Risk Factors for Heart Disease, Vascular Disease

Heart disease remains the number one cause of death. Cardiovascular disease, as a whole, encompasses far more ailments as well, including stroke, peripheral arterial disease, and atherosclerosis of the aorta, all of which are a result of the same process of atherosclerosis. For example, a stroke (ischemic, not hemorrhagic) is sometimes referred to as a “brain attack” – the equivalent of a heart attack in the brain.

There are a number of identified risk factors for cardiovascular disease, some of which you can do something about and others that you can blame on your parents or other factors out of your control.

Unmodifiable

  1. Age – Older age, increased risk. Considered a risk factor when men > 55, women > 65.
  2. Sex – Generally, men are at higher risk of disease compared to women who receive protective benefits from estrogen. But, certain other risk factors have greater impact in women than in men (e.g. smoking).
  3. Family History – Father having heart attack before age 55 or mother having heart attack before age 65.
  4. Other genetic conditions/predisposing factors – e.g. homocysteine and other inherited disorders of clotting

Modifiable

  1. Tobacco use – need I expound?
  2. Hypertension – high blood pressure, known as the “silent killer” because it rarely causes symptoms until it is extraordinarily high. Roughly speaking, the goal BP is less than 140/90, but the lower, the better.
  3. Diabetes Mellitus – an emerging epidemic due to obesity and inactivity
  4. Overweight – any degree of being overweight increases risk
  5. Inactivity – not as strongly associated with heart disease as some of the others, but exercise definitely reduces one’s risk
  6. Hyperlipidemia – high cholesterol, high triglycerides, can be broken down into all kinds of scenarios that increase risk:
  • Elevated LDL-cholesterol
  • Low HDL-cholesterol
  • Increased total-to-HDL-cholesterol ratio
  • Hypertriglyceridemia
  • Increased Lipoprotein (a)
  • Increased non-HDL-cholesterol
  • Increased apolipoprotein B and decreased apolipoprotein A-I
  • Small, dense LDL particles
  • Granted, there is certainly some genetic/family history influence on blood pressure and cholesterol, but for the most part that can still be significantly altered with good lifestyle. It’s not okay to just blame your genetics and give up because it’s a losing battle. Study after study demonstrates improvement in all-cause morbidity and mortality by improving on the basics: diet and exercise.

    Not to sound morbid, but your lifestyle basically determines how you will die. Very few non-alcoholics die of cirrhosis; very few non-smokers die of emphysema; and very few fit individuals die of a premature heart attack. We’re all going to die. I just don’t want to die clutching my chest while shoveling snow or running the bases. So choose your habits wisely, because they will come back to haunt you. Some also say to choose your parents wisely, but I can’t help you with that one.

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