Cardiologists seeing more preclinical heart disease

LONGMONT – If you have plaque in your arteries in your 30s and 40s and you’re sedentary, you might not suspect anything is wrong until you have a heart attack — years down the road.

But if you have plaque in your arteries in your 30s and 40s and you exercise, you’ll probably see at least some symptoms earlier in life, according to some heart doctors in the Boulder Valley.

In addition, more area residents are finding out at younger ages that they have preclinical heart disease symptoms, mainly because more people are getting screenings for conditions such as high blood pressure and high cholesterol, those heart doctors said.

Since younger people are getting screened for heart disease, it seems anecdotally that more are getting some sort of treatment, those heart doctors said. It’s certain that a “significant” number of residents know they have high cholesterol, according to the Colorado Department of Public Health and Environment. The state office did not give specific statistics on how many residents know about their high-cholesterol issues or how rapidly awareness had gone up.

“We are definitely seeing more people with preclinical heart disease that has been picked up by heart scans,” said Nelson Trujillo, a doctor at Boulder Heart, a practice under the auspices of Boulder Community Hospital. “They’ve been referred for treatment.”

For example, a female patient in her 50s recently tested positive for preclinical heart disease, Trujillo said. Her brother recently had quadruple bypass surgery at Boulder Community Hospital, so the woman wants to take preventive medicine if she needs it, Trujillo said. High-cholesterol drugs called “statins” can substantially lower a person’s risk of heart disease, he said.

In Louisville, a smoker in his 30s came into the emergency room with chest and arm discomfort symptoms recently and couldn’t believe he was having a heart attack, said Juan Weksler, a cardiologist at Avista Adventist Hospital. Since patients must give their consent to receive treatment, Weksler said he was in the awkward position of impressing on the man that his symptoms were going to mean heart surgery.

“You just don’t really think you should be having heart surgery at that age,” Weksler said. “He wasn’t excessively unhealthy. He smoked, but he didn’t have diabetes or high blood pressure or a family history (of heart disease). It was unfortunate for him.”

Perhaps in contrast, a number of younger patients have come in for treatment at Milestone Cardiology Associates at Longmont United Hospital, said Dr. Murry Drescher, a cardiologist there. He said he sees more smokers who are unwilling to quit in Colorado than he saw in a previous practice in Florida. Just 50 percent of smokers in Colorado are willing to quit, Drescher said, while about 90 percent quit in Florida once he told them to. Also, people coming to the Milestone office are overweight at younger ages than they used to be, Drescher said, meaning that they may deal with all sorts of health problems earlier in life, including high blood pressure and diabetes.

“A lot of young people come in here. Longmont is not your typical Boulder County community. (These people) smoke, they drink, they eat lots of beef,” Drescher said. “I try to make them stop smoking. I tell them, ‘You’re working against yourself.’ ”

At Exempla Good Samaritan Medical Center, anecdotal heart attack data may show that younger people are coming in with heart disease, said Jeanette Smith, director of cardiovascular services. But the number isn’t statistically significant, Smith said.

“We’ll have a string of patients ages 45 to 52 and think ‘They’re younger than they used to be’,” Smith said. “But it kind of just comes in waves. Overall, we haven’t seen that as a trend.”

From the statistical standpoint, both the region and the state have a similar prevalence of heart disease as anywhere else in the nation. About 2 percent of state residents from 45 to 54 have reported having angina (chest pain from heart spasms) or coronary heart disease, according to statistics from the Colorado Department of Public Health and Environment. About 5 percent of the population has reported angina or heart disease from ages 55 to 64; about 10 percent to 11 percent reported angina or heart disease at 65 or older.

“It turns out that in heart disease, the single biggest predictor of risk still is age,” Trujillo said. “It’s incredibly common that we develop heart disease at some point with a steady stream of high calorie foods leading to plaque build-up on the arteries, and family history.”

Boulder Heart recommends heart screening for patients at age 35 who have strong family histories of heart disease. Aggressive screening for heart disease is important because early treatment helps, Trujillo said.

However, risk-factor patterns are changing, with the rate of obesity and diabetes rising across the nation, said Alan Go, chairman of the American Heart Association statistics committee. While obesity and diabetes don’t directly lead to heart disease, he said, people who are overweight also often have high cholesterol. At the same time, Go added, people age 65 and older have seen a slight drop in the total number of heart attacks in their population.

“Risk-factor patterns are a concern from a public health perspective, but is it a higher risk of actual heart attacks for younger people?” Go asked rhetorically. “I’m not sure there are systematic differences.”

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