Age outweighs all the other risk factors for heart disease combined — high cholesterol, high blood pressure, even smoking. And unfortunately, age is a risk factor that can't be modified.
Or can it?
People cannot stop aging, of course, but two doctors think that the aging of the arteries can be slowed significantly if people take action well before heart disease starts to produce symptoms.
In other words, they think we can transform time from an enemy in the fight against heart disease into an ally.
In their paper in a recent issue of the noted medical journal the Lancet, doctors Allan Sniderman of McGill University in Montreal and Curt Furberg of Wake Forest University School of Medicine in North Carolina compared the natural history of coronary disease to a three-act tragedy:
• The first act introduces the characters — high cholesterol and triglycerides, high blood pressure and smoking.
• During the second act, which lasts for decades, these villains relentlessly attack the lining of the arteries, creating scars that allow cholesterol and lipids to get behind the arterial wall and produce the bulges that constrict blood flow.
• In the final act, "which can be tragically brief," according to the authors, one of these bulges ruptures, creating a clot that can block an artery, producing a heart attack or a stroke.
The "script'' for this tragedy is not fixed, however, according to Sniderman and Furberg.
"If some of the characters are edited out of the play as soon as they appear, the third act need never take place," they write.
Start early in life.
"Coronary artery disease is a disease of people over 55," Sniderman said in an interview.
"After 65 is when rates go sky high, but the disease started when you were 30, so if we want to get on top of this, we need to interrupt the disease sequence, before people get into the higher-risk period."
That means don't smoke, or if you do, quit.
If your blood pressure is high, get it down — no matter what your age — either through exercise and weight loss, or medication, or all three.
And if your LDL, or "bad" cholesterol, is high, get it down.
But Sniderman also advocates an extra test to measure your blood levels of apoB, the protein that is the bulk of the LDL.
"LDL cholesterol is an imperfect marker," he said. "In my view, the key event in atherosclerosis (so-called hardening of the arteries) is the entry and the trapping of apoB particles in the arterial wall. If you don't have too many apoB particles circulating in blood, you won't have any disease."
The American Diabetes Association and the American College of Cardiology agree. Earlier this month the two organizations issued a statement saying that apoB "has been found to be a better predictor" of heart disease than LDL cholesterol.
The test for apoB is readily available, Sniderman said, but it hasn't been done routinely because it hasn't been widely advocated by the medical community.
"That should change now," Sniderman said.
Freelancer Tom Valeo writes about medical and health issues. Write to him in care of Pulse, St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731, or e-mail firstname.lastname@example.org.