Field Notes Risk Reduction
Heart disease remains the Nation's number one cause of death. It begins early in life and develops at a rate that depends on heredity and lifestyle (diet, physical activity, smoking, body weight). Among wildland firefighters, heart attacks account for 9 of 10 deaths from medical causes. While exertion may trigger a heart attack in a person with preexisting disease (only 10 percent of all heart attacks occur during exertion), it does not cause the disease. Reducing the risk of heart disease is a personal obligation that cannot be delegated. Risk reduction strategies include:
Regular physical activity—Exercise reduces heart disease risk from 30 to 70 percent. Inactive individuals are 56 times more likely to experience heart problems during exertion.
Diet—A healthy diet includes a moderate amount of calories and fat with five or more daily servings of fruits and vegetables (for vitamins and antioxidants).
Body weight—A body mass index between 19 and 24 is associated with a lower risk of heart disease and type 2 diabetes.
Smoking cessation—Smoking increases the risk of heart disease, lung cancer, emphysema, and many other conditions.
Alcohol—Moderate (one to two drinks daily) alcohol consumption lowers risk by raising high-density lipoprotein cholesterol and lowering inflammation (see C-reactive protein below).
Aspirin—One small aspirin (81 milligrams) daily reduces platelet stickiness, inflammation, and heart disease risk (use an enteric-coated aspirin to avoid stomach problems).
Vitamins C and E—These vitamins are related to reduced risk of heart disease.
C-Reactive Protein—This protein is an independent risk factor for heart disease and sudden death. This risk factor may be a better predictor of a future cardiovascular event than low-density lipoprotein cholesterol.
Statins—This class of cholesterol-lowering drugs has proven effective in reducing the risk and incidence of heart disease. Statins lower cholesterol and raise high-density lipoprotein cholesterol. Recent evidence suggests that statins may also lower inflammation and C-reactive protein.
SummaryIndividuals with a family history of heart disease and those with significant risk factors (smoking, inactivity, overweight, hypertension, elevated cholesterol, and elevated blood glucose) should take every step to reduce their risk. If diet, exercise, weight control, and other steps do not reduce the risk, their physician may recommend drug therapy.
This blood test has been linked to heart disease. The test reflects the response of the body to inflammatory reactions in diseased coronary arteries. The C-reactive protein may interact directly with the fatty plaque lining coronary arteries, leading to inflammation and formation of clots (thromboses). This unstable plaque can rupture, form clots, and clog an artery, leading to a heart attack and sudden death. This protein may emerge as a marker of unstable plaque, a serious risk for a sedentary individual who engages in exertion. C-reactive protein is associated with coronary risk factors such as elevated blood pressure, increased body mass index, diabetes, low HDL cholesterol, and high triglycerides. C-reactive protein is also associated with estrogen and progesterone hormone use, chronic infection (such as gum disease), and chronic inflammation, as in rheumatoid arthritis. Increased physical activity, endurance exercise, weight loss, moderate alcohol intake, aspirin, and cholesterol medications (such as statins) are associated with decreased levels of C-reactive proteins, inflammation, and the risk of sudden cardiac death.
In September 2002, the Institute of Medicine, a branch of the National Academy of Sciences, made the following announcement: "To prevent weight gain as well as to accrue additional weight-independent health benefits of physical activity, 60 minutes of daily moderate intensity physical activity is recommended." This recommendation doubles the Surgeon General's 1996 recommendation that adults accumulate at least 30 minutes of moderate physical activity most days of the week. The increase is aimed at slowing the rise in overweight and obesity that has reached epidemic proportions in the population.
