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What Is Your Personal Risk For Heart Disease? Cardiovascular disease and blood cholesterol Many years of experience and scientific studies have shown a close relationship between cardiovascular disease and blood cholesterol levels. The National Heart and Blood Institute periodically brings together a panel of experts to discuss the latest advances in our understanding of cholesterol and cardiovascular risk and to create a set of national guidelines for patient evaluation and treatment. LDL or "bad" Cholesterol To get a better appreciation of your actual cardiovascular risk, it is helpful to look more closely at the pattern of fats or "lipids" carried in the blood. Within that total cholesterol number are a number of sub fractions. One of the most important of these is the "LDL Cholesterol", commonly described as the "bad" cholesterol because the higher the level of LDL Cholesterol, the greater the risk for developing cardiovascular disease. It is thought that "LDL Cholesterol" is taken up by the blood vessels where it accumulates and this process is important in the development of arteriosclerosis and vascular disease. Desirable levels are less than 130mg/dL and ideal levels are less than 100mg/dl. HDL or "good" Cholesterol Another important cholesterol sub fraction is the "HDL Cholesterol" commonly described as the "good cholesterol" because in most cases, the higher the level, the lower the risk for developing cardiovascular disease. The HDL cholesterol is thought to be involved in a process called "reverse cholesterol transport" by which cholesterol is carried from the tissues of the body back to the liver for removal from the body. Desirable levels of HDL cholesterol are 45mg/dl or above for men and 55mg/dl for women. Levels of 40mg/dL or less are associated with high risk of developing cardiovascular disease and levels of 60mg/dL or more are associated with a reduction of risk for cardiovascular disease. Triglycerides Triglicerides are another component of the group of fats that are carried in the blood that are associated with cardiovascular risk. Triglycerides are the body's way of carrying fatty acids to the tissues where they can be metabolized to provide energy. High levels of triglycerides have been associated with increased incidence of cardiac events and very high levels can also cause pancreatitis (inflammation of the pancreas). Desirable levels are less than 150mg/dL and optimal levels are less than 100mg. In trying to evaluate your own personal risk for developing cardiovascular risk, one needs to take into consideration risk factors other than cholesterol and triglycerides. One of the most important of these is the presence of diabetes mellitus. If you have diabetes, your risk for a cardiovascular event is very high, in fact as high as someone that already has had documented cardiovascular disease. Other major risk factors that are important include: Cigarette Smoking, High Blood Pressure, A family history of heart disease at a young age (the older the age, the higher the risk), obesity and physical inactivity. Other Risk Factors In trying to evaluate your own personal risk for developing cardiovascular disease, one needs to take into consideration risk factors other than cholesterol and triglycerides. One of the most important of these is the presence of diabetes mellitus. If you have diabetes, your risk for a cardiovascular event is very high, in fact as high as someone that already has had documented cardiovascular disease. Other major risk factors that are important include:
Cardiac Risk Self Assessment The Adult Treatment Panel III has developed a simplified risk analysis algorithm utilizing some of these risk factors including smoking, age, blood pressure, total cholesterol and HDL cholesterol level to help you evaluate your personal risk. This chart assigns a point score for your measurement in each of these risk categories. Totaling these points up will give you an estimate of your personal risk for having a cardiac event in the next 10 years. Using your 10 year risk score, and the number of risk factors (1-5 from the list above), you can calculate your personal risk for having a cardiac event.
Metabolic Syndrome There is another group of individuals that have a high cardiac risk but do not have markedly elevated levels of total cholesterol or LDL cholesterol. These people have a disorder that is commonly called the "METABOLIC SYNDROME" This disorder is composed of a cluster of abnormalities, one of which is an abnormality of glucose metabolism where the individuals are resistant to the effects of their own insulin. Another name for this is the "Insulin Resistance Syndrome". These people may have mildly elevated levels of glucose (sugar) in the blood or their blood glucose levels may be normal, but they may require a higher than normal level of circulating insulin to maintain a normal glucose level. Many but not all will eventually go on to develop diabetes as they get older, become more obese, or adopt a more sedentary life style. The ATP III guidelines have defined the following components to the "metabolic syndrome":
If you have 3 or more of these characteristics, you have the "Metabolic Syndrome" and are at increased risk for cardiovascular disease as well as at increased risk for the development of diabetes. Cardio-CRP Another blood measurement which is proving to be very helpful in evaluating the risk of developing a heart attack or a stroke is called the "high sensitivity C-Reactive protein (HS-CRP) , also known as "Cardio-CRP". Cardio-CRP is a marker for low level tissue injury or inflammation within the body. Low levels of chronic inflammation are thought to accelerate the process of atherosclerosis. The test is not specific for any particular type of tissue injury or inflammatory process so that it should be measured several times in order to clarify that the individual does has "chronic inflammation". Knowing your Cardio-CRP measurement is especially valuable for people with an intermediate cardiac risk (i.e. 2 or more risk factors) to help determine how aggressive a risk factor modification program should be initiated. Having an elevated HS-CRP also is associated with a large increase in risk in individuals with the "Metabolic Syndrome". Actual numbers may vary with different laboratories but in general, an HS-CRP level below 1.0mg/L signifies low risk, 1-3 mg/L signifies intermediate risk, over 3mg/L signifies high risk. The test is particularly helpful when used in conjunction with the cholesterol profile to evaluate risk. However, even patients with normal cholesterol levels that have a chronically elevated HS-CRP are at increased risk for heart attack anhd stroke. Drugs that lower cardiovascular risk such as "Statins" or aspirin also lower HS-CRP. |
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