Features September 2013 Issue

A Heart-Healthy Lifestyle Now May Prevent Events Later On

Cardiovascular disease doesn’t happen overnight. It’s a slow process that starts as early as age 5. From the moment fatty plaques appear in the arteries, the chance they will eventually block blood flow to the heart, brain or kidneys steadily grows.

Just as developing cardiovascular disease takes time, so does slowing its progression. The good news is that you can. Two recent studies illustrate how taking control of certain risk factors can help keep you healthy.

“There is no way to predict how cardiovascular disease might affect you, whether you will have a heart attack or a stroke or kidney failure. That’s why you need to pay attention to all the risk factors you have,” says Leslie Cho, MD, Director of Preventive Cardiology and Rehabilitation at Cleveland Clinic.

Healthy lifestyle, healthy heart
There are seven risk factors that can be modified to change the risk of cardiovascular disease, a group the American Heart Association calls “Life’s Simple 7.” A study published in the June 2, 2013, American Journal of Epidemiology found that individuals who did the best job of managing four of these risk factors by maintaining a normal weight, eating a heart-healthy diet, staying physically active and not smoking had less coronary artery disease than those who had no healthy behaviors. As a result, they were 80 percent less likely to die over the eight-year study period.

In this study, the researchers determined the extent of hard calcium deposits in participants’ arteries using coronary artery calcium (CAC) scoring. A higher CAC score means more disease and greater risk.

CAC identifies old, stable plaques, the kind that produce chest pain with exertion. It doesn’t see the soft, lipid-filled plaques that are prone to sudden rupture, causing a heart attack without warning. Today, we know that soft plaques are far more dangerous than hard plaques, which are primarily found in the arteries of many senior citizens.

“The test has very limited role in the elderly, because as you get older, your calcium score will be high,” says Dr. Cho. “We can figure out your risk for heart attack with a physical examination, personal and family medical history and a blood test. Using more traditional methods, we can determine your treatment will be the same.”

Take kidney disease seriously
Although heart attack and stroke get more press, kidney disease is a common and serious consequence of uncontrolled cardiovascular risk factors in general, and blood pressure and blood sugar in particular.

“Hypertension and diabetes increase the risk for renal (kidney) failure and account for the majority of cases of renal dysfunction. And in every study, poor kidney function increases the risk of heart attack, stroke, deaths and hospitalizations,” says Dr. Cho.
In a study published in the June 28, 2013, Journal of the American Society of Nephrology, researchers found that good management of Life’s Simple 7 helped patients with chronic kidney disease slow disease progression and prevent kidney failure.

How is this connected to heart disease? Dr. Cho explains. “When the heart isn’t pumping well due to heart failure or heart attack, blood flow through the kidneys is poor, and kidney cells die. Renal artery disease, which is just like coronary artery disease, but in the kidneys, can also restrict blood flow and high blood pressure in the kidney can kill its cells,” she says.

Diabetes, a major risk factor for heart disease, is a leading risk factor for kidney failure. Although tight blood sugar control does not reduce the risk of heart attack, it does help preserve kidney health.

“We tell patients with diabetes that tight blood sugar control is critical, not so much for their heart, but for their kidneys,” says Dr. Cho.

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