Preventing the unknown killer -- heart disease

  • Published
  • By Lt. Col. Alison Helmkamp
  • 22nd Medical Group medical staff chief
While most folks are still finishing their heart-shaped boxes of chocolate (those fruit creams are the last to go), the topic of heart health naturally came up as a topic for February.

Heart disease, particularly coronary artery disease (hardening of the arteries), doesn't get tons of press, but it should. It is, after all, the number one cause of death for both men and women in this country, accounting for 630,000 deaths a year. In the United States, someone has a heart attack every 34 seconds; each minute, someone dies of a heart disease-related event.

This means that roughly one in four deaths in this country are from heart disease. Coronary disease can be detected as early as the teenage years in folks with a very high risk.

Common risks
That heart disease is so common is reflected in the cost to Americans. In 2010, heart disease cost the United States $316.4 billion (cost of medications, health care services, and lost productivity). To understand these numbers, it is important to understand heart disease. The most common cause of heart disease is coronary artery disease, which is caused by hardening of the arteries, which caused blockage. The coronary arteries are responsible for supplying the heart with oxygen; blockage may lead to a heart attack.

Certain risk factors a person cannot control include age, gender (male more than female) and family history. Several medical conditions and lifestyle choices can put people at increased risk for heart disease, including high cholesterol, high blood pressure, diabetes, cigarette smoking, overweight/obesity, poor diet, physical inactivity and alcohol use. Smoking is a terrific predictor of early death from cardiac disease, in case anyone is looking for another good reason to quit.

Types of cholesterol
In addition to avoiding risky behavior, it is important to understand the different types of cholesterol. High Density Lipoprotein is the "good" cholesterol, and a higher level is protective against heart disease. Few medications will raise HDL, though it may increase with niacin, a B vitamin used medically for cholesterol imbalance, and exercise. HDL should be more than 30 when measured.

Triglycerides, which when high are associated with heart attack and stroke, may be reduced by limiting simple sugars and increasing physical activity, though significantly elevated levels may require medication. The recommended blood level is 150 or less. Low Density Lipoprotein is the really "bad" cholesterol, in other words, the one most closely related to heart health. This can be lowered in some non-medical ways (increasing dietary fiber, increasing fish or taking a fish oil supplement, taking in less saturated fats with diet modification, losing weight, and increasing exercise), though often a medication is recommended.

There are many different medications for cholesterol problems, and there is good science behind most that they can reduce cholesterol and will decrease the risk of heart attacks and prevent early cardiac deaths. LDL should be under 130 in the average young adult.

Risk Factor Modification
One of the strongest predictors of heart disease is family history. People with a history of early heart attacks in the family (less than50 years old in a male relative, less than 60 in a female) should bring it up with their provider at their first physical. Early intervention of modifiable risk factors can save lives. For example, diabetes is very commonly associated with heart disease, and proper management of diabetes does lower the risk of heart attacks.

Taking care to exercise regularly, keeping weight under control, knowing and addressing cholesterol levels, quitting tobacco, and eating properly can all prevent heart disease and prolong life. In some circumstances, prescription medication is needed.

Anyone looking for help with any of these should contact their provider for information. The Health and Wellness Center has programs to address each of these modifiable risk factors, and the enthusiastic and dedicated personnel to help all Tricare beneficiaries. Other resources for information include the American Heart Association and Centers for Disease Control web sites at and