Am I at high risk for a heart at­tack?

The Globe and Mail (Atlantic Edition) - - HEALTH - RONI CARYN RABIN

QUES­TION

How do physi­cians as­sess a pa­tient’s risk for heart at­tack and what fac­tors are taken into con­sid­er­a­tion? Af­ter 20 years of re­sist­ing med­i­ca­tion and be­ing told my choles­terol num­bers were so off the chart I was at ex­treme risk for a heart at­tack, I was told at my last checkup that my 10-year risk for a heart at­tack was only 9 per cent.

AN­SWER

Physi­cians use a num­ber of fac­tors to as­sess your risk of hav­ing a heart at­tack or stroke, in­clud­ing your age, gen­der, race, to­tal choles­terol and lev­els of “good” HDL and “bad” LDL choles­terol. Whether you have high blood pres­sure or di­a­betes and whether you smoke also are im­por­tant risk fac­tors.

Though your level of “bad” choles­terol is a very im­por­tant risk fac­tor, “the need for a choles­terol­low­er­ing statin is not based solely on the LDL level, but on the other risk fac­tors it keeps com­pany with,” said Dr. Robert Eckel, a former pres­i­dent of the Amer­i­can Heart As­so­ci­a­tion.

Weight, phys­i­cal ac­tiv­ity and diet also play a role in heart dis­ease, though they usu­ally aren’t in­cluded in heart-risk cal­cu­la­tors that you find on­line and that physi­cians uti­lize to as­sess risk, from groups such as the Amer­i­can Col­lege of Car­di­ol­ogy. (Some heart-risk cal­cu­la­tors you’ll find on­line have been crit­i­cized for over­es­ti­mat­ing the risk of heart dis­ease, but they can give you a rough idea of where you stand, as long as you’ve had your choles­terol and blood pres­sure tested re­cently).

The es­ti­ma­tion of risk can change based on a sin­gle fac­tor. So, for ex­am­ple, while a 50- or 60-yearold woman with high LDL choles­terol but no other prob­lems might face a very low risk of a heart at­tack or stroke dur­ing the next 10 years, a man of the same age with a sim­i­lar pro­file will be at con­sid­er­ably higher risk. Ad­vanc­ing age in­creases the risk for both men and women.

That said, if your 10-year risk of de­vel­op­ing car­dio­vas­cu­lar dis­ease is as­sessed at 9 per cent, you should con­sider med­i­cal treat­ment. Cur­rent med­i­cal guide­lines rec­om­mend start­ing non-di­a­betic pa­tients ages 40 to 75 on statins once their 10-year risk for car­dio­vas­cu­lar dis­ease is 7.5 per cent or higher.

STU­ART BRAD­FORD/THE NEW YORK TIMES

Physi­cians use a num­ber of dif­fer­ent fac­tors to as­sess your risk of hav­ing a heart at­tack or stroke and the es­ti­ma­tion of risk can change based on a sin­gle fac­tor.

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