Here’s what you need to know to boost your heart health and reduce heart attack risk.
The words “coronary artery disease” immediately make us think of people in their 60s, 70s, and beyond. We hardly think about heart disease in young adults. But young adult hearts need attention and care… at a time of life when most of us take healthy hearts and unclogged arteries for granted.
A 30-year population study shows clearly that what we do in our early adult life will impact our health later in life, said lead author Jeffrey Carr, M.D., M.Sc., Cornelius Vanderbilt Chair in Radiology and Radiological Sciences at Vanderbilt University Medical Center.
The study, released online and published in April in the Journal of the American Medical Association Cardiology, began in 1985 by the National Institutes of Health to look at factors of everyday life including diet and physical activity that could determine why some people have and die of heart disease. The Coronary Artery Risk Development in Young Adults or “CARDIA” started with 5,115 black and white adults age 18-30 recruited from four cities: Birmingham, Alabama; Chicago; Oakland, California; and Minneapolis.
The volunteers have and continue to receive detailed studies related to heart and vascular disease for more than 30 years now. Fifteen years into the study, when the volunteers were on average 40 years old, CT scans measured if they had developed calcified plaques in their coronary arteries, then again in 2005 and in 2010.
A key finding is that developing even a tiny amount of coronary artery calcium before age 50 is an early sign of significantly increased risk for a heart attack in the next 10 years. As the amount of coronary artery calcium increases, the risk of heart attacks and even death before age 60 years markedly increases compared to those participants without it. In the past, only high scores of calcium would cause concern and intervention.
Empowering individuals about heart health
The coronary arteries are the blood vessels that go to the heart. Heart attacks, in most cases, are the result of a disease in the coronary arteries called “atherosclerosis,” which results in the formation of plaques in the wall of the coronary arteries.
This is where we get the saying “clogged arteries.” These plaques are made up of several substances including fats (cholesterol), scar tissue and calcium. The calcium of atherosclerosis is easily measured by the CT scanner. In people with plaques, the breaking apart, or rupture, of the plaque is what actually blocks blood flow to part of the heart and can cause a heart attack or the medical term myocardial infarction or “MI.”
“We were not surprised that coronary artery calcium predicted heart disease, because the presence of it tells us the person has at least early or silent disease in the coronary arteries,” Carr said. “We were surprised at how strongly coronary artery calcium predicted actual heart attacks and premature death over a relative short period of about 12.5 years in middle age adults.
“This is all about empowering the individual and their healthcare team. People commonly want to know, ‘How can I avoid having a heart attack? What can I do?’ … The first step is to start the conversation with their healthcare teams and begin with the basics. We don’t think everyone needs to run out and get CT scan.”
He explains with an analogy about taking care of your car. So, it’s just like you should check the oil, tire pressure and fluids.
“One of the exciting findings of the study, seen in multiple reports, is just how important the basics of a healthy lifestyle are for preventing heart disease. People should see their health provider in their 30s to get basic numbers, including blood pressure, BMI, lipids, bad and good cholesterol and diabetes marker,” Carr said. Is anything elevated? Pay attention to it and work to lower heart attack risk.
A good place to start online is the American Heart Association with the American Heart Association’s Simple 7: manage blood pressure, control cholesterol, reduce blood sugar, get active, eat better, lose weight and stop smoking.
Changes to reduce heart attack risk
And, family history plays a key role.
“Let’s say there’s a brother or father who died of a heart attack,” he said. “And say your cholesterol numbers are good, but maybe the blood pressure is on the high end of the normal range. It’s conversation time with your doctor.
“It’s a two-tiered approach. We want people to start with improving their habits that affect their heart attack risk. Your doctor may say, ‘OK, let’s try some diet and exercise and see how much progress you can make.’ If lifestyle measures don’t get your risk down, then these are people who might benefit from a CT scan to measure coronary artery calcium.”
The message, Carr stressed, is that we’re not one-size-fits-all.
“The goal is to prevent heart attacks by having people pay attention to their bodies. Everyone should know their own risk for heart disease by their early 30s and start making choices to lower that risk,” he said. “Relatively few young people have truly elevated cholesterol or blood pressure requiring medications, unfortunately those with high normal values appear to accumulate a small amount of increased risk each year resulting in early heart in the 40s, 50s and 60s. Of course, smoking cigarettes is a major risk factor for heart disease and cancer.”
The higher the risk of heart disease or stroke, together called atherosclerotic cardiovascular disease, determines how aggressive your doctor will be at addressing various risk factors that can be lowered, Carr explained.
“With people at increased but not high risk, the debate is when to use medications to lower this risk. Based on our work in the National Institute Health CARDIA study, the presence of coronary artery calcium on the CT scan can help individuals and their doctors make this decision,” Carr said. “Based on your age and risk factors you might have say, a 5 percent risk of a heart attack or stroke over the next 10 years. However, if you have the CT scan and coronary artery calcium is present your risk could increase 15 percent or more over the next 10-years and tip the scale toward mediations to lower your risk of atherosclerotic cardiovascular disease.
“The really good news is people at higher risk for atherosclerotic cardiovascular disease have powerful interventions to lower risk for heart disease. Physical activity, smoking cessation, weight loss, stress reduction and statin therapy have shown that when they are done well, there are marked improvements in health.”