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Dr K K Aggarwal

Nine modifiable risk factors for heart attack

By Dr K K Aggarwal
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The majority of known risk factors for heart attack are modifiable by specific preventive measures.

The nine potentially modifiable factors include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, daily consumption of fruits and vegetables and regular physical activity. These account for over 90 percent of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10-year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one-half, and after several years begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

The majority of known risk factors for heart attack disease are modifiable by specific preventive measures.

Nine potentially modifiable factors: include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, and one should daily consume of fruits and vegetables and do regular physical activity. These account for over 90 percent of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10-year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one-half, and after several years begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

A too-tight shirt collar can indicate future heart trouble. The standard ways to assess obesity is to measure the waistline and determine body-mass index.

An obese person can be pear-shaped, with most of the non visceral excess fat weight around the hips; or apple-shaped, with most of the visceral fat weight in the upper part of the body. Cardiologists up till now have been measuring the abdominal fat to help assess the risk of heart disease but now fat in the neck has been shown to be associated with good cholesterol levels and diabetes.

Waist circumference represents visceral fat in the abdomen and neck fats denote visceral fat in the upper body. Both independently contribute to cardio metabolic risk. A fat neck is a ‘crude measure’ of upper body fat.

The Framingham Heart Study using data on 3,320 people has shown that “Neck circumference is associated with cardio-metabolic risk factors, even after adjustment for visceral fat. While risk was higher regardless of waistline, it was compounded for those who had both a fat neck and who were larger than average around the middle.

The research findings

1. Average neck circumferences were 40.5cm in men and 34.2 cm in women.

2. For every nearly-3 cm more of neck, men had 2.2 mg/dl less good HDL cholesterol.

3.  For every nearly-3 cm more of neck, women had 2.7 mg/dl less good HDL cholesterol.

4. For every nearly-3 cm more of neck, men had 3.0 mg/dl more blood glucose levels.

5. For every nearly-3 cm more of neck, women had 2.1 mg/dl more blood glucose levels.

Implications

1. 1% reduction in HDL cholesterol increases the chances of heart attack by 3% and vice versa.

2. In adults with a BMI of 22.9 to 34.9 kg/m2, a waist circumference greater than 85 cm for men and 80 cm for women is associated with a greater risk of hypertension, type 2 diabetes, and dyslipidemia, and heart disease.

3. In patients with a BMI ≥ 35 kg/m2, measurement of waist circumference is less helpful since it adds little to the predictive power of the disease risk classification of BMI; almost all individuals with this BMI also have an abnormal waist circumference.

4. A neck circumference of > 42.5 cm is also associated with snoring with sleep apnea and subsequent high blood pressure.