Assessing Your Risk

More than 1.2 million Americans have a heart attack each year.
The best way to avoid being one of them is to know
which factors put you in jeopardy.


February 2012

By Beverly Burmeier

Heart attack. Those words can strike fear, especially if you are worried about having them appear on your own medical chart. Because 25% of sudden heart attack victims have no symptoms, it’s especially important to assess your risk early in order to prevent potentially deadly coronary events.
According to information from the National Health and Nutrition Examination Survey, 60% of Americans have some cardiovascular risk factors; 25% are considered to be at high risk. Approximately 35% run a low risk of heart disease.

While some risk factors can’t be changed, many are related to lifestyle habits you can control. “All risk factors are important over a lifetime because the damage is cumulative,” says C. Noel Bairey Merz, MD, medical director of the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai Medical Center in Los Angeles. The American College of Cardiology recommends that, starting at age 18, all adults be checked annually for common risk factors such as high blood pressure and cholesterol. Cardiac risk factors that lie beyond your control include aging; about 85% of people who die of heart disease are over age 65. Members of some ethnic groups are also more susceptible.

According to the American Heart Association (AHA), African Americans, Hispanics and Native Americans are at greater risk because they are more likely to have contributing factors such as high blood pressure, obesity, high cholesterol and diabetes.

Genetics is a cardiovascular risk factor that, despite popular perception, can be influenced by lifestyle. For example, one study found that eating a diet rich in fresh produce, especially green vegetables, can reduce risk among people who have genetic markers associated with cardiac problems (PLoS Medicine 10/11/11). “Even if you’ve inherited a tendency towards heart disease, you don’t have to repeat it,” says Sharonne Hayes, MD, of the Mayo Clinic in Rochester, Minnesota.

Gender is another risk factor. Men have a greater cardiac risk than women, although women’s heart disease risk increases after age 55. What’s more, women are more likely to die of heart disease than men. “There is no good study that tells us how similar or different women are from men when it comes to heart attacks. Sometimes the symptoms are not clear, clustered differently and can be attributed to something such as indigestion or anxiety,” says Hayes. Symptoms that many people don’t associate with heart attacks include sweating, nausea, shortness of breath and lightheadedness.

Heart Attack in Women

Because female heart attack symptoms can be more vague and diffuse compared with the classic crushing chest pain—and because more women tend to be of the “Oh, I don’t want to bother anyone” type—more women than men die of heart attacks before reaching the hospital. And the problem doesn’t stop when a woman reaches the ER, where hospital staff have traditionally been more likely to assume that a woman is suffering from something such as gallstones or asthma instead of a heart attack.

If you’re a woman and you think you’re having a heart attack, the most important thing is to call 911 immediately. (Some women have actually been known to straighten up the house before going to the hospital.) Besides avoiding the risk of passing out behind the wheel of your car, being seen by the EMTs allows monitoring of vital signs to begin as soon as possible. While you’re waiting, chew a full-strength aspirin to help break up any blood clots that may exist. Have a friend or loved one accompany you or meet you at the hospital, if possible, but not at the expense of wasting precious minutes.

Remember that if it is a heart attack, the sooner you get help the less damage your heart muscle is likely to sustain.

Once you’re in the emergency room, describe your symptoms as calmly and fully as you can without trying to interpret them (“I first thought it
was a stomachache, but then...”).

Tell the ER personnel you are concerned you may be having a heart attack; if the problem turns out to be something else no one will hold it against you. Also inform the nurse or doctor if you have any pre-existing risk factors, such as diabetes or high blood pressure.

Men and women face additional risks related to gender. Men with erectile dysfunction (ED), a vascular disease in the smaller arteries, should consider an enhanced screening schedule, as this could be an early warning sign of heart disease. And men who are deficient in vitamin D have been found to run an increased heart attack risk compared with men who have sufficient amounts of the sunshine vitamin (Archives of Internal Medicine 6/9/08). “Vitamin D deficiency is known to affect blood levels of various factors, including parathyroid hormone, which may be linked to heart disease,” explains Edward Giovannucci, MD, of the Harvard School of Public Health.

Among risks unique to women, those who smoke—itself a risk factor—should not compound the problem by using oral contraceptives because of an increased risk for blood clots that can lead to heart disease and stroke. Women with abnormal menstrual periods or who developed pre-eclampsia (pregnancy-induced high blood pressure) or diabetes during pregnancy may be at greater risk for heart disease later in life. The same is true for women who have chronic polycystic ovary syndrome or autoimmune diseases such as lupus or rheumatoid arthritis. While any of these factors alone may not be significant, Hayes cautions that women who have more than one factor should be especially diligent about checking vital numbers as they age.

Factors You Can Change

Tobacco usage is one of the biggest controllable risk factors for heart disease. The AHA says cigarette smoking increases cardiac risk two to four times beyond that for nonsmokers. (Cigars and pipes also raise risk, but not as much as cigarettes.) Smoking decreases HDL (good) cholesterol, increases blood pressure, decreases one’s ability to exercise and increases the tendency for blood to clot. Secondhand smoke is a proven danger. So in addition to not smoking yourself, avoid places where people are lighting up.

Did you know toenails can predict heart disease risk? “Checking nicotine levels in toenails as a result of exposure to tobacco smoke helps predict health risks from tobacco and identify high-risk populations,” says Wael Al-Delaimy, PhD, of the Department of Family and Preventive Medicine, University of California, San Diego.

High cholesterol may be a more potent risk factor for men because they tend to have lower levels of HDL cholesterol, which should be above 40 mg/dL for men and 50 mg/dL for women. Total cholesterol should be less than 200 mg/dL and triglycerides below 150 mg/dL. Keep LDL (bad) cholesterol below 100 mg/dL if your heart disease risk is low and less than 70 mg/dL if it’s high.

Cholesterol levels can be affected by smoking, age, sex and heredity. They can also be influenced by diet; plant sterols found in produce and nuts, for example, help prevent cholesterol from being absorbed into the bloodstream. In addition, coenzyme Q10, garlic, green tea and grape seed all have heart-healthy properties, as does the herb hawthorn.

Monitor your blood pressure, too. A connection has been shown between hypertension and heart disease; Bairey Merz says this is especially true for older women. Combine high blood pressure—which affects the heart’s ability to function properly—with obesity, smoking, high cholesterol or diabetes, and your risk of heart attack or stroke increases significantly.

Two online sites that can help you quickly calculate your risk are www.cardiosmart.org and www.nhlbi.nih.gov (click on the Public tab and scroll to find the 10-Year Heart Attack Risk Calculator under Health Assessment Tools). Be sure to consult your healthcare professional if you discover significant risk factors.

A serious but often preventable risk factor for heart disease is diabetes. “Having diabetes is considered a ‘disease equivalent,’ as bad as having a heart attack,” warns Bairey Merz. A fasting blood glucose level (taken at least eight hours after eating) of 126 mg/dL or above indicates the presence of diabetes. Levels between 100 and 125 mg/dL indicates that someone is prediabetic and at a greater risk of developing not only diabetes but heart disease as well.

Cinnamon is the best-known natural blood sugar regulator, a category that also includes banaba, beta-glucan, bitter melon, chromium, corosolic acid, fenugreek and gymnema. In addition, brown seaweed polyphenols help block sugar absorption within the intestines. (Work with your healthcare practitioner to design a suitable supplementation program.)

How much you weigh isn’t necessarily as important as how much you move. “Exercise trumps body weight as a risk factor,” says Bairey Merz. However, body fat carried mainly around the waist (visceral obesity) makes the heart work harder. Waist measurement at the navel should be under 35 inches for women and 40 inches for men.

Whether you need to lose a few pounds or simply maintain a healthy weight, the AHA recommends getting at least two and a half hours of mod­erate to vigorous physical activity each week.

Like being sedentary, eating a diet filled with junk food raises your risk for heart disease. You should focus on getting healthy fats from avocados, olive or canola oil and nuts, and build the rest of your diet on legumes, lean protein and fresh produce. “Items on your plate should be predominately things that grow in the ground—a Mediterranean-style diet,” Bairey Merz says. (A high-quality whole-food multivitamin can help cover nutritional gaps.) The AHA recommends eating fish, a good source of heart-healthy omega-3 fatty acids, at least two times a week.

Other heart disease risk factors include:

• Alcohol—While consuming a moderate amount—no more than two drinks for men and one drink for women per day—is good for your heart, too much increases risk for cardiovascular abnormalities. Res­veratrol, the inflammation-fighting component of red wine, is available in supplemental form and is sometimes combined with vitamin D, another anti-inflammatory nutrient.

• Depression—“Depression is the least known widespread cardiac risk factor, as strong a predictor as smoking in some cases,” says Hayes. Depression has been linked to increased risk of death from cardiovascular disease among people between the ages of 17 and 39 (Archives of General Psychiatry 11/11). The herb St. John’s wort is the best-known natural antidepressant. SAM-e, a naturally occurring substance found throughout the body, may also be helpful.

• Sleep—A 2003 analysis of more than 71,000 women aged 45 to 65 found that poor sleep habits (more than nine hours or less than five hours per night) can increase risk for coronary disease.

• Stress—Stress has been linked to cardiac ischemia, or decreased blood flow to the heart muscle. The members of the B-complex are known as “stress vitamins” for good reason and vitamin C helps regulate release of the stress hormone cortisol. Magnesium is known for its stress-reducing effects, as are the herbs passionflower, eleuthero and rhodiola.

There’s no magic bullet that can provide iron-clad protection against cardiovascular disorders. But by working on those risk factors you can control—and trying your best to offset those you can’t—you can reduce your chances of suffering a heart attack.

 

A Healthy Smile Brightens Your Cardiovascular Outlook

Preventing periodontal disease can save you the pain and cost of having teeth replaced by either dentures or implants. But that’s not all: It’s been known for years that having diseased gums leaves you more prone to cardiovascular woes.

The development of arterial plaque, or atherosclerosis, is a major contributing factor to heart attacks and strokes. What’s the link to poor oral health? Researchers believe that excessive bacterial growth in the mouth may increase chronic low-level inflammation, a known factor in many disorders including cardiovascular disease. What’s more, it’s now thought that a runaway immune response to bacteria-produced proteins may also spur plaque development.

Keeping your heart in good shape—and hanging onto all of your own teeth—makes regular oral care imperative. Aloe vera gel and strained chamomile tea can help ease the discomfort of inflamed gums. If you are already experiencing tooth loosening, coenzyme Q10 and vitamin C may help rebuild the collagen that holds teeth in place. And green tea extract inhibits an enzyme called collagenase that breaks down healthy gum tissue; this discovery validates the ancient use of tea twigs as an early form of toothbrush.

Speaking of toothbrushes, you should be using one at least once and preferably twice a day, along with daily flossing. Many practitioners, especially in India’s Ayurvedic tradition, also recommend the use of a tongue scraper to help reduce tooth plaque and reduce mouth odor.

A number of natural substances can be used instead of standard commercial toothpastes and mouthwashes. Neem is an Indian remedy that helps reduce cavity-causing microbes. So is tea tree oil, which has been found to reduce bacteria associated with gingivitis and cavities. (Oil-infused toothpicks make tea tree’s dental protection more portable.) Peppermint and spearmint oils help freshen breath.

 

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