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The major risk factors for heart attack are ones you ought to pay attention to - more evidence
(April 2005)

Healthful Life has always argued that to prevent heart attacks we should concentrate on the major risk factors - elevated blood cholesterol level, high (and high normal) blood pressure, smoking, low levels of high-density lipoprotein cholesterol (HDL, good cholesterol), elevated levels of low-density lipoprotein cholesterol (LDL, bad cholesterol), the cholesterol:HDL ratio. That is confirmed in an important 52 country study published in the journal The Lancet, September 11, 2004. The investigators analyzed 12,461 cases of heart attack and 14,637 controls, most of whom were hospitalized patients with other diseases (though more than one-third of controls were community based).

The results were striking. Nine variables accounted for over 90 percent of the total risk for heart attacks both for men and women. Six of these promote heart attacks - smoking, high blood pressure, diabetes, a high cholesterol:HDL ratio, abdominal obesity, and psychosocial variables (depression, stress). Three factors were protective: exercise, regular alcohol use, eating fruits and vegetables. Each of the promoting factors raised risk roughly two to three times. Each of the three protective factors reduced risk by 10 to 30 percent.

When individuals had two or more of the promoting or preventing factors, the results were even more impressive. If an individual did not smoke, drank an alcoholic beverage up to several times a week, exercised regularly, and included ample amounts of fruits and vegetables in the diet, risk of heart attack was reduced by more than 80 percent. On the other hand, if an individual smoked, had diabetes plus a high cholesterol:HDL ratio, and had high blood pressure (that is, had four of the six promoting factors), the risk of heart attack was increased an incredible 42-fold. If the other two risk factors were added (abdominal obesity and psychosocial factors [depression and stress]), the risk of heart attack was increased by more than 300-fold .

So, single promoting or protecting factors had a significant effect, but having several acting in concert dramatically increased risk or protection.

These findings applied to men and women, various age groups, and all regions of the world.

Commentary: Although impressive, this is not a perfect study.

- The case-control design is not ideal, especially since the controls were mostly recruited from hospitalized persons.

- The diagnosis of high blood pressure was based on history, not direct measurement of the blood pressure. The same was true of diabetes.

Still, it is a strong study and it is supported by many other good studies.

For the conclusions that the overwhelming majority of the risk for heart attack is based on standard, well known risk factors - and that we know what needs to be done to reduce risk.

In particular,

-  do not smoke

-  try to keep your blood pressure in the optimal range (systolic less than 120 millimeters of mercury, diastolic less than 80 millimeters of mercury - see Human Tune-Up and Archives articles New blood pressure recommendations; and Diet with or without salt restriction can keep your blood pressure lower or can treat mild hypertension )

-  cholesterol level should be 200 milligrams or less, cholesterol:HDL ratio 4.5 or less

-  eat plenty of fruits and vegetables

-  get adequate amounts of regular exercise (see Archives article Exercise and Health )

-  avoid a big gut (abdominal obesity)

-  for those who are so inclined, one alcoholic drink a day may help reduce risk a bit. These days, the recommended alcoholic beverage is red wine (but no more than one to two glasses a day and very little - better still, none at all - when pregnant.

Following the risk reduction suggested in this and other articles is good preventive medicine. Healthful Life would add a good folic acid intake (by diet or supplement).

CLICK HERE for a table of folic acid-containing foods. At least 400 micrograms a day is recommended; better still, aim for 800 micrograms.

The take home message is that you can do what is needed to reduce heart attack risk without the newer fancier blood tests, heart scans, etc. Just pay attention to the major risk factors and protective factors - and do something about them!

Yusuf, S., et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries. The Lancet. Vol 364 (September 11) Pgs 937-952. 2004.

A member of our Scientific Advisory Board believes that the last paragraph is much too dismissive of newer tests. He notes these are all under continuing investigation and some, especially those measuring inflammation, may turn out to be very useful.

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