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Coronary risk factors

The problem of coronary heart disease

The number one cause of death in modern Western society is coronary heart disease (CHD), whether it be from sudden fatal heart attacks or blocked coronary arteries causing angina and heart failure. CHD is responsible for 1 in 3 deaths in Australia. However, there has been a very pleasing reduction in deaths from coronary heart disease and stroke in the past 20 years because people have made the effort to reduce their risk factors. In spite of this, it is still a major cause of preventable death and we still need to work hard at reducing the risk.

What are the risk factors?

• hypertension (high blood pressure)
• smoking
• high cholesterol
• diabetes
• obesity
• lack of exercise
• stress
• alcohol excess
• family history

The benefit of reducing these risk factors which increase the likelihood of development of hardening of the arteries (or atherosclerosis) is obvious. It should be pointed out that the factors are interrelated; for example, excessive intake of alcohol will lead to hypertension.

Hypertension

The higher the blood pressure, the greater the risk. Regular checks, say yearly for people over 40 years, are advisable. Doctors recommend that you have the diastolic level (lower level) of blood pressure kept at 85 mm Hg or below.

Smoking

Cigarette smoking has been clearly shown to increase the risk of heart disease. The death rate from coronary heart disease is about 70 per cent higher for smokers than for non-smokers, and for very heavy smokers the risk is almost 200 per cent higher. The more one smokes, the greater the risk.

It has also been proved that the incidence of heart disease falls in those who have given up smoking.

High cholesterol

It has been proved that high blood cholesterol is related to heart attacks. High cholesterol is caused by a diet high in saturated fats, as compared with polyunsaturated fats. It is recommended that every effort should be made to keep the blood cholesterol level as low as possible and certainly below 5.5 mmol/L in adults. This acceptable level can usually be achieved through dieting. Saturated fats are found in regular milk and its products (e.g. cream, butter, cheese); fatty meats; pies and pastries, cakes, biscuits and croissants; cooking fats; most fast foods and potato crisps.

Stress and heart attacks

The stress of our modern lifestyle is regarded as a risk factor. Evidence for this is supported by the increased incidence of heart attacks in Asians (who have a low incidence) when they move into Western societies or become business executives in their own environment. Consider ways to modify your stress factors and seek relaxation programs such as meditation.

The significance of risk factors

Most of the risk factors are interdependent, and if two or more are present they have a multiplication effect. If only one risk factor is present, the patient does not have so much cause for concern. Your doctor is the best person to assess the combined risk.

Rules for living

• Do not smoke.
• Do not drink alcohol (or in only very small amounts).
• Keep to an ideal weight.
• Avoid saturated fats.
• Take regular exercise.
• Practise relaxation.

Note: The risk factors for coronary heart disease apply also to other cardiovascular disease, such as cerebral artery disease and hardening of the arteries of the legs.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia