We West Virginians love our red meat, greasy fried foods, freshfrom-the-oven bread slathered with melting butter and, of course, fat-packed desserts. Our love affair with nicotine hasn't waned, despite smoke-free regulations in public places statewide that make it hard to light up. For many of us, exercise is what we get walking from the sofa to the refrigerator to grab a diet soda or a light beer.
Is it any wonder we're at or near the head of the class nationally for bad outcomes like heart disease, diabetes and stroke?
"It's certainly urgent," agreed Dr.
West Virginia DHHR's State Health Report, released three years ago, pegged heart disease rates in 2011 at 6 percent, well above the national average of 4.1 percent. Likewise, cardiovascular deaths per 100,000 in 2011 stood at 321.2 in
DHHR said all three of those numbers had improved from 2008, though it also pointed out three critical risk factors for heart disease - high blood pressure and diabetes - were on the rise.
"I see heart disease every day," said Dr.
"I'm seeing more risk factors for heart disease than I used to. I'm seeing a painful incidence of young people with sudden death. I'm seeing heart disease at a younger age than I used to."
Heart disease is defined as any disease that affects the heart, a list that includes cardiac arrest, arrhythmias, valve disorders and, its most common form, coronary artery disease.
In coronary artery disease, the most common form, the blood can't deliver oxygen and other nutrients to cells in the heart muscle because arteries are blocked. Left untreated, CAD can lead to a myocardial infarction, or heart attack. The longer a person suffering a heart attack goes without treatment, the greater the damage to the heart.
Fanning said individuals suffering heart attacks typically wait at least two hours before seeking help. Unfortunately, the longer they wait, the more damage that's done to their heart muscle.
"The sooner you fix it, the more muscle you preserve and the better the prognosis," he said. "In my mind, heart attacks and sudden death are not a medical problem, they're community problems.
"A couple weeks ago I had someone who waited 17 hours before getting help. ... The message needs to get out that you can't ignore chest pain, you've got to go and get it evaluated."
Just as having one of the risk factors for heart disease - high blood pressure, high cholesterol, smoking, alcohol, stress, diabetes, obesity, sedentary lifestyle and a family or personal history of a heart attack or stroke - increases your risk of suffering a heart attack, seeking treatment early on increases the odds of surviving.
"Everybody thinks the medical industry will fix their problem for them, and to some extent we do," Fanning said. "But prevention is a whole lot cheaper and there's a lot less side effects.
"Weight loss plus moderate exercise will fix half the issue with blood pressure, diabetes and cholesterol."
Instead, he said there's been an explosion of diseases such as metabolic syndrome, obesity, diabetes, sleep apnea "and the consequences that go along with them," Fanning said, adding atrial fibrillation - an irregular heartbeat, or arrhythmia - is on the upswing.
Atrial fibrillation can lead to blood clots, stroke, heart failure and other heart-related complications. The
"So clearly, one of the reasons we're seeing more of it is because we have an aging population," he said. "But it's also happening in younger people because of sleep apnea and obesity."
"People think of heart disease as coronary artery disease and a plumbing problem," Fanning added. "But atrial fibrillation is an electrical problem. It's the new horizon - it's not a new problem, but its incidence is increasing dramatically."
The more risk factors a person has, the greater the chance he'll suffer from heart disease. While medical advancements make it possible to treat heart disease and, in many cases, save lives, Fanning said prevention remains key.
"There are people who don't care about the risk factors engendered with lifestyle, with obesity, with diabetes and cholesterol, because they figure we can fix them," Fanning said. "But the startling thing is more people are dropping dead of heart attacks, and at a younger age.
"Prevention is a far better means of avoiding complications than fixing a problem after it's occurred. Everybody thinks medical science is what's going to cure them, but having systems in place to care for heart attack patients and patients with atrial fibrillation is not a solution. Ultimately, the solution is prevention."
He said a 10 percent weight loss, for instance, reduces the risk of atrial fibrillation by 50 percent and is far more cost-effective than treating, fixing and managing atrial fibrillation. But some patients figure going to the hospital for a catheterization is akin to going to the supermarket.
"There's a feeling that medical care is there to fix their problems," he said, pointing out he's had patients suffer their first heart attacks at age 40, "and they come back and say, 'Why should I take medicine every day when I can come back in a few years and have you fix it for me?"'
"We're not making any headway," he added. "With all the work we do in the middle of the night taking care of heart attack patients, the overall mortality from heart attacks hasn't gone down. I think what's happening is we're taking care of sicker and sicker people. But there's a point where we can't catch up."
"Everybody thinks about lack of exercise, excess weight, high blood pressure and diabetes, and those certainly are risk factors," Anderson said. "But lifestyle, this fast-paced world we live in and chronic stress tends to isolate us; I think that's the icing on the cake."
The Ornish program is an intensive, nine-week cardiac rehabilitation regimen that uses nutrition, exercise, stress management and group support to treat and reverse heart disease, providing an alternative to conventional treatments, including surgery and medications. Its focus on a meatless, low-fat diet and daily meditation sets it apart from traditional rehab programs, which CAMC system also offers.
Anderson concedes the regimen is strict and not for everyone. Some people prefer traditional rehab.
"It's very individual," she said. "That's kind of what we try to figure out - what makes one person receptive and another person not.
"You might have two people who go through the very same thing and one may say, T hear you, I've got to do something.' The other may say, 'Leave me alone, I'm good.' We don't know what makes that happen in some people, what causes some people to get it."
Anderson said the Ornish program's focus is using the four core lifestyle changes - nutrition, exercise, stress management and group support - to treat and prevent heart disease.
"If people follow the Ornish guidelines, they can have reversal of their heart disease," said Anderson, who ad- mits she's biased. "They can undo a lot of the damage that's been done."
'Scared Me Straight'
"I was not living my life very healthfully," he said. "I certainly felt the impact of stress and everything else. I knew if I didn't make some wholesale changes to how I live, I didn't anticipate being able to see my daughter get married."
It was, he said, a time in his life when he was ready for "wholesale changes."
"I had been a diabetic; 1 was giving myself shots twice a day before my heart attack," DeChiazza said. "After 90 days in the program, I was completely off all my diabetic medicine - my blood sugar just responded so well. Really, it was a holistic change."
Now weighing in at about 205 pounds, he's kept the weight off for about four years. He's become a proponent of yoga and meditation as well as a vegetarian diet.
"The most amazing thing I see is just the transformation a person is able to make in nine weeks," she said. "You certainly see a lot of changes related to cholesterol numbers, weight reduction, better management and even stopping the progress of diabetes, but one of the most rewarding is seeing people embrace stress management."
The idea, she said, is to reset the nervous system and train the mind and body to cope with stress better."
"There's not very much in our daily lives in this culture that teaches people to do that," she added. "That's why people are on anti-depressants, blood pressure medications, anxiety medications.
"I don't want to discount medications because many times people need them, but there's so much good you can do from a lifestyle perspective on a daily basis to give your nervous system a chance to reboot."
Gupta credits smoking regulations in communities all across the Mountain State with helping change the state's culture. He cited a 2011 study that found in the decade since
"There have been attempts to make (it) controversial, but the fact remains the evidence is undisputed," he said. "When you can make public places like restaurants, schools, college campus smoke free, fewer people end up having heart disease and heart attacks."
Just as important, he said, is working with schools, employers and even communities to effect change, whether it's assessing cardiovascular wellness, smoking cessation or partnering with grassroots groups such as TryThisWV to make
All of that is a big deal for a state that ranks "at the top for presence of cardiovascular disease."
"We're at almost twice the national rate for any cardiovascular disease, including stroke," Gupta said. "What's important and cool about it is the ideas are not being handed down from
"A small amount of money in communities is helping drive innovation and generate activities."
Whether the target audience is in a school or a workplace, Gupta said the message needs to be the same.
"We want the healthy choice to become the easy choice," he said. "When people start making the healthy choice their easy choice, it becomes much more integrated into their lifestyle."