Physician-in-Chief, The Mount Sinai Hospital
Director of Mount Sinai Heart
We all know someone—a relative, friend, coworker, or acquaintance—who has had a heart attack or stroke. Together, these devastating events are the leading cause of death in the world. Fortunately, they are also preventable. And taking steps to avoid heart attacks and strokes may help protect you from dementia, too.
Coronary artery disease, which can lead to heart attacks and strokes, occurs when plaque builds up in the major vessels that supply blood to the heart. This build-up narrows and hardens the arteries, and can cause blood clots to form and cut off the flow of blood to the heart (a “heart attack”). Clots can also travel to the large arteries of the brain, blocking blood supply and causing ischemic stroke (a “brain attack”).
The good news is that you can decrease the likelihood of suffering a heart attack or stroke by taking care of seven risk factors that play a key role in the development of heart disease. Doing so may also help stave off cognitive decline. Recent research suggests that these same risk factors affect the tiny vessels of the brain, leading to microinfarcts, or mini-strokes, that damage or destroy small areas of brain tissue. These mini-strokes initially may have no symptoms, but can affect cognitive function in the long term, resulting in dementia, as well as speeding the progression of Alzheimer’s disease in people who already have it.
The seven modifiable risk factors fall into three categories:
· Mechanical: obesity and high blood pressure
· Chemical: high cholesterol and high blood sugar/diabetes
· Behavioral: cigarette smoking, lack of exercise, and poor nutrition (excessive salt and fats)
In the United States, for example, less than four percent of adults over the age of 50 have none of these risk factors. Most people have more than one, and risk factors tend to “gang up” and worsen each other’s effects. So, it is not enough to obsessively address a single risk factor, like losing weight or stopping smoking. Rather, you need to make a firm decision to be healthy overall. Once you make this decision, there are several approaches you can take.
Approaches to Health
Individual. One approach is as an individual. That is, you go to the doctor to find out which risk factors affect you—for example, whether you have diabetes, hypertension, or poor nutrition—and work with him or her to care for yourself as a whole. You might need help from a dietitian or exercise trainer, or medication to lower your blood pressure or help you stop smoking.
Specific health goals depend on your package of risk factors. If you have many risk factors, you need to be more aggressive in addressing each of them. Ideally, people should maintain the lowest blood pressure possible without causing fainting, lower their LDL (“bad”) cholesterol as much as possible, and not smoke at all. Exercising regularly, eating right, and achieving a healthy weight are also critical. You don’t have to become a marathon runner, or as thin as a fashion model. Your doctor can help you figure out what goals are right for you.
Community. There are two community approaches. The first is similar to Alcoholics Anonymous, where a group meets regularly to motivate each other to address one or more risk factors that they have in common. Research shows this to be very helpful for minimizing risk factors and improving health.
The second approach is guided to a specific risk factor that predominates in a community. For instance, in a study of hypertension in western Kenya, my colleagues and I observed the custom of using salt instead of refrigeration to preserve food. Hypertension due to consuming excess salt is common there, and consequently, many people experience heart attacks and strokes. For the study, we distributed easy-to-use blood pressure machines in the community so people could check their own and their neighbors’ blood pressure and enter the results in a registry. This helped motivate the whole population in this part of the country to work on lowering their blood pressure and improve their health.
Policy. The third approach involves rules and regulations issued by local and federal governments. For example, tobacco taxation and laws banning smoking in public have helped many people improve their health. The World Health Organization also advocates taxing sugary drinks like soda as a way to cut down on sugar consumption. This approach is justified because heart issues are very expensive not just for the individual, but also for society.
I sometimes come across patients who dismiss decreasing their risk factors, feeling that if they have a heart attack or a stroke, death will come suddenly rather than being drawn out. Of course, they are failing to realize that a quick death is not guaranteed, and that cognitive function may be slowly eroded by the same health issues. None of us wants to reach old age suffering from dementia.
With an aging American population, our epidemic of at-risk individuals will only increase unless people take responsibility for avoiding heart attack, stroke, and dementia.
In the end, it is up to you to decide that your health is important.