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Published on March 22, 2010

Can We Prevent Coronary Heart Disease?

By Ronnier J. Aviles, MD
Overlake Hospital Medical Center-affiliated cardiologist

Coronary heart disease is a preventable disease in many patients. Prevention requires meeting specific treatment targets to address each patient’s risk factors. As I counsel my patients, I find that meeting these targets is often challenging. New medications and public health campaigns have led to significant reductions in cholesterol levels and rates of smoking? two of the major risk factors for coronary heart disease. Despite this progress, a recent study presented at the American Heart Association’s Scientific Sessions 2009 suggests any strides forward have been tempered by a rise in the rates of obesity in the U.S. population. The result, according to the study’s lead investigator: no net improvement in reducing the overall risk profile for coronary heart disease over the past 20 years.

Researchers found:

Positive Findings:

  • An increase in the number of people with optimal cholesterol levels.
  • An increase in the number of people who never smoked.

Negative Findings:

  • An increase in average body mass index (BMI), from 26.5 to 28.8 kg/m2.
  • A decrease in the number of people with optimal blood pressure, from 48 to 43 percent.
    A decrease in the number of people with optimal fasting glucose, from 67 to 58 percent. (Blood pressure and glucose are both linked to obesity.)
  • No change in number of people in whom ALL risk factors were treated optimally.

The call to action for the medical community and patients is clear: focus on prevention of obesity, with lifestyle changes and physical activity identified as key drivers.

Successfully lowering heart attack risk requires a new level of commitment to prevention between patient and physician. This is a partnership where physicians commit to working closely with patients, patients know their specific risk factors and their treatment goals, and both patient and physician commit to achieving these targets. Education is critical. I spend a lot of time listening and discussing each patient’s specific risk factor profile. Some risk factors include:

  • Age. Risk for coronary heart disease increases as you get older.
  • Gender. Men are at greater risk for heart attack than women, but heart attacks are still the number one cause of death in women.
  • Heredity. Heart disease tends to run in families and African Americans are more likely to develop heart disease.
  • High cholesterol. As cholesterol rises, so does the risk for coronary heart disease. Optimal cholesterol level depends on the risk profile for each patient.
  • High blood pressure. High blood pressure makes the heart work harder and causes the heart to increase in size. When combined with other risk factors like obesity, smoking and high cholesterol, the risk for heart attack rises dramatically.
  • High blood sugar. Diabetes increases your risk for high cholesterol and high blood pressure.

The lifestyle changes I recommend to prevent coronary heart disease include:

Eat a heart-healthy diet. Focus on portion control and healthy food groups: lean protein, low-fat dairy, whole grains, vegetables and fruits. Avoiding saturated fats also reduces heart attack risk.

Add physical activity. Try to get 30 minutes of moderate aerobic exercise five days per week, including walking, running, swimming, biking and dancing. Moderate strength training is also helpful.

Quit smoking. Healthy people reduce their risk of heart disease by 50 percent one year after quitting smoking.

Maintain a healthy weight. Excess weight, especially around the middle, can increase cholesterol, blood pressure and your risk for diabetes.

Limit alcohol consumption. Too much alcohol can increase your blood pressure, contributes to obesity and irregular heartbeat. The daily limit is no more than one drink for women and two for men.

This study highlights a very important issue: to lower the number of patients suffering heart attacks in our communities, we need to do a better job of treating all the risk factors that lead to development of coronary heart disease. Know your risk factors and know your specific targets for treatment. I encourage you to partner with your physician to prevent coronary heart disease.

Helpful Web sites include: