Monday, October 29, 2012

Lifestyles & Risk Factors for Heart Disease

We are forever looking for the next big thing.  In the world of high definition television, we'll soon be bombarded by advertisements for 4K Ultra High Definition.  In heart disease, every company is pushing its test as the being capable of more accurately predicting risk of future events.  But as I informed a patient over the weekend who asked about this test and that, do it if the result will change your decision.  In other words, if the outcome of the test will convince you to take a medication, change your diet, and/or get physically active on a regular basis, sure, by all means, go get the test.

But what if you haven't reached 150 minutes/week of moderate intensity or 75 minutes/week of vigorous intensity exercise?  What if your body mass index is greater than 25kg/m2?  What if you still smoke?

What if you consume less than 4 cups/d of fruits & vegetables, less than 2 servings/week of oily fish, less than 3 servings/d of fiber-rich whole grains, greater than 1,500mg/d of sodium (salt), and/or greater than 35 ounces/week of sugar-sweetened beverages?  (You need to meet at least 4 of these nutritional guidelines to have this point count in your favor).

What if your total cholesterol is greater than 200mg/dL?  What if your blood pressure is greater than 120/80mm Hg?  And what if your fasting blood glucose is greater than 100mg/dL?  

In a prospective observational study published in this month's Mayo Clinic Proceedings, the authors followed for over 11 years 11,993 participants (almost 1 out of 4 who were female) with an average age of 45yo.  Those who met 5 to 7 of the above ideal lifestyle metrics had a 63% lower risk of heart disease associated death compared to those who met 2 or less while those who met 3 to 4 had 55% lower risk.

But you already knew this, right?  Want to know what's really sad?  Of the almost 12K individuals, only 29 (yeah, just over 2 dozen) met all 7 criteria for lowest risk of heart disease.  As for the rest, why bother to spend money on the newest, latest tests when they've got their work already cut out for them.

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