How Important Are Risk Factors?To say which risk factors are the greatest predictors of coronary artery disease for a particular person is fraught with assumptions. However, most doctors would probably agree that the most important risk factors are smoking, elevated lipids (cholesterol) in the blood, high blood pressure, excess weight, diabetes, and sedentary life-style. Obviously, many of these are not independent factors. For example, many overweight people are relatively inactive and have high cholesterol levels.Working to reduce one risk factor may have benefits for others. If you change your diet to lose weight, you may also lower your cholesterol level and blood pressure. You may also decide to start an exercise program.Is Prevention Worth the Effort?The whole purpose of identifying and controlling your cardiovascular risk factors is to prevent a heart attack, early disability, and death. Millions of Americans have learned about these risk factors and have tried to modify them with help from health professionals. You can control high blood pressure, stop smoking, and lower your cholesterol level. As a matter of fact, the average cholesterol level of the population has decreased during the past 20 years, most likely because many people have changed their diets and some people are getting more physical activity. These changes have probably contributed to the declining death rate from heart disease in the United States.Most people agree that a more healthful life-style is worth the effort, but they need a little help. It is not easy to change habits that you have lived with for many years. *227\252\8*
MODIFIABLE RISK FACTORS OF CORONARY ARTERY DISEASE: UNDERSTANDING YOUR RISK – HOW IMPORTANT ARE RISK FACTORS? IS PREVENTION WORTH THE EFFORT?
Symptoms usually develop gradually with atherosclerosis. As the arteries become increasingly blocked, progressive symptoms frequently develop. The specific symptoms depend on which artery or arteries are obstructed. If the leg arteries are affected, then the symptoms are usually numbness, fatigue, or pain in the leg (claudication). Atherosclerotic obstruction of the coronary arteries may lead to symptoms of angina or even a heart attack. Other commonly—affected arteries include the carotid arteries in the neck (a situation that predisposes to stroke) and the abdominal aorta (which may become partially obstructed and cause claudication or become weekend and lead to aneurysm).Symptoms caused by progressive atherosclerotic narrowing of an artery are more likely to occur during exercise than at rest, at least initially. Early symptoms may occur only after great exertion, but as the narrowing worsens, less and less activity required. The symptoms develop during exertion because your arteries cannot supply your muscles with enough oxygen and nutrients. The more severe the blockage, the less exertion it takes to surpass the ability of the artery to supply adequate-’blood. When you stop and rest, the discomfort resolves in a few minutes. However, blockages can be so severe that even resting muscle does not get enough blood flow, and you may experience symptoms, such as claudication or angina, even when sitting still.Indeed, it is the symptoms caused by inadequate blood flow to a part of the body that may bring you to a physician, who then attempts to discover the cause. Atherosclerosis is the of chronic obstruction of the a in 95 percent of cases, but other causes are important to know about.*192\52\8*
When people begin to look at ways they may have participated in their development of cancer, it is a good idea to seek the aid and support of a trained counselor or therapist. Many times, just asking for help is the first step in breaking a “rule” one learned in early childhood and establishing a more healthy way of responding to stress. Unfortunately, many of us grew up with a culturally induced reluctance to seek help for emotional problems. Yet if we are diagnosed with a severe illness, we do not feel embarrassed or ashamed to seek the help of a physician who has spent many years learning about the body. Neither should we feel embarrassed about enlisting the help of a professional to learn the ways in which stress has played a role in our illness.Most of our patients who go through this process of self-examination see important links between their emotional states and the onset of their disease, as well as the ways they participated in these emotional states. But, having seen how their beliefs and behaviors in response to stress may have contributed, some begin to feel guilty about their actions in the past. You may have similar feelings, so we would like to give you the same advice we give our patients.First, it is not our intent, nor is it desirable, for you to feel guilty for having recognized that you’ve participated in your disease. There is a difference between being “to blame” for something and having “participated” in it. It makes no sense to blame persons living in this society for becoming ill in light of the rules they were taught for dealing with their emotions and feelings. (Few individuals in our culture have been taught how to deal with emotions and feelings appropriately.) Further, blame suggests a person consciously knew better and yet decided to respond or act in a self-damaging way. That is certainly not true of people who respond to stress by developing a physical illness. Like most people in our culture, you were probably not even aware of a link between emotional states and illness. Thus, the ways in which you did participate are almost certain to have been a result of unconscious beliefs and habitual behavior.It is a particularly sad course of events, that many times those people who most steadfastly and responsibly attempt to live up to cultural rules develop the most serious illnesses. The literature describing the emotional aspects of cancer is replete with examples characterizing cancer patients in general as “too good to be true”—people who are kind, considerate, unselfish, and pleasant in the face of all adversity.Individuals who begin to accept responsibility for influencing the state of their health deserve the greatest of congratulations. Not only are they willing to begin the process of exploring their own attitudes, emotions, and feelings—and the ways these contribute to their response to stressful situations—but they are also finding the courage to stand up to the cultural rules they were taught and to reject those that are not conducive to health.The real point of a self-examination is to turn up clues on how you can participate in health through a process of recognizing and changing self-destructive beliefs. If you have participated in the onset of the disease, you also have the power to participate in your recovery.*35\347\2*