Know Your Risk: Heart Disease
by Roberta Lee, MD (topic expert: health)

A recent Los Angeles Times article discussed the topic of public fear and disasters. The article suggested that public fears were overblown. As a person living and working in New York since 1999 it is not hard to understand how this could happen -- especially after living through September 11th when the world trade center collapsed. It is true that a lot of things of great significance have happened. However, acknowledging the fear of things that can be, are we seeing things that are dangerous in perspective?

My colleague Dr. Dipti Itchaporia, a cardiologist, thinks not. I invited her to share her perspective. She writes:

Our one-year risk of death from cancer is 1 in 510 and our lifetime risk of death is 1 in 7. What would you guess is our number one risk of death? For most people the answer will come as a surprise. The number one killer is heart disease and approximately 900,000 people die annually from this medical condition. Or expressed in other words, 1 in 300 persons will die from heart disease within a one-year time interval and over a lifetime 1 in 4 will die of heart disease. Furthermore, heart disease is not just a killer of men -- it is also the number one killer of women.

Every disease comes with certain hallmarks for increased risk that that disease may occur, and heart disease is no exception.

What are the risk factors for heart disease?

• Hypertensionis one of the risk factors for heart disease and it has been called the silent killer. It earned this nickname because over the years so many people with high blood pressure have received a delayed diagnosis by their doctors. People can experience no symptoms with active hypertension. As a result, many of these people fail to be treated for years. Not only can high blood pressure lead to a higher risk of heart attack, it can also contribute to stroke, kidney failure and congestive heart failure. An ideal blood pressure reading is 130/70. The most common form of hypertension, essential hypertension, is generated from the combination of decreased elasticity and increased constriction of the arteries in combination with an elevated heart rate. The exact physiologic explanations are still being researched but most experts agree that these factors contribute to the development of it.
• Diabetes: Diabetics are more likely to develop heart disease than non-diabetics. The risk of heart disease to diabetics is so high that we recommend even more aggressive treatment of their high blood pressure and cholesterol. For the average person, the normal level for the LDL (the bad cholesterol) is less than 130. In a diabetic, we want to see the LDL cholesterol to be less than 70. We recommend that patients check their fasting cholesterol as part of their cardiac risk assessment.
• Genetics: Having a family member with a history of heart disease before the age of 65 is important history to share with your doctor.
• Obesity and smoking: Physical inactivity, which can lead to becoming overweight, makes your heart muscle work a lot harder. A minimum of 30 minutes of physical activity daily can cut your cardiac mortality by 50%. What's more, a loss of two points in your Body Mass Index can reduce cardiovascular disease in men by 5% and in women by 7%, according to the New England Journal of Medicine. As a smoker, you're more prone to accumulate plaque in your heart arteries and clog them as a result.

Don't give short shrift to the risk factors you can control. And certainly discuss with your doctor those you can't.