A crucial group within the British Regional Heart Study were those who already had signs of heart disease when they were first enrolled in the survey in 1978. Doctors tended to believe at that time that once a heart attack had occurred, there was little point in trying to reduce the risks by altering lifestyle, because the damage to the heart was already done, and couldn’t be undone or reversed.
The study showed, on the contrary, that the risk factors still mattered. Even after a heart attack, those with higher cholesterol and blood pressure levels were at higher risk than their colleagues in whom they were lower. It was concluded from this that even after an attack it was wise to keep the risks as low as possible, by whatever means possible.
It is often said, mostly by those who do not wish to change their own lives, that many heart attack victims do not have any identifiable risk factors, such as smoking, a high blood cholesterol level, or high blood pressure: the British Regional Heart Study disproved that.
In the study, men with either:
• a serum cholesterol level equal to or above 230mg/dl
• a systolic blood pressure equal to or above 148 mm Hg
• a diastolic blood pressure equal to or above 93 mm Hg or who:
• currently smoked cigarettes
had twice the risk of a heart attack than the others.
Only 5 of the 202 cases of major heart attack in the British Regional Heart Study did not meet one of these criteria, and over two-thirds of them met at least two of them. Of the five men not meeting the criteria, three had evidence of a previous heart attack.
So only one in a hundred of the cases of heart attack possessed none of the risk factors listed, and this does not take into account previous smoking habit, treatment for high blood pressure, or a change in eating habits that might have lowered serum cholesterol. Here is how Professor Shaper (1988), the author of the study, sees it: “It would appear that major coronary heart disease events virtually do not occur in middle-aged British men in the absence of at least one significantly increased risk factor.”
I would add two corollaries to that statement. The first is that it surely applies to women as well. The second is that if anyone with angina wishes to avoid a heart attack, and at the same time lessen his or her angina, then the best way to go about it must surely be to lose any current risk factor. The next chapters show you exactly how to do that.
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