Cardiovascular Profile 

Overview

Several recent and very large studies involving tens of thousands of people have demonstrated the importance of the cardiovascular profile which can identify patients at different levels of risk. People in the low risk categories have a substantially lower risk of having a heart attack. In response to the data, several national organizations have developed guidelines to identify optimal, normal, high-normal, and treatable criteria for these major cardiovascular factors.

The major cardiovascular profile includes:

Age— The incidence of cardiovascular disease increases with advancing age.

Sex— Males have a higher risk of heart disease than females until menopause when women catch up with men.
Ten times more women will die of heart disease than will die of breast cancer.

Smoking— Smoking is one of the leading causes of premature death in America. More people die of tobacco-related heart disease than lung cancer.

Family History— A first-degree relative (father, mother, brother, or sister) with early heart disease increases your own risk. Recognizing an undesirable family history allows a person to take steps to prevent the development of their own disease. These steps can include smoking cessation, reducing a high cholesterol, treating elevated blood pressure, maintaining a normal weight, and exercising regularly. The National Cholesterol Education Program defines a high risk family history as one with a male first degree relative (father or brother) under age 55 or a female relative (mother or sister) under age 65 who has had a major coronary event.

High total and low HDL (good) cholesterol— High cholesterol is one of the primary causes of heart disease. Numerous studies have demonstrated that heart disease can be prevented or reduced if cholesterol is lowered to optimal levels. Pharmaceutical companies have recently developed several very effective medications to treat high cholesterol.

HDL, the "good" cholesterol, is now recognized as an independent risk factor for heart disease. An HDL value over 60 is considered protective while a value below 40 carries increased risk.

The National Cholesterol Education Program has set the benchmarks for lipid control.

High blood pressure— One third of all atherosclerosis is due to high blood pressure. There is a continuous graded increase in cardiovascular risk proportionate to the degree of blood pressure even when the blood pressure does not require treatment. The Joint National Commission national classification of blood pressure is:

Obesity— Obesity is the second leading cause of preventable death in America and is responsible for nearly as many premature deaths as smoking. Overweight and obesity are best measured by the body mass index, BMI. The national benchmarks were set by the National Institute of Health which has a BMI calculator at http://nhlbisupport.com/bmi/bmicalc.htm.

Diabetes Mellitus— Diabetes including both Type 1 and the increasingly prevalent Type 2 Diabetes associated with obesity are both associated with cardiovascular disease.

The goal of current medical practice is to identify and modify a person's cardiovascular profile to normal or optimal levels. We could achieve a substantial decrease in coronary disease, morbidity, and mortality, if everyone achieved optimal or normal cardiovascular profile.

These national benchmarks will help physicians better stratify patients, identify those who need treatment and move everyone toward an optimal cardiovascular profile. Understanding the cardiovascular profile has taught us that it is far better to prevent a heart attack than to treat one.

Body Mass Index

Traditionally, build has been measured by weight and height tables. These tables lacked a single number to identify the health benefits or risks of different body sizes. Fortunately, weight and height measurements can be reduced to a single number that accurately identifies health risks. This number is called the Body Mass Index, or BMI.

The Body Mass Index, BMI, is a calculated number reflecting a person's relative degree of body weight for his or her height. The BMI calculation and results apply to both men and women. The formula is either:

Weight in kilograms/Height in meters²

- or -

Weight in pounds x 703/Height in inches²

It is simpler to find your BMI by looking up your own height and weight on the table below. The weights listed are the top weight within each BMI column. If your height or weight is not on the table, then you can use the formula above or use one of the many BMI calculators available on the Internet. The National Institutes of Health's calculator can be found at http://nhlbisupport.com/bmi/bmicalc.htm.

What Does the BMI Mean?

The BMI is a single number that can be used to determine whether a person's build and his or her associated risk of disease are normal or elevated. The National Institutes of Health has established national classifications of varying BMI values. The "normal" or "ideal" category defines the group with the lowest mortality rate. These guidelines are used to develop clinical guidelines for the practicing physician. The experts at the National Institutes of Health established the following categories and associated risks for each weight classification. The classifications below apply to adults over the age of 18. Children between the ages of 3 and 18 must use an age and sex specific BMI chart.

The BMI is an excellent tool to assess risks associated with varying degrees of obesity. The BMI is accurate for all but the most extreme athletes.

The Obesity Epidemic

Everyone finds the issue of weight, overweight, and obesity a sensitive one. However, there is no avoiding the fact that America has a real epidemic of obesity. Obesity is an important part of the cardiovascular risk profile. Overweight and obese people are at an increased risk of heart disease, hypertension, type 2 diabetes, cancer, abnormal lipids, and sleep apnea.

The Future

The very real health issues associated with obesity can only be addressed as the country begins to talk about and do something about the population's weight problem. Wider use of the Body Mass Index as a real measure will help us move toward better health.

Reducing the Risk of Heart Attack

Jonathan was 44 when he buried his 63-year-old father who had died from a heart attack, the dad's first and last and only sign of heart disease. Jonathan and his father shared a set of health problems—obesity, high cholesterol, and high blood pressure. Wisely, Jonathan went straight from the funeral to the physician for a checkup. He soon learned that he had all of the same cardiovascular risks as his late father. Determined to avoid an early death, Jonathan changed his lifestyle and his life expectancy.

Jonathan's story is just one example of a huge problem in health care. In the United States, heart disease has been the leading cause of death every year since 1900, with the exception of the influenza epidemic of 1918. In 2000, heart disease remained the leading cause of death for both men and women and claimed more lives each year than the next five leading causes of death combined. Tragically, for one third of patients, a fatal heart attack is the first and last sign of their heart disease. The average age at which a person suffers a first heart attack is 66 for men and 70 for women.

These numbers are too high. Fortunately, scientific medicine has made tremendous strides toward identifying the causes of coronary artery disease. The major risk factors for heart disease include increasing age; a family history of premature heart disease; smoking; abnormal blood lipids including total LDL, and HDL cholesterol; high blood pressure; obesity; and diabetes.

Recent scientific understanding of the causes of heart disease has led to the knowledge that it is possible to identify both favorable and unfavorable cardiovascular profiles based on the number of major risk factors a patient presents. Further, a person who has unfavorable risk factors for heart disease can significantly improve his or her cardiovascular profile with medical treatment and by following a heart-healthy lifestyle.

The chart below can help you figure out your risk factors for heart disease. If you are concerned about your cardiovascular profile, contact your physician.

Clearly Jonathan was in a high risk group—one that is all too common in America today. He smoked, was overweight, did minimal exercise, had elevated total cholesterol and low HDL cholesterol, had untreated high blood pressure, and was borderline diabetic.

Changing his lifestyle was imperative! Jonathan quit smoking and lost weight by eating sensibly. He began an exercise program and started taking medication to treat his high cholesterol and hypertension.

By taking these actions, Jonathan reduced his risk of cardiovascular disease from very high to low. Medical science has demonstrated that achieving a favorable cardiovascular profile is possible and makes a high difference in promoting better health.

Jonathan at the Time of His Father's Death

Jonathan Four Years Later