Cardiac risk refers to the likelihood of developing heart-related issues or cardiovascular events. You cannot prevent what you do not know. As cardiovascular disease (CVD) is a leading cause of death globally, it is vitally important to understand what constitutes cardiac risk so that we can implement mitigating strategies before events occur. In this article, we’ll define cardiac risk, discuss the main health conditions linked to it, and explain how it relates to metabolic and systemic health issues.
Table of Contents
Understanding Cardiac Risk
Cardiac risk refers to the likelihood of developing heart-related health issues such as coronary artery disease, heart attacks, heart failure, abnormal heart rhythms (atrial fibrillation), and sudden cardiac death.
Various factors increase the probability of developing heart conditions. These factors can be classified as modifiable—such as lifestyle choices and health conditions—and non-modifiable, including age, sex, and family history. High cardiac risk indicates a greater likelihood of severe outcomes, including life threatening ones such as heart attacks, heart failure, and other cardiovascular complications.
Cardiac Risk: Key Conditions
Understanding these conditions associated with cardiac risk can help individuals recognise their own risk factors and take preventive measures.
1. Coronary Artery Disease (CAD)
Coronary artery disease (CAD), also known as ischaemic heart disease, is the most common type of heart disease and a major cause of heart attacks. It happens when the coronary arteries, which supply blood to the heart muscle, become hardened or narrowed due to cholesterol plaque buildup (atherosclerosis).
As plaque accumulates, the arteries get narrower, limiting blood flow to the heart muscles. This can cause symptoms like chest discomfort (angina), shortness of breath, or fatigue.
Some key risk factors for CAD include high blood pressure, high cholesterol, smoking, diabetes, obesity, and a sedentary lifestyle. Left untreated, complete blockages can happen over time, leading to increased risks of developing heart failure, intractable symptoms or even an acute heart attack.
2. Heart Attacks
A heart attack occurs when blood flow to a part of the heart is obstructed acutely, typically due to sudden plaque disruption (rupture or erosion) within a coronary artery. This blockage can cause part of the heart muscle to die due to oxygen deprivation, causing crushing chest pain, or sudden cardiac arrest which can be fatal.
Other symptoms include discomfort in other areas of the upper body (arms, back, neck, jaw), shortness of breath, and nausea. A heart attack is a medical emergency that requires immediate treatment.
3. Heart Failure
Heart failure is a chronic condition in which the heart cannot pump enough blood to meet the body’s needs. It can be caused by several factors, including coronary artery disease (CAD), high blood pressure, and past heart attacks.
People with heart failure may have symptoms such as excessive and unexplained tiredness, shortness of breath, and swelling in the legs and abdomen due to fluid buildup. While heart failure can be managed with medications and lifestyle changes, it can significantly impact quality of life and lead to more hospital visits. Advanced heart failure can also increase the risk of sudden death due to pump failure or unstable heart rhythms.
4. Abnormal Heart Rhythms (Arrhythmias)
Arrhythmias are abnormal heart rhythms that can disrupt the normal function of the heart. Depending on their duration, rate, regularity, and their subsequent effect on blood flow and blood pressure, arrhythmias can range from benign (no clinical significance) to health- or life-threatening.
Symptoms may include palpitations, missed/irregular beats, chest pain, dizziness, and fatigue. Managing risk factors such as hypertension, diabetes or alcohol intake, is crucial for preventing arrhythmias and their complications.
5. Sudden Cardiac Death
Sudden cardiac death is an unexpected circulatory arrest resulting in death that happens when the heart suddenly stops working due to an electrical malfunction or pump failure. This is commonly known as cardiac arrest. The heart relies on electrical signals to pump blood effectively, and when these signals malfunction, the heart can stop beating suddenly.
This consequence is often linked to dangerous heart rhythms (arrhythmias) or existing heart disease, and can happen without warning, especially in populations with cardiovascular risk factors.
During cardiac arrest, a person may suddenly collapse and become unresponsive. If they don’t receive immediate medical attention — especially CPR or the use of an AED (automatic external defibrillator) — to jumpstart the heart within a few minutes, it can lead to death.
Now that we understand some of the conditions associated with cardiac risk, let's dive into what drives that risk.
The Impact of Metabolic and Systemic Conditions on Cardiac Risk
Cardiac risk does not exist in isolation and is closely related to metabolic and systemic conditions.
- Metabolic conditions: Health issues that affect how our bodies process things like nutrients and energy. Common examples include diabetes and obesity.
- Systemic conditions: Conditions that affect the whole body instead of just one part. An example is chronic kidney disease (CKD), which impacts how the body balances fluids and controls blood pressure. This can affect many organs and overall health.
The development of one condition can lead to the development of others. Recognising these connections is essential for effective prevention and management strategies.
Insulin Resistance
Insulin resistance in diabetes (and pre-diabetes) can lead to elevated blood sugar levels. Over time, this can harm blood vessels and increase the risk of atherosclerosis, a key factor in heart disease.
Insulin resistance can also lead to high blood pressure, unhealthy cholesterol levels, and obesity—all of which raise the risk of heart problems.
Making lifestyle changes, like getting regular exercise and eating a balanced diet, can improve how the body uses insulin. This can help lower the risk of heart disease and prevent the development of diabetes.
Obesity
Obesity is a major contributor to cardiac risk because having too much body fat can cause issues like insulin resistance, chronic inflammation, and unhealthy cholesterol levels (dyslipidaemia). This increases the chances of developing heart conditions such as coronary artery disease (CAD), heart failure, and irregular heartbeats (arrhythmias).
To lower the risk of heart problems, it’s important to manage weight through a healthy diet and regular exercise. Even losing a little weight can lead to major improvements in heart health and overall well-being.
Renal Impairment (Kidney Dysfunction)
Chronic kidney disease (CKD) is another significant condition that can increase cardiac risk. The kidneys help control blood pressure and balance fluids in the body, so when they aren’t working well, it can lead to high blood pressure and extra fluid buildup, which can make heart issues worse.
People with CKD are at a higher risk for heart-related events, so it’s important to keep an eye on and manage heart health in these individuals. Managing blood pressure, blood sugar, and cholesterol levels can help reduce the risk of heart problems for those with kidney dysfunction.
Conclusion
The relationship between various cardiovascular risk factors is often interdependent. For instance, obesity can cause insulin resistance, which increases the risk of type 2 diabetes and heart disease. Similarly, chronic conditions like chronic kidney disease (CKD) can lead to heart problems, while existing heart disease can worsen kidney function.
Understanding these intricate connections help us approach health in a more holistic manner. Addressing one condition can have positive knock-on effects on others, hence comprehensive management strategies should focus on lifestyle changes, regular health screenings, and effective treatment of existing conditions.
At Nobel Heart Centre, we serve our patients across the spectrum of conditions – ranging from detection and mitigation of cardiovascular risk factors, to managing and treating various heart conditions, to ensure the best possible outcomes for each and every person.
Edited by Dr Koh Choong Hou
