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For patients with heart disease, it can be an overwhelming world of medical terms, treatments and medications. While there are many kinds of heart disease, the most common is chronic coronary disease (CCD), also known as coronary artery disease (CAD) or coronary heart disease (CHD). All these terms mean the same thing – which is that one or more of the heart’s arteries are blocked due to cholesterol (plaque) buildup and/or inflammation. These blockages limit blood flow to the heart, which can lead to chest pain (angina) or heart attack. According to the Centers for Disease Control and Prevention, this common condition affects 1 in 20 adults over the age of 20 in the United States.

Yet, while CCD is extremely common — there’s a lot to know about the condition, and things are changing frequently, including how cardiologists are using medications, diagnostic testing and lifestyle interventions to manage it. That’s why it’s so important for patients with CCD to see their cardiologist regularly.

New Treatment Guidelines Released

Earlier this year, the American Heart Association and the American College of Cardiology released new guidelines to help inform patients and the medical community on best practices for CCD treatment. At 118 pages, the new guidelines can be a bit overwhelming and they’re written for medical providers. That’s why we teamed up with cardiologist Dr. Raj Fofaria to summarize the key highlights in simple terms.

“Heart disease is such a complex disease that patients don’t always know what questions to ask — and as physicians, we couldn’t possibly address all of the changing guidelines and research that affect how we develop and refine our treatment plans in every visit,” explains Dr. Fofaria. “My hope is that this overview can help educate and reinforce some important things patients should know about heart disease — and to encourage you to have regular conversations with your cardiologist and to ask any questions you might have as it relates to your individual situation.”

Six Key Highlights

Get the skinny on weight loss drugs.

If you’re curious about weight loss drugs and how they could affect heart disease, the latest guidelines highlight several important points. First, new research suggests that the use of certain diabetes and weight loss drugs (such as semaglutide, or Ozempic/Wegovy) may reduce the likelihood of heart attack and stroke in people with type 2 diabetes and heart disease. As a result, the new guidelines recommend them for certain patients.

At the same time, the new guidelines advise against patients with heart disease using weight loss drugs that contain phentermine and benzphetamine. Research indicates these medications can raise your heart rate and blood pressure, which can lead to added strain on the heart. They may also lead to heart rhythm problems. The bottom line? Always consult with your cardiologist before starting a new medication for weight loss.

Who needs a stress test?

While many patients with heart disease think they need an annual stress test, the new guidelines reinforce that patients who aren’t exhibiting symptoms (such as chest pain or discomfort, particularly with exertion) do not need an annual stress test. Why? Dr. Fofaria explains that stress tests are only indicated for patients who exhibit symptoms, because the test will help determine the best plan of care for each individual patient.

“Having a routine stress test for patients without symptoms won’t actually reduce your risk of having a heart attack. Because heart disease can progress so rapidly, a negative stress test doesn’t mean you won’t have a heart attack — and it can actually create a false sense of security,” he says.

Focus on lifestyle.

While much has changed as it relates to managing heart disease, many lifestyle recommendations remain the same — and the new guidelines reinforce
the importance of incorporating a heart-healthy diet (particularly avoiding trans fat) and regular exercise. They call out the importance of these specific recommendations (for patients without contraindications to exercise):

  • Reduce the time spent sitting or being sedentary.
  • Participate in routine, habitual physical activity.
  • Increase aerobic and resistance exercise.
  • For eligible patients, cardiac rehab is recommended and is proven to reduce the risk of chronic disease and death.

Watch out for OTC medications and supplements.

Common over-the-counter (OTC) medications aren’t all safe — particularly for patients with heart disease. Specifically, the guidelines warn patients of the risks of taking nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofren (Advil, Motrin or generics) and naproxen sodium (Aleve, Midol or generics). Dr. Fofaria tells us that these medications are risky when taken on a regular basis, and have been linked to various cardiovascular problems — including having a second heart attack. They can also cause bleeding in the stomach and/or intestines – and when combined with blood-thinning medications can lead to serious bleeding risks. A less risky alternative could include acetaminophen (Tylenol).

“Many patients are unaware of these risks – and instead assume that anything available over-thecounter is safe,” explains Dr. Fofaria. “These guidelines serve as an important reminder to talk with your cardiologist about any and all medications and supplements you’re taking — even some vitamins can be dangerous for patients with heart disease.”

Smoking, secondhand smoke & e-cigarettes are all risk factors.

The link between smoking and heart disease is undeniable, but secondhand smoke puts even non-smokers at risk. The chemicals in secondhand smoke can lead to inflammation that increases risk for both chest pain and heart attacks. It can also contribute to the formation of blood clots, which can lead to heart attack or stroke. If you have friends or family members who smoke, encouraging them to do, so outside can help protect you and your heart.

If you are a smoker who’s trying to quit, you may have contemplated transitioning to e-cigarettes. While e-cigarettes can increase the likelihood of quitting successfully when compared to the use of nicotine replacement therapy, there’s just too much we don’t know about the risks of e-cigarettes, yet. For that reason, e-cigarettes are not recommended as a first-line therapy for smoking cessation.

“For my patients who want help quitting, I recommend our Quit With WakeMed program, which offers a comprehensive team approach that is 10 times more effective for quitting than going it alone. For those who commit to the program, it’s highly effective,” says Dr. Fofaria.

What’s the verdict on HRT?

While hormone replacement therapy (HRT), including estrogen and progestin, can often help women manage postmenopausal symptoms such as hot flashes, patients with chronic coronary disease should first talk with their cardiologist to discuss the risks and benefits.

While there has been much talk of these therapies offering cardiovascular protective benefits, these theories have not yet been proven. On the other hand, research has confirmed that HRT does increase the risk of deep vein thrombosis (DVT), which is a dangerous blood clot formed deep in the vein or lung.

“As cardiologists, it’s our job to help patients weigh the pros and cons of these therapies so we can come to an informed decision together about what’s best,” Dr. Fofaria explains.

The Bottom Line

Recommendations for patients with heart disease are constantly evolving, thanks to new research, technologies and the availability of new therapies. At WakeMed Heart & Vascular, we’re always on top of the latest guidelines — which is why it’s critical to stay in touch with us and to have regular discussions about any new symptoms you may be experiencing, and medications or supplements you’re taking or considering taking.

“Establishing a partnership with our patients who are managing heart disease is part of our treatment philosophy — we know our patients can’t navigate this complex disease alone,” says Dr. Fofaria. “We’re here to serve as a resource, a sounding board and a true partner in helping our patients live their healthiest lives.”

About Raj Fofaria, MD, FACC

Dr. Raj Fofaria is a board-certified cardiologist located in WakeMed Heart & Vascular’s Cardiology office in Clayton. As a non-invasive cardiologist, he specializes in the management of coronary artery disease, valvular heart disease, cardiac arrhythmia, congestive heart failure and the medical management of vascular disease. He performs diagnostic services including EKG, Treadmill Stress, Cardiac Ultrasound, Holter and Event monitoring, Stress Echo and Peripheral Vascular Ultrasound.

Before joining WakeMed Heart & Vascular, Dr. Fofaria completed his active duty service in the US Army where he worked as staff cardiologist and assistant chief of cardiology, as well as medical director for cardiac rehabilitation at Tripler Army Medical Center in Honolulu, HI. He also was a cardiologist consultant using remote echocardiography for Kona Community Hospital in Kailua Kona, HI.

Dr. Fofaria earned his medical degree from Medical College of Virginia at Virginia Commonwealth University in Richmond, VA, and his Bachelor of Science in biology, with a concentration in genetics, from Duke University. He completed his residency in internal medicine and fellowship in cardiovascular medicine at Brooke Army Medical Center in San Antonio, TX.

He is certified in cardiology and internal medicine by the American Board of Internal Medicine. He is a fellow of the American College of Cardiology and American College of Physicians. He has been an assistant professor of medicine at the Uniformed Services University of the Health Sciences and previously served as the Non-invasive Cardiology Program Director at WakeMed. He currently serves as the Medical Director for Cardiology at WakeMed.

In his spare time, he enjoys spending time with his wife and daughter and their three dogs as well as travelling internationally with his family.


This article is adapted from our Heart to Heart. Interested in getting future issues delivered to your home? Subscribe here.

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