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Heart Disease and Stroke Prevention: Know Your Numbers

By: Close the Gap
 
 
By Cam Patterson, M.D., M.B.A.
 
Medical studies show over and over again that people who are well-informed about their health take fewer medicines, get admitted to the hospital less often, and live longer. When I talk to my patients about this, I get a common reaction: All of that medical talk is too complicated. This is true, and often health care providers confound this problem by choosing complicated terms when a simple one will do and failing to have meaningful discussions with patients about their health care problems and concerns.
 
 
Heart diseases and stroke are the most common causes of death and disability in the United States. As a cardiologist, I take care of many patients who have mild or severe heart disease and are highly motivated to prevent another heart attack or worsening of their heart failure symptoms. But there are more people out there who are concerned about whether or not they will ever develop a serious heart problem, and even more who should be.
 
 
It turns out that there are some things that affect the risk of heart disease that we don’t have any control over. If you have a parent or sibling who has heart disease, your own risk is increased because heart disease has a genetic component. Young men have a higher risk of heart disease than young women (although women catch up after menopause, and more women than men die of heart disease). African-Americans are more likely to have heart disease than individuals of European descent.
 
 
There are also certain behaviors that influence risk of heart disease and stroke. You probably know what they are, but we shouldn’t ignore them. Tobacco use in all forms is certainly something we all should stay away from, as it dramatically increases the risk of heart disease, emphysema, and many cancers. Regular exercise, on the other hand, provides important protective effects on the heart. Thirty minutes of vigorous walking three times a week is a good place to start.
 
 
You may also hear your physician say “Know your numbers.” These are four treatable numbers that everyone should be familiar with. Some people have no problems with their numbers, some control them with diet and exercise, and some people take medications. Unfortunately, too many people don’t know their numbers at all and don’t have them under control. So let’s review what “the numbers” are.
 
 
The first of the four is blood pressure. Your blood pressure is given as a ratio of two numbers, the systolic (higher) pressure over the diastolic (lower) pressure, such as 110/60. Physicians-in-training are taught that a value above 140/90 requires treatment, but we now consider that a value below 120/80 is ideal. Numbers in between are called “prehypertension” and bad outcomes can occur if the blood pressure is regularly in this range, especially in diabetics, who have higher risk of complications from hypertension.
 
 
The second number is blood glucose. This is an indicator whether someone has diabetes, or is trending in that direction. Because glucose levels fluctuate, we measure them in the fasting state. A normal fasting glucose is below 100, and values above 125 indicate diabetes. For individuals who have glucose levels on the high side, weight loss can be critical in preventing diabetes from developing.
 
 
Cholesterol levels are the third number to know. Elevated cholesterol levels are strongly associated with risk of heart disease or stroke, and reducing cholesterol levels can be lifesaving. There are lots of cholesterol numbers—total cholesterol, good cholesterol, bad cholesterol—but the one that is most important is the LDL cholesterol. The target LDL cholesterol has been moving downward based on recent research, but I think that any value about 100 is concerning and for high risk patients I shoot for an LDL level below 70. We now have effective and safe drugs called statins that reduce cholesterol levels efficiently, and many of these drugs are available in generic forms that are inexpensive.
 
 
The last number I want my patients to know is the BMI, which stands for body mass index. This is basically the weight normalized for how tall someone is. A BMI of 25 or less is ideal and a value over 30 is considered “obese.” Heart disease risk goes up as BMI goes up, and so does the likelihood of developing other risk factors for heart disease and stroke, like hypertension and diabetes. Physicians are taking obesity more seriously now that it is becoming epidemic in the United States. Diet and exercise are the obvious considerations, and we know a lot more than we used to about how to make an impact on BMI and to make it stick.
 
I hope this overview helps. Make sure you know your numbers. All you have to do is ask.
 
Cam Patterson, MD, MBA, is chief of cardiology and Physician-in-chief of the Center for Heart and Vascular Care for the University of North Carolina at Chapel Hill School of Medicine, UNC Hospitals, and the UNC Health Care System.
 
Close the Gap (CTG) is a national heart health awareness initiative sponsored by Boston Scientific and led by a team of physicians and health care professionals from across the country. Close the Gapis an educational initiative designed to educate, equip and empower communities and individuals to reduce disparities in heart care treatment for women, black and Latino Americans as well as raising awareness of sudden cardiac arrest (SCA) in young athletes. Learn more at www.your-heart-health.com.