STRIKE BACK AGAINST HEART ATTACK: ARE YOU AT RISK?
The high-risk factors for heart disease include:
A family history of early coronary disease or of ischemic stroke (a father or brother who has had a heart attack or stroke before the age of 55, or a mother or sister who has suffered one before age 65.)
Age. Over 45 if you’re a man. Over 55 if you’re a woman. Also, women in premature menopause, such as those who’ve had a hysterectomy and aren’t taking estrogen.
Menopause in women. Before menopause, the hormone estrogen has a protective effect, keeping women at far lower risk than men. After menopause, however, and the decline in estrogen, their heart disease risk increases ten-fold. The fall in estrogen levels is thought to lower levels of “good” HDL cholesterol, while raising levels of LDL (“bad”) cholesterol.
Hypertension (high blood pressure). Uncontrolled hypertension (140/90 or greater) elevates heart disease risk by about 17 per cent.
High blood cholesterol. Apart from the cholesterol you get from animal foods, your liver manufactures its own. When blood levels are too high they can lead to fatty deposits (called “plaque”) which clog arteries and set the stage for heart disease and stroke. The estimated increase in risk is 11 per cent, according to the Centers for Diseases Control in Atlanta.
Cholesterol moves through your blood in protein-fat packages called lipoproteins. There are two kinds: HDL (or high-density lipoproteins), also known as the ‘good’ cholesterol because it appears to attach to excess cholesterol and escort it out of the arteries; and LDL (low-density lipoproteins), also called the ‘bad cholesterol’, which travels in the bloodstream en route from the liver and can settle in artery walls.
“Total cholesterol” is a combination of HDL and LDL, but
when it’s high it’s unfortunately most likely to be due to an excess
of the ‘bad’ cholesterol. The “good guy” HDLs are usually out-
numbered by the “bad guy” LDLs.
The safe limits of “total cholesterol” are Desirable: Under 200 Borderline : 200 to 239 High : 240 and over
Studies show that heart-attack risk begins to rise steadily once the total cholesterol level exceeds 200 milligrams per deciliter (mg/dl). The risk rises by about 2 per cent for every 1 per cent increase in blood cholesterol.
If you already suffer from heart disease, your total cholesterol should be below 160.
High LDL cholesterol or low HDL cholesterol. A total-cholesterol reading does not, in itself, provide enough information to determine whether you are at risk.
Heart attack risk begins to rise if your LDL level is too high (over 160 mg/dl), or if LDL is above 130 mg/ml and you also have any two of these other risk factors: being male or obese, smoking, or having diabetes, high blood pressure, vascular (blood vessel) disease, or a family history of heart disease before age 55.
HDL level has also emerged as an important determinant of heart-disease risk. Several studies have suggested that a very low level of HDL (below 35mg/dl) puts you at increased risk even if your total cholesterol is in the safety zone.
The type of LDL particles. Newer research has found that
it’s not just the load of LDL cholesterol in your system that points to your risk, but also the type of LDL particles — their size and their density.
This can be a matter of genetics — you can be born with a tendency to LDL particles that are teensy and dense. Or your LDL particles can metamorphose into this type with poor lifestyle habits — too little exercise rich and hearty eating, too much stomach fat.
Whatever its origin, this LDL pattern is known as pattern B, and it triples your risk of developing clogged arteries — even if you have good HDL and LDL totals.
A high level of triglycerides. Derived directly from foods, triglycerides are a type of fat produced by the liver for use as energy. Whether elevated levels of triglycerides constitute a risk factor for everyone remains in dispute; however, there is widespread medical consensus that they appear to put at least women and diabetics at higher risk for heart disease. More and more doctors believe they constitute a risk for men, too.
The desirable level for triglycerides is pegged at below 200 mg/dl; lower than that is even better, particularly if your HDL level is low, or if your LDL falls into the dreaded B pattern.
Your level of homocysteine. This is a chemical produced by your body and in recent years it has emerged as one of the prime suspects in heart disease. Homocysteine is an amino-acid that rushes into your bloodstream after you’ve eaten a meal rich in animal protein. Its dirty-tricks specialty appears to be to trigger off damage in the lining of one of the heart’s arteries. As your immune system rushes to repair the injury, plaque is deposited on the arterial wall, setting the first stage for heart disease.
Levels of homocysteine (which can be measured in a blood test) should not exceed 14. Those with low intake of three B vitamins — B6, B12 and folic acid — have been found to be prone to high homocysteine levels.
Diabetes or certain chronic diseases such as vascular disease.
Smoking. Tobacco, once linked primarily to lung cancer, is now known to generate more heart disease than cancer. It raises the risk of heart disease by 25 per cent.
Steady exposure to second-hand smoke. Virtually every health organization in the U.S., from the National Academy of Sciences to the American Medical Association, has concluded that second-hand smoke is responsible for the deaths of tens of thousands of non-smokers each year, mostly from heart disease.
Severe obesity. Heavier people tend to have higher LDL levels. Excess weight raises heart disease risk by 22 per cent. Every two pounds of excess weight is associated with an increase of 1 mg/dl of total cholesterol.
A sedentary lifestyle. The perils of sitting are still underestimated, though studies have shown that sedentary living ups the risk of heart disease by 65 per cent and is the primary modifiable hazard leading to fatal heart attacks.
Except for those with extremely high cholesterol — above 240 mg/dl — it is sedentary living, not blood cholesterol, that is the greater risk factor for heart disease. Surprised? You’d better believe it.
If a heart attack does occur, sedentary people are about twice as likely to die from it as people who are physically active. By sedentary, researchers mean people who either do no purposeful physical activity or who exercise irregularly — less than three times a week or less than 20 minutes at a time, or both.
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