More people could be spared from sudden death or a non-fatal heart attack if their physicians assessed their risk factors.
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October 9, 2001
By Alice Chang, M.D.
Harvard Medical School
How does this article relate to you?
In the past decade, medicine has made huge strides in the treatment of heart attacks. But what this article highlights is that we still have room to improve when it comes to reducing risk factors to prevent first heart attacks. Prevention specialists in this article are recommending more aggressive testing to better define a person's risk of heart disease in order to take earlier action to reduce these risks.
Physicians already screen for the prime risk factors for coronary heart disease, the narrowing of the arteries that leads to heart attacks. But it can be difficult to get someone to make lifestyle changes or to follow treatment recommendations when there are no symptoms of disease. If this article simply makes us more willing to make dramatic changes in our diet and our activity levels, or to treat with or to take medications, then it could have a significant impact.
The problem with this article's recommendations is that we don't know for sure that any of the tests recommended will change your doctor's recommendation about your risks. If ultrasound and special blood-pressure checks reveal diseased arteries in your legs or neck, you may have a higher risk of having heart disease. Ultimately, however, your physician would make the same treatment recommendations to lower your "bad cholesterol" or improve your "good cholesterol" without these extra tests.
What changes do you need to make?
It is important to realize that these are recommendations but not studied, proven measures for reducing heart attacks or deaths due to heart attacks. This article is a call to action for health-care providers and their patients to step up prevention measures a notch. At your next physical, make sure to find out if you have any of the following risk factors:
- Smoking
- High blood pressure
- High total blood cholesterol
- High LDL (bad cholesterol
- Low HDL (good cholesterol)
- Obesity and a sedentary lifestyle
If you have even one of these risk factors you can do something to lower your chances of having a heart attack. Discuss with your doctor whether you are having any symptoms of diseased arteries and whether you should have an appropriate test to see if you are indeed at higher risk, because you can find diseased arteries in places other than the heart. The results might change whether you start a medication for your cholesterol or your blood pressure. If you are still struggling to quit smoking, try a new tactic with the help of your health-care provider.
The article's authors make the strongest recommendation for people in the highest risk group, who are known to have diseased arteries in other parts of the body, coronary artery disease, diabetes and/or have multiple risk factors. Many drugs have been shown to decrease deaths and repeat heart attacks after a first heart attack, and these therapies should be offered to people at high risk, even if they have not had a heart attack yet.
What can you expect in the future?
As always, studies help to determine whether a treatment strategy works. We would like to see proof that ordering more tests will help save lives before anyone makes this a national guideline for preventing heart attacks. In addition, additional testing and prescribing could mean a significant cost to you and/or the health-care system.
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