Risk Factors for Heart Disease

Having a heart attack increases the probability of having another because coronary artery disease can progress over time. Certain interventions or treatments such as angioplasty, artherectomy and bypass surgery decrease the probability by improving the blood supply but do not cure the disease. In order to attempt to slow down this process, it is very important to reduce risk factors associated with the development and progression of coronary artery disease.

Extensive studies have identified certain characteristics or risk factors, which have been demonstrated to increase the risk of developing heart disease. These risk factors can be grouped into two classifications: 1) major risk factors and 2) contributing risk factors. The more risk factors a person has, the greater the chance of developing heart disease.

MAJOR RISK FACTORS Major risk factors are those factors that medical research has shown to be definitely associated with an increased risk of heart disease.

Can be changed or modified:

  • Smoking cigarettes, pipes, cigars
  • High blood pressure
  • Elevated blood cholesterol (greater than 200mg/dl), high LDL and low HDL
  • Lack of regular exercise

CONTRIBUTING RISK FACTORS

Contributing risk factors are those associated with increased risk of heart disease, but their significance and prevalence have not been directly determined.

Cannot be changed or modified:

  • Male gender
  • Heredity (inherited traits)
  • Increasing age (greater than 65 years old)

Can be changed or modified:

  • Obesity (greater than 25 -30% of ideal body weight)
  • Diabetes
  • Stress

SMOKING (Cigarettes, chewing tobacco, pipes, cigars and second-hand smoke)

Why is Smoking Dangerous?

  • A smoker’s risk of having a heart attack is more than twice that of a nonsmoker.
  • Nicotine increases oxygen demand by increasing heart rate and blood pressure.
  • Carbon monoxide from the smoke decreases the oxygen supply by taking the place of oxygen in the blood. One cigarette increases the carbon monoxide level for about 4 hours making it difficult for the heart muscle to get enough oxygen.
  • The heart has to beat faster and harder to pump more blood to deliver the same amount of oxygen.
  • Smoke damages the inner lining of the artery walls, causing small abrasions or rough spots to develop on the artery wall. This rough surface attracts cholesterol resulting in a buildup called plaque. This leads to a narrowing of the artery which decreases blood flow.
  • Smoke may trigger coronary artery spasms, which can cause the vessel to constrict and decrease blood supply to the heart muscle.
  • HDL levels, the good cholesterol, can decrease.
  • The possibility of having irregular heart beats increases.

What Can be Expected After Quitting?

The beneficial effects are apparent almost at once, regardless of the number of years or packs/day smoked.

  • Heart rate and blood pressure will be lower.
  • The heart muscle receives more oxygen.
  • The risk of having another heart attack is reduced to almost that of a non-smoker within six months!

HYPERTENSION (HIGH BLOOD PRESSURE)

What is Blood Pressure?

  • Blood pressure is the amount of pressure the circulating blood puts on the artery walls.
  • Each time the heart contracts or beats, blood is pumped out and creates pressure in the arteries. This surge of pressure is known as systolic pressure and is the top number of the blood pressure reading.
  • Each time the heart relaxes between beats, the blood pressure will go down. This is known as the diastolic pressure and is the bottom number of the blood pressure reading.

What is High Blood Pressure?

  • High blood pressure is a reading higher than 130/85 mmHg.
  • It is called the “Silent Killer,” as there are no warning symptoms.

Why is High Blood Pressure Dangerous?

  • It increases the workload of the heart, causing the heart muscle to become enlarged over time.
  • It increases the heart’s need for oxygen.
  • The constant increased pressure damages the inside lining of the arteries and causes small rough spots that attracts cholesterol resulting in a build up of plaque. This leads to a narrowing of the artery which decreases blood flow.
  • It is a contributing factor in:
    • Coronary artery disease
    • Heart attack
    • Stroke
    • Congestive heart failure
    • Kidney failure

How is High Blood Pressure Treated?

  • Low sodium (salt) diet
  • Medication
  • Weight loss
  • Exercise

HIGH CHOLESTEROL LEVELS

What is Cholesterol?

  • Cholesterol is the fat that is found in atherosclerotic plaque. It narrows the artery, reducing blood flow.
  • Age, gender, heredity, and diet affect cholesterol levels.
  • Refer to section on Cholesterol.

LACK OF REGULAR EXERCISE

  • Lack of regular exercise decreases the efficiency of the heart’s vascular system (blood vessels) blood vessels.
  • Exercise can help decrease other risk factors such as high blood pressure, stress, obesity, and high cholesterol levels.

STRESS

  • Chronic stress of an intense and negative nature can have a detrimental effect on the heart.
  • See section on Stress

OBESITY (25 – 30% over recommended weight for age, sex and height)

  • Makes the heart work harder to pump blood throughout a larger body
  • Increases the heart’s need for oxygen
  • Increases blood pressure
  • Increases cholesterol levels
  • Can lead to diabetes

FAMILY HISTORY

If there is a family history of coronary artery disease, it is more likely that future generations will develop coronary artery disease.

  • Genetic makeup determines the way the body handles cholesterol and other fats.
  • Family habits and traits such as eating high-fat meals, smoking, sedentary lifestyle, overweight, and hypertension can contribute to the development of heart disease.

DIABETES

  • People with diabetes are at greater risk for developing heart disease at an earlier age and it is also likely to progress at a faster rate.
  • It negatively affects cholesterol and triglyceride levels.
  • The risk is lessened when diabetes is controlled by observing dietary restrictions and/or taking prescribed medications.

AGE

  • About 5% of all heart attacks occur in people under age 40, and 45% occur in people under age 65. Of those who die, almost four out of five are over 65. Atherosclerosis is part of the aging process, but its progression and severity depend on family history and lifestyle factors.

GENDER

  • Men are at greater risk for heart attacks, and they occur at an earlier age in men than women. Female hormones protect women in their younger years. After menopause, women’s death rate from heart disease increases because of decreasing estrogen levels. Yet, in today’s society, women are also exposed to additional stressors e.g. careers, and they are more likely to smoke, thus increasing their risk of heart disease.

 

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Aspirin or Pycnogenol for Heart Health?

I recently received a question asking, “is it better to take a baby aspirin or pycnogenol, a natural bark extract, to prevent blood clots (platelet aggregation) and improve heart health?”

My Answer:

Take aspirin if your doctor concurs. “The degree of measured anti-inflammatory potential of pycnogenol on COX enzymes (targets of Aspirin) are still lower than Aspirin itself.” (COX enzymes makes prostaglandins, creating inflammation. Aspirin prevents the prostaglandins from ever being synthesized).

What Aspirin Does

Aspirin interferes with your blood’s clotting action. When you bleed, your blood’s clotting cells, called platelets, build up at the site of your wound. Aspirin therapy reduces the clumping action of platelets in the vessels that supply blood to the heart and possibly prevents a heart attack. Aspirin “thins” the blood and helps prevent blood clots from forming. So it helps prevent heart attack and stroke. Aspirin also helps reduce inflammation. It has been suggested that inflammation may play a major role in cardiovascular disease.

For individuals who have already had a heart attack or stroke, or have other evidence of coronary artery disease, such as angina or a history of a coronary bypass operation or coronary angioplasty, the FDA states that there is more benefit than risk of taking aspirin. They feel that the available evidence does not supports the use of aspirin for preventing a heart attack or strok and that there are risks of bleed in the brain and stomach. 

https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm390574.htm

https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm390539.htm

To see the guidelines about taking aspirin, go to this Mayo Clinic article: http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/ART-20046797

You should not start aspirin therapy without discussing it with your doctor. The benefits and risks of aspirin therapy vary for each person.

Sources:

https://examine.com/supplements/pycnogenol/

http://www.webmd.com/vitamins-supplements/ingredientmono-1019-PYCNOGENOL.aspx?activeIngredientId=1019&activeIngredientName=PYCNOGENOL&source=0

http://www.docsopinion.com/2013/05/03/inflammation-and-heart-disease/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317089/

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Is There A Direct Relationship Between Exercise And Longevity?

Bronka Sundstrom is shown here with me in 2005. She is the oldest woman ever to have climbed Mt. Rainier, in only 1 day, at age 77.

Bronka Sundstrom is shown here on Mt. Rainier with me in 2005. She is the oldest woman ever to have climbed Mt. Rainier, in only 1 day, at age 77. Don’t we all want to be fit, healthy and able to do the things we want to do when we’re older?

There is a direct relationship between exercise and longevity. Someone who is moderately active lives at least two years longer than a sedentary person. A simple formula states that for each hour of exercise, you will prolong your life by two hours. After stopping cigarette smoking, exercise is the single most important lifestyle decision for improving health and longevity. Exercise strengthens the heart, lowers risk for colon and breast cancer, strengthens bones, lowers risk for diabetes and stroke, lowers blood pressure, boosts the immune system, combats depression, and maintains muscle mass as we age (strength training is best for this).

The Cooper Clinic in Dallas studied 25,000 men over a 20-year period and found that the least fit men had a 70% higher risk of death from cardiovascular disease. The less fit men were also 50% more likely to die from all causes. Similar results were found in a smaller cohort of women.

The Cooper Clinic also found that the least fit 20% were 3.7 times more likely to develop diabetes over a six-year period, compared with the most fit 40%. Exercise enhances the muscle’s ability to respond to insulin and remove sugar form the circulation. Exercise also lowers body fat, which is implicated in the development of diabetes. Being sedentary increases the risk for colon cancer by at least 20% (some studies show a doubling or tripling of risk). Evidence also suggests risk for breast and prostate cancer is reduced.

Procedures like colonoscopies can be great screening tools and treatments for bowel cancer. But patients may be able to take measures at home to reduce their risk for this disease. According to the National Cancer Institute, people who exercise regularly have a 40% to 50% lower risk of colon cancer, compared with those who don’t exercise regularly.

A study by the National Cancer Institute found that people who engaged in leisure-time physical activity had life expectancy gains of as much as 4.5 years.

As we age, muscle and bone strength is essential for maintaining an independent lifestyle, and avoiding the kind of physical deterioration that often ends in a nursing home. Physical activity appears to stimulate the production of new white blood cells and remove older ones, thus boosting our immune defenses and helping to stave off infection and even cancer.

Of course, a person’s lifestyle factors can affect their longevity.  Lifestyle factors such as smoking, drinking alcohol, and being underweight or overweight predict mortality among the elderly. A study published in the BMJ set out to identify modifiable factors associated with longevity among adults aged 75 and older.The associations between leisure activity, not smoking, and increased survival still existed in those aged 75 years or more, with women’s lives extended by five years and men’s by six years. These associations, although reduced, were still present among people aged 85 or more and in those with chronic conditions. Their results suggest that encouraging healthy lifestyle behaviors even at advanced ages may enhance life expectancy, probably by reducing morbidity.

Moore SC, et al. Leisure Time Physical Activity of Moderate to Vigorous Intensity and Mortality: A Large Pooled Cohort Analysis. PLoS Medicine. November 6, 2012. doi: 10.1371/journal.pmed.1001335.

BMJ 2012;345:e5568

BMC Medicine, Oct. 10, 2014

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