How young is too young to start focusing on heart attack risk? And how good are we at calculating risk in younger individuals to predict their risk of a heart attack before age 50?
Heart Month is approaching and the emphasis on preventing heart disease is at high alert for all. We have learned a lot about heart disease in young adults from the Coronary Artery Risk Development in Young Adults or CARDIA study. This project recruited more than 3,500 young adults aged 18–30 in the 1980s, and followed their health habits for 20 years. At the end of this period they measured whether the heart arteries of these young people were already showing silent but deadly plaque using my favorite screening exams, a coronary artery calcium scan (CACS) by CT and a special ultrasound of the carotid arteries.
Five healthy habits were tracked several times during the 20-year span, including maintaining a normal weight, abstinence from smoking, regular exercise, eating a healthy diet, and drinking a low amount of alcohol.
Each healthy habit that was added during the study, like beginning an exercise program, reduced the risk of finding silent artery damage in these young people by 15%. On the flip side, losing one prior healthy habit, such as starting to smoke, increased the odds of finding these early killers plaques. Even more startling was that a third of previously healthy young people who let it all go, losing three or more health habits (e.g. gaining weight, stopping exercise, and excessive drinking), were walking around with silent artery damage at a young age.
Fortunately, maintaining a youthful and healthy heart in your 20’s and 30’s is not a major sacrifice and involves:
• Keeping a healthy body weight
• Not smoking
• Engaging in at least 30 minutes of moderate to vigorous activity five times a week
• Drinking no more than one alcoholic beverage a day for women, and no more than two for men
• Eating a healthy diet that’s high in fiber, low in sodium and contains lots of fruit and vegetables
In another study phase of the same patient group, the power of a widely available test for silent heart disease, the CACS, was assessed in apparently healthy 32–46 year old subjects that had the CT done and were followed for over 12 years on average. Even at this relatively young age, 10% of subjects had an abnormal CACS and over 100 of the 3,000 subjects suffered a heart event during follow-up. The young adults with any CACS greater than a perfect zero had a 5-fold increase in heart events. The highest risk was found in those with a CACS over 100. The authors concluded that in apparently healthy young adults screened in their 30’s and early 40’s, the CACS can predict heart attack and heart deaths.
Finally, brand new data indicates that standard “calculators” of risk fail at least half of those individuals who actually suffer a heart attack before age 50. In the YOUNG-MI registry, 1,685 persons who had a heart attack at that young age were assessed as to whether the guidelines of the American College of Cardiology/American Heart Association or the U.S. Preventive Task Force would have predicted their risk and recommended statin cholesterol lowering therapy to lower their risk before the heart attack. The findings were that 50–70% of them would NOT have been tagged as enough risk to intervene, at least with prescription drugs. However, over 80% of the young people suffering a heart attack did have a recognized risk factor like smoking, high blood pressure, or diabetes mellitus.
If you are a young adult who feels you can wait until you are over 50 to adopt a healthy lifestyle, or that it really doesn’t matter what you eat or whether you exercise at a younger age, these studies point out that the risk of that viewpoint. Coronary heart disease begins in childhood and can be found in young adults with alarming frequency. Following a heart protective lifestyle beginning at as young an age as possible and maintaining it for life is a plan to start this month.
As risk calculators fail to identify most young people on their way to a heart attack, do not feel satisfied with a pat on the back from your health care provider. Consider a more advanced evaluation like a CACS if you need a kick in the rear to quit smoking, lose weight, change your diet, begin exercise, and control your blood sugar, cholesterol and blood pressure. If you are not a ZERO score, today is the day you must institute changes ASAP. Do not wait, you might not get a second chance.