What every person should
know about heart disease
- Risk factors for coronary artery disease
The Framingham Heart Study, a 50-year study in
Framingham, Massachusetts, developed the concept of risk factors and
their relationship to coronary artery disease-a concept that is widely
accepted and used throughout the world.
- Atherosclerosis and coronary artery disease
Atherosclerosis is the buildup of fatty, fibrous
plaques on the inner wall of arteries causing them to become narrowed or
hardened. Atherosclerosis starts as a fatty streak and develops over
time to become a complicated obstructive lesion that blocks blood flow.
Early fatty streaks have been seen at autopsy in very young children
(under 10) who have died accidentally. Significant atherosclerosis has
been seen in young men in the military who have died in combat. From
this, we know that atherosclerosis starts at a very young age and
develops silently and slowly without symptoms or warning.
Atherosclerosis of the
coronary arteries can develop in any of the main coronary arteries or
any of their many branches. Atherosclerosis of the coronary arteries is
called coronary artery disease or CAD.
There are two types of risk factors for the
development of coronary artery disease-those you cannot control and those
The "uncontrollable" risk factors are:
- Age (the risk increases
- Gender (men develop CAD
10 years earlier than women)
- Family history (genetic
predisposition and common lifestyles increase risk)
- Race (incidence is
greater in some groups of African Americans, Hispanics, Asian Americans,
native American Indians,)
The "controllable" risk factors are:
- High blood pressure
- High blood cholesterol
- High blood sugar
- Obesity and
- Obesity and Overweight
- Physical inactivity
Unfortunately, many people tend to ignore the
importance of the "uncontrollable" risk factors because they feel they can
do nothing about them. While it is true that you cannot change your age,
gender, race, or the family you were born into, these risk factors
compound and worsen the impact of the other risk factors.
Remember-the first symptom which 30% of heart
attack victims experience is sudden death. It is a dangerous game of
Russian roulette with your life if you wait for symptoms to appear before
you take action.
And the only action you can
take is to identify and reduce the "controllable" risk factors.
Major risk factors for heart disease that can be
controlled or changed
- Smoking. Smoker's
are at twice the risk of heart attack than are non-smokers. Cigarette
smoking is the biggest risk factor for sudden cardiac death. Smokers are
two to four times more likely to have sudden cardiac death than
non-smokers. Smokers who have a heart attack are more likely to die and
die suddenly, as quickly as an hour after the heart attack, than
non-smokers. People who smoke cigars and pipes have a higher risk of
death from heart disease, but not as high as people who smoke
cigarettes. Environmental (or second-hand) tobacco smoke increases the
risk of heart disease, even if you don't smoke. Decrease your risk of heart disease by not smoking.
If you smoke, stop.
- High blood
pressure. High blood pressure puts more stress, or workload, on the
heart, causing it to enlarge and get weak over time. The risk of stroke,
heart attack, kidney failure, and congestive heart failure is also
greater in people with high blood pressure. Combined with obesity,
smoking, high blood cholesterol and/or diabetes increases a person's
risk of heart attack or stroke several times. If
you have high blood pressure, learn how to manage it through lifestyle
changes, stress management, and/or medication.
- High blood
cholesterol. The risk for heart disease increases in people with
high blood cholesterol levels. When other risk factors are present, the
risk increases. Age, gender, heredity and diet all play a role in blood
cholesterol levels. If you have not had your
blood cholesterol level checked, ask your doctor. If you know you have a
high blood cholesterol level, do what you can to lower it, through diet
and exercise and/or medication.
- High blood sugar
(diabetes). Diabetes is a complicating factor for heart disease, and
vice-versa, greatly increasing the risk for heart disease and stroke.
Millions of Americans have diabetes but don't know it. Medical
management of diabetes and lifestyle changes can help reduce your risk
for heart disease. If you have not been tested
for diabetes, talk to your doctor. If your family has a history of
diabetes, you are at increased risk and may need to be tested sooner. If
you do have diabetes, learn all you can about how to manage your disease
effectively. There is much you can do to control your diabetes, and help
reduce your risk of heart disease.
- Obesity and
overweight. People with excess body fat, especially in the waist,
are more likely to develop heart disease even if they don't have any
other risk factors. Excess weight increases the stress, or workload, on
the heart and raises blood pressure. Blood cholesterol and triglyceride
levels also go up as weight increases, and lowers the "good"
cholesterol. Diabetes is more likely to develop, too, in people who are
obese or overweight. By losing as little as 10 to 20 pounds, you can
improve your health and decrease your risk for heart disease. If you are overweight or obese, change your
lifestyle to include healthy weight management techniques such as
portion control, nutritious diet, and regular exercise. If you need help
learning how to achieve a healthy weight, talk to your doctor.
inactivity. People who are inactive, or "sedentary," are at a higher
risk for heart disease. Regular, moderate-to-vigorous exercise is
essential to prevent cardiac and vascular disease. The more vigorous the
activity, the greater the benefits to your cardiovascular system.
Exercise also helps control blood cholesterol, diabetes and obesity, and
has been shown to lower blood pressure in some people. If you do not currently exercise, begin slowly.
Even moderate exercise has benefits. If you haven't exercised in a long
time, talk to your doctor first to ensure you are healthy enough to
participate in regular exercise. Vigorous exercise isn't necessary to
achieve good outcomes and reduce your risk of heart disease; even
moderate activity such as walking-but doing so on a regular basis, 3 or
more times weekly, will be of benefit to you.
- Stress may be a
contributing factor to heart disease. Everyone experiences stress. It is
part of being human, of being alive, and part of interacting with the
world. It is our reaction to stress that matters in terms of our
health-especially the risk of heart disease. If
you feel that you are under chronic stress, learn some techniques to
help you manage your response to the stress in your life.
- Sex hormones have
been shown to be a contributing factor to heart disease in women after
menopause, resulting from the natural loss of estrogen. If you have had a natural or surgical menopause
(removal of the uterus and ovaries), talk to your doctor about estrogen
replacement therapy or hormone replacement therapy.
- Early forms of birth
control pills which
had higher doses of estrogen and progestin, increased the risk of heart
disease and stroke, particularly in women who smoked heavily. Newer oral
contraceptives have a much lower risk, unless women who take them also
smoke or have high blood pressure. If you took
early forms of birth control pills, or smoke and take birth control
pills now, make sure you have yearly medical check-ups to include blood
pressure screening, triglyceride and glucose levels. If you are taking
birth control pills and smoke, try to quit smoking to reduce your risks
of heart disease.
- Alcohol consumption
on a regular basis, or in considerable quantity, can raise blood
pressure, cause heart failure, and lead to stroke. It also contributes
to obesity, alcoholism, accidents and suicide. If you drink, do so moderately ( no more than one
drink for women or two drinks for men daily). One drink is defined
as 1 ½ fluid ounces of 80-proof alcohol, 1 ounce of 100-proof alcohol,
or 12 oz. of beer. If you have trouble limiting
how much alcohol you drink, talk to your doctor to learn how you can
gain control over it.