Heart Risk Factors

The following major risk factors for cardiovascular disease can be improved and should be considered in all adults:

The presence of multiple risk factors increases the risk of cardiovascular disease. In the Framingham study, those with five risk factors or more had a 10 year risk of a first CAD event of 25-30%.

Cumulative Risk of Cardio Vascular Diseases at five years

(From: Jackson, R, Lawes, CM, Bennett, DA, et al, Lancet 2005; 365:434)

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Risk Factors You Cannot Control

Your age

As you get older the risk for developing heart disease increases and procedures become more risky, in part because other illnesses are more likely to occur that will influence a successful outcome. Living a heart healthy life style will minimize the risk of future illnes and slow down the consequences of aging. If treatment is necessary, an older person can be an excellent candidate for a procedure if in otherwise good health.

Your gender

Although men are more likely to develop coronary artery disease, the major risk factors for Coronary Artery Disease are similar for both men and women. However, women run a higher risk than men when a procedure becomes necessary. A factor may well be the smaller size of women in general and thus often smaller coronary arteries that are harder to fix with either a stent or coronary bypass procedure.

Women and Cardiovascular Disease

Worldwide, 8.6 million women die from heart disease each year, accounting for a third of all deaths in women. Three million women die from stroke each year. Stroke accounts for more deaths among women than men (11% vs 8.4%) with additional risk for CHD unique to women related to oral contraceptive use in combination with smoking.

• 8 million women in the US are currently living with heart disease;
• 435,000 American women have heart attacks annually;
• It is the No. 1 killer of American women.

(For more information: http://www.womensheart.org/index.htm).

Your genes

You cannot control your heredity any more than your sex. If heart disease is common in your family (parents, siblings etc.), you are at risk as well.

Your ethnicity

Statistics show that African-Americans and Hispanics/Latinos have a higher risk for cardiovascular disease than Caucasians and are less aware of their cardiovascular risk factors.

African, Hispanic/Latinos and other ethnic groups

Research studies reveal that cardiovascular disease is the leading cause of death for African-American males and females age 20 and older.

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Other illnesses (some of which are controllable by you)

• Your heart function
• Other heart diseases such as valve & rhythm problems
• Previous heart surgery
• Vascular problems in other parts of your body
• Hypertension
• Your lung function
• Your kidney function
• Diabetes
• Your cholesterol
• Problems with your blood, including anemia, HIV status, clotting disorders
• Major other illnesses such as cancer

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Risk Factors You Can Control & major treatable risk factors for CAD

Hypertension

The risk of both stroke and coronary disease increase as the blood pressure rises above 110/75. Reducing the blood pressure in hypertensive patients, even those with mild hypertension, lowers the risk of stroke. The target blood pressure in this setting is not well defined, and should be individualized. A goal of <130/80 mmHg seems reasonable for most patients.

(From: http://www.euphix.org/object_document/o5134n27415.html)

Current data have shown a benefit of the combination of a diuretic with an ACE inhibitor for reduction of stroke recurrence.

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Dyslipidemia (abnormal cholesterol levels)

Hyperlipidemia is a major risk factor for CAD as well as Carotid artery disease and stroke related to complications of Carotid disease. The American Heart Association/American Stroke Association (AHA/ASA) and the National Stroke Association have published guidelines for the prevention of stroke in patients with ischemic stroke risk factors.

• Blood pressure reduction
• Glucose control
• Cholesterol and statin therapy with a target LDL goal of <100 mg/dL and HDL cholesterol (>40 mg/dL)

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Diabetes Mellitus

Patients with diabetes mellitus have approximately twice the risk of ischemic stroke compared with those without diabetes. Strict diabetes control reduces the risk of vascular complications (eg, your eyes, kidneys, and brain & nerves).

Obesity

During the past 20 years there has been a dramatic increase in obesity in the United States.

Currently, more than 64% of US adults are either overweight or obese, according to results from the 1999-2000 National Health and Nutrition Examination Survey (NHANES). This figure represents a 36% increase from 1980.

The greatest increase took place in the obese group (Body Mass Index > 30), where the prevalence doubled from 1976 to 2000. Roughly 59 million American adults are in this group, which is at the greatest health risk.

(Source: http://www.obesity.org/resources-for/obesity-statistics.htm)

Obesity is associated with significantly increased risk of diabetes mellitus, hypertension, dyslipidemia, certain forms of cancer, sleep apnea, and osteoarthritis. In addition, the increasing prevalence of obesity and its associated complications places a tremendous burden on healthcare utilization and costs. This epidemic of obesity mandates prompt attention from the heath care and preventive health services in order to minimize the rise in the incidence of new case of diabetes, heart disease and other obesity-related complications.

There are Relationships of increased BMI with

• Mortality risk
• Hypertension
• Type 2 diabetes

New data have shown that for effective weight loss to be effective, more than occasional exercise will be necessary.

(Adapted from The Obesity society: http://www.obesity.org/)

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Metabolic syndrome

Metabolic syndrome (a combination of Hypertension, Dyslipidemia (abnormal cholesterol levels), central obesity and Diabetes) is a risk factor for stroke and CAD.

Childhood Obesity

The American Heart Association and the Clinton Foundation are working together to raise public awareness about the serious threat posed by childhood obesity. Learn more about this alliance and how you can become involved in improving children’s health.

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How Do You Maintain Weight Loss?

Obesity increases several risk factors for CVD, including hypertension, dyslipidemia, and insulin resistance as well as diabetes. Data from a number of large studies have consistently shown a direct relationship of higher body weight with CAD.

Once you’ve lost weight, the next step is to keep it off.  Learn what to expect and get tips for success:

.Exercise

Physical inactivity is a major risk factor for developing CAD. Regular aerobic physical activity increases your fitness level and capacity for exercise. Regular physical activity can help control blood lipid abnormalities, diabetes and obesity and reduce blood pressure. Everybody can improve their fitness!!

AHA Recommendation

For most healthy people:

For health benefits to the heart, lungs and circulation, perform any moderate-to-vigorous-intensity aerobic activity for at least 30 minutes on most days of the week at 50–85 percent of your maximum heart rate. You can accumulate 30 minutes in 10 or 15 minute sessions. What’s important is to include physical activity as part of a regular routine.

These activities are especially beneficial when done regularly:

• brisk walking, hiking, stair-climbing, aerobic exercise
• jogging, running, bicycling, rowing and swimming
• activities such as soccer and basketball that include continuous running

The training effects of such activities are most apparent at exercise intensities that exceed 50 percent of a person’s exercise capacity (maximum heart rate). If you’re physically active regularly for longer periods or at greater intensity, you’re likely to benefit more. But don’t overdo it. Too much exercise can give you sore muscles and increase the risk of injury.

What about moderate-intensity activities?

Even moderate-intensity activities, when performed daily, can have some long-term health benefits. They help lower the risk of cardiovascular diseases. Here are some examples:

• walking for pleasure, gardening and yard work
• housework, dancing and prescribed home exercise
• recreational activities such as tennis, racquetball, soccer, basketball and touch football

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What risk factors are reduced?

Regular physical activity can also help reduce or eliminate some of these risk factors:

• High blood pressure — Regular aerobic activities can lower blood pressure.
• Cigarette smoking — Smokers who become physically active are more likely to cut down or stop smoking.
• Diabetes — People at their ideal weight are less likely to develop diabetes. Physical activity may also decrease insulin requirements for people with diabetes.
• Obesity and overweight — Regular physical activity can help people lose excess fat or stay at a reasonable weight.
• High levels of triglycerides — Physical activity helps reduce triglyceride levels. High triglycerides are linked to developing coronary artery disease in some people.
• Low levels of HDL — Low levels of HDL (“good”) cholesterol (less than 40 mg/dL for men/less than 50 mg/dL for women) have been linked to a higher risk of coronary artery disease. Recent studies show that regular physical activity can significantly increase HDL cholesterol levels and thus reduce your risk.

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Intense Exercise & the risk of exercise-related death

Though often attributed to “heart attacks,” such deaths rarely involve myocardial infarction(the medical term for heart attack), which occurs when blood flow to the heart is blocked.

Other medical conditions, however — which are often unrecognized — are more likely to be involved, including:

• Cardiac hypertrophy
• Atherosclerosis
• Cardiac arrhythmia
• Electrolyte imbalances
• Enlargement of the heart

Exercise itself is rarely life-threatening, especially when compared with the alternative (not exercising). It does make sense, though,  to ask your doctor about cardiac screening — and not just if you’re planning to start (or significantly ramp up) a personal exercise routine. Cardiac screening is important for seasoned athletes as well as for rank beginners.

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