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Many, people will continue taking risks with their health for the simple reason that they think nothing will affect them. First, we strongly believe that the negative attitude will only affect the other person and not us. We usually take our health for granted. Second, social risky activities may seem fun or glamorous, and finally, the consequences of Cardiac Risk Factors do not show up immediately but much later in life. Alas, the span of life is short and before most of us know it, we start suffering the consequences.
Risk factors are divided in two groups and subgroups, they are:
Uncontrollable Risk Factors
Controllable Risk Factors
Uncontrollable Risk Factors:
Geography
Gender
Age
Family heredity
Race
Controllable Risk Factors:
Diabetes
Hypertension
High cholesterol
Smoking
Lack of exercise
Nutrition
Caffeine
Stress
Obesity
Oral contraception
Each of the above is discussed in a respective group along with the remaining risk factors.
Heart disease has no limitations and no rules. It has been shown it affects and a kills large number of people both young and old alike. However, because the causes of heart disease are known; , the disease is preventable. Like any other disease, certain elements usually are involved that enhance or slow down the progress of the disease. These elements are called risk factors. A number of risk factors are directly involved, and they play an important role in enhancing heart disease. The media, the publications, books, the news and much more, constantly stress the danger of these risk factors, but we still tend to ignore them.
Uncontrollable Risk Factors
While there are risk factors that are beyond our control and cannot be changed or altered, one should be aware of them because they may be directly related with risk factors that can be controlled.
Geography
It has been found that coronary heart atherosclerosis and ischemic heart disease are more common in industrialized countries than in the underdeveloped countries. However, in Japan, which is considered to be an industrial country, heart disease is less than the United States. Even so, cardiovascular diseases and related disorders are much more common in the more industrialized nations of Western Europe (Keys, 1970). It has also been found that men in the United States have an incidence rate of coronary heart disease double than that of European men of the same age, blood pressure, cholesterol, and smoking habits. Although there is some degree of geographic influence on the occurrence of ischemic heart disease, the correlation is not high and probably reflects other more significant factors such as diet, lifestyle, and personal habits.
Gender
Coronary artery disease has always been and still is more common in men than in women. However, the gap is closing very rapidly. Today women are accepting positions outside the home that are stressful or involve hard work. Furthermore, more women than ever are smoking, particularly young ones, are sole family supporters. While some studies have revealed that the female sex hormone can reduce the severity of coronary atherosclerosis, the results are inconclusive and quite controversial (Manchester et al, 1971).
Age
The chance of developing heart disease increases as one gets older. However, it is a mistake to think that only old people suffer from heart disease. In fact, about a quarter of all heart attack fatalities are individuals below the age of sixty-five, and many of those are under forty. It is not yet known whether aging acts as a mechanism in the process of promoting heart disease. Scientists are still researching this possibility.
Heredity
Family heredity is a predisposing factor of coronary artery disease. The death rate from heart disease is considerably higher among subjects with long-lived parents and grandparents, even in the absence of such risk factors as hypertension, diabetes, and smoking (Hammond et al, 1971). Coronary disease is twice as common in the fathers of patients with heart disease as it is with patients whose fathers do not have the disease. A positive history of cardiovascular disease is over one and a half times more frequent in one or both parents with coronary disease as compared with the parents who are free of the disease.
Race
Black Americans tend to develop high blood pressure more often than the Caucasian race, and it is usually severe in nature. However, the mortality rate is significantly lower in black patients than in white patients. That includes Hispanics and Orientals. This phenomenon is not understood.
Controllable Risk Factors
In this category risk factors are acquired during a person's lifetime. They have a great effect on the process of atherosclerosis and heart attack; however, they are controlled through proper low-fat diet, medication, and exercise. (Review the chapter on exercise).
Diabetes
Diabetes is a disease in which the body cannot make proper use of carbohydrates, causing the failure of the pancreas to produce enough insulin. It is a chronic disease marked by high levels of sugar in the blood. To understand a little about diabetes, it is important to know the normal process by which food is broken down and used by the body. A sugar called glucose is the end result of digestion.
Glucose is an excellent source of fuel used by muscles, liver and other tissues. Insulin from the pancreas controls the usage of glucose by driving this fuel into the cells. If the pancreas does not produce enough insulin or insulin is not effective, glucose will remain outside the cell, and diabetic symptoms will arise. Diabetes greatly increases the risk of having a heart attack and stroke because the disease directly affects the cardiovascular system, and because it is associated with high levels of fats in the blood.
Diabetes can promote the process of hardening of the arteries, although the exact process is unknown. Diabetes cannot be prevented; however, it can be controlled by staying on a proper diet, take insulin regularly (if necessary), and keeping body weight under control by losing weight particularly in obese people diabetes can be eliminated, also by staying active, and getting regular physical examinations. Diabetes can be controlled. Because of modern medicine, diabetics can lead a very normal life provided, they get the proper medical attention.
Ischemic heart disease occurs at a younger age in diabetics than in non-diabetics. Diabetic patients with atherosclerosis have higher triglycerides and cholesterol levels than diabetics who are free of atherosclerosis or the normal individuals.
Type II diabetes is by far the milder of the two forms; it can be easily controlled, and in certain individuals, completely cured. Your physician will normally recommend an exercise program and a diet plan. Once the condition is controlled, your diet and physical activity will be slightly limited.
Similar to hypertensive individuals, many people are diabetics and do not even know it. If you suspect having diabetes, watch for these signs:
Excessive hunger and thirst
Frequent urination
Skin infections
Slow-healing wounds
Very easily fatigued
Weight loss
If you have any of these signs, notify your physician for further evaluation and testing. If the preliminary results are positive, you will be given a glucose tolerance test, which determines how well your body is using glucose or blood sugars. However, remember that diabetes is not a crippling disease, and you should be able to lead a normal life.
Hypertension
Everyone needs a certain amount of pressure in the blood vessels. Your blood could not circulate without it, and without circulation, none of the vital organs can survive. Blood pressure varies continuously. It increases with fear, excitement, and exercise, and this increase is normal. What does high blood pressure mean? It simply means that the pressure goes up and stays up, even after the fear, excitement, or exercise is gone. High blood pressure is known as hypertension.
Your heart is a very strong muscle; it pumps blood to every part of your body through approximately 13,000 miles of soft, elastic tubing called blood vessels.
Blood pressure is the amount of force the blood exerts against the wall of arteries. Each time the heart contracts' blood is pushed out, which creates a surge of pressure in the arteries. This surge reaches a maximal pressure called systolic blood pressure. During the second phase, when the heart relaxes, the pressure goes down to its lowest level called diastolic blood pressure. A simple instrument called a sphygmomanometer measures, the higher (systolic) and lower (diastolic) pressures. Systolic pressure is placed over the lower pressure; for example, a blood pressure reading of 125/75 is expressed as 125(systolic) over 75 (diastolic).
There are two types of high blood pressure:
Primary high blood pressure is by far the most common form of high blood pressure. Its main causes are unknown.
Secondary high blood pressure, which affects a very small group of people and usually has a specific cause, results from a disease or a physical problem. Secondary high blood pressure could result from chronic kidney disease, disorders of the adrenal gland, pregnancy, medication such as birth control pills, diet pills, and narrowed artery to the kidney. This secondary type of high blood pressure is beyond the scope of this book.
Because only primaryhigh blood pressure will be discussed in this book, we will not use the term primary but simply when referring to high blood pressure or hypertension. Normal blood pressure is usually around 120/60, although this reading can vary considerably depending on several factors, such as age and the circumstances under which the blood pressure was taken.
Arterioles are the smaller vessels that branch from the arteries. These arterioles regulate a person's blood pressure. To understand how they work, think of a garden hose nozzle: if it is wide open, the water will flow very easily with relatively little pressure; but if the nozzle is partially closed with the thumb, the water pressure will increase drastically. The same principle applies to arterioles. If, for some reason, the arterioles are partially narrowed, it is harder for the blood to go through them, and therefore, an elevated blood pressure occurs.
The results obtained from scientific studies have not determined the exact reasons of high blood pressure. No specific explanation is discovered. Some predisposing factors to elevated blood pressure are obesity, excessive consumption of alcohol, use of oral contraceptives, sensitivity to sodium, and a sedentary lifestyle.
High blood pressure, like atherosclerosis, often has no pain or symptoms are associated with it. One can feel great and yet be hypertensive. Over a long period, hypertension will damage the heart because it adds to the workload of the heart and the arteries. Therefore, the heart tends to enlarge because of the additional high pressure, and because the heart works harder to pump the blood. If it enlarges significantly, it may have a hard time keeping up with the demands of the body.
Hypertension damages the brain, by the development of plaques that in turn occlude an artery that can cause a stroke. It can also damage the kidneys and other major organs. Therefore, high blood pressure should not be taken lightly. Have your blood pressure checked regularly by your physician or by a qualified professional. Unfortunately, high blood pressure is not curable, but it can be controlled by the following:
Maintaining your normal weight; being overweight can contribute to high blood pressure. In many cases, losing weight lowers your blood pressure. If you are overweight, lose weight gradually. Keep your body fit through a regular exercise program.
Decreasing the amount of salt intake; sodium contributes to high blood pressure. If you like a lot of salt in your cooking, cut down gradually. In addition, cut down on the consumption of salty snacks. It is essential to reduce salt intake.
If you are a smoker, you should stop as it causes vasoconstriction or narrowing of the arteries which increases stress on the heart.
Take your prescribed medication regularly. Certain medications help the body eliminate excess fluid and sodium (salt) in the blood. Others open up narrowed blood vessels, and others prevent arterioles from constricting. Know your medication and its effects and take it exactly as prescribed.
You and your doctor are a team; you cannot treat your condition alone, and he or she cannot treat you effectively without your willingness. Cooperate with your doctor, and keep all appointments. If you have any side effects from medication, let your doctor know about them, so he or she can change the medication or alter the dosage. Follow your doctor's advice on diet, weight control, and exercise.
It is clear that hypertension is one of the cardinal risk factors for ischemic heart disease and is the most influential risk factor that affects all age groups. Most of all the symptoms related to coronary heart disease, such as angina, heart attack, and non-sudden death, are directly related to hypertension. Furthermore, high blood pressure predisposes one to atherosclerosis, problems with your vision, poor blood supply to your legs and kidney disease. Atherosclerotic plaque is found early in hypertensive individuals. Thus, hypertension accelerates the natural progression of atherosclerosis rather than acting as a primary cause of coronary lesions.
Cholesterol
Most scientists agree that dietary cholesterol is one of the leading risk factor in cardiovascular diseases. Unfortunately, Americans are so accustomed to high-fat, high-cholesterol foods, and that there is substantial opposition from food processors concerning changes. Cholesterol is not a fatty substance, but a waxy one carried in the bloodstream by fat, and it does not generate any calories. Cholesterol is essential because it is needed for the production of the female and male hormones and Vitamin D. It also plays a role in the synthesis of bile, helping in the digestion.
According to the US Department of Health, Education and Welfare, the normal cholesterol level for Americans should be between 160–175 mg. The body produces about 150 mg of cholesterol without help from any diet. Therefore, we should consider the normal level to be 150 mg. Even though, many other classifications have put normal levels of cholesterol as high as 300 mg. Many research studies believe that 300 mg is incorrect and that any level above 150 to 160 mg is considered elevated.
The body produces all the cholesterol that it needs, and if one stops ingesting any additional cholesterol the body will keep producing it, and it will show as an average level in the blood. Therefore, any cholesterol ingested with the food adds to the cholesterol produced by the body. Animal-origin foods contain high amounts of cholesterol. Moreover, fish and poultry have lower quantities than beef and pork. On the other hand, cholesterol is absent in all vegetables and fruits. Foods that are very high in vegetable fat, such as corn oil, margarine, and peanut butter, contain no cholesterol. However, good health requires the reduction of all forms of fat, both animal and vegetable.
We can divide foods containing cholesterol into three groups:
Animal flesh, such as meats, fish, and chicken, contain about 15 to 35 mg of cholesterol per ounce of meat.
Shell fish, such as crab, shrimp, and lobster, have a cholesterol level of about 55 to 80 mg of cholesterol per ounce of fish.
Organ meats, such as liver, kidney, and brain, contain from 75 to 125 mg of cholesterol per ounce of meat.
The first two groups of cholesterol containing foods vary in fat content, the first group having a higher content of fat than the second group.
The egg is in a group by itself since it contains about 213-220 mg of cholesterol, and not what it was believed to contain 280 mg of cholesterol, all concentrated in the yolk. The average American breakfast that consists of two eggs contains about 440 mg of cholesterol. This is a high-cholesterol intake, and yet thousands of Americans eat eggs for breakfast every morning. Another problem with eggs is that they are hidden in many of the foods we consume, such as pancakes, some breads, sauces and most all desserts. On the other hand, egg white is void of cholesterol but is very high in proteins and should be part of any diet
The definition of saturation is "the impregnation of one substance by another to the greatest possible degree." For example, a glass of water can dissolve a certain amount of sugar until no more sugar can be dissolved. The same applies to cholesterol. Research data shows, that after the consumption of 600 to 750 mg of dietary cholesterol (about two and a half eggs), there is no further measurable elevation of cholesterol in the blood level. This is called the saturation point and is the point at which the intestine is unable to absorb any more cholesterol for a period of twenty-four hours. If cholesterol and fat ingested past the saturation point, the excess cholesterol and fat will pass to the colon and cause the development of certain kinds of cancers.
Additional intake of cholesterol would not be measurable in the blood. It also has been determined that as little as thirteen mg of ingested cholesterol can be easily detected because it is enough to increase the cholesterol level in the blood. High blood cholesterol simply promotes atherosclerosis. Drs. Hokanson and Austin, in a study conducted by the Journal of Cardiovascular Risks pointed out that elevated plasma cholesterol is universally recognized as a risk factor in both the development of atherosclerosis and coronary artery disease.
The average American's cholesterol blood level is about 220 mg, which is dangerously high. This average is because of fatty, high-cholesterol diets. It was as early as 1958 that Dr. Ancel Keys, Professor Emeritus at the Laboratory of Physiological Hygiene at the University of Minnesota found, "one effect of our kind of high-fat diet is elevated blood cholesterol, and this is so universal among us that our so-called cholesterol norms are simply standard for pre-clinical coronary disease."
It is quite clear that high-cholesterol levels, along with cigarette smoking and hypertension, are clearly established as the major risk factors for coronary artery disease; it was demonstrated that the higher the cholesterol, the higher the risk. In twenty-one worldwide studies, the relationship of elevated blood cholesterol level and increased risk of coronary heart disease was upheld in all twenty-one studies. Thereby, it is concluded that any cholesterol level above 150 to160 mg should be considered elevated and dangerous.
Dr. William Castelli, director of the Framingham studies and his colleagues, pointed out that a cholesterol level of 150 mg or lower almost guarantees immunity from heart disease. 500 individuals with blood cholesterol of 150 mg or lower were followed over a period of twenty-five years in Framingham, Massachusetts, have yet to have a heart attack or die from heart disease. This information was obtained by a study titled Cholesterol Risk Chart. (http://heartriskonline.com/CholesterolChart.htm).
It is very unfortunate and frightening to see that certain laboratories in this country have established that levels of cholesterol of 150 to 300 mg are considered to be within normal levels. The average American cholesterol level is 220 mg. Thousands of men and women across the nation are in coronary care units suffering from heart attacks, and have cholesterol levels of 180 to 290 mg, well within what is considered a normal level.
Cholesterol travels in the bloodstream attached to larger molecules of fat and protein. There are three different types of cholesterol carriers:
To obtain the total level of blood cholesterol, one must add all the cholesterol carried by all three carriers. The HDL cholesterol carriers are the most desirable to have because they seem to limit cholesterol by delivering it to the liver. In the liver, it is converted into bile. People with high levels of HDL (good cholesterol) and low total cholesterol have the lowest risk of having a heart attack. Exercise and small amounts of alcohol seem to elevate HDL levels in the blood. Scientists are constantly searching for new methods to elevate the HDL levels in the blood.
The LDL cholesterol, on the other hand, is "the bad guy." It is this carrier who attaches itself to the wall of the arteries and promotes atherosclerosis. Therefore, elevated levels of LDL cholesterol are extremely dangerous. Take, for example, two men with total blood cholesterol of 240 mg: the first has a high level of LDL and a low level of HDL; the second man has a low level of LDL and a high level of HDL. The first man has a significantly higher risk of having a heart attack than the second man because the higher fraction of HDL carries more cholesterol to the liver to be excreted.
We discussed the role of cholesterol in heart attacks. Further discussion on how to limit and supplement cholesterol intake will be addressed in the chapter on nutrition.
Smoking
Smoking is the third major risk factor for developing heart disease, and it is one of the most controllable.
The body reacts immediately to the chemicals present in the cigarette. Nicotine increases blood pressure, increase's heart rate, and causes the arteries to constrict or narrow. Carbon monoxide produced by cigarettes is absorbed into the bloodstream, interfering with the delivery of oxygen to the tissues; therefore, blood is deprived of oxygen content. If the heart is already deprived of oxygen because of coronary artery disease, the cardiac muscle will suffer more because it must work harder to compensate for the loss of oxygen.
Carbon monoxide can damage the inner layer of cells of the arterial wall, and nicotine promotes and accelerates atherosclerosis. Furthermore, nicotine contributes to the clustering of red blood cells, decreasing further the amount of oxygen they carry, these effects in turn, lead to angina and heart attack .
People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than of people who do not smoke. People who smoke more than one pack a day are three times more likely to suffer from a heart attack; see Coronary Heart Disease Statistics: Smoking-Related Heart Diseases by Terry Martin.
It is a fallacy to assume that switching to low-tar, or low-nicotine cigarettes will reduce the risk of heart attack. There is no scientific data proving that theory, and people who switch to low-tar, low-nicotine tend to smoke more and inhale deeper, which results in the same level of nicotine being absorbed.
Furthermore, smoking is the main cause of chronic lung diseases such as bronchitis and emphysema. These two conditions put additional stress on the heart, which can lead to heart failure. Smoking also promotes several types of cancers. (Contact your local cancer association for further details.)
It is frightening to see that smoking has increased among teenagers. Smoking among youths in the United States rose after a decline in the previous 10-15 years, the proportion of teenage smokers has gone up by a third. This statistic is very disturbing given the fact that smoking among adults has decreased. In an article written by David R. Francis titled "Dramatic Rise in Teenage Smoking," we are in the alarming position of having a youth smoking rate that is roughly 50 percent greater than the smoking rate of adults," note NBER (National Bureau of Economic Research) Research Associate Jonathan Gruberand Jonathan Zinman in Youth Smoking in the U.S.: Evidence and Implications (NBER Working Paper No. 7780).
The greatest risk to smokers is their health at that age; even teenagers develop signs and symptoms such as coughing, decreased stamina, and a fast heart rate. Later, these conditions will worsen and can develop into heart disease or chronic lung disease. It is also established that the younger they start smoking, the more difficult it is to quit soon. An association of hypertension, high cholesterol and smoking puts an individual at increased risk for an ischemic heart attack. From 1965 to date, several studies have been conducted discovered the effect of long-term and short-term cigarette smoking on the walls of the arteries. These studies have shown detrimental data, and the results have gone unchallenged. It has also been shown that the percentage of individuals with advanced atherosclerosis who died of diseases other than coronary heart disease was higher among cigarette smokers than non-smokers. In addition, the percentage of death increased with the amount of cigarette smoking (Kool M. J. et al., 1993). Furthermore, the severity of atherosclerosis is found to increase with an increased use of cigarettes measured in both the number of cigarettes smoked per day and the number of years of smoking (Goodson, NJ et al., 1993). The important fact is that cigarette smoking is a risk factor for ischemic heart disease is present in both man and women alike. (Exerts from WebMD on Smoking and Heart Disease).
By now, it is evident cigarette smoking is extremely dangerous and contributes to as high as 30 percent of all coronary heart disease proving it one of the main risk factors. Smoking, with other risk factors, increases the risk of Coronary Heart Disease as well as Peripheral Vascular Disease. (Circulation. 1997;96:3243-3247 by Ira S. Ockene, MD for the American Heart Association). Unfortunately, many people who already suffered a heart attack resume their smoking habits after they have been discharged from the hospital, despite the fact they have received the strongest of all warnings: a heart attack.
No one disputes the fact that to quit smoking is a hard task, especially after being a smoker for many years. Psychiatrists believe that there are four different types of smokers:
The addictive type: this is the person who is addicted to the nicotine found in a cigarette.
The busy type: this is the person who enjoys having a cigarette in his/her hand but does not pay much attention to it and eventually will let it burn down.
The attractive type: this is the person who likes to play with a cigarette and enjoys seeing the smoke rise; he/she actually feel important holding a cigarette.
The oral type: this person craves having a cigarette constantly in his/her mouth. For them, a cigarette gives great comfort.
Contact the American Heart Association for additional information on smoking. The two guides on smoking at the end of the book give simple instructions on how to stop smoking and most importantly how to remain an ex-smoker. Refer to them when you need encouragement in accomplishing your goal.
Lack of Exercise
Exercise plays an important role in the prevention of heart disease. Inactivity or lack of exercise is a risk factor for coronary heart disease. Regular exercise prevents and controls blood pressure; it also controls the blood cholesterol levels, particularly raising the level of HDL cholesterol (good cholesterol) and reduces the level of LDL cholesterol (bad cholesterol). It also controls the insulin amounts in blood, thus controlling diabetes. Exercise improves blood circulation by preventing blood clot formation that can lead to a heart attack, stroke, and peripheral artery disease.
Nutrition
The consumption of calories, total intake of lipids, the amount of saturated fats and cholesterol in the diet have all shown to correlate with both the frequency and extent of coronary atherosclerosis (McGill, 2002) and the incidence of ischemic heart disease. Thus, populations with high caloric and total lipid intakes tend to have higher levels of saturated fats, and the intake of saturated fats is directly related with cholesterol intake.
Therefore, in populations with a dietary high fat intake, both cholesterol and the risk of heart disease are, as a rule, higher in those populations and segments of populations in which consumption of saturated fats is low. It is well-known that blood cholesterol levels can be lowered when the percentage of saturated fats in the diet is decreased and polyunsaturated fats is increased.
Caffeine
Many people are addicted to caffeine without even knowing it. At the beginning of each morning, they must have one or two cups of coffee or tea. Some people crave sodas and chocolate bars, which contain caffeine. The American Heart Association has found that large amounts of caffeine put a tremendous strain on the heart. Concentrated caffeine acts as a strong stimulant by increasing blood pressure and heart rate. It is important for those who already have suffered a heart attack to reevaluate their habits and limit the intake of caffeine. The stronger the coffee or tea, the more caffeine content a person is consuming. We encourage decaffeinated coffee, caffeine-free sodas, and herbal teas.
Energy drinks have about 72 to 150 mg of caffeine per serving. Many bottles contain 2 to 3 servings of caffeine
Coffee has 60 to 150 mg of caffeine per cup
Over-the-counter medications have up to 65 mg of caffeine for pain killers. Caffeine is also commonly found in appetite suppressants and many cold and cough remedy medicines
Colas have 47 to 64 mg of caffeine per 12-ounce can
Tea has 40 to 80 mg of caffeine per cup
Chocolate bars have up to 35 mg of caffeine per ounce
Cocoa has up to 8 mg of caffeine per cup
Decaffeinated coffee has up to 7 mg of caffeine per cup
According to the American Heart Association, one to two cups of regular coffee which contains 120 mg to 300 mg is fine, but more than that could be risky
Stress
Stress can be a most dangerous risk factor, and rarely a day goes by without encountering some degree of stress. The definition of stress is "consequences or failure of organism human or animal to respond adequately to emotional or physical demands, whether real or imagined" (Wikipedia). Stress itself is not dangerous, but how we react to stress can determine our emotional and physical well-being. The ambitious, aggressive individual is more prone to stress than persons who are relaxed and easygoing. Individuals that are classified as aggressive, ambitious, competitive and hard driving have a significantly higher incidence of ischemic heart disease than individuals who are easygoing.
When you are faced with a certain danger, your brain registers this threat and immediately sends signals to your body for preparation to protect yourself. During this short period of time, a number of things take place: the pupils dilates, breathing gets faster the face flushes the palms get sweaty, digestion slows down, and blood is diverted to the muscles, and they become tense. The heart rate increases, and blood pressure increases to pump more blood to the tense muscles; adrenaline is excreted in large quantities into the cardiovascular system.
The muscular layer in the wall of the coronary arteries tend to spasm or contract, which narrows the blood vessels. Narrowing of the coronary arteries may cause angina. Therefore, if the arteries are already affected by atherosclerosis, the onset of angina is more severe. This, of course, is why some heart patients experience anginal pain when they get upset. A coronary artery already narrowed due to atherosclerosis combined with further narrowing or spasm due to emotional stress may cause a heart attack.
Although the role of stress on the cardiovascular system is controversial, modern stress is usually more subtle and prolonged. Stress alone will rarely promote anginal pain and heart attack; although, it has been documented that certain individuals have suffered a heart attack because of business-related stress, extreme determination, competitiveness, and long working hours.
Some people are tense and anxious for weeks. This stress can take the form of everyday hassles, excessive noise at home or work, disagreement with a spouse, overwork, traffic jams, long lines at supermarkets or banks, disappointments, unpleasant colleagues and many others. Eventually, this subtle, slow stress will cause some damage to the arteries that manifests itself in the form of angina or even a heart attack. Therefore, it is befitting we repeat our opening statement that "stress can be a dangerous risk factor" and we should put forth the effort to reduce the stressors in our lives.
Obesity
The role of obesity in the development of atherosclerosis has been verified and definitely shown to accelerate, especially in young adults. Therefore, proper, weight control has proven to be important in dietary management. Obesity is often associated with increased amounts of cholesterol and sometimes hypertension. This combination of risk factors could result in the development of heart disease.
Unfortunately, obesity is quite prevalent in this country because food is abundant and most adults do not engage in significant physical labor or exercise. Moreover, we are constantly bombarded by advertisements for alcohol and high fat, high-calorie foods. Fast food's chains do not help anyone in controlling-- which have a very high-fat food and a population always "eating on the run" which effects do not help anyone in controlling the quality or quantity of their meals.
Obesity causes the heart to work much harder to compensate for the additional weight; it must pump more blood to supply the extra fat. Furthermore, all the risk factors tend to be interrelated, which means that if you are overweight, your chances of having high blood pressure, a high-cholesterol level, and diabetes are significantly higher than if your weight is under control.
Lack of exercise is usually associated with being overweight, and it decreases the amount of HDL cholesterol (good cholesterol) in the blood. For these reasons, avoidance of being overweight should be a therapeutic goal
Oral Contraceptives
Oral contraceptives, better known as birth control pills,which can lead to blood clottinghave been associated with heart attacks in women over the age of forty. It is a fact that oral contraceptives cause salt retention, which in turn raises blood pressure, and they also promote the formation of blood clots by increasing levels of our clotting factors. Oral contraceptives increase the triglyceride level in the blood while decreasing the amount of HDL cholesterol (good cholesterol). If you are a woman approaching the age of forty, and on birth control, you should consult your physician and discuss the matter. Your physician will base his or her decision upon your general physical condition.
Conclusion
We have discussed the most important risk factors that promote atherosclerosis. Remember that these risk factors are based on statistics from studies of large groups of people might not be valid. Being in a high-risk group does not mean that you will suffer a heart attack; it means that statistically it is possible to develop the condition. Furthermore, being free of risk factors is no guarantee of immunity. Many individuals who have suffered a heart attack never smoked, have low cholesterol levels, and exercise regularly.
Assess the state of your health with your physician and establish a follow-up program and regular visits to maintain a good and a healthy body.
Learn more about your risk factors and determine which risk factor predisposes you to have a heart attack. Try to apply the guidelines presented in this chapter and benefit from them.
Risk factors are divided in two groups and subgroups, they are:
Uncontrollable Risk Factors
Controllable Risk Factors
Uncontrollable Risk Factors:
Geography
Gender
Age
Family heredity
Race
Controllable Risk Factors:
Diabetes
Hypertension
High cholesterol
Smoking
Lack of exercise
Nutrition
Caffeine
Stress
Obesity
Oral contraception
Each of the above is discussed in a respective group along with the remaining risk factors.
Heart disease has no limitations and no rules. It has been shown it affects and a kills large number of people both young and old alike. However, because the causes of heart disease are known; , the disease is preventable. Like any other disease, certain elements usually are involved that enhance or slow down the progress of the disease. These elements are called risk factors. A number of risk factors are directly involved, and they play an important role in enhancing heart disease. The media, the publications, books, the news and much more, constantly stress the danger of these risk factors, but we still tend to ignore them.
Uncontrollable Risk Factors
While there are risk factors that are beyond our control and cannot be changed or altered, one should be aware of them because they may be directly related with risk factors that can be controlled.
Geography
It has been found that coronary heart atherosclerosis and ischemic heart disease are more common in industrialized countries than in the underdeveloped countries. However, in Japan, which is considered to be an industrial country, heart disease is less than the United States. Even so, cardiovascular diseases and related disorders are much more common in the more industrialized nations of Western Europe (Keys, 1970). It has also been found that men in the United States have an incidence rate of coronary heart disease double than that of European men of the same age, blood pressure, cholesterol, and smoking habits. Although there is some degree of geographic influence on the occurrence of ischemic heart disease, the correlation is not high and probably reflects other more significant factors such as diet, lifestyle, and personal habits.
Gender
Coronary artery disease has always been and still is more common in men than in women. However, the gap is closing very rapidly. Today women are accepting positions outside the home that are stressful or involve hard work. Furthermore, more women than ever are smoking, particularly young ones, are sole family supporters. While some studies have revealed that the female sex hormone can reduce the severity of coronary atherosclerosis, the results are inconclusive and quite controversial (Manchester et al, 1971).
Age
The chance of developing heart disease increases as one gets older. However, it is a mistake to think that only old people suffer from heart disease. In fact, about a quarter of all heart attack fatalities are individuals below the age of sixty-five, and many of those are under forty. It is not yet known whether aging acts as a mechanism in the process of promoting heart disease. Scientists are still researching this possibility.
Heredity
Family heredity is a predisposing factor of coronary artery disease. The death rate from heart disease is considerably higher among subjects with long-lived parents and grandparents, even in the absence of such risk factors as hypertension, diabetes, and smoking (Hammond et al, 1971). Coronary disease is twice as common in the fathers of patients with heart disease as it is with patients whose fathers do not have the disease. A positive history of cardiovascular disease is over one and a half times more frequent in one or both parents with coronary disease as compared with the parents who are free of the disease.
Race
Black Americans tend to develop high blood pressure more often than the Caucasian race, and it is usually severe in nature. However, the mortality rate is significantly lower in black patients than in white patients. That includes Hispanics and Orientals. This phenomenon is not understood.
Controllable Risk Factors
In this category risk factors are acquired during a person's lifetime. They have a great effect on the process of atherosclerosis and heart attack; however, they are controlled through proper low-fat diet, medication, and exercise. (Review the chapter on exercise).
Diabetes
Diabetes is a disease in which the body cannot make proper use of carbohydrates, causing the failure of the pancreas to produce enough insulin. It is a chronic disease marked by high levels of sugar in the blood. To understand a little about diabetes, it is important to know the normal process by which food is broken down and used by the body. A sugar called glucose is the end result of digestion.
Glucose is an excellent source of fuel used by muscles, liver and other tissues. Insulin from the pancreas controls the usage of glucose by driving this fuel into the cells. If the pancreas does not produce enough insulin or insulin is not effective, glucose will remain outside the cell, and diabetic symptoms will arise. Diabetes greatly increases the risk of having a heart attack and stroke because the disease directly affects the cardiovascular system, and because it is associated with high levels of fats in the blood.
Diabetes can promote the process of hardening of the arteries, although the exact process is unknown. Diabetes cannot be prevented; however, it can be controlled by staying on a proper diet, take insulin regularly (if necessary), and keeping body weight under control by losing weight particularly in obese people diabetes can be eliminated, also by staying active, and getting regular physical examinations. Diabetes can be controlled. Because of modern medicine, diabetics can lead a very normal life provided, they get the proper medical attention.
Ischemic heart disease occurs at a younger age in diabetics than in non-diabetics. Diabetic patients with atherosclerosis have higher triglycerides and cholesterol levels than diabetics who are free of atherosclerosis or the normal individuals.
Type II diabetes is by far the milder of the two forms; it can be easily controlled, and in certain individuals, completely cured. Your physician will normally recommend an exercise program and a diet plan. Once the condition is controlled, your diet and physical activity will be slightly limited.
Similar to hypertensive individuals, many people are diabetics and do not even know it. If you suspect having diabetes, watch for these signs:
Excessive hunger and thirst
Frequent urination
Skin infections
Slow-healing wounds
Very easily fatigued
Weight loss
If you have any of these signs, notify your physician for further evaluation and testing. If the preliminary results are positive, you will be given a glucose tolerance test, which determines how well your body is using glucose or blood sugars. However, remember that diabetes is not a crippling disease, and you should be able to lead a normal life.
Hypertension
Everyone needs a certain amount of pressure in the blood vessels. Your blood could not circulate without it, and without circulation, none of the vital organs can survive. Blood pressure varies continuously. It increases with fear, excitement, and exercise, and this increase is normal. What does high blood pressure mean? It simply means that the pressure goes up and stays up, even after the fear, excitement, or exercise is gone. High blood pressure is known as hypertension.
Your heart is a very strong muscle; it pumps blood to every part of your body through approximately 13,000 miles of soft, elastic tubing called blood vessels.
Blood pressure is the amount of force the blood exerts against the wall of arteries. Each time the heart contracts' blood is pushed out, which creates a surge of pressure in the arteries. This surge reaches a maximal pressure called systolic blood pressure. During the second phase, when the heart relaxes, the pressure goes down to its lowest level called diastolic blood pressure. A simple instrument called a sphygmomanometer measures, the higher (systolic) and lower (diastolic) pressures. Systolic pressure is placed over the lower pressure; for example, a blood pressure reading of 125/75 is expressed as 125(systolic) over 75 (diastolic).
There are two types of high blood pressure:
Primary high blood pressure is by far the most common form of high blood pressure. Its main causes are unknown.
Secondary high blood pressure, which affects a very small group of people and usually has a specific cause, results from a disease or a physical problem. Secondary high blood pressure could result from chronic kidney disease, disorders of the adrenal gland, pregnancy, medication such as birth control pills, diet pills, and narrowed artery to the kidney. This secondary type of high blood pressure is beyond the scope of this book.
Because only primaryhigh blood pressure will be discussed in this book, we will not use the term primary but simply when referring to high blood pressure or hypertension. Normal blood pressure is usually around 120/60, although this reading can vary considerably depending on several factors, such as age and the circumstances under which the blood pressure was taken.
Arterioles are the smaller vessels that branch from the arteries. These arterioles regulate a person's blood pressure. To understand how they work, think of a garden hose nozzle: if it is wide open, the water will flow very easily with relatively little pressure; but if the nozzle is partially closed with the thumb, the water pressure will increase drastically. The same principle applies to arterioles. If, for some reason, the arterioles are partially narrowed, it is harder for the blood to go through them, and therefore, an elevated blood pressure occurs.
The results obtained from scientific studies have not determined the exact reasons of high blood pressure. No specific explanation is discovered. Some predisposing factors to elevated blood pressure are obesity, excessive consumption of alcohol, use of oral contraceptives, sensitivity to sodium, and a sedentary lifestyle.
High blood pressure, like atherosclerosis, often has no pain or symptoms are associated with it. One can feel great and yet be hypertensive. Over a long period, hypertension will damage the heart because it adds to the workload of the heart and the arteries. Therefore, the heart tends to enlarge because of the additional high pressure, and because the heart works harder to pump the blood. If it enlarges significantly, it may have a hard time keeping up with the demands of the body.
Hypertension damages the brain, by the development of plaques that in turn occlude an artery that can cause a stroke. It can also damage the kidneys and other major organs. Therefore, high blood pressure should not be taken lightly. Have your blood pressure checked regularly by your physician or by a qualified professional. Unfortunately, high blood pressure is not curable, but it can be controlled by the following:
Maintaining your normal weight; being overweight can contribute to high blood pressure. In many cases, losing weight lowers your blood pressure. If you are overweight, lose weight gradually. Keep your body fit through a regular exercise program.
Decreasing the amount of salt intake; sodium contributes to high blood pressure. If you like a lot of salt in your cooking, cut down gradually. In addition, cut down on the consumption of salty snacks. It is essential to reduce salt intake.
If you are a smoker, you should stop as it causes vasoconstriction or narrowing of the arteries which increases stress on the heart.
Take your prescribed medication regularly. Certain medications help the body eliminate excess fluid and sodium (salt) in the blood. Others open up narrowed blood vessels, and others prevent arterioles from constricting. Know your medication and its effects and take it exactly as prescribed.
You and your doctor are a team; you cannot treat your condition alone, and he or she cannot treat you effectively without your willingness. Cooperate with your doctor, and keep all appointments. If you have any side effects from medication, let your doctor know about them, so he or she can change the medication or alter the dosage. Follow your doctor's advice on diet, weight control, and exercise.
It is clear that hypertension is one of the cardinal risk factors for ischemic heart disease and is the most influential risk factor that affects all age groups. Most of all the symptoms related to coronary heart disease, such as angina, heart attack, and non-sudden death, are directly related to hypertension. Furthermore, high blood pressure predisposes one to atherosclerosis, problems with your vision, poor blood supply to your legs and kidney disease. Atherosclerotic plaque is found early in hypertensive individuals. Thus, hypertension accelerates the natural progression of atherosclerosis rather than acting as a primary cause of coronary lesions.
Cholesterol
Most scientists agree that dietary cholesterol is one of the leading risk factor in cardiovascular diseases. Unfortunately, Americans are so accustomed to high-fat, high-cholesterol foods, and that there is substantial opposition from food processors concerning changes. Cholesterol is not a fatty substance, but a waxy one carried in the bloodstream by fat, and it does not generate any calories. Cholesterol is essential because it is needed for the production of the female and male hormones and Vitamin D. It also plays a role in the synthesis of bile, helping in the digestion.
According to the US Department of Health, Education and Welfare, the normal cholesterol level for Americans should be between 160–175 mg. The body produces about 150 mg of cholesterol without help from any diet. Therefore, we should consider the normal level to be 150 mg. Even though, many other classifications have put normal levels of cholesterol as high as 300 mg. Many research studies believe that 300 mg is incorrect and that any level above 150 to 160 mg is considered elevated.
The body produces all the cholesterol that it needs, and if one stops ingesting any additional cholesterol the body will keep producing it, and it will show as an average level in the blood. Therefore, any cholesterol ingested with the food adds to the cholesterol produced by the body. Animal-origin foods contain high amounts of cholesterol. Moreover, fish and poultry have lower quantities than beef and pork. On the other hand, cholesterol is absent in all vegetables and fruits. Foods that are very high in vegetable fat, such as corn oil, margarine, and peanut butter, contain no cholesterol. However, good health requires the reduction of all forms of fat, both animal and vegetable.
We can divide foods containing cholesterol into three groups:
Animal flesh, such as meats, fish, and chicken, contain about 15 to 35 mg of cholesterol per ounce of meat.
Shell fish, such as crab, shrimp, and lobster, have a cholesterol level of about 55 to 80 mg of cholesterol per ounce of fish.
Organ meats, such as liver, kidney, and brain, contain from 75 to 125 mg of cholesterol per ounce of meat.
The first two groups of cholesterol containing foods vary in fat content, the first group having a higher content of fat than the second group.
The egg is in a group by itself since it contains about 213-220 mg of cholesterol, and not what it was believed to contain 280 mg of cholesterol, all concentrated in the yolk. The average American breakfast that consists of two eggs contains about 440 mg of cholesterol. This is a high-cholesterol intake, and yet thousands of Americans eat eggs for breakfast every morning. Another problem with eggs is that they are hidden in many of the foods we consume, such as pancakes, some breads, sauces and most all desserts. On the other hand, egg white is void of cholesterol but is very high in proteins and should be part of any diet
The definition of saturation is "the impregnation of one substance by another to the greatest possible degree." For example, a glass of water can dissolve a certain amount of sugar until no more sugar can be dissolved. The same applies to cholesterol. Research data shows, that after the consumption of 600 to 750 mg of dietary cholesterol (about two and a half eggs), there is no further measurable elevation of cholesterol in the blood level. This is called the saturation point and is the point at which the intestine is unable to absorb any more cholesterol for a period of twenty-four hours. If cholesterol and fat ingested past the saturation point, the excess cholesterol and fat will pass to the colon and cause the development of certain kinds of cancers.
Additional intake of cholesterol would not be measurable in the blood. It also has been determined that as little as thirteen mg of ingested cholesterol can be easily detected because it is enough to increase the cholesterol level in the blood. High blood cholesterol simply promotes atherosclerosis. Drs. Hokanson and Austin, in a study conducted by the Journal of Cardiovascular Risks pointed out that elevated plasma cholesterol is universally recognized as a risk factor in both the development of atherosclerosis and coronary artery disease.
The average American's cholesterol blood level is about 220 mg, which is dangerously high. This average is because of fatty, high-cholesterol diets. It was as early as 1958 that Dr. Ancel Keys, Professor Emeritus at the Laboratory of Physiological Hygiene at the University of Minnesota found, "one effect of our kind of high-fat diet is elevated blood cholesterol, and this is so universal among us that our so-called cholesterol norms are simply standard for pre-clinical coronary disease."
It is quite clear that high-cholesterol levels, along with cigarette smoking and hypertension, are clearly established as the major risk factors for coronary artery disease; it was demonstrated that the higher the cholesterol, the higher the risk. In twenty-one worldwide studies, the relationship of elevated blood cholesterol level and increased risk of coronary heart disease was upheld in all twenty-one studies. Thereby, it is concluded that any cholesterol level above 150 to160 mg should be considered elevated and dangerous.
Dr. William Castelli, director of the Framingham studies and his colleagues, pointed out that a cholesterol level of 150 mg or lower almost guarantees immunity from heart disease. 500 individuals with blood cholesterol of 150 mg or lower were followed over a period of twenty-five years in Framingham, Massachusetts, have yet to have a heart attack or die from heart disease. This information was obtained by a study titled Cholesterol Risk Chart. (http://heartriskonline.com/CholesterolChart.htm).
It is very unfortunate and frightening to see that certain laboratories in this country have established that levels of cholesterol of 150 to 300 mg are considered to be within normal levels. The average American cholesterol level is 220 mg. Thousands of men and women across the nation are in coronary care units suffering from heart attacks, and have cholesterol levels of 180 to 290 mg, well within what is considered a normal level.
Cholesterol travels in the bloodstream attached to larger molecules of fat and protein. There are three different types of cholesterol carriers:
To obtain the total level of blood cholesterol, one must add all the cholesterol carried by all three carriers. The HDL cholesterol carriers are the most desirable to have because they seem to limit cholesterol by delivering it to the liver. In the liver, it is converted into bile. People with high levels of HDL (good cholesterol) and low total cholesterol have the lowest risk of having a heart attack. Exercise and small amounts of alcohol seem to elevate HDL levels in the blood. Scientists are constantly searching for new methods to elevate the HDL levels in the blood.
The LDL cholesterol, on the other hand, is "the bad guy." It is this carrier who attaches itself to the wall of the arteries and promotes atherosclerosis. Therefore, elevated levels of LDL cholesterol are extremely dangerous. Take, for example, two men with total blood cholesterol of 240 mg: the first has a high level of LDL and a low level of HDL; the second man has a low level of LDL and a high level of HDL. The first man has a significantly higher risk of having a heart attack than the second man because the higher fraction of HDL carries more cholesterol to the liver to be excreted.
We discussed the role of cholesterol in heart attacks. Further discussion on how to limit and supplement cholesterol intake will be addressed in the chapter on nutrition.
Smoking
Smoking is the third major risk factor for developing heart disease, and it is one of the most controllable.
The body reacts immediately to the chemicals present in the cigarette. Nicotine increases blood pressure, increase's heart rate, and causes the arteries to constrict or narrow. Carbon monoxide produced by cigarettes is absorbed into the bloodstream, interfering with the delivery of oxygen to the tissues; therefore, blood is deprived of oxygen content. If the heart is already deprived of oxygen because of coronary artery disease, the cardiac muscle will suffer more because it must work harder to compensate for the loss of oxygen.
Carbon monoxide can damage the inner layer of cells of the arterial wall, and nicotine promotes and accelerates atherosclerosis. Furthermore, nicotine contributes to the clustering of red blood cells, decreasing further the amount of oxygen they carry, these effects in turn, lead to angina and heart attack .
People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than of people who do not smoke. People who smoke more than one pack a day are three times more likely to suffer from a heart attack; see Coronary Heart Disease Statistics: Smoking-Related Heart Diseases by Terry Martin.
It is a fallacy to assume that switching to low-tar, or low-nicotine cigarettes will reduce the risk of heart attack. There is no scientific data proving that theory, and people who switch to low-tar, low-nicotine tend to smoke more and inhale deeper, which results in the same level of nicotine being absorbed.
Furthermore, smoking is the main cause of chronic lung diseases such as bronchitis and emphysema. These two conditions put additional stress on the heart, which can lead to heart failure. Smoking also promotes several types of cancers. (Contact your local cancer association for further details.)
It is frightening to see that smoking has increased among teenagers. Smoking among youths in the United States rose after a decline in the previous 10-15 years, the proportion of teenage smokers has gone up by a third. This statistic is very disturbing given the fact that smoking among adults has decreased. In an article written by David R. Francis titled "Dramatic Rise in Teenage Smoking," we are in the alarming position of having a youth smoking rate that is roughly 50 percent greater than the smoking rate of adults," note NBER (National Bureau of Economic Research) Research Associate Jonathan Gruberand Jonathan Zinman in Youth Smoking in the U.S.: Evidence and Implications (NBER Working Paper No. 7780).
The greatest risk to smokers is their health at that age; even teenagers develop signs and symptoms such as coughing, decreased stamina, and a fast heart rate. Later, these conditions will worsen and can develop into heart disease or chronic lung disease. It is also established that the younger they start smoking, the more difficult it is to quit soon. An association of hypertension, high cholesterol and smoking puts an individual at increased risk for an ischemic heart attack. From 1965 to date, several studies have been conducted discovered the effect of long-term and short-term cigarette smoking on the walls of the arteries. These studies have shown detrimental data, and the results have gone unchallenged. It has also been shown that the percentage of individuals with advanced atherosclerosis who died of diseases other than coronary heart disease was higher among cigarette smokers than non-smokers. In addition, the percentage of death increased with the amount of cigarette smoking (Kool M. J. et al., 1993). Furthermore, the severity of atherosclerosis is found to increase with an increased use of cigarettes measured in both the number of cigarettes smoked per day and the number of years of smoking (Goodson, NJ et al., 1993). The important fact is that cigarette smoking is a risk factor for ischemic heart disease is present in both man and women alike. (Exerts from WebMD on Smoking and Heart Disease).
By now, it is evident cigarette smoking is extremely dangerous and contributes to as high as 30 percent of all coronary heart disease proving it one of the main risk factors. Smoking, with other risk factors, increases the risk of Coronary Heart Disease as well as Peripheral Vascular Disease. (Circulation. 1997;96:3243-3247 by Ira S. Ockene, MD for the American Heart Association). Unfortunately, many people who already suffered a heart attack resume their smoking habits after they have been discharged from the hospital, despite the fact they have received the strongest of all warnings: a heart attack.
No one disputes the fact that to quit smoking is a hard task, especially after being a smoker for many years. Psychiatrists believe that there are four different types of smokers:
The addictive type: this is the person who is addicted to the nicotine found in a cigarette.
The busy type: this is the person who enjoys having a cigarette in his/her hand but does not pay much attention to it and eventually will let it burn down.
The attractive type: this is the person who likes to play with a cigarette and enjoys seeing the smoke rise; he/she actually feel important holding a cigarette.
The oral type: this person craves having a cigarette constantly in his/her mouth. For them, a cigarette gives great comfort.
Contact the American Heart Association for additional information on smoking. The two guides on smoking at the end of the book give simple instructions on how to stop smoking and most importantly how to remain an ex-smoker. Refer to them when you need encouragement in accomplishing your goal.
Lack of Exercise
Exercise plays an important role in the prevention of heart disease. Inactivity or lack of exercise is a risk factor for coronary heart disease. Regular exercise prevents and controls blood pressure; it also controls the blood cholesterol levels, particularly raising the level of HDL cholesterol (good cholesterol) and reduces the level of LDL cholesterol (bad cholesterol). It also controls the insulin amounts in blood, thus controlling diabetes. Exercise improves blood circulation by preventing blood clot formation that can lead to a heart attack, stroke, and peripheral artery disease.
Nutrition
The consumption of calories, total intake of lipids, the amount of saturated fats and cholesterol in the diet have all shown to correlate with both the frequency and extent of coronary atherosclerosis (McGill, 2002) and the incidence of ischemic heart disease. Thus, populations with high caloric and total lipid intakes tend to have higher levels of saturated fats, and the intake of saturated fats is directly related with cholesterol intake.
Therefore, in populations with a dietary high fat intake, both cholesterol and the risk of heart disease are, as a rule, higher in those populations and segments of populations in which consumption of saturated fats is low. It is well-known that blood cholesterol levels can be lowered when the percentage of saturated fats in the diet is decreased and polyunsaturated fats is increased.
Caffeine
Many people are addicted to caffeine without even knowing it. At the beginning of each morning, they must have one or two cups of coffee or tea. Some people crave sodas and chocolate bars, which contain caffeine. The American Heart Association has found that large amounts of caffeine put a tremendous strain on the heart. Concentrated caffeine acts as a strong stimulant by increasing blood pressure and heart rate. It is important for those who already have suffered a heart attack to reevaluate their habits and limit the intake of caffeine. The stronger the coffee or tea, the more caffeine content a person is consuming. We encourage decaffeinated coffee, caffeine-free sodas, and herbal teas.
Energy drinks have about 72 to 150 mg of caffeine per serving. Many bottles contain 2 to 3 servings of caffeine
Coffee has 60 to 150 mg of caffeine per cup
Over-the-counter medications have up to 65 mg of caffeine for pain killers. Caffeine is also commonly found in appetite suppressants and many cold and cough remedy medicines
Colas have 47 to 64 mg of caffeine per 12-ounce can
Tea has 40 to 80 mg of caffeine per cup
Chocolate bars have up to 35 mg of caffeine per ounce
Cocoa has up to 8 mg of caffeine per cup
Decaffeinated coffee has up to 7 mg of caffeine per cup
According to the American Heart Association, one to two cups of regular coffee which contains 120 mg to 300 mg is fine, but more than that could be risky
Stress
Stress can be a most dangerous risk factor, and rarely a day goes by without encountering some degree of stress. The definition of stress is "consequences or failure of organism human or animal to respond adequately to emotional or physical demands, whether real or imagined" (Wikipedia). Stress itself is not dangerous, but how we react to stress can determine our emotional and physical well-being. The ambitious, aggressive individual is more prone to stress than persons who are relaxed and easygoing. Individuals that are classified as aggressive, ambitious, competitive and hard driving have a significantly higher incidence of ischemic heart disease than individuals who are easygoing.
When you are faced with a certain danger, your brain registers this threat and immediately sends signals to your body for preparation to protect yourself. During this short period of time, a number of things take place: the pupils dilates, breathing gets faster the face flushes the palms get sweaty, digestion slows down, and blood is diverted to the muscles, and they become tense. The heart rate increases, and blood pressure increases to pump more blood to the tense muscles; adrenaline is excreted in large quantities into the cardiovascular system.
The muscular layer in the wall of the coronary arteries tend to spasm or contract, which narrows the blood vessels. Narrowing of the coronary arteries may cause angina. Therefore, if the arteries are already affected by atherosclerosis, the onset of angina is more severe. This, of course, is why some heart patients experience anginal pain when they get upset. A coronary artery already narrowed due to atherosclerosis combined with further narrowing or spasm due to emotional stress may cause a heart attack.
Although the role of stress on the cardiovascular system is controversial, modern stress is usually more subtle and prolonged. Stress alone will rarely promote anginal pain and heart attack; although, it has been documented that certain individuals have suffered a heart attack because of business-related stress, extreme determination, competitiveness, and long working hours.
Some people are tense and anxious for weeks. This stress can take the form of everyday hassles, excessive noise at home or work, disagreement with a spouse, overwork, traffic jams, long lines at supermarkets or banks, disappointments, unpleasant colleagues and many others. Eventually, this subtle, slow stress will cause some damage to the arteries that manifests itself in the form of angina or even a heart attack. Therefore, it is befitting we repeat our opening statement that "stress can be a dangerous risk factor" and we should put forth the effort to reduce the stressors in our lives.
Obesity
The role of obesity in the development of atherosclerosis has been verified and definitely shown to accelerate, especially in young adults. Therefore, proper, weight control has proven to be important in dietary management. Obesity is often associated with increased amounts of cholesterol and sometimes hypertension. This combination of risk factors could result in the development of heart disease.
Unfortunately, obesity is quite prevalent in this country because food is abundant and most adults do not engage in significant physical labor or exercise. Moreover, we are constantly bombarded by advertisements for alcohol and high fat, high-calorie foods. Fast food's chains do not help anyone in controlling-- which have a very high-fat food and a population always "eating on the run" which effects do not help anyone in controlling the quality or quantity of their meals.
Obesity causes the heart to work much harder to compensate for the additional weight; it must pump more blood to supply the extra fat. Furthermore, all the risk factors tend to be interrelated, which means that if you are overweight, your chances of having high blood pressure, a high-cholesterol level, and diabetes are significantly higher than if your weight is under control.
Lack of exercise is usually associated with being overweight, and it decreases the amount of HDL cholesterol (good cholesterol) in the blood. For these reasons, avoidance of being overweight should be a therapeutic goal
Oral Contraceptives
Oral contraceptives, better known as birth control pills,which can lead to blood clottinghave been associated with heart attacks in women over the age of forty. It is a fact that oral contraceptives cause salt retention, which in turn raises blood pressure, and they also promote the formation of blood clots by increasing levels of our clotting factors. Oral contraceptives increase the triglyceride level in the blood while decreasing the amount of HDL cholesterol (good cholesterol). If you are a woman approaching the age of forty, and on birth control, you should consult your physician and discuss the matter. Your physician will base his or her decision upon your general physical condition.
Conclusion
We have discussed the most important risk factors that promote atherosclerosis. Remember that these risk factors are based on statistics from studies of large groups of people might not be valid. Being in a high-risk group does not mean that you will suffer a heart attack; it means that statistically it is possible to develop the condition. Furthermore, being free of risk factors is no guarantee of immunity. Many individuals who have suffered a heart attack never smoked, have low cholesterol levels, and exercise regularly.
Assess the state of your health with your physician and establish a follow-up program and regular visits to maintain a good and a healthy body.
Learn more about your risk factors and determine which risk factor predisposes you to have a heart attack. Try to apply the guidelines presented in this chapter and benefit from them.
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