Heart Month: A Canadian Cardiac Surgeon Offers Advice For Keeping Your Ticker in Top Shape

February is Heart Month in North America and the perfect time to reflect on the many ways in which heart disease can be prevented or, at the very least, delayed.

In fact, according to the Heart and Stroke Foundation, nearly eight out of 10 cases of premature heart disease and stroke are preventable. And that message seems to be getting through, in Canada at least, where heart disease has dropped from its long-time No. 1 position for cause of death to number two. (In the United States, heart disease is still the No. 1 killer.) 

Dr. Arvind Koshal is one of Canada’s leading cardiac surgeons. During his illustrious career, he performed 8,500 open-heart surgeries in Ottawa and, later, Edmonton. There, as chief of cardiovascular surgery, he dramatically reduced waiting times for surgery and was instrumental in the development of the world-class Mazankowski Alberta Heart Institute. 

With anything heart-related, “there are certain things you can control and certain things you cannot control,” explains Koshal, author of the forthcoming book, Transplant: A Cardiac Surgeon’s Story of Immigration and Innovation.

One risk factor that cannot be controlled is a strong family history of heart disease. But a family history is even more reason to get on top of the controllable lifestyle-related factors, like quitting smoking (which will help fend off more than just heart disease) and keeping cholesterol, blood pressure and blood sugar at healthy ranges. 

To Koshal, most of the lifestyle changes are simple to make. Exercise, for one, needn’t be complicated. “It’s not a lot of activity that’s required for cardiovascular health,” he says. Koshal himself plays golf and takes a 20-minute walk five days a week with weekends off. In studies, that amount of walking has been shown to increase lifespan by eight years, he adds. 

While it’s easy to get overwhelmed by diet advice and choices, Canadian and American cardiovascular societies keep it simple: eat plant-based foods more often; skip or minimize processed foods; eat whole grains, nuts and seeds; opt for water over sugary drinks. Koshal eats almost anything he likes, he adds, but in small quantities. “I enjoy it. I don’t over-indulge, and I think that’s important.”

What’s just as essential not only for heart health but for longevity, says Koshal, is social engagement and staying mentally active. “People who are socially engaged, at an older age particularly, live longer than those who are not. That is now well-known to be one of the most important factors to a longer life, and that obviously has to do with heart health as well.”

When Koshal was retiring from his busy life as a surgeon, a friend counselled him to make sure he had something planned for every day – even if it was something as simple as going to the grocery store. Facing free time for essentially the first time in his life, Koshal chose to work on his golf game and has taken up bridge. “It’s important to have something to look forward to,” he says. 

When people talk about heart disease, they typically mean coronary artery disease, which is a hardening of the arteries. “Even if you do the right things, you cannot always completely prevent it,” says Koshal. “But you can slow its progress – so instead of having your heart attack at 60 or whatever, you may defer it for another 10 years or more.”

Seeing your doctor regularly, knowing the warning signs of heart attack and getting immediate help if there are any concerns are keys to a better outcome. Warning signs can be unusual: sudden chest pain, pain in the left arm or jaw, tightness in the chest, fatigue, heartburn or indigestion, cold sweat and/or shortness of breath. 

“If you suspect a heart attack, you should call 911,” says Koshal. “Don’t drive yourself to the hospital and go to the nearest hospital because initial treatment should be done as soon as possible. Don’t waste time and do not drive.” 

In addition, if a normal activity suddenly causes unusual symptoms, like shortness of breath or some tightness in the chest, see a doctor. It could be nothing at all, he adds, or it could be something non-urgent like angina, which is a lack of blood flow to some segments of the heart. 

But if there’s ever a question or a doubt, he adds, “go to a doctor.”

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