Heart Attack (cont.)
What are the risk factors for atherosclerosis and heart attack? Factors that increase the risk of developing atherosclerosis and
heart attacks include increased blood cholesterol, high blood pressure, use
of tobacco, diabetes mellitus, male gender, and a family history of coronary
heart disease. While family history and male gender are genetically determined,
the other risk factors can be modified through changes in lifestyle and
medications.
- High Blood Cholesterol (Hyperlipidemia). A
high level of cholesterol in
the blood is associated with an increased risk of heart attack because
cholesterol is the major component of the plaques deposited in arterial walls.
Cholesterol, like oil, cannot dissolve in the blood unless it is combined with
special proteins called lipoproteins. (Without combining with lipoproteins,
cholesterol in the blood would turn into a solid substance.)
The cholesterol in
blood is either combined with lipoproteins as very low-density lipoproteins
(VLDL), low-density lipoproteins (LDL) or high-density lipoproteins (HDL).
The
cholesterol that is combined with low-density lipoproteins (LDL cholesterol) is
the "bad" cholesterol that deposits cholesterol in arterial plaques. Thus,
elevated levels of LDL cholesterol are associated with an increased risk of
heart attack.
The cholesterol that is combined with HDL (HDL cholesterol) is the
"good" cholesterol that removes cholesterol from arterial plaques. Thus, low
levels of HDL cholesterol are associated with an increased risk of heart
attacks.
Measures that lower LDL cholesterol and/or increase HDL cholesterol
(losing excess weight, diets low in saturated fats, regular exercise, and
medications) have been shown to lower the risk of heart attack. One important
class of medications for treating elevated cholesterol levels (the statins) have actions
in addition to lowering LDL cholesterol which also protect against heart
attack. Most patients at "high risk" for a heart attack should be on a
statin no matter what the levels of their cholesterol.
- High Blood Pressure (Hypertension).
High blood pressure is a
risk factor for developing atherosclerosis and heart attack. Both high
systolic pressure (when the heart beats) and high diastolic pressure (when
the heart is at rest) increase the risk of heart attack. It has been shown
that controlling hypertension with medications can reduce the risk of heart
attack.
- Tobacco Use (Smoking). Tobacco and
tobacco smoke contain
chemicals that cause damage to blood vessel walls, accelerate the
development of atherosclerosis, and increase the risk of heart attack.
- Diabetes (Diabetes Mellitus). Both insulin dependent and
non-insulin dependent diabetes mellitus
(type 1 and 2, respectively) are associated with accelerated atherosclerosis
throughout the body. Therefore, patients with diabetes mellitus are at risk
for reduced blood flow to the legs, coronary heart disease, erectile
dysfunction, and strokes at an earlier age than non-diabetic subjects.
Patients with diabetes can lower their risk through rigorous control of
their blood sugar levels,
regular exercise, weight
control, and proper
diets.
- Male Gender. At all ages,
men are more likely than women to develop atherosclerosis and coronary heart
disease. Some scientists believe that this difference is partly due to the
higher blood levels of HDL cholesterol in women than in men. However, this
gender difference narrows as men and women grow older.
- Family History of Heart Disease. Individuals with a family history of
coronary heart diseases have an increased risk of heart attack. Specifically,
the risk is higher if there is a family history of early coronary heart disease,
including a heart attack or sudden death before age 55 in the father or other
first-degree male relative, or before age 65 in the mother or other female
first-degree female relative.
Next: How is a heart attack diagnosed? »
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