Heart disease is the leading cause of death in the U.S., responsible for nearly one in four Americans who die each year.
But that rate has fallen dramatically since the mid-20th century, says Sandeep Jauhar, director of the Heart Failure Program at Long Island Jewish Medical Center.
“In the 1940s and 50s, before the government got involved in heart research, nearly one out of two Americans were dying of cardiovascular disease,” says Jauhar.
Lifestyle changes and developments in technology have changed the landscape of cardiovascular disease. But as the mortality rates begin to level out in the 21st century, Jauhar wants people to pay attention to something else — their feelings.
“The heart was always thought to contain the emotions, but it was always thought to be sort of a metaphorical link,” he says. “But now we know that the actual biological heart, the pump is strongly sensitive to emotional outbreak, disruption, stress.”
That means that even with the evolution of new drugs and minimally-invasive procedures, American hearts could still be at risk because of loneliness and work-related stress.
One solution? A couple of recent studies suggest dog ownership is correlated with longer lives and healthier hearts.
Pet ownership provides several health benefits, but Jauhar says “on a deeper level, dogs provide companionship and combat loneliness.”
Here & Now’s Jeremy Hobson talks to Jauhar, author of “Heart: A History,” about lifestyle recommendations, valve replacement and why pet ownership might be keeping us alive.
On why heart disease mortality rates have fallen significantly
“Things have improved for a lot of reasons … There are drugs that have come about like cholesterol-lowering drugs. There are procedures like angioplasty, bypass surgery, a lot of technology. And then there've been societal changes like decreases in smoking and encouraging, you know, exercise and knowledge of risk factors.”
On whether technology or lifestyle changes have had a bigger effect
“I think it's multifactorial. You know, one of the first results out of the landmark Framingham trial was that smoking increased risk for heart disease. And so there was a concerted effort at a national level to cut down on smoking. And that's largely been successful, though, in recent years, the rate of decline of smoking has significantly slowed. So I think lifestyle factors have played a role, [but] I think there's still a lot more to be done on the lifestyle front. And that's one of the things I talk about in my book, is how stress management increasingly will need to be front and center in how we think about heart problems.”
On how to curb stress and improve heart health
“So there are a number of things that we can do. The first thing is to recognize that it's a problem. We have now more data in the last few decades to show that stress is incredibly detrimental to heart function. We know, for example, that the heart can acutely weaken in response to acute grief, like after a romantic breakup, the so-called broken heart syndrome. So how we cope with it is probably individual. It has to do with our own individual proclivities of what works for us. But on a society-wide level, I think we need to have more understanding of the role that stress plays in our lives.”
"We know, for example, that the heart can acutely weaken in response to acute grief, like after a romantic breakup, the so-called broken heart syndrome."Sandeep Jauhar
On the major treatments and procedures for heart disease and how they’re changing
“We have, over the last 50 or so years, developed incredibly powerful medications, like statins, for example, to lower cholesterol. And beta blockers, ACE inhibitors and so on. So drugs, you know, undoubtedly play a strong role in treating heart disease. And then … most people don't realize that in the last maybe 60 or 70 years, we've developed most of the procedures that we really take for granted in helping us treat heart disease: coronary angioplasty, like stents, for example, coronary bypass surgery, pacemakers, defibrillators, heart transplants. All those things were developed mostly in America after World War II. So it's been a huge technological progress.”
On the risk of having a heart procedure done
“What’s riskier is having the disease. The treatments often are much less risky for a patient. So, for example, when heart attacks were relatively untreated in the 1950s, the mortality from an acute heart attack in hospital was about 30%. Now it's about 3% with angioplasty and so on. That's a 10-fold decrease.
“Any surgery poses some risks. But I think those risks are decreasing, especially now as we develop relatively noninvasive ways of fixing our heart. [For valve replacements] it used to be that we'd have to cut open the chest, cut open the heart, cut out the diseased valve, put in a new valve, sew it in, and then sew up the heart and then close the chest. That was a huge procedure that took several hours and usually involved weeks of rehabilitation. Today, we can put in a valve, a new valve in a patient through a sort of stent procedure: a catheter that goes in through the groin and is pushed up to the heart ... No surgery involved … And the patients have rehab times that are a couple of days rather than several weeks.”
On recent studies that link dog ownership to healthier hearts
“It seems that dog ownership provides several health benefits. I mean, you know, one thing is that you have to walk your dog, and so the exercise from that. But I think on a deeper level, dogs provide companionship and combat loneliness. And we know that these things are tremendously detrimental to health. So I think that the love that we get from pets alleviates stress and we know stress is bad. So I would say, you know, when you asked me earlier, well, what do we do about the stress? Well, we don't have a pill like we do for cholesterol … but I would say, figure out what's right for you. Yoga, physical exercise, meditation. And, yes, you know, pet ownership.”
On reducing his risk of health problems after having his own heart issues
“Well, I got a dog! But ... when I learned that I have heart disease, I sort of looked at my life and I looked at what I wasn't doing right. And I was doing a lot of things right already. I was eating pretty well. I was exercising. I was already taking a cholesterol-lowering medication. But for me, it was really on the emotional front. I mean, I was like running on a treadmill ... I was very ambitious about my work, and I realized I had to slow down a little bit. What's been most effective is focusing on this sort of stress management front, you know, spending more time with my children, trying not to get so stressed out about things that happen at work. For example, having a puppy, these things just make me happy. And so people need to figure out what's right for them. What's right for me or for someone else may not be right for you.”
On whether a work-oriented culture in the U.S. could be stressing our hearts
“I think there's truth to that. I spent some time in Europe recently ... and it's amazing. In the evenings, people gather, you know, in the town square and have a beer together with people they know from the town. I mean, there isn't that kind of conviviality — at least in the places I've lived in the U.S. And then there are other things, obviously we have a pretty sedentary lifestyle. We tend to be more overweight than we should be. And yes, we are very driven as a society to consume and achieve more and more. So I think all these things play a role.”
This segment aired on October 22, 2019.