Disease Management

Heart Disease: Risk Assessment and Prevention

Cardiovascular Disease – The Facts

(From the Centers for Disease Control & Prevention, “Preventing Heart Disease and Stroke, Addressing the Nation’s Leading Killers, 2004”)

Heart disease and stroke—the principal components of cardiovascular disease—are the first and third leading causes of death for both men and women in the United States, accounting for nearly 40% of all deaths.
Over 930,000 Americans die of cardiovascular disease each year, which amounts to one death every 34 seconds.
Although these largely preventable conditions are more common among people ages 65 years and older, the number of sudden deaths from heart disease among people ages 15–34 has increased.
Deaths are only part of the picture. Over 64 million Americans (almost one-fourth of the population) live with cardiovascular disease.
Coronary heart disease is a leading cause of premature, permanent disability in the U.S. workforce.
Stroke alone accounts for disability among more than 1 million Americans.
Over 6 million hospitalizations each year are due to cardiovascular disease.
The economic impact of cardiovascular disease on the U.S. health care system continues to grow as the population ages. The cost of heart disease and stroke in the United States is projected to be $368 billion in 2004, including health care expenditures and lost productivity from death and disability.

Preventing Cardiovascular Disease

Key strategies for addressing cardiovascular disease risk factors include:

Educating the public, physicians and other health care practitioners about the importance of prevention
Encouraging and supporting physicians and other health care practitioners in adhering to the guidelines for treating patients with or at risk for heart disease and stroke (such as prescribing beta-blockers and aspirin).
Educating the public about the signs and symptoms of heart attacks and stroke and the importance of calling 911 quickly.
Addressing risk factors for heart disease and stroke—such as high blood pressure, high cholesterol, diabetes, tobacco use, physical inactivity, poor nutrition, and overweight and obesity
Encouraging lifestyle changes and appropriate use of medications

Addressing Risk Factors

Risk factors that can’t be changed include:

Heredity – children of parents with cardiovascular disease are more likely to develop it themselves. African-Americans have more severe hypertension than whites. Consequently, their risk of heart disease is greater.
Gender – Men have a greater risk of heart attack than premenopausal women do, and have attacks earlier in life.
Increasing Age – about four out of five people who die of a heart attack are over 65. At older ages, women are twice as likely as men to die within a few weeks of a heart attack.

Risk factors that can be changed include:

Cigarette/Tobacco Smoke – Cigarette smoking is the most important preventable cause of premature death in the United States. It accounts for more than 440,000 of the more than 2.4 million annual deaths. Cigarette smokers have a higher risk of developing a number of chronic disorders. Many studies detail the evidence that cigarette smoking is a major cause of coronary heart disease, which leads to heart attack.
High Blood Cholesterol Levels – The risk of coronary artery disease rises as blood cholesterol levels increase. When other risk factors such as high blood pressure and cigarette smoke are present, this risk increases even more.
High Blood Pressure – High blood pressure increases the heart’s workload, causing it to enlarge and weaken over time. It also increases the risk of stroke, heart attack, kidney failure and congestive heart failure. When someone with high blood pressure is overweight, abuses tobacco, has high blood cholesterol levels or diabetes, the risk of heart attack increases several times.
Physical Inactivity – Even modest levels of low intensity physical activity are beneficial if done regularly and long term. Exercise can help control blood cholesterol, diabetes and obesity as well as help to lower blood pressure.
Obesity – People with an excessive amount of body fat are more likely to develop heart disease even if they have no other risk factors. Excess weight increases the strain on the heart; it influences blood pressure and cholesterol. Current recommendations for cardiovascular risk reduction include maintaining a Body Mass Index (BMI) range between 18.5 – 24.9.
Stress –A relationship between coronary heart disease and chronic stress has been noted.
Substance Abuse – People with a history of substance abuse, particularly cocaine and alcohol abuse place themselves at risk for heart disease.

Reducing the Risk of Cardiovascular Disease

Helping your patients prevent cardiovascular disease begins with assessing their overall cardiovascular risk and helping them to develop and implement a plan for heart healthy living. An interactive assessment tool using information from the Framingham Heart Study can be accessed through a link at our website at PHPMM.org or at http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof.

A complete plan for helping your patients live a heart healthy life includes the following:

Encourage patients to be physically active and to try to get 30-60 minutes of vigorous activity at least 3-4 times a week.
Encourage patients to maintain a healthy weight and to take steps to lose weight if needed. An interactive BMI calculator can be accessed through a link at our website at PHPMM.org or at http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm or http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/profmats.htm (for BMI Palm OS handheld devices download).
Obese children are more likely to be obese adults. Successfully preventing or treating obesity in childhood may reduce the risk of adult obesity, which can help to reduce the risk of heart disease and other diseases. An interactive BMI calculator for children can be accessed through our website at PHPMM.org or at http://www.keepkidshealthy.com/welcome/bmicalculator.html.
Encourage patients to stop smoking! The five major steps to intervention (the “5A’s”) are: Ask, Advise, Assess, Assist and Arrange. For more information, see http://www.surgeongeneral.gov/tobacco
Check your patient’s blood cholesterol & blood pressure levels regularly. Work with your patients to develop a plan to lower blood pressure and/or cholesterol levels if they are elevated.
Recognize and treat diabetes and pre-diabetes in your patients.
Encourage your patients to choose healthy foods that are low in saturated fat, cholesterol and sodium.
Discuss and counsel your patients regarding their use of alcohol and/or illicit drugs.
Assess your patient’s stress level. Offer suggestions to your patients on how to decrease stress.

Sources: Centers for Disease Control, American Heart Association and National Heart, Lung and Blood Institute.