February is Heart Month—A Perfect Time to Asses Your Risks by Andrew Rudin MD

 

It’s Heart Month, which means it’s as good a time as ever to remind you of the importance of understanding your individual risks for heart disease. Heart disease is the #1 cause of death in America for both men and women. It’s essential to your health and quality of life to understand which factors could be putting you at greater risk and to form a cohesive plan to address those risks, so you can lower your chances of having a heart attack or stroke.

There are many conditions and habits that increase your likelihood of developing heart disease. Some of these risk factors are out of your control, but many are capable of being fully managed or at least mitigated. Remember, the more risk factors you have, the greater your chance of developing heart disease and heart related problems. The more of these risk factors you can tackle, the better off you’ll be.

First off: the risk factors we have no control over

There are certain risk factors that we cannot change, including having a family history of heart disease, getting older, being a male, being African-American, experiencing early menopause, or having diabetes.

We can’t change these, but identifying them as risk factors should alert you to the fact that it is increasingly important for you to manage as many of the risk factors you can control as possible. The less risk factors you have overall, the lower your chances of a heart disease related death.

Now onto the ones we can control: Blood pressure

First, you need to understand how to read your blood pressure. Blood pressure is typically recorded as two numbers, written as a ratio. The top number, or “Systolic,” measures the pressure in the arteries when your heart beats. The bottom number, or “Diastolic,” measures the pressure in your arteries between heartbeats.

Second, you need to understand what healthy blood pressure looks like. This blood pressure chart reflects the current categories as defined by the American Heart Association:

American Heart Association Blood Pressure Chart

And finally, you should know when and how often to monitor it. The AHA recommends that all people, starting at the age of 20, should be receiving a blood pressure screening during their regular healthcare visit or once every 2 years if their blood pressure is less than 120/80 mm Hg.

About one in three U.S. adults has high blood pressure. If you fall into this group, your doctor can help you devise a program to lower your blood pressure. This usually involves lifestyle changes (such as diet, exercise, sleep habits, and stress management) and sometimes medication, if it cannot be managed with lifestyle changes alone.

It should also be noted that more attention is often given to the top number (the systolic blood pressure), especially in people over 50 years of age because systolic blood pressure tends to rise steadily with age due to increasing stiffness of large arteries, long-term build-up of plaque, and increased incidence of cardiac and vascular disease.

Cholesterol

First, you should understand what cholesterol isn’t: Cholesterol itself isn’t actually bad. In fact, cholesterol is created naturally in our bodies and is used to keep us healthy. Problems arise when we have too much “bad” cholesterol and/or not enough “good” cholesterol.

Excess “bad” cholesterol leads to plaque forming between the layers of your arteries walls. When that plaque builds up over time, it makes it harder for your heart to circulate blood. That plaque can also break open and cause blood clots. If a clot blocks an artery that feeds to the brain, it causes a stroke. If a clot blocks an artery that feeds to the heart, it causes a heart attack.

Second you should know where you’re getting cholesterol from. Cholesterol comes from two sources: your body and your food. Your body, and especially your liver, makes all the cholesterol your body needs, and it circulates it throughout your body via your blood. We also get cholesterol from food, particularly animal sources, such as meat, poultry, and dairy products. Not only do you get cholesterol from these sources, but your diet can also influence how much your body is naturally producing. For example, when you eat a diet high in saturated and trans fats, your liver produces more cholesterol.

So what can you do to understand and manage your cholesterol? A doctor can run a simple blood test to let you know what your cholesterol levels are. From there, you can work together to determine the best strategy to get it back to a healthy level. Again, this will probably be a combination of lifestyle changes and medication, if lifestyle changes alone are not enough.

Triglycerides

Triglycerides are a type of fat found in your blood that your body uses for energy. Like cholesterol, triglycerides themselves are not bad for you. You need some for a healthy body, but if your triglycerides levels are too high, they raise your risk of heart disease and could be a symptom of other health issues that similarly increase your risk for heart disease, diabetes, and stroke.

Also like cholesterol, the same blood test will measure your triglycerides.

To understand your results, compare them to the following:

Normal: less than 150
Borderline-high: 150 – 199
High: 200 – 499
Very high: 500+

Your doctor will help determine if your triglyceride levels could be an indicator of any other health problems. They will also be able to help get you on the right track towards reducing your triglyceride levels if necessary.

Smoking

Smoking is one of the most important risk factors because it is by far the most preventable.

First, you should understand what smoking is really putting you at risk of. Aside from cardiovascular disease, smokers have a higher risk of developing atherosclerosis, COPD including emphysema and chronic bronchitis; cancers throughout the body with the most obvious being lung cancer; reduced fertility in women with an increased risk of preterm delivery, stillbirth, low birth weight, sudden infant death syndrome, ectopic pregnancy, and orofacial clefts; reduced fertility in men and increased risks for birth defects and miscarriage from infants conceived from their sperm; weaker bones more prone to fracture; tooth loss; cataracts; type 2 diabetes; rheumatoid arthritis; and more.

Smoking is estimated to increase your risk of developing coronary heart disease by 2 – 4 times and stroke by 2 – 4 times. For men, the risks of developing lung cancer are increased by 25 times and for women by 25.7 times.

Smoking also puts those around you at risk, with secondhand smoke being responsible for about 34,000 adult deaths a year. Furthermore, the risk of stroke for nonsmokers who are exposed to secondhand smoke is increased by an estimated 20–30 percent.

You don’t need any tests to determine whether you should quit smoking your not (you should.) And your doctor can help you create a plan for quitting. It’s not easy to quit, but the benefits for your health as well as those around you are phenomenal.

Activity level

If you’re living a sedentary lifestyle, you’re increasing your risks of heart disease.

First, you should know what physical activity is: physical activity is anything that makes you move your body and burn calories, and there are 4 categories of exercise: endurance, strength, balance, and flexibility.

  • Endurance activities, sometimes called “aerobic exercise,” increase your breathing and heart rate to improve your the health of your heart, lungs, and circulatory system. Examples of this kind of activity include walking/jogging, yard work, or dancing.
  • Strength exercises, often referred to as “strength training” or “resistance training,” are movements that focus on making your muscles stronger. Examples of this kind of activity include lifting weights, using resistance bands, or repetitive exercises such as pushups and lunges that utilize your own body weight.
  • Balance exercises improve our ability to do more complex movements and prevent falls as we age. Examples of this kind of activity include yoga and tai chi.
  • Flexibility exercises stretch your muscles to improve your range of motion. Flexibility is key for proper form, executing more advanced movements, and for remaining active as we age. Examples of this kind of activity include yoga and general stretches.

Second, you should understand how much activity you should be getting. The AHA recommends at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity). For people looking to lower their blood pressure or cholesterol, the AHA recommends 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week to lower the risk for heart attack and stroke.

An easier way to remember it: thirty minutes a day, five times a week. Pretty simple, right?

If you’re new to exercise, or just haven’t done it for awhile, I’d recommend seeing your general practitioner first to asses what kind of exercise and level of intensity is right, and safe, for you. You can build up to more frequent, intense, or longer durations of exercise over time, until you can hit or exceed the AHA’s recommendations. A physical trainer is also a great way to get started. They can teach you new exercises and proper form under trained supervision.

Weight

Your heart beats close to 100,000 times per day, and excess weight increases that workload. As little as a 10 percent reduction in excess weight has been found to show improvements in blood pressure, cholesterol levels, and blood sugar control, all of which will decrease your risks of cardiovascular disease.

Where you carry your weight is also important. Excess weight carried in the abdominal region has been linked with a greater increased risk for cardiovascular disease as opposed to weight around the hips and thighs.

So how do you know if you’re overweight? BMI has been a somewhat controversial way of determining what your ideal weight should be, and it’s often better to look to body fat percentage instead. The American Council on Exercise provides the following ranges for body-fat percentage:

Women

  • Essential fat: 10-12%
  • Athletes: 14-20%
  • Fitness: 21-24%
  • Acceptable: 25-31%
  • Obese: 32% plus

Men

  • Essential fat: 2-4%
  • Athletes: 6-13%
  • Fitness: 14-17%
  • Acceptable: 18-25%
  • Obese: 26% plus

A combination of exercise and a healthy diet can help you reduce your weight and get back into a healthy range. Being overweight increases your risk of developing many of the other risk factors we discussed here, so it’s immensely important that you monitor and actively manage your weight to reduce many of these risks.

Conclusion

Assess your risk, know your numbers (e.g. cholesterol, blood pressure, weight), and form a plan to reduce as many of these risk factors as you can. By adopting healthy habits, working with your doctor, and making your health a priority, you can live a longer, healthier, and heart-disease-free life.

It’s been estimated that up to 80 percent of heart attacks and strokes could be prevented if Americans simply made changes to their lifestyles. Prevention rather than treatment is how we need to be thinking about heart disease as a culture moving forward.