Dr. Loh: An important update concerning cardiovascular risk factor — lack of sleep

And now, in non-COVID news…

The prevention of cardiovascular disease has been the core principle of the Ventura Heart Institute at the old (pre-Columbian history, so to speak, which occurred before 1994) HCA Los Robles Regional Medical Center ever since VHI’s founding almost four decades ago. It has been a paradox in the private practice world since the prevention of cardiovascular disease works against the operating dogma of a fee-for-service world.

After all, most hospitals and doctors make their money by doing things to you, e.g., angiograms, stents, surgeries, procedures for diseases and conditions that develop. And health care providers hopefully are rewarded for doing the best job possible, marketing those results, and thus getting to do more of them.

Prevention is actually an anathema to that philosophy since you can’t bill for something that never happened. I designed the Ventura Heart Institute to be a separate department within the organizational chart of Los Robles Hospital, focusing on community outreach and education, screening for preventable cardiovascular risk factors (especially utilized by the Ventura County Fire Department personnel), conducting clinical research on new medications for treatment of cardiovascular disease, and providing certified continuing education programs for physicians and nurses.

The new Columbia-HCA healthcare administrators politely, but firmly, invited VHI to vacate its location off the lobby of the old Los Robles Hospital to a remote off-campus site because I was told, verbatim, “every square foot of the hospital has to make money.” And prevention, as admirable and laudable goal as it is, doesn’t make money. Since having the Ventura Heart Institute considerably off-campus made my hands-on approach untenable since my practice at that time was also in the hospital, I obtained a release of the rights of the name from hospital administration, and took it private and blended into my practice and moved out of the hospital.

The reason for explaining this background is that over the summer, perhaps lost like so many other things in the noise of COVID and Ukraine, something significant in the arena of cardiovascular disease prevention occurred. Perhaps not as big as adding a fifth Horseman of the Apocalypse or a fourth Wise Man, but it is something that may positively affect the cardiovascular well being of many of the readers of this column. I know that it has helped me so I felt I should share.

According to data gathered over the last century and reviewed by the Centers for Disease Control and Prevention, heart disease remains the leading cause of death in the U.S. Indeed, based on the projects I have around the world, I can state that cardiovascular disease rises to the top of causes of death in developing and developed countries. Although genetics plays a huge role, it is the lifestyles that follow pari-passu rising wealth that contribute to heart disease’s pre-eminence. And most of the research work VHI has done in the past was focused on developing and validating new investigational products that would mitigate those genetic and lifestyle risk factors.

Since 2010, the American Heart Association (AHA) focused on educating the public on the primary seven modifiable risk factors most influential in reducing cardiovascular risk. These were maintaining a healthy weight, not smoking (including secondhand smoke and vaping), being as physically active as feasible and on a regular basis, eating a healthy diet, and maintaining evidence based guidelines for blood pressure, cholesterol (actually non-HDL cholesterol) and blood sugar. Healthy lifestyle habits and judicious use of medications if needed to achieve those goals have been the cornerstones of primary care and specialty management of patients at risk for most physicians and nurse practitioners who have these patients in their practices.

But an eighth risk factor recently has been added as reported in one of the American Heart Association’s scientific journals, Circulation, which I can provide to interested readers, but it’s not a lay article. The new consideration is obtaining healthy sleep, both quality and quantity, which varies by age groups. For adults, the suggested goal is 7-9 hours, for children aged 13-18 years old, the recommended level is 8-10 hours, for those aged 6-12 years old, 9-12 hours, and for children aged 5 or younger, 10-16 hours.

If you’d like to check out your cardiovascular health score, which includes sleep, and track it as you implement changes, you can go to the AHA “My Life Check” page at mlc.heart.org.

Lack of sleep has been correlated with development of higher risks for obesity, diabetes, hypertension, and cognitive changes. Adequate sleep quantity and quality leads to both better physical and neuro-psychological health. As someone who prided himself on being able to “get by” on 4-6 hours of sleep when in training and during my most active years of practice, this addition to “Life’s Essential 8” is indeed sobering. As my family points out, I’d probably be a lot smarter now.

Irving Kent Loh, M.D., is a preventive cardiologist and the director of the Ventura Heart Institute in Thousand Oaks. Email him at drloh@venturaheart.com.

This article originally appeared on Ventura County Star: Dr. Loh: An important update concerning cardiovascular risk factor