Cardiac heart disease risk factors

Cholesterol is a waxy substance produced and released into the bloodstream by cells in the liver.  The body uses cholesterol to form cell membranes, aid in digestion, convert Vitamin D in the skin and develop hormones.  Cholesterol is stored inside a waterproof envelope of lipids (fat), along with specific proteins that weave in and out of the envelope’s outer shell.  These particles are called lipoproteins.  While there are several types of lipoproteins, your cholesterol score measures just two:

• Low density lipoproteins (LDL) are considered ‘bad’ cholesterol.  While they carry required cholesterol to all parts of the body, too much LDL in the system can lead to coronary artery disease, due to the build-up of LDL deposits in the artery walls.
• High density lipoproteins (HDL) are called ‘good’ cholesterol because they remove cholesterol from the bloodstream and the artery walls.  A higher HDL score is desirable and will improve your overall cholesterol score.
• Triglycerides are a type of fat that is packaged with cholesterol when the lipoproteins form in the liver cells.  Triglycerides are stored in fat all over the body and can be an energy source, like carbohydrates.  Your cholesterol scores will show a measurement for triglycerides.  A score higher than normal may mean you have a higher chance of developing coronary artery disease.

Hypertension (HTN) is the medical name for high blood pressure.  Even though it typically has no symptoms, HTN can have deadly health consequences if not treated.  High blood pressure is not uncommon.

The first step in preventing and controlling high blood pressure is to learn the answers to a few questions.

What is high blood pressure, and what happens in a person's body that makes it dangerous?

Over time, if the force of the blood flow is often high, the tissue that makes up the walls of arteries gets stretched beyond its healthy limit and damage occurs.  This creates problems in several ways.

What do the numbers in a blood pressure reading mean?

The two numbers (systolic and diastolic pressures) tell you the amount of force pushing against your artery walls when the heart is contracting and when the heart is at rest.  It’s important to find out why these numbers are so important to your health.

This chart reflects blood pressure categories defined by the American Heart Association.

* Your doctor should evaluate unusually low blood pressure readings.

Cigarette smoking is the most important preventable cause of premature death in the United Kingdom.  It accounts for a significant proportion of the premature deaths which occur each year.  Cigarette smokers have a higher risk of developing several chronic disorders.  These include fatty build-ups in arteries, several types of cancer and chronic obstructive pulmonary disease (lung problems).  Atherosclerosis (build-up of fatty substances in the arteries) is a chief contributor to the high number of deaths from smoking.  Many studies detail the evidence that cigarette smoking is a major cause of coronary heart disease, which leads to heart attack.

Cigarette and tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and diabetes are the six major independent risk factors for coronary heart disease that you can modify or control.

Cigarette smoking increases the risk of coronary heart disease by itself.  When it acts with other factors, it greatly increases risk.  Smoking increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot.  Smoking also increases the risk of recurrent coronary heart disease after bypass surgery.

Cigarette smoking is the most important risk factor for young men and women.  It produces a greater relative risk in persons under the age 50 than in those over 50.

Women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease and stroke compared with non-smoking women who use oral contraceptives.

Smoking decreases HDL (good) cholesterol.  Cigarette smoking combined with a family history of heart disease also seems to greatly increase the risk

How diabetes develops

Most of the food you eat is turned into glucose, or sugar, for your body to use for energy.  The pancreas, an organ near the stomach, produces a hormone called insulin.  This hormone is necessary for the body to be able to use sugar or glucose, the basic fuel for cells in the body.  Insulin's role is to take sugar from the blood into the cells.  When your body does not produce enough insulin and/or does not efficiently use the insulin it produces, sugar levels rise and build up in the bloodstream.  When this happens, it can cause two problems:

• right away the body's cells may be starved for energy
• over time, high blood glucose levels may damage the eyes, kidneys, nerves or heart

Types of diabetes

There are two main types of diabetes: type 1 diabetes and type 2 diabetes.  Both types may be inherited in genes, so a family history of diabetes can significantly increase a person's risk of developing the condition.

Type 1 diabetes

Type 1 diabetes is a serious condition that occurs when the pancreas makes little or no insulin.  Without insulin, the body is unable to take the glucose (blood sugar) it gets from food into cells to fuel the body.  So without daily injections of insulin, people with type 1 diabetes won't survive.  For that reason, this type of diabetes is also referred to as insulin-dependent diabetes.

Type 1 diabetes was previously known as juvenile diabetes because it's usually diagnosed in children and young adults.  However, this chronic, lifelong disease can strike at any age, and those with a family history of it are particularly at risk.

Health risks for type 1 diabetes

During the development of type 1 diabetes, the body’s immune system attacks certain cells (called beta cells) in the pancreas.  Although the reasons this occurs are still unknown, the effects are clear.  Once these cells are destroyed, the pancreas produces little or no insulin, so the glucose stays in the blood. When there's too much glucose in the blood, especially for prolonged periods, all the organ systems in the body suffer long-term damage

Type 2 diabetes

Type 2 diabetes is the most common form of the disease.  Historically, type 2 diabetes has been diagnosed primarily in middle-aged adults.  Today, however, adolescents and young adults are developing type 2 diabetes at an alarming rate.  This correlates with the increasing incidence of obesity and physical inactivity in this population, both of which are risk factors for type 2 diabetes.

This type of diabetes can occur when:

• the body develops ‘insulin resistance’ and can't make efficient use of the insulin it makes
• the pancreas gradually loses its capacity to produce insulin

In a mild form, this type of diabetes can go undiagnosed for many years, which is a cause for great concern since untreated diabetes can lead to many serious medical problems, including cardiovascular disease.  Type 2 diabetes may be delayed or controlled with diet and exercise.

People with a body mass index (BMI) of 30 or higher are considered obese.  The term ‘obesity’ is used to describe the health condition of anyone significantly above his or her ideal healthy weight.  Don’t be discouraged by the term - it simply means you are 20% or more above your ideal weight and you are not alone.

Many adults are either overweight or obese.  Being obese puts you at a higher risk for health problems such as heart disease, stroke, high blood pressure, diabetes and more.

Your healthiest weight

Everyone needs a goal and positive reasons to achieve that goal.  Even losing a few pounds can provide you with cardiovascular benefits, so every step in the right direction is a step toward healthier living.  Consider these reasons to work toward maintaining a healthy weight.

When your weight is in a healthy range:

• your body more efficiently circulates blood
• your fluid levels are more easily managed
• you are less likely to develop diabetes, heart disease, certain cancers and sleep apnoea

Obesity is defined simply as too much body fat.  Your body is made up of water, fat, protein, carbohydrate and various vitamins and minerals.  If you have too much fat, especially around your waist, you are at higher risk for health problems, including high blood pressure, high blood cholesterol and diabetes.

Being obese can:

• raise blood cholesterol and triglyceride levels
• lower ‘good’ HDL cholesterol.  HDL cholesterol is linked with lower heart disease and stroke risk, so low LDL tends to raise the risk
• increase blood pressure
• induce diabetes.  In some people, diabetes makes other risk factors much worse.  The danger of heart attack is especially high for these people.

Obesity increases the risk for heart disease and stroke.  But it harms more than just the heart and blood vessel system.  It is also a major cause of gallstones, osteoarthritis and respiratory problems.

What is metabolic syndrome?

Metabolic syndrome is a cluster of metabolic risk factors.  When a patient presents with these risk factors together, the chances for future cardiovascular problems are greater than any one factor presenting alone.

For example, high blood pressure alone is a serious condition, but when a patient has high blood pressure along with high fasting glucose levels and abdominal obesity, this patient may be diagnosed with metabolic syndrome.  There is a greater chance this patient will have cardiovascular problems because of the combination of risk factors.

Metabolic syndrome is a serious health condition that affects about 34% of adults and places them at higher risk of cardiovascular disease, diabetes, stroke and diseases related to fatty build-up in artery walls.  The underlying causes of metabolic syndromes include being overweight and obese, being physical inactivity and several genetic factors.

How is metabolic syndrome diagnosed?

Metabolic syndromes occur when a person has three or more of the following measurements:

• abdominal obesity (waist circumference of 40 inches or above in men, and 35 inches or above in women)
• triglyceride level of 150 milligrams per decilitre of blood (mg/dL) or greater
• HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women
• systolic blood pressure (top number) of 130 millimetres of mercury (mm Hg) or greater, or diastolic blood pressure (bottom number) of 85 mm Hg or greater
• fasting glucose of 100 mg/dL or greater

Although metabolic syndrome is a serious condition, you can reduce your risks significantly by reducing your weight; increasing your physical activity; eating a heart-healthy diet that's rich in whole grains, fruits, vegetables and fish; and working with your healthcare provider to monitor and manage blood glucose, blood cholesterol, and blood pressure.

In the modern world many changes have led us to lead sedentary lives.  Transportation as well as our work environments has changed significantly.

Inactivity causes us to gain weight and to lose fitness with the result that our heart and other organs become less fit and more prone to disease.

A healthy diet and lifestyle are your best weapons to fight cardiovascular disease.  It’s not as hard as you may think!  Remember, it's the overall pattern of your choices that counts.  Make the simple steps below part of your life for long-term benefits to your health and your heart.

Use up at least as many calories as you take in.

• Start by knowing how many calories you should be eating and drinking to maintain your weight. Nutrition and calorie information on food labels is typically based on a 2,000 calorie diet.  You may need fewer or more calories depending on several factors including age, gender, and level of physical activity.
• If you are trying not to gain weight, don’t eat more calories than you know you can burn up every day.
• Increase the amount and intensity of your physical activity to match the number of calories you take in.
• Aim for at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity – or an equal combination of both – each week.

Regular physical activity can help you maintain your weight, keep off weight that you lose and help you reach physical and cardiovascular fitness.  If it’s hard to schedule regular exercise sessions, try aiming for sessions of at last 10 minutes spread throughout the week.

If you would benefit from lowering your blood pressure or cholesterol, it is recommended that you undertake 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week.

Eat a variety of nutritious foods from all the food groups.

You may be eating plenty of food, but your body may not be getting the nutrients it needs to be healthy. Nutrient-rich foods have minerals, protein, whole grains and other nutrients but are lower in calories.  They may help you control your weight, cholesterol and blood pressure.

Eat an overall healthy dietary pattern that emphasizes:

• a variety of fruits and vegetables
• whole grains
• low-fat dairy products
• skinless poultry and fish
• nuts and legumes
• non-tropical vegetable oils

Limit saturated fat, trans fat, sodium, red meat, sweets and sugar-sweetened beverages.  If you choose to eat red meat, compare labels and select the leanest cuts available.

One of the diets that fit this pattern is the DASH (Dietary Approaches to Stop Hypertension) eating plan.  Most healthy eating patterns can be adapted based on calorie requirements and personal and cultural food preferences.

Eat less of the nutrient-poor foods.

The right number of calories to eat each day is based on your age and physical activity level and whether you're trying to gain, lose or maintain your weight.  You could use your daily allocation of calories on a few high-calorie foods and beverages, but you probably wouldn’t get the nutrients your body needs to be healthy.  Limit foods and beverages high in calories but low in nutrients.  Also limit the amount of saturated fat, trans fat and sodium you eat.

As you make daily food choices, base eating patterns on these recommendations:

• eat a variety of fresh, frozen and canned vegetables and fruits without high-calorie sauces or added salt and sugars.  Replace high-calorie foods with fruits and vegetables
• choose fibre-rich whole grains for most grain servings
• choose poultry and fish without skin and prepare them in healthy ways without added saturated and trans fat.  If you choose to eat meat, look for the leanest cuts available and prepare them in healthy and delicious ways
• eat a variety of fish at least twice a week, especially fish containing omega-3 fatty acids e.g. salmon, trout and herring
• select fat-free (skim) and low-fat (1%) dairy products
• avoid foods containing partially hydrogenated vegetable oils to reduce trans fat in your diet
• limit saturated fat and trans fat and replace them with the better fats, monounsaturated and polyunsaturated.  If you need to lower your blood cholesterol, reduce saturated fat to no more than 5-6% of total calories.  For someone eating 2,000 calories a day, that’s about 13 grams of saturated fat
• cut back on beverages and foods with added sugars
• choose foods with less sodium and prepare foods with little or no salt.  To lower blood pressure, aim to eat no more than 2,400 milligrams of sodium per day.  Reducing daily intake to 1,500 mg is desirable because it can lower blood pressure even further.  If you can’t meet these goals right now, even reducing sodium intake by 1,000 mg per day can benefit blood pressure
• if you drink alcohol, drink in moderation.  That means no more than one drink per day for women and no more than two drinks per day for men

You cannot stop the passage of time, but you should be aware that your cardiac risk increases as you get older.

Like your age, you cannot change your family history, but you should be aware of it.

Is heart disease or stroke in your family?  If so, your risk may be higher.  Did your father have a stroke?  Did your mother have a heart attack?  Did any of your grandparents have heart disease?

Those might seem like random questions, but they’re very important when it comes to understanding your risk for these diseases.  Knowing your family’s health history can help you avoid both heart disease and stroke – the no. 1 and no. 5 causes of premature death.

Both the risk of heart disease and risk factors for heart disease are strongly linked to family history.  If you have a history of stroke in your family, you are more likely to have one.