• Risk Factor Modification and Cardiovascular Disease

    There are risk factors you can control, and some you can’t. Learn more from Dr. Gregory Dehmer.

    Cardiovascular disease remains the leading cause of death among Americans. But there are steps you can take to reduce your odds to having a heart attack or stroke suffering from angina, or developing blockages in the arteries that supply blood to your limbs (peripheral artery disease) or kidneys (renal artery disease).

    Before you sit down and make a plan to reduce your chances of developing cardiovascular disease, there are several important things you need to know:

    First, everyone is at risk for cardiovascular disease. You need to know your individual risk factors and what to do about them. There is a lot of good information on this website and other places on the Internet to help you.

    Second, some risk factors can be treated or controlled, and some cannot. The more risk factors you have, the greater your chance of developing cardiovascular disease. And the more risk factors you can eliminate or reduce, the better your chances of preventing and controlling cardiovascular disease.

    Here we will:

    • Take a look at the cardiovascular risk factors you may be able to control and those you cannot,
    • Analyze what each risk factor means,
    • Discuss how to measure your risk, and
    • Outline strategies for managing cardiovascular risk.

    Risk Factors You Can’t Control

    Age.The risk of cardiovascular disease increases as you age. For men, the risk starts to climb at about age 45, when 10 out of every 1,000 men develop signs of heart disease. By age 55, the risk has doubled to about 21 out every 1,000 men. It continues to rise until, by age 85, about 74 out of every 1,000 men have cardiovascular disease. For women, the risk of cardiovascular disease also climbs with age, but the trend begins about 10 years later than in men and especially with the onset of menopause.

    Gender. Men are more likely to develop cardiovascular disease than women, but that difference begins to disappear after women go through menopause. In fact, it’s very important to realize that women develop heart disease and suffer heart attacks, too – just like men. In fact, cardiovascular disease is the number-one killer of women in the United States, just as it is for men.

    Family history of heart disease.Your risk of heart disease is approximately doubled if a parent or a brother or sister developed heart disease early in life (before age 55 for men, and age 65 for women).

    Risk Factors You May Be Able to Control

    While there are risk factors you’re born with or simply cannot change, there are some that you have control over and some that you can influence. Here’s an overview of the risk factors you may be able to impact by following some guidelines for heart-healthy living:

    Smoking and using other tobacco products. When you smoke, you expose your heart and blood vessels to nicotine, carbon monoxide and other harmful substances contained in smoke. This causes blood vessels to constrict, blood pressure to go up and cholesterol levels to climb. In addition, smoking deprives the body’s tissues of oxygen, damages the inner lining of blood vessels, allows plaques to grow inside your arteries, and makes it more likely that dangerous blood clots will form.

    High cholesterol levels. High levels of LDL cholesterol—the so-called bad cholesterol—can increase the build-up of plaque in the arteries of the heart. It’s also unhealthy to have low levels of HDL, or “good” cholesterol. The ideal blood cholesterol level for you depends on your age, gender, and history of heart disease, but for most people with coronary artery disease, the target LDL cholesterol level is 100 mg/dL or below, and the target HDL cholesterol level is above 40 mg/dL for men, and above 50 mg/dL for women. There is more information on controlling your cholesterol here.

    High blood pressure.If your blood pressure is above 140/90 mmHg for long periods of time, it can damage the blood vessels. This not only makes it more likely that cholesterol plaques will form, it also causes the artery walls to become thicker, stiffer and less able to expand and contract with changes in activity and other physical demands.

    Diabetes. High blood sugar levels can damage the blood vessels throughout the body, making it more likely that atherosclerotic plaques will develop. In fact, about one out of three people with diabetes also has coronary artery disease. Learning more about diabetes prevention and treatment is a wise investment in your cardiovascular health.

    Being overweight or obese. Carrying around too much body weight not only puts a strain on your heart, it also makes it more difficult to control high blood pressure, high cholesterol levels, and diabetes. Men and women who are overweight are about 20 percent more likely to develop cardiovascular disease. Being obese—more than 20 percent above ideal body weight—is even more dangerous. Obesity increases the risk of cardiovascular disease by 46 percent in men and 64 percent in women.

    Recent research also suggests that your waist size can be a predictor of cardiovascular risk, too. Women should try to keep their waist size under 35 inches and men should aim for a waist of less than 40 inches.

    SecondsCount features helpful information on eating a heart-healthy diet and being physically active – two good strategies for maintaining or losing weight. 

    Physical inactivity. A lack of exercise weakens your muscles and makes it harder to control several other heart disease risk factors, including blood pressure, cholesterol levels, diabetes, obesity, and stress. Check out SecondsCount’s practical tools, tips and support to show you how to be less sedentary and more physically active.
    Metabolic syndrome. The term metabolic syndrome is used to describe a cluster of traits that, together, increase the risk for developing heart disease. These traits include high blood sugar, high blood pressure, low levels of “good” HDL cholesterol, high blood levels of fats known as triglycerides, and excess body weight, particularly in the belly area.

    Stress. High levels of stress in your life, or a tendency to often feel angry, have also been linked to an increased risk for heart disease. Learning how to manage your stress can be good for your heart.

    High levels of C-reactive protein. CRP is produced by the body in response to infection or inflammation. Your doctor may use a special high-sensitivity CRP test to look for signs that you have inflammation in the arteries of your heart. If your CRP levels are high, your risk of having a heart attack is increased.

    Measure Your Cardiovascular Risk

    Who should examine their risk factors? If you are over 20 years of age, now is the time to sit down and carefully look at your risk factors.

    It’s also recommended to see your family doctor every two years to track measurements such as your weight, blood pressure, cholesterol levels, and blood sugar.

    Between doctors’ visits, there are some helpful tools that you can use:

    • The National Heart, Lung, and Blood Institute has developed an excellent tool for calculating your body mass index, or BMI. Your goal is to keep your BMI under 25.
    • Many doctors also use a popular, easy-to-use, 10-year risk assessment tool based on the Framingham Heart Study.The information derived from using this tool helps physicians and patients to work together as a team as they develop an individualized treatment plan for each patient’s specific risk factors.

    Manage Your Cardiovascular Risk

    So, after you’ve identified your risk factors, what do you do next? Start by having a conversation with your doctor or other healthcare provider. Together you can develop a risk factor modification plan that makes sense for you. In general, the best way to have a positive impact on these “manageable” risk factors is to take these steps:

    If you smoke or use other tobacco products, it’s time to stop.
    It’s not easy to stop smoking, but it’s essential. Smoking is toxic to your heart and blood vessels.

    Eat a healthy diet. A diet that is low in fat, cholesterol, salt, and sugar—and with just enough calories to achieve or maintain a healthy body weight—will help you to control your blood pressure, cholesterol levels, blood sugar, and weight. And it’s healthy for the whole family!

    Exercise. Studies have shown that you can improve your heart health by exercising at a moderate intensity just 30 minutes a day, five days a week. Be to check with your doctor to find out what level of exercise is best for you. 

    Stress. Anger, depression and anxiety have all been linked to heart disease. If you have difficulty with any of these emotions, finding ways to restore your sense of inner peace will not only make you happier, it will keep your heart and blood vessels healthier.