DIAGNOSTICS
How preventive cardiology works
A healthy human heart beats around 100,000 times a day, usually without us noticing. It works hard without demanding much attention. This makes it all the more important to look after your heart health with a regular heart health check, as many changes in the cardiovascular system develop over years – long before they cause any symptoms. Good medicine means thinking ahead rather than treating problems after they have occurred.
When it comes to our heart, we need to think years ahead. Many changes in our cardiovascular system can develop while we still feel perfectly healthy. That is why foresight is essential in preventive medicine, and specifically in preventive cardiology. Modern preventive medicine identifies risks, detects vascular changes at an early stage and helps us to age in good health. Listening to your heart before it has to make itself heard gives you the best chance of staying healthy for years to come. In this interview, Peter Gartner, Head Physician at Park Igls Medical Spa Resort, and Norbert Schauer, an internist and cardiologist, explain which tests are useful as part of a thorough heart health check and why modern heart health takes a holistic view of each individual.
Dr Peter Gartner:
"We thought we already knew everything about the body. But this is only the beginning."
Cardiovascular diseases are still the number one cause of death in Austria. Yet it seems that heart health only becomes an issue once symptoms become apparent.
Peter Gartner: Unfortunately, this is very common in medicine – many people only see a doctor when something hurts or is no longer working properly. At Park Igls, we're very fortunate, as many guests come specifically for a comprehensive check-up. In everyday medical practice, however, we often find that people only take action when the house is already on fire. Yet this is exactly what shows how important a regular heart health check really is.
Norbert Schauer: Today, there are excellent ways to identify risks long before symptoms occur. One example is the Prospective Cardiovascular Münster Study, one of the largest German long-term studies on cardiovascular diseases. Based on this research, we can calculate a score that assesses an individual's risk of experiencing a cardiovascular event within the next ten years. The two strongest – and, unfortunately, uncontrollable – factors are age and sex. Other risk factors include blood pressure, blood sugar and smoking. What's fascinating is that this score can be used to demonstrate quite clearly just how much the risk changes if you take targeted measures. If, for example, someone manages to lower their blood pressure, the effect becomes immediately apparent – an eye-opening moment for many: suddenly, cardiovascular disease prevention is no longer an abstract concept but has measurable effects.
Cardiovascular diseases are often regarded as a 'men's issue' – is that fair?
Norbert Schauer: Statistically speaking, men do indeed have a higher risk of cardiovascular disease and, on average, develop related conditions earlier. This is also reflected in the risk models we use – which, in turn, means that women often underestimate their own risk.
Peter Gartner: Hormones play an important role in women's cardiovascular health. Before menopause, oestrogen protects the cardiovascular system by keeping the blood vessels elastic, lowering blood pressure and having a beneficial effect on blood lipids. After menopause, however, the risk gradually becomes similar to that of men. At that point, heart health definitely becomes a women's issue, too.
Why a heart health check matters
A look inside your arteries
Norbert Schauer: The problem is that the most important risk factors often go unnoticed for a long time. High blood pressure, early vascular changes or metabolic disorders usually do not cause any symptoms at first. Typical warning signs such as chest pain, shortness of breath or a feeling of pressure in the chest should, of course, always be taken seriously. However, when such symptoms occur, the problem is often already advanced. The real challenge in cardiology is therefore to detect changes before they cause any symptoms. An ultrasound scan of the carotid artery is particularly helpful in this regard.
Norbert Schauer: Because it gives us valuable insight into vascular health. The carotid artery lies directly under the skin and can be examined very precisely using high-resolution ultrasound. This allows us to detect changes in the inner wall of the artery at an early stage – early enough, in many cases, to take steps that help reduce plaque in arteries before more serious damage occurs. Put simply: if the wall of the carotid artery shows changes, this might indicate that similar processes are also taking place in other arteries.
Peter Gartner: That is why carotid ultrasound is one of the most valuable tools in cardiovascular screening. It's one of the most common tests we carry out at Park Igls, forming a key part of every heart health check. It is painless, non-invasive and has no side effects – and it provides very useful information.
Peter Gartner: Yes, certainly. A classic example is an exercise stress test on a cycle ergometer, which we use as part of a broader heart health check. It allows us to observe how the heart reacts to increasing exertion. This provides valuable information about the cardiovascular system's performance and adaptability.
Norbert Schauer: The key is always a combination of different tests during a comprehensive heart health check. An echocardiogram shows the heart's structure and pumping capacity, as well as the functioning of the heart valves; a stress ECG provides information about electrical activity during exertion; and a clinical examination completes the overall picture. Although we cannot see every single coronary artery directly, the combination of these findings allows a very reliable assessment of individual risk.
Peter Gartner: Fortunately, yes. A good example is smoking. Studies show that, after five years without smoking, cardiovascular risk returns to a level similar to that of non-smokers. So it's never too late to make positive changes. Another example is high blood pressure. Many people with slightly elevated readings feel perfectly capable of carrying on with their daily lives, yet at the same time their heart constantly has to work against increased resistance. Over time, the heart muscle thickens, and eventually the system reaches its limits.
Norbert Schauer: We see similar processes in the blood vessels. Persistently high blood pressure puts strain on the vessel walls and triggers structural changes. This is precisely why early treatment of high blood pressure is so important – although the situation is more nuanced. Blood pressure is very dynamic. It changes within seconds, depending on movement, stress, emotions or tension. Many people are familiar with what is known as 'white coat syndrome': the medical examination itself causes blood pressure to rise. Sometimes, all you need to do is to sit still and breathe slowly for a few minutes. Blood pressure reacts surprisingly quickly to relaxation, which is why we never consider just a single parameter.
Peter Gartner: If we want to gain a more accurate picture, we use modern 24-hour monitoring. This allows us to see not only the daytime readings, but also whether blood pressure drops sufficiently at night. It is the night-time readings that provide particularly important insights.
Gut health plays a vital role at Park Igls
Is there a connection between the gut and the heart?
Peter Gartner: We now know that the systems in our body are much more interconnected than was long assumed. The gut-brain axis is one example of this – and it is now well studied. Furthermore, numerous research projects focus on the microbiome – our gut bacteria – and its influence on other organs such as the skin and kidneys. Initial findings suggest that metabolic by-products of certain gut bacteria may affect the heart and blood vessels. There are still many questions that need to be answered, but the findings are highly informative. One thing is certain: a healthy lifestyle never affects just a single organ. The concept of holistic medicine has therefore gained increasing scientific support in recent years – further evidence that effective cardiovascular disease prevention looks at the whole person, not just the heart.
DR NORBERT SCHAUER
… is a consultant in internal medicine and cardiology and has his own practice in Innsbruck. He began his training at Innsbruck University Hospital before moving to a major cardiac centre in Wels in eastern Austria. When he returned to Innsbruck, he rejoined the hospital and eventually set up his own practice, where he specialises in prevention. Dr Schauer has been a consultant at Park Igls for over 25 years.
