HeartHealth offers a unique way of thinking about cardiovascular health and prevention. Our unsurpassed imaging capabilities, combined with our unique approach to treating our patients, sets us apart from traditional approaches. First and foremost, we spend time with our patients individually to assess concerns, family history, lifestyle and mind-set. So much is gained by an open conversation, which unfortunately has all but disappeared in clinical practice these days. We offer the most up to date imaging read by experts in cardiovascular radiology to diagnose “pre-clinical” disease so that participants can then be proactive in prevention of heart attack, stroke and other cardiovascular diseases.
Once our physicians assess risk, participants will work with our team of experts to formulate a unique plan that promotes health and well-being. Our goal is to involve our patients intimately. We will always start with lifestyle adjustments to decrease risk holistically, but occasionally we may be facing a genetic predisposition or underlying condition that requires more. For those at significant risk, this may include medication. We will discuss the benefits and possible risks of all tests and medications thoroughly. We also work with technology companies to devise patient-centered apps that will improve communication by providing real-time data and invaluable feedback to our patients and providers.
Additionally, our staff will assist you with navigating through your HeartHealth experience at Weill Cornell. This includes scheduling of appointments for various diagnostic tests, obtaining the necessary pre-authorization from third-party payors, and directing you to the appropriate personnel or office for your inquiries, as appropriate. Our goal is personalization at each step of your journey to wellness.
All of the following will be offered at HeartHealth. (Click on the service name to view the description):
Advanced Cardiovascular Imaging
This includes coronary artery calcium scoring (CAC) for asymptomatic individuals at high risk of disease, CT angiography (CCTA, a noninvasive way to fully image the coronary arteries), cardiac PET (the newest stress imaging technique that allows us to see the “microvascular” circulation, a common cause of chest pain in patients whose larger arteries are free of disease), cardiac MRI and perfusion CT. We, of course, offer traditional cardiovascular imaging including echocardiography, exercise stress testing, stress echo and SPECT nuclear stress tests.
Advanced Cholesterol Analysis
The Advanced VAP and NMR lipo-profile tests provide measurements on particle size and the various subtypes of HDL (“good” cholesterol), LDL (“bad” cholesterol) and triglycerides (the fat component of the blood related to sugar, carbohydrate and fat consumption), offering greater accuracy and a more detailed assessment of your risk. In addition, other nontraditional lipid and non-lipid markers add incrementally to assessment of risk. These include LDL and HDL subtypes, remnant lipoproteins, lipoprotein little [Lp(a)], and the Apoproteins: Apoprotein B-1(ApoB-100), Apoprotein A1 (apo-A1), Apoprotein CIII (Apo-CIII), and insulin. Some studies suggest that ApoB-100 is more predictive of CVD risk than LDL.
In this non-stop world of hyper-stimulation, stress, sleep deprivation and anxiety, how do we cope? What is prompting poor choices in diet, exercise, sleep patterns and relationships? Cognitive psychology is the scientific study of mind and mental function, including learning, memory, attention, perception, reasoning, language, conceptual development and decision-making. Cognition is involved in everything we do. Making significant changes in what we do often requires a specialist in this area. Our experts apply behavioral and cognitive sciences, including biofeedback, to reduce anxiety and depression, understand human behavior and develop interventions that enhance well-being.
Early Lung Cancer Screening
If you are 55 – 80 years old, a smoker or former smoker (quit with in the last 15 years), you may qualify for lung cancer screening with low-dose computed tomography (LDCT) imaging under the guidance of a coordinated, multidisciplinary team of experts.
Based on evidence from the National Lung Screening Trial (NLST) and several other studies, the U.S. Preventive Services Task Force (USPSTF) has recommended annual screening with low-dose CT in persons at high risk for lung cancer. In fact, the most critical finding of the NLST is that annual screening with low-dose CT for 3 years reduced lung cancer specific mortality by 20% in this high-risk population, as opposed to chest x-ray screening.
Exercise and Fitness
Individuals who maintain at least 75 minutes per week of vigorous exercise or 150min/week of moderate exercise, along with a healthy diet, ideal body weight, moderation of alcohol intake and no smoking have 80% improvement in mortality. Exercise has been proven to maintain bone density, improve balance, regulate sleep, improve mood and increase the good cholesterol (HDL). The “best” exercise is an individual choice, but what is clear is that consistent activity every day is vital.
Inflammation and Metabolic Testing
There is now abundant scientific evidence that chronic inflammation is linked to cardiovascular risk, both in patients who have diagnosed inflammatory disorders and in individuals with elevations of “nonspecific” inflammatory markers. Inflammatory testing is therefore an integral part of the assessment of cardiovascular risk. Markers tested are C-reactive protein (hs-CRP), Homocysteine, sedimentation rate (ESR), fibrinogen, and interleukins 1 and 6 (IL-1 and IL-6), with advanced testing available on an individual basis. If these markers are elevated, we devise a plan with our team of colleagues to minimize risk. If an inflammatory disease is diagnosed, we work closely with rheumatologists at The Hospital for Special Surgery who provide expert care of Rheumatologic Disorders.
The “Metabolic Syndrome” is also associated with high cardiovascular events and mortality. We screen all individuals for the metabolic syndrome, which includes assessment of waist circumference, body mass index, blood pressure, advanced lipids as above, hemoglobin A1-c (a better screen for diabetes and insulin resistance than the glucose level alone), vitamin B and D levels, fatty acid profile, and other individualized markers as required based on family and personal history.
Although there are many medications and supplements, both proven and unproven, to decrease cardiovascular risk, most of us can reduce risk by making simple but powerful adjustments to our diet. Our nutritionist specializes in preventative nutrition, cardiovascular risk, metabolic syndrome and weight management, sports nutrition and women’s health. She will help you navigate the confusing world of nutraceuticals and advise you on the best diet to maintain an ideal body weight and active lifestyle.
As above, exercise is integral to any cardiovascular care plan. Initiating an aggressive exercise routine, however, can carry risk. This is particularly true for some of the popular exercise regimens that push the body to an “anaerobic” threshold. At HeartHealth, we will screen for asymptomatic disease and diagnose underlying, often silent cardiovascular conditions such as hypertension, diabetes, aortic aneurysms and peripheral arterial disease. We will then help devise an exercise program that is beneficial and safe.
Smoking Cessation Counseling
Of all modifiable risk factors, smoking carries the highest risk of events such as heart attack and stroke, in addition to causing numerous cancers. Within minutes of your last cigarette, your heart rate slows. Within months, your risk of heart attack begins to drop. After five and 15 years, your risk of stroke, lung cancer and coronary heart disease drop significantly, sometimes to the level of someone who had never smoked. At Weill Cornell, we have numerous resources to assist in your quest to stop smoking.
Meditation and biofeedback have proven benefit in reducing heart rate, blood pressure, respiratory rate, insulin resistance, heart attack and stroke. Several studies suggest that these methods can also assist in reducing anxiety and depression, decrease drug and alcohol use, lessen professional “burnout” and improve coping mechanisms. Our physicians work and practice with several cognitive psychologists and specialists in Transcendental Meditation.
Despite significant headway in the understanding of how cardiovascular disease differs between women and men, there is still a void in our diagnosis and treatment of women – both because women themselves do not present in a timely manner and because healthcare professionals do not think of women as being at risk. The fact is that more women will die of cardiovascular disease than all cancers combined. As our population ages, women continue to outlive men by a few years, but the risk of cardiovascular disease increases to the same level as men within 10 years of menopause.
Young women, especially those with underlying inflammatory disorders and diabetes, or previous high risk pregnancies (such as gestational diabetes, hypertension or eclampsia), are at significantly increased risk of cardiovascular disease and often do not present with classic symptoms. Our advanced imaging with cardiac PET is able to diagnose “microvascular” disease. This occurs more frequently in women, causes chest pain syndromes, and carries with it increased risk of symptoms and cardiovascular events. Women who have continued symptoms but “normal” coronary arteries by our conventional tests would benefit from an evaluation for microvascular disease.
In addition, shortness of breath is a very common complaint, especially as women age, and is frequently ignored. It is often caused by stiffening of the heart muscle (called diastolic dysfunction or “heart failure with preserved ejection fraction”), which then causes pressure and fluid to build up in the lungs. It is associated with hypertension and obesity, and can be treated with lifestyle modification, hypertension control and medications.