Prevention of ischaemic heart disease
Heart disease is bad
Heart disease is the number one cause of death in the uk, so its quite a bit problem. The big problem in ischaemic heart disease is the ischaemia. This means lack of oxygen reaching the muscle cells of the heart. The only real cause of said ischaemia is atherosclerosis, which is the narrow of arteries by the deposition of fat in the walls.
Risk factors
The following risk factors are the key causes of atherosclerosis:
- Smoking
- Cholesterol
- Hypertension
Prevention
Smoking
If you want to be healthy, stop smoking. You may have noticed that the government fund "stop smoking" schemes, print labels on cigarettes saying "Smoking Kills People You've Never Even Met!" and have increased the tax rate so that a pack of 10 cigarettes cost £211. All of these are aimed at reducing the smoking rate, and thus heart disease (and lung cancer) rates.
Cholesterol
Cholesterol is the bad boy. If you had no cholesterol (fat in the blood), there would be no atherosclerosis. When you do a serum blood test, you get 4 results: Total Cholesterol, High Density (HDL), Low Density (LDL) and the Ratio between.
Ideally you want a low total, with a ratio showing a high amount of HDL and a low amount of LDL, since HDL is known as "good" cholesterol, and its the LDL that is particularly harmful. As a rule of thumb, you really want to lower the total it below 5mmol.
Primary Prevention - This is giving statins in patients who have not got any heart disease. Current guidelines are that you treat anyone with a calculated 10 year risk level of more than 20% with a statin. You don't measure cholesterol levels after that, you just "fire and forget".
Secondary Prevention - This is giving statins in patients have have got heart disease. Advice is to get that total lipid level down below 5mmol.
Hypertension
Whilst hypertension isn't necessarily a huge cause of atherosclerosis, it definitely plays some kind of role, and a healthy blood pressure leads to a healthy heart.
Read the page on hypertension for more details on specific management, but basically: In otherwise healthy people, to avoid excess cardiovascular risk, you should aim to get a blood pressure down below 160/100. In people with diabetes, or other risks, you should be aiming to get below 140/90.