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Risk Factors for Heart Disease

by Rashmi Gulati, MD

It has been estimated that every 34 seconds someone dies of heart disease in the United States—a calculation based on available figures for the year 2007. In 2008, according to the National Health Interview Survey, 26.6 million adults (18 years or older) not in hospital had diagnosed heart disease—approximately 12% of the US population. Heart disease has taken on epidemic proportions in the modern world. It is the leading cause of death in the US, and the second leading cause worldwide. If undetected and untreated, heart disease will cause death.

There are several known significant risk factors for heart disease. These include factors over which we have little control, such as age, genetics, and family history; factors related to lifestyle and dietary choices; and factors in our environment, such as exposure to air pollution. Fortunately, there is much we can do to reduce our risk for heart disease.

Blood cholesterol levels are one indicator of the potential to develop heart disease. Diet and levels of physical activity have direct effects on blood cholesterol levels. Poor diet and a lack of physical exercise contribute to high cholesterol and thus to risk of heart disease, but high cholesterol can also be traced to genetic factors in some people. Cholesterol is a waxy substance carried in the bloodstream by lipoprotein "packets" that are described as either high-density lipoproteins (HDL), or low-density lipoproteins (LDL). Low-density cholesterol is thought of as "sticky" cholesterol and in excess can accumulate in blood vessels as plaques. Elevated LDL levels in a cholesterol screening are a risk factor for heart disease. High-density cholesterol, however, helps to remove LDL plaques, transferring LDL to the liver to be expelled in bile.

Another component found in the blood, known as C-reactive protein, is a marker for elevated risk of heart disease. C-reactive protein is a protein found in the blood that increases dramatically in response to inflammatory processes in the body. Many, if not most of the risk factors of heart disease are associated with, or give rise to increased inflammation. An example of this can be found in the link between periodontal disease and heart disease.

High blood pressure (hypertension) is another risk factor for heart disease. High blood pressure can result from leaky valves and heart failure that develop in response to the increased effort the heart must make to pump blood, and vasoconstricting factors that systemically constrict blood vessels in response to poor blood flow.

Smoking contributes to both high cholesterol levels and hypertension, increasing the risk of developing heart disease. Tobacco use is shown to increase levels of blood-clotting factors, promote atherosclerosis, and raise blood pressure. Carbon monoxide from tobacco smoke displaces oxygen in the blood, limiting the oxygen reaching the body's tissues. Second-hand smoke increases the risk of developing heart disease for nonsmokers, by as much as 25% to 30%. Even short-term exposure to secondhand smoke can damage the lining of blood vessels and decrease blood flow to the heart by rendering blood platelets "stickier" and more likely to adhere to vessel walls.

Diabetes mellitus is a condition that results from insulin resistance, resulting in insufficient insulin production, inefficient use of insulin, or a combination of both problems. Sugar metabolism is dysfunctional in diabetes mellitus, which can result in several serious conditions, including heart or vascular disease. Managing and controlling one's diabetes is a step toward managing the risk factors of heart disease.

Obesity is another significant risk factor for heart disease. Being overweight or obese means a person's mass is out of proportion relative to their height. "Body mass index" (BMI), a measure used to denote this proportion, correlates a person's height with the amount of fat they carry on their body. It is not a direct measure of fat, as total body weight including fat, muscle, and bone, is used to calculate BMI. For a given height, a BMI value of 25 to 29.9 indicates an overweight individual; a BMI value over 30 indicates obesity. Excess fat contributes to elevated LDL levels, lower HDL levels, high blood pressure and diabetes, all risk factors for heart disease.

Age is likewise a risk factor for heart disease. As men and women age, the risk for atherosclerosis increases from either genetics and a family history of heart problems, or from lifestyle decisions, dietary choices, smoking, or levels of activity. In men the risk of developing coronary arterial disease begins to increase after age 45, in women after age 55. Although age and a family history of heart disease are both risk factors, they do by no means guarantee the individual will develop heart disease. Healthy diet and lifestyle choices are powerful tools that may lessen genetic effects and keep one healthy and disease-free.

In most cases, heart disease is undetectable in the beginning stages due to a lack of symptoms. When it goes undetected it goes untreated, leading to increased risks and severe symptoms such as sudden and severe chest pains, irregular heartbeat, shortness of breath, nausea, weakness, and other symptoms. Gradually heart disease will affect other organs. It may disrupt the proper functioning of the lungs, liver, and kidneys. Eventually it can lead to total organ failure, and ultimately to a sudden, premature death.

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Our first job at Patients Medical is to listen, to connect the dots between a patient's medical history, their symptoms, and the underlying causes of their cardiovascular concerns. Patients Medical is a superb place for men and women to secure integrative and holistic cardiology health care from providers who provide personalized care, partnering with the patient to support their health.

For those that can make the journey, we are happy to welcome new patients to our medical center in New York City. Call us at 1-212-661-4441. We are here to listen and to help.

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