If you are black or Asian you are more at risk of heart disease, although different underlying risk factors are at play for each group. If you are Asian you have a higher risk of developing diabetes, which is a risk factor for heart disease. If you are black you are more at risk of high blood pressure, a separate risk factor for both heart disease and heart disease.
Diabetes
If you have diabetes you are three times more like to develop coronary heart disease. You are also more likely to have silent ischemia because diabetes can affect the nerves which send pain messages.
Being overweight and inactive
Both of these are separate risk factors for coronary heart disease and increase your risk of developing diabetes in middle age. Unfortunately, because in the early stages diabetes often has no symptoms, many people remain undiagnosed sometimes for years, during which time their arteries may be becoming more damaged.
Of course, other risk factors such as high blood pressure, raised cholesterol levels, smoking, being overweight and physical inactivity still apply if you have diabetes. In fact, Diabetes appears to be an extra risk - which may possibly amplify the risk of these other factors.
The Whitehall Study
While low status
was associated with obesity, smoking, less leisure time physical activity, more baseline illness, higher blood pressure, and shorter height (78), controlling for all of these
risk factors accounted for no more than 40% of the grade difference in CHD mortality (Marmot, Shipley and Rose, 1984; Marmot, Kogevinas and Elston, 1987). After
controlling for standard risk factors, the lowest grade still had a relative risk of 2.1 for CHD mortality compared to the highest grade (Marmot, 1994).
One possible explanation of the remaining grade differences in CHD mortality is grade differences in job control and job support (Marmot, Kogevinas and Elston, 1987).
In addition, blood pressure at work was associated with "job stress", including "lack of skill utilization", "tension", and "lack of clarity" in tasks. The rise in blood pressure
from the lowest to the highest job stress score was much larger among low grade men than among upper grade men. Blood pressure at home, on the other hand, was
not related to job stress level (78).
Newer risk factors for coronary artery disease have been identified over
the past several years, including elevated homocysteine levels, elevated
c-reactive protein, and apo-a. Homocysteine levels can be treated with
folic acid supplements in the diet. Studies are still ongoing about the
practical value of these new markers.
Chest pain is a major symptom of heart attack, but in many cases the
pain may be subtle or even completely absent, especially in the elderly
and diabetics. Other symptoms such as weakness, shortness of breath,
nausea, or vomiting may predominate.
Heart attack accounts for 1 out of every 5 deaths. It is a major cause of
sudden death in adults.
Prevention
Control cardiac risk factors whenever possible. Control blood pressure
and total cholesterol levels, reduce or avoid smoking, modify diet if
necessary (increase high density lipoproteins and decrease low density
lipoproteins), control diabetes, and lose weight if obese. Follow an
exercise program to improve cardiovascular fitness. (Consult your health
care provider first.)
After a heart attack, follow-up care is important to reduce the risk of
developing a new heart attack. Often, a cardiac rehabilitation program is
recommended to help you gradually return to a "normal" lifestyle. Follow
the exercise, diet, and medication regimen prescribed by your doctor.
Treatment
A heart attack is a medical emergency! Hospitalization is usually
required for 1 to 14 days. Treatment may include intensive care and
involve emergency surgery. ECG monitoring is started immediately,
because life-threatening dysrhythmias are the leading cause of death in
the first few hours after a heart attack.
The goal of treatment is to reduce the demands on the heart so that it
can heal, and prevent and treat complications. Activity may be restricted
initially, then gradually increased.
An intravenous catheter will be inserted to administer emergency
medications and fluids. Various monitoring devices may be neccessary.
A urinary catheter may be inserted to closely monitor fluid status.
Oxygen is usually given, even if blood oxygen levels are normal. This
makes oxygen readily available to the tissues of the body and reduces
the workload of the heart.
Diet may or may not be restricted. Diet restrictions often include low salt
intake, no caffeine, and low fat.
MEDICATIONS
Morphine is the analgesic most often given for pain. Nitrates such as
nitroglycerin are given for pain and to reduce the oxygen requirements of
the heart. Beta-blockers (metoprolol and atenolol) reduce the workload of
the heart. Digitalis improves the heart’s pumping action. Calcium channel
blockers reduce oxygen requirements in the heart muscle.
Anti-arrhythmics and diuretics may also be prescribed.
Clot-dissolving (thrombolytic) therapy is usually initiated within 6 hours of
when chest pain begins. The initial therapy will include an IV infusion of
clot-dissolving medication (streptokinase or tissue plasminogen activator)
immediately followed by IV infusion of heparin. Heparin therapy will last
for 48 to 72 hours. Additionally, oral aspirin and warfarin may be
prescribed to prevent further development of clots.
Thrombolytic therapy is not appropriate for people who have had:
A major surgery, organ biopsy, or major trauma within the past 6
weeks
Recent neurosurgery
Head trauma within the past month
History of GI (gastrointestinal) bleed
Intracranial tumor
Stroke within the past 6 months
The person is currently pregnant
Possible complications of thrombolytic therapy include bleeding and
hemorrhage.
SURGERY
Emergency angioplasty may be required to open blocked coronary
arteries. Emergency coronary artery bypass surgery (CABG) may be
required in some cases.
Prognosis
The expected outcome varies with the amount and location of damaged
tissue. The outcome is worse if there is damage to the electrical
conduction system (the impulses that guide heart contraction).
Approximately 1/3 of cases are fatal. If the person is alive 2 hours after an
attack, the probable outcome for survival is good, but may include
complications. Uncomplicated cases may recover fully. Heart attacks are
not necessarily disabling. Usually, the person can gradually resume
normal activity and lifestyle, including sexual activity.
Complications
Arrhythmias such as ventricular tachycardia, ventricular fibrillation,
heart blocks
Congestive heart failure
Cardiogenic shock
Extension of the amount of affected heart tissue
Pericarditis
Complications of treatment (For example, treatment with
thrombolytic agents increases the risk of bleeding during
treatment.)
Tobacco taxation
Increasing the cost of cigarettes is proven to save lives by encouraging smokers to quit, although it is recognised that high cigarette prices hit poorer smokers hardest. To prevent tax policy worsening health and social inequalities, the NHF supports the recommendation for continued above-inflation increases in tobacco taxation to be made subject to the government using the increased revenues to support NHS-based smoking cessation services and stepping up action against tobacco smuggling.
In March 2000, 29 NHF member organisations endorsed a pre-Budget submission to the Chancellor of the Exchequer prepared by ASH.
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Tobacco advertising
Tobacco advertising is banned in several EU countries including Italy, Portugal, France and Finland. Experience from these countries and elsewhere shows that a ban on tobacco advertising and sponsorship is an essential public health measure to protect people, especially children, from tobacco addiction. An effective ban must cover all print and media advertising, including indirect advertising which uses non-tobacco products to advertise tobacco brands, and sports sponsorship by tobacco companies.
Passive smoking is a well-established risk factor in coronary heart disease and other diseases such as lung cancer. Strengthening legislation to reduce exposure to tobacco smoke is an important public health measure benefiting both smokers especially those trying to quit - and non-smokers alike. Around one in five workplaces does not have an effective policy to safeguard employees’ health from passive smoking, and more than three million people are exposed to second-hand smoke at work.4 The NHF supports proposals for an Approved code of practice on smoking in the workplace introduced in the white paper, Smoking kills. The code sets out formal guidance on how the Health and Safety at Work Act should apply to passive smoking in the workplace.
In October 1999, the NHF submitted a response to a consultation by the Health and Safety Commission on proposals for an Approved Code of Practice on passive smoking at work. Contact NHF for a copy of the response.
