Heart Health: Separating the Truth From the Myths

When it comes to your heart, it’s very easy to be lulled into a false sense of security. You may assume that heart disease is only something that happens to older people, or that you’d have symptoms if you did have it. If you have a strong family history of it, you may shrug and figure you can’t do anything about it. But before you reach for that burger and cheese fries, hear this: Cardiovascular disease kills more Americans each year than any other condition. But you can lower your risk and boost your heart smarts by separating fact from fiction. Here’s the straight talk on some common myths.

Myth No. 1: If I had high blood pressure or cholesterol, or other risk factors for heart disease, I’d know it.

Actually, no. Of the 75 million Americans who have high blood pressure, almost 15% — about 11 million — don’t know their blood pressure is too high. This means they aren’t getting treatment to control it. “Oftentimes, people with high blood pressure or high cholesterol are completely asymptomatic,” explains Nicholas Ruthmann, MD, a cardiologist at the Cleveland Clinic. “Genetics also plays a strong role in both, so you could still silently be at elevated risk even if you’re active and not overweight.”

The best way to truly know if you have high blood pressure or high cholesterol is to get an annual physical, Ruthmann stresses. This way, your doctor can check your blood pressure and run a blood test to check your cholesterol.  

Myth No. 2: Heart disease is the same for men and women.

Unfortunately, heart disease isn’t an equal opportunity killer. The symptoms of heart attack, for example, are often very different in men and women: “Men tend to present with more classic symptoms, like chest pain, related shoulder or arm pain, and sweating,” Ruthmann says. “But women often suffer from what we call ‘silent heart attacks.’ They may only feel fatigued or have flu-or cold-like symptoms.”

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Women who have heart attacks are also more likely to get a wrong diagnosis. One recent study found that about 5% of women are likely to be misdiagnosed when they go to the hospital with a heart attack, compared to 3% of men.

Women are also more likely than men to have a type of heart condition known as microvascular coronary disease. This condition is difficult to pick up on screening tests like angiograms, says Nieca Goldberg, MD, a cardiologist and medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone. A 2018 study found that about 8% of women who had chest pain but had normal angiograms actually had heart scar tissue that indicated a heart attack.

If your doctor says your angiogram is normal and you’re sent home, get a follow-up if chest pain and other symptoms like fatigue and shortness of breath persist.

Myth No. 3: If you have a family history of heart disease, there really isn’t anything you can do.

It’s true that your odds of having a heart attack or stroke rise if a close family member, like your mom or dad, had one. This is especially so if they had it at a younger age (age 55 for men, 65 for women). But research also shows you can defy those odds. People with a high genetic risk for heart disease lowered their odds by nearly half (46%) with a healthy lifestyle. This meant they followed at least three of these four guidelines:

  • Not smoking
  • Having a healthy weight
  • Getting regular physical activity
  • Eating a healthy diet

The best diet for heart health is a Mediterranean-style diet, which is rich in fruits, veggies, whole grains, legumes, nuts and seeds, fatty fish, and olive oil, Goldberg says. One 2019 study of over 25,000 women found that women who followed this eating pattern cut their risk of events like a heart attack or stroke by 28%. But if lifestyle alone doesn’t help, Ruthmann says, you may need to treat and manage your blood pressure and cholesterol levels with medications.

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Myth No. 4: Diabetes won’t threaten your heart.

More than 31 million adults — about 13% of the U.S. population — has diabetes. If you’re one of them, you’re twice as likely to have heart disease or a stroke than someone without the condition, and at a younger age. Over time, high blood sugar damages the blood vessels that control your heart, Goldberg says. People with diabetes are also more likely to have other conditions that raise their risk for heart problems, like high blood pressure or high levels of LDL (“bad”) cholesterol.

To help manage your diabetes, get a regular A1c test, which manages your blood sugar over 2 to 3 months. Your doctor can keep an eye on it and tell you if you’re in the target range. But it’s also important to keep your blood pressure below 140/90, manage cholesterol, and not smoke.

If you don’t know your blood sugar levels, get them checked. About 20% of people with diabetes don’t know they have it.

Myth No. 5: You should avoid exercise if you have heart disease.

It’s even more important to get regular exercise when you have a history of heart disease. Research shows that even light physical activity in the year following a heart attack lowers your chances of dying.

“Your heart is a muscle, just like any other muscle in your body, so if you want to make it stronger, you need to engage in exercise to help keep it in shape,” Ruthmann says. Each time you exercise, you engage both the large and microscopic blood vessels that supply its blood flow. The more you stay active, the better this vascular network functions. That can help continue to provide adequate blood flow to the heart over time.

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If you do have this condition, you may benefit from cardiac rehabilitation, Goldberg says. This is an outpatient exercise and education program that’s designed to help you recover from a heart attack or surgery for heart disease. It usually involves education about lifestyle changes to reduce your heart disease risk. You’ll also get training on how to exercise safely and correctly. Research shows it lowers your chances of death from heart disease and future heart problems.

Myth No. 6: Heart disease is colorblind.

Heart disease is the No. 1 killer of Americans, but it takes a particularly heavy toll on minority groups. Black people are about a third more likely to die of it as the overall population, for example. They’re also nearly twice as likely to have a stroke and die from the condition than white people. More than a third of American Indian people and Alaska Native people die from heart disease under age 65, compared with 17% for the U.S. population overall. Reasons for these disparities include:

  • Lack of access to health insurance
  • Higher rates of obesity, high blood pressure, and type 2 diabetes
  • Poverty: Living in poorer areas is associated with up to a 90% higher risk of heart disease.
  • Doctor bias. Some research suggests Black people, for example, are less likely to get the right care if they show up in the ER with chest pain.
  • Distrust of medical providers

Groups like the American Heart Association work to address this important issue. Steps include community outreach, increasing the number of minority doctors, and expanding access to health care.

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