It is far better to prevent a heart attack than to treat it well

Heart disease is the leading cause of death for both men and women. This year an estimated 1,000,000 men and women will have a heart attack and 500,000 to 700,000 will die of heart disease. This death rate has decreased substantially over the past 40 years because of advances in the medical and surgical treatment of heart disease and a better understanding of the factors which cause heart disease.

Several recent and very large studies involving tens of thousands of people have demonstrated the importance of the cardiovascular profile which can identify patients at different levels of risk. People in the low risk categories have a substantially lower risk of having a heart attack. In response to the data, several national organizations have developed guidelines to identify optimal, normal, high-normal, and treatable criteria for these major cardiovascular factors.

The major cardiovascular profile includes:

Age— The incidence of cardiovascular disease increases with advancing age.

Sex— Males have a higher risk of heart disease than females until menopause when women catch up with men. Ten times more women will die of heart disease than will die of breast cancer.

Smoking— Smoking is one of the leading causes of premature death in America. More people die of tobacco-related heart disease than lung cancer.

Family History— A first-degree relative (father, mother, brother, or sister) with early heart disease increases your own risk. Recognizing an undesirable family history allows a person to take steps to prevent the development of their own disease. These steps can include smoking cessation, reducing a high cholesterol, treating elevated blood pressure, maintaining a normal weight, and exercising regularly. The National Cholesterol Education Program defines a high risk family history as one with a male first degree relative (father or brother) under age 55 or a female relative (mother or sister) under age 65 who has had a major coronary event.

High total and low HDL (good) cholesterol— High cholesterol is one of the primary causes of heart disease. Numerous studies have demonstrated that heart disease can be prevented or reduced if cholesterol is lowered to optimal levels. Pharmaceutical companies have recently developed several very effective medications to treat high cholesterol.

HDL, the "good" cholesterol, is now recognized as an independent risk factor for heart disease. An HDL value over 60 is considered protective while a value below 40 carries increased risk.

The National Cholesterol Education Program has set the benchmarks for lipid control.

High blood pressure— One third of all atherosclerosis is due to high blood pressure. There is a continuous graded increase in cardiovascular risk proportionate to the degree of blood pressure even when the blood pressure does not require treatment. The Joint National Commission national classification of blood pressure is:

Obesity— Obesity is the second leading cause of preventable death in America and is responsible for nearly as many premature deaths as smoking. Overweight and obesity are best measured by the body mass index, BMI. The national benchmarks were set by the National Institute of Health which has a BMI calculator at http://nhlbisupport.com/bmi/bmicalc.htm.

Diabetes Mellitus— Diabetes including both Type 1 and the increasingly prevalent Type 2 Diabetes associated with obesity are both associated with cardiovascular disease.

The goal of current medical practice is to identify and modify a person's cardiovascular profile to normal or optimal levels. We could achieve a substantial decrease in coronary disease, morbidity, and mortality, if everyone achieved optimal or normal cardiovascular profile.

These national benchmarks will help physicians better stratify patients, identify those who need treatment and move everyone toward an optimal cardiovascular profile. Understanding the cardiovascular profile has taught us that it is far better to prevent a heart attack than to treat one.