In the last decade, there has been a dramatic decline in the number of deaths from heart attacks. In 1970, nearly a million Americans died of cardiovascular disease; now the annual toll is below 600,000. The cause for this improved mortality rate are unknown, but most experts believe that the increased awareness of cardiovascular risk factors and their correction have played an important role in cutting the death toll.
In recent years, a number of these risk factors have been identified. Some of them, such as age, sex and family history of heart disease, are things over which we have no control. But there also are a number of factors that can be modified or eliminated, and such action appears to reduce the portability of a heart attack. The three most important controllable risk factors are high blood pressure, high levels of blood cholesterol and cigarette smoking. In fact, many experts attribute the recent decline in cardiovascular deaths to the fact that more people than ever before are now being treated for high blood pressure. Changes in the American diet that have reduced the consumption of butter, eggs and animal fats - and consequently lowered the average blood cholesterol -- and a reduction in smoking by middle-aged men also are credited with lowering the toll. Since the likelihood of developing heart disease increases when two or more risk factors are present, modifying the controllable ones helps reduce the hazard of those over which we have no control.
Role of Diet
Studies have shown that population groups whose diets are rich in cholesterol and other animal and dairy fats have more heart attacks that those whose diets are low in these saturated fats. Americans, whose diets are high in meat and eggs, have a higher incidence of heart disease than the Japanese, who end to eat very little meat and other animal and dairy fats.
Studies have also shown that high blood cholesterol -- more than 200 miligrams per mililiter of blood -- can be lowered by modifying the diet. This means eating more fish and poultry while cutting consumption of red meat, eggs, butter and other dairy fats, and increasing consumption of fruits, vegetables and cereal grains. Substituting polyunsaturated cooking oils (corn, safflower or sunflower oil, for example) for lard or hardened shortening, and using margarines whose labels indicate a high ratio of polyunsaturated to saturated fats (for example, 4 to 2) instead of butter or margarines with less favorable ratios (e.g., equal or 2 to 3) also help to lower blood cholesterol.
Role of High Blood Pressure
People with high blood pressure have a marked increase in heart attacks and strokes. The cause of most high blood pressure is unkown, but it usually can be lowered by the use of antihypertensive drugs, reduced salt intake, and weight loss in people who are overweight. Controlling high blood pressure is an important preventive measure because it increases the work load of the heart and also directly contributes to hardening of the arteries (arteriosclerosis).
Role of Cigarette Smoking
Since 1964, when the Surgeon General reported that cigarette smokers on the average had a 70 percent greater chance of having a heart attack than nonsmokers, many other studies have confirmed that cigarette smoking is a major risk factor. This risk increases with the number of cigarettes smoked, and recent studies hae found that low-tar, low-nicotine cigarettes do not lower the risk of heart disease. Stopping smoking is now considered one of the best things you can do to help prevent a heart attack.
Other Risk Factors
Sedentary life style. Although evidence linking a sedentary life style to increased likelihood of heart disease is indirect, physically active people are known to have wider coronary arteries, which presumably would not be as prone to blockage as those sedentary people.
Type A personality. In recent years, much discussion has focused on the relationship between the type A personality, characterized by anxiety, impatience and perfectionism, and the risk of a heart attack. Although many assessments have confirmed this relationship, scientific proof definitely linking personality type and the development of heart disease is yet to come.
Diabetes. People with diabetes, a serious disease in which the body cannot regulate its blood sugar (glucose), have a higher incidence of coronary disease and heart attacks. The incidence is increased further if the diabetic has other risk factors.
Obesity. the Framingham Study recently concluded that obesity alone increases the risk of heart disease -- a hypothesis that has been debated for years. Since obesity often coexists with hypertension, diabetes and a sedentary life style, weight control is an important factor in reducing a number of coronary risk factors.
Sex and age. Some risk factors, such as age and aging and a person´s sex, are unavoidable. Statistics show that men under the age of 45 years are 10 times as likely to develop coronary artery disease as women in the same age group. Between the ages of 45 and 60 years, however, the sex difference diminishes. After age 60 years, the incidence of coronary artery disease is about equally distributed between men and women.
Family history. An inherited susceptibility is also an important risk factor that cannot be avoided. Some manifestations, such as high blood pressure or an inherited tendency to have very high blood blood cholesterol levels (familial hyper-cholesterolemia) can be controlled by drugs and diet.
Summing Up
The relationship between heart disease and certain risk factors, such as high blood cholesterol, hypertension and cigarette smoking, has been established by many studies. Because coronary artery disease is the leading cause of death (via heart attacks) in the United States, prevention takes on a special importance. Reduction of dietary fat, cessation of cigarette smoking, control of hypertension, weight loss and exercise are all steps that help check the development of atherosclerotic coronary disease and reduce the risk of heart attack.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
