Given that heart disease affects millions of Canadians, it’s somewhat mystifying to me that we (health professionals) only seem to highlight the broad strokes of risk.
I think it’s fair to say that many people know that things like cholesterol, blood pressure, smoking, diet, and exercise all have something to do with heart health. You may not understand what the relationship is, but you probably know it exists. It’s true; these factors are definitely important and improving them can make a huge difference.
But what about the other elements that can contribute to developing heart disease later on in life? We just don’t hear as much about them. Now, in all fairness, some of these things have only been recently identified. But that is not the case for all of them. Given that these circumstances aren’t rare, we should be doing a better job of getting the word out.
A quick note about risk factors
Remember that we’re talking about potential consequences, not definite ones. Having a risk factor for something means you are more likely to develop or experience that thing at some point. You may be a little more likely or a lot more likely. You may never experience it at all even if your chances were higher than someone else’s. I think of identifying and managing risk factors as better setting you up for success.
- Complications in Pregnancy
Pregnancy has been called a natural stress test. What the human body accomplishes and withstands during this time is simply amazing. But various complications aren’t that rare; it’s believed the issues below may occur in up to as many as 20% of pregnancies. If you’ve experienced these situations in any of your pregnancies, you’re at greater risk of developing heart disease later in life.1
- Preeclampsia or gestational hypertension
- Gestational diabetes
- Preterm delivery
- Delivering a small for gestational age (SGA) baby
- Early menarche (first period) and/or menopause
Hormones of all kinds are involved in heart health. Estrogen in particular plays an important role and both the timing, and lifetime exposure, seem to impact risk. Both starting *and* stopping your period early increase your chance of developing heart disease in the future.1
What does early mean?
- Premature menarche (< 10 years of age)
- Premature menopause (menopause < 40 years of age, due to premature ovarian failure or surgical/medical menopause)
- Early onset menopause (40-45 years of age)
- Inflammatory Disorders
Chronic inflammation increases cardiovascular disease risk. This seems to be particularly true in certain autoimmune conditions, termed immune-mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis, ankylosing spondylitis, lupus, and inflammatory bowel disease.2
This risk relationship is actually fairly complicated and warrants in-depth discussion with your healthcare provider. Managing your condition by reducing inflammation is crucial, but certain anti-inflammatory drugs (such as NSAIDs and steroids) are problematic for heart health in other ways.
A particular note with rheumatoid arthritis is the presence of something called the “lipid paradox”. This paradox, observed during times of active disease (or flare up), consists of unexpectedly low cholesterol levels.3 Unfortunately this does not lead to lower risk and should not be mistaken for “good cholesterol levels”.
- Radiation Treatments
It is an unfortunate truth that some medical treatments create problems as they necessarily solve others. This can be particularly true in cancer care. Radiation therapy is used to treat a number of cancers including ones located in, and around, the chest such as Hodgkin’s lymphoma and breast cancer. In these cases, the proximity of the area being treated to the heart is problematic.4,5 Although the intensity of exposure has diminished over time as techniques have improved and safety measures better understood, that was not the case many years ago.
Although some radiotherapy side effects are obvious in the short term, it is the delayed effects I want to emphasize. Radiation-induced heart disease can manifest over time as damaged coronary arteries, valves, or the heart muscle itself. To complicate things, it isn’t uncommon for past cancer treatments to go unmentioned when discussing current health concerns, especially if the treatment was literally decades ago.
Where to Go from Here (aka wow, Alex, that was discouraging – what do I do now?)
As I often say, knowledge is power. If these situations are your situations, I hope you’re able to use that information to help put any pieces together you’ve been wondering about. I hope you feel more confident reaching out to your healthcare providers to discuss your circumstances. I hope that you feel motivated to be proactive in regards to the aspects of your cardiovascular health which can be supported. And there are so many!
You can “know your numbers”; staying on top of your cholesterol and blood pressure. You might feel extra incentive to work on those nutrition and exercise goals. You could decide this is the time to finally quit smoking.
The good news is that there are things you can do to head off your risk and improve your overall heart health. We may not be able to control all the things, but we sure can make a ton of difference overall.
Yours in Health,
Dr. Alexandra Verge, ND
1. Agarwala, A., Michos, E. D., Samad, Z., Ballantyne, C. M. & Virani, S. S. The Use of Sex-Specific Factors in the Assessment of Women’s Cardiovascular Risk. Circulation 141, 592–599 (2020).
2. Agca, R., Smulders, Y. & Nurmohamed, M. Cardiovascular disease risk in immune-mediated inflammatory diseases: recommendations for clinical practice. Heart 108, 73–79 (2022).
3. Myasoedova, E. et al. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann Rheum Dis 70, 482 (2011).
4. Kirkham, A. A., Beaudry, R. I., Paterson, D. I., Mackey, J. R. & Haykowsky, M. J. Curing breast Cancer and killing the heart: A novel model to explain elevated cardiovascular disease and mortality risk among women with early stage breast Cancer. Prog Cardiovasc Dis 62, 116–126 (2019).
5. Nimwegen, F. A. van et al. Cardiovascular Disease After Hodgkin Lymphoma Treatment: 40-Year Disease Risk. Jama Intern Med 175, 1007–1017 (2015).
