Reducing Risk of Heart Disease for Men

Editorial suggests heart disease guidelines should emphasize lifetime risks

(RxWiki News) Guidelines issued in November aim to reduce cholesterol and cardiovascular disease in adults across the board, but they highlight the risk men face when it comes to heart disease. Doctors may need to go even further than the guidelines suggest to keep men healthy.

According to a recent editorial, physicians should highlight the lifetime risk men face, not just the 10-year risk. The lifetime risk tends to have more of an impact.

"Speak to your cardiologist about ways to reduce your risk of heart disease."

The editorial was written by Stephen Kopecky, MD, of the Mayo Clinic in Rochester, MN, and Ajay Nehra, MD, of Rush University Medical Center in Chicago.

In November, the American College of Cardiology and American Heart Association released new guidelines on the risk US men and women face for atherosclerotic cardiovascular disease (ASCVD).

ASCVD is heart disease caused by hardening of the arteries.

The risks include gender, age, race, total cholesterol, HDL cholesterol (considered "good" cholesterol), systolic blood pressure (the upper number), blood pressure treatment, diabetes and smoking status.

The editorial authors discuss the new guidelines, which they say highlight the fact that white men are at least twice as likely to die as white women with similar risk profiles from cardiovascular disease, heart attack or stroke.

Before the latest guidelines, if a person had a 10 percent risk for ASCVD within 10 years, then treatment, such as cholesterol-lowering medication, should be considered, the authors report.  The new recommendations drop the point to consider treatment to 7.5 percent risk.

The editorial authors note that, of disease-free, non-pregnant women aged 40 to 79, about 48 percent have extremely low risk for ASCVD within 10 years. Their risk is only 2.5 percent, compared to men’s risk of 17.4 percent.

According to the editorial, erectile dysfunction should also be considered a risk factor for ASCVD. Men aged 40 to 49 have a 48-times greater risk for ASCVD per 1,000 years than men in the same age groups who do not have difficulty getting and keeping an erection.

The authors suggest that, if doctors want to ensure their patients follow their advice to give up smoking, reduce their blood pressure or make other healthy lifestyle changes, they should word the risk for ASCVD differently.

For the average 50-year-old white man who smokes, the 10-year risk for developing ACVD is about 7.1 percent, the authors report. This is for someone whose total cholesterol is 144 milligrams per deciliter, HDL is 44 milligrams per deciliter and systolic blood pressure is 148,  and who is not on medication for either blood pressure or diabetes. However, with these variables, the lifetime risk of experiencing a first-time event of ASCVD is 50 percent.

"This marked jump in lifetime risk is impressive to patients, and it should be utilized, especially in the younger age group, to help educate and motivate them on the importance of lifestyle and risk factor change,” the editorial authors write.

The editorial reiterates that physicians should prescribe lipid-lowering mediation to reduce ASCVD risk.

The editorial authors note that 75 percent of the risk factors for heart attack, stoke, diabetes, erectile dysfunction, and dementia are the same and specifically center on age, gender, ethnicity, cholesterol, blood pressure, diabetes, tobacco use and body mass index. When gender is a factor in a disease, men are most at risk, they add.

The authors conclude that it should be stressed to men that reducing the risk for ASCVD reduces the risk of erectile dysfunction, diabetes and dementia.

Sarah Samaan, MD, cardiologist and physician partner at the Baylor Heart Hospital in Plano, TX, noted that heart disease usually affects men at younger ages than women.

"While heart disease is the leading cause of death for both men and women, it does strike men about 10 years earlier in life, and for that reason more aggressive risk factor reduction is warranted in younger men than in younger women," she said. "Having said that, each one of us is different, and women with multiple risk factors and/or a family history of early heart disease should generally be monitored more closely and treated for high cholesterol (along with other conditions) if needed."

Many cases of heart disease are preventable, Dr. Samaan said.

"Although many people, physicians and patients alike, may balk at the idea of starting medical therapy, it really does save lives when used appropriately," she said.

The editorial was published July 11 in the Journal of Men’s Health.

Dr. Kopecky disclosed that he has received research grant support from Regeneron Pharmaceuticals, Inc., Applied Molecular Genetics (Amgen) and Genzyme. He is also a consultant to Prime Therapeutics and is on the advisory board for Merck and Fusion Conferences. Dr. Nehra made no disclosures.

Review Date: 
July 24, 2014