Risk factors for heart disease can be divided into those you may have some control over and those you do not (see below right). The two sets interlink. For example, if you have a family history of heart disease, it is even more advisable to do something about those things you can control. Moreover, risks do not just add up as in 2 + 2 + 2 = 6; rather they multiply as in 2 x 2 x 2 = 8. Depressing? Not necessarily. It means that reducing smoking or cholesterol intake has an even greater benefit than you might think.
Your heart must last a lifetime
Smoking and poor nutrition during pregnancy increase the chances of having a low birthweight baby. It would appear that such children have an increased risk of heart disease as adults. Although the link is as yet controversial and unexplained, it is sensible not to smoke during pregnancy and to eat a properly balanced diet right the way through from conception to birth.
Evidence suggests that obese and overfed children grow into overweight adults who are more at risk of heart disease than slimmer people. Set a pattern of sensible eating habits and regular, healthy meals from an early age. It is also important to encourage your children to get plenty of exercise and play sports.
Continue the habits of eating healthily and taking exercise. Check your cholesterol and blood pressure from time to time to make sure that levels are as they should be. Do not smoke.
Old age Now is the time to pay more attention to your blood pressure and to concern yourself less about cholesterol. An active life promotes good health. Diabetes is an important risk factor for heart trouble and if it is present it should be carefully controlled.
Early recognition of heart trouble
You do not want your first symptom of heart trouble to be a heart attack. Rather, you should take note of the early warning symptoms.
High cholesterol may cause changes in the eye area of some people. You may notice a white ring around the iris (the coloured part) oi the eye – the medical name for this is an arcus senilis. This is normal in people over the age of 60, but if you are younger it is advisable to have a cholesterol check. Another warning sign is yellow plaques on the skin beneath the lower eyelids – the medical term is xanthelasma.
Risk Factors For Heart Disease
These can be divided into those you may have some control over and those you do not:
- Being male
- Adverse family history 4k
- Age (risk increases with age)
- Congenital heart disease
- Infections such as rheumatic fever or diptheria
- High cholesterol
- High blood pressure
- Lack of exercise
Miscellaneous factors linked with Heart Disease
These are factors where research suggests a link to heart disease, but the weight to be attached to these is debatable:
- Alcohol — drinking 2 or 3 units a day (a couple oj glasses of wine)
- Hard water, high in calcium salts
- Warm climate
- Higher socio-economic class
- Vegetarian and vegan diets – people following these diets probably benefit from an improvement in their harmful /beneficial blood-fat ratio
- Fruit and vegetables – these appear protective thanks to vitamin E and other antioxidants
- Other trace minerals may he relevant, for example selenium – an area of vigorous current research
- Taking hut after the menopause
- Stress — people who make their own stress and are hard- driven appear at greater risk
- The cold — unaccustomed exertion in cold weather is risky, for example shovelling snow
- Salt intake is probably significant. Do not add salt to food
Chest pain on exertion This is angina, the classic warning sign of heart trouble. It indictaes that the coronary arteries cannot deliver an adequate blood supply to the heart muscle when under exertion. Not all ehest discomfort is from angina by any means, but it is the most important possibility to exclude. Get it checked by your doctor.
Modern technology allows the clinical impression of heart disease to be objectively proven. The basic tests arc harmless and straightforward: first, an exercise F.CC, an electrical recording of the heart while running or walking briskly on a treadmill. This shows whether there is a blood flow problem even in people whose resting f.cg is normal, and detects about 75% of such cases. If there is still doubt, you might have a radioactive scan of the heart. If that is normal, it is highly unlikely that you have significant heart disease.
Another important investigation is an echocardiogram, to show the valves of the heart beating and to give an idea of how efficiently the heart is working.
A number of people can be diagnosed only by coronary artery angiography, where a dye is injected into the circulation around the heart to check for narrowing of the coronary arteries. ‘JTiis carries a one in 2500-5000 risk of death, so it is used only in order to plan surgery or, rarely, to exclude heart disease in someone getting pains suggestive of heart disease but where all other investigations are normal.
Breathlessness A heart with a poor blood supply will be inefficient at pumping blood, and breathlessness may be a consequence. Again, there are many more innocent reasons possible, so do get a medical opinion.
Never has there been such a wide range of treatment for heart trouble and it should be possible to find something that suits you. Medieal treatment is the preferred option, pending exact diagnosis of the state of blood flow in the heart. It may be as simple as taking an aspirin every day. This reduces the tendency of the blood to clot and thereby lessens the risks of a heart attack. It has side effects, especially bleeding from the stomach, so cannot be recommended to everyone, but for those who either have angina or have had a heart attack it
This means opening up coronary arteries narrowed by atherosclerosis. It is an important alternative to coronary artery surgery. A thin tube is guided to the heart from the large femoral artery in the groin. Once it reaches its destination, instruments are inserted through the tube to clear the blockage.
Coronary artery surgery
This involves replacing diseased arteries with a vein graft from the leg or from the chest. It is highly effective and can be repeated if the grafts block up, which happens in 5-10% of people each year.
This amazing technology has, in 35 years, moved from experiment to routine, h is reserved for people who have no other hope of survival and who are otherwise healthy. There is now the very real prospect of an artificial heart that can be inserted more easily than those currently available, or even of using hearts taken from specially bred pigs. Such developments would transform the prospects for people with heart failure which is treatable by no other means.
Treatment of a heart attack
If you experience a sudden constant central chest pain and breathlessness, assume you have a heart attack until proven otherwise. Early treatment greatly improves the outlook, so ring for an ambulance. Take an aspirin immediately, as this reduces the size of the clot forming in the heart.
Once in hospital, you will be given an injection of a clot-busting drug such as streptokinase, unless you are one of the small number who should not have it, for example if you have had recent surgery or a history of abnormal bleeding, especially from the gastrointestinal tract.
For at least six months after recovery you should take a beta-blocking drug such as atenolol to prevent abnormal heart rhythms. You will probably have to take an ACL inhibitor such as ramipril to reduce the chances of subsequent heart failure. These modem measures have lowered the risk of death from a heart attack by some 40%.