A HEART IN YOUR HANDS

Heart disease is the leading cause of death in Australia, yet it’s surrounded by misconceptions and remains very poorly understood. So what can we do to safeguard our heart health?

Heart disease is the leading cause of death, so what can we do to safeguard our health?

Dan Lowe arrived at his local gym for a 6am group work-out with a spring in his step. He’d just returned from a work trip and chatted to the reception staff about how he had managed to stick to his exercise regimen despite the change of routine. At 35, he was in good shape – “probably the fittest and lightest I’d been in five years,” he says.

He couldn’t have known it, but he was about to have a heart attack.

“I didn’t feel anything prior to provide me with any warning signs. It just happened. I was on the treadmill, six minutes into my session, and then I collapsed, going into cardiac arrest,” Lowe recalls.

Lowe was very lucky. He was surrounded by people who knew exactly what to do – a nurse, surf lifesavers and well-trained gym staff. CPR started almost immediately and a defibrillator (AED) was quickly used to shock his heart back into action.

“You hear stories about this happening to other people, but you never think that it will happen to you,” he says.

Lowe is one of over 180,000 New Zealanders and 600,000 Australians living with the effects of heart disease. The numbers are simply staggering. In Australia, at least 51 lives are lost to the condition every day. In New Zealand, meanwhile, a person dies of heart disease about every 90 minutes.

Despite this, research from the Australian Heart Foundation shows that there has been a major decline in the number of people who know that heart disease is the leading cause of death in Australia. And on top of this, even fewer people know what the key risk factors are. For example, only three per cent of Australians say they would focus on lowering their blood pressure or cholesterol to reduce the risk of heart disease (two of the biggest risk factors).

In New Zealand, a sharp rise in the number of people living with heart disease (The New Zealand Health Survey 2015/16 found that about 172,000 people were living with heart disease – but in 2016/17 the number had shot up to 186,000) paints a similar picture. Cardiologist and NZ Heart Foundation medical director Gerry Devlin says that New Zealanders have become stuck in the mindset that this disease is something that only affects the elderly.

So why is there so much apathy? Julie-Anne Mitchell, national director of prevention at the Australian Heart Foundation, says a common assumption is that heart disease is easily fixed. “Media depictions, TV, films and books – they always show heart disease as this one emergency situation where a man falls to the ground clutching his chest having a heart attack – and then in the next scene we get to see his instantaneous recovery,” she states. “The reality is often quite different. Heart disease doesn’t discriminate. It happens to men and women, young and old.”

The misconception that heart disease can be quickly and easily cured is simply false. Though some people, like Dan Lowe, do recover and go on to lead normal, healthy lives, 25 per cent of heart attack survivors never return to work.

Another big problem is that stereotypes about heart disease do persist. “When people think of heart disease their mind goes to an older man, often overweight, someone who eats fast food and drinks a lot, and is physically inactive. But you can’t tell that a person has heart disease just by looking at them,” Mitchell notes.

KNOW YOUR RISKS

While lifestyle factors such as diet, alcohol intake and exercise do play a significant role in heart health, clinical factors such as high blood pressure and high cholesterol are often forgotten. Mitchell refers to them as silent killers.

“They don’t have any obvious signs or symptoms,” she says. “Unless you have had a blood test and a blood pressure test, you won’t know if you have high cholesterol or high blood pressure. It’s not like your hand turns purple or you break out in spots. You could be walking around with high blood pressure or high cholesterol and have no idea at all.”

In a recent initiative established by the UK’s National Health Service, cardiologists have urged the public to know their numbers (cholesterol and blood pressure) just like they know their PIN codes. “We know our PIN numbers, but not the numbers that save our lives. Thousands of heart attacks and strokes can be prevented by more people knowing their blood pressure and cholesterol numbers and by seeking help early,” Duncan Selbie, chief executive of Public Health England, told the BBC.

Mitchell says it’s good advice, but would suggest taking it even further. “I’d say know your waist circumference too. It’s a good indicator of how much

abdominal fat you are carrying,” she explains. “Your risk of heart disease and stroke increases if your waist is over 80cm if you’re a woman and 94cm if you’re a man.”

A WOMAN’S ISSUE

For women, another dangerous myth persists – that heart disease is a male problem. In 2017 research published by Harvard Medical School, only half the women surveyed knew that heart disease is actually the leading cause of death among women, and only 13 per cent of them ranked it as their greatest personal health risk. And on top of this, additional data showed that on a day-to-day basis, women worry more about getting breast cancer than they do about heart disease.

The truth is that heart disease kills nearly three times as many Australian women as breast cancer.

Dr Clara Chow, professor of medicine and academic director at Westmead Applied Research Centre in Sydney, has been paying close attention to the way that gender impacts heart disease patients. “I think there is still the perception out there that heart disease is a man’s disease,” she says.

To further complicate things, women experiencing a full-blown heart attack present very differently than men do in the same situation. For instance, less than 40 per cent of women experience chest pain during a heart attack, while this is one of the most common signs in men. This then means that in emergency departments women are frequently misdiagnosed.

Of course, there are always cases that don’t follow the script. Journalist Natasha Johnson is a prime example. Last year, at the age of 50, Johnson – who was fit, active, and had healthy cholesterol levels and normal blood pressure – experienced a string of symptoms that just “didn’t feel right”.

Johnson was on holiday with her family in Byron Bay, NSW. During a six-kilometre walk to the lighthouse (a route she had travelled many times before) she started to feel unwell.

“I had this weird aching feeling that came on about 10 minutes after I started the walk,” she explains. “It was across my back, between my shoulders and then as it got worse I felt it at the top of my chest and into my jaw.”

Johnson had been seeing a physiotherapist because of pain related to poor posture, so initially she dismissed the ache as something muscular-skeletal. But as the holiday went on the pain persisted. Then, on the last evening of the holiday, she started to feel nauseous while just walking down the street.

Thankfully, Johnson decided to get her symptoms checked out. She found a GP, and an electrocardiogram (ECG) revealed a slight abnormality. She was advised to take aspirin and follow up with her GP back home.

After another ECG and some blood tests, Johnson was sent for a stress test. Hooked up to a range of monitors, she walked on an inclined treadmill while medics observed. “I didn’t even get to the end of the stress test,” she says. “The ache came on and they said ‘Stop, lie down’ and they gave me medication.”

It turned out that Johnson had a 95 per cent narrowing of the most important artery. “It was a ticking time bomb, and it could have gone off at any moment,” she says. “I was completely gobsmacked – it was the last thing I was expecting.”

Johnson was lucky; there was a quick fix. She had a stent put into her artery to restore blood flow and she was discharged from hospital the very next day. But while she was physically fine, the experience left her reeling.

“It was really hard to come to terms with. I felt like I’d dodged a bullet,” she recalls.

THE MENTAL TOLL

Dr Mark Pitney, staff cardiologist at Sutherland and Prince of Wales Hospitals, says that it’s very common for heart disease patients to feel like Johnson. “Those that had little risk factors and were not expecting it are often devastated by it,” he says.

And it’s not just the element of surprise. Pitney notes that all heart attack survivors have a psychological response. This is something that the Heart Foundation takes very seriously.

“The psychological scars can be significant,” says Mitchell. “A heart attack is a near-death experience. For many people it’s quite shocking. It can cause people to become depressed … some people become anxious because they didn’t see it coming.”

Mitchell notes that there is a lack of emotional support for heart disease patients, and that many survivors will feel like they’re on the journey alone.

To compound the psychological aftermath, there is still great stigma attached to heart disease in general. “Many people [in the general public] will assume that heart disease is selfinduced – we need to move away from the stereotype,” says Mitchell.

Johnson experienced this stigma first-hand. “I felt really ashamed,” she says. “You can’t help but feel that you must have done something wrong.”

To offset the judgement, Johnson found herself telling people about her “perfect cholesterol”, and her active lifestyle. “I feel like I have to defend myself. It’s probably how non-smokers who get lung cancer feel,” she says.

How do we get women to take the risk of heart disease more seriously? For Johnson, at least, the answer is simple: “we need to keep talking about it,” she says.

“Heart disease doesn’t discriminate. It happens to men and women, young and old.”

On top of this, being aware of the range of symptoms is vital. “It’s frightening – the symptoms are so vague that it’s easy to think it could be something else. But if it crosses your mind, get yourself checked out. Your heart’s not something you can stuff around with.”

Mitchell echoes this when she says that if you experience anything that might be heart related, call 000. “If it turns out to be indigestion then that’s a great outcome. A paramedic would rather be called out to a false event than be too late.” Dan Lowe agrees. Three years after his cardiac arrest, he continues to educate himself about heart disease. “I read, research and attend seminars, which helps me understand more,” he says.

For the rest of us, Lowe’s advice is to get a Healthy Heart Check. “It’s simple and can tell you a lot,” he says. “Just go and get it done.”