Wellstar Health System‘s chief cardiologist Dr. Barry Mangel spoke with the Courier about the importance of American Heart Month, and steps people can take to avoid death by heart disease.

“Cardiovascular disease is the number one killer of both men and women in the country,” Dr. Mangel said. “And so having an opportunity really to spend a few weeks of the year where we can truly just focus on this problem, and all of the things that raise risk, and all the new treatments that are available is really important.”

American Heart Month falls in February, which is appropriate, Dr. Mangel said, since Valentine’s Day, when people are thinking about hearts, is in the same month.

High rate of heart disease in the South

Asked about the significance of the month for Georgians, Mangel said, “What I would say about Georgia, and this is really true about most of the states in the southeast, is that we live in what we call the “heart attack and stroke belt.”

“What that means is that it’s the epicenter of heart disease and stroke in our country,” said Mangel. “We have more heart disease and cerebrovascular disease strokes per capita in our area than any other part of the country. And Cobb County is no different.”

He said Cobb and the other counties in metro Atlanta have lower rates than the rural counties in the South, but is still “very, very high.”

“We attribute that to higher rates of obesity, higher rates of diabetes, smoking and, and physical inactivity, and that is much more pervasive in in our communities.”

He also said the rates are disproportionately high in the Black and Hispanic communities.

How to avoid heart disease

Dr. Mangel then talked about how to avoid heart disease.

“I would suggest that some of the most important things are knowing your own risk,” he said. “And that entails knowing your numbers.”

“Your numbers include things like your weight, your cholesterol, your blood pressure, and also your blood sugar,” he said. “So all of these are metrics that we use to measure risk.”

“Obesity, diabetes, physical inactivity are all contributors to heart disease,” said Mangel.

“It’s really important to see your doctor (who will) assess your risk by doing certain measurements, and understanding you as an individual and seeing where you fall in the spectrum of risk,” he said. “There are so many treatments that we have available to us now that will reduce individual risk, and we know that they’re safe and effective.”

What are signs of heart disease?

The Courier asked Dr. Mangel what symptoms of heart disease a person should watch out for.

“Some of the some of the most significant heart disease symptoms are chest pain, pressure or tightness,” he said. “And that usually occurs with physical activity … with some sort of exertion.”

“Shortness of breath that’s unusual for an individual is also an important sign of potential heart disease,” he said. “Routine fluids swelling, swelling of the abdomen, swelling in the legs can be a sign of heart disease.”

“Irregular heartbeat or palpitations can be a sign of heart disease as well,” he said.

“But it’s also very important to know that lots of people don’t have those symptoms and can still have underlying heart disease,” Mangel said. “Women particularly don’t experience heart problems the same way that men do, and oftentimes don’t have the same symptoms.”

“And people with diabetes many times don’t have any symptoms at all,” he said.

He said that is a reason monitoring by a doctor is important, because a physician has other means of detecting problems than the obvious symptoms.

He also said that changes in stamina can be a sign of a problem.

“If you’re feeling great, and then all of a sudden you’re not able to do what you used to be able to do: you’re unable to climb a flight of stairs or carry a package because you’re short of breath … that’s very important to note.”

When should you call 911?

He said the time to call 911 is, “if you’re having symptoms that are persistent, you have chest discomfort, and that can be associated with sweating or being sick to the stomach … those can be a sign of a heart attack.”

He said other signs of a heart attack are discomfort that radiates to the left arm, the neck, the jaw, or the upper back area.

“If they’re new or unusual for you, then calling 911 is always the best idea,” he said. “You don’t want to drive yourself to the emergency department because you potentially could not allow us to start treatment as quickly as possible.”

Diet and Exercise

The Courier asked Dr. Mangel what the current recommendations are for diet and exercise.

“For diet, not much has changed in our overall recommendations, and that includes things like a lower fat, lower cholesterol diet,” he said. “Animal fat being the number one culprit, so we say to avoid excessive animal fats, and those are our highest in red meats, fattier meats, and fried foods, things that that are cooked in fat.”

“On the other hand, there are healthier fats that you can eat, and the Mediterranean diet seems to be a healthier overall diet,” he said.

He said the Mediterranean diet uses healthier fats such as olive oil, doesn’t include many fried foods, is higher in vegetables, and uses lower fat meats and cheeses.

As for exercise, Dr. Mangel recommends a half hour of exercise three or four times a week.

He said you should not start with the full exercise program immediately, but should gradually build up to it.

If you’re experiencing symptoms of hear disease, he said, your doctor should be consulted before starting an exercise program.

The new hybrid lab at Wellstar Kennestone Hospital

Dr. Mangel said a new hybrid lab will be opening at Wellstar Kennestone Hospital.

“The hybrid lab really means that we can do both surgical and non surgical procedures in the same location,” he said. “And these procedures specifically would be things like structural heart procedures, where we implant new heart valves, or fix valves that are that are leaking or don’t open well, and we have specialized equipment in the room.”

“That equipment allows us to go from a minimally invasive procedure to an open heart procedure in the same room,” he said. “That’s important, because these procedures are such that sometimes they do require surgical intervention.”

He said the importance of the new room is that if during a diagnostic or minimally invasive procedure a need for more aggressive operation becomes known, anesthesiology equipment can be brought in, and the entire intervention can be done in one room.

Construction will begin within a few weeks, and should be completed within four to six months.

Mayo Clinic study

Wellstar Health Systems will be involved in a Mayo Clinic study of “shared decision-making.”

“It’s an important study,” he said. “We’re one of only three or four other centers in the country that are going to be participating in this.”

“First, we’re looking at what we call shared decision making for prevention where physicians and patients work together,” he said. “We give them information and a shared decision is made about specific types of treatment.”

“And we’re looking at the effectiveness of that shared decision making on on patient compliance,” Mangel said.

“The second part of the trial is we’re going to be using an electronic tool that’s embedded in our health record, to do a risk assessment.”

He said the software tool will allow them to track patient risk over time.

Heart risk and COVID-19

Asked if he had any final words for Courier readers, Dr. Mangel said, “There’s a lot of concern out there about COVID.”

“So what I what I’d like to say, in closing, is that, number one, patients who have heart disease are at significantly higher risk of serious complications from COVID, much higher morbidity, much higher mortality.”

“And throughout the pandemic, we have seen people avoiding care, routine medical care, and we understand that by avoiding that care, they can actually put themselves at much higher risk if they do develop COVID,” he said.

“The two points I want to make are, number one, don’t avoid care. And number two, if you are at higher risk, get vaccinated,” Dr. Mangel said. “Because these are the things that we know can help people to avoid serious complications from this virus.”