Heart of the matter
Cotten on front line of war on cardiovascular disease
Certified by the American Board of Internal Medicine, Dr. Reid Cotten is a cardiovascular physician with the Jackson Heart Clinic and serves as medical director of St. Dominic’s Healthy Heart Advantage. The Carthage native recently sat down with the Mississippi Business Journal’s Nash Nunnery for a conversation about the cause and effect of cardiovascular disease.
Q — If someone in your family has a history of cardiovascular disease, what are the chances that a person might inherit the disease?
A — There is no question coronary artery disease runs in families. It is difficult to be precise in ascribing a percentage risk to individuals, but it is clear a family history of coronary heart disease is an independent risk factor for developing the disease. That is to say if one has no other traditional coronary disease risk factors ( high blood pressure, diabetes, smoking history, abnormal cholesterol, sedentary lifestyle) but has a family history of disease, these individuals are at risk of developing premature plaque build-up in arteries. An abnormal family history is basically defined as heart disease occurring in first degree relatives (parents/sibling) in women under 65 years of age or men under 55 years of age. Although you and I cannot change our family history, we can modify all of the above-mentioned risk factors by lifestyle changes.
Q — What does high blood pressure have to do with heart disease?
A — Hypertension is an independent risk factor for coronary artery disease and stroke. Essentially, high blood pressure stresses arteries in the body. Over the course of time, an elevated blood pressure can raise the risk of stroke, heart attack, congestive heart failure and kidney failure. Most hypertensive individuals do not feel the acute effects of high blood pressure, just as they do not feel the effects of an abnormal cholesterol profile, but damage is occurring at the level of the artery. Hypertension is common in humans, particularly as we age and as we consume more sodium in our diet. The good news is that lowering blood pressure translates into a reduction of risk to our brain, heart and kidneys.
Q — What role does diabetes play in diseases of the heart and cardiovascular system?
A — Diabetes is one of the leading risk factors for cardiovascular disease. In fact, research indicates diabetics with no history of a heart attack have the same risk of having a heart attack as a non-diabetic who has already had a heart attack. Approximately 75-80 percent of diabetics die from heart disease (heart attacks, heart failure, etc.) or stroke. For diabetic women, the risk of heart attack/stroke is four to six times greater that that of non-diabetics. As a result, diabetics are treated more aggressively with blood pressure and cholesterol medicines as compared to non-diabetics.
Q — What are the risks of not treating cardiovascular disease? Can a change to a healthier lifestyle make a big difference in preventing heart disease?
A — Since we know treating risk factors for coronary disease reduces the risk of cardiovascular events such as strokes and heart attacks, then it stands to reason that not addressing these risk factors increases the risk of events. The modifiable risk factors include high blood pressure, sedentary lifestyle, smoking, abnormal cholesterol and diabetes. I suspect most patients grow weary of hearing the old adage from their physician of “diet, exercise and weight loss,” but this is perhaps the best way we can reduce our individual risk for disease. Clinical trials have consistently shown heart attack and stroke risk can be decreased with a healthy diet, regular aerobic exercise and maintaining a healthy body mass index (BMI), primarily because it brings these risk factors under control. Personal responsibility in these areas is the cornerstone of cardiovascular disease prevention..
Q — Is surgery a last resort?
A — Yes. The encouraging news is we are able to address so many coronary disease problems with balloon angioplasty and newer generation coronary stents these days, requiring an overnight stay in the hospital. Consequently, the number of individuals needing coronary bypass surgery has declined in the last 10 years. Even patients suffering from peripheral artery disease can benefit from stent procedures in a similar fashion, reducing the need for surgical intervention. However, there are clear situations in which surgery is needed. In general, it is reserved for patients with advanced disease or for arteries where blockages occur in areas where it may be too dangerous or difficult to deliver stents safely. For patients with advanced heart valve disease with severely leaky or narrowed valves, surgery remains the best treatment option. Clinical trials are in progress to look at ways to treat some of these valve problems with a catheter-based approach.
Q — Can you offer our readers some tips to stay “heart healthy?”
A — Regular aerobic exercise and a heart healthy diet and avoiding cigarettes are vitally important components. If one consumes alcohol, it should be done in moderation. Aerobic activity needs to be frequent, preferably daily. At the very minimum, we should walk briskly 30 minutes per day, five to seven days per week. For fitness training or weight loss efforts, obviously more is required. A moderate approach to food is needed for all of us. In general, we consume too many calories, and food portions are out of control. Fad diets inevitably fail, as the do no lead to the lifestyle healthy eating habits that we should all adopt. We must think of these issues in terms of lifestyle behaviors.
Q — What has been your greatest challenge in the cardiovascular field?
A — It has to do with the fact that cardiovascular disease remains the number one cause of death. To bring this closer to home, Mississippi leads the country in heart disease. The disease burden is extremely high. Part of the problem is this plaque disease process begins silently very early in our bodies with fatty plaques noted in children and teenagers by autopsy data. Our Western diet simply fuels the disease, and our sedentary lifestyle has led to an obesity epidemic. The scary statistic is that childhood obesity is climbing significantly, and the natural consequences of that are obvious with early onset diabetes, high blood pressure and earlier coronary disease. It is imperative we not only recognize this and take some personal responsibility for our own health but we teach our children how to make good choices as well.
Q — Should a person with heart disease seek emotional support from a counselor, therapist or support group?
A — In certain situations, the answer is yes. Most patients who have been through a heart attack, bypass surgery or a stent procedure can have some screening through a cardiac rehabilitation program that can be arranged before leaving the hospital. Cardiac rehabilitation is a comprehensive program that begins while a patient is in the hospital and continues into the outpatient setting for 12 weeks, covering exercise prescriptions, physical therapy, education and those people who might be suffering from depression. It is important for cardiac patients and their families to be aware depression is not uncommon, especially after a heart attack, stroke or cardiac surgery. Signs of depression might include difficulty sleeping, social withdrawal, tearfulness and difficulty with concentration.
Degree(s): Undergraduate, Ole Miss; Medical school, University of Mississippi Medical School; Internal medicine internship, Mayo Clinic; Cardiology Fellowship, UMMC
Hobbies/Interests: Cycling, family outings
Favorite Food: Anything with chocolate
Favorite Movie: Anything with Harrison Ford
Last Book Read: “The Reason for God,” by Tim Keller
Person who’s inspired you the most: My father