What's your "cardiovascular destiny"?

It’s well documented that certain factors increase your risk of dying from cardiovascular disease. Most people know the big ones - high blood pressure, high cholesterol, smoking and diabetes.  But age, gender and ethnicity also have been thought to play a role. 

Now a report published Wednesday in The New England Journal of Medicine shows that these risk factors alone are responsible for your cardiovascular destiny, and that having just one can up your risk considerably.

Study authors analyzed the data from 18 studies involving more than 250,000 men and women from different ethnic backgrounds whose risk factors were measured at age 45, 55, 65 and 75.  This allowed the authors to determine the risk of dying from heart attack or stroke over the course of a lifetime, rather than just 5 to 10 years in the future as has been previously studied.

What the researchers found can be boiled down to this:

“Regardless of how old you are, male or female, white or black, what decade you were born in, your cardiovascular destiny is determined by those risk factors,” study author Dr. Donald Lloyd-Jones said.

Cardiovascular destiny - an interesting phrase.  Lloyd-Jones, a cardiologist and researcher at Northwestern University’s Feinberg School of Medicine , uses the term to describe a person’s likelihood of dying from a heart attack or stroke.  He said that destiny can be set in stone by your mid-forties.

So what does that mean?  Let’s say a 45-year-old man comes into a doctor’s office with zero risk factors: His cholesterol level is less than 180, his blood pressure is less than 120 over 80, he doesn’t smoke and he doesn’t have diabetes. His risk of dying from cardiovascular disease at any point during his lifetime is approximately 1.4%, according to the study.

But let’s assume he’s more like the majority of Americans, this man has high blood pressure and high cholesterol.  Or he has diabetes and he smokes.  Just having two major risk factors increases our patient’s likelihood of eventually dying from cardiovascular disease to 49.5%.

And although the statistics are slightly different, this big jump is true if you’re male or female, black or white, young or old.  Turns out, when it comes to heart health – race, sex and age don’t really matter, according to this new study.

“Once these risk factors develop, the horse is already pretty well out of the barn,” Lloyd-Jones said. “If you reach middle age with the [zero] risk levels, you’ve almost abolished the chance you’ll have a heart attack or stroke.”

If not, your cardiovascular destiny is a bit bleaker. Even if your chances of having a heart attack five years from now are small, your chances of having a heart attack over the next 20 years are still high, Lloyd-Jones said.

The study’s real message is that it’s never too early to begin prevention, said Gordon Tomaselli, president of the American Heart Association .

“Be aware of your risks for cardiovascular disease and manage them as early in life as possible,” Tomaselli said.  That means staying active, eating right, not smoking and knowing your family’s blood pressure and cholesterol levels – even your children’s.  And if you are that 45-year old patient with any one of the risk factors, Tomaselli recommends seeing your doctor right away so you can get treated. 

Tomaselli further believes the study’s results should push policy makers to change how we manage cardiovascular disease as a population.  Rather than treatment, we need to focus on creating an environment where the risk factors don’t exist through a proper food supply, tobacco regulation and providing open areas for activity, he said.

“All those things are really as important, and arguably more important, than anything we can do as doctors to prevent cardiovascular disease.”