Lowering Risk for Cardiovascular Disease

Risk factors for cardiovascular disease

There are several risk factors for cardiovascular diseases. Some of these are un-changeable. These include advancing age, male sex and women after menopause and genetic disposition to acquire heart diseases.

However, there are several risk factors that can be changed or modified to lower the risk of cardiovascular disease. These include risk factors like smoking, obesity, lack of physical activity, unhealthy diet etc.

How to lower the risk of cardiovascular disease

Guidelines to lower the risk of cardiovascular diseases include lifestyle and behavioral changes or modifications:

Cessation of smoking

The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication.

Nutrition

The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids. All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily.

Diet should have vegetables, fruits and legumes, grain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements.

Alcohol consumption

All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day.

Physical activity

The aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i.e. 150 mins/week minimum).

Maintaining a healthy body weight

The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18.5–24.9 kg/m2

Lowering blood cholesterol

The aim of therapy should be to maintain blood cholesterol at:

• Low density lipoprotein (LDL) at – less than 2.0 mmol/L
• HDL – more than 1.0 mmol/L
• Triglyceride (TG) less than 1.5 mmol/L

The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin.

Lowering blood pressure

High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control. The aim should be a blood pressure of less than 130/80 mm of Hg.

Diabetes and blood sugar control

Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%.

Other drugs to lower risk of cardiovascular disease

Other drugs used to lower risk of cardiovascular diseases include:

• Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events.
• ACE inhibitors like Enalapril, Captopril, Lsinopril and Angiotensin II receptor antagonists (ARA) like Losartan, Candesartan, Telmesartan – these help in cardiac remodelling and prevent cardiovascular events like heart attacks, kidney damage etc.
• Beta blockers like Atenolol, Metoprolol, Carvedilol – these help in lowering blood pressure and preventing cardiovascular events like heart attacks.
• Aldosterone Antagonists like Spironolactone – this helps in preventing heart failure and other cardiovascular conditions.
• Reduction of blood levels of homocysteine by regular supplementation with Vitamins B6 and B12, and folic acid.