The crushing majority of cardiovascular diseases are linked to atherosclerosis, in other words, fatty deposits appearing on the walls of arteries which can lead to heart attacks and cerebrovascular accidents (strokes), among other conditions. To what extent can it be avoided?
Our lifestyles account for 90% of the risk of atherosclerosis and are therefore considered to be avoidable. However, we don’t have a handle on other factors including age, gender and genetic makeup.
Dr. Sophie Béliard is an associate professor and hospital practitioner in nutrition (Hôpital de la Conception, in Marseille) and a member of the Cardiovascular Disease Program at Fondation de France.
Are western lifestyles directly to blame?
Absolutely. Just look at how obesity and diabetes have increased exponentially in countries like China, Brazil and India, which have adopted these lifestyles. This has naturally led to a sharp increase in atherosclerosis. I have no hesitation in calling this a catastrophe for these countries, because cardiovascular disease has an important impact on these societies. For instance, in France, it generates 400 deaths each day and represents the first cause of disability.
Is changing lifestyle the solution?
It would be wrong to say that it’s easy to change the habits of a lifetime. “Patients needs to be patients” and accept incremental progress rather than hope for immediate change. For example, gradually adapting the Mediterranean diet, rich in vegetable and fruit and poor in animal fat, is a better bet than embarking on diets we now know to accelerate the trend for obesity.
What are the main risk factors for atherosclerosis?
Four of them are considered to be major. Get rid of them and the risk will decrease significantly. Tobacco comes first, multiplying the risk by a factor of three or four. It stimulates atheroma and arterial lesions. It can also lead to what we call “Sunday heart attacks”, which occur after an evening with friends where there has been too much smoking.
Cholesterol is also to blame: many types of serious and detailed studies show an obvious and non-refutable link between this substance and atherosclerosis. The Interheart survey carried out with 25,000 people in 52 countries has shown that 50% of heart attacks were due to cholesterol alone.
Tobacco, cholesterol... are diabetes and arterial hypertension also risk factors?
Yes, they are. Cardiovascular disease is the primary cause of death in people affected by diabetes, whose prevalence – in other words the number of cases – increases by 1.5% every year. Currently, in France, more than three million people are diabetic. As to hypertension, it is also a known risk factor. And today, one French person in three suffers from hypertension, a phenomenon which increases with age.
What about women? Are they particularly at risk?
No, it’s the other way round. Being a man increases the risk of cardiovascular disease. And yet, women die as often as men. Why do we have this paradox? Scientists recently realized that in France, women were not being cared for as well as they could expect. They are admitted to emergency rooms late and medical monitoring is less extensive. With the result that cardiovascular disease is the primary cause of death in women, and the second in men.
True, women affected by a myocardial infarction present atypical signs. These could include suddenly feeling extremely tired, digestive signs, nausea etc. Particular attention to women should help improve treatment for them.
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