As we enter “heart month” 2010, and with the healthcare debate fresh in everyones mind, it is important to reflect upon two remarkable facts: 1) despite continued and remarkable advances in scientific knowledge and therapeutic capability, cardiovascular disease remains the leading killer of men and women in this country and increasingly throughout the entire world; and, 2) perhaps in no other sphere of human disease (except, arguably, injury due to trauma) does human behavioral choice play such a major role in disease initiation and progression.
Years ago, when speaking about risk factors for cardiovascular disease, we used to distinguish between “modifiable” and “non-modifiable” risk factors. However, upon more careful reflection, the distinction is somewhat misleading. For example, hypertension, lipid abnormalities, cigarette smoking and physical inactivity are all potentially modifiable. Age, family history and diabetes were viewed as non-modifiable. Upon more careful examination, it may well be that age per se is not the core issuei.e. that the physiology of aging, a very poorly understood phenomenon in and of itself, somehow promotes or accelerates the atherosclerotic process. Although that may certainly be true, we have very little evidence in this area. What we do know, however, is that age represents the length of time an individual has been living with the disease. Atherosclerotic vascular disease is a complex process that progresses over years. Autopsy studies dating back to the Korean war demonstrated that one fifth of ostensibly healthy young Americans in the 1950s already harbored evidence of the early states of the atherosclerotic process in their aortas.
The evolution of that process into a clinically significant event, such as a heart attack, may, depending upon a given person and the complex milieu of risk factors, take any number of years. In fact, even in the presence of disease in an individual with a genetic predilection, a clinical event may never occur. Therefore, the most compelling contribution of age to risk is the length of exposure to disease. If other risk factors are rigorously controlled, disease progression may be slowed, arrested or even reversed sufficiently to protect a given individual from a clinical problem. Likewise, one can clearly see that while one can do nothing with current medical technology to alter ones genetic predisposition (assuming that future studies will continue to tease apart the complex array of genetic markers for this multifactorial disease process) to cardiovascular disease, one may be able to accomplish a tremendous amount through control of known risk factors to help protect the genetically “at risk” individual from a clinical problem. Lastly, although we used to think of diabetes as somewhat of an unpreventable disease, the current epidemic of obesity is bringing with it an inexorable rise in the incidence of insulin-resistance “Type II” diabetes. Currently 33% of adults are obese, 29% exhibit signs of prediabetes and 7.7% have diagnosed diabetes. Alarmingly, almost a third (31.9%) of children aged 2 to 19 years are also overweight or obese. We are currently seeing the tip of the iceberg.
The news from the “modifiable” risk factors is far from optimal as well. High rates of men (25%) and women (20%) continue to smoke, despite that fact that this risk factor is synergistic with the others. Unlike the risk of cancer, which is cumulative, much of the risk of cardiovascular disease recedes immediately upon cessation of smoking. One third of adults have hypertension, while only two-thirds of these are being treated, and less than one half are meeting currently recommended therapeutic goals. Approximately one sixth of the adult population has elevated serum lipids, but less than half are receiving lipid-lowering therapy. Among adolescents, 31% of females and 18% of males recently reported no vigorous physical activity within the previous 7 days, while 59% of adults report engaging in no regular vigorous activity.
Discouraging? Perhaps. But the “full” half of the glass teaches us that the potential for improvement rests largely in our own hands. It is for this reason, the Florida Heart Research Institute, while pursuing an aggressive and innovative program of scientific research, balances these efforts with an active program of screening and education, especially in currently underserved high risk populations. It is only through translating our scientific knowledge into individual and community awareness through education that we can begin to harvest the benefits of our knowledge and reduce the incidence and danger of this lethal disease.
Post Views: 721
