To have a healthier heart, we often don’t have to change much in our lives. Cardiologist Ulf Landmesser also explains in the interview: Which heart problems particularly endanger women and why erectile dysfunction can be an alarm signal for men.
“The special thing about cardiovascular diseases is that they usually have a relatively long lead time before they lead to problems or, in the worst case, death,” says Ulf Landmesser, head of the cardiology clinic at the Berlin Charité, in an interview with FOCUS online. However, there are now well-studied risk factors.
If you know the most important ones for your heart health, you can tackle them specifically and reduce your personal risk of heart attack:
“These are all risk factors that we can treat well today,” explains Landmesser. “The sooner we take countermeasures, the better.”
In the vast majority of cases, the cause of a heart attack is arteriosclerosis in the coronary arteries. Their creation is a process that takes place over many years, even decades. The expert reports that a third of 30 to 40-year-olds already have plaques in their blood vessels.
“This means that if you have risk factors and recognize them early, even a small change is enough to reduce the lifelong risk of a heart attack or coronary heart disease by up to 90 percent – this is what genetic studies suggest,” explains the cardiologist. This small change is again about LDL cholesterol.
Studies have shown that in order to achieve this strong effect, it must be possible to keep the value at 100 milligrams per deciliter of blood or below. Conversely, according to Landmesser, it also means: “Those who check blood pressure and LDL cholesterol early have a very low risk of a heart attack.”
To keep these values under control, small changes such as appropriate training sessions or dietary changes are often enough – with a focus on fiber-rich whole grain foods, sufficient potassium, lots of unsaturated fatty acids and polyphenols, for example from fish, vegetables and fruit.
Ideal values:
If the values are above these ideal values, you need to take a closer look.
When it comes to LDL cholesterol, it depends a lot on whether you already have cardiovascular disease or not. “It is ideal if the value can be maintained at around 100 milligrams per deciliter of blood (mg/dl) or lower if there is no coronary artery disease yet,” explains the cardiologist. “If someone reaches a value of 190 milligrams per deciliter or more, this is an indication of familial hypercholesterolemia.” In such a case, a defect in the LDL receptor is often the cause. This should definitely be addressed.
“If the value is between 100 and 190, you will always first try to improve the value through diet,” explains Landmesser about the therapy. “We also check whether there are already signs of heart disease, such as plaques in the vessels.”
For a heart-healthy diet, the menu should include lots of vegetables and fruit, as well as fiber-rich whole grain products and fish.
If medication is needed, a statin is used. Cardiologists adapt the dosage to the overall cardiovascular risk.
A special look is also needed at men’s and women’s hearts. In men, cardiovascular diseases often begin in middle age. In women, it is more likely to start after menopause, but can also occur less frequently before.
Risk factors that promote erectile dysfunction can also be risk factors for heart attack. Which are they? “Erectile dysfunction often has something to do with the vascular function in this area,” explains the cardiologist. Accordingly, risk factors that damage the coronary arteries could also cause problems for men.
The heart professor cites well-known threats to the heart: high blood pressure, high LDL cholesterol, diabetes as well as lifestyle factors such as smoking, too little exercise and sleep or an unhealthy diet. Erectile dysfunction and heart attacks are not causally related, but they often have common causes.
“Men who experience erectile dysfunction should definitely have their cardiovascular risk factors examined. So you should not only have your cardiovascular risk checked by a urologist, but also by your family doctor or cardiologist, for example,” advises Landmesser.
Stress is also a risk factor for the heart – especially for women’s hearts. “Above all, long-term stress, which occurs when people feel under pressure, is very likely to have a negative impact on cardiovascular risk,” explains the cardiologist. In fact, acute stress can lead to Tako-tsubo syndrome, a stress cardiomyopathy – also known as broken heart syndrome. This affects women in 90 percent of cases.
Acute stressful situations such as separation from a partner, the death of a loved one or life crises can trigger such a syndrome in women. In the worst case, it causes the heart to barely work. This can then be found out with cardiac ultrasound and cardiac catheter examination.
If the heart is not too severely restricted, patients are given beta blockers, among other things, to protect and relieve the strain on the heart. In the acute phase it is also very important to pay attention to cardiac arrhythmias. If it gets to the point where the heart is actually no longer pumping adequately, those affected must be monitored in the intensive care unit. Over time, the heart can often recover. This usually happens within four to five weeks. Afterwards, the movement disorders in the heart muscle are often no longer visible. The therapy is usually temporary.
Another phenomenon in women around the menopause phase are spontaneous tears in the heart vessels, so-called spontaneous dissections. This cause of a heart attack should be considered in women, especially between the ages of 47 and 53. Women should definitely take chest pressure, back pain or upper abdominal problems seriously and remember that these could also come from the heart.
First, doctors will write an EKG (electrocardiogram) and determine the corresponding blood values. Treatment is with heart-friendly therapy – for a limited period of time with blood-thinning or anticoagulant medication. The treatment also depends on whether the tears in the heart vessels are already causing acute circulatory problems. In this case, cardiologists would place a stent to prevent the vessel from closing. This is necessary to prevent a major heart attack or damage to the heart. If the situation is not yet so acute, the vessel usually regenerates itself well.
In order to identify the above-mentioned risk factors at an early stage, the Charité expert recommends examining them carefully. Specifically, this means: As early as the age of 40, men and women should have their atherogenic lipoproteins checked, i.e. LDL cholesterol and, if there is a family history of this, also lipoprotein (a).
Family history also includes: If, for example, your father had a heart attack at the age of 40, you obviously have to take a closer look at the risk factors. Checking blood pressure is very important. Likewise, the blood sugar level in order to detect diabetes in good time.
In addition, the heart professor believes plaque imaging is useful if there is uncertainty about the cardiovascular risk. It would be a good instrument, especially if someone determines a medium risk based on other risk factors and is concerned about how to treat them. If there is suspicion, cardiac CTs (computed tomography) could now show well whether the heart vessels are already showing damage, whether there are plaques and whether they look dangerous. However, this is not yet widely used in Germany.
The check and whether plaque formation is already visible becomes even more important from the age of 50. A cardiac ultrasound should then be performed to determine whether there is already any damage to the heart. For example, high blood pressure causes the heart muscle to thicken (hypertrophy). “You want to avoid that because it can lead to the heart stiffening,” explains Landmesser. “And thus to restrict cardiac performance and function.”
