Heart attacks risk factors

FIGURE 6-9. Decision algorithm for stroke prevention in atrial fibrillation.27 Risk factors for stroke prior transient ischemic attack or stroke hypertension heart failure rheumatic heart valve disease prosthetic heart valve. Target International Normalized Ratio = 2.5 (range 2 to 3). 

As noted above, obesity is a health problem. It is associated with both elevated mortality and morbidity. More specifically, obesity is a risk factor for cardiovascular disease, including heart attack and stroke, and for high blood pressure (hypertension), diabetes, and hyperlipidemia (elevated levels of lipids in the blood, a risk factor for atherosclerosis and its sequelae), and for cancer. 

It is well-established that an elevated level of cholesterol, particnlarly that carried largely in the form of LDLs, is an independent risk factor for the development of atherosclerosis and its sequelae, including coronary artery disease (leading to heart attacks), strokes, and peripheral arterial disease. 

A number of chronic conditions such as high blood pressure or diabetes bear certain similarities to snbstance use disorders. These illnesses prodnce a variety of physical symptoms that, if left untreated, can resnlt in significant medical complications and even death. Complications of uncontrolled diabetes inclnde blindness, kidney failure, neuropathies, and limb amputation. Similarly, inadeqnately controlled hypertension is a risk factor for stroke, heart attack, and other serions complications. Recognizing that these are diseases does not relieve the patient of responsibility indeed, the knowledge that one has snch an illness imposes significant responsibility. For example, knowing the likely ontcome of nncontrolled diabetes is hopefully an impetus for the diabetic to exercise, take medication, and... 

The risk factors for vascular dementia are essentially the same as those for stroke and heart attack. They include high blood pressure, heart disease, diabetes mellitus, sickle cell disease, obesity, smoking, alcohol use, depression, and high cholesterol levels. 

Although development and clinical expression of coronary heart disease (CHD) are determined by the interaction of numerous risk factors, lowering blood cholesterol is the major approach to prevention and suppression of heart disease, the number one cause of death in Western society. The risk of CHD is directly proportional to blood cholesterol levels (Fig. 23.1), and a lowering of cholesterol, specihcally LDL cholesterol, deceases the incidence of heart attacks. 

These potential benefits are balanced by a slightly increased risk of gallbladder disease, hypertension, myocardial infarction, cerebral infarction, and pulmonary embolism. The increased risk of stroke and heart attack associated with the pill is accentuated when compounded by other risk factors, including smoking, migraine headaches, and advancing age. Indeed, convincing data support an upper age limit of 35 years for oral contraceptive use by women who smoke. 

Assessing the effectiveness of a new drug candidate can be complex and often difficult. This is because some diseases or symptoms do not follow a predictable path. For example, acute conditions such as influenza or insomnia may resolve without intervention, while chronic conditions such as multiple sclerosis or arthritis follow a varying course of progression. Depending on age, treatment, and other risk factors, heart attacks and strokes may produce variable mortality rates. Additional difficulty is introduced by subjective evaluation, which can be influenced by the expectations of patients and physicians. Some of these issues can be addressed in controlled clinical trials. 

Antihypertensive Agents. Hypertension (high blood pressure) is a significant risk factor for cardiovascular diseases such as angina heart attacks, and strokes. /(-Adrenoceptor (adrenergic nervous system receptors of the /(-type) antagonists (/(-blockers), calcium channel blockers, angiotensinconverting enzyme (ACE) inhibitors, and potassium channel activators... 

Hence, it appears that hormone replacement can play a role in modifying certain risk factors associated with coronary heart disease in postmenopausal women, but the actual outcomes (heart attack, death) do not seem to be affected significantly by these hormonal interventions. Clearly, continued research in this area is needed to clarify if hormone replacement therapy can help decrease cardiac morbidity and mortality in certain postmenopausal women.60,121... 

Some 7 million Americans suffer from coronary heart disease (CHD). CHD is the number one killer of both men and women in the United States. Each year, more than 500,000 Americans die of heart attacks caused by CHD. Risk factors include the following ... 

I m one of the very lucky ones. I survived a heart attack and bypass surgery at age thirty-five in 1978 and a second bypass at age forty-one in 1984. In a very real way, I did have that crystal ball, but I just didn t know how to use it back then. My major risk factor was an elevated cholesterol level. I d known that for years before the heart attack, but in those days the issue of cholesterol and heart disease was controversial. Moreover, there weren t effective ways to get cholesterol down to healthy levels. 

This isn t a book about cholesterol, although I ll discuss it in one of the chapters. This book deals with another one of the Big Three risk factors for heart attack and stroke blood pressure. The third one, by the way, is cigarette smoking. Those three factors are responsible for the vast majority of heart attacks and strokes, although other factors, especially diabetes, come into play as well. 

Blood pressure is sort of like the weather. Everyone talks about it, but not enough people do anything about it. It s often called the silent killer because, for the most part, it has no symptoms. Headaches associated with blood pressure are relatively rare. We see hypertension mentioned over and over again as one of the main risk factors for heart attack and stroke. Every time we visit a doctor s office, we get our blood pressure tested. But the sad fact is that while literally millions of men and women have blood pressure levels that put them at risk, most of them don t get their numbers under control. 

Why the big deal What s the difference you might well ask. As I ll detail shortly, the risk of cardiovascular disease, heart attack, stroke, and death rises linearly with blood pressure. Anything more than 120/80 begins to increase the risk, especially when other risk factors are concurrently present, such as elevated cholesterol, cig-... 

Most men and women have had their blood pressure measured at one time or another. But, bearing in mind that without knowing it, many individuals have either pressure above optimal levels or frank hypertension, if you haven t had a test lately, call your doctor s office and schedule an appointment. While you re there, it would be a good idea to have your cholesterol levels checked as well. Elevated cholesterol counts are not only a major risk factor for heart attack and stroke, in and of themselves, but they also predispose a person to developing hypertension. 

Exercise can slash the ten-year risk of having a heart attack or a stroke by at least 25 percent in the average hypertensive patient, because of the effect on blood pressure and other cardiovascular risk factors. 

Only niacin offers benefits in regard to newly determined, independent risk factors for the development and progression of heart disease and the incidence of heart attacks and strokes. It lowers levels of a particularly nasty variant of LDL termed lipoprotein(a). The vitamin improves the balance of the hormonelike substances called prostaglandins, with the detrimental thromboxane falling and the protective prostacycline going up. Activity of blood platelets, cells involved in the clotting process, decrease, resulting in fewer clots that can lead to heart attacks. 

Next was a long-term study of workers at the Western Electric Company in Chicago, hinting that fish lovers enjoyed protection against heart disease. The risk of a fatal heart attack was slashed by a third just from this one lifestyle factor. A similar investigation that examined the habits of tens of thousands of male physicians revealed that those who ate fish at least once a week had half the risk of sudden cardiac death. 

When we talk about heart disease, we re really talking about a disease of the arteries that supply blood to the heart muscle. A heart attack occurs when the coronary arteries fail to get enough blood to that muscle and it begins to die from lack of oxygen. A stroke happens when the carotid arteries in the neck can t provide sufficient blood and oxygen to the brain, most typically when a clot forms in a narrowed carotid artery. In discussions of cholesterol, smoking, blood pressure, and other risk factors, we tend to forget the importance of the arteries themselves. 

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