Question: Someone told me that a large percentage of heart-attack victims have none of the classic “risk factors” for heart disease. Is it true that people have heart attacks without high cholesterol or other risk factors?
Dr. Crandall’s Answer:
I’m glad you asked this question. It’s one I often get, especially when a patient or someone making healthy changes finds the going is getting tough.
It would be better to say that people with no “known” risk factors sometimes have heart attacks or other cardiovascular problems. I’ve never done an autopsy on someone who has died of heart disease without seeing a significant build-up of plaque in the arteries. The thousands upon thousands of catheritizations I’ve performed on heart patients “with no previous risk factors” tell the same story —in 99 percent of the cases, there’s significant underlying disease.
The statistics your friend cites are off, too, because of changing standards for risk factors, which keep being revised as the result of greater understanding. The classic one is cholesterol. Doctors used to tell us we were fine if we had a combined cholesterol count that was no greater than 280. Now the standard is 200, and for people who have had heart problems most doctors advise a cholesterol level of 170 or below.
The full truth is that populations in which heart disease is virtually absent, such as Chinese workers, have a combined cholesterol count of between 118 and 124. That compares with what we all had as healthy children. Likewise, our targets for high blood pressure (hypertension) and glucose have been revised downward.
Western medicine has tried to be as forgiving as possible when counseling people about heart disease. We’ve wanted to ask of our patients the minimum in terms of lifestyle changes since we know such changes are hard to make. But we haven’t really done anyone any favors. It’s the truth — the full truth — that sets us free. I now aim for target counts for cholesterol and other risk factors that ensure, as much as humanly possible, that those I counsel will not suffer from heart disease.
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