Senator Bernie Sanders, a democratic candidate running in the 2020 presidential election, was recently hospitalized to have stents put into two of his coronary arteries to restore blood flow to and from his heart. It was later revealed he was actually hospitalized for a heart attack. Until further notice, Mr. Sanders has cancelled all of his campaign appearances. Mr. Sanders, who is 78, tweeted on the day following his surgery that he was "feeling good. I'm fortunate to have good health care and great doctors and nurses helping me to recover." Senator Bernie Sanders is known for his grueling campaign schedule, and during his first presidential campaign, in 2016, released a letter from his doctor stating that the senator had "no history of cardiovascular disease."5
As Life Line Screening is in the business of helping people understand their risk for developing cardiovascular disease, we naturally ask ourselves if Mr. Sanders' need for stents, or if the plaque buildup in his arteries could have been prevented.
The answer is that there is really no answer. Heart disease is the #1 cause of death for men and women, not only in the U.S., but worldwide.1 Many, many people have cardiovascular disease, and for some of these people, the first symptom they feel is chest pain (as Mr. Sanders experienced), other physical symptoms, or a full blown heart attack or stroke. So despite the fact that so many people have cardiovascular disease, diagnosis often comes too late, and only after a catastrophic (or near catastrophic event). In fact, for 4 out of 5 people who have a stroke, the first symptom is the stroke.2 The biggest opportunity for prevention comes in understanding your risk for developing cardiovascular disease, and working with your doctor to minimize your risk factors and possibly prevent these events from occurring.
Understanding Risk for Cardiovascular Disease
Using medical data and research around how cardiovascular disease develops, the medical community has identified these key risk factors for the development of cardiovascular disease:
- Age 55+
- A family history of cardiovascular disease or stroke
- High blood pressure
- High cholesterol
- Smoking (past or present)
Some of the risk factors listed above are modifiable with lifestyle changes (which is much easier said than done) but heart disease can also run in families, meaning it is genetic. Not everyone can prevent the development of cardiovascular disease, no matter what their eating habits are or how much they exercise. But taking a few simple steps can help to minimize the risk of developing cardiovascular disease:
- Manage high blood pressure: If you have been diagnosed with high blood pressure (also known as hypertension), work with your doctor to develop an effective treatment plan. Your doctor will most likely want to try exercise, a low-fat diet and weight loss first, but medication can also help a great deal.
- Lower your cholesterol: All adults age 20+ should have a lipid panel blood test to identify the level of HDL cholesterol, LDL cholesterol, and triglycerides. Again, the first step in lowering cholesterol is eating a diet mostly of fruits and vegetables, low-fat dairy products, and very low in saturated fats. Many doctors recommend the Dietary Approaches to Stop Hypertension (DASH) diet, which you can learn about at this link. If diet modification alone is not effective, your doctor may prescribe medication to lower your cholesterol level.
- Manage diabetes: If you have diabetes, it is critical to take your medication, follow the diet ordered by your doctor, and have your HbA1c tested regularly. Diabetes is one of the primary risk factors for developing cardiovascular disease.
- Lose weight: Studies have shown that even a 5% reduction in total body weight can reduce the risk of developing diabetes and cardiovascular disease.
- Get moving: The benefits of exercise are far reaching, including aiding in weight loss, improving cholesterol levels, building the ability of the heart to pump blood, and improving mood.
- Stop smoking: We know you have heard it before, but what you may not know is that there are more medical options to help people overcome nicotine addiction than ever before. Talk to your doctor about what options are available for you.
- Investigate your screening options: There are affordable screening options available, including consumer pay screenings that do not require insurance or a doctor to order them. More on that in the screening section below.
Screening for Cardiovascular Disease
Screening methods that can actually identify the presence of cardiovascular disease are available, but access to these tests can be a complicated process. Unless you are actively experiencing symptoms of cardiovascular disease, your insurance may not cover the cost of diagnostic testing for cardiovascular disease, even if you are a presidential candidate. It can also be expensive. Much of standard insurance coverage is based on treatment, not prevention, so when someone experiences chest pain like presidential candidate Senator Sanders did, access to the diagnostic and treatment tools becomes available. The good news is that there are options available for people to take control of their health and get screening tests that provide concrete data around their risk for cardiovascular disease that they can discuss with their doctors:
- Carotid artery ultrasound: A simple, painless and non-invasive ultrasound of the carotid arteries can identify the presence of plaque, which can affect the blood flow to the brain. Carotid artery disease is a form of atherosclerosis, and most of the time develops without symptoms. People with carotid artery disease have a higher risk for developing artery blockage elsewhere in the body, including the coronary arteries, which is where Senator Bernie Sanders had artery blockage (requiring the stents). You can learn more about carotid artery disease and screening options at this link.
- Peripheral Artery Disease (PAD) screening: PAD is when the large and/or medium sized arteries supplying blood to the legs become narrow or clogged with plaque, constricting the flow of blood. As with carotid artery disease, PAD is a form of atherosclerosis, and people with PAD have a higher risk for developing artery blockage elsewhere in the body, including the arteries around the heart. Screening is simple and non-invasive, requiring only the removal of your socks and shoes. Read more about PAD and the screening process at this link.
- Atrial Fibrillation screening: Atrial Fibrillation (Afib) is an irregular heartbeat (also known as arrhythmia) that occurs when the upper chambers of the heart (the atria) do not beat at a regular pace. Because of the fibrillation, the heart sometimes does not pump all of the blood out of the atria, and blood can pool, causing blood clots. When blood clots travel to the brain, it causes a stroke. People with Afib are 5 times more likely to have a stroke.3 Find out about simple and painless Afib screening here.
- High-sensitivity C-Reactive protein screening: C-Reactive protein (CRP), a by-product of inflammation in the body, has been linked by many studies to heart disease.4 With a finger-stick blood test, a CRP test can indicate that inflammation is present in the body, potentially because plaque is building up in the arteries. This is because plaque in the arteries actually injures the arteries, causing inflammation and higher levels of C-Reactive protein in the blood. High-sensitivity screening is an advanced level of analysis; detecting even small changes in the C-reactive protein levels in the blood. This is important when evaluating a person's overall risk for developing cardiovascular disease. Learn more about the CRP blood test by clicking here.
- Complete Lipid Panel (cholesterol screening): This simple blood test provides the important cholesterol information discussed above in the risk factors for cardiovascular disease section. All adults age 20+ should have a lipid panel blood test to identify the level of HDL cholesterol, LDL cholesterol, and triglycerides. Excess cholesterol in the blood can bind with proteins and start building up in the arteries as plaque, leading to atherosclerosis. Plaque buildup in the arteries is a major risk factor for heart disease and stroke, which is why monitoring cholesterol levels in the blood is so important. Learn more about the benefits of this screening here.
While there is no guaranteed way to prevent all forms of cardiovascular disease, there are steps people can take to understand their risk for cardiovascular disease and work with their doctors to manage the risk.