What every person should know about heart disease

• Risk factors for coronary artery disease
  The Framingham Heart Study, a 50-year study in Framingham, Massachusetts, developed the concept of risk factors and their relationship to coronary artery disease-a concept that is widely accepted and used throughout the world.
  
  
• Atherosclerosis and coronary artery disease
  Atherosclerosis is the buildup of fatty, fibrous plaques on the inner wall of arteries causing them to become narrowed or hardened. Atherosclerosis starts as a fatty streak and develops over time to become a complicated obstructive lesion that blocks blood flow. Early fatty streaks have been seen at autopsy in very young children (under 10) who have died accidentally. Significant atherosclerosis has been seen in young men in the military who have died in combat. From this, we know that atherosclerosis starts at a very young age and develops silently and slowly without symptoms or warning.
  
  Atherosclerosis of the coronary arteries can develop in any of the main coronary arteries or any of their many branches. Atherosclerosis of the coronary arteries is called coronary artery disease or CAD.

The Risk Factors

There are two types of risk factors for the development of coronary artery disease-those you cannot control and those you can.

The "uncontrollable" risk factors are:

• Age (the risk increases with age)
  
  
• Gender (men develop CAD 10 years earlier than women)
  
  
• Family history (genetic predisposition and common lifestyles increase risk)
  
  
• Race (incidence is greater in some groups of African Americans, Hispanics, Asian Americans, native American Indians,)

The "controllable" risk factors are:

• Smoking
  
  
• High blood pressure
  
  
• High blood cholesterol
  
  
• High blood sugar (diabetes)
  
  
• Obesity and overweight
  
  
• Obesity and Overweight
  
  
• Physical inactivity
  
  
• Stress

Unfortunately, many people tend to ignore the importance of the "uncontrollable" risk factors because they feel they can do nothing about them. While it is true that you cannot change your age, gender, race, or the family you were born into, these risk factors compound and worsen the impact of the other risk factors.

Remember-the first symptom which 30% of heart attack victims experience is sudden death. It is a dangerous game of Russian roulette with your life if you wait for symptoms to appear before you take action.

And the only action you can take is to identify and reduce the "controllable" risk factors.

  Major risk factors for heart disease that can be controlled or changed

1. Smoking. Smoker's are at twice the risk of heart attack than are non-smokers. Cigarette smoking is the biggest risk factor for sudden cardiac death. Smokers are two to four times more likely to have sudden cardiac death than non-smokers. Smokers who have a heart attack are more likely to die and die suddenly, as quickly as an hour after the heart attack, than non-smokers. People who smoke cigars and pipes have a higher risk of death from heart disease, but not as high as people who smoke cigarettes. Environmental (or second-hand) tobacco smoke increases the risk of heart disease, even if you don't smoke. Decrease your risk of heart disease by not smoking. If you smoke, stop.
   
   
2. High blood pressure. High blood pressure puts more stress, or workload, on the heart, causing it to enlarge and get weak over time. The risk of stroke, heart attack, kidney failure, and congestive heart failure is also greater in people with high blood pressure. Combined with obesity, smoking, high blood cholesterol and/or diabetes increases a person's risk of heart attack or stroke several times. If you have high blood pressure, learn how to manage it through lifestyle changes, stress management, and/or medication.
   
   
3. High blood cholesterol. The risk for heart disease increases in people with high blood cholesterol levels. When other risk factors are present, the risk increases. Age, gender, heredity and diet all play a role in blood cholesterol levels. If you have not had your blood cholesterol level checked, ask your doctor. If you know you have a high blood cholesterol level, do what you can to lower it, through diet and exercise and/or medication.
   
   
4. High blood sugar (diabetes). Diabetes is a complicating factor for heart disease, and vice-versa, greatly increasing the risk for heart disease and stroke. Millions of Americans have diabetes but don't know it. Medical management of diabetes and lifestyle changes can help reduce your risk for heart disease. If you have not been tested for diabetes, talk to your doctor. If your family has a history of diabetes, you are at increased risk and may need to be tested sooner. If you do have diabetes, learn all you can about how to manage your disease effectively. There is much you can do to control your diabetes, and help reduce your risk of heart disease.
   
   
5. Obesity and overweight. People with excess body fat, especially in the waist, are more likely to develop heart disease even if they don't have any other risk factors. Excess weight increases the stress, or workload, on the heart and raises blood pressure. Blood cholesterol and triglyceride levels also go up as weight increases, and lowers the "good" cholesterol. Diabetes is more likely to develop, too, in people who are obese or overweight. By losing as little as 10 to 20 pounds, you can improve your health and decrease your risk for heart disease. If you are overweight or obese, change your lifestyle to include healthy weight management techniques such as portion control, nutritious diet, and regular exercise. If you need help learning how to achieve a healthy weight, talk to your doctor.
   
   
6. Physical inactivity. People who are inactive, or "sedentary," are at a higher risk for heart disease. Regular, moderate-to-vigorous exercise is essential to prevent cardiac and vascular disease. The more vigorous the activity, the greater the benefits to your cardiovascular system. Exercise also helps control blood cholesterol, diabetes and obesity, and has been shown to lower blood pressure in some people. If you do not currently exercise, begin slowly. Even moderate exercise has benefits. If you haven't exercised in a long time, talk to your doctor first to ensure you are healthy enough to participate in regular exercise. Vigorous exercise isn't necessary to achieve good outcomes and reduce your risk of heart disease; even moderate activity such as walking-but doing so on a regular basis, 3 or more times weekly, will be of benefit to you.
   
   
7. Stress may be a contributing factor to heart disease. Everyone experiences stress. It is part of being human, of being alive, and part of interacting with the world. It is our reaction to stress that matters in terms of our health-especially the risk of heart disease. If you feel that you are under chronic stress, learn some techniques to help you manage your response to the stress in your life.

Additional Cautions

1. Sex hormones have been shown to be a contributing factor to heart disease in women after menopause, resulting from the natural loss of estrogen. If you have had a natural or surgical menopause (removal of the uterus and ovaries), talk to your doctor about estrogen replacement therapy or hormone replacement therapy.
   
   
2. Early forms of birth control pills which had higher doses of estrogen and progestin, increased the risk of heart disease and stroke, particularly in women who smoked heavily. Newer oral contraceptives have a much lower risk, unless women who take them also smoke or have high blood pressure. If you took early forms of birth control pills, or smoke and take birth control pills now, make sure you have yearly medical check-ups to include blood pressure screening, triglyceride and glucose levels. If you are taking birth control pills and smoke, try to quit smoking to reduce your risks of heart disease.
   
   
3. Alcohol consumption on a regular basis, or in considerable quantity, can raise blood pressure, cause heart failure, and lead to stroke. It also contributes to obesity, alcoholism, accidents and suicide. If you drink, do so moderately ( no more than one drink for women or two drinks for men daily). One drink is defined as 1 ½ fluid ounces of 80-proof alcohol, 1 ounce of 100-proof alcohol, or 12 oz. of beer. If you have trouble limiting how much alcohol you drink, talk to your doctor to learn how you can gain control over it.