Are You at Risk for Heart Disease?
Are you at risk for heart disease?
One of the most common reasons patients come to see me is because they are concerned about their risk for heart disease, typically because of concern for a family history or risk factors for heart disease. The problem is that it’s not always easy to tell someone’s risk. While some are clearly at high risk, others can appear to be the picture of health and yet be prone to heart disease. This video tells a patient’s story that shows some of the challenges of determining future risk and strategies on how to determine your risk for heart disease.
If the question is “Who is at risk for heart disease?”, the answer is unfortunately, “Most of us.” About 60% of adults in the United States will have a heart attack, stroke or heart failure in their lifetime.
The numbers are striking. In an hour, there are about 90 people who have a heart attack, 90 who have a stroke, 120 people hospitalized for heart failure and 90 people who die from heart disease.
Here is a real patient that I saw because she was concerned about her risk for heart disease. This was a 65-year-old woman, a retired cardiac nurse, who had seen a lot of heart disease in her work and was wondering if she was at risk. She was perfectly healthy in all respects, normal weight, good blood pressure, she never smoked, had no diabetes and took no medications. She had no family history of heart disease and her blood sugar was normal.
Here is her cholesterol panel.
Total = 202 mg/dl
LDL = 119 mg/dl
HDL = 65 mg/dl
TG = 90 mg/dl
When I give talks at medical conferences, I often ask the room full of doctors if they think this patient is at high risk for heart disease or low risk? Typically, about 80% of the doctors will say low risk, but the remaining 20% will say high risk. Why such disagreement about such a seemingly easy question? As it turns out, there is a lot of disagreement about who is at risk among doctors and even among the national and international guidelines. In recent years there have been several different guidelines on how to assess risk for heart disease and what to do about it. For the most part, these guidelines agree on what saves lives for those who are at high risk, but what they disagree on, is “Who is at high risk?’.
All of the guidelines recommend assessing risk by using a risk calculator. For example, the American Heart Association uses a calculator that takes into account
· Blood pressure
To determine a 10-year risk for heart attack, stroke or heart related death. A score over 7.5% is considered “high risk”.
Back to our 65-year-old patient of mine who was concerned about her heart risk, when we put her numbers in the risk calculator, her risk score is 7.6% which is in the high risk range. However, other guideline’s criteria would put her at low risk. The problem is that without more information, we don’t know which one is right.
This illustrates 2 important points:
1. Risk calculators are very good in calculating risk in a big group of people, but are not always good at predicting risk in an individual.
2. Who is at “high risk” often depends on your view point and how you define “high risk”.
In future videos, we will talk about how more information may be helpful in individualizing heart disease risk assessment.
In summary, heart disease is unfortunately very common. About 60% of adults in the US will have heart disease in their lifetime. However, the question “Who is at risk?” is challenging. Risk scores can be helpful but have limitations in assessing an individual’s risk for heart disease.
And the beat goes on,
R. Todd Hurst, MD, FACC, FASE