Heart Disease
Major Risk Factors
A strong partnership with your doctor is a vital first step in protecting your heart health. But to make a lasting difference, you’ll also need to learn more about heart disease and the kinds of habits and conditions that can increase your risk. It’s your heart, and you’re in charge. What follows is a guide to the most important risk factors for heart disease and how each of them affects your health.
Smoking
Smoking is “the leading cause of preventable death and disease in the United States,” according to the Centers for Disease Control and Prevention (CDC). People who smoke are up to six times more likely to suffer a heart attack than nonsmokers, and the risk increases with the number of cigarettes smoked each day. Smoking can also shorten a healthy life, because smokers are likely to suffer a heart attack or other major heart problem at least 10 years sooner than nonsmokers.
But heart disease is far from the only health risk faced by smokers.
Smoking also raises the risk of stroke and greatly increases the chances of developing lung cancer. Smoking is also linked with many other types of cancer, including cancers of the mouth, urinary tract, kidney, and cervix. Smoking also causes most cases of chronic obstructive lung disease, which includes bronchitis and emphysema.
If you live or work with others, your secondhand smoke can cause numerous health problems in those individuals. A recent study shows a 60-percent increased risk of heart disease for nonsmokers who are regularly exposed to secondhand smoke.
Currently, 25 percent of American men are smokers. Even in high school seniors, 26 percent smoke. In young people, smoking can interfere with lung growth and cause more frequent and severe respiratory illnesses, in addition to heart disease and cancer risks. The younger people start smoking cigarettes, the more likely they are to become strongly addicted to nicotine.
There is simply no safe way to smoke. Low-tar and low-nicotine cigarettes do not lessen the risks of heart disease or other smoking related diseases. The only safe and healthful course is not to smoke at all.
High Blood Pressure
High blood pressure, also known as hypertension, is another major risk factor for heart disease, as well as for kidney disease and congestive heart failure. High blood pressure is also the most important risk factor for stroke. Even slightly high blood pressure levels increase your risk for these conditions.
New research shows that at least 65 million adults in the United
States have high blood pressure-a 30-percent increase over the last several years. Equally worrisome, blood pressure levels have increased substantially for American children and teens, which increases their risk of developing hypertension in adulthood.
Major contributors to high blood pressure are a family history of the disease, overweight, and dietary salt. Older individuals are at higher risk than younger people. Among older individuals, women are more likely than men to develop high blood pressure.
Americans are more likely to develop high blood pressure, and at earlier ages, than Whites. But nearly all of us are at risk, especially as we grow older. Middle-aged Americans who don’t currently have high blood pressure have a 90-percent chance of eventually developing the disease.
High blood pressure is often called the silent killer because it usually doesn’t cause symptoms. As a result, many people pay little attention to their blood pressure until they become seriously ill.
According to a national survey, two-thirds of people with high blood pressure do not have it under control. The good news is that you can take action to control or prevent high blood pressure, and thereby avoid many life-threatening disorders. A new blood pressure category, called prehypertension, has been created to alert people to their increased risk of developing high blood pressure so that they can take steps to prevent the disease.
What Is Blood Pressure?
Blood pressure is the amount of force exerted by the blood against the walls of the arteries. Everyone has to have some blood pressure, so that blood can get to all of the body’s organs. Usually, blood pressure is expressed as two numbers, such as 120/80, and is measured in millimeters of mercury (mmHg). The first number is the systolic blood pressure, the amount of force used when the heart beats. The second number, or diastolic blood pressure, is the pressure that exists in the arteries between heartbeats.
Because blood pressure changes often, your health care provider should check it on several different days before deciding whether it is too high. Blood pressure is considered “high” when it stays above
prehypertensive levels over a period of time.
Understanding Risk
It’s important to understand what each of these categories means.
High blood pressure, of course, increases heart disease risk more than any other category. But many people don’t realize that the second category-prehypertension-also increases your risk of heart attack, stroke, and heart failure. To the extent possible, everyone should aim for normal blood pressure levels. Be aware, too, that a high systolic blood pressure level (first number) is dangerous. If your systolic blood pressure is 140 mmHg or higher, you are more likely to develop cardiovascular and kidney diseases even if your diastolic blood pressure (second number) is in the normal range. After age 50, people are more likely to develop high systolic blood pressure. High systolic blood pressure is high blood pressure. If you have this condition, you will need to take steps to control it. High blood pressure can be controlled in two ways: by changing your lifestyle and by taking medication.
Changing Your Lifestyle
If your blood pressure is not too high, you may be able to control it entirely by losing weight if you are overweight, getting regular physical activity, cutting down on alcohol, and changing your eating habits. A special eating plan called DASH – “Dietary Approaches to Stop Hypertension” can help you lower your blood pressure. The DASH eating plan emphasizes fruits, vegetables, whole-grain foods, and low-fat or fat-free milk and milk products.
It is rich in magnesium, potassium, and calcium, as well as protein and fiber. It is low in saturated and total fat and cholesterol, and limits red meat, sweets, and beverages with added sugars.
If you follow the DASH eating plan and also consume less sodium, you are likely to reduce your blood pressure even more. Sodium is a substance that affects blood pressure. It is the main ingredient in salt and is found in many processed foods, such as soups, convenience meals, some breads and cereals, and salted snacks.
Taking Medication
If your blood pressure remains high even after you make lifestyle changes, your doctor will probably prescribe medicine. Lifestyle changes will help the medicine work more effectively. In fact, if you are successful with the changes you make in your daily habits, you may be able to gradually reduce how much medication you take.
Taking medicine to lower blood pressure can reduce your risk of stroke, heart attack, congestive heart failure, and kidney disease. If you take a drug and notice any uncomfortable side effects, ask your doctor about changing the dosage or switching to another type of medicine.
A recent study found that diuretics (water pills) work better than newer drugs to treat hypertension and prevent some forms of heart disease. If you’re starting treatment for high blood pressure, try a diuretic first. If you need more than one drug, ask your doctor about making one of them a diuretic. If you’re already taking medicine for high blood pressure, ask about switching to or adding a diuretic. Diuretics work for most people, but if you need a different drug, others are very effective. To make the best choice, talk with your doctor.
A reminder: It is important to take blood pressure medication exactly as your doctor has prescribed it. Before you leave your doctor’s office, make sure you understand the amount of medicine you are supposed to take each day, and the specific times of day you should take it.
What Else Affects Blood Pressure?
A number of foods and other factors have been reported to affect blood pressure. Reducing your sodium intake will lessen your chances of developing high blood pressure. Here are more of the latest research findings:
Garlic and onions. These foods have not been found to affect blood pressure. But they are tasty, nutritious substitutes for salty seasonings and can be used often.
Caffeine. This may cause blood pressure to rise, but only temporarily. Unless you are sensitive to caffeine, you do not have to limit how much you consume in order to prevent or control high blood pressure.
Stress. Stress, too, can make blood pressure go up for a while, and is popularly thought to contribute to high blood pressure. But the long-term effects of stress are not clear. Furthermore, stress management techniques alone do not seem to prevent high blood pressure.
However, stress management approaches may help you control other unhealthy habits, such as overeating or smoking.
High Blood Cholesterol
High blood cholesterol is another major risk factor for heart disease that you can do something about. The higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack. To prevent these disorders, you should make a serious effort to keep your cholesterol at healthy levels. Cholesterol lowering is important for everyone-women and men; younger, middle-aged, and older adults; and people with and without heart disease.
Cholesterol and Your Heart
The body needs cholesterol to function normally. However, your body makes all the cholesterol it needs. Over a period of years, extra cholesterol and fat circulating in the blood build up in the walls of the arteries that supply blood to the heart. This buildup, called plaque, makes the arteries narrower and narrower. As a result, less blood gets to the heart. Blood carries oxygen to the heart; if enough oxygen-rich blood cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off, the result is a heart attack.
Cholesterol travels in the blood in packages called lipoproteins.
LDL carries most of the cholesterol in the blood. Cholesterol packaged in LDL is often called bad cholesterol, because too high a level of LDL in your blood can lead to cholesterol buildup and blockage in your arteries.
Another type of cholesterol is HDL, also called good cholesterol.
That’s because HDL helps remove cholesterol from the body, preventing it from building up in your arteries.
Getting Tested
High blood cholesterol itself does not cause symptoms, so if your cholesterol level is too high, you may not be aware of it. That’s why it is important to get your cholesterol levels checked regularly. Starting at age 20, everyone should have their cholesterol levels checked by means of a blood test called a lipoprotein profile. Be sure to ask for the test results, so you will know whether you need to lower your cholesterol. Ask your doctor how soon you should be retested.
Total cholesterol is a measure of the cholesterol in all of your lipoproteins, including the “bad” cholesterol in LDL and the “good” cholesterol in HDL. An LDL level below 100 mg/dL is considered “optimal” or ideal. The higher your LDL number, the higher your risk of heart disease. Knowing your LDL number is especially important because it will determine the kind of treatment you may need.
Your HDL number tells a different story. The lower your HDL number, the higher your heart disease risk.
Your lipoprotein profile test will also measure levels of triglycerides, which are another fatty substance in the blood.
HDL Cholesterol Level
An HDL cholesterol level of less than 40 mg/dL is a major risk factor for heart disease. An HDL level of 60 mg/dL or higher is somewhat protective.
Heart Disease Risk and Your LDL Goal
In general, the higher your LDL cholesterol level and the more other risk factors you have, the greater your chances of developing heart disease or having a heart attack. The higher your overall risk, the lower your LDL goal level will be. Here is how to determine your LDL goal:
Step 1: Count your risk factors. Below are risk factors for heart disease that will affect your LDL goal. Check to see how many of the following risk factors you have:
■ Cigarette smoking
■ High blood pressure (140/90 mmHg or higher, or if you are on blood pressure medication)
■ Low HDL cholesterol (less than 40 mg/dL)2
■ Family history of early heart disease (your father or brother before age 55, or your mother or sister before age 65)
■ Age (45 or older for men)
Step 2: Find out your risk score. If you have two or more risk factors on the above list, you will need to figure out your “risk score.” This score will show your chances of having a heart attack within the next 10 years. To find out your risk score, click here for the Men’s Risk Scorecard.
Step 3: Find out your risk category. Use your number of risk factors, risk score, and medical history to find out your category of risk for heart disease or heart attack.
A Special Type of Risk
Nearly 25 percent of Americans have a group of risk factors known as metabolic syndrome, which is usually caused by overweight or obesity and by not getting enough physical activity. This cluster of risk factors increases your risk of developing heart disease and diabetes, regardless of your LDL cholesterol level. You have metabolic syndrome if you have three or more of the following conditions:
■ A waist measurement of 35 inches or more for a woman or 40 inches or more for a man
■ Triglycerides of 150 mg/dL or more
■ An HDL cholesterol level of less than 50 mg/dL for a woman and less than 40 mg/dL for a man
■ Blood pressure of 130/85 mmHg or more (either number counts)
■ Blood sugar of 100 mg/dL or more
If you have metabolic syndrome, you should calculate your risk score and risk category as indicated in Steps 2 and 3 above. You should make a particularly strong effort to reach and maintain your LDL goal. You should also emphasize weight control and physical activity to correct the risk factors of the metabolic syndrome.
Your LDL Goal
The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of heart disease or heart attack. The higher your risk category, the lower your LDL goal will be.
How to Lower Your LDL
There are two main ways to lower your LDL cholesterol-through lifestyle changes alone, or through lifestyle changes combined with medication. Depending on your risk category, the use of these treatments will differ.
Lifestyle changes. One important treatment approach is called TLC, which stands for “Therapeutic Lifestyle Changes.” This treatment includes a low saturated fat and low-cholesterol diet, regular moderate-intensity physical activity, and weight management.
Everyone who needs to lower their LDL cholesterol could use a little TLC. Maintaining a healthy weight and getting regular physical activity are especially important for those who have metabolic syndrome.
Medication. If your LDL level stays too high even after making lifestyle changes, you may need to take medicine. If you need medication, be sure to use it along with the TLC approach. This will keep the dose of medicine as low as possible, and will lower your risk in other ways as well. You will also need to control all of your other heart disease risk factors, including high blood pressure, diabetes, and smoking.
Overweight and Obesity
A healthy weight is important for a long, vigorous life. Yet overweight and obesity (extreme overweight) have reached epidemic levels in the United States. Today, nearly two-thirds of American adults are overweight or obese. Groups at highest risk for obesity include African American women, Mexican Americans, and
American Indians, but millions of people from all backgrounds weigh more than is healthy for them. Since 1991, the proportion of Americans who are obese has soared by 75 percent.
Overweight among children is also swiftly increasing. Among young people ages 6-19, more than 16 percent are overweight, compared to just 4 percent a few decades ago. This is a disturbing trend because overweight adolescents have a greatly increased risk of dying from heart disease in adulthood. Even our youngest citizens are at risk. About 10 percent of preschoolers weigh more than is healthy for them.
Our national waistline is expanding for two simple reasons-we are eating more and moving less. Americans consume about 200-300 more calories per day than they did in the 1970s. Moreover, as we spend more time in front of computers, video games, TV, and other electronic pastimes, we have fewer hours available for physical activity.
There is growing evidence of a link between “couch potato” behavior and increased risk of obesity and many chronic diseases.
It is hard to overstate the dangers of an unhealthy weight. If you are overweight, you are more likely to develop heart disease even if you have no other risk factors. The more overweight a person is, the more likely he or she is to develop heart disease. Overweight and obesity also increase the risks for diabetes, high blood pressure, high cholesterol, stroke, congestive heart failure, gallbladder disease, arthritis, breathing problems, and gout, as well as cancers of the breast and colon. Each year, an estimated 300,000 U.S. adults die of diseases related to obesity. The bottom line: Maintaining a healthy weight is a vital part of preventing heart disease and protecting overall health.
Should You Choose To Lose?
Do you need to lose weight to reduce your risk of heart disease?
You can find out by taking three simple steps.
Step 1: Get your number.
You’ll see that your weight in relation to your height gives you a number called a Body Mass Index (BMI). A BMI from 18.5 to 24.9 indicates a normal weight. A person with a BMI from 25 to 29.9 is overweight, while someone with a BMI of 30 or higher is obese.
Those in the overweight and obese categories have a higher risk of heart disease-and the higher the BMI, the greater the risk.
Step 2: Take out a tape measure. The second step is to take your waist measurement. For women, a waist measurement of over 35 inches increases the risk of heart disease as well as the risks of high blood pressure, diabetes, and other serious health conditions. For men, a waist measurement of more than 40 inches increases these risks. To measure your waist correctly, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out.
Step 3: Review your risk. The final step in determining your need to lose weight is to find out your other risk factors for heart disease.
It is important to know whether you have any of the following: high blood pressure, high LDL cholesterol, low HDL cholesterol, high triglycerides, high blood glucose (blood sugar), a family history of heart disease, physical inactivity, or smoking. If you’re a man, being age 45 or older is also a heart disease risk factor. For a woman, being age 55 or older or having gone through menopause increases the risk. If you have a condition known as metabolic syndrome, your risk of heart disease is increased. If you aren’t sure whether you have some of these risk factors, ask your doctor.
Once you’ve taken these three steps, you can use the information to decide if you need to take off pounds. While you should talk with your doctor about whether you should lose weight, keep these guidelines in mind:
■ If you are overweight AND have two or more other risk factors, or if you are obese, you should lose weight.
■ If you are overweight, have a high waist measurement (over 35 inches for a woman; over 40 inches for a man), AND have two or more other risk factors, you should lose weight.
■ If you are overweight, but do not have a high waist measurement and have fewer than two other risk factors, you should avoid further weight gain.
Lose a Little, Win a Lot
If you need to lose weight, here’s some good news: A small weight loss-just 5 to 10 percent of your current weight-will help to lower your risk for heart disease and other serious medical disorders. The best way to take off pounds is to do so gradually by getting regular physical activity and eating a balanced diet that is lower in calories and saturated fat. For some people at very high risk, medication also may be necessary. To develop a weight-loss or weight-maintenance program that works well for you, consult with your doctor, registered dietitian, or qualified nutritionist.
Physical Inactivity
“I’d love to take a walk-tomorrow.”
“I can’t wait to start yoga-if I can find a good class.”
“I’m going to start lifting weights-as soon as I get the time.”
Many of us put off getting regular physical activity, and hope that our bodies will understand. But our bodies don’t understand, and sooner or later, they rebel. Even if a person has no other risk factors, being physically inactive greatly boosts the chances of developing heart-related problems. It also increases the likelihood of developing other heart disease risk factors, such as high blood pressure, diabetes, and overweight. Lack of physical activity also leads to more visits to the doctor, more hospitalizations, and more use of medicines for a variety of illnesses.
Despite these risks, most Americans aren’t getting enough physical activity. According to the CDC, nearly 40 percent of Americans are not active at all during their free time. Overall, women tend to be less physically active than men, and older people are less likely to be active than younger individuals. But young people need to get moving, too. Forty percent of high school-aged girls and 27 percent of high school-aged boys don’t get enough physical activity to protect their health.
Fortunately, research shows that as little as 30 minutes of moderate intensity physical activity on most, and preferably all, days of the week helps to protect heart health. This level of activity can reduce your risk of heart disease as well as lower your chances of having a stroke, colon cancer, high blood pressure, diabetes, and other medical problems.
Examples of moderate activity are taking a brisk walk, light weightlifting, dancing, raking leaves, washing a car, house cleaning, or gardening. If you prefer, you can divide your 30-minute activity into shorter periods of at least 10 minutes each.
Diabetes
Diabetes is a major risk factor for heart disease and stroke. More than 65 percent of people who have diabetes die of some type of cardiovascular disease. Diabetic women are at especially high risk for dying of heart disease and stroke. Today, about 14 million people in the United States have diagnosed diabetes. In addition, nearly 6 million people have this serious disease but don’t know it.
The type of diabetes that most commonly develops in adulthood is type 2 diabetes. In type 2 diabetes, the pancreas makes insulin, but the body cannot use it properly and gradually loses the ability to produce it. Type 2 diabetes is a serious disease. In addition to increasing the risk for heart disease, it is the #1 cause of kidney failure, blindness, and lower limb amputation in adults. Diabetes can also lead to nerve damage and difficulties with fighting infection.
While the risk of type 2 diabetes increases after age 45, the disease is on the rise among both children and adults. A major risk factor for type 2 diabetes is overweight, especially having extra weight around the waist.
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