Cardiac Risk Factors and Primary Prevention

Get to know all the relevant information to keep in check to ensure a healthy heart

Cardiac risk factors are the things that increase your likelihood of developing heart disease. These can be genetic, environmental, or lifestyle-related. As cardiac health concerns are rising in the population, these are some of the general question asked to doctors:

What is heart attack and what are its causes?

A heart attack results from an interruption in the blood flow to your heart. The interruption can be caused by a clot or plaque that blocks one of the arteries that supply oxygen-rich blood to your heart, or a ruptured artery can cause it. A heart attack can also occur when the coronary arteries become narrowed or clogged with plaque, which prevents blood from flowing freely through your cardiovascular system, depriving your heart of oxygen. There is no specific cause for a person to develop coronary artery disease; instead, it is a group of risk factors that are either modifiable or non-modifiable.

What are modifiable and non-modifiable risk factors?

Modifiable risk factors are those that can be changed. For example, if you're overweight, reducing your calorie intake can help you lose weight and reduce your risk for heart disease. Most heart attacks can be prevented by controlling the modifiable risk factors such as diabetes, hypertension, high cholesterol (especially LDL cholesterol), obesity, physical inactivity, smoking, and psychosocial stress. Most of these can be controlled by lifestyle modification or taking medication to keep the required blood parameters and blood pressure within normal limits, thus preventing a cardiac event.

The non-modifiable factors are the ones that are already set in stone. They're age, race/ethnicity, gender, and family history.

If I start medication for hypertension, diabetes, or hyperlipidemia, will I have to continue it for my entire life?

This is a question that worries most patients. Another worry is the side effects of the tablets being taken to control the above risk factors. The answer is if patients don't control their risk factors by exercise or diet, they may need to start on low-dose medicines to achieve their targeted goals. Otherwise, they can develop problems secondary to the risk factor. For example, if blood pressure is not kept under 150/100mmHg, it can increase stress on your heart, kidneys, eyes, etc. It can have long-term effects on these organs, which may result in heart attack and kidney failure.

This brings us to the point of primary prevention of cardiac disease or secondary prevention if the person has already had a cardiac event.

Primary Prevention of Cardiovascular Disease: Primary prevention is an approach that focuses on preventing the development of cardiovascular disease in people with no prior history. Promoting a healthy lifestyle is essential to preventing atherosclerotic vascular disease, heart failure, and atrial fibrillation. A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Most clinicians evaluate the social determinants of health that affect individuals to inform treatment decisions. Adults aged between 40 to 75 years who are being evaluated for cardiovascular disease prevention should undergo a 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician-patient risk discussion before starting medications, such as anti-hypertensive therapy, aspirin, or a statin.

Obese or overweight adults must consider caloric restriction under the guidance of a dietician or a physician to achieve or maintain weight loss. A healthy diet with a mix of fruits, whole grains, vegetables, nuts, lean vegetables or animal protein, and fish must be considered by all adults. They should minimise the intake of trans fats, red meat, processed red meats, refined carbohydrates, and sweetened beverages.

All adults who use tobacco should be strongly advised to quit. Even if you're not currently using tobacco products, they can still be harmful (especially through inhaling secondhand smoke). And even if you do smoke, the sooner you quit, the better off your body will be. In addition to lowering your risk of heart disease and stroke, quitting smoking can also improve your overall health and increase your quality of life.

All adults should engage in moderate-intensity physical activity (at least 150 minutes per week of accumulated) or vigorous-intensity physical activity (75 minutes weekly). Exercise helps reduce stress on the heart, while improving circulation and lowering blood pressure—which can help stave off heart attacks and strokes.

If you need more motivation than just knowing the primary prevention tips try setting goals for yourself in coordination with your physician.

Heart Health Screenings

The primary cardiac evaluation involves clinical evaluation to understand the vitals and to see if the blood pressure is within the accepted level. An ECG can help the cardiologist or physician know the heart's electrical system's health and identify any evidence of ischemic changes in the heart. Additionally, an echocardiogram can help to see the functioning of heart muscles and valvular functions. Finally, a stress test helps diagnose flow-limiting blocks in blood vessels that may require Intervention/surgery.

Based on your cardiac risk factors, your cardiologist will pay attention to below mentioned lab results: total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), complete blood count with differential (CBC), Lipoprotein (a), Apolipoprotein B, Homocysteine, Hemoglobin A1c (HbA1c), Fasting glucose, Creatine kinase (CK), Alanine aminotransferase (ALT), or SGPT, Aspartate transaminase (AST), or SGOT, Fibrinogen, Thyroid-stimulating hormone (TSH), Ultra-sensitive C-reactive protein (us-CRP), or high-sensitivity CRP, Urine albumin-creatinine ratio, Amino-terminal, Pro-brain natriuretic peptide, or NT-proBNP, and Serum creatinine.

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