Heart disease
Heart disease, stroke and other circulatory system conditions are the single largest cause of death in Ireland. In 1997, 43 per cent of all deaths were attributed to this disease. The Republic's death rate from heart disease is twice the European average.
The risk factors are well known. Cigarette smoking, high blood pressure, elevated blood cholesterol, being overweight, lack of exercise and stress all contribute to coronary heart disease. Risk is greater for men than women, although family history is also important.
So, clearly, a blockage of the coronary arteries leading to angina or heart attack is the result of a number of different factors. Not all are of equal importance, and - just to make the screening task even more difficult - what may be a significant risk for one of us, may be less of a risk for someone else. A cumulative and individualised risk assessment becomes very important in attempting to reduce the incidence of coronary heart disease.
The European Societies of Cardiology, Athersclerosis and Hypertension task force to address this problem came up with many useful recommendations, but probably the most helpful to both the public and doctors alike is the Coronary Heart Disease Risk Table (see graphic).
These are two sets of tables, one for men and one for women. Each one combines age, cholesterol levels, blood pressure measurement and whether the person is a smoker or not, in assessing the future risk of a coronary event.
A 40-year-old female smoker with a high cholesterol and an elevated blood pressure has a 1020 per cent chance of a suffering a heart attack within 10 years. However, her male counterpart of the same age, cholesterol and blood pressure readings, has a 2040 per cent chance of a coronary event in 10 years. This reflects the protective effect of female hormones up to the menopause.
However, if the female reduces her blood pressure and cholesterol and gives up smoking, her risk drops to less than 5 per cent. Similarly, the 40-year-old male can drop his risk of a heart attack to less than 10 per cent, by taking the same preventative action.
These simple examples do not take into account family history of heart disease or stress, but they do give a very good illustration of the value of modifying your lifestyle. So if you are a smoker or have high blood pressure you can see a real benefit in making that New Year health resolution.
The tables also demonstrate the need to consider risk factors in combination. There is less to be gained from minding your cholesterol levels while continuing to smoke heavily than there is from tackling both factors together over a period of time.
Family doctors now use these risk-factor charts as a matter of routine, so that a visit to your GP to assess your risk of heart disease becomes more focused. As a healthcare consumer, you will come away with a clear idea of risk and, in particular, you will be able to decide which of the causative factors you need to address, and in which order and timescale to undertake this modification in your lifestyle.
In addition, because there is a timescale incorporated into this assessment, a yearly or two-yearly check will begin to accumulate information, so that after a number of check-ups you will appreciate the pattern of your own personal risk of coronary heart disease as it changes over time.
The Finnish people are an example of how a structured approach to risk factor reduction can produce dividends. North Karelia in Finland managed, over
25 years, to reduce cardiac mortality in 35- to 64-year-old men by 65 per cent. The Department of Health in this country has recently produced a discussion document on cardiovascular risk factor intervention, so it is likely that we will see a community programme here in the years to come.
However, do not wait for this to happen. If you decide nothing else this New Year, promise yourself you will go to your general practitioner for a coronary disease risk assessment. The typical cost would be in the region of £30 - £40 for a private patient. The benefit to your future health could be very significant indeed.
Osteoporosis
Osteoporosis, or thinning of the bones, is the classic "silent" disease. Often the first indication of a problem is when a bone fracture is diagnosed after a relatively minor fall or accident. While osteoporosis affects at least 30 per cent of post-menopausal women, it does occur in men also.
Anyone taking regular steroid medication is at a significant risk of developing thinning of the bones. Osteoporotic fractures are particularly common in the wrist, hip and spine.
Studies have shown that one in two women will have developed an osteoporotic-related fracture by the end of their 70th decade. The estimated financial cost to the Exchequer, including the health costs, is approximately £10 million per year.
Some physicians hold the view that osteoporosis would be an ideal condition for a countrywide screening programme. There are no plans for such an initiative in the Republic at present, so it is up to each of us to make ourselves aware of our personal risk profile and to present ourselves for targeted screening.
What are these risks? Being female, experiencing early onset of the menopause and having a thin body type are physical characteristics which we cannot change. Modifiable risk factors include smoking, a high alcohol intake, either having no exercise or exercising excessively, and a low dietary intake of calcium. Taking long-term steroids, such as for arthritis or asthma, at a dose greater than 7.5mg a day is a significant independent risk factor also.
Osteoporosis cannot be diagnosed on a plain X-ray of the bones - a specialist test called a DEXA scan is the only reliable way to make this diagnosis. There is limited availability of DEXA scanning in the Republic. Although it is never too late to take action to prevent osteoporosis, younger women can make significant lifestyle changes which will bring health benefits in their later years.
Occupational health
With employment at an all-time high, most of us are working at least part-time. Health and safety in the workplace is covered by extensive legislation, which has led progressive employers to set up health screening for their employees.
The two biggest programmes cover hearing and breathing. A hearing-conservation programme is required where noise in the workplace exceeds a certain level. This involves having a hearing test at intervals to ensure that potential problems are picked up early. Respiratory surveillance is similarly designed to prevent the development of occupational asthma, which can be a problem in some of our high-tech industries.
So, if your employer is offering such a programme, make sure you take part. And if not, and you feel there may be potential health problems in your workplace, then bring your concerns to the attention of management. Some of the most effective health screening programmes take place in the work setting.
So, should you go for a check-up as part of your New Year health resolutions? The answer has to be yes, especially if you are over 40 and have not been near a doctor for some years. Bring along your family- and personal-health history, which will help with risk factor evaluation. Simply having your blood pressure and Body Mass Index (a height/weight ratio) recorded, along with an individualised risk assessment, will be a very good starting point. Blood tests and other screening examinations may follow this initial assessment. And even if you come away with a relatively clean risk assessment, remember to repeat the process in two or three years' time to build up an ongoing picture of your health.
A definition of health I came across recently is "something you have when you do not notice you have it". Tomorrow we will look at diet and exercise and their role in maintaining good health.