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Samuel D. Goldberg, MD
Preventing Heart Disease and Stroke
Johns Hopkins Community Physicians Heart Care - Bethesda
. https://www.hopkinsmedicine.org/jhcp

Preventing Heart Disease and Stroke

Heart attack and stroke are the leading causes of death in the United States, accounting for nearly one million deaths annually. Of patients who experience sudden cardiac death, 20-40% have no known history of heart disease. These illnesses can be largely delayed or prevented by early identification of risk-prone individuals and the initiation of treatment in younger age groups than has been done in the past. Atherosclerosis (the process that leads to heart attack and stroke) starts in the teenage years for males and perhaps in the 30s and 40s for females and progresses as one ages.
Those persons with abnormal lipid patterns (cholesterol and triglycerides), obesity, higher than normal fasting blood sugar, and family history of vascular disease are the groups that early intervention is most likely to be successful. A strategy of early identification of risk and subsequent appropriate treatment is likely to add many years to ones life.
Useful in quantifying risk is calculating what is termed ones Framingham Risk Score, which can be determined by a careful medical history and a few simple tests. Age, sex, smoking history, blood pressure, weight, and cholesterol both total and high density (HDL) are each given weight in determining the score.
In addition to the Framingham score, additional tests can further identify risk such as determining cardiac CRP (an index of inflammation in the blood vessels) and an X-ray test called a Calcium Scoring Test or EBCT scan or just heart scan. This test identifies calcified plaque in the coronary arteries. Determining the presence of plaque in the carotid arteries (the arteries supplying the brain with blood) and in the lower extremities is also useful. These tests may identify asymptomatic advanced disease that needs further evaluation.
Treatment options consist of life style changesappropriate diet and exercise, smoking cessation, medication for hypertension and diabetes, and possibly aspirin and statin drugs. The statin drugs (Lipitor, Zocor, etc.) have been particularly useful in reducing risk. In patients with established coronary heart disease these drugs reduce the risk of subsequent cardiac events by about 30%. With early treatment, before the disease manifests itself clinically, these drugs coupled with serious life-style changes may lower the risk of events even more dramatically. In the past we have been reluctant to prescribe the statin drugs to younger individuals, but early treatment is likely to pay large dividends and should be given strong consideration.

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