Risk Factors, Prevention, and Treatment

Heart attack and stroke share many similar risk factors such as elevated blood pressure, smoking, elevated cholesterol, diabetes, obesity, and physical inactivity (Figure 4). A family history of heart disease co-existing with diabetes can contribute to even greater risk.¹⁶ According to the WHO, tobacco use worldwide will contribute to the single greatest cause of death and disability with a projected 7 million deaths yearly by 2030.¹⁷ Smoking the equivalent of one cigarette per day carries a risk of developing coronary heart disease and stroke much greater than expected, that is, around half that for people who smoke 20 per day.¹⁸ Smoking e-cigarettes daily doubles risk of heart attacks, and when combined with daily cigarette use, heart attack risk rises five-fold.¹⁹ Obesity is another risk factor for several chronic conditions. Older women are heavier now than they were a decade ago. Approximately 62% of American women 20 years of age and older are reported overweight and 33% of the women are identified as extremely overweight.

Figure 4. Cardiovascular Disease – Risk Factors, Treatments and Connections to Oral Health.

Figure 4. Cardiovascular Disease – Risk Factors, Treatments and Connections to Oral Health.

Fortunately, there are preventive treatment and lifestyle recommendations that can significantly reduce risk. Research indicates when smoking, obesity, stress, and physical inactivity are altered with lifestyle changes, positive health benefits are realized.²⁰

In 2019, the ACC/AHA issued a “Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.”²¹ The most important way to prevent cardiovascular disease is to promote a healthy lifestyle throughout life. The guidelines are helpful in assessing for other risk-enhancing factors can help guide decisions about preventive interventions in select individuals, such as coronary artery calcium scanning, as well as treatments pharmacological therapy. A healthy diet healthy that focuses on consumption of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sweetened beverages is encouraged.²² Maintaining a healthy weight and exercising are part of the regimen, and tobacco use should be stopped.

Figure 5. Spotlight on a Finnish Study.

Figure 5. Spotlight on a Finnish Study.

When lifestyle changes are inadequate, medications are often used to reduce risk, such as:

• Calcium channel blockers(Calan^®, Procardia^®, Cardizem®) to dilate coronary arteries that in turn increase blood flow to the heart

• Angiotensin-converting enzyme (ACE) inhibitors (Vasotec^®, Prinivil^®, and Zestril^®) that aid in lowering blood pressure by inhibiting the formation of angiotensin II

• Statins (Zocor^®, Lipitor^®) that block the enzyme (HMG-CoA) necessary for cholesterol production

Medications such as anti-hypertensives are frequently used to lower blood pressure.²⁴

In addition to these preventive and pharmaceutical approaches, new scientific breakthroughs are on the horizon. For example, research is being conducted on stem cell applications that actually repair the damaged heart muscle and improve cardiac function. According to the National Institute of Health, stem cells can create new blood vessels to supply the necessary oxygen to the heart.^26,27 Researchers in a 2020 study found that human cardiopoietic cells focus on damaged proteins to reverse complex changes caused by a heart attack.²⁷ Cardiopoietic cells are derived from adult stem cell sources of bone marrow. These medical advances may lead to significant reductions in cardiovascular disease for future generations.