Cardiovascular Risk Factors

Malnutrition and the lack of physical activity are the causes of excess weight, diabetes, high blood pressure and lipometabolic disorders. These factors combined with the intake of nicotine are the primary health conditions of our society and are thus often responsible for premature death. Among other problems, these conditions damage our blood vessels (arteriosclerosis) and might lead to cardiac arrest or strokes. The more and the longer one exposes oneself to these risk factors, the higher the risk of such medical conditions. In view of this, the number of obese teenager and children with diabetes and high blood pressure is alarming, since they are at risk from a very young age onwards. Later in life, time pressure and work stress contribute their share to the increased risk of heart conditions and often preventive care is just forgotten in the course of dealing with the struggle of survival in our daily life. Almost everybody knows a friend, colleague or relative who died from cardiac arrest or just survived a heart attack. Cardiologists are frequently only consulted when it is too late. A heart attack leaves heavy psychological marks behind, not to mention the physical impairment caused by cardiac insufficiency, cardiac arrhythmia or the side effects of the indispensable treatment with medicines.

It is crucial to intervene by means of preventive care as early as possible and to come up with the adequate strategy aimed at reducing the risk of cardiovascular conditions for any risk patient. The prerequisite for this consists of a careful analysis of the individual’s risk and a thorough cardiologic examination. Following this, the patient should be advised on diet, stop smoking approaches and adequate physical exercise. These will serve as the basis for staying healthy in the long run.

Definition

Cardiovascular risk indicates the probability to acquire cardiovascular conditions such as heart attack, stroke or peripheral arterial occlusive disease. Certain cardiovascular risk factors increase this probability – the main one being arteriosclerosis.

Arteriosclerosis is the clogging up of blood vessels by fatty substances, blood clots, connective tissue and in small amounts calc. In the long run this causes the lumen of the vessels to become narrow. The following organs are the most affected by arteriosclerosis:

• Heart: coronary disease, heart attack
• Brain: stroke
• Peripheral vessels: peripheral arterial disease of the legs such as intermittent claudication
• Kidney: renal artery stenosis, cirrhotic kidney
• Eyes: damages to the retina (sight impairment or blindness)
• Intestines: bowel infarction caused by occlusion of the mesenteric arteries

Risk factors

Avoidable risk factors for arteriosclerosis are

• High blood pressure
• Disorders of the lipoid metabolism
• Diabetes mellitus
• Overweight
• Smoking
• Stress

A high number of these risk factors are due to lack of physical exercise, malnutrition and high intake of alcohol.

Non-influenceable risk factors include age, being male as well as genetic disposition.

It is difficult to predict the individual influence of each of these risk factors, however, it is certain that the unhealthier the life style is and the more risk factors accumulate, the higher the risk of developing arteriosclerosis and thus heart attack or peripheral arterial occlusive disease.

High blood pressure

Arterial hypertension, also called high blood pressure in everyday language, is a disorder, where the blood pressure of the arterial system is chronically increased. According to the WHO definition, systolic blood pressure over 140 mmHg or diastolic blood pressure over 90 mmHg is considered hypertension. Reasons for hypertension are conditions of the hormone system, the cardiovascular system, as well as kidney problems. The majority of hypertension cases, however, are due to unknown causes.

Quite frequently, hypertension goes unnoticed for a number of years, as it does not cause any problems in its early stages, and is thus often only diagnosed after the onset of any complications. Consequential damage, like coronary heart disease with its possible sequelae of heart attacks, kidney failure and strokes, is responsible for the majority of the death cases in developed countries. There are different groups of medications available, which in connection with changes of the life style, can decrease the blood pressure and thus reduce the risk of complications.

Consequences of acute hypertension (hypertensive crisis: increase in blood pressure > 120 mmHg diastolic):

• Cardiac: angina pectoris (chest pain), breathing problems, cardiac arrhythmia, stroke, acute, left ventricular failure with pulmonary oedema, aortic dissection
• Cerebral: head ache, nausea, impaired vision, confusion, coma, intracerebral bleeding
• Renal: acute kidney failure

Consequences of chronically increased blood pressure:

• With heart involvement = hypertensive heart condition
  • Cardiac hypertrophy
  • Coronary arteriosclerosis, heart attack
  • Cardiac insufficiency
  • 70% of all hypertonic patients die from cardiovascular squelae (heart attack, cardiac insufficiency, stroke)
• With brain involvement = stroke
• With kidney involvement = hypertensive nephropathy, chronic kidney failure
• With vessel involvement = arterial obstruction

Diabetes mellitus

Diabetes mellitus is a metabolic condition in which a person has high blood sugar levels as a result of the body not being able to absorb the glucose from the blood. At the beginning, elevated sugar levels produce symptoms such as increased thirst, frequent urination, and fatigue. If not treated and consequently the sugar level stays elevated over years, there will be damage to vessels and organs (arteriosclerosis, heart attack, retinal disorder, nephropathy, neuropathy, diabetic foot ulcers). Diabetes is diagnosed if

• Casual plasma glucose is at or above 200 mg/dl
• Fasting plasma glucose level at or above 126 mg/dl in two test results
• The long term plasma glucose HbA1c at or above 6,5%

Casual plasma glucose levels can be tested at any time of the day and even fasting is not required, however, for a fasting level, the patient is required to fast 8 hours before. Long term values do not depend on food intake and can be done at any time of the day.

Overweight

Body mass index (BMI) defines people as overweight when their BMI is over 25km/m2 and as obese as of 30kg/m2. The body mass index is calculated by dividing the subject’s mass (kg) by the square of his or her height (m) (BMI = kg/m2). The decisive factor for a cardiovascular disease, however, is not only the BMI but also the fat distribution. Fat accumulations around the stomach and the inner organs have shown to be more harmful. Thus, waist girth of over 92 cm in males and over 80 cm in females increases the risk of cardiovascular conditions. Weight reduction is advised in such cases.

Diet and life style should be reconsidered in case of obesity. The right choice of foods can have a positive influence onto metabolic disorders such as lipoid metabolic disorder or elevated blood sugar levels. High fiber foods, whole meal products, sufficient fluid intake, as well as a good variety of lettuce, fruit and vegetables are recommended. Known sources of fat like butter, nuts or mayonnaise as well sugary foods, salt and alcohol should be avoided.

Smoking

Smokers suffer from an 2-5 times elevated risk of heart attack, depending on the number of cigarettes consumed per day and the years of smoking (pack-years). Nicotine penetrates into the autonomic nervous system and causes stenosis of the arteries, increases the heart beat and the blood pressure. In sum, the risk of arteriosclerosis is increased.

Stress

Stress is one of the core risk factors for coronary heart conditions. It leads to an increase of the stress hormone cortisol, which triggers the production of molecules damaging the vessels. For a long time cardiologists considered the stress factor primarily in “manager-type” patients, i.e. people under huge pressure to perform, working more than 12 hours per day with no time to relax. Meanwhile, it has emerged that stress per se is not the decisive factor, rather the way stress is felt is more crucial. If stress fires a person up and is connected with the feeling of success and achievement – psychologists call this eustress – it rarely has a negative impact onto the heart, of course under the condition that there is no consumption of performance-enhancing drugs, such as cocaine. Stress with a high level of frustration, called distress, has a much higher influence onto the function of the heart. To reduce stress one should relax by regularly exercising or by methods such as autogenic training or mediation.

Lack of exercise

Lack of physical exercise might not directly lead to damage in the vessels, but all other risk factors for arteriosclerosis are avoided or improved by physical movement; and progression of the condition can be brought to a halt. At the same time, stamina increases. Best results of the miracle exercise are achieved through regularity and adequate intensity, though excessive overtraining should be avoided. It is best to consult the physician first to assess which type of sports is appropriate. Personal performance limits can be established through exercise ECG.

Endurance sports such as walking, gentle running, cross country skiing, swimming and cycling are well suited. Training should last for a longer period (optimal: 30 mins) with low to medium intensity, whereby it has to be stated that frequency is better than duration. Therefore, it is better to train 3 times a week for 30 minutes rather than once for 90. It is important not to demand too much from oneself and angina pectoris pain should not increase during exercise. Even extensive walks three to four times a week suffice to become healthier. Power training with its short but intensive stress is less recommended. Such sports include tennis, mountain biking, squash or weight training with heavy weights.

Genetic disposition

The risk for developing coronary heart condition is clearly increased in case of a positive family history (first degree relatives with coronary heart conditions). In order to assess the risk of arteriosclerosis, lipoprotein-a values in the blood have to be measured. The higher the value of lipoprotein-a, the higher the risk for arteriosclerosis, despite the fact that the amount of lipoprotein-a in our blood is genetically determined. This value poses an additional independent indicator for arteriosclerosis. The genetic disposition cannot be influenced, which means that the total of risk factors should be kept as low as possible (blood pressure, blood sugar, cholesterol, etc.).

Tips for a vessel-healthy lifestyle

• Do not smoke.
• Adjust your diet: less alcohol, less fat and fatty (red) meats, more fish, white meat (poultry), vegetables, fruits and whole-grain products.
• Exercise regularly. Take a brisk walk of at least 30 minutes a day. Choose an activity that you will enjoy such as running, swimming or cycling.
• Reduce any overweight. You can achieve a lot by eating right and exercising. If this does not bring the desired results, consult your doctor or dietician.
• Go in for regular check-ups and preventive exams. If you suffer from high blood pressure, diabetes or high cholesterol, you need to be treated.
• Take all the medication prescribed to you.