The bad news about heart disease is that it remains extremely prevalent in our society. The good news is that the factors that determine our risk of developing heart disease are, to a large extent, under our control. We ourselves have a lot to say about whether we will develop early cardiac disease.
Our doctors are supposed to assess our risk for us, and coach us on what we should be doing to reduce that risk. But, despite pleas from medical experts and professional societies to the contrary, doctors are still generally bad at assessing their patients' risk of developing coronary artery disease, and are particularly terrible about spending the time needed to stress the importance of taking the appropriate steps to reduce that risk.
(Note well: Doing simple risk assessment is one of the most important basic jobs of the physician. The failure to do such risk assessment probably ought to be considered evidence that your doctor is doing sub-standard work. Many of the things doctors need to think about are complicated - this one isn't. DrRich, for one, wouldn't stick with a doc who isn't even doing the simple things right.)
Fortunately, the tools exist today for individuals to accurately assess their own risk of getting heart disease, without waiting for their doctors to initiate the action. And lots of information is available as to what to do about it if your risk is elevated.
To assess your own risk, here's what you need to know
You need to gather the following information:
- whether you smoke or not
- your total and HDL cholesterol levels
- your blood pressure
- whether you have evidence of diabetes or metabolic syndrome
- whether you are overweight for your age and height
- your family history
With this information, you can place yourself into one of three categories: low, intermediate, or high.
With this information, to be in the low risk category, all of the following must be present:
- nonsmoker
- total cholesterol < 200 mg/dL, HDL cholesterol > 40 mg/dL
- systolic BP < 120, diastolic BP < 80
- no evidence of diabetes
- not overweight
- no family history of premature vascular disease
You are in the high risk category if you have any of the following:
- known coronary artery disease or other vascular disease
- type 2 diabetes
- over age 65 with multiple (more than one) risk factors
And you are in the intermediate risk group if you don't fit into either the low or high risk groups.
Low risk patientscan be managed without any further intervention, except for routine coaching on maintaining a healthy lifestyle. About 35% of U.S. adults fall into this category.
High risk patientsshould immediately be placed on appropriate treatments proven to reduce the risk of heart attack and death, such as statin drugs, beta blockers, aspirin, and/or ACE inhibitors. About 25% of U.S. adults are in this category. Click here for more on what to do if you are in the high risk category.
Intermediate risk patients, in addition to taking steps to modify the risk factors keeping them out of the low risk category, should have non-invasive tests to measure whether or not they already have evidence of coronary artery disease, such as stress/thallium testing or electron beam tomography (EECP). Roughly 40% of U.S. adults are in the intermediate risk category.
Here are more resources on the cardiac risk factors, and what to do about them.
