by Dr. Richard Becker –
Risk factors are health related issues that affect our chances of developing a future medical condition. In the case of the heart, there are several major risk factors, some of which can be modified by intervention, to reduce the risk of future disease, and others that cannot be changed. For example, having a first degree relative, such as a mother, father, or sibling with coronary artery disease (CAD), increases your own risk for developing similar issues.
Since we cannot change our ancestry, we cannot yet modify this risk factor.
In contrast, other risk factors can be modified, by our own conscious efforts, and it is these to which we direct our attention.
One of the biggest risk factors, is of course, smoking. It has been known since the 1960s that smoking is a major cause of lung cancer, emphysema, and cardiovascular disease, including the heart and brain (Stroke). Smoking cessation will immediately slow progression of any plaque buildup, and the longer one abstains, the less likely there will be progression. Smoking cessation is not an easy thing to do. Although some are able to quit when they decide to do so, most individuals require assistance from professionals. Interventions include medication (such as Nicotine Patches and gums, Chantix, etc), hypnosis, acupuncture, and exercise programs. Most smokers require several attempts, so one should not be discouraged, and some require a combination of therapies. There are now physicians that specialize in helping smokers quit.
A second modifiable risk factor is “cholesterol,” and we have also known for decades that this is a major cause of heart disease. When doctors today review your cholesterol, they are really reviewing your lipid panel, which consists of your LDL (low density lipids —“lousy cholesterol”), HDH (high density lipids —“good cholesterol”) and triglycerides. Attempts at modifying HDL cholesterol (the higher the better) have not been shown yet to be helpful. LDL is now considered THE major lipid risk factor, and there are several ways to reduce your LDL cholesterol. A low fat diet, weight loss, and exercise are the traditional life style changes that are recommended. The mainstay of treatment today are the statins, such as Lipitor (atorvastatin), Crestor (Rosuvastatin) and Mevacor (Lovastatin). All have been shown safe and effective. Early worries about these drugs causing cancer, memory loss, and permanent liver damage have been disproved; they do not cause these problems. Today, we know that for LDL, LOWER is better and there probably is no “too low.” High LDL is defined as over 130, and desirable is less than 100. “Borderline LDL” is 100-130. For those with known heart disease, your doctor will likely try to get your LDL under 70. Triglycerides can be lowered by a low sugar (low carbohydrate) diet. Medications such as fish oils can help lower triglycerides (but not LDL). The risk of elevated triglycerides, and the benefit of lowering them, is less certain than for LDL.
Hypertension is a major risk factor for cardiovascular disease. So much so, that recent guidelines for doctors have been updated, suggesting that hypertension should be treated when the systolic BP (when the heart is contracting) should be less than 130, and the diastolic BP (between heart beats) less than 90. These are the levels at which treatment should be initiated, as well as the goal of treatment. Lifestyle changes such as weight loss, exercise, and a low salt diet can help, and should always be tried before and if necessary, with medications.
Diabetes is also considered a major risk factor. Diabetes definitely has a genetic or hereditary basis, but obesity, lack of exercise, and a high diet of concentrated sweets raises the probability of developing sugar intolerance.
Medications can lower the sugar levels, but despite normalizing the sugar, residual cardiovascular risk will remain.
One important caveat, is that multiple risk factors for heart disease increase risk exponentially, more than one risk factor alone. Smoking and diabetes for example, places one at a very high risk. Doctors use risk assessment tools to predict the risk of heart disease, and these tools incorporate age, sex, smoking, BP, diabetes, and family history into the calculation.
In summary, several well-known factors affect and predict our risk of developing cardiovascular disease. Weight loss, exercise, smoking cessation, and BP management, as well as controlling diabetes are all ways to modify our risk of future problems. The medications available today are safe and effective, and with proper motivation and effort, we can reduce our chances of heart disease.
Richard Becker, MD, F.A.C.C. is Chief, Division of Cardiology at Phelps Hospital in Sleepy Hollow.