If You Are At High Risk For Heart Disease - Recommendations
So you've done an assessment of your risk of developing heart disease, and it turns out to be high. (Click here for information on assessing your cardiac risk.) What needs to happen now?
Step 1: Take this seriously
If you have sufficient risk factors for cardiac disease to place you in a high-risk category, this means one of two things. Either your risk of developing heart disease within the next few years is high, or you already have heart disease and don't know about it.
Unfortunately, a substantial proportion of individuals upon learning that they're in the "high risk" category turn out to already have significant coronary artery disease - they just don't know about it because, so far, they are not having symptoms.
The fact a high-risk patient is not having symptoms is no reason to relax, especially since, in 30% of patients with coronary artery disease, the very first symptom is sudden death.
Being at high risk is very serious stuff, and requires a very serious response.
Step 2: Make sure your doctor is taking this seriously
Finding that a patient is at high risk for a serious cardiac event (such as heart attack or sudden death) ought to elicit a certain type of response from a doctor. The doc should act with alacrity to accomplish two things: a) rule out an imminent risk, and b) modify all the risk factors that are producing the high risk in the first place.
Because some high-risk patients will already have heretofore unknown but significant coronary artery disease, and thus might be at imminent risk for a cardiac event, an evaluation ought to be done to rule out this possibility. Generally this should be a stress/thallium study, but in some instances it might be appropriate to go directly to cardiac catheterization. The purpose here is to make sure the patient is not in imminent danger of a heart attack.
At the same time, the doctor should also lay out a clear plan for attacking all modifiable risk factors - including diet, weight loss, smoking cessation, hypertension, and cholesterol - and should initiate therapy immediately. The doc should offer you all the resources at his/her disposal to encourage and assist in exercise, weight loss, and smoking cessation, and should ride you pretty hard about accomplishing these things.
He/she should display an especially aggressive attitude toward reducing LDL cholesterol, increasing HDL cholesterol, and controlling the blood pressure, since accomplishing these tasks is usually primarily the doctor's responsibility, and since doing so often requires using the right drug therapy in the right doses. In general, controlling cholesterol and hypertension will require fairly frequent office visits and frequent measurements of blood pressure and/or cholesterol levels, as well as many medication adjustments. This all should be done on a fairly aggressive schedule, with clear targets in mind.
Beware of the doc who puts you on a medication or two, pats you on the back, and then considers his job done. The doctor should clearly understand what "high risk" implies, and should behave accordingly. If this lackadaisical physician is also the one who neglected to mention assessing your cardiac risk in the first place, it's time to go to someone who will actually care whether you live or die.
However, also keep in mind that doctors are human, and human nature makes it difficult to pull out all the stops for a patient who is refusing to act in his/her own best interests. It's hard to motivate yourself as a doctor to go the extra mile for the patient who just won't make a genuine and persistent effort to exercise, lose weight, or stop smoking. Which brings us to -
Step 3: Start your own Manhattan Project
While it is important that your doctor take appropriate action to make sure you are not at imminent risk and to guide you to appropriate risk factor modification, the real responsibility rests with you. Successfully reducing your risk is something that happens only with your dedication, and it's not easy. Doing what needs to be done often involves fundamental changes in both attitude and lifestyle of the sort that many people seem not to be able to accomplish. The degree of effort required is akin to the effort the US made to develop an atomic bomb during WWII. It was something that seemed to be barely possible, yet, if we did not do it the risk was high that either the Germans or the Japanese would beat us to the punch. So, against all the odds, we marshaled the resources and did it.
And it's a good thing we did.
This is exactly the kind of effort you need to make. Against the odds, you need to change your life. If you don't you will suffer the consequences - possibly decades earlier than is necessary.
That the vast majority of patients who are in the high risk category end up making only half-hearted efforts to modify their risk may be related to the failure of primary care docs and cardiologists to stress the utter life-and-death importance of changing their lifestyles, to their use of "you really should" instead of "you must, or your children will be orphans."
Is there any group of docs who have succeeded in getting their patients to stop whatever they're doing, to suddenly focus every ounce of energy on regaining their health? Yes. The oncologists. Patients who are told they have cancer often put everything else on hold and steel themselves to doing whatever is necessary (whether surgery, radiation, or chemotherapy, often painful, and often lasting for months or years) to attempt a cure. This is the same attitude that patients ought to adopt who are told they are at high risk for heart attack, sudden death, or stroke. After all, being told you are at high risk for a cardiac event is not all that much different than being told you have cancer. Heart disease is often no less fatal, and the outcome no less dependent on your attitude and your active participation in doing what's necessary. If anything, you have a much better chance of favorably altering the ultimate outcome than the average patient with cancer.
In general, the high-risk patients who are most successful are the ones who adopt a "change it all now" attitude - the ones who accept that a complete change in lifestyle is needed. They'll stop smoking, adopt an exercise program and change their diet all at once. And they do it by making risk factor modification the central organizing theme of their lives. One day they're a high-risk-lifestyle kind of person, and the next day they're not. They take on all the modifiable risk factors at once - it becomes the chief focus of their lives until the new lifestyle is an ingrained habit (and they are a different person.) DrRich seen several of these patients achieve remarkable success. But when DrRich hears "I can't do everything at once," in general he worries that he's facing a patient who doesn't quite get it. The sort of lifestyle changes that are necessary to reduce the high risk we're talking about here essentially amount to a complete transformation of attitude, something like the transformation of attitude Americans experienced at about 9 AM on 9/11/01. America became a different kind of country. These patients must become a different kind of person.
The more gradual approach to lifestyle changes, while seeming quite reasonable on its face, often does not work. If diet and exercise are postponed until smoking is stopped, for instance, think about what that means. The patient is essentially living the same kind of life they always did except they're trying to stop smoking. Somehow the smoking never really stops, and and the diet and exercise never get addressed at all, and pretty soon a year or two or five go by - and then it's too late.
There's no a priori reason the gradual approach can't work. DrRich's theory is that gradualism here simply reflects a constitutional failure to accept the deep-rooted changes that are really necessary. Gradualism, in other words, may reflect a lack of the sort of battle-ready attitude that is necessary to achieve the desired end.
Which risk factors need to be modified?
All the risk factors are important, and it is important to improve all the modifiable risk factors that count against you. Here is information on what those modifiable risk factors are, and what you can do to improve them: The cardiac risk factors and what you can do about them
From Richard N. Fogoros, M.D.
Health's Disease and Condition content is reviewed by our Medical Review Board
Source: About.com
Step 1: Take this seriously
If you have sufficient risk factors for cardiac disease to place you in a high-risk category, this means one of two things. Either your risk of developing heart disease within the next few years is high, or you already have heart disease and don't know about it.
Unfortunately, a substantial proportion of individuals upon learning that they're in the "high risk" category turn out to already have significant coronary artery disease - they just don't know about it because, so far, they are not having symptoms.
The fact a high-risk patient is not having symptoms is no reason to relax, especially since, in 30% of patients with coronary artery disease, the very first symptom is sudden death.
Being at high risk is very serious stuff, and requires a very serious response.
Step 2: Make sure your doctor is taking this seriously
Finding that a patient is at high risk for a serious cardiac event (such as heart attack or sudden death) ought to elicit a certain type of response from a doctor. The doc should act with alacrity to accomplish two things: a) rule out an imminent risk, and b) modify all the risk factors that are producing the high risk in the first place.
Because some high-risk patients will already have heretofore unknown but significant coronary artery disease, and thus might be at imminent risk for a cardiac event, an evaluation ought to be done to rule out this possibility. Generally this should be a stress/thallium study, but in some instances it might be appropriate to go directly to cardiac catheterization. The purpose here is to make sure the patient is not in imminent danger of a heart attack.
At the same time, the doctor should also lay out a clear plan for attacking all modifiable risk factors - including diet, weight loss, smoking cessation, hypertension, and cholesterol - and should initiate therapy immediately. The doc should offer you all the resources at his/her disposal to encourage and assist in exercise, weight loss, and smoking cessation, and should ride you pretty hard about accomplishing these things.
He/she should display an especially aggressive attitude toward reducing LDL cholesterol, increasing HDL cholesterol, and controlling the blood pressure, since accomplishing these tasks is usually primarily the doctor's responsibility, and since doing so often requires using the right drug therapy in the right doses. In general, controlling cholesterol and hypertension will require fairly frequent office visits and frequent measurements of blood pressure and/or cholesterol levels, as well as many medication adjustments. This all should be done on a fairly aggressive schedule, with clear targets in mind.
Beware of the doc who puts you on a medication or two, pats you on the back, and then considers his job done. The doctor should clearly understand what "high risk" implies, and should behave accordingly. If this lackadaisical physician is also the one who neglected to mention assessing your cardiac risk in the first place, it's time to go to someone who will actually care whether you live or die.
However, also keep in mind that doctors are human, and human nature makes it difficult to pull out all the stops for a patient who is refusing to act in his/her own best interests. It's hard to motivate yourself as a doctor to go the extra mile for the patient who just won't make a genuine and persistent effort to exercise, lose weight, or stop smoking. Which brings us to -
Step 3: Start your own Manhattan Project
While it is important that your doctor take appropriate action to make sure you are not at imminent risk and to guide you to appropriate risk factor modification, the real responsibility rests with you. Successfully reducing your risk is something that happens only with your dedication, and it's not easy. Doing what needs to be done often involves fundamental changes in both attitude and lifestyle of the sort that many people seem not to be able to accomplish. The degree of effort required is akin to the effort the US made to develop an atomic bomb during WWII. It was something that seemed to be barely possible, yet, if we did not do it the risk was high that either the Germans or the Japanese would beat us to the punch. So, against all the odds, we marshaled the resources and did it.
And it's a good thing we did.
This is exactly the kind of effort you need to make. Against the odds, you need to change your life. If you don't you will suffer the consequences - possibly decades earlier than is necessary.
That the vast majority of patients who are in the high risk category end up making only half-hearted efforts to modify their risk may be related to the failure of primary care docs and cardiologists to stress the utter life-and-death importance of changing their lifestyles, to their use of "you really should" instead of "you must, or your children will be orphans."
Is there any group of docs who have succeeded in getting their patients to stop whatever they're doing, to suddenly focus every ounce of energy on regaining their health? Yes. The oncologists. Patients who are told they have cancer often put everything else on hold and steel themselves to doing whatever is necessary (whether surgery, radiation, or chemotherapy, often painful, and often lasting for months or years) to attempt a cure. This is the same attitude that patients ought to adopt who are told they are at high risk for heart attack, sudden death, or stroke. After all, being told you are at high risk for a cardiac event is not all that much different than being told you have cancer. Heart disease is often no less fatal, and the outcome no less dependent on your attitude and your active participation in doing what's necessary. If anything, you have a much better chance of favorably altering the ultimate outcome than the average patient with cancer.
In general, the high-risk patients who are most successful are the ones who adopt a "change it all now" attitude - the ones who accept that a complete change in lifestyle is needed. They'll stop smoking, adopt an exercise program and change their diet all at once. And they do it by making risk factor modification the central organizing theme of their lives. One day they're a high-risk-lifestyle kind of person, and the next day they're not. They take on all the modifiable risk factors at once - it becomes the chief focus of their lives until the new lifestyle is an ingrained habit (and they are a different person.) DrRich seen several of these patients achieve remarkable success. But when DrRich hears "I can't do everything at once," in general he worries that he's facing a patient who doesn't quite get it. The sort of lifestyle changes that are necessary to reduce the high risk we're talking about here essentially amount to a complete transformation of attitude, something like the transformation of attitude Americans experienced at about 9 AM on 9/11/01. America became a different kind of country. These patients must become a different kind of person.
The more gradual approach to lifestyle changes, while seeming quite reasonable on its face, often does not work. If diet and exercise are postponed until smoking is stopped, for instance, think about what that means. The patient is essentially living the same kind of life they always did except they're trying to stop smoking. Somehow the smoking never really stops, and and the diet and exercise never get addressed at all, and pretty soon a year or two or five go by - and then it's too late.
There's no a priori reason the gradual approach can't work. DrRich's theory is that gradualism here simply reflects a constitutional failure to accept the deep-rooted changes that are really necessary. Gradualism, in other words, may reflect a lack of the sort of battle-ready attitude that is necessary to achieve the desired end.
Which risk factors need to be modified?
All the risk factors are important, and it is important to improve all the modifiable risk factors that count against you. Here is information on what those modifiable risk factors are, and what you can do to improve them: The cardiac risk factors and what you can do about them
From Richard N. Fogoros, M.D.
Health's Disease and Condition content is reviewed by our Medical Review Board
Source: About.com
Labels: heart disease, heart disease recommendations, heart patients
