Getting to the heart of the matter

Edward Rocco was running on a treadmill at his gym when he began to feel a sharp pain in his upper body. Assuming it was just the usual aches and pains related with age, he took a break, hoping the burning sensation would subside. “But it got much worse,” recalls the 56-year-old graphic artist from London, Ont. “I began to feel light-headed and couldn’t catch my breath.” Then he fainted. Coming to in a hospital emergency room, he found himself hooked up to a frightening array of machines, a worried wife at his side.

Rocco was lucky — he hadn’t suffered a heart attack. Instead, he had what his doctor called unstable angina. It’s one of the life-threatening conditions brought on by a sudden reduced blood flow to the heart, otherwise known as Acute Coronary Syndrome, or ACS.

What is ACS?

The second leading cause of death in Canada,* ACS describes any condition brought on by reduced blood flow to the heart. ACS may develop over time as plaques build up in the arteries in your heart. These plaques, caused by cholesterol and other factors, narrow the arteries, making blood flow increasingly difficult. If the build-up becomes too much, the heart muscle can’t get enough oxygen to pump enough blood to the body, and insufficient oxygen is delivered to the tissues and organs, including the heart. Without sufficient oxygen supply, the person may begin to feel chest pain (unstable angina) or, in the worst cases, a plaque ruptures causing blockage — and a heart attack occurs. In fact, up to 30 per cent of those with unstable angina will go on to experience a heart attack later.*

For many, living with an ACS diagnosis can be physically and emotionally draining. Rocco, for example, was forced to take a leave of absence from work to recover, which put a bite on his finances.

Besides the physical and financial costs ACS may have on the individual, it also places a profound economic burden on society. A recent study* estimates that in 2008-09, Canadians missed an estimated 1.3 million days of work due to the effects of poor health associated with ACS. This puts a massive hit — almost $1.8 billion — on our economy.

Because ACS treatment require countless tests, hospital visits, specialist consultations, surgical procedures, pharmaceutical treatment and visits to the family doctor, an added strain is placed on our already overburdened health budgets. The same study estimated that in 2008-09, it cost health care an estimated $1.6 billion to treat heart attack and chest pain.

When you add the economic and health-care costs together, the total is approximately $3.4 billion a year. Because ACS commonly occurs in older people, as the numbers of 45-plus Canadians continues to increase, costs could skyrocket. That’s why preventing and managing ACS has become so crucially important.

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Preventing ACS

Those of us in the Zoomer age bracket can help: if we begin to make serious changes to our lifestyles, we can lessen — or even prevent — our chances of developing ACS.
The first thing on everyone’s agenda should be lowering your cholesterol. Rocco, like many, assumed that because he was active, his cholesterol levels were fine. But they were slowly and silently building plaques on the walls of his arteries.

By controlling cholesterol and addressing the other risk factors that contribute to ACS, we can limit the chances of developing the condition.Strategies include:
• quitting smoking
• drinking alcohol in moderation
• eating a healthy diet 
• getting regular exercise
• maintaining a healthy weight

Not only will these help prevent ACS, but they’ll also help us look and feel better, reduce stress and allow ourselves to get more enjoyment from life.

Managing ACS

The No. 1 goal becomes avoiding a heart attack. However, if an event does occur, Dr. Alan Bell, Assistant Professor of the Department of Family and Community Medicine at the University of Toronto, says the condition must be carefully managed to ensure the patient doesn’t have another heart attack.

Dr. Bell, who is also the co-chair of the Canadian Cardiovascular Society’s Antiplatelet Guideline Committee and manages a clinical practice, says that in most cases today, patients who have experienced a heart attack will be managed invasively. This means an angiogram (a test that takes pictures of blood flow in an artery) will be done to determine which artery is blocked. Then a stent (a small mesh tube that’s used to prevent the artery from becoming narrowed or blocked again) will be inserted into the artery.

After this procedure, the patient may feel much better, but it’s not a cure. “It’s particularly important to prevent clots (thrombosis) forming in stents,” says Dr. Bell. “If you clot a stent, the chances of surviving are only 50/50.”

To prevent this, says Dr. Bell, “one of the most important interventions is antiplatelet therapy.” Platelets are useful — they help clot the blood and stop excessive bleeding from cuts and bruises. However, patients with stents cannot afford to risk any clotting — so they must rely on antiplatelet therapies to reduce the risk of blocked arteries and a second heart attack. Patients may complain that the therapy causes nosebleeds or bruising. Dr. Bell explains why: “The more you inhibit platelets, the more you’re going to prevent the next heart attack. But you’re also going to increase the risk of bleeding more.” He cautions that patients must remember that bruising or other minor bleeding is not a reason to stop or reduce this important treatment.

But, he says, newer antiplatelet agents aim to overcome this — they give further protection by providing better thrombosis risk reduction with less risk of bleeding. “Our guidelines emphasize the importance of these newer therapies,” says Dr. Bell.

Besides the antiplatelet therapy, doctors will work closely with patients to develop a program of drug therapy and lifestyle changes that aim to manage the condition, including: lowering cholesterol, controlling blood pressure, monitoring blood sugars (if the patient has diabetes) and
referring the patient to a cardiac rehab program to educate them on the need to exercise regularly and eat properly.

The good news, says Dr. Bell, is that by adhering to these interventions, ACS can indeed be a manageable condition. Yes, there will always be a greater risk of heart attack. However, in most cases, patients who follow their medical and lifestyle advice can return to a healthy, normal lifestyle.

Acute Coronary Syndrome Risk Factors

• Age (45-plus for men, 55-plus for women)
• High blood pressure
• High blood cholesterol
• Smoking
• Family history of ACS
• Low physical activity
• Type 2 diabetes

For help in making lifestyle changes, the Heart and Stroke Foundation has resources on its website at www.heartandstroke.ca. Take the Heart & Stroke Risk Assessment to learn about your risk factors for heart disease. If you have high blood pressure, you can sign up for the Heart & Stroke Blood Pressure Action Plan to help you manage it. And to help lower your cholesterol, you can choose from 250 exclusive heart-healthy recipes.

$3.4 Billion: The estimated amount of direct health-care expenditure and economic losses due to acs in 2008-09.*

Every 5 minutes, someone is admitted to hospital suffering from
a heart attack or chest pain event, totalling more than 100,000 hospitalizations
a year and causing 21,000 deaths.*