Dr. Donna Arnett's new position is two jobs in one: a historic honor, and a daunting challenge. Arnett, Chair of Epidemiology at the University of Alabama at Birmingham, was elected president of the American Heart Association in July. She's the first epidemiologist to be AHA president, and only the second PhD, since the organization was founded in 1924.
The opportunity comes at a time when cardiovascular disease is the major cause of death worldwide, and the number one cause of death for women in the United States. One in three women will die from the disease, according to Arnett, which is more than from all forms of cancer combined. And yet, she says, heart attacks are commonly considered a male phenomenon.
For one thing, symptoms differ considerably between genders. Classic warning signs for men are severe chest pain and jaw discomfort, while women tend to experience nausea, vomiting, and back pain.
Though technological breakthroughs for treating heart disease are coming at an impressive pace, Arnett says the most effective tool in the medical arsenal is prevention and education: "The good news is, heart disease is preventable, and our focus on heart health needs to start during childhood."
The AHA presidency is a volunteer post (she's been a volunteer in other aspects since 1991), but it requires a good deal of travel, public speaking, and media interviews. Fortunately she enjoys those tasks. "I like meeting new people and working with the media,” she says. “I'm just fortunate to have such a strong administrative team here at UAB that I can rely on to keep the trains of the department running while I'm on the road for AHA."
The prevention plan that Arnett will be promoting for the next year is named "Life's Simple Seven," which focuses on blood pressure management, reducing blood sugar, quitting smoking, losing weight, increasing physical activity, controlling cholesterol, and eating better.
The rewards for following the plan are considerable. "If you can make it to age 50 with normal cholesterol, are not diabetic, hypertensive, or overweight, eat a healthy diet, are active physically, and have never smoked, then your chances of developing heart disease are close to zero,” she says.
"People are so busy with work and school that they often believe they don't have the time to incorporate these factors into their daily lives. But in reality, those can be a lot easier to include than you might think."
Though researchers still have a lot to learn about the many genetic factors involved in cardiovascular disease, the statistics are clear: if you have a parent, brother, or sister with heart problems, your own risk of developing the disease is roughly doubled. Even then, Arnett says, your risk factors are mediated through your lifestyle: controlling hypertension and hypocholesteremia (elevated levels of lipids in the blood) and avoiding smoking can significantly reduce the risk.
The gene revolution may someday offer new therapies for cardiovascular disease, but right now Arnett says gene research is providing "insights into conditions like elevated cholesterol. Not actually transferring genes but helping to identify genes that relate to treatments for high cholesterol and hypertension."
There's also a lot to be excited about in the new spectrum of comprehensive clinical care for strokes. "People are getting to the emergency room earlier when they have the signs of a stroke, and they're getting the message that every minute of time saved is part of the brain saved. We can use clot-busting drugs to open up the vessels and restore blood flow to people's brains," she says.
One high-tech heart breakthrough that's not commonly known yet is an implantable defibrillator that automatically intervenes to shock a failing heart back to life. The devices known as S-ICDS (subcutaneous implantable cardioverter-defibrillators), made possible by advances in electronic and battery technology, were approved by the FDA in April. They're implanted under the skin outside the rib cage, a minor procedure that can be done under conscious sedation.
While the more familiar pacemaker provides low-voltage stimulation to keep heart rhythm regulated, the ICDs are more similar to the larger defibrillators with paddles that are used in the ER, according to Arnett: "The device is able to sense when the heart is going into defibrillation--not pumping blood through the system effectively--and it shocks the heart to restore rhythm.
"For the first time, we're seeing a decline in sudden cardiac deaths, and that's very encouraging."