It Turns Out That Most Cases Of Heart Disease Could Have Been Predicted
A new study suggests that the "silent killer" should have been predictable.
Most of us know someone who died suddenly or unexpectedly from heart disease. It is an all too familiar story that goes something like this: “Did you hear Frank dropped dead at work today? He had no symptoms or history of heart trouble.” A new study suggests this is not entirely true.
The study did not look specifically at sudden unexpected cardiac death. However, it looked at suboptimal levels of four traditional risk factors for CVD (cardiovascular disease): blood pressure (BP), cholesterol, glucose, and tobacco smoking before the first diagnosis of coronary heart disease (CHD) or blocked arteries, heart failure (HF), or stroke. The population studies were conducted in Korea and among multiple ethnic groups in the USA.
At least one of these traditional risk factors was suboptimally treated before the diagnosis of those three things. Suboptimal treatment was defined as BP higher than 120/80 or on BP meds, total cholesterol blood levels of >200 or taking lipid-lowering medications, fasting blood sugar> 100 or a diagnosis of diabetes, and past or current tobacco use. One more suboptimally treated risk factors correlate highly with CHD, HF, or stroke.
Less strict criteria for suboptimal treatment of these risk factors were examined and showed similarly strong results.
These results not only challenge claims that CHD events frequently occur without antecedent major risk factors but also demonstrate that other CVD events, including HF or stroke, rarely occur in the absence of nonoptimal traditional risk factors, highlighting the importance of primordial prevention efforts.
This binational study showed that >99% of people who developed CHD, HF, or stroke had one or more suboptimally treated risk factors before the disease event. The findings were consistent across all age groups and sexes.
The conclusion was that CVD events rarely occur in the absence of these antecedent traditional risk factors. The study has some limitations. It is possible that Frank, in our first example, died without risk factors, but never saw a doctor to be diagnosed. When it comes to CVD, “what you don’t know can kill you.”
The bottom line is that all adults should be screened at least annually for these traditional risk factors, and if present, attempts should be made to get these levels to optimal levels.
My dad had the high blood pressure and the high cholesterol, but him and his doctor went back and forth on when and how to intervene. With poor sleep, obesity, and a calorie-dense diet my dad had all the right risk factors which predictably led to a cardiac event requiring several stents. I'm grateful for medical technology such as CABG and PCI but not everyone is lucky enough to survive their first cardiac event. Until that puzzle is solved, decreasing any existing risk is really valuable.
Excellent and timely post, Dr. Mokotoff.
This is a powerful reminder that in the vast majority of cases, cardiovascular disease doesn't just appear out of the blue. Your summary of the study showing that over 99% of CVD events are preceded by at least one suboptimal risk factor is a crucial message. It effectively debunks the myth of the "silent killer" striking without any warning signs and reframes it as a "predictable killer."
The case of "Frank" is a perfect and sobering illustration of this. It highlights a critical gap in our healthcare approach: the disconnect between the existence of risk factors and the awareness and management of them. The idea that "what you don't know can kill you" is particularly potent here. It underscores the importance of proactive and regular health screenings.
This also brings to mind the challenge of patient engagement and health literacy. Even when risk factors are identified, motivating individuals to make the necessary lifestyle changes or adhere to treatments can be difficult. Your call to action for annual screening is spot on, and it would be interesting to hear your thoughts on the most effective strategies to ensure that once these risk factors are identified, they are consistently and optimally managed.
Thank you for breaking this down in such an understandable way. This is a message that needs to be shared widely.
Dr Tom Kane