Cardiac Risk: Late repentance is useless

5. March 2012

Whoever cuts their cardiac risk factors often believes that they are then on the safe side. Yet this sense of safety is a deception for the middle-aged: according to U.S. authors, five-or ten-year cardiac risk may then be reduced, but over a lifetime period it isn't.

Excess body weight, lack of exercise, stress, smoking and more – in the prevention of cardiovascular diseases, each risk factor that can be eliminated counts. As long as physical changes and damage are not as yet detectable, nothing has as yet happened – a process of rethinking and behavioral changes made towards a healthy lifestyle are the best guarantee of longevity.

This is wrong: such is the opinion of cardiologists working under Jarret Barry of the University of Texas Southwestern Medical Center, because the current approach in the prevention of heart problems is to identify only the short-term cardiac risk. Only a few studies, such as one investigation done in 2006 with participants in the Framingham study, shed some light on the long term risk. Early life decisions might have a major impact on the rest of one’s life and this rule would not apply any differently to the heart. Risk factors for the young and middle aged have an impact on one’s total lifetime, says one analysis of studies from the scientists published in the New England Journal of Medicine.

Each risk factor counts

Data based on the analysis of the lifetime risks for the heart has been collected from 18 cohort studies making up the Cardiovascular Lifetime Risk Pooling Project. The data is part of a 50-year-long investigation. Risk factors such as blood pressure, cholesterol, diabetes and smoking were recorded for more than 250,000 people – men and women – at 45, 55, 65 and 75 years of age as well as cardiovascular disease status. For each age category, the risk of cardiovascular events was determined.

An optimal risk profile was defined as having cholesterol at <180 mg/dl, blood pressure lower than120/80 mmHg, non-smoking status, and no diabetes. For this optimal risk profile at the age of 55 years, the lifetime risk (up to age 80 years) of dying due to cardiovascular disease, with figures being 4.7 percent for men and 6.4 percent for women, is low. With two or more risk factors present, the risk of death due to vascular disease increases to 29.6 percent in men and 20.5 percent for women. Coronary heart disease or nonfatal heart attack is suffered by 3.6 percent of men and less than one percent of women, when they have no risk factors. For those with two or more risk factors, those figures are 37.5 percent for men and 18.3 percent for women.

Who has no risk factor?

Even more dramatic is the comparison of the risks for 45-year-olds. A man of that age not having risk factors only carries a risk of 1.4 percent of dying up to the age of 80 years from cardiovascular disease. With two or more risk factors, the risk increased to 50 percent. For women, the difference is 4.1 versus 31 percent.

Taking into consideration – as is done in most studies – only the five-or ten-year risks, where the risks for 50-year-old risk factor-carriers then become rather small, is something the study’s authors have criticised. In addition, only a slight increase in risk factors – such as slightly elevated cholesterol levels or blood pressure – can increase the risk significantly. Most study participants presented at least one risk factor.

With regard to the prevention of cardiovascular events, the results show that only the avoidance of risk factors in young and middle age was able to considerably reduce cardiovascular disease. When discovered and treated only in middle age, risks can only be slightly reduced and disease only slowed down in progression.

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