Heart disease and stroke, together known as cardiovascular disease (CVD), kill approximately 195 people a day in South Africa.
Research shows that in the past two decades CVD has become a lifestyle disease and that it’s affecting younger people than in past generations. Murishca Martheze, the Heart and Stroke Foundation of South Africa’s Communications Officer (at the time this article was written), says, ‘Previously CVD was seen as a “senior disease”, mostly affecting the elderly, but the statistics are changing. It is vitally important for every individual to take responsibility for their heart health.’ Fortunately, there’s a lot you can do to reduce your risk, and knowing the factors that increase your risk for CVD is a good place to start.
• Increasing age. Men in their 40s have a higher risk of coronary heart disease (CHD) than women. But as women get older (especially after they reach menopause), their risk increases to almost equal that of a man’s. This is due to a decrease in oestrogen, which is thought to play a protective role in the development of heart disease in women.
• Abnormal cholesterol levels, especially if your low-density lipoprotein (LDL) is raised. The aim is to have lower LDL ‘bad’ cholesterol levels and higher high-density lipoprotein (HDL) ‘good’ cholesterol levels.
• Metabolic syndrome refers to high triglyceride levels, high blood pressure, increased insulin levels and excess body fat around the waist (increased risk of heart disease is indicated by a waist measurement of greater than 94cm in men and 80cm in women; a high risk is indicated by a waist measurement of greater than 102cm in men and 88cm in women).
• Being overweight or obese implies abnormal or excessive fat in the body. A good indicator is your Body Mass Index (BMI) – your weight in kilograms divided by your height in metres squared. A healthy range is 18.5 to 25. Overweight is 25 to 30 and obese, over 30.
• Smoking causes a narrowing of blood vessels and expands blood clots. Reduce blood flow to the heart and you risk a heart attack. Reduce it to the brain and you risk a stroke.
• A family history of CHD. You are more likely to develop the condition if someone in your family has had a history of heart disease – especially if they had it before age 50. (Familial hypercholesterolaemia (FH), a specific hereditary condition, causes a very high blood cholesterol concentration and a high risk of heart disease in middle adulthood. In South Africa, 1 in 72 Afrikaner people have the condition and it is common in the Indian and Jewish communities.)
• Diabetes is a strong risk factor. If you have diabetes, you are more likely to develop atherosclerosis and blood clot formation. Constant high blood sugar is also associated with increased blood triglycerides (a type of fat), decreased levels of HDL (good) cholesterol and high blood pressure.
• High blood pressure is one of the leading causes of heart attacks and strokes. It develops if the walls of the larger arteries lose their elasticity and become rigid, and the smaller blood vessels become narrower.
• Chronic kidney disease.
• Already having atherosclerosis or hardening of the arteries in another part of your body (examples are stroke and abdominal aortic aneurysm).
• Other factors such as alcohol abuse, not getting enough exercise, and excessive amounts of stress.
• Increased levels of a chemical called homocysteine, an amino acid.
• Higher-than-normal levels of inflammation-related substances, such as C-reactive protein and fibrinogen are being studied as possible indicators of an increased risk for heart disease.
• Studies have found that among men with erectile dysfunction, those who also have low testosterone levels have a higher than normal risk of dying from cardiovascular disease. Low testosterone levels can therefore be an early indicator of heart disease.
TOMORROW: Positive steps to maintain a healthy heart
This article originally appeared in Heart magazine, for the Heart and Stroke Foundation SA