Cardiovascular Risk in Men
Article Outline
- Abstract
- Risk Factors
- Risk Factor Assessment and Screening
- Management of Primary and Secondary Risk Factors
- References
- Copyright
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in US men, affecting an estimated 30 million. The estimated lifetime risk for men developing CVD is about 49% after age 40. Approximately 40% of all deaths are related to CVD. The average age for a man to experience his first cardiovascular event or ischemic heart episode is 65.8. African American men experience a disparate death rate from premature and total CVD. CVD risk factors are multiplicative.1
Risk Factors
Risk factor identification is a critical component of CVD prevention and treatment. Routine screening and management of risk factors are the best preventive measures. A CVD risk factor assessment consists of a comprehensive history, physical examination, laboratory testing, and electrocardiogram. A comprehensive history should focus on the assessment of signs and symptoms that suggest CVD. The five main symptoms are chest pressure or tightness; radiation of pain to the left arm, neck, or jaw; exertional pain; dyspnea on exertion or with the presence of pain; associated symptoms such as nausea, vomiting, or diaphoresis; and pain lasting for 30 seconds to about 5 minutes.2
The prominent and known CVD risk factors include advancing age, cigarette smoking, elevated blood pressure, elevated low-density lipoprotein (LDL) cholesterol, low serum high-density lipoprotein cholesterol, diabetes mellitus, obesity, physical inactivity, and a positive family history of premature heart disease.2 In addition to sex, other risk factors associated with CVD include lower socioeconomic status, mental depression, and ethnicity.
Some CVD risk factors are considered modifiable, meaning they can be changed or altered. Modifiable CVD risk factors include cigarette smoking, diabetes mellitus type 2, hypertension, hypercholesteremia, obesity, sedentary lifestyle, and psychosocial factors.1, 3, 4 Nonmodifiable risk factors include sex, age, race or ethnicity, and genetics.
Emerging risk factors associated with an increased risk of CVD include elevated serum triglycerides, small LDL particles, lipoprotein (a), high-sensitivity C-reactive protein, homocysteine, coagulation factor abnormalities, and elevated white blood cell counts.2 A comprehensive CVD risk assessment, outlined in Table 1, must include the simultaneous consideration of all factors.
Table 1. Guidelines for Cardiovascular Disease (CVD) Risk Assessment
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•CVD risk factor assessments should begin at age 20. |
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•Family history of CVD should be assessed at each visit. |
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•Routine assessment for CVD risk factors at each visit should include smoking status, activity level, diet, alcohol intake, blood pressure, and pulse. |
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•Consider waist circumference measurement and body mass index measures on each visit. |
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•Screen for the following every 2 years in men with CVD risk factors or at least every 5 years in men without known CVD risk factors: serum lipoprotein and fasting blood glucose. |
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•Men older than 40 years or who have more than 2 risk factors should have an assessment for cardiovascular heart disease every 10 years. |
Lipid profiles provide vital information about CVD risk factors. Assessment of serum lipids should be initiated in men aged 20 to 35 years and repeated at least every 5 years, depending on the CVD risk factors present. Men who have CVD risk factors, such as a family history of premature atherosclerosis, family history of hypercholesteremia, obesity, diabetes mellitus, or 2 or more CVD risk factors, should initiate serum lipid screenings before age 35.1, 2
Risk Factor Assessment and Screening
Noninvasive screening tests allow the clinician to accurately assess CVD risk factors. Clinicians should consider using noninvasive screening measures such as carotid intima media thickness and electron beam computed tomography (CT). Carotid intima media thickness assesses subclinical atherosclerosis and correlates with coronary atherosclerosis. Electronic beam CT detects calcium in the coronary arteries, which is an indication of preclinical CVD.2
Other screening tests for CVD include exercise treadmill test, pharmacologic stress test, nuclear imaging, coronary angiography, echocardiography, and electrocardiography.
Management of Primary and Secondary Risk Factors
The best intervention for CVD is prevention, which should focus on the modification of and management of risk factors. Risk factor management should focus on modifiable risk factors, especially lifestyle. Male patients at risk of or with known CVD should receive regular evaluations with a focus on positive lifestyle modification to reduce future risk. Management of primary risk factors includes cigarette smoking cessation, regular physical exercise, appropriate body mass index, balanced diet with appropriate fiber intake, limited intake of sodium and caffeine, and a positive mental outlook.
The risk of a second CVD event can be managed with the following various interventions: aspirin or antiplatelet therapy, angiotensin-converting enzyme inhibitor, β-blocker, cholesterol therapy, smoking cessation, dietary management, exercise, and cardiac rehabilitation.2
References
- . Heart disease and stroke statistics—2005 update . Dallas, Tex: American Heart Association; 2005;
- . Assessment and management of cardiovascular risk in men . Prim Care. . 2006;33(1):75–91
- . Passive smoking and heart disease: mechanisms and risk . JAMA . 1995;273(13):1047–1053
- . Physical fitness and all-cause mortality: a prospective study of healthy men and women . JAMA . 1989;262(17):2395–2401
PII: S1555-4155(07)00012-8
doi:10.1016/j.nurpra.2007.01.009
© 2007 American College of Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
