While it is important that your doctor take the appropriate actions to make sure you are not at imminent risk, and to guide you to appropriate risk factor modification, the real responsibility rests with you. Successfully reducing your risk is something that happens only with your dedication, and it's not easy. Doing what needs to be done often involves fundamental changes in both attitude and lifestyle of the sort that many people seem unable to accomplish.
The degree of effort required is akin to the effort the U.S. made to develop an atomic bomb during WWII. It was something that seemed to be barely possible, yet if we did not do it, the risk was high that either the Germans or the Japanese would beat us to the punch. So, against all the odds, we marshaled the resources and did it. And it's a good thing we did.
This is exactly the kind of effort you need to make. Against the odds, you need to change your life. If you don't, you will suffer the consequences -- possibly decades earlier than is necessary.
That the vast majority of patients who are in the high risk category end up making only half-hearted efforts to modify their risk may be related to the failure of primary care docs and cardiologists to stress the utter life-and-death importance of changing their lifestyles, to their use of "you really should" instead of "you must, or your children will be orphans."
Is there any group of doctors who have succeeded in getting their patients to stop whatever they're doing, to suddenly focus every ounce of energy on regaining their health? Yes. The oncologists. Patients who are told they have cancer often put everything else on hold and steel themselves to doing whatever is necessary (whether surgery, radiation, or chemotherapy, often painful, and often lasting for months or years) to attempt a cure. This is the same attitude that patients ought to adopt when are told they are at high risk for heart attack, sudden death, or stroke. After all, being told you are at high risk for a cardiac event is not all that much different than being told you have cancer. Heart disease is often no less fatal, and the outcome no less dependent on your attitude and your active participation in doing what's necessary. If anything, you have a much better chance of favorably altering the ultimate outcome than the average patient with cancer.
In general, the high-risk patients who are most successful are the ones who adopt a "change it all now" attitude - the ones who accept that a complete change in lifestyle is needed. They'll stop smoking, adopt an exercise program, and change their diet all at once. And they do it by making risk factor modification the central organizing theme of their lives. One day they're a high-risk-lifestyle kind of person, and the next day they're not. They take on all the modifiable risk factors at once -- it becomes the chief focus of their lives until the new lifestyle is an ingrained habit (and they are a different person). It sounds tough, and it is. But it's a matter of life and death -- and it can be done. I have seen seen several of these patients achieve remarkable success.
The sort of lifestyle changes that are necessary to reduce the high risk essentially amount to a complete transformation of attitude, something like the transformation of attitude Americans experienced at about 9 AM on 9/11/01. America became a different kind of country. These patients must become a different kind of person.
The more gradual approach to lifestyle changes, while seeming quite reasonable on its face, often does not work. If diet and exercise are postponed until smoking is stopped, for instance, think about what that means. You essentially will be living the same kind of life you always did, except you're trying to stop smoking. Somehow the smoking never really stops, and the diet and exercise never get addressed at all, and pretty soon a year or two or five go by -- and then it's too late.
While there's no a priori reason the gradual approach can't work, in practice "gradualism" often reflects a constitutional failure to accept the deep-rooted changes that are really necessary. Gradualism, in other words, is often an indication that a patient lacks the sort of battle-ready attitude that is necessary to achieve the desired end.
Which Risk Factors Need To Be Modified?
All the risk factors are important, and it is important to improve all the modifiable risk factors that count against you. Here is information on what those modifiable risk factors are, and what you can do to improve them:Sources:
Smith, SC Jr, Allen, J, Blair, SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006; 47:2130.
