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February 11, 2010

Understanding your risk factor profile for heart disease

In 1963, Congress designated February as “American Heart Month” to encourage prevention of cardiovascular disease, the leading cause of death in the United States.



As part of this effort, I find it valuable to engage my patients in a discussion of their risk factor profile for coronary artery disease, the most common and preventable form of heart disease. Coronary artery disease occurs when the arteries that feed the heart become narrowed or clogged by cholesterol and fat deposits — a process called atherosclerosis. Complications can include angina (chest pain) from the narrowed arteries and heart attack, if a coronary artery becomes completely blocked.


Even though it is more common later in life (for men after 45 and for women after 55), coronary artery disease can strike at any time. Major risk factors include smoking, diabetes, high blood pressure, high cholesterol, obesity and a sedentary lifestyle. It is also more likely if you have a family history of early heart disease (a father or brother diagnosed before 55; a mother or sister diagnosed before 65).


While age and family history are beyond our control, the good news is that we can target many risk factors based on each patient’s profile. For general guidance, the American Heart Association has created “My Life Check,” a seven-step plan to prevent heart disease: Get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar and stop smoking.


For people with normal risk factors, a healthy lifestyle is the best way to prevent heart disease:



  • Don’t smoke (or quit if you are a smoker).
  • Maintain an appropriate body weight based on your body mass index (BMI), a measure of body fat calculated from your height and weight. Calculate your BMI.
  • Observe a low-fat, high-fiber diet. Good choices are vegetables, fruits, whole-grain products and fat-free or low-fat dairy products. Try the National Institutes of Health’s Interactive Menu Planner.
  • Exercise for a minimum of 35 minutes, five times a week. I encourage my patients to try for 45 minutes of aerobic exercise, such as walking, jogging, swimming and biking, every day.


Patients with diabetes, high cholesterol and high blood pressure have a more complicated risk factor profile. To control these conditions, it may be necessary to take prescription medicines. But in some cases, great improvements can be achieved by lifestyle changes alone.


One of my patients, a 55-year-old male with a sedentary lifestyle and poor diet, was diagnosed with new onset diabetes and obesity, elevated cholesterol and hypertension. Prior to his multiple new diagnoses, he did not have significant risk factors for heart disease other than his age and gender. However, with these new conditions, his risk of developing heart disease during the next 10 years more than doubled.


After we discussed his increased risks, he made aggressive lifestyle changes. He lost significant weight, changed his diet, reversed his diabetes, normalized his blood pressure and lowered his cholesterol — clearly showing how effective diet and exercise are to heart health.


The Web sites of the American Heart Association and National Heart, Lung, and Blood Institute  have tools and resources that can help you understand your risk of heart disease. It is also a good idea to schedule an appointment with your primary-care provider to discuss heart health by age 35 (or earlier, if you have specific risk factors). In addition to reviewing your personal and family history, your provider will use this visit to check for blood pressure, cholesterol and diabetes.


Along with family and friends, a trusting relationship with your primary-care provider can provide support for making healthy lifestyle changes. As I get to know my patients, I gain an understanding of what motivates them and try to provide positive reinforcement to help them achieve our mutual goal of preventing heart disease.


David Camitta, M.D., is an internal medicine doctor at the UW Medicine Neighborhood Clinic in Belltown.