Heart disease: epidemiology, risk factors, and management

Heart Disease

According to the Centers for Disease Prevention and Control (CDC), heart disease currently causes almost a third of all deaths in the United States: about 652,091 per year. The National Institutes of Health calls heart disease the "number one killer" in the United States. The statistics are alarming not only in their sheer numbers but also in the fact that heart disease is a partly a preventable problem. Although heredity plays a major role in heart disease etiology, lifestyle choices tremendously increase risk for heart disease. Smoking, poor dietary habits, and a sedentary lifestyle are all major causes for increased risk for heart disease, and are preventable. Obesity and diabetes, which can also be caused by lifestyle factors, increase risk for heart disease. High cholesterol places persons at a greater risk for heart disease, and in most cases cholesterol levels can be lowered by changes to diet. Similarly, high blood pressure can be a precursor to heart disease and can be readily controlled with dietary and lifestyle changes. Other risk factors that are less linked to lifestyle include arrhythmias (irregular heart beats) and peripheral artery disease (PAD).

Some individuals are born with defects that can lead to serious heart complications and disease. Although risk for heart disease increases with age, children born with congenital heart defects may develop heart disease at a younger age than the general population. Individuals who increase their risk by smoking or becoming overweight may develop heart disease at a relatively young age. Women are more likely to develop heart disease after menopause because of the lack of estrogen production ("The Heart Truth").

Proximate causes of heart disease include atherosclerosis, the hardening of the arteries due to a buildup of fat and plaque. Diet is the predominant cause of artherosclerosis. The most common type of heart disease is coronary heart disease, which can cause heart attacks. Signs that a heart attack is taking place include chest pain or discomfort, pain or discomfort in the arms, jaw, neck or stomach, and shortness of breath (CDC).

Populations most at risk for developing heart disease include all whose lifestyle habits put them at risk, combined with the presence of congenital heart defects or a history of heart problems including high blood pressure. However, some ethnic groups have a higher prevalence of heart disease. Heart disease is more prevalent among African-American women than white women ("The Heart Truth"). Latinas also have a high risk of heart disease, which is the leading cause of death among Latinas. Most of the risk factors affecting African-American and Latina women are the same for those that affect white women including those that are preventable like diet, smoking habits, and exercise. African-American women do tend to develop high blood pressure earlier than white women, which likely increases their risk of developing heart disease ("The Heart Truth").

Lifestyle changes can reduce risk for heart disease by as much as 82% ("The Heart Truth for Latinas"). Lifestyle factors like diet and exercise require only the knowledge and willingness to change. However, some preventable causes of heart disease are those only doctors and public health organizations can warn patients about. For example, some prescription drugs have been shown to increase risk for heart disease (Fries, nd). In particular, non-steroidal anti-inflammatory drugs (NSAIDs), which are commonly prescribed for relieving the pain associated with arthritis, have been shown to cause heart-related side effects (Fries, nd). Unfortunately, patients who suffer from chronic pain sometimes need to choose between increasing their risk for heart disease and coping with severe chronic pain. Interestingly, though, regular doses of aspirin (between 80 and 160 mg once a day) may help prevent heart disease ("Heart Disease: Antioxidants, Vitamin E, Beta-Carotene and Cardiovascular Disease," nd).

Quitting smoking, eating right, and exercising are among the most important steps for reducing risk of heart disease. Second-hand smoke can unfortunately increase the risk for heart disease. Dietary changes such as eliminating trans fats (partially hydrogenated and hydrogenated oils) and other heavily processed foods will reduce risk for developing heart disease. Stress reduction is also important. Heart disease is best tackled preventatively, via simple lifestyle changes. Screening for heart disease can also alert patients to risk factors and encourage them to adopt lifestyle changes that reduce their risk.