Heart problems usually develop slowly over many years. That is why annual physicals matter, even when you feel well. A yearly primary care visit creates a consistent opportunity to treat risk factors to prevent disease and to detect early signs of heart disease.
“Much of my job is prevention,” says Kevin Heaton, MD, Clinical Instructor of Medicine at Harvard Medical School and Concierge Physician at Exceptional Health. “If we can change exercise habits or diet even a small amount (e.g. adding a 20 minute daily brisk walk, replacing French fries with a salad ), it’s like turning the helm of a ship a few degrees; it seems trivial, but over a long enough time period, you end up in a totally different ocean.”
Below is how Dr. Heaton explains the link between annual physicals and long-term heart health.
Why are annual physicals important for heart health, even if you feel healthy?
Annual visits are a chance to intervene years before a heart attack or stroke might otherwise occur. Discussing one’s family history, dietary and other habits, physical activity patterns, and sleep and psychological health, allows your doctor to identify and change the factors that are putting you at risk for serious disease later in life, says Dr. Heaton.
He focuses on two goals.
- Identify risks early. Detect unhealthy lifestyle habits and other risks as early as possible to prevent problems that often become symptomatic only after many years, often not until your 50s or 60s.
- Make small changes that add up. Even a few behavior changes or adding medication when appropriate (such as persistently high cholesterol) can dramatically change your long-term likelihood of heart disease.
One major goal of the primary care clinician is prevention. This means intervening on risks so that patients never present to their doctors reporting sudden chest pain (a heart attack) or a sudden inability to speak or visual loss (signs of a stroke), says Dr. Heaton. “These are devastating, often irreversible injuries, and to prevent them, I want to act 10, 15, or even 20 years before something like this occurs.”
What heart-related checks are typically part of an annual physical?
Dr. Heaton explains that an annual physical is not just labs. It is far more than lab tests. It is a comprehensive conversation about one’s personal and family health history, one’s habits, an assessment of one’s health understanding, mental health, and overall health and life goals. This is followed by a meticulous physical exam and personalized testing as needed.
- Interview
The core of every visit is an interview. The goal is to engender trust and a feeling of safety so that patients feel comfortable honestly discussing their habits and disclosing symptoms. - Physical exam
He performs a careful exam. Not every issue can be detected this way, but many can, including heart murmurs, high blood pressure, vascular problems, certain lung diseases, liver disease, enlarged lymph nodes, skin cancers, etc. - Predictive labs
He selects a set of screening labs based on the individual’s risk factors and age to help predict future disease risk, including, but not limited to:- Cholesterol
- Average blood sugar (A1C)
- Kidney function
- Liver enzymes
- Complete blood count
Kevin Heaton, MDAs a generalist physician who cares for people for many years, I have the privilege of being trusted with personal information and getting to know people intimately. It’s my joy and my duty to use this information to help prevent disease and try to prolong lives
How do doctors use these results to estimate heart risk?
Dr. Heaton explains that a person’s predicted cardiovascular risk is determined by combining all of the above-mentioned information obtained from the interview (e.g., lifestyle, blood pressure, cholesterol, A1c, etc.). He then uses guideline-based heart disease risk calculators to quantify risk. He also uses coronary artery calcium scanning in certain patients in whom it will change treatment decisions. “The key is to match the treatment plan to the person (not to treat everyone the same), which is why getting to know people well is critical to success.”
That risk estimate helps guide recommendations, which can include:
- Lifestyle changes to reduce risk
- Increasing aerobic exercise
- Adding resistance exercise
- Substituting saturated fats (butter) for unsaturated “healthy” fats (olive oil)
- Reducing sodium intake
- Medication when risk factors warrant it (for example, treating high cholesterol more aggressively)
- Statins to lower cholesterol if dietary changes are insufficient
- Metformin or GLP1 medications for prediabetes and obesity
- Blood pressure medications if lifestyle changes are insufficient
How does an annual visit help track heart health over time?
After the initial visits in which we define the risk factors, we can monitor changes over time to ensure we are addressing them. At every follow-up visit, we discuss exercise, diet, mood, life events, relationships, blood pressure, cholesterol, etc. We can view trends over time and correlate them with changes in job, familial, or social stressors (and, as a result, diet and exercise) to better inform the patient about how their overall life influences their risk for disease.
Why context matters?
Dr. Heaton says that patients are often fully aware of what they should be eating and how much they should exercise, but because of their children’s needs, a sick family member, or a very busy season (or year) at work, they have not been able to prioritize their own health. In those taxing situations, patients exercise less and eat less healthy foods. We can measure the negative effects: weight gain, increased blood pressure, increased blood sugar, and cholesterol. “The vital signs and labs really only make sense in context. I can only help people troubleshoot healthy changes if I know what is happening in their life and see them as a whole person integrated into family and social networks.”
Why labs cannot stand alone?
Dr. Heaton says you cannot check labs in isolation and truly understand what is going on, as noted above. It is critical to understand what is happening in a patient’s life and then work together on realistic solutions.
He often discusses difficult dilemmas like, “How can you perform well at work AND take care of your health?” and “How can you take care of a beloved family member AND yourself?”
Why lab trends over time can be motivating?
Dr. Heaton explains that it can be a revelation for patients to see their vitals and labs on a graph showing the changes that occur during difficult periods of their life.
Patients often connect those changes to their own lives, for example:
- “That was the month when I started to diet.”
- “That was when I was more active because of the warmer weather.”
- “That was when I was really into cycling.”
Dr. Heaton says this can be very impactful because patients directly see the effects of their habits.
Why the relationship with your primary care doctor matters for prevention?
Annual visits are most meaningful if they are used to build a relationship over time. Dr. Heaton says trust is the essential component of the patient-doctor relationship. When patients trust that their doctor listens genuinely and compassionately, they are more likely to be honest and to make healthy changes.
Dr. Heaton also notes that it is challenging to maintain healthy habits day after day, year after year. Ongoing guidance from someone you trust can help you maintain your priorities.
Disease prevention requires this open dialogue and practical partnership. Instead of one-time advice, patients receive steady support from someone who knows them, can track patterns, and help them through difficult times and maintain healthy routines. The doctor also makes sure they are availing themselves of the latest scientific treatments for human disease (e.g., newer diabetes and weight loss treatments, evidence-based treatments for joint disease). That long-term personalized guidance is a major reason annual physicals protect heart and overall health.
