Unlikely Suspects

Heart disease remains the leading cause of death in men and women in the United States. According to the American Heart Association, about 600,000 Americans die annually of heart disease. More than 2,200 Americans die of cardiovascular disease every day—an average of one death every 39 seconds. Every year, about 935,000 people in the United States have a heart attack. Of that number, 610,000 were first-time heart attacks.

Among the most well-known conditions, or the usual suspects, that can lead to heart disease are high LDL cholesterol numbers, high blood pressure and diabetes.

The existence of those three conditions together is called metabolic syndrome. Other conditions such as obesity, arrhythmias and congenital heart defects can also play a significant role in heart health.

But there are other lesser-known health conditions and lifestyle factors than can contribute to heart disease. With the assistance of Ocala Cardiologists Dr. Rakesh Prashad and Dr. Prem Singh, here’s a look at perhaps some surprising, unlikely suspects with links to heart disease.


According to a Centers For Disease Control and Prevention population-based sample of 5 to 17 year olds, 70 percent of obese youths had at lease one risk factor for heart disease. Also, obese children are likely to be obese adults, putting them at greater risk for heart disease. In addition, obese childrenhave an increased risk of developing type 2 diabetes, high blood pressure and high cholesterol and triglycerides—all risk factors for heart disease.

An Australian health study of obese children and teenagers found evidence of hardened artery walls and the high cholesterol numbers one would normally find in a 45-year-old adult.

“There is more and more evidence of elevated cholesterol numbers and artery plaque buildup in obese children,” says Cardiologist Dr. Prem Singh of Marion Heart Associates.

But according to Cardiologist Dr. Rakesh Prashad of Heart and Vascular Care of Ocala, there is a solution to the situation.

“The key is weight loss through diet and exercise as soon as possible,” says Prashad, who is also a clinical assistant professor at the University of Florida College of Medicine. “And it all begins at home, because obese children generally have obese parents. So parents must set the example of good health.”

Prashad added that studies show “with no already existing heart disease, obese children who lose weight return to a baseline of a low risk group.”


Estrogen provides heart health benefits by naturally increasing good HDL cholesterol levels and lowering bad LDL cholesterol levels in the blood. The decrease in estrogen production during menopause has a detrimental effect on cardiovascular function and metabolism. The latter can lead to weight gain, increasing the risk for high blood pressure, type 2 diabetes and elevated LDL cholesterol levels.

A Johns Hopkins research study of more than 2,500 women found that women who underwent menopause before age 46 were twice as likely to develop heart disease.

“The National Cholesterol Education Program recognizes that the post-menopausal state is a risk factor for heart disease,” says Prashad. “Early menopause, between 44 and 46, increases the risk factors.”

But Prashad says, “Surprisingly, long-term studies have not shown that hormone replacement therapy decreases the risk of
heart disease.”

Signs Of Aging

A University of Copenhagen study of 11,000 people over 35 years reported that looking older than your age was an indicator of poor cardiovascular health. The study results were presented at the 2012 American Heart Association Scientific Sessions conference in Los Angeles.

Danish researchers documented signs of aging, such as crow’s feet, wrinkles, receding hairlines and baldness, for evidence of the difference between biological and chronological age as a link to heart disease. Over the course of the study, those with receding hairlines, baldness at the crown of the head, earlobe creases or yellowish fatty deposits around the eyelids had a 57 percent greater risk for a heart attack and a 39 percent greater risk of heart disease.

There was an increased risk of heart health problems with each aging sign present at the start of the study. This was the case among men and women, even taking into account a history of heart disease in the family. Of the original 11,000 study participants, 3,400 developed heart disease and 1,700 suffered a heart attack.

Interestingly, facial wrinkles and gray hair did not show any link to heart disease.

“These types of studies give us interesting data to look at, but my opinion is that they are not always that definitive,” says Prashad. “Their value lies in awareness and pointing out ways we should better manage our health.”

Periodontal Disease

According to the American Academy of Periodontology, people with periodontal disease are almost two times as likely to develop heart disease. Bacteria in the mouth can enter the bloodstream through the gums, causing an inflammatory response in the body and possibly leading to artery blockages.

In a case of which came first, the chicken or the egg, periodontal disease can also be a sign of already existing heart disease. The AAP cites several studies that show a link between gingivitis, cavities and missing teeth with heart disease.

“Despite some studies, my opinion is that there isn’t a conclusive link of periodontal disease as a high risk factor to heart disease,” says Singh.

Prashad agrees that it’s a controversial topic with not enough scientific evidence.

“In my opinion, patients with chronic poor oral health, particularly with tooth loss and cavities, have, in general, poor health,” says Prashad. “The periodontal disease may be associated with a moderate increase in heart disease factors. But these patients tend to have other high risk factors for heart disease that have little to do with periodontal disease.”


A Wake Forest University study of 4,500 elderly participants with no history of heart disease but with signs of depression, found that the participants had a 40 percent higher risk of developing heart disease in the future than a person who didn’t show signs of depression. A University of Maryland School of Medicine study reported that depressed people of all ages were four times more likely to have a heart attack. Part of the reason could be that depressed people are more likely to suffer from fibrosis, a stiffening of the heart muscles, which impedes blood flow to the heart.

“The association between psychosocial factors, such as depression, with increased risk of heart disease is not clear,” says Prashad. “But in those patients with existing underlying heart disease, then the risk of a heart attack increases. These patients should be treated aggressively.”

Some factors contributing to depressed people maybe being at a greater risk of developing heart disease include:

Depressed people are more likely to smoke, drink excessively and not exercise.

Depression possibly increases free radical and fatty acid production, which damages blood vessels lining the heart.

Depression is a stress response that can increase plaque buildup in 
coronary arteries.


Flu viruses increase inflammation in the body, usually the lungs, but also in the heart. Some British medical studies indicate that in those with high blood pressure or who are overweight, the flu could cause a heart attack. The same research found a consistent link between the flu and heart attacks in those with heart disease, diagnosed and undiagnosed.

According to the American Heart Association, flu-related complications may be a stressor for underlying heart disease.

“The flu viruses may cause systemic inflammation in those with heart disease,” says Prashad. “Those with heart disease can and should get an annual flu vaccine.”


Radiation Cancer Treatments

Harvard University research showed that, although rare, chemotherapy might increase risks for heart disease, including weakening of heart muscles (cardiomyopathy); rhythm disturbances (arrhythmias); high blood pressure and heart attack.

“There is an association of certain chemotherapy agents with the development of heart dysfunction,” says Prashad. “This is especially so in breast cancer patients.”

If the area receiving radiation therapy includes the heart area, there can be an increased risk of coronary artery disease (CAD), cardiomyopathy and heart attack. It often takes many years after radiation therapy to see any signs of heart disease.

“We believe that radiation increases free radicals, which can lead to heart disease,” says Singh.

A combination of chemotherapy and radiation can further increase the risk of
 heart disease.

Cocaine Use

The American Heart Association reports that cocaine use increases heart rate and blood pressure while constricting arteries supplying the heart. This can lead to arrhythmias, cardiomyopathy, inflammation of the heart muscle (myocarditis) and inner lining of the heart (endocarditis), as well as an enlarged heart (dilated cardiomyopathy) and heart attack. The AHA reports that young men ages 18 to 25 are the largest group of cocaine users.

“Most people, especially young people, who use cocaine are not aware that it can cause a heart attack,” says Singh.

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