Friday, January 20, 2006

Understanding coronary artery disease: Risk Factors

This is part two in our series on the Heart of the Matter. The first part can be found here. As usual, read the disclaimer if you haven't already done so.

Doctors always talk about risk factors because for many years, our approach to prevention of heart attacks had been targeted at modifying the risk factors to maintain good cardiac health. It is important to note that about 60% of patients with heart artery blockage have none or only one risk factor, suggesting that many of us who are apparently hale and hearty, may in fact be at risk of coronary heart disease.

Cholesterol has always been touted as “the risk factor”, almost making it synonymous with heart artery disease. “If my cholesterol is high, I have heart artery disease “. This is a fallacy. Although, cholesterol is an important cardiac risk factor (don’t get me wrong), it is important to note that 35-40% of patients with heart attacks have normal blood cholesterol. Clearly, many people with normal cholesterol levels are at risk of heart artery blockage, and conversely, many with high levels of cholesterol, may not have heart artery disease. Cholesterol is but one of the many risk factors.

It is important to note that in the developed first world countries, over the last twenty years, this strategy had worked well. With good control of blood cholesterol levels, cessation of smoking and control of blood pressure, the incidence of heart disease and heart attacks have been declining. But this favourable trend has been negated by the rising incidence of obesity and diabetes. We now see a renewed emphasis in prevention of obesity and diabetes. These two seems to be intricately related.

In the next part of the series we discuss atherosclerosis.

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