For many, a heart attack or sudden cardiac death is the first manifestation
of their heart disease. One of the reasons for this is that they never develop
any warning symptoms.
Even a small build up of plaque in
the arteries – which typically does not produce any symptoms – can rupture and
cause a heart attack. This is very concerning, particularly considering all the
people that have symptoms and ignore them, or those with known risk factors that
never present to their doctor.
This is why it is very important to
understand the risk factors for heart disease.
While some risk factors are not
“modifiable” – such as family history and age, there are many other common ones
that can be controlled through the combination of lifestyle changes and
medications. About 90 per cent of all patients with heart disease have at least
one of the common modifiable risk factors, including high blood pressure,
diabetes, high cholesterol and cigarette smoking.
For people with such risk factors,
or a strong family history of heart trouble, it is even more important to be
vigilant and try to prevent problems before they start.
Dr. Mikhail Kosiborod is a visiting
cardiologist at the Heart Health Centre. He describes heart disease as being a
combination of “nature and nurture”. In other words, patients typically acquire
heart problems both through genetic predisposition and unhealthy lifestyle
How should you go about
understanding your risks?
Kosiborod says that different tests
are appropriate for different people. For patients that do not have a history
of prior heart disease, screening for risk factors (such as diabetes, elevated
blood pressure and cholesterol) are useful. If these conditions are discovered,
controlling the risk factors is very important.
In addition, recent findings from
clinical studies suggest that inflammation is important in atherosclerosis, the
process in which fatty deposits build up in the inner lining of the arteries. A
blood test called high-sensitivity C-reactive protein can evaluate the level of
inflammation, and can provide additional information in the assessment of one’s
Kosiborod points out an interesting fact about inflammation.
“Even people who have seemingly normal cholesterol levels can have increased
level of hsCRP, and this inflammation can contribute to higher risk of heart disease.”
Yet another predictor is calcium
deposits, which can show up on a special CAT scan and can identify
atherosclerotic plaques that are too small to be causing symptoms (but can
still put one at risk for future heart problems).
However, these tests are most
appropriate for people who might be concerned about their risk factors, but
have not yet experienced any symptoms.
What if you have symptoms?
Kosiborod says that a different set
of tests would be useful for this group.
“A stress test, for instance, is
most useful for patients who have known heart problems, or symptoms suggestive
of heart disease. These symptoms may include chest discomfort, shortness of
breath or excessive fatigue. In addition, ultrasound of the heart
(echocardiogram) can also be used to evaluate heart function, heart valves and
pressures inside the heart”.
The stress test examines whether
patient’s symptoms of chest discomfort or shortness of breath can be due to a
significant build up of plaque in the heart arteries. “Different types of
stress tests are appropriate for different patients,” Kosiborod says. While in
some patients a simple treadmill test is sufficient, others may need to have
more sophisticated tests, using either nuclear or ultrasound (echocardiography)
imaging. If the stress test shows a significant abnormality, more invasive
assessment may be necessary.
If you do have heart disease, or
significant risk factors, a combination of lifestyle modifications and
medications can help prevent further problems. Dietary changes – cutting down on salt, animal fat, cholesterol
and calories, loosing weight, increasing physical activity, and quitting
cigarettes are of outmost importance. In addition, medications may be necessary
to help lower blood pressure and cholesterol.
The bottom line, says Kosiborod, in
reducing your risk of heart disease is to “know, understand and control your
risk factors, have regular health assessments, live a healthy lifestyle, and
seek medical attention right away of you have any warning symptoms”.