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Risk of Developing Heart Disease

We have a lot of new tests and studies that help us assess the risk of developing heart disease, such as the blood cholesterol level, more specialized lipid profiles, coronary calcium scores, and even coronary CT angiograms. But many data points, such as family history, lifestyle, and biomarkers, may be even more predictive than the tests mentioned above.

The Pretest Probability of Developing Heart Disease

It’s nothing we haven’t heard; the risk factors for developing heart disease include:

  • hypertension
  • family history of heart disease
  • processed food intake
  • high saturated fat intake
  • stress
  • obesity
  • sedentary lifestyle
  • signs of inflammation

Knowing these data points, it’s often not necessary to do further testing. Though we can never predict an individual’s chance of having a heart attack, we can take an educated guess and be right 80% of the time.

Do You Need to Be On Meds?

Quite a few patients come to me requesting more specialized testing such as the list mentioned above but also very unique blood tests like oxidized lipid levels, homocysteine, nuclear stress tests, Holter monitors, etc.

They want to know whether they should start a statin drug; that’s the most common dilemma I see with my patients. And while I can’t give anyone here an answer, if you feel that your risk of heart disease is high, further testing cannot put your mind at ease.

If you have a less favorable lifestyle and family history and comorbidities like hypertension, then the risk of developing heart disease – and cardiovascular disease, such as stroke – is high enough that even if the tests were all negative, some sort of intervention is necessary.

Even a lipid panel may be of little value if you have no risk factors for developing heart disease. Just because it’s high, does that mean you’ll suffer a heart attack? Unlikely. And the chance that your lipid profile will be atrocious is relatively low unless you don’t fully understand what a risk factor is.

Convincing Yourself to Start an Intervention

Sometimes, my patients just need a nudge, a push to convince them that something is wrong and that they should take action. After all, imagine doing something drastic as taking medication for life for something that is causing you no symptoms whatsoever.

I know my lifestyle isn’t good and my dad had a fatal heart attack at 51. I just can’t get myself to start Lipitor because I know I can change things with my lifesyle. But if my cholesterol is high, okay, I get it, I’ll start it because then I’ll know that my risk of cardiovascular disease is actually high.

My experience is that the patient above won’t be convinced with the lipid test either. They are then going to want the CAC, and if that’s high or low, the coronary CT angio, and on and on.

Of course, I always meet my patients where they are but I’ll advise them along the way. Unnecessary testing adds to stress, is expensive, and has some potential harm.

Assessing Your Risk of Heart Disease

Heart risk calculators have been around for a long time. The new kid on the block is the PREVENT calculator for predicting the risk of cardiovascular disease.

We aren’t big fans of these calculators here at Digital Nomad Health. They’re a great place to start but aren’t granular enough for the individual. They’re adequate for a population-level assessment, but that’s not why you visit your doctor.

I do my own risk assessment for each patient and it’s a lengthy process because capturing all the proper data points just takes time. Asking someone point blank what their diet is like doesn’t often give me a good picture, but I learn their dietary habits over time.

Assessing your heart disease risk is the first step. The main reason to do it is to figure out what changes you can make to lower the risk. No drug exists that can overcome a poor lifestyle.

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