Heart Disease Risk – What? Me Worry???



I’ve been talking about heart attacks, what the symptoms are, how the symptoms may differ between men and women, what they actually are, what causes them, and what may happen as a result.  Now it’s time to talk about risk factors for developing heart disease.
First, let me point out that heart disease includes many more conditions other than heart attacks.  I’ll talk about those other conditions in  future posts; but for now my focus is on what have been identified as risk factors which can lead to heart disease.
There are two broad catagories of risk factors – Modifiable and Non-Modifiable.  What does that mean?  Simply, there are things we can control and things we can’t when it comes to managing our risk of developing heart disease.  First, let’s take a look at those over which we have no control.

1)  Non-Modifiable Risk Factors:
a.  Age – As we get older, our chances of developing certain types of heart disease increase.  Most of us feel getting older is, in general, a good thing. 🙂
b. Gender – We’re born with it; live with it; die with it.  And while there may be psychological, social and other aspects to our gender – our cells know, and respond, to the initial blueprint.  Women and men (genetically) have different risk factors.
c. Race – Once again, something determined long before birth and completely out of our control, but which can have significant impact on our risk for developing heart disease.
d. Family History – Last, but certainly not least, what conditions did our parents, grand parent, great grand parents, and on up the line, experience?  Some of the risks for developing heart disease have a genetic factor, and if it happened to our ancestors, it may happen to us.
Before I conclude this post, I’ll revisit the Non-Modifiable risk factors and note some of the more common heart disease conditions associated with each, but now I want to talk about the things over which we do have control.

2) Modifiable Risk Factors:
a. Smoking – Smoking damages your body in many ways.  Of couse, components in the smoke directly affect the lungs, impairing the exchange of oxygen and carbon dioxide, and over time the ongoing inflamation of the lungs by cigarette smoke permanently damages the lungs, leading to a loss of elasticity, as well as increasing the risk of lung cancer.  The nicotine has a profound effect on the blood vessels, causing them to contract, which both raises your blood pressure and interferes with oxygen and nutrient exchange in the tissues, and consequently, increases the heart’s work.
b. Physical Inactivity Physical inactivity allows your heart and respiratory system to “decondition.”  That is, since they are never asked to work hard, they don’t develop the ability to significantly increase their output, or if they were “conditioned,” the lack of activity allows them to lose what conditioning they had.  The result is that the heart and respiratory system end up without much reserve capacity.  In essence, just sitting around, your heart and lungs may well be working near their capacity.  A sudden increase in work load, say running  a couple of blocks to catch that 6:15 commuter train can create a crisis where the body, and especially the heart, need more blood (oxygen) but the heart and lungs can’t work any faster, leaving all the tissues crying out for oxygen. Expect some chest pain… 🙁
c. Obesity – Being overweight, and I have some personal experience with this, has an impact on the work the heart has to do.  Imagine lugging couple of suitcases full of bricks through an airport, you’d likely find your heart beating a bit faster, and perhaps you’d be a little short of breath.  Well, it’s the same with being overweight, except you can’t let go of the suitcases to take a rest. What may be a bit less apparent though, is that the fat tissue needs a blood supply too.  Just like every other tissue, it needs oxygen and nutrients.  So, not only are you asking your heart to work harder to cart around the extra weight, you are also asking it to pump the blood through all the fat tissue as well, even more work!
d. High Blood Cholesterol – High cholesterol levels in the blood have been long connected to vascular (circulatory) and heart disease.  While many of the relationships remain somewhat unclear, it is fairly certain that when there are increases in the cholesterol blood level, there is an increase in damage to the walls of the blood vessels resulting in “plaques” – think of old plumbing with all the accumulated rust and other deposits.  These plaques have three major issues associated with them: 1) They narrow the arteries.  This, of course, reduces the amount of blood that can flow through the artery. 2) They reduce the flexibility, or suppleness, of the artery wall.  Arteries need to be elastic, both to aid the heart in its work of pumping the blood, but also to allow for increased flow under increased work loads. 3) They are a source of debris that can break loose and block the narrower vessels downstream, much like a log jam.  Associated with this is an increase in the tendency for the flowing blood to form clots that can also get trapped in narrow vessels, leading to heart attacks, strokes, pulmonary embolisms, etc.
Although dietary cholesterol was first believed to be a major contributor in the development of high blood cholesterol levels, the current research indicates that stress is more likely the major culprit, and that keeping track of moderate dietary intake of cholesterol is sufficient.  Furthermore, regular exercise has been demonstrated to help reduce blood cholesterol levels. Most effective blood cholesterol level control is achieved with prescribed medications (such as statins) combined with regular exercise and moderate diet.
e. Stress and Behavior – Stress in our lives is both good and bad.  There is a famous theory on stress – The General Adaptation Syndrome, by  Hans Selye,  often referred to as GAS.  He noted that living organisms respond to stress, and that there are two basic responses, the first, which he named the General Adaptation Syndrome, is a normal response to environmental stresses on an organism.  The second, which is a response to unrelieved chronic stress, is a pathological response.  We need a certain amount of “stress” in our lives to remain healthy, but in this case “stress” includes activities like healthy exercise.  On the other hand, situations which cause unrelieved anxiety – sitting in traffic with concerns about being on time, worrying about job stability, repeated concerns about our ability to maintain food, shelter, safety, etc., also cause a stress reaction, but lead to our bodies producing the substances related to fight-or-flight, which we never act upon.  The continued presence of these chemicals in our bodies leads to unhealthful changes in our heart, kidneys, lungs, and circulatory system.  Look for a future posting specific to chronic stress and how our bodies respond.
f. High Blood Pressure – High blood pressure is particularly insidious.  For the vast majority of us, there are rarely any symptoms over the years.  However, when the blood pressure is elevated day-in and day-out, the results are devastating to many organs and the circulatory system.  Aside from the risk of a ruptured blood vessel which can bleed into the surrounding tissue (aneurysms, hemorrhagic strokes), the higher pressures are particularly damaging to kidneys, lungs, and of course, the heart.
In the case of the kidneys, they undergo “remodeling” – and believe me, the remodelled kidneys are not an upgrade! The net result can be kidney failure, a good topic for a future post (both text and video).
With the lungs, the higher blood pressure can lead to fluid being forced into the lungs air spaces and tissue, possibly resulting in pulmonary edema,  pneumonias, etc., and a reduced ability to exchange oxygen and carbon dioxide.
Finally, the heart has to work harder with each stroke to push the blood out, both to the lungs, and to the body.  This never-ending increase in work can lead to both an enlarged heart, as well as congestive heart failure.

Well, now you at least know what areas you can explore when it comes to making changes in your life that could lead to a healthier, maybe happier and more long-lived time on planet Earth.

Stay Well -NurseBob

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