12 Risk Factors for Heart Disease
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February is heart awareness month and it’s a good reminder of why we should keep our momentum for healthy living in the new year.
Every week this February, we are going to be sharing tips and information to help you achieve and maintain a heart healthy lifestyle.
To kick off the month, Dr. Rajal Patel from our office in Mooresville, N.C. is sharing information on how to assess our risk for heart disease.
Heart disease remains the leading cause of death in the United States. The good news is that we are able to significantly change our cardiometabolic risk. Most of us can list the usual suspects: obesity, diabetes, hypertension, high cholesterol, and smoking. Let’s take a deeper dive into those risks and expand to other risks.
We’ll focus on those that we can impact with our lifestyle first.
Weight, it’s not just about the BMI, but where are you carrying that extra weight? While it’s important to know your BMI, your waist circumference and waist to hip circumference ratio is a better predictor of cardiometabolic risk. You have higher risk if your waist circumference is above 35 inches for a woman, or 40 inches for a man, and/or if your waist to hip ratio is greater than 0.8. Excess body fat increases inflammation and toxic byproducts. It will increase your insulin level which will worsen your glucose and cholesterol management. It increases estrogen levels in women which may lead to fibroids, breast cancer, PCOS, PMS, etc. It will decrease testosterone levels for men. Each of these imbalances will feed into one another and any of them may further increase your cardiometabolic risk.
Diabetes, or rather glucose dysregulation and insulin resistance. Diabetes doesn’t develop overnight, there’s usually been at least 10-15 years of gradual glucosedys regulation before the diagnosis is made. Look at your labs. Current definitions for glucose impairment are a fasting above 99, or an elevated A1c (prediabetes 5.7-6.4, diabetes 6.5 or above). However, you have years of slow dysregulation before you may see those numbers. Consistent glucose levels above 86 or A1cs above 5.3 suggest the beginnings of dysregulation. Hyperglycemia causes inflammation and increases oxidative stress leading to damage to blood vessels and nerves. Insulin resistance occurs as organs in your body such as muscles, fat, and liver cells no longer respond to insulin signaling to utilize glucose. This in turn contributes to rising glucose levels, fatty liver, hormonal dysregulation such as PCOS, increased risk for Alzheimer’s and osteoporosis, and increased weight gain. Increased stressors in your life, may increase your cortisol levels which will worsen insulin resistance. An unhealthy gut microbiome, and increased bowel permeability (leaky gut) also increase your risk for developing diabetes and obesity.
Hypertension. Healthy blood pressure is under 120/80. Elevated blood pressures cause strain and damage to blood vessel walls which allow cholesterol and other substances to deposit and form plaques. It may cause congestive heart failure as the heart enlarges to pump against the stiffened vessels. Narrowed arterial walls may cause kidney damage, erectile dysfunction, non-healing wounds, and peripheral vascular disease.
Cholesterol. There are two things you need to know - elevation or dysfunctional patterns help create plaques and plaque formation is an inflammatory state.
Most of us know that LDL (bad cholesterol) being high is a risk factor. The particle size and number of LDL provides a much better assessment of that risk. Particle number indicates the concentration of LDL, the higher the number the higher the risk. Particle size will show how many small, medium, or large size LDLs are present. The greater the number of small LDL the higher the risk. These small particles are more likely to enter small cracks and damaged areas in arterial walls and cause an inflammatory reaction leading to plaques.
Your LDL may also be modified and damaged increasing your risk. If your A1c is elevated, you will have sugar molecules that attach to your LDL, this will make them smaller, denser, and stickier and therefore more likely to attach to arterial walls and cause inflammation (think of spilling a soft drink on a couch and the stickiness of that area). You can oxidize your LDL with things like smoking, poor diet, leaky gut, infection. The oxidation makes them more atherogenic or plaque forming. Picture it like rust on a car.
If your triglycerides are high and your HDL is low, it’s a good indication that you are having insulin resistance issues.
HDL is your good cholesterol, if it is low or dysfunctional (smaller in size) than it is less effective in reabsorbing cholesterol in your arteries and keeping them clean.
Apo B will measure the number of atherogenic (plaque forming) particles and is also a better measure than just LDL. You have significantly elevated risk If the number is 130 mg/dL or above.
Lp(a) is a genetic marker, it is the preferred carrier of oxidized LDL. If it’s elevated, there’s a greater potential for plaque formation and inflammation.
hsCRP gives us information on inflammation, elevated levels indicate higher risk for plaque formations.
Lp PLA2 represents inflammation in the vascular walls and plaque vulnerability (how likely it is to cause an acute blockage).
Smoking causes increased inflammation, plaque formation, oxidation of LDL, raises the risk of developing diabetes and hypertension, and sets off a host of other inflammatory cascades that will affect your health.
Physical inactivity and sedentary behavior. Exercise helps reduce your blood pressure, improve your sugars and cholesterol panel, lose weight, sleep better, relieve stress, and improve hormone levels for a start. All of these will reduce your risk. Sedentary behavior seems to be an independent risk from exercise or inactivity. Avoid sitting for hours at a time, try to move every hour.
Sleep apnea may increase the risk for hypertension, heart failure, arrhythmias, stroke, heart attacks, and is often associated with obesity.
Alcohol will raise your blood pressure, cause liver damage, and may increase weight with extra calories.
Then there are risk factors that you may not be able to change directly, however, lifestyle factors help may offset their risk.
Family history of early cardiovascular disease.
Chronic inflammatory diseases like psoriasis, rheumatoid arthritis, lupus, or HIV/AIDS may directly affect the heart and other organs by causing inflammation and increase plaque formation. Chronic kidney disease may increase blood pressure, cause electrolyte and calcium abnormalities, and anemias that may affect the ability to carry oxygen, dilate arterial walls, and increase the stress the heart pumps against.
Early menopause (before age 40).
Preeclampsia with pregnancy.
Stay tuned, next week we’ll discuss what you’re able to do and how we may help to offset these risks.
Dr. Rajal Patel is a physician at WellcomeMD’s medical concierge clinic in Mooresville, North Carolina. Dr. Patel is proficient in all aspects of primary care, with expertise in gut and hormone health and considerable experience treating patients with chronic conditions. To help her patients find optimal health, she focuses on the underlying lifestyle behaviors, stressors, and environmental exposures that drive disease.
Dr. Patel is board-certified in Family Medicine, a Diplomate of the American Board of Integrative Holistic Medicine. After earning her dual Doctor of Medicine and Master of Public Health degrees from the University of Michigan, Dr. Rajal Patel served as an attending physician in New York City before relocating to Mooresville in 1999.
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