Understanding Your Heart Attack and Stroke Risk

After cancer, heart disease and stroke are the leading causes of death in Canada. Every 8 or 9 minutes, give or take, someone dies from one of the two.

Certainly, many of those deaths are in older populations. After all, there’s no such thing as ZERO risk. All of us have a risk of having a heart attack or stroke just by being alive, and as we age that risk rises simply because we are growing older.

But age is far from the the only factor.

Calculating Your Risk

There’s been a lot of research into the risk factors for heart disease and stroke. The Framingham Risk Calculator was developed to give you a very good idea of what your risk of having a heart attack or stroke is based on what your risk factors are. If you know your blood pressure and cholesterol numbers, you can calculate your own 10-year risk in 30 seconds right here. (And if you don’t know those numbers, we can help–just ask.)

The Impact of Risk Factors

The information the Calculator asks for are risk factors. High cholesterol, high blood pressure, and high blood sugar increase your risk of a heart attack or stroke over time. To see the impact, let’s check out an example using the Risk Calculator.

  • If you are a 59 year old male, with normal blood pressure, normal cholesterol, were a non–smoker and didn’t have diabetes – basically a pretty healthy guy by those measures–your 10-year risk of having a heart attack or stroke is 4.25%.

Now let’s add some risk factors.

  • Add high blood pressure (a systolic blood pressure of 150), and your risk goes up to 6.47%.
  • Add a high cholesterol to that (total of of 6.2, a good cholesterol of 0.9) and the risk rises to 15.13%.
  • Add smoking to that it goes up to 27.07%.
  • Add diabetes to that it goes up again to a whopping 42.90%!

So if you are a 59 yo male with slightly elevated blood pressure, who smokes, has high cholesterol and diabetes, your risk of having a heart attack or a stroke in the next 10 years is 42.9%. That is a big difference from the 4. 25% of your healthy age match.

That is some scary stuff. But hey–we have great drugs to treat blood pressure and cholesterol and diabetes…don’t we? That will bring the risk down, right?

Well let’s add a blood pressure medication:

Let’s use the example of our 59 year old smoking, diabetic with high blood pressure and high cholesterol. That person’s risk of having a heart attack or stroke in the next 10 years is 42.9%.

  • If he takes a blood pressure medication, his absolute risk reduction of having a heart attack is 0.7% so his risk goes from 42.9 to 42.2%.
  • The same blood pressure medication gives him a 1.3% absolute risk reduction for stroke. So that 42.9% risk turns into a 41.6% risk.

What about the statin drugs?

  • Well our fictitious patient will have a 1.3% risk reduction for heart attack and the 0.4% for stroke. Again, 42.9% risk turns into 41.6% or 42.5% risk respectively.

What about the baby aspirin everyone is taking to stave off heart attacks and strokes?

  • You get an absolute reduction in risk of just 0.06% for heart attack and no reduction for stroke.

Those reductions in risk are pitifully small. And they come at a cost.

To put it in perspecitve, 1666 people need to be treated with aspirin for 1 person not have a heart attack.

And of those same 1666 people, 16 of them will have a gastrointestinal bleed within one year of taking the drug.

(Information taken from Compendium of Therapeutic Choices)

So what is our poor 59 year old, smoking, diabetic with high blood pressure and high cholesterol to do?

First, understand the real risk reduction. If you have a high risk of heart attack or stroke, medication is, on average, barely helping.

Second, don’t let medication stop you from making lifestyle change. If you can take control of your blood sugar and smoking, you can have a huge impact.

  1. Stop smoking
  2. Start eating whole foods and stop eating processed foods.
  3. Exercise daily.

Don’t settle for just the bottle of pills. You can do much better by making lifestyle changes that will ultimately change your overall risk.

 

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