Assessing Risk of Developing Heart Artery Disease

• Major risk factors
• Are additional tests helpful as a checkup if one has not had a heart attack or angina?
• CT calcium scores- can be helpful as part of a routine checkup.
• Questions that can arise after a family member has an unexpected heart attack.
• Heart artery disease in families

Risk Factors For Heart Artery Disease

A number of factors have been consistently identified to increase the risk of heart artery disease and are the targets for modification to reduce the risk of developing heart artery disease, and also to reduce the risk of future problems in those that have already had a heart attack or have had angina.

The following are regarded as the major risk factors

• high blood pressure
• diabetes
• abnormal cholesterol levels
• smoking
• family history of heart artery problems occurring early in more than one first degree relative. The definition of early disease does vary. Heart attack or angina occurring before the age of 45 years in men and before the age of 55 years in women is can be definitely regarded as early disease.

Being overweight contributes to the development of heart artery problems by:

• increasing blood pressure
• increasing the chances of development of type II diabetes
• increasing the chances of development of a pre-diabetic status
• contributing the development of abnormal cholesterol levels, such as:
  • high levels of bad (LDL) cholesterol
  • low levels of the (HDL) cholesterol
  • high levels of fat (triglycerides)

Being overweight not only are refers to an excess weight for a person's height, but can also refer to excessive amount of weight within the abdomen, termed abdominal obesity. Abdominal obesity is also harmful to future health.

Target levels for those that have had a heart attack or have angina

• blood pressure below 130/85, a lower target is set for those with diabetes
• excellent control of diabetes
• complete smoking cessation
• optimal cholesterol levels
  • LDL (bad) cholesterol levels below 2.5 mmol/l
    there is evidence that we do obtain additional benefit from lowering LDL cholesterol below 1.8 mmol/l.
    A lower target is set for those that have had heart bypass surgery.
  • HDL (good) cholesterol levels above 1.0 mmol/l (for men) and above 1.1 mmol/l (for women)
  • Triglyceride (fat) levels below 1.5 mmol/l
  • Cholesterol and fat levels are improved by weight loss, eating a low fat diet, and with the aid of medication.

Target levels for those that do not have evidence of heart artery disease

• The NZ Guidelines would recommend all persons attempt to maintain a healthy lifestyle. This includes maintain a healthy weight, regular exercise, a healthy diet, and not smoking.
• The risk of heart artery problems in the subsequent five years is lower in younger persons. Moderate elevation of cholesterol and blood pressure, although not ideal, do not require treatment with drugs. Some persons may not find these recommendations easy to accept and might request additional tests.

Other factors that have also been identified to either reduce or increase the risk of heart artery disease include:

• a diet that contains fruit and vegetables reduces the risk
• exercise reduces the risk
• stress increases the risk

Those with multiple risk factors are at higher risk of future problems, but conversely, we might also see this as an opportunity to make more changes to reduce the future risk.

Healthy living guidelines from The National Heart Foundation of New Zealand.

Hitesh Patel, Cardiologist
April, 2007