AS cardiologists, we assess your risk for developing coronary artery disease (blocked arteries), the worse-case scenario being a heart attack. There are several tools or risk-scoring systems that we use to predict your risk of having a heart attack within the next 10 years. We put together your history, family history, social habits, along with blood work and physical exam to come up with the percentage likelihood. As with any risk-scoring system, it is not 100 per cent accurate or foolproof.

Less than one per cent of people (thankfully), who, in spite of having no traditional risk factors, may still develop a heart attack. Today, we will look at the traditional risk factors for developing coronary artery disease and risk assessment.

HEART DISEASE RISK FACTORS

Some risk factors are non-modifiable, meaning there isn’t anything we can do to change these risk factors.

1. Age: As you get older, your overall risk for heart attack and stroke increases. From birth, we start to build up plaque (atherosclerosis) inside the lining of our arteries. This process continues into old age, and we may die of something else, but most of us, by age 60, will have small amounts of plaque build-up. Men over 45 years of age and women over 55 years of age are more likely to have a heart attack.

2. Gender: Men have a higher risk of coronary artery disease compared to women. This appears to be so until menopause, and was believed to be due to the protective effects of oestrogen.

3. Family History: If you have a first-degree relative (such as brother, sister, mother, or father) who have had a heart attack or stroke before age 45 for men and 55 for women, this indicates that you may be at an increased risk for a heart attack.

Other risk factors are modifiable, meaning we can change these risk factors.

4. Cholesterol: Cholesterol is a type of fat that plays a very important role in our bodies. It is the main component of the membrane (casing) of each cell in our body. Cholesterol is found in all animal sources of meat, even lean portions of meat, such as chicken breast. Cholesterol is also made and broken down by our liver.

There are two main types of cholesterol

* High Density Lipoprotein (HDL) or “good cholesterol”

* Low density Lipoprotein (LDL) or “bad cholesterol”

In Jamaica, the cholesterol level is usually quoted in Standard International Units. Normal total cholesterol being less than 5 mmol/L and LDL <3.4 mmol/L. The United States uses mg/dL and normal values are less than 200mg/dL and 100mg/dL, respectively. The good cholesterol level should be higher than 1mmol/L, to be considered protective against heart disease.

5. Cigarette smoking

Smoking cigarettes and exposure to second-hand smoke increases risk of heart attack. Now there are e-cigarettes, which appear to bypass this risk and help smokers to quit the habit. This is an area requiring further discussion.

6. Diabetes mellitus (Sugar)

Having diabetes is considered to be the same as having a heart attack or stroke in the past. It increases your risk of a heart attack significantly. Persons who have type 1 diabetes (insulin dependent) from an early age, may have a heart attack in their 30s. Diabetes wreaks havoc on the blood vessels and in addition to increasing risk for heart attack, increases risk of eye damage, kidney damage. and stroke.

7. High blood pressure (hypertension)

Having a blood pressure higher than 140/90mmHG increases your risk of heart attack. The normal blood pressure falls between the range 90/60mmHG to 140/90mmHG. Contrary to popular belief, there isn’t just one blood pressure reading which is normal (120/80).

WHAT IS YOUR RISK?

Here are two examples:

* Ms Pansy is a 55-year-old female who has diabetes and hypertension with a blood pressure of 150/90mmHG and total cholesterol is 5.5 HDL 0.8. She is a non-smoker. Her risk of having a heart attack in 10 years is 32 per cent, and throughout her lifetime 50 per cent. This is a very high risk.

* Ms Peaches is a 55-year-old woman who does not have high blood pressure or diabetes, with very similar cholesterol results as Ms Pansy and is also a non-smoker. Her risk for heart attack over 10 years is 4.6 per cent, and throughout her lifetime 39 per cent.

By not having diabetes or hypertension, Ms Peaches’ risk is significantly lower than Ms Pansy’s. Ms Pansy can lower her risk by controlling her diabetes and blood pressure with a combination of lifestyle measures (diet and exercise), and medication under the supervision of her doctor.

Dr Claudine Lewis is an adult cardiologist and medical director at Heart Smart Centre in Montego Bay. She is also a cardiologist at the Cornwall Regional Hospital and an associate lecturer with the University of the West Indies. Questions may be sent to questions@heartsmartcentre.com and for additional information call 684-9989 or visit the website www.heartsmartcentre.com