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The Four Horsemen of Heart Disease

Dec. 1, 2000 (New Orleans) – A quartet of heart disease risk factors — obesity, diabetes, high blood pressure and high triglyceride levels — may pack a more dangerous punch in women than in men, say heart experts who track the rate of heart disease.

And while this “deadly quartet” drives up heart disease rate in women, a trio of risk factors is emerging as a major health risk for children, according to new data presented at the American Heart Association scientific sessions held here recently.

Dennis L. Sprecher, MD, director of preventive cardiology at the Cleveland Clinic Foundation, tells WebMD that when he analyzed data collected from almost 6,500 patients who underwent bypass surgery at the clinic, he discovered that men and women are affected differently by the so-called deadly quartet.

“Women who had all four risk factors were 10 times more likely to die of heart disease during the 10 years following bypass surgery than were men with all four risk factors,” he says. Men who have all four factors “are about 2.5 times more likely to die of a heart attack, than men who don’t have the risk factors following surgery,” Sprecher says. “That means that if a woman has these four risk factors, she faces a one in four chance of dying within eight years after surgery,” he says.

Moreover, Sprecher says this difference “can be seen all along the line — a woman with even one risk factor is three times more likely to die than a man with just one risk factor following bypass surgery.”

While Sprecher reported on the gender differences, epidemiologist JoAnne S. Harrell, PhD, a professor at the University of North Carolina in Chapel Hill, says even children are vulnerable to heart disease risk factors. When she studied nearly 700 11-to 14-year-old children who lived in rural areas, she found that a cluster of risk factors called multiple metabolic syndrome or MMS is present in an alarming number of so-called healthy children.

In recent years MMS has attracted a great deal of interest among researchers because it is believed that this cluster is a precursor to type 2 diabetes, a disease that is sometimes called noninsulin-dependent diabetes. Until recently most physicians believed that type 2 diabetes only developed in middle age or later. Now, however, Harrell says there has been an alarming increase in the number of cases of type 2 diabetes diagnosed in children — almost always obese children.

Again high blood pressure is one of the risk factors that make up MMS but the other two are high insulin levels and either of two specific changes in cholesterol — high triglycerides or low levels of HDL, the so-called “good cholesterol.”

When Harrell divided the children into groups by risk factor status — no risk factors, one risk factor and so on — she found that “obesity appears to be a common link. Most children with MMS were obese, in fact, children with MMS were 53 times more likely to be obese than children who had no risk factors.”

She tells WebMD that the number of children in her study who have MMS was “seven times higher than I had expected. This is a surprising and disturbing finding.”

Sprecher says that Harrell’s finding, combined with his own research, lead him to conclude that “it may be that all heart disease has a common [cause], comes from some central factor and obesity is the likely candidate.” The issue, he says, is “what are we going to do about it?”

From his perspective, the answer to that question is “we are going to have to concentrate our prevention programs on children: increase physical activity, target poor nutrition, and monitor risk factors closely.”

Moreover, after heart disease is diagnosed — as was the case in his study of patients who had heart surgery — patients need to be encouraged to lose weight, eat well-balanced low-fat diets, and maintain blood pressure at normal ranges, says Sprecher.

Posted by: Dr.Health

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