When you go see your family physician or cardiologist, s/he will typically calculate your risk for heart disease and spit out an estimated guess for the next 10 years. Based upon that
educated guess (Framingham Risk), which itself is based upon age, gender, systolic blood pressure, total & HDL (good) cholesterol and smoking status, we will then give you a goal LDL (bad) cholesterol for which to aim. If your risk of a heart attack is less than 10% over the next 10 years, we accept an LDL of less than 160md/gL as adequate or "good enough". If your risk of a heart attack is greater than 20% over the next 10 years, your goal LDL is less than 100mg/dL with an option to aim for less than 70mg/dL. Those at intermediate risk have intermediate goals.
However, why settle for "good enough"? After all, that just delays the inevitable, right? At which point, you then have a new lower LDL goal. Well, why not just aim for it in the first place? But how do you convince someone that they need to be more aggressive in their current management?
It turns out that in a new
pooled survival analysis published this week in JAMA, the
authors concluded that lifetime risk for heart disease was almost 1 in 3 individuals in middle age when followed for upwards of 40 years or more. In fact, for 45yo men & women, total lifetime risk of a cardiovascular event, eg heart attack, heart failure, stroke, and cardiovascular death was almost 2 in 3 men and 1 in 2 women. On the other hand, those with an optimal profile reported living 14+yrs longer than those who had 2 major risk factors (see above).
So what are we to make of this information? Well, this makes for a great half-full/half-empty interpretation of the proverbial glass of water. After all, the odds are almost stacked against you with regards to heart disease. But let's not forget that those who did the right thing on a regular basis lived almost a decade and half longer compared to those w/2 major risk factors.
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