Each year close to 1.4 million Americans experience a
heart attack,
and more than 500,000 die from it. Strikingly, according to the Society
for Heart Attack Prevention and Eradication, 50 to 70 percent of those
who suffered fatal heart attacks were not even aware of their risk.
Despite recent scientific advances in heart disease prevention, many
high-risk patients are overlooked when conventional risk assessment
methods such as cholesterol and blood pressure screenings are used
alone.
Here’s what you need to know about the No. 1 predictor of a heart
attack, the calcium score, plus eight other risk factors to consider.
The Calcium Score
A
calcium score,
obtained from a noninvasive computed tomography (CT) scan of your
heart, is the measure of the amount of calcium in your coronary
arteries.
This number reflects the total amount of atherosclerotic
plaque. It’s an indication of how all of your risk factors interact with
each other to cause heart disease.
The higher your calcium score for
your age, the greater your risk of a heart attack or stroke.
Many
preventive cardiologists are recommending that asymptomatic men over age
40 and most postmenopausal women over age 50 have a heart scan to
determine their calcium score, unless they have been determined by a
doctor to be at very low risk.
A calcium score of zero means you have no calcium deposits and a low
risk of heart attack in the next five years.
A score of 400 or more puts
you at high risk of a heart attack within 10 years; a score of
1,000-plus means you have up to a 25 percent chance of having a heart
attack within a year without medical treatment.
The significance of a given score also depends on your age. For
instance, if you’re 40 and have a score of 50, it indicates you are at
high risk.
If an 80-year-old has a score of 50, it indicates low risk
because the atherosclerotic process has proceeded very slowly. If your
score is high for your age, then your doctor may advise adopting a
heart-healthy diet, such as the South Beach Diet, along with other
lifestyle changes, and often medications, to improve your risk profile.
It may be a statin to lower cholesterol and/or a medication to lower
your blood pressure.
You can get a CT scan for coronary calcium at most major medical
centers, with the cost ranging from $99 to $399. The test takes about 10
minutes and radiation is minimal, about the same as a mammogram. Check
with your insurance carrier to see if this test is covered.
Family History of Heart Disease
If
one or both of your parents died prematurely of a heart attack, it puts
you at greater risk.
Still, there are other factors to consider when it
comes to
family history.
If your father smoked, rarely exercised, and ate a diet high in bad
carbs and bad fats, his death could have been hastened by any or all of
those factors.
You may have been dealt a bad set of genes, but there’s a
great deal you can do when it comes to lifestyle to reduce and even
eliminate the familial risk.
Often, medications are also needed to
overcome the effect of bad genes.
While, many people know the cardiovascular health of their parents
influences their level of risk, they are unaware that the health of
their siblings matters, too.
If you have a brother or sister with
cardiovascular disease, your own risk is increased by as much as 100
percent. In fact, if you grew up in the same household as your sibling,
your sibling’s medical history is likely to be even more informative
than your parents’.
You and your brothers and sisters not only have
similar genes, but you also ate similar food and grew up in the same
environment.
Smoking and Heart Disease Risk
At
any age, smoking at least doubles your risk of heart disease.
In fact,
smoking can trigger a heart attack even if your arteries are nearly
perfect.
Once you light up, smoking narrows your arteries, raises your
blood pressure, increases your risk of irregular heartbeat, and makes
your blood sticky and more likely to clot.
Smoking also lowers your
HDL (“good”) cholesterol and increases arterial inflammation. This is the perfect recipe for a heart attack.
If you smoke, and particularly if you have other risk factors for
heart disease, each time you light a cigarette, you’re playing Russian
roulette with your heart.
A smoker who has high blood pressure and high
LDL (“bad”) cholesterol has
14 times the normal risk
of having cardiovascular disease.
A woman who takes birth control pills
(which increase the risk of blood clots) and who also smokes has a much
greater risk of heart disease than does a woman who takes birth control
pills but does not smoke.
In young people with heart attacks, smoking
is often the biggest culprit.
Diagnosis of Diabetes or Prediabetes
If you are an American age 40 to 70, the odds are about 40 percent that you’ve been diagnosed with diabetes or
prediabetes
(also known as metabolic syndrome and typically characterized by
increased waist circumference, high blood pressure, high triglycerides,
low good HDL cholesterol, and a mildly elevated blood sugar). Diabetes
is such a strong risk factor for heart disease that medical
professionals define it as a “coronary heart disease risk equivalent.”
This means that a person with diabetes has the same high risk of a heart
attack as someone who has already had one. Up to 70 percent of people
in coronary care units have prediabetes or diabetes.
Women, take note:
If you have diabetes and have suffered a heart attack, you have an even
greater risk of having another heart attack or heart failure than a man who has diabetes and has suffered a heart attack.
Waist Circumference and Your Heart
The
circumference of your waist is an indicator of your odds of having a
heart attack or stroke.
If you have an apple-shaped body and carry much
of your weight around your middle, you are at greater risk for
cardiovascular disease than if you have a pear-shaped body and store fat
mainly in your buttocks and thighs, or evenly over your entire body.
Studies have found that waist circumference is an excellent predictor of
who will develop diabetes and heart disease.
A
waist circumference
of more than 35 inches if you’re a women (and 40 inches if you’re a
man) puts you at risk. Get rid of that extra belly fat through diet and
exercise.
High Blood Pressure
About one in three American adults has
high blood pressure,
also called hypertension.
High blood pressure is currently defined as a
reading of 140/90 mm Hg or higher, but guidelines regarding what
constitutes “high” versus “normal” keep changing.
Right now, blood
pressure anywhere between 120/80 (normal) and 139/89 are labeled
prehypertension.
The American Heart Association estimates that 65
million Americans are in this category.
It also estimates that people
with prehypertension may be three times as likely to have a heart attack
as those with normal blood pressure.
Although blood pressure can vary
from minute to minute with exercise, stress, sleep, and even changes in
posture when at rest and relaxed, it should normally be less than 120/80
mm Hg for both men and women age 20 and older.
Cholesterol and Your Heart
Total cholesterol, when considered alone, is a poor predictor of heart disease and heart attack. Studies show that total
cholesterol levels
among people who’ve had heart attacks are almost the same as those of
people who haven’t, and that roughly half of heart attacks occur in
people without high cholesterol.
If you have other risk factors for heart disease, particularly a
family history, having your HDL and LDL particle size measured with an
advanced blood test will give you a far clearer picture of your heart
risk than the conventional lipid panel.
Having a lot of large particles
cuts your risk for a heart attack, while having a lot of small ones
raises it. You do not want more than 15 percent of your particles to be
the small, dense type.
Triglycerides and Your Heart
Triglycerides are the form in which fat is stored in your body’s fat cells. Your
triglyceride level
is almost always strongly influenced by lifestyle.
If you have high
triglycerides (over 150 mg/dL is borderline high) and low HDL (less than
40 mg/dL if you’re a man and less than 50 mg/dL if you’re a woman),
your risk of heart disease is compounded.
To find out if you have this
added risk, divide your triglyceride count by your HDL count. Ideally,
the resulting number will be 2 or lower.
For example, if your
triglyceride level is 200 and your HDL is 40, divide 200 by 40 and you
get 5.
This is much higher than the desirable ratio, and it tells you
that you have a heightened risk of a heart attack that will need to be
addressed.
Your triglyceride level can also offer insight into your LDL particle
size. In general, the higher your triglycerides and the lower your HDL,
the smaller and denser your LDL and the greater your risk of heart
disease. If your triglycerides are higher than 200 and your HDL is lower
than 45, it is likely that you have too many small, dense LDL
particles.
A Sedentary Lifestyle and Your Heart
A
life with little to no physical activity leads to a number of
undesirable body changes.
Your blood pressure goes up, your
triglycerides increase, your level of good HDL falls (this is why
triglycerides and HDL are often called the “lifestyle” numbers), and you
are more likely to gain weight, especially around your midsection.
This
is a picture of a heart attack in the making. No wonder the AARP
recently called sitting the new smoking.
The sad news is that two-thirds
of American adults report that they are physically inactive — that is,
they are sedentary most of the time. It’s time to
get up and get moving.
