before we act? So, our mission today for this deep dive is to unpack that. Why is being proactive so critical here? What does the science actually tell us about getting ahead of this? And importantly, how can you listening now feel more empowered with, you know, better information and tools?

It is pretty astonishing, isn't it, that despite being the number one killer, heart disease often doesn't get that same aggressive uh early detection focus that cancer does.

Right? We have things like mammograms, colonoscopies. We actively look for cancer early. Well, for heart disease, it often feels more like uh let's wait and see, maybe check cholesterol.

Exactly. And the core argument you see in the studies from experts like Dr. Joel Khan is precisely that heart care should mirror cancer care. It means a big shift. Proactive screening, proactive treatment before any symptoms show up. So, not just the usual approach then, which is often what? Wait for symptoms, maybe a cholesterol test, possibly a stress test if something seems off.

Yeah, that's the traditional model. Contrast that with how we approach cancer. Those regular screenings, CT scans, actively searching for the earliest signs.

Okay, here's where it gets really interesting. Imagine applying that same vigilance, that active search to our hearts. What would that look like?

Well, first it helps to remember what we're looking for. The science is pretty clear on the main drivers of heart attacks. It's the stuff we often hear about. High blood pressure, high cholesterol definitely diabetes or pre-diabetes smoking is a big one obesity inflammation also just not moving enough a sedentary lifestyle and of course an unhealthy diet they all play a role.

Right those are the usual suspects but this next part this is really empowering I think studies suggest that up to 85% of heart attacks are actually preventable. 85% that shifts it from feeling helpless to feeling like okay there's something real we can do here.

Precisely it means action matters a lot.

So what does this mean for you listening? It means there's a lot we can do. It does. And it brings us to this uh this really critical shift in thinking about detection. Tests don't guess because the science shows like we said many people have heart disease, plaque in their arteries and they just don't know it. They feel fine. So we can't just guess based on cholesterol or how you feel. We need to you know actually look at the arteries.

Okay. So test don't guess. That means using specific tools.

Right? What does the science recommend? What are these modern tests?

Yeah. Exactly. There are some key ones. A foundational test is the coronary artery calcium score. Uh CCS for short. It's basically a quick CT scan, low-cost, non-invasive, and it looks for calcium, which is a marker of plaque buildup in your heart's arteries. And study after study shows it predicts your future risk way better than just looking at cholesterol levels alone because you're seeing the actual disease.

So, it's like getting a direct look instead of just looking at risk factors.

Exactly. And then there's an even more advanced scan, the coronary CT angography or CCTA. This one often uses AI technology to help analyze the images and its power is that it can see the plaque inside the artery walls. Even the plaque that isn't causing a major blockage yet, the soft stuff, it helps spot those early signs, including the really dangerous types of plaque.

Dangerous types. So, not all plaque is the same.

That's a crucial point. No, it's not all the same. You can have hard, stable, calcified plaque, but you can also have soft, fatty, inflamed plaque. And that soft stuff, even if it's not causing a big blockage, is much more likely to rupture and cause a sudden heart attack.

Ah, okay. So, it's not just if you have plaque, but what kind of plaque?

Precisely? And these advanced CCTA scans, especially with AI analysis, can help tell the difference. That really guides treatment. It helps understand the real risk. It reminds me of that quote from Dr. Ernest Schaefer. The best test for heart disease risk is to actually look for heart disease. Direct visualization.

Makes perfect sense. And there's actual evidence showing this approach works better in practice. Right. Like the transform study.

Yes. The transform study is a great real world example. They took I think it was over 7,000 patients who had risk factors. They split them up. One group got the usual standard care, you know, based on risk factors and symptoms. The other group got CCTA imaging and their care was then based on what the scan actually showed like the stage of any disease found.

And the results?

The CCTA group did better. They had better targeting of treatments and ultimately better prevention of major heart events. like heart attacks. It really supports the idea that looking directly helps you manage the risk more effectively.

No, that really drives it home. It also blows up that idea that if your routine lab work looks normal, you're automatically okay.

Oh, absolutely. That's a common and potentially dangerous misconception. There's one study, it's pretty shocking, actually. It found that 77% 77 of patients hospitalized for heart attack had LDL cholesterol levels that were considered normal by standard guidelines. So, under 130 mil GDL. Wow. 3/4ers had normal cholesterol. That tells you loud and clear that standard labs aren't catching everyone. Not by a long shot.

Exactly. It shows the need to look beyond just those basic numbers.

So besides the plaque we can see with imaging, are there other like hidden risks, things that routine tests might miss entirely? You hear about things like LPA.

Yes. Uh lipoprotein A or LPA is a really important one. It's definitely a hidden risk factor for many people. It's largely genetic. meaning you inherit your level and it significantly increases risk for heart attack and stroke independent of cholesterol sometimes. The tricky part is it's almost never included in a standard cholesterol panel. You usually have to specifically ask your doctor to test for it.

So that's something listeners can actively do ask for an LPA test. It's just a blood test.

Just a simple blood test, but it can give you a really crucial piece of information about your personal risk profile that you wouldn't otherwise know.

Okay. Now after all this about detection and risk, let's shift to something really positive because the science isn't just about finding the problem earlier. It also offers some pretty amazing news. Heart disease can be reversible.

It absolutely can be. That's perhaps the most motivating message in all of this. The research is clear. With the right tools to know what's going on, combined with, you know, targeted diet changes, the right medications if needed, and significant lifestyle adjustments, you can actually shrink plaque. Arteries can heal. Heart disease can improve. It can regress. Yes, it's not necessarily a one-way street.

That's incredible. But it links back directly to what we started with, doesn't it? This kind of reversal, this healing, it's really only possible or at least much more likely if we find the disease early and we treat it seriously right from the start, just like we aim to do with cancer. It changes everything.

Exactly. Early detection opens the door to prevention and even reversal rather than just managing a crisis after it hits.

Okay, so let's quickly recap the big takeaways from our deep dive today.

• First: Maybe the biggest shift — treat heart disease with the urgency and proactive strategy we use for cancer. Find it early. Treat it aggressively.
• Second: Don't just wait for symptoms. Over half of heart attacks happen without warning signs. Waiting isn't a strategy.
• Third: Utilize the better diagnostic tools available now, like the CACS and especially CCTA, potentially with AI, to really see your risk. Test, don't guess.
• Fourth: Remember those hidden dangers. Ask about tests like LPA to get a fuller picture.
• Finally: The focus really needs to shift fundamentally towards prevention and early intervention, not just reacting after a heart attack or stroke.

And thinking about all this, it does raise a bigger question, doesn't it? If we know how to look for heart disease directly, and we know it's often preventable and even reversible, how do we sort of collectively push for a healthcare system that truly prioritizes this kind of proactive prevention over just managing crises after they happen? Something to think about.

That's a powerful thought to end on. Thank you for diving deep with us today on this crucial topic. Until next time, keep learning, keep asking questions, and keep advocating for your own health.