Heart disease remains the leading cause of death in the U.S. But who's at the most risk?
A study in the lastest New England Journal of Medicine offers a simple way to predict the risk of a fatal or debilitating heart attack or stroke for a middle-aged person over the rest of his or her life.
"If at age 45 you have two or more of either elevated blood pressure, cholesterol, diabetes or smoking, and you're a man, then there's a 50-50 proposition that you will have a heart attack or a stroke during your remaining lifespan," cardiologist Donald Lloyd-Jones, who headed the study at Northwestern University's Feinberg School of Medicine. Women with two risk factors have about a 30 percent chance.
Having even one risk factor dramatically increases the risk of heart disease. And 95 percent of middle-aged Americans (ages 45-55) have at least one risk factor for heart disease.
In this study, Lloyd-Jones and his colleagues tallied the results of 18 long-term studies conducted over the past 50 years. The studies included men and women, African-Americans and whites. All told, there was information on more than 250,000 adults.
The specific risk factors were most important, regardless of age or race.
If you've got some of these risk factors, don't despair, though. You may not be able to get down to zero, but you can reduce the odds for cardiovascular trouble with exercise, a better diet and treatment for the conditions.
Indeed, Lloyd-Jones says talking about lifetime risks may help motivate patients do that sooner rather than later.
He says he worries that patients won't take action on diet or exercise when they hear they have just a 3 or 4 percent risk of suffering a debilitating heart attack or stroke over the next five or 10 years. If, on the other hand, he provides a clearer picture about what is in store for them over a lifetime, they'll be more likely to adhere to a healthful lifestyle.
There was some heartening information in the study, according to Lloyd-Jones. Nonsmokers who make it to middle age with normal blood pressure, cholesterol and blood sugar have almost no risk of heart disease. "Our data suggested that for a 45-year-old man the likelihood that he would have a heart or stroke by 80 was only 1.4 percent," Lloyd-Jones says.
If more people could get to middle age without the usual risks, it could make a big difference. That means patients and doctors should start tracking blood pressure, cholesterol and blood sugar starting early in adulthood.
Cardiologist Gordon Tomaselli, president of the American Heart Association, says young adults without a doctor should measure their blood pressure on their own with one of the automated blood pressure cuffs common at pharmacies and grocery stores. If the reading is high, get to a doctor.
If there's a family history for high cholesterol or diabetes, get that checked early too.
Diet, exercise and drugs can be highly effective when people have these health problems, Tomaselli says. And while they can't wipe out heart disease risk entirely, they can keep it under control.