Debunking myths about heart disease

Much of the basic advice about staying healthy has stood the test of time: Don't smoke. Exercise. Eat your vegetables. Over the decades, however, certain recommendations about avoiding heart disease have evolved, thanks to the constant stream of new evidence from medical research.

Long-held habits and beliefs are often hard to shake. But knowing the latest evidence can help you make better choices for preventing, monitoring, and recognizing heart disease. Here's a look at four misconceptions related to heart disease, along with take-home advice from Heart Letter editor in chief Dr. Deepak L. Bhatt.

Myth #1: Taking a daily fish oil supplement can help prevent heart disease. In the 1970s, scientists noticed that people whose diets featured lots of fatty fish had low rates of heart disease. Fatty fish are rich in the omega-3 fatty acids EPA and DHA, which have biological effects that may benefit the cardiovascular system, such as easing inflammation and preventing blood clots. By the 1980s, omega-3 fish oil supplements started showing up in stores. Today, these amber capsules are among the most popular supplements sold in the United States.

However, over the past two decades, numerous trials that compared omega-3 supplements against placebos have found no evidence that the capsules can help stave off heart attacks or related problems in healthy people. "Don't waste your money on over-the-counter omega-3 supplements," says Dr. Bhatt. Like all supplements, they are not regulated by the FDA, and some contain unhealthy saturated or oxidized fats, industrial pollutants, or mercury, he adds.

Myth #2: It's okay to have higher blood pressure when you're over 65. As people age, their artery walls stiffen, forcing the heart to pump harder. As a result, blood pressure tends to rise. This phenomenon was originally referred to as "essential hypertension" because doctors thought that for older people, high blood pressure was essential to deliver enough blood to the brain. That's why some doctors have suggested that after around age 65, systolic blood pressure (the first number in the reading) can be as high as 150.

Current guidelines, however, advise adults to aim for a systolic reading of 130 or lower. Reaching that goal often requires people to take two or more blood pressure drugs. While that could leave older adults prone to side effects such as dizziness and falls, those concerns don't appear to be warranted in most cases. Recent research revealed similar side effect rates among older people who aimed for lower (around 120 to 130 systolic) vs. higher (130 to 150 systolic) blood pressure targets. More importantly, the lower targets led to reduced rates of strokes, heart attacks, and other serious cardiovascular problems. Dr. Bhatt's advice: no matter how old you are, work with your doctor to achieve a blood pressure below 130/80, assuming you don't experience any side effects.

Myth #3: A family history of heart disease means you're destined to have it too. It's true that having a parent or sibling with heart disease increases your risk of this common condition, especially if that relative had premature (early) heart disease, defined as a heart attack that occurs before age 55 in a man or before age 65 in a woman. Coronary artery disease, which happens when fatty plaque narrows the arteries feeding the heart, is by far the most common form of heart disease. Factors such as high cholesterol and high blood pressure that boost heart disease risk may be linked to genes that run in families.

However, unhealthy behaviors — such as smoking or poor diet or exercise habits — also tend to run in families and may contribute to the elevated risk. "For most people, lifestyle factors carry more weight than genetics, and healthy habits can help counteract inherited risks," says Dr. Bhatt.

If early heart disease runs in your family, you might have an inherited lipid disorder such as familial hypercholesterolemia (abnormally high LDL cholesterol) or elevated lipoprotein(a); the Family Heart Foundation (www.familyheart.org) has more information about testing and treatments.

Myth #4: Only women get unusual heart attack symptoms. Nearly 20 years ago, the American Heart Association launched the "Go Red for Women" campaign to help raise awareness of heart disease in women. The key message — recognizing heart attack symptoms — highlighted some of the less common ones, such as nausea or vomiting, dizziness, and jaw pain. Some studies suggested that women are more likely to experience these symptoms than men. But the differences aren't all that great, and less typical symptoms can also occur in men (see "Common and less common heart attack symptoms"). "Be aware of all of these symptoms, and call 911 if you suspect you're having a heart attack," says Dr. Bhatt.

Source: Journal of the American Heart Association, May 5, 2020, p. e014733.

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