Cardiovascular risk factors

Dr Cameron Meyer (MBChB, BSc)

Business Manager, Intercare Centre for Lifestyle Management.

Cardiovascular disease (CVD) refers to damage to the heart and brain in the form of heart attacks (coronary artery disease) and strokes. This results from arteries becoming damaged, which affects the supply of blood to organs.

There are many risk factors associated with coronary heart disease and stroke. Some, such as a history of these events in your family, ethnicity and age, cannot be changed and are referred to as non-modifiable risk factors. Other risk factors that can be changed or improved (modifiable risk factors) include smoking, high blood pressure (hypertension), high cholesterol, obesity, lack of exercise, diabetes, an unhealthy diet, and excessive use of alcohol. l. These are referred to as modifiable risk factors.

It is important to understand that having a single risk factor does not predict that you will suffer from these conditions. However, these factors compound each other and the more risk factors you have and the more uncontrolled they are, the greater the likelihood that you will suffer a heart attack or stroke. Thankfully, most of the factors which increase one’s risk of cvd are modifiable, often through easy and affordable means. It is never too late to make changes to your risk factors. It will greatly improve your future health even after suffering one of the complications.

Modifiable risk factors

  • High blood pressure (hypertension) is the single biggest risk factor for stroke. It also plays a significant role in heart attacks. It is often known as the “silent killer” as individuals can suffer from the condition for years before it is diagnosed. It is easily detected through tests and can be controlled through a combination of stopping smoking, losing weight, exercising, improving ones diet and medication.
  • High cholesterol is the term used to describe a number of possible abnormalities in a person’s blood lipid levels. This mayinclude high total cholesterol, high levels of triglycerides, high levels of low-density lipoprotein (ldl) or low levels of high-density lipoprotein (hdl) cholesterol. Having one or more of these abnormalities can increase the risk of heart disease and stroke. Cholesterol levels can be controlled through a combination of exercise, a healthy diet, losing weight and medication.
  • Tobacco use,whether it is smoking or chewing tobacco, increases the risk of cardiovascular disease. The risk is especially high if you started smoking at a young age, smoke heavily or if you are a woman. Passive smoking (living with a smoker or being around smokers in enclosed spaces) is also a risk factor for cardiovascular disease. Stopping your use of tobacco can reduce your risk of cardiovascular disease significantly, no matter how long you have smoked. In addition, you will also decrease the risk of many other diseases including emphysema and cancer. Speak to your doctor regarding ways to help kick the habit.
  • Physical inactivity increases the risk of heart disease and stroke by up to 50%. A lack of physical exercise is also associated with obesity, which itself is a major risk for cardiovascular disease and predisposes you to diabetes and high blood pressure.
  • Diabetes is a major risk factor for coronary heart disease and stroke. Having diabetes makes you twice as likely to develop cardiovascular disease compared to a non-diabetic. Uncontrolled diabetes can result in an earlier and more severe onset of cvd. If you are a pre-menopausal woman, your diabetes counter-acts the protective effect of estrogen and your risk of heart disease rises significantly. If you are a diabetic, it is also very important to control your blood pressure, as this helps to further reduce your cvd risk.
  • Unhealthy diets greatly increase the risk of heart disease and stroke. A diet high in unhealthy fats (fried foods and animal fat) increases your risk of high cholesterol and obesity. A diet high in sugar and other unhealthy forms of carbohydrates is a risk factor for obesity and diabetes. Excessive salt intake increases your risk of high blood pressure. Be particularly careful of “hidden” salt – normally found in sauces, chips, dips, dry soups etc.
  • Psychological stress, especially at high levels for long periods of time, increases the risk of heart disease and stroke. Social isolation, anxiety and depression are also risk factors.
  • Excessive alcohol use can directly damage the heart, and increases the risk of liver disease and obesity. Although some alcohol use can actually reduce the risk of heart disease, a level of more than 1-2 units per day increases your cvd risk. 1 unit is equal to 1 tot of spirits, 1 small glass of wine or 1 small can of beer.
  • Certain medicines may increase the risk of heart disease such as the oral contraceptive pill and hormone replacement therapy (hrt). Please note that this does not mean that these medications should never be taken or do not have an important role to play in appropriate patients. Please consult your doctor should you be on these and have any concerns, before stopping the intake of these medicines.

Non-modifiable risk factors

  • Ageing is a risk factor for cardiovascular disease; the risk of stroke doubles every decade after the age of 55.
  • Family history is also an important risk factor for cvd. If a first-degree blood relative has had a heart attack orstroke before the age of 55 years (for a male relative) or 65 years (for a female relative) your risk is increased.
  • Gender is also significant: as a man you are at greater risk of heart disease than a pre-menopausal woman. Once past the menopausehowever, a woman’s risk is similar to that of a man.
  • Ethnic origin may play a role. People with African or Asian ancestry are at higher risk of developing cardiovascular disease than other racial groups. Ethnicity also plays a role in your risk for some of the conditions which lead to CVD, such as diabetes, high cholesterol and hypertension.

Take home messages

  • Many of the risk factors for CVD are silent, and may be present for long periods of time before being diagnosed. When they do present themselves, it’s often as a result of their complications. Because of this, testing yourself regularly for these conditions can help detect them early and allow you to control them before you have a heart attack or stroke.
  • Being diagnosed with one or more of these risk factors is not the end of the world. Through regular check- ups with your doctor, improving your lifestyle, and taking prescribed medication, most of these can be controlled and your risk of cvd reduced.  It is never too late to begin controlling your risk factors – even patients who have a heart attack or stroke benefit greatly from managing these underlying conditions.
  • The 4 easiest things to do to reduce your risk are: exercise, stop smoking, lose weight and eat healthier.

References: http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors

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