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Assessing a person’s risk for heart disease is an essential task for the
primary care physician. Heart disease (including hypertension, coronary artery
disease and stroke) is by far the leading cause of death in the United States
and will claim more lives this year than cancer, accidents and AIDS combined.
Coronary artery disease (hardening of the arteries supplying the heart
muscle, leading to loss of blood supply) will cause 1.5 million heart attacks
this year, and one-third of those suffering heart attacks will die. Even more
worrisome, 250,000 people with heart attacks this year will die before ever
reaching the hospital. Because heart disease is very common and often silent
until it strikes, it is important to try to detect those at risk before it’s
too late.
What are the risk factors for coronary artery disease?
Luckily, much work has been done to identify conditions that increase a
person’s risk for heart disease. These conditions are called risk factors.
Some risk factors are not changeable, and are therefore termed non-modifiable
risk factors. Non-modifiable risk factors include:
- Male sex
- Older age
- Family history of heart attack or angina (a chest pain caused by lack
of oxygen to the heart muscle)
- Post-menopause
Other risk factors, fortunately, can be changed. These conditions are termed
modifiable risk factors and include:
- Cigarette smoking High cholesterol
- Hypertension (high blood pressure) Physical inactivity
- Obesity
By improving modifiable risk factors, a person can reduce his or her risk of
heart attack or angina, so it is important to assess these risk factors in all
adults.
Cigarette smoking
In 1979, the U.S. Surgeon General characterized smoking as "The most
important of the modifiable risk factors." Smokers have more than twice the
risk for heart attack as nonsmokers and are much more likely to die if they
suffer a heart attack. Smoking is also the most preventable of risk factors. If
you smoke, quit. Better yet, never start smoking at all.
Cholesterol
Due to intense public and media interest in cholesterol in recent years, many
people know that a high blood cholesterol level increases the risk for coronary
artery disease. The risk for angina and heart attack increases over the entire
range of elevated blood cholesterol levels, with a sharp increase in risk at
levels of total cholesterol over 240.
Although there is no single right age to check a person's cholesterol levels,
it is reasonable to check men at around age 30 and women around age 40. People
with family histories of heart disease or high cholesterol, as well as people
with other risks factors, should be checked earlier and managed more
aggressively to lower cholesterol levels.
A total cholesterol level over 240, or high density lipoprotein (HDL, or
"good" cholesterol) level under 35, indicates an increased risk for
heart disease and warrants checking a fasting cholesterol panel to determine the
percentage of low-density lipoprotein (LDL, or "bad" cholesterol). LDL
is the kind of cholesterol most closely associated with heart disease.
Of course, interpretation of cholesterol values must be individualized,
taking into account all of a person’s risk factors for heart disease. Finally,
no matter what your cholesterol level, a diet low in cholesterol and saturated
fat will lower cholesterol levels and reduce your risk for heart disease.
Hypertension
Over 50 million people in the United States have hypertension, or high blood
pressure, making it the most common heart disease risk factor. One in four
adults has systolic (upper) blood pressure over 140, and/or diastolic (lower)
blood pressures over 90, which falls within the strictest definition of
hypertension. (Hypertension is defined as blood pressure that regularly exceeds
140/90.) Like cholesterol, blood pressure interpretation should be
individualized, taking into account a person’s entire risk profile. If
treatment is warranted, today’s blood pressure medications are effective, safe
and easy to take.
Physical inactivity
Many Americans lead sedentary lives, with low or absent levels of exercise
both at work and in their leisure time. It is documented that sedentary
individuals have higher rates of death and heart disease compared to people who
perform even mild to moderate amounts of physical activity. Indeed, leisure-time
activities like gardening, bowling, or walking all can lower the risk of heart
disease. You don't have to be a marathon runner to help your heart!
How can you reduce your risk for heart disease?
Risk factors of heart disease are no secret, and most can be changed once
detected. You should know your cholesterol level and have your blood pressure
checked every 1 to 2 years. If you’re a smoker, QUIT. Your doctor can help. If
you don't exercise, start, and if you do, try to do a little more. Seeing a
primary care doctor (internist or family physician) can help you accomplish all
of these goals and is the first step toward a healthier heart and a longer life.
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