Preventive cardiology


Preventive Cardiology: Keeping Heart Disease Risk Factors at Bay

Baptist Health Miami Cardiac & Vascular Institute

Optimal cardiovascular health — as measured by the American Heart Association’s "Life’s Essential 8" checklist of healthy habits — can slow biological aging by at least six years, a new study found. That was just the latest research to confirm how heart disease can be well managed, and most significantly, prevented.

Preventive cardiology is a subspecialty that is widespread and becoming more necessary as rates of obesity and diabetes continue to climb nationwide. February is American Heart month, a time to remind everyone of the importance of cardiovascular health and taking action to help lower the risk for heart disease, stroke and other major health problems.

“Preventive cardiology is very important because many discussions with patients can involve nonmedical interventions,” explains Patrick Azcarate, M.D., a cardiologist with Baptist Health Miami Cardiac & Vascular Institute. “I spend time speaking with them and getting the nitty-gritty about their dietary modifications and exercise routines. There are so many things that patients can do in their day-to-day span where they can fix that problem themselves without medications.”

Patrick Azcarate, M.D., cardiologist at Baptist Health Miami Cardiac & Vascular Institute.


Coronary artery disease (CAD), more commonly known as heart disease, remains the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. The American Heart Association’s Life’s Essential 8 metricsincludes healthy sleep, not smoking, regular physical activity, healthy diet, ideal body weight, and optimal levels of blood glucose, cholesterol and blood pressure.

Recent studies have found that even less than 10,000 steps a day can benefit individuals with heart disease risk factors. One study by research teams from the U.S., Netherlands and Spain concluded that 8,000 daily steps can prevent the risk of early death from heart disease.

Dr. Azcarate says he has seen patients vastly improve by becoming more active in between visits to the doctor’s office. “I've seen quite a few patients in the last year saying: ‘I did what you recommended. I started working out and my palpitations improved. I started going on walks and I have lost weight, my blood pressure has improved." And we've been able to stop some medications for these patients. The goal is to avoid medications and only use them if absolutely needed.”

For substantial health benefits, U.S. guidelines call for adults to get at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity exercise, such as brisk walking, jogging or cycling. Adults should also do some muscle-strengthening activities of moderate or greater intensity that involve all major muscle groups on two or more days a week

The Dangers of Ignoring Risk Factors

Despite ongoing campaigns to educate the public about Life’s Essential 8 checklist, many younger or middled-aged patients ignore early signs of heart disease by becoming complacent about risk factors such as high blood pressure or high cholesterol. They do so because they haven’t had any symptoms that has affected their daily lives – thus far.

One of the frequent responses I get when people come in for hypertension is: ‘But I've always had hypertension.’  But that’s not reassuring,” says Dr. Azcarate. “Hypertension is a silent disease. High blood pressure is quite common and, most of the time, it has no symptoms. So, they feel good. And then someone says: “I have had high cholesterol since I'm 20 but nothing bad has happened.’ And now they’re 50-years-old. This is a big misconception -- that prior ‘success’ does not guarantee future success.”

Dr. Azcarate emphasizes that there is no guarantee of have no problems in the future because you have not had any problems from one or two risk factors.  “So I tell patients: ‘I  hope you do not have a heart attack or a stroke, but I don’t have a crystal ball. And based on other patients that I’ve seen similar to you, you are at a high risk for developing more serious conditions. Here are some things I recommend to lower that risk.’ “

Here is Life’s Essential 8 list as stated by the American Heart Association:

1. Eat Better: Aim for an overall healthy eating pattern that includes whole foods, lots of fruits and vegetables, lean protein, nuts, seeds, and cooking in non-tropical oils such as olive and canola.

2. Be More Active: Adults should get 2 ½ hours of moderate or 75 minutes of vigorous physical activity per week. Kids should have 60 minutes every day, including play and structured activities.

3. Quit Tobacco: Use of inhaled nicotine delivery products, which includes traditional cigarettes, e-cigarettes and vaping, is the leading cause of preventable death in the U.S., including about a third of all deaths from heart disease. And about a third of U.S. children ages 3-11 are exposed to secondhand smoke or vaping.

4. Get Healthy Sleep: Most adults need 7-9 hours of sleep each night. Children require more: 10-16 hours for ages 5 and younger, including naps; 9-12 hours for ages 6-12; and 8-10 hours for ages 13-18. Adequate sleep promotes healing, improves brain function and reduces the risk for chronic diseases.

5. Manage Weight: Achieving and maintaining a healthy weight has many benefits. Body mass index, a numerical value of your weight in relation to your height, is a useful gauge. Optimal BMI is 25. You can calculate it online or consult a health care professional.

6. Control Cholesterol: High levels of non-HDL, or “bad,” cholesterol can lead to heart disease. Your health care professional can consider non-HDL cholesterol as the preferred number to monitor, rather than total cholesterol, because it can be measured without fasting beforehand and is reliably calculated among all people.

7. Manage Blood Sugar: Most of the food we eat is turned into glucose (or blood sugar) that our bodies use as energy. Over time, high levels of blood sugar can damage your heart, kidneys, eyes and nerves. As part of testing, monitoring hemoglobin A1c can better reflect long-term control in people with diabetes or prediabetes.

8. Manage Blood Pressure: Keeping your blood pressure within acceptable ranges can keep you healthier longer. Levels less than 120/80 mm Hg are optimal. High blood pressure is defined as 130-139 mm Hg systolic pressure (the top number in a reading) or 80-89 mm Hg diastolic pressure (bottom number).

Healthcare that Cares

With internationally renowned centers of excellence, 12 hospitals, more than 27,000 employees, 4,000 physicians and 200 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties, Baptist Health is an anchor institution of the South Florida communities we serve.

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