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Eating well, exercising regularly and reducing stress are important steps in preventing heart disease. Many factors beyond our control also increase the risk of developing heart disease.
Through a new set of guidelines on cholesterol presented by a coalition comprising the American College of Cardiology, the American Heart Association and 10 other health organizations, these additional risk-increasing factors are a little easier to understand, communicate and evaluate.
The new guidelines, which identify risk factors such as family history of cardiovascular disease and chronic inflammatory conditions, include a risk calculator used to determine the risk of developing cardiovascular disease over the next 10 years. The guidelines also refer to ethnicity as a risk-increasing factor – the first set of guidelines for this purpose.
Health professionals and researchers have known for decades that there are four main risk factors for coronary heart disease: smoking, diabetes, hypertension, and high cholesterol, Dr. Aly said. Rahimtoola, cardiologist at the Providence Heart and Vascular Institute. "Yet, even in 2019, we are not very good at diagnosing (coronary heart disease) before a cardiac event. We are a little better at predicting the risks. On the basis of risks, health care providers may propose interventions to modify or reduce risks. "
Risk calculators are not new, said Dr. Michael Shapiro, director of MRI and Cardiac Computed Tomography at Oregon Health & Science University. "There have been several versions of guidelines in recent decades, but risk assessment has always been the centerpiece."
Ethnicity "has not been addressed in previous iterations or guidelines," added Shapiro. "In 2013, this began to be addressed, but never to the extent indicated in this directive."
Although the simple risk-calculating tool has long been the basis of preventive cardiovascular care, it has focused exclusively on white American-specific research until 2013, when the risk calculator was developed to take into account race, using the American "white" and "other" categories. Although it is a step forward, it still includes many, diverse and dissimilar populations.
A January article from the American Heart Association, which heralded ethnicity as a new risk-increasing factor, drew more specific distinctions. People of South Asian descent in particular had a higher risk of heart disease and people in Puerto Rico were more likely to have a heart attack than those in Mexico. At the same time, white women were the second most likely group to have "bad" LDL cholesterol.
"The benefit of identifying ethnicity as a risk factor is to help patients of this ethnic group understand and change their risk," said Rahimtoola. "As long as you are not biased or prejudicial against a patient of this ethnicity, there is probably no problem."
The reasons for the different risk levels of ethnic groups are complex. Although socio-economic conditions and physical environments may provide an indication, this is not something that can be easily or simply summarized.
"Socio-economic status is a huge predictor of cardiovascular and other chronic diseases, but this is not specifically addressed in this calculator (or) guidelines," said Shapiro. "It's very important, but it's not something that's covered here. (We do not have) specific and explicit instructions on what we are supposed to do because it has not been resolved. This has to do with the unfairness of society, so there may be no good answer at the medical level. "
In an ideal setting, primary care physicians routinely assess their patients' risk of heart disease through a short series of questions and, if necessary, additional tests. Any patient with a risk of coronary heart disease of 5% or less is considered low risk and the treatment focuses on "healthy living" rather than medication. Any patient with a risk greater than 20% is considered high risk and should be treated more strictly.
It's within a range of 5 to 20% that guidelines are crucial in determining the risk a person can actually face. When a person is at risk of developing heart disease by 7%, for example, additional risk-increasing factors may increase the initial score, or vice versa. The guidelines complement the risk calculation by enabling strategic and individualized health initiatives.
Shapiro and Rahimtoola recommend that patients who are concerned or curious about their level of risk of coronary heart disease talk about coronary heart disease talk with their doctor.
"Remember that seven modifiable factors can dramatically reduce chronic illnesses, including stopping smoking, regular aerobic exercise, maintaining a healthy weight, adopting a diet." healthy food, controlling hypertension, controlling cholesterol and reducing blood sugar, "said Rahimtoola.
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