The prevalence of atherosclerosis and coronary artery disease has stimulated a great deal of research related to risk factors and prevention. The goals of these studies are to identify the risk factors associated with coronary artery disease and effective preventive measures. These days there is no shortage of books and well-known celebrities advocating certain diet and lifestyle modifications to reduce the risk of heart disease. In addition there are a variety of prescription and nonprescription agents being sold. While some advice may be beneficial, it is difficult for both the lay public and health professionals to determine if some of these other interventions are really helpful.
A note about the term risk factor. It is important to clarify what is meant by the term risk factor. If something is a risk factor for a particular disease, it doesn't mean that it causes the disease; it just means that there is an association between the presence of the risk factor and the disease. Furthermore, different risk factors have different degrees of significance.
Frequently Asked Questions
What are the risk factors associated with coronary artery disease?
The common risk factors include:
- high cholesterol
- family history of coronary artery disease
- male sex
- smoking
- high blood pressure (hypertension)
- obesity
- sedentary lifestyle
- diabetes
- kidney failure
What happens if I have smoked for many years but now have stopped?
The risk factor from smoking decreases but is still likely to be higher than for someone who has never smoked.
Is smoking pipes and cigars a risk factor?
Pipes and cigars are probably intermediate risk factors between cigarettes and no smoking. The bottom line is don't smoke.
How does family history contribute to coronary artery disease?
Certain inherited traits can increase the risk of coronary artery disease. Families with high levels of cholesterol in their blood may be the result of an inherited genetic defect related to the metabolism of cholesterol. There are different genetic defects that can increase the risk of coronary artery disease and their degree of severity can vary.
How do I know if I have is a family history of coronary artery disease?
A positive family history is suspected when someone in the family has been diagnosed with angina or has died from a heart attack. If the heart attack or death took place at a relatively early age, meaning someone in their 50s or younger, the presence of a significant family history may be likely.
What should I do if I have a family history of coronary artery disease?
If there is a family history of heart disease, you should be particularly vigilant about preventive measures and getting the necessary medical attention. An annual physical examination should be performed, probably by a primary care physician first. The evaluation should include a test for cholesterol and related blood chemistry. You may benefit from a more extensive cardiovascular examination such as a stress test that is begun at an earlier age and given more frequently than for those without a family history. A referral to a cardiologist may be made at the discretion of your primary care physician. Remember each individual is different and your diagnosis and treatment is adjusted according to your particular condition, lifestyle, and risk factors.
Today, there are diet modifications and drug therapies that can lower blood cholesterol. If these changes are initiated at an early age, the onset of coronary artery disease may be delayed or stopped. If other risk factors are present, such as smoking, these should be stopped or modified.
How Does Diet Affect Risk?
There have been thousands of studies on diet and coronary artery disease. Reading these reports can be confusing. Overall, the studies show that the intake of a high fat and high cholesterol diet contributes to coronary artery disease. The next question that usually follows from my patients is, "How much fat and cholesterol should I have in my diet each day?" My first answer is to tell them about my habits: I don't count my calorie, fat, and cholesterol intake on a daily basis; I try to stay away from fatty food as often as I can, but I do eat out and occasionally go to fast food restaurants and indulge in desserts. But that's me. According to the American Heart Association, the daily cholesterol intake should not exceed 300 milligrams, and the total fat intake each day should be less than 30% of the total calories. A convenient way to determine your daily caloric requirement is adding a zero to your weight in pounds. Therefore, if you weigh 150 pounds, your daily caloric requirement is approximately 1,500 calories and no more than 30% of that (in this example, 450 calories) should come from fat. If, in your actual situation, you need to lose weight or have heart disease or high cholesterol, then the above formula is different and I would suggest a consultation with a nutritionist. Also, it is important to remember that the benefits from a diet program take time.
What about being overweight?
It is not clear whether being overweight directly contributes to coronary artery disease. Being overweight may have more significance when you also have diabetes, high blood pressure, or elevated cholesterol levels.
Can Excercise Reduce Risk?
The evidence is not clear-cut, but it does suggest that moderate exercise has a protective effect against coronary artery disease. You should have a thorough physical examination prior to starting a regular exercise program and avoid exercise during extreme weather conditions.
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