Deepak Bhatt, MD: Threats to Heart Health

As the decades have come and gone, the most prominent threats to heart health have changed as our knowledge of potential risk factors have evolved.

In the Unites States, the population has ridden a roller coaster ride of cardiovascular risk that has included epidemics of smoking, obesity, and other habits detrimental to heart health. Despite this, cardiologists and other physicians have been working to combat these and have made major progress.

Smoking rates have subsided and the population has become more knowledgeable about the impact of exercise and proper diet, but as threat becomes diminished new threats continue to emerge. While Deepak Bhatt, MD, MPH, executive director of Interventional Cardiovascular Programs at Brigham and Women's Hospital and professor of medicine at Harvard Medical School, sat down with MD Magazine® to discuss the current state of cardiovascular health.

While he has grabbed headlines recently for his role in large clinical trials, Bhatt is regarded as both a research and opinion leader in the field and shared some of his opinions on threats to heart health in the US and globally.

MD Mag: What are some emerging threats to cardiovascular health that concern you most?

Bhatt I think there are a lot of emerging threats to cardiovascular health. Of course, some things are identified. Things like diabetes and it's remarkable the advances that have occurred in terms of diabetes drugs that have cardiovascular benefits. It's just been incredible experience being part of some of those trials and seeing other ones unfold.

So, that's not to say that the war on diabetes is over. Diabetes, at least on a global level, is certainly increasing. Obesity is another potential risk factor, again, worldwide something that's increasing. Smoking? It depends. Rates have stabilized in the United States but, in other regions of the world are still increasing. So, that's still an important cardiovascular risk factor.

In the US of course vaping has really taken off more so among young people and that's a potential threat for years to come. There's a high rate of vaping it appears in high school-age students and there is still nicotine with its addictive potential in those different products and they also come with flavorings, which itself can get someone that's young hooked on them. So, there's potential concerns there at least some preliminary data emerging that vaping isn't safe and carries cardiovascular risks as well. You know maybe 20 years from now we'll be looking back and saying why didn't we do something more to curb the vaping epidemic. I wouldn't be surprised if that happens.

You know, another sort of risk factor that's emerging is pollution. That is a greater appreciation that pollution of any sort air pollution noise pollution, but I'm really referring to air pollution, seems to be associated with excess cardiovascular risk and that's a problem globally it's actually more of a problem outside the US than in the US. In particular, places like China and India — where the rates of air pollution are 5-fold are more higher than the US. I think it's a potent risk factor for cardiovascular disease. There's epidemics of cardiovascular disease occurring there already but I think air pollution will further fuel that.

So, while we made a lot of progress in terms of things like diabetes medicine is lipid-lowering therapy — now it might even say triglyceride lowering therapy — lots of different things that the medical community and scientific community can be proud of and happy about I think there is still a lot of room for cardiovascular risk reduction both in the United States and globally.