Risk Factors for Heart Trouble: Where Do They End?
Male pattern baldness and homocysteine . . . cholesterol and alcohol . . . genetics and gender . . . stress and C-reactive protein? Hardly a week goes by without some news about heart health. It seems that science keeps discovering ways by which men and women can increase or decrease their odds in cardiac roulette.
While you can't change your ancestors, age, or maleness, you can lower your blood pressure and cholesterol levels and avoid tobacco. These three potent risk factors accelerate dangerous plaque buildup in the blood vessels that can lead to coronary artery disease and heart attack .
Family history of early death related to heart attack or early manifestations of blockages in relatively young people (younger than 55) should serve as important warnings for checking your own profile and making appropriate lifestyle changes that will minimize the development of blockages, says Dr. George Sopko of the National Heart, Lung, and Blood Institute (NHLBI).
Along with the three traditional risk factors listed above, researchers continue to find other factors related to the development of heart disease. For example, Mondays, winter, living in the South, and hair loss may put you at a higher general risk for a heart attack and increases in blood pressure. On the other hand, pets, moderate alcohol consumption and dietary fiber can give you an edge against America's number one killer. Here are some details.
A variety of infections, including gum disease and a common respiratory bug, can cause artery inflammation and plaque buildup. Researchers continues to investigate whether antibiotics can help. There's quite a bit of interesting research focusing particularly on the role of infections (bacterial or viral) in facilitating development of blockages, Dr. Sopko says.
Is Baldness Bad?
Researchers at Harvard recently found that men with severe baldness on the top of their heads experienced more coronary artery disease than their hirsute peers, especially those already at risk due to high blood pressure or cholesterol. These men also had more male hormone receptors in the scalp and higher testosterone levels. Testosterone has been known to speed plaque buildup and clot formation, and it may play a role in raising blood pressure and cholesterol levels.
While baldness falls into the "can't change" category, Harvard researcher Dr. JoAnn Manson says it serves as a marker for increased vigilance in reducing modifiable risks. And remember, this study shows possible associations rather than cause and effect.
Folate, Vitamins, and Homocysteine
Medical professionals consider high levels of homocysteine—an amino acid byproduct of animal protein metabolism—a risk factor for heart disease and stroke. High levels of homocysteine may cause some damage to the cells that line the inner vessel wall, according to Dr. Sonia Skarlatos at the the NHLBI. "We know injury to the vessel wall may be one of the mechanisms to increase atherosclerosis."
People with low levels of folic acid, vitamin B6, or vitamin B12 are prone to homocysteine elevations. An Ohio State University study showed mild psychological stress can increase homocysteine levels, which may be one reason stress contributes to heart disease.
Caring for a pet helps to keep blood pressure down if you're under stress and lowers cardiac risks, according to researchers at the State University of New York at Buffalo.
"Companions, such as a dog, can eliminate some stress and have a beneficial effect," Dr. Sopko says. "Stress is like an amplifier. It may not be the risk factor that puts you over the edge, but it can modify in a negative way all the other risk factors. If you have high blood pressure, the addition of stress will make it worse."
Pets make great listeners and give unconditional love. Plus, if you have a dog, going for a walk provides great fun for them and good exercise for you. Even low-intensity exercise, such as brisk dog walking, helps.
Exercise Is Essential
The American Heart Association attributes approximately 12% of cardiovascular deaths to lack of regular exercise. Inactivity increases your cardiac risk about as much as smoking, high blood pressure, or high cholesterol.
Regular exercise helps:
- Lower blood pressure
- Raise protective HDL cholesterol
- Manage stress
- Control weight
- Improve metabolism of carbohydrates
"I recommend that my patients start with something that is doable," Dr. Sopko says. "Focus first on developing a pattern, so it becomes part of the daily routine. Start with 10 or 15 minutes and, when it becomes part of your routine, build it up to 30 minutes."
Closing in on Cholesterol
Keep your total cholesterol down by eating plenty of fruits and vegetables. Many are rich in vitamins, antioxidants, and fiber, which combat natural destructive processes in the body.
Decreasing LDL, or "bad" cholesterol, lowers heart-disease risk. Doctors have long advocated that patients switch from red to white meats to help facilitate this shift. Red meats contain more cholesterol and saturated fats than fish or poultry, and saturated fats are known to increase LDL levels. But Johns Hopkins researchers reported last year in the Archives of Internal Medicine that lean red meats were just as effective at lowering cholesterol.
Dr. J.W. Anderson at the University of Kentucky in Lexington touts the cholesterol-lowering properties of psyllium, a soluble fiber preparation often prescribed for constipation. His research has shown the soluble fiber can lower cholesterol, and he predicts that regular psyllium intake could lower heart attack risk approximately 20%.
Alcohol: a Mixed Blessing
While drinking one or two glasses a day may cut your risk of heart disease by 30%, too much alcohol can raise blood pressure and certain types of fats circulating in the blood, subsequently increasing your risk. Drinking also can damage the liver and other organs. Scientists attribute the protective properties of alcohol to its ability to raise HDL, or "good" cholesterol.
As you head for the refrigerator, though, consider a recent University of California, Davis finding that grape-based nonalcoholic beverages include the same antioxidants as red wine and work just as effectively at lowering cardiac risk. Perhaps you'd rather choose grape juice?
Dr. Sopko recommends discussing cardiac risks with your doctor, then setting short- and long-term goals. He adds, "An appropriate diet that is low in fat and high in fiber, an appropriate level of exercise, and smoking cessation are general recommendations to which I think everyone should adhere."
American Heart Association
National Heart, Lung, and Blood Institute
National Institutes of Health
Grubben MJ, Boers GH, Blom HJ, et al. Unfiltered coffee increases plasma homocysteine concentrations in healthy volunteers: a randomized trial. Am J Clin Nutr . 2000;71:480-484.
Lotufo PA, Chae CU, Ajani UA, Hennekins CH, Manson JE. Male pattern baldness and coronary heart disease. Arch Intern Med . 2000;160(2):165-171.
Heart attack warning signs. American Heart Association website. Available at: http://www.americanheart.org .
Cardiovascular information. National Heart, Lung, And Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/public/heart/index.htm .
New studies show death rates significantly lower when major risk factors for cardiovascular disease and coronary heart disease are absent. National Heart, Lung, And Blood Institute website. Available at: http://www.nhlbi.nih.gov/new/press/nov30_99.htm .
Ridker PM. Evaluating novel cardiovascular risk factors: can we better predict heart attacks? Ann Intern Med. 1999;130:933-937.
Rimm EB, Giovannucci EL, Willett WC, et al. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet. 1991;338:464.
Last reviewed February 2007 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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