Ask the Expert: Tips on Managing Heart Health in Your 50s and Beyond

Hopefully, this isn’t a secret, but tobacco use is the number one risk factor for heart disease — primarily cigarette smoking, but also nicotine vaping, cigar smoking, and chewing tobacco. The second most important risk factor is a sedentary lifestyle and the features that accompany it, like diet. And finally, family history.

I often tell my patients the three most important things you need to do are not to smoke cigarettes, be physically active, and pick the right parents!

The bottom line is that sometimes you can do everything right and still have heart issues because family history is such a significant risk factor.

When should someone in their 50s consider seeing a cardiologist?

Women tend to have a later onset of heart disease than men — about 15 years later — but are certainly still at risk for cardiac events.

While men should start to think about heart screenings in their 50s, women may only need to start thinking about testing between 60 and 65 years of age, depending on their risk factors (e.g., smoking, sedentary lifestyle, family history of heart disease).

It doesn’t mean that if you’re a 48-year-old man, for example, you don’t have any risk for heart disease or heart attack. Your 50s are simply when the risk curve starts to increase and when a screening test has some benefit in larger populations.

Are there any recommended heart health screening tests people should consider in their 50s? Why are these important?

There’s currently no one standard guideline for heart health screening. People in their 50s should consider regular:

• blood pressure checks
• cholesterol testing
• symptom assessment by a primary physician

If you have any of the risk factors listed above or symptoms like chest pain or shortness of breath, more specific heart screening tests may be appropriate.

• Stress test. This involves walking or running on a treadmill while a healthcare professional looks at your heart function and blood flow. It’s important to note that stress testing can often deliver false positives, showing a problem when there isn’t one.
• Coronary calcium scan. This type of scan looks for calcium deposits in the coronary arteries, which signal an increased risk of heart attack.
• Coronary CT angiogram. This non-invasive procedure gives healthcare professionals a literal picture of the coronary arteries and can pinpoint blockages and their severity. It involves the administration of intravenous (IV) contrast dye to highlight your blood vessels. Offered in all of our Novant Health Heart & Vascular locations, it’s one of the most advanced screening tests —- with the lowest false positive rates —- that we have.

Findings on these tests may lead to further tests or evaluations like heart catheterization.

Your primary care provider should be able to help you manage your heart health by providing information and guidance on things like smoking cessation, lowering blood pressure and cholesterol, and controlling blood sugar (if you have diabetes).

It might be time to see a specialist if you:

• have some risk factors (like those listed above) and symptoms like shortness of breath or chest pain upon exertion
• are having trouble managing risk factors like high cholesterol or high blood pressure
• have multiple strong risk factors (e.g., you’re a smoker with a family history of heart disease and you have a sedentary lifestyle)

What should people look for when choosing a cardiologist?

It’s important to choose a board-certified cardiologist. At Novant Health Heart & Vascular Institute, they require board certification or board eligibility for all physician cardiovascular specialists.

Beyond that, finding someone you mesh well with is key.

For example, I’m a heart rhythm doctor, so I specialize in arrhythmias. But Novant Health Heart & Vascular Institute also has cardiologists who practice in other specialties such as Interventional Cardiology, Advanced Heart Failure, and Imaging, like the coronary CT angiogram.

How should people modify their activity levels to support heart health?

You should aim for a target heart rate that’s 70% of your maximum predicted heart rate. You can determine a ballpark for your maximum heart rate using the following formula → 220 minus your age.

If you’re 50 years old, your maximum heart rate would be 170.

So, your target heart rate would be about 120.

Not everyone uses a heart rate monitor, though, so you may wonder how to tell if you’re meeting that target heart rate. You’ll know you’re in that aerobic, heart-healthy zone when you start to build up a sweat and breathe harder.

For some people, like those recovering from a heart attack or those who have been sedentary for a long time, it may take some time to work up to this ideal activity level.