"Less than 25 per cent of Canadians know the symptoms," says Victoria Newstead, of the Victoria Branch of the Heart and Stroke Foundation.
Yet, coronary artery disease is the leading cause of hospitalization for Canadian men and women (excluding childbirth). It is important that people monitor their health with the help of their doctor and be aware of the signs of heart disease.
So, what are the signs?
Victoria cardiologist Dr. Evan Lockwood cites central chest pain related to exertion, and pain in the right or left arm, jaw, neck, or into the back, dizziness, shortness of breath, loss of consciousness, nausea, and sweatiness as some key symptoms to pay attention to.
"Most people downplay the chest pain itself," says Lockwood. "Men over 55, especially those who are obese or have diabetes and who have pain after meals, will often put it down to reflux disease."
Pain that could mimic gastro-esophageal reflux disease, commonly known as heartburn, could be something more serious. Do not hesitate to ask your doctor about any symptoms.
Like men, women are at risk, but may be less likely to recognize symptoms as heart disease.
"Women experience what is often not typical chest pain, as portrayed in the media. They may experience chest pains that are not a typical squeezing sensation or a feeling of tightness in the arm or the jaw and they may not recognize them as heart attack symptoms," says Lockwood.
For both men and women, "any chest pain that is reproducible or becoming more frequent definitely needs urgent medical attention," says Lockwood.
Symptoms can be subtle. The ability to exercise can be effected.
"Normal walking was OK, but my jogging ability went down by about 25 per cent," says Richard Neve*. "It was thought that I had what is known as runner's asthma, which is chest soreness."
However, angiograms showed artery blockages, which proved to be the real source of his lessened ability to exercise.
Smoking increases the risk of heart disease because it can cause plaque to build in arteries, makes blood clots more likely, and causes blood pressure to increase. According to the Heart and Stroke Foundation, the risk of having heart disease related to smoking is cut in half after only one year of not smoking, and even those over 60 can extend their life by quitting.
High blood pressure causes significant strain on the heart, but it can be managed with the help of a doctor. High blood cholesterol can lead to plaque building up in arteries and can be managed by eating well, especially avoiding a high-fat diet, not smoking, and staying active. Ask a doctor to test cholesterol levels.
People with diabetes are at risk for heart disease, but controlling other factors can significantly reduce this risk.
Obesity or sedentary lifestyles increase risk, but can be easily managed.
Factors people can't control are age, family history and ethnicity. Risk for men increases after 55 years, and for women, increases after about 60 years. The risk increases if someone has a close family member who has had heart disease before 55 for men and before 60 for women. Both men and women are susceptible to heart disease.
"[Women] are at the same risk as men, just later," says Lockwood. People of First Nations, African or South Asian descent are more likely to have high-blood pressure and diabetes according to the Heart and Stroke Foundation of Canada, and are in turn more likely to have heart disease.
The good news is that everyone can reduce risks and decrease the chance of heart disease causing a stroke or heart attack. People should ask their doctor for guidelines on prevention of heart disease for their age group, and share family history and other relevant information to identify any testing that should be done.
Richard advises telling a doctor about the possibility of heart disease in the family, even when the family history is inconclusive. He cites the case of a patient he met while going through treatment.
"He told his doctor that he had no family history of heart problems, but what he didn't tell his doctor was that his dad died in a car accident at 40."
Some people who have heart disease, "are thin and they exercise, but if heart problems are in their genes, they eventually will probably have problems. A lot of them are fit people," says Richard.
The importance of regular exercise cannot be overstated as it both substantially increases health and the ability to recover from heart disease.
"I didn't have a heart attack. I put it down to exercising every day and I took an Aspirin a day," says Richard. (Always check with a doctor before taking Aspirin or any other medication).
It is never too late to start eating well. Follow the 0-5-30 rule, recommended by the Heart and Stroke Foundation, where zero is smoke-free, five is at least five servings of fruits and vegetables a day and 30 refers to the minutes of exercise a person should get each day. Increase the intake of high-fibre foods such as fruits, vegetables and whole grains, cut out fat whenever possible and use vegetable fats instead of animal fats. Cutting down on meat helps to reduce fat and calorie intake.
"I stay away from red meat," says Steven. "I just realized how important it is to make the adjustment to healthier eating."
Steven had a successful open-heart bypass surgery, and he doesn't take his health for granted.
Don't ignore heart disease.
"I think there is a reluctance to seek medical attention," says Lockwood. "Men tend to think everything is fine."
Have routine annual check-ups, check blood pressure and cholesterol and pay attention to diet and exercise, even if there are no signs of heart disease.
"By exercising and eating correctly, I did all the good things that prevented a heart attack," says Richard. "Others get to the point where they can hardly walk and they finally see someone. They ignored symptoms, didn't listen to their bodies, and they had an attack. That's much harder on their heart."
Myocardial infarction, or heart attack, due to reduced blood flow through coronary arteries will cause more serious damage to heart muscle.
Fortunately, coronary heart disease is getting a lot of attention from the medical community. In Victoria, world-class research is taking place.
"We do state-of-the-art coronary heart disease and arrhythmias (heart rhythm) research," says Lockwood.
Thousands of medical interventions, including open-heart bypass surgery, which creates a bypass for a clogged artery, and angioplasty and vascular stenting, which inflates then reinforces a clogged artery, are performed successfully each year in Victoria. Medical knowledge of treatment is improving, and combined with a healthy lifestyle, heart disease is largely manageable.
February is Heart Month. Victoria Newstead encourages people to look out for heart month events and plenty of volunteer opportunities this year. The Heart and Stroke Foundation offers many opportunities to get involved, and publishes the Annual Report Card on Canadians' Health each February.
*Not his real name.