Heart disease remains the No. 1 killer of Americans, despite efforts to stop cigarette smoking and control blood cholesterol levels. Obesity and related illnesses are the greatest threat to heart health, and Nathan D. Wong, UC Irvine Heart Disease Prevention Program director, is working to improve heart health awareness.
Q: Why is heart disease the No. 1 killer of American women and men?
A: We do not know all the reasons. However, we do know the risk factors that are very common in Americans – hypertension, cholesterol disorders, diabetes, obesity and cigarette smoking. These often lead to cardiovascular diseases and stroke, which are the eventual causes of death in nearly 60 percent of American adults. Since about 1985, more women than men have died each year from cardiovascular diseases. Women need to understand this is a great concern for them.
Q: How much of our cardiac health is inherited, and how much can we control?
A: This is a moving target. The expanding field of cardiovascular genomics is uncovering new markers of cardiovascular disease that can help us better target who might benefit most from certain therapies. While genetics set the stage, lifestyle often is the trigger. Risk from cardiovascular disease can be reduced through proper diet and exercise and following doctor’s orders concerning medication for cholesterol, blood pressure, diabetes and other problems not adequately controlled by lifestyle. These efforts are even more important in people with a family history of heart disease. Another important control is early detection. New imaging methods such as CT and ultrasound screening can help identify high-risk people who may benefit from more aggressive intervention. We have done collaborative research nationwide over 20 years to understand better how these techniques predict and assess risk.
Q: Even though people are better controlling blood cholesterol levels, you’ve found that among people with cardiovascular disease, it’s still a struggle. Why is that?
A: There are several reasons. Persons with cardiovascular diseases and diabetes often have other lipid problems as well, such as low HDL-C (“good cholesterol”) and high triglycerides. It is important to control these, but few people with heart disease or diabetes are at recommended levels for all key lipid fractions, including “bad” LDL-cholesterol. Also, the difficulty of controlling blood pressure is even more apparent in those with cardiovascular and related problems, such as stiffer arteries and old age.
Q: Can lifestyle factors – diet, exercise, not smoking – determine our cardiac health or does the answer lie with medical breakthroughs?
A: Lifestyle is part of the equation, but not all of it. Healthy diet and exercise go a long way toward reducing risk factors, including blood pressure, lipids and prediabetic conditions. When lifestyle is not enough, medications also reduce risk. In the future, medical breakthroughs will target therapies that have the best chance of success according to an individual’s genetic makeup, which will help address residual cardiovascular risk that remains despite best treatment.
Q: What is metabolic syndrome and how does it affect heart health?
A: It refers to people who have multiple factors known to increase the risk of cardiovascular disease. The American Heart Association defines someone with metabolic syndrome if three or more of the following are present:
- Waist circumference more than 40 inches for men and more than 35 inches for women;
- Blood pressure over 130 mm systolic or over 85 mm diastolic, or on treatment for high blood pressure;
- Fasting glucose of 100 mg or higher, or on treatment for glucose, such as diabetic treatment;
- Fasting triglycerides over 150 mg;
- And low HDL-cholesterol under 40 mg for men and under 50 mg for women.
This constellation of risk factors is associated with higher risk of cardiovascular disease. While there is no single treatment for metabolic syndrome, serious adherence to a healthy lifestyle can help control it along with medication for blood pressure, lipid or glucose needs.