A 48-year-old man with a history of hypertension and diabetes is 20 pounds overweight, smokes a pack of cigarettes a day, rarely exercises and frequently eats fast food on the run. His younger brother recently had a heart attack, and, visiting his doctor, he wants to know if there is anything he can do to reduce his risk of developing heart disease himself.
The man is right to be concerned. Cardiovascular disease is one of the leading causes of death in the United States. It is responsible for about one-third of all deaths in Americans over the age of 35, and about one-half of all American men and one-third of all American women will develop cardiovascular disease at some point in their lives.
The man has several fixed risk factors for developing heart disease. He is male, and men have more heart attacks than women. He is getting older. People of both sexes develop more heart disease as they age. Furthermore, he now has a family history of heart disease. If a close relative (a mother, father, brother, sister, aunt or uncle) has had heart disease at a young age (less than 50 for a man and less than 60 for a women), you are more likely to get coronary disease.
The patient also has several risk factors he can do something about. He has high blood pressure and diabetes, both of which increase the risk of developing heart disease. However, controlling high blood pressure, either through diet and exercise or through medication, will greatly decrease the risk of heart disease. Simply having diabetes puts a person at higher risk of heart disease. Keeping diabetes well controlled will also decrease this risk.
Because the man has several risk factors for heart disease, his cholesterol should be checked and aggressively lowered if the level is high. Cholesterol levels are influenced by diet. However, there are many people who are genetically pre-disposed for high cholesterol. Even if your diet is good, you should have your cholesterol checked periodically. Borderline cholesterol can be treated with diet and exercise, but higher levels will often require medication. People with known cardiac disease or who have conditions such as diabetes that put them at high risk for heart disease are likely to require medication.
Probably, the patient’s biggest risk factor is that he is a smoker. Rates of cardiac disease are much higher among people who smoke (three times higher in male smokers than non-smokers and six times higher in female smokers). Quitting smoking decreases your risk of a heart attack by at least half, and your risk of cardiac disease decreases almost immediately after quitting and continues to decrease the longer you abstain.
Diet can also be a risk factor. High-fat diets, especially those high in red meat, are a risk factor for heart disease. Conversely, low-fat diets, especially those that are higher in fruits and vegetables, are associated with lower cardiac disease. Following a good diet also makes it easier to lose weight, which also reduces risk.
The patient also would be well advised to begin an exercise program. Exercise is probably one of the most important determinants of your risk for heart disease. In fact, people who exercise a lot and have high cholesterol actually have lower rates of heart disease than people who have low cholesterol and don’t exercise (people who have low cholesterol and exercise have the lowest rates). It is recommended that you exercise at least 30 minutes per day at least 5 days per week. However, that does not mean you have to go out and run a marathon. Simple exercise such as walking, even for relatively short periods of time, will decrease your cardiac risk.
Most of us know that we should eat right, exercise and not smoke. However, even if we know that we have heart disease or are at high risk for it, it is often hard to motivate ourselves to keep up good habits. It may be easier to visualize our good or bad habits in life gained or lost. For example, each cigarette smoked, on average, shortens your life by 10 minutes, and quitting a one-pack-a-day habit will add about three-and-a-half hours to your life for every day you do not smoke. Similarly, deciding to get up off the couch and take a walk adds about 20 minutes of life; deciding to stay on the couch subtracts 30.
Heart disease is very common, and, essentially, all of us are at risk of developing coronary disease at some point in our lives. However, you can greatly decrease your risk by being checked for high blood pressure, high cholesterol and diabetes, by treating these diseases if they develop, and by following good habits—not smoking, eating a good diet and exercising.
Dr. John Goldman is the Program Director of Internal Medicine at PinnacleHealth.
