Can Heart Disease Be Prevented? A Cardiologist Explains
Introduction
"She came in with a very big heart attack. She had a total of about 15 electric shocks."
That's how Dr. Adekunle Kiladejo, an interventional and structural cardiologist, opened his conversation with Dr. Shakeilla Smithbey on the Tree of Life podcast. He sees moments like this often. And many of them, he says, could have been prevented.
In this post, we break down the key takeaways from that conversation: which heart disease risk factors you can change, when stents save lives (and when they don't), how to speak up for yourself before a heart procedure, and why social factors play such a big role in who dies of heart disease in America.
Want to hear it straight from the cardiologist? Watch the full conversation below.
full YouTube episode- Ep 13 Part 2 Straight from the Heart | Podcast with Dr. Adekunle Kiladejo
Heart disease risk factors you can and can't change
Dr. Kiladejo sorts heart disease risk factors into two groups: the ones you can change and the ones you can't. (Watch this part)
Risk factors you can't change:
Age. Risk rises as you get older.
Genetics and family history. If heart disease runs in your family, your risk is higher.
Clinical risk factors you can manage:
High blood pressure (hypertension)
High cholesterol
Diabetes
Obesity or metabolic syndrome
Lifestyle risk factors you can change:
Diet
Inactivity or a sedentary lifestyle
Poor sleep
Stress
Smoking
The lifestyle group is where you have the most power. As Dr. Kiladejo puts it, these are things you can change in a very short amount of time.
Not sure where you stand? A cardiovascular risk assessment looks at your blood pressure, labs, and habits together. If metabolic syndrome is a concern, see the conditions we treat.
Can heart disease be prevented? Plaque starts in your teens
Yes, a significant amount of heart disease can be prevented, according to Dr. Kiladejo. And prevention starts earlier than most people think. (Watch this part)
He points to autopsy research showing plaque buildup in the arteries begins in the mid-teen years. The PDAY study examined nearly 3,000 people aged 15 to 34. Researchers found that adult heart disease risk factors speed up plaque buildup in the teen years, 20 to 30 years before symptoms appear.
So almost all of us carry some plaque. The real question is whether it grows into full-blown coronary artery disease or stays small and stable. That's where managing your modifiable risk factors makes the difference.
This is the heart of preventive medicine, a field Dr. Kiladejo says "cannot be overemphasized." See how we offer preventive health and wellness through virtual visits.
Do stents save lives? The truth about stents
Stents can save lives, but only in specific situations. That surprises many patients, Dr. Kiladejo says. (Watch this part)
He explains that blockages fall into two broad groups:
Acute coronary syndrome. This is a heart attack or a severe blockage that's about to cause one. In these emergencies, a stent can lower your risk of dying.
Stable coronary artery disease. You feel fine at rest but get chest discomfort or shortness of breath when you're active. Here, a stent mainly relieves symptoms and may not help you live longer.
He also notes that stents should only be placed for at least moderate to severe blockages, or very high-risk ones.
The research behind this is the ISCHEMIA trial, published in the New England Journal of Medicine in 2020. It followed 5,179 patients with stable coronary disease and moderate or severe ischemia. Over a median of 3.2 years, an initial stent or bypass strategy did not lower the risk of heart events or death compared with medication alone.
That doesn't make stents useless for stable patients. Patients with frequent chest pain saw lasting improvements in symptoms and quality of life after a procedure. The key is finding the right treatment for the right patient.
Questions to ask your cardiologist before a heart procedure
Before any major heart procedure, you should fully understand why it's being done. Dr. Kiladejo calls this informed consent: a real conversation between you, your family, and your care team, not just a form to sign. (Watch this part)
Based on his advice, bring these questions to your appointment:
What exactly is my diagnosis?
What is going on in my heart and arteries?
What are my treatment options, including medication?
Do I need a procedure, or can medication work for me?
What happens if we don't treat this?
What happens if we do, and what is the recovery time?
His other tips:
Write your questions down before the visit.
Bring a support person who can help you understand and remember the answers.
Get a second opinion if something doesn't feel right. Another expert's insight could change your decision.
As he reminds listeners, every procedure carries some risk, no matter how small. Our care coordination and specialist referrals can help you find a specialist for a second opinion.
Why are Black Americans more likely to die of heart disease?
Social factors like income, food access, and employment drive much of the gap. Health disparities are a lifelong passion for Dr. Kiladejo, and he shared a study that shows why. (Watch this part)
A Tulane University study published in Annals of Internal Medicine looked at health data from more than 50,000 U.S. adults. Here is what researchers found as they adjusted for each group of risk factors:
Adjusted for age and sex: Black adults had a 54% higher rate of death from heart disease than White adults.
Adjusted for clinical and lifestyle factors like blood pressure, diabetes, cholesterol, and diet: the gap shrank but did not go away.
Adjusted for social factors like income, employment, and food access: the gap disappeared completely.
In other words, where you live and what resources you have can shape your heart health as much as your habits. As Dr. Kiladejo says, "we still have ways to go" in educating our community and serving underserved patients.
What you can do to protect your heart
If Dr. Kiladejo had to pick one solution, it's education. "Knowledge is power," he says, and that education should start early, with aggressive preventive care in underserved areas.
Here's where to start:
Know your numbers. Check your blood pressure, cholesterol, and blood sugar.
Work on what you can change. Small shifts in diet, movement, sleep, and stress add up.
Ask questions. Understand any procedure before you agree to it.
Get a second opinion when you're unsure.
At Tree of Life Integrative Family Medicine, Dr. Smithbey offers virtual cardiovascular risk assessments, lab ordering, and specialist referrals, all from home. Book a visit or call 609-354-5553. Now serving patients in [STATES].
Want the full conversation? Watch the full episode with Dr. Adekunle Kiladejo.
This article is for educational purposes and isn't medical advice. Book a visit to discuss your situation.
Frequently asked questions
Can heart disease be prevented? Much of it can. Managing blood pressure, cholesterol, blood sugar, weight, diet, activity, sleep, stress, and smoking lowers your risk.
At what age does plaque start building up in arteries? Autopsy research shows plaque can begin forming in the teen years, decades before symptoms appear.
Do stents save lives? Stents can lower the risk of death during a heart attack or acute coronary syndrome. For stable coronary artery disease, research shows medication can be just as effective at preventing heart events, though stents may ease chest pain.
Can I treat stable heart disease with medication instead of a stent? For many stable patients, yes. Talk with your cardiologist about your options and ask what happens with and without a procedure.
Should I get a second opinion before a heart procedure? If you feel unsure, yes. A second opinion can give you more insight before a major decision.
Why are Black Americans more likely to die of heart disease? A Tulane study found the 54% higher death rate was mainly linked to social factors like income, employment, and food access.
