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RISK FACTORS
A risk factor raises the likelihood that you will be affected by a disease. Risk factors can be grouped into three categories.
 
1 Smoking
    Physical inactivity
    Being Overweight
Lifestyle is the category we have an important influence over
 
2 Diabetes
    High Cholesterol & LDL/HDL
    High blood pressure
 
There are some other medical conditions that increase the chance of developing heart disease. High levels of “bad cholesterol” and low levels of “good cholesterol” are now well established risk factors. A further risk factor is diabetes, where the levels of sugar in the blood are elevated. In addition high blood pressure contributes to the total risk of developing heart disease.
Making sure you follow the regime outlined by your GP or specialist, when treating these conditions is very important. These conditions can sometimes exist without you knowing it, and it is important to check for these factors if you feel that you may be at risk.
 
3 Family History
 
You can do little to influence genetic risk factors, which are inherited. However, taking care
of your body by managing any
risk factors that you can control will lessen your risk of developing heart disease.
If you have a first degree relative who suffered from heart disease, it is important to let your doctor know.


Am I at a higher risk because of my gender?

Heart disease continues to be thought of as a man's disease with little recognition of its importance in women. Women are less likely to seek medical help due to the lack of awareness and may go untreated. This is because of lack of awareness that they may be suffering from heart disease. Women with heart disease may, therefore, go untreated or present late in the disease process.

Being a woman per se is not a risk factor, but once you reach menopause, your risk increases.

Heart disease is a serious condition and may affect quality of life. This is why it is important to address any risk factors you may have at a young age to reduce your risk of developing heart disease in later years. If you have one or more risk factor, do not be afraid to discuss this with your GP who will help you understand how to protect your heart and formulate a plan to decrease your risks.

Don't be afraid to ask questions about any aspect of your health, for example,

What is my blood cholesterol, what does this mean to my heart, what do I need to do now?
When should I have it checked again?

What is my blood sugar? Do I have diabetes?

What is my blood pressure, what does this mean to my heart? When should I have it checked again?

How can I change my diet to help my heart?

How much activity should I undertake each week?

Is there help available to assist me to stop smoking?

What is my ideal weight?


Dietary Risk Factors and Diabetes

Raised Cholesterol Levels
(Hyperlipdaemia or Hypercholestrolaemia)
Hyperlipidaemia is a general term that refers to abnormally raised levels of total blood lipids and can mean an excess of cholesterol and triglyceride in your body. The risk of coronary artery disease is directly related to blood cholesterol levels. Blood cholesterol levels can be reduced by medication, physical activity and dietary changes, in particular a reduction in the consumption of saturated fats. It is estimated that 47% of deaths from coronary artery disease in women are due to a raised blood cholesterol level. Hypercholesterolaemia is common with over half of the Britain have cholesterol levels exceeding the ‘optimal' 5.0mmol/L.

Cholesterol is a fatty substance produced in your liver and from the fatty foods we consume. Cholesterol is transported around our body by proteins, when cholesterol and protein combine they form a lipoprotein. There are two main forms of lipoproteins. Low-density lipoprotein (LDL) is recognised to be a harmful from of cholesterol and high-density lipoprotein (HDL) is recognised as a helpful form of cholesterol.

Obesity
Being overweight and obese increases the risk of coronary artery disease. Being overweight or obese also denotes an increased likelihood of hypertension, hyperlipidaemia, and diabetes mellitus. By reducing your weight, you will live a longer, happier and healthier life along with your heart. The assessment of obesity is made using the body mass index (BMI) which takes into account the relationship between height and weight
BMI = weight (kg) ¸ height 2 (m)

In England 32% of women are overweight with a BMI between 25 and 30kg/m 2 . Obesity is taken as a BMI greater than 30kg/m 2 .

BMI Key
< 18.5 - underweight
18.5 to 24.9 -
healthy weight
25 - 29.9 - overweight
30 - 34.9 -
grade 1 obesity
35 - 39.9 -
grade 2 obesity
> 40 -
grade 3 (morbid obesity)

Diabetes
Diabetes significantly increases an individual's risk of developing coronary artery disease. It is estimated that about 3% of the adult population have been diagnosed with diabetes and this number is increasing. Diabetes associated with other risk factors including raised blood cholesterol, raised blood pressure, obesity and smoking will increase your risk of developing heart disease.

Patients with new onset of type 1 diabetes can have the symptoms of polyuria and polydypsea (increased urine output and increased thirst) combined with significant weight loss. Those with type 2 diabetes may have no symptoms at all for years, presenting with the sequelae of diabetes later on. This may include impaired vision, foot numbness, kidney damage or heart disease. Tests for diabetes are simple and available at most GP surgeries.

Non-Modifiable Risk Factors

Age
Increasing age adds to the possibility of having a first and subsequent heart attack. Age brings with it increased likelihood of exposure to smoking, the coexistence of high blood pressure, raised cholesterol levels and diabetes, in addition reduced regular exercise.


Family History and Genetic Predisposition
Coronary artery disease commonly occurs in families. The presence of coronary artery disease in a first degree male relative before the age of 55 years and 65 years in a first degree female relative is considered a strong risk factor. Some people may be more genetically predisposed to having coronary artery disease. This is a growing area of research, and meaningful genetic screening for heart disease may become possible.



Modifiable Risk Factors


Smoking
An increasing number of women are now smoking, yet smoking remains the major cause of premature deaths in the UK . The amount of oxygen carried in your blood is reduced if you smoke. Smoking can cause your blood to clot by increasing the levels of fibrinogen and platelets in the clotting process, thus significantly increases your risk of having a heart attack.

There have been many scientific studies showing that smokers were more likely to die from heart disease than non-smokers. This is due to many factors including the fact that smoking causes the blood vessels to narrow. In recent years, more women are taking up smoking than men. Women also appear to find it harder to give up smoking, and thus may require more help and attention. By quitting smoking you will reduce your risk of having a heart attack.

The other added benefits from stopping smoking are: Your eyes will appear much brighter You will no longer have the smell of stale tobacco in your breath, hair and clothes You will save over £1,800 a year if you smoke 20 cigarettes a day The appearance of your skin will improve Food and drink will taste and smell much better.


High Blood Pressure (Hypertension)

High blood pressure is also known as hypertension. Blood pressure indicates the pressure in your arteries. The top reading is called the systolic pressure, this is the pressure in the arteries when the heart contracts. The bottom reading is called the diastolic pressure and this is the pressure in the arteries when the heart rests in between each heartbeat.

You are deemed to have hypertension when your blood pressure is always higher than the recommended level. If you have been diagnosed with hypertension you are at risk of developing coronary artery disease therefore putting you at increased risk of a heart attack. By reducing your blood pressure by a small amount you can help reduce your risk of coronary artery disease. The lifestyle changes you can adopt to help reduce your high blood pressure or prevent high blood pressure are listed below: Reduce your salt intake Eat a healthy diet Take regular exercise Maintain a healthy weight Drink alcohol in moderation.


Alcohol

There appears to be some evidence to suggest that drinking 1-2 units of alcohol a day can help reduce the risk of coronary artery disease. Although, drinking more than 2 units per day will have the opposite effect and increase your risk instead.

1 in 7 women drink over and above the recommended safe level. Drinking heavily or binge drinking is a risk to your health. Women should drink no more than 14 units of alcohol per week (no more than 3 units per day).

A unit of alcohol is the equivalent of:
a small glass of wine (125mls)
½ a pint of beer
a single pub measure of spirit (25mls)


Physical Activity
Physical activity is known to both increase a sense of well being and can reduce your risk of developing coronary artery disease. Regular physical activity is the key to maximising the effect on heart health. Exercise could involve a brisk walk and ideally should be no less than 10 minutes to be beneficial, ideally 30 minutes everyday. Set yourself target dates, progress slowly to gradually increase your fitness and the duration of each session. Exercising with a friend or in a group is shown to be more motivating and provides better long term success. Y ou should speak with your GP before you undertake any physical activity if you are on any prescription medication.



Stress

Stress is not a main risk factor but it can increase the levels of adrenaline and cortisol being produced in your body. These hormones increase your blood pressure and can cause your blood to clot in your arteries, but there needs to be more research to find out the mechanisms of this. Stress is difficult to measure as we all find different things in our lives stressful. It is therefore important that you are able to relax through adopting a healthy behaviour to deal with your stress. Some women find taking a long bath, going for a stroll, yoga classes or physical exercise can help them relax.



Does Hormone Replacement Therapy (HRT) Increase my risk of heart disease?
Most medical authorities now agree that long term use of HRT increases the risk of both clots forming in the veins, such ad deep vein thrombosis, as well as ischaemic heart disease ( IHD), however HRT significantly reduces the risk of fractures resulting from osteoporosis. The most up do date advice from both British and American authorities advise against the long term use of HRT, as the risks may outbalance the benefits. However, HRT has an important role in helping with symptoms of the menopause, and remain important in managing these symptoms, specially if they are severe. Please ask your GP for your personal risks versus benefits of continuing to take HRT, as every case is different.

 
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