Common risk factors for heart attack and stroke should be curbed early in life to avoid trouble later. Doctors at Northwestern University studied more than 250,000 patients and found that low risk in the short term doesn't preclude higher risks in the long term based on four health factors.
Researchers monitored traditional indicators for heart disease - blood pressure, cholesterol levels, smoking status and diabetes - and discovered that even one elevated factor, present at any age, substantially increases an individual's lifetime risk for heart problems.
Dr. Donald Lloyd-Jones, a cardiologist and chair of the Department of Preventive Medicine at Northwestern, discusses his research and its implications for future patient care.
Q: How does your study change the way we look at risk factors?
A: If you're a 45-year-old man and you've been able to maintain your cholesterol and your blood pressure, you don't have diabetes and you don't smoke, the chance that you'll have a stroke by age 80 is only 1.4 percent. In contrast, if you're a 45-year-old man who already has two of those risk factors elevated, then the chance you'll have a heart attack or stroke by age 80 is 50 percent. There's a similar contrast in women who have either optimal or two major risk factors.
There's a huge gradation of risk depending on what you've been able to accomplish by middle age.
Q: How do you hope your research will be used?
A: I would like to be able to use data like ours to have a more intelligent conversation about risk with my patient, to help him really understand that now's the time to get serious about lifestyle and it may even be time to think about a medication to control those factors.
Q: What would you say to a 30-year-old who might not be worried about having heart problems?
A: It's critically important for our younger adults to understand that their behaviors, the choices that they're making today in their 20s and 30s actually are allowing the start of plaques that are going to cause heart attacks and strokes in their 40s, 50s and 60s. These plaques could potentially limit their lifespan or at least change their quality of life and overall health as they age.
Q: This study looks across age groups and ethnicities. What are the key findings?
A: Across the whole adult age spectrum in both men and women, in African Americans and whites, and in people born in different generations, we found that the traditional risk factors really are the determinants of whether you will have a heart attack or stroke during your remaining lifetime.
Whether people smoke, what their diet content looks like - all those things are changing in the background - but we found that those risk factors, such as high blood pressure, once present, have almost identical associations with what's going to happen to you.
Q: What is the current strategy for assessing a patient's risk factors?
A: The current prevention guidelines recommend that we use these risk factor levels to calculate the risk of having a heart attack in the next ten years.
If I have a 45-year-old man sitting in front of me, even if he's got elevated risk factors, his risk for a heart attack in the next 10 years is likely to be only 4 or 5 percent simply because he's young.
If I give information like that to a patient I worry that he's going to go out and eat a cheeseburger and start smoking because he's so happy that his risk is low. But the truth is while his 10-year risk is low, that same man has a lifetime risk of 50 percent or higher of having a major cardiovascular event.
Q: What are the implications of your research?
A: First, we need to get many, many more of our young adults into middle age with optimal risk factor levels. Our data and other data from across the country would suggest that only about 5 percent of Americans adults make it into middle age with these optimal risk factor levels preserved. That's really a public health problem.
The other implication is more of a clinical and healthcare issue. If you're in middle age, you really need to get with your doctor, to figure out what your numbers are and understand where your risks might be coming from. Using a combination of medication and lifestyle improvement, you can get control of those as much as possible.
If you can preserve those optimal levels, which most of us have when we're teens and young adults, that turns out to be the fountain of youth for your heart and healthy living overall.