Determining Your Odds for Coronary Heart Disease
More than 13.9 million Americans have coronary heart disease (CHD) and over 481,000 died of the disease in 1995. It is estimated that one in two women will die of CHD making this is by far the leading cause of death above breast or cervical cancer.
What is CHD?
Coronary heart disease is the narrowing of the coronary arteries usually by arteriosclerosis. The good news for residents of Telluride is that you are a more active population with fewer risk factors than the general population, although your active lifestyle may bring you to the doctor's office for other various injuries! Hopefully this article can help determine your risk for CHD and what studies and interventions to discuss with your physician.
How do you get it?
Cardiac risk factors include; smoking, high blood pressure, high cholesterol, previous heart disease, family history of heart disease, age, being male, and diabetes. The studies we will review are the exercise stress test, cardiac echocardiography (cardiac ultrasound) and the ultra-fast CT. These tests are all considered noninvasive. There are many more methods to study CHD but they are reserved for higher risk populations and would merit of another article, entirely.
The exercise stress test involves running on the treadmill with EKG electrodes connected to your body. The EKG or electrocardiogram shows the electrical rhythms of your heart. The test is done with a nurse and physician present. A positive screening result would be EKG changes, significant blood pressure changes, submaximal heart rate and new chest pain. These people would need further testing. People who should have the exercise stress test are those have had chest pain or a heart attack at any age. Also, people in high-risk occupations (i.e. pilots, firemen, etc) or men over 40 whom are sedentary and plan to start vigorous exercise. The exercise stress test is not very useful for women, because there is a higher incidence of exercise intolerance and nondiagnostic EKG changes. A more appropriate diagnostic study for women is the echocardiography.
Echocardiography (cardiac ultrasound) is done when a target heart rate is achieved either by treadmill or IV medication. Ultrasound images demonstrate the size and function of the heart. More specifically it can tell you the strength of the left ventricle. Weakened left ventricles and hearts can give the diagnosis of congestive heart failure. All of these studies indirectly demonstrate the blood flow to the tissues of the heart and the amount artery narrowing.
One recently, highly publicized test is the ultrafast CT. It is involves using an ultrafast computed tomography images to pick up the amount calcium in the arteriosclerosis (plaques) in the coronary arteries. What it doesn't tell you is the amount of blood flow around the plaque. Therefore is has yet to be proven as diagnostic or prognostic tool at this time. Don't give up hope on this test. With enough time and studies, the ultrafast CT will probably become a fine screening device in low risk populations.
Intervention
OK, here's a quick rundown on interventions and their scientifically proven benefit. The details of each I will leave for discussion between you and your physician.
Cholesterol lowering by either exercise or medications has proven to be beneficial. There are some fine points from your lipid (fat) profile that will determine which method to use. Smoking cessation is always a good thing. It is proven beneficial and in some studies, quitting lowers your risk to that of a nonsmoker within 3 years of quitting. Again, a lot of new methods are out there both pharmacological and nonpharmacological that merits discussion with your doc. Lowering blood pressure is also beneficial, although maximum benefit has been seen in those over 60. Aspirin therapy is mostly beneficial. It is mostly cheap but not entirely benign. Again, talk to your caregiver to see if it is right for you. Exercise is of course beneficial. You might be surprised as to how much you need to improve your risk of CHD. Antioxidant vitamins A and C are of no benefit and are potentially dangerous. Very high doses of these vitamins have had complications such as stomach ulcer and liver problems. Vitamin E is potentially beneficial. Vitamin B12, pyroxidine and folate for the treatment of Homocysteinuria is probably beneficial and is always recommended in women of childbearing age. Estrogen replacement looks to be beneficial but continuing conflicting studies regarding cancer risks limits its unconditional recommendation.
