February is designated American Heart Month to raise awareness of heart disease and encourage people to make lifestyle choices that promote a healthy heart. With heart disease being the leading cause of death for both men and women in the US, February’s focus on the heart is more than justified. However, it’s important to remember that heart disease doesn’t occur in isolation; it goes hand-in-hand with vascular disease.
“Each blood vessel is connected to every other vessel in the body, 60,000 miles worth. The reality is, if you have heart disease, you have vascular disease,” explains Robert Hacker, MD, FACS, of Mercy Health – Heart and Vascular Institute, Director of Vascular Surgery. On the flip-side, the same lifestyle choices and habits that help keep the heart strong and healthy also promote good vascular health.
Who is at risk for developing vascular disease? According to Dr. Hacker, some people have a genetic predisposition to the disease, but this is only a small portion of the population. Those at highest risk are smokers and diabetics. Age is a factor as well; 15 to 20 percent of people over age 70 have peripheral vascular disease. Males and African Americans/people of African descent are also at increased risk. Only a small number of people develop the disease as a result of taking particular medications.
Dr. Hacker notes that statistics shed some light on the prevalence of vascular disease in smoking and diabetes populations. According to the Centers for Disease Control and Prevention website (cdc.gov), 36.5 million US adults currently smoke cigarettes and 75 percent of those individuals smoke every day. What’s more, cigarette smoking accounts for 480,000 deaths each year in the US, including 41,000 from secondhand smoke.
With respect to diabetes, the American Diabetes Association’s website (diabetes.org) reports that 1.5 million Americans are diagnosed with the disease every year. In 2015 alone, 30.3 million Americans—9.4% of the population—had diabetes, though only 23.1 million of them were diagnosed with the disease; nearly 7.5 million people have no idea they are ill. Adding insult to injury, 15 percent of patients with diabetes also experience foot ulcers or other lower extremity wound complications.
“When you consider these numbers along with the fact that 15 percent of diabetics develop foot ulcers and other various pathologies, you start to get a sense of how dramatic the problem really is. These same people are at risk for coronary artery disease, kidney disease, and even stroke,” states Dr. Hacker.
Vascular disease can affect both the arteries (vessels that carry blood away from the heart) and veins (vessels that carry blood back to the heart), though Dr. Hacker points out that the vast majority of cases involve the arteries. Arterial disease can cause symptoms or conditions such as non-healing wounds, reproducible pain when walking, painful and discolored toes (“blue toe syndrome”), heart attack, aneurysm disease, and stroke. Venous insufficiency can lead to non-healing wounds of the legs, skin discoloration and staining around the ankles, large varicose veins, and pain.
Dr. Hacker adds, “One group with peripheral vascular disease suffers from a condition called claudication. This is when an adequate amount of oxygenated blood reaches the muscles when the person is at rest, but not when they are exerting themselves. As a result, painful cramping occurs with certain activities such as walking or climbing stairs. Sometimes they have back pain, hip pain, thigh pain, or even calf pain. It’s very important to identify these individuals and follow them closely because 15 to 20 percent of these patients will convert within a year to clinical limb ischemia, an imbalance of oxygen delivery that results in wounds or pain at rest that may require bypass surgery or even amputation.”
Unfortunately, 20 percent of people with vascular disease are asymptomatic—meaning they don’t even know they have it. In many cases, the first sign of the disease is some type of cardiac malfunction, such as coronary artery disease. Also noteworthy is the fact that nearly all people on dialysis for kidney dysfunction have vascular disease.
Though many doctors can treat vascular disease with competence, patients who seek treatment at the Mercy Health – Heart and Vascular Institute stand to benefit from a more nuanced, finessed approach to care. “You wouldn’t take your Maserati or John Deere to just any mechanic for maintenance or repairs, and the same holds true for your vascular health. Seeing a vascular specialist enhances patient-to-physician communication and understanding, allows for the development of a long-term relationship that significantly improves care if a problem does arise, and even helps contain healthcare costs because you’re getting the right testing or treatment at the right time. In some cases, the right care doesn’t involve surgery at all. Oftentimes, the most appropriate course of action is observation and supportive care in coordination with the patient’s primary care physician,” Dr. Hacker states.
Dr. Hacker and fellow Mercy Health vascular surgeon Mohammed Junaid Akbani, MD, are highly skilled, fellowship trained, and experienced surgeons who utilize the most cutting-edge open and endovascular surgical techniques. They use the very latest x-ray, laser, and wire-catheter technology, allowing them to provide comprehensive treatments of both arterial and venous problems with exceptional patient satisfaction and outcomes. “For example, we’ve seen a tremendous improvement in the survival of patients with ruptured abdominal aortic aneurysms using newer techniques,” says Dr. Hacker. “In the old days, only about five percent of these patients survived their repair at 30 days. But with the new endovascular procedure, survival at 30 days is greater than 90 percent; I have had patients even leave the next day with an incision no larger than a fingernail.”
Having extensive training and experience has allowed Dr. Hacker to engage with a wide variety of vascular specialists around the nation and in other countries. Dr. Hacker is also proud to be part of the “complex, hybridized, multidisciplinary treatment paradigm” at the Mercy Health – Heart and Vascular Institute. “We’re combining all the cutting-edge techniques with the very latest research so we can provide the right care at the right time for the right reason on the right patient,” he says.
Of course, the best way to treat vascular disease is to prevent it from developing in the first place. To help keep vascular disease at bay, Dr. Hacker suggests the following guidelines, but a discussion with your primary care physician is critical:
- Maintain a good relationship with a primary care physician.
- Avoid smoking.
- Exercise regularly (150 minutes of moderate-intensity exercise or 75 minutes of vigorous exercise per week).
- Maintain a healthy weight (BMI below 30).
- If appropriate and recommended by your doctor, follow an antiplatelet therapy regimen (aspirin therapy).
- Keep your blood pressure below 130 mm Hg (systolic) and 80 mm Hg (diastolic).
- Keep your LDL cholesterol level below 100 (below 70 if you have diabetes or other complex medical conditions), using a statin drug if appropriate and prescribed by your doctor.
- If vascular disease is already present, follow up with a vascular specialist every six months, with testing as appropriate.
“Building that relationship with a specialist is so important for patients with vascular disease. It’s a comfort knowing you have someone with that level of expertise on your side,” says Dr. Hacker.
Dr. Hacker is double board certified in General and Vascular Surgery, a Fellow of the American College of Surgeons, and holds two credentials in vascular ultrasound. He is the Medical Director of Mercy Health – St. Vincent’s Vascular Division and Medical Director of Mercy Health’s Vascular Ultrasound Lab. ➠
Dr. Hacker, Dr. Akbani and the entire Mercy Health – Heart and Vascular Institute are committed to providing you with rapid compassionate care for all your heart and vascular-related conditions. For more information, got to mercy.com. Same-day appointments are available.❦