Heart Attack Facts in Australia

• Each year around 56,000 Australians suffer a heart attack.
• This equates to around 153 heart attacks a day, or one heart attack every 9 minutes.
• More than 340,000 Australians have had a heart attack at some time in their lives (From the ABS National Health Survey)

Disclaimer: The following information is for educational purpose only and is not to replace qualified advice form your primary care practitioner or cardiac specialist. This information was collected from various sources to provide general information as to what tests exist. Information sourced from prevention.com and heart foundation Australia.

Each year almost 60,000 Australians have a heart attack, in America it’s more than 1 million and almost half die. Men have more than women do, but the gap is closing. From 1988 to 2004, attacks among women ages 35 to 54 spiked 42%.

Warning signs of an impending heart attack may include shortness of breath, jaw tightness, radiating arm pain and chest pain and tightness.

But these are emergency signs that tell you a heart attack is likely imminent and to seek paramedical assistance. Why do we wait around for warning signs and not take preventative measures and tests while we are healthy? It’s possible that we are not aware that there are many tests available that can predict the likely hood that you may be a prime candidate for a heart attack, thus hopefully motivation to make healthier lifestyle and diet choices.

These tests are the best ways to tell who is in danger, because they can catch cardiovascular disease 20 to 30 years before it gets severe enough to cause a heart attack or stroke.

The short facts:

If you are over 40 and just want to get an idea of your heart health, the first few tests I’d recommend are:

Standard Blood test + Vitamin D, C-Reactive Protein (CRP), Advanced lipid profile and Homocysteine Testing

From there you can take the direction of your GP as to further testing to do

or

If you are overweight, smoke or have a history of smoking, have a family history or heart disease, the Cardiac Calcium Scoring would be a wise addition, especially if you are also over 50.

Coronary CT Agiography/Cardiac Calcium Scoring

How It Works: A CT scanner checks for atherosclerotic plaque (made up of calcium, cholesterol, and scar tissue) in your heart’s arteries. After electrodes are attached to your chest and to an EKG machine that monitors your heartbeat, you lie on an exam table that slides into a short, doughnut-shaped tunnel and hold your breath for 10 to 20 seconds.

Cost: Free – $150-$500 ; Duration: 10 minutes

Why It’s Heart Smart: “Calcium scoring is the number one best predictor of a future heart attack,” Dr. Agatston, cardiologist and author of the South Beach Heart Program, says. Calcified plaque—a major warning sign of coronary artery disease, the leading cause of heart attacks—shows up at least 10 years before a heart attack or stroke hits. By catching the problem early, you can treat it before the buildup narrows arteries so severely that it triggers a heart attack.

Get It If: You’re 50 or older with risk factors—or you’re younger with a family history and several risk factors. Since the test involves x-rays women shouldn’t have it if there’s any chance they might be pregnant.

What the Results Mean: You’ll get an Agatston Score (developed by Dr. Agatston), which indicates the total amount of hard and soft plaque in your heart’s arteries. A score of zero means you have no calcium deposits and a low risk of heart attack in the next 5 years. A score of 400 or more puts you at high risk of a heart attack within 10 years; a score of 1,000+ means you have up to a 25% chance of having a heart attack within a year without medical treatment.

Next Steps: Where to get them in Melbourne: Hampton, Brighton, Moorabbin, Mulgrave, Warragul, Clayton, Alexandra, Rowville, Wonthaggi. If your score is 200 or higher, your doctor may advise lifestyle changes, a statin to lower cholesterol, or a diabetes drug to lower blood sugar. A statin drug may be discussed with your GP. However, please be aware that research shows that statin drugs do not increase life expectancy significantly, except in cases of familial hypercholesterolemia. Time and money are probably better spent taking healthier lifestyle choices, however consult your trusted and open minded GP.

Carotid Intimal Medial Thickness Test

How It Works: This “ultrasound of the neck” takes a picture of the left and right carotid arteries, which supply blood to your head and brain. After putting a gel on your neck, a technician glides an ultrasound transducer over your carotids to measure the thickness of the arteries’ lining.

Cost: $150 to $500; Duration: 15 minutes

Why It’s Heart Smart: Studies show a link between abnormal thickness of the carotid lining and coronary artery diasese. “This test can detect even the earliest stages, before blood flow is blocked,” says Dr. Agatston. Because it’s not an x-ray, it’s also helpful for women who are or may be pregnant.

Get It If: You’re 40 or older—or you’re under 40 and a close relative (parents or siblings) had a heart attack or stroke before age 55.

What the Results Mean: You’ll get two numbers: the thickness of your carotid lining (normal is less than 1.06 mm) and your “arterial age,” an estimate of how that thickness compares to that of healthy women your age. If your arteries are more than 8 years “older” than you are, your doctor can tailor treatment to reduce your risk.

Next Steps: A diet and exercise plan, stress reduction, and, if necessary, drugs to lower your cholesterol, blood pressure, and blood sugar and reduce your intimal medial thickness. A statin drug may be discussed with your GP. However, please be aware that research shows that statin drugs do not increase life expectancy significantly, except in cases of familial hypercholesterolemia. Time and money are probably better spent taking healthier lifestyle choices, however consult your trusted and open minded GP.

High-Sensitivity C-Reactive Protein Test

How It Works: A blood test measures CRP, a protein in your blood that’s a strong indicator of inflammation throughout your body.

Cost: Free in Australia as part of regular blood test; Duration: 5 minutes

Why It’s Heart Smart: Cholesterol plaque injures blood vessels, triggering inflammation and raising CRP levels in your blood. That’s dangerous because women with high levels of CRP may be up to 4 times more likely to suffer a heart attack or stroke. A high CRP is most dangerous if you also have another risk factor: a waist circumference of more than 35 inches, indicating the presence of belly fat.

Get It If: You’re 40 or older.

What the Results Mean: If your score is under 1.0 mg per liter, your risk of developing heart disease is low. A score between 1.0 and 3.0 mg/l equals average risk. Above 3.0 mg/l, you’re at high risk. It’s possible to have high CRP without heart disease, though, because infections and injuries can also trigger a spike in levels.

“We don’t consider high CRP to be a warning sign unless we’ve done the test on three separate occasions with the same results and there’s no other reason for the inflammation,” says Dr. Agatston. If you get three high scores, you need cardiac calcium scoring and the CIMT test to check your blood vessels.

Next Steps: A statin drug may be discussed with your GP. However, please be aware that research shows that statin drugs do not increase life expectancy significantly, except in cases of familial hypercholesterolemia. Time and money are probably better spent taking healthier lifestyle choices, however consult your trusted and open minded GP.

Advanced Lipid Profile and Lipoprotein(a) Test

How They Work: Unlike the traditional cholesterol blood test, which measures total cholesterol, HDL, LDL, and triglycerides, the advanced test also looks at particle size. This is important because some particles are big and fluffy, so they tend to bounce off artery walls as they travel through the body. Others are small and dense, meaning they can penetrate the artery lining and form clumps of plaque. (Think beach balls versus bullets.) The Lp(a) blood test analyzes a specific type of cholesterol that can triple heart risk.

Cost: $100-$200 Liposcan Australia each; Duration: 5 minutes

Why They’re Heart Smart: Sizing up your particles gives a clearer picture of heart risk than the conventional test: Having a lot of large particles cuts risk, while small ones raise it. The more Lp(a) you have, the worse it is too—it makes LDL particles extra sticky, so they cling to the lining of blood vessels, causing plaque and clots.

Get Them If: You have a family history of heart disease.

What the Results Mean: “You do not want more than 15% of your particles to be the small, dense type,” says Dr. Agatston. For Lp(a), levels above 30 mg/dl put you at increased risk.

Next Steps: If you have small particles, your doctor may prescribe a drug to increase their size, most likely a fenofibrate (such as TriCor or Trilipix) or niacin (vitamin B3), along with a healthy diet and exercise. Niacin is also the best treatment for high Lp(a).

Homocysteine Blood Test

Why get tested: To determine if you are folate-deficient or vitamin B12-deficient; to help diagnose a rare inherited disorder called homocystinuria; to determine if you are at increased risk of a heart attack or stroke. According to the National Heart Foundation and the American Heart Association (AHA), some evidence suggests that excess homocysteine may promote atherosclerosis by damaging blood vessel walls and supporting the formation of inappropriate blood clots, but there is
not a direct link between the two.

When to get tested: When a doctor suspects a vitamin B12 or folate deficiency or suspects that an infant or young person may have homocystinuria; when you have had a heart attack or stroke and do not have traditional risk factors, as part of a cardiac risk assessment

Sample required? A blood sample taken by needle from a vein in the arm

Test preparation needed? You may be instructed to fast for 10 to 12 hours prior to this test.

Medical Journal of Australia explainer

A1C Blood Glucose Test

How It Works: A blood test indicates your average level of blood sugar over the prior 3 months. Unlike other glucose tests that require fasting or drinking a sugary beverage, this test requires neither.

Cost: Free in Australia on Medicare; Duration: 5 minutes. RACGP explination

Why It’s Heart Smart: “This is the simplest way to detect your future risk of diabetes,” Dr. Agatston says. This disease puts you at 5 times higher risk of developing heart disease—yet 5.7 million Americans have undiagnosed diabetes (on top of the 17.9 million who are diagnosed) because they haven’t had their blood sugar checked.

Get It If: You’re 45 or older—or earlier if you’re overweight and have one or more diabetes risk factors, such as family history, high triglycerides, or low HDL.

What the Results Mean: An A1C level between 4.5 and 6% is normal, between 6 and 6.4 indicates prediabetes, and 6.5 or higher on two separate tests means you have diabetes.

Next Steps: The disease can often be reversed with weight loss, exercise, and dietary changes. If that’s not enough, you may need oral medication or insulin injections.

Genetic Tests

How They Work: A blood sample is tested at a lab for mutations of the KIF6 and APOE genes.

Cost: $200 at 23andme but in the US -$500 at Smart DNA in Brighton each; Duration: 5 minutes

Why They’re Heart Smart: A common variation in the KIF6 gene and two mutations in the APOE gene raise your heart disease risk. “You have no control over your genes,” says Dr. Agatston, “but these tests can help your doctor better tailor your treatment to head off a heart attack.”

Get Them If: You’re 40 or older.

What the Results Mean: “The KIF6 gene test predicts how effective statins are likely to be at heading off a future heart attack,” says Dr. Agatston. A recent study found that people with a certain variant of KIF6 had a better response to statin treatment, with a 41% drop in heart attack risk, while people without this mutation didn’t respond as well, with a 6% drop. “So we’ll use a different treatment in these cases,” he says—typically, a fenofibrate or niacin. As for the APOE gene, certain people with those variants have a much greater response to a low-saturated-fat diet. “So they may not need medication if they’re diligent about avoiding saturated fat,” Dr. Agatston says.

Next Steps: A drug to lower cholesterol, changes in diet, or both.

Stress Echocardiography

How It Works: This test is an improvement over the standard stress test because it adds an ultrasound both before and after exercise to evaluate blood flow to your heart’s pumping chambers and check for blockages in the arteries that supply the heart.

Cost: $850 to $1,600 But most should attract a rebate on Australian Medicare; Duration: 45 minutes. RACGP explainer

Why It’s Heart Smart: Adding echocardiography to the standard stress test raises accuracy by as much as 85% for women.
“It’s an excellent way to tell if your heart disease is severe enough that you could require treatments like a stent or a bypass,” he says.

Get It If: You have signs of heart disease, regardless of your age. “If you experience shortness of breath, chest pain, neck pain, or any other symptom, you need this test,” says Dr. Agatston.

What the Results Mean: If the test detects reduced blood flow, one or more of your coronary arteries may be blocked.

Next Steps: Your doctor may recommend a cardiac catheterization to check for blockages. If your vessels are clogged, they can be reopened with angioplasty, a stent, or bypass surgery.

Prevention Pioneer: Arthur Agatston, MD

A preventive cardiologist and Prevention advisory board member, Dr. Agatston passionately believes that the right combination of diet, exercise, medication, and advanced tests can wipe out heart disease—and he’s proving it: Of the 2,500 patients he sees in his Miami clinic each year, only one or two have heart attacks.

“One of the best-kept secrets in cardiology,” he says, “is that doctors using cutting-edge prevention have stopped seeing heart attacks in their patients.”

It was Dr. Agatston and Warren Janowitz, MD, who developed the first CT scan heart screening—the cardiac calcium scoring test—in the 1980s. “At first, it was a constant battle to educate physicians that the standard of care needed to change,” Dr. Agatston says. But now, because of his work, patients everywhere can get this test.

Not content to stop there, he continues to develop treatments to prevent heart attacks. “This disease,” he repeats emphatically, “does not need to exist.”

25 days to a healthier heart – Lower your heart attack risk by up to 92%

Try 1 per day

Day 1: Drink green tea: great for blood pressure, contains anti oxidants

Day 2: Throw out your margarine or anything with trans-fats in it, butter is better.

Day 3: Cook with olive oil – get rid of cheap vegetable oils

Day 4: Get extra sleep during dark hours. When you’re sleep deprived, your body releases stress hormones that constrict arteries and cause inflammation.

Day 5: Increase fiber that you like. Oats, fibrous veggies – as many different colors as you can.

Day 6: Eat more fish, especially wild caught salmon.

Day 7: Increase dark fruits in your diet, they contain resveratrol and antioxidants to stop your red blood cells clumping.

Day 8: Eat at least 50% veggies as part of your meal. As many colors as possible, especially the highest nutrient dense ones- water cress and kale.

Day 9: Have a snack of healthy nuts – macadamias and almonds.

Day 10: Exercise. A 20 minute walk can reduce your heart attack risk by one-third.

Day 11: Decrease your sugar intake

Day 12: Flax seeds. Adding these seeds to your breakfast can reduce the development of heart disease by 46% by preventing clots.

Day 13: Stretch. By just stretching 10-15 minutes a day, you can reduce arterial stiffness by 30%.

Day 14: Red wine. This is an easy one.

Day 15: Garlic, if your stomach can handle it is a great one for reducing arterial damage.

Day 16: Burn some calories dancing.

Day 17: Meditate and reduce stress.

Day 18: Social involvement. Get out and interact with people, volunteer, be generous, it warms and opens the heart.

Day 19: Stay connected to young ones.

Day 20: Vitamin D and fish oil in healthy levels may reduce heart disease risk by 80%.

Day 21: Do something special for a loved one.

Day 22: Dark chocolate

Day 23: Stay away from cigarettes and second hand smoke. Passive smoking can be 80-90% as bad as smoking yourself.

Day 24: Bananas. Increase your potassium to counteract all the sodium you’re having.

Day 25: Laugh out loud.