About Risk Factors

Heart Disease is one of the leading causes of death in many countries, including Singapore. An understanding of the risk factors contributing to heart disease is important to secure one's quality of life, for a lifetime.

The National Institutes of Health(NIH), USA , the Center for Disease Control (CDC), USA and many other respected medical institutes have adopted an 8 factors classification, collectively known as Risk Factors for Cardiovascular Disease. These are:

1. Family History - Myocardial infarction, coronary revascularization or sudden death before age 55 in male descent, or before age 65 in female descent.

2. Age - current age of more than 55 for males and 65 for females.

3. Smoking - Current smoker or those who quit within the last 6 months.

4. Hypertension - Systolic blood pressure of more than 140 mmHG or diastolic of more than 90 mmHG; confirmed by at least 2 separate occasions 7 days apart

5. Hypercholesterolemia - Total serum cholesterol of more than 200 mg/dL or HDL less than 35 mg/dL. If LDL is available, then use more than 130 mg/dL rather than total cholesterol. A high HDL is considered a bonus which can be used to offset another negative risk factor.

6. Diabetes Mellitus - Fasting blood glucose of more than 110 mg/dL at 2 separate occasions.

7. Obesity - BMI of more than 30 or Waist circumference of more than 100cm.

8. Sedentary Lifestyle - Persons not participating in a regular exercise program or meeting the minimal physical activity recommendations from the US Surgeon General's report (of 3x/week lasting 20min-30min each time).

Unalterable factors are : Age (we all grow old) and Family History (we're born into the family, we didn't choose it) and Diabetes (Type 1 diabetes starts from birth, Type 2 is developed and possibly alterable).

The other risk factors are alterable. For example: quit smoking , switch from a sedentary lifestyle to an active lifestyle, reduce the BMI etc.

Blood Cholesterol Levels - Cholesterol is a waxy substance produced by the liver or consumed in certain foods. It is needed by the body, and the liver makes enough for the body's needs. When there is too much cholesterol in the body—because of diet and the rate at which the cholesterol is processed—it is deposited in arteries, including those of the heart. This can lead to narrowing of the arteries, heart disease, and other complications.

Some cholesterol is often termed "good," and some often termed "bad." A higher level of high–density lipoprotein cholesterol, or HDL, is considered "good," and gives some protection against heart disease. Higher levels of low–density lipoprotein, or LDL, are considered "bad" and can lead to heart disease. A lipoprotein profile can be done to measure several different forms of cholesterol, as well as triglycerides (another kind of fat) in the blood.

High Blood Pressure - High blood pressure is another major risk factor for heart disease. It is a condition where the pressure of the blood in the arteries is too high. There are often no symptoms to signal high blood pressure. Lowering blood pressure by changes in lifestyle or by medication can lower the risk of heart disease and heart attack.

Diabetes Mellitus- Diabetes also increases a person's risk for heart disease. With diabetes, the body either doesn't make enough insulin, can't use its own insulin as well as it should, or both. This causes sugars to build up in the blood. About three–quarters of people with diabetes die of some form of heart or blood vessel disease. For people with diabetes, it is important to work with a healthcare provider to help in managing it and controlling other risk factors.

Smoking - Tobacco use increases the risk of heart disease and heart attack. Cigarette smoking promotes atherosclerosis and increases the levels of blood clotting factors, such as fibrinogen. Also, nicotine raises blood pressure, and carbon monoxide reduces the amount of oxygen that blood can carry. Exposure to other people's smoke can increase the risk of heart disease even for nonsmokers. Smoking is an addiction, pure and simple. Smokers often refuse to acknowledge this fact, for them it's preferable to smoke and die than to quit and live.

Smoking is the single most avoidable cause of death. On a global scale, the World Health Organisation (WHO) estimates that tobacco kills one person every 10 seconds. Smoking causes cancer and is a major risk factor for coronary heart disease, stroke and chronic obstructive lung disease. Together, they account for close to two-thirds of all deaths in Singapore in the year 2000. (Health Promotion Board, Singapore). Despite this, the Singapore Government does not ban the import/sale of cigarettes while it has banned the import/sale of sex magazines. Amazing Singapore !

Cholesterol - Several aspects of peoples' dietary patterns have been linked to heart disease and related conditions. These include diets high in saturated fats and cholesterol, which raise blood cholesterol levels and promote atherosclerosis. High salt or sodium in the diet causes raised blood pressure levels.

Sedentary Lifestyle - Physical inactivity is related to the development of heart disease. It also can impact other risk factors, including obesity, high blood pressure, high triglycerides, a low level of HDL (good) cholesterol, and diabetes. Regular physical activity can improve risk factor levels.

Obesity - Obesity is excess body fat. It is linked to higher LDL (bad) cholesterol and triglyceride levels and to lower HDL (good) cholesterol, high blood pressure, and diabetes.

Heredity - Heart disease can run in the family. Genetic factors likely play some role in high blood pressure, heart disease, and other vascular conditions. However, it is also likely that people with a family history of heart disease share common environments and risk factors that increase their risk; for example traditional dietary habits of the family.