I would venture to guess the majority of people reading this have wondered whether they need to be worried about having a heart attack. And wondered what they can do to prevent it. I’ve spent countless hours trying to figure out this question for myself, and it’s led to some interesting discoveries.
I was reading a paper recently discussing associations of risk factors with heart disease later in life. The study followed more than 28,000 women for an average of 21 years. It was part of the study called the Women’s Health Study.
While there were many other findings in the larger study (Dugani, 2021), the part that I’ll focus on here are the risk factors associated with developing heart disease. The study conclusion in plain language was as follows: “Risk profiles appear to differ by age at coronary heart disease onset in women, with the greatest risk for premature events associated with diabetes and insulin resistance.” So probably preventing and reversing diabetes is the most important factor to address in preventing heart disease.
For a visual interpretation of the risk, see the chart below. Things on the right are associated with increased risk, things on the left are associated with decreased risk. With some pun intended, you get the picture. Diabetes (and other metabolic syndrome components) are likely the most important risk factors in developing heart disease. Granted, this study was done in women, but I think it’s still applicable for men especially given other studies showing similar outcomes.
So what’s the best way to test for this constellation of symptoms that are risk factors for developing diabetes? And to check for progression of disease before being diagnosed with prediabetes or diabetes?
The right answer for a lot of people is checking a fasting insulin level.
A lot of that thought process is based on the work of Joseph Kraft who gave people 75 grams of glucose and then checked glucose and insulin levels every hour for 5 hours after that. Doing that provides tremendous insight into who has an excessive insulin response to glucose ingestion. Which is also an excellent predictor of who will go on to develop what we formally call Diabetes. But doing a test that takes 5 hours and multiple blood draws is something most people aren’t very fond of.
So I go for what I think is second best. Fasting for 12 hours (water is okay to drink) then checking a fasting insulin level along with a fasting glucose level. This can be used to calculate a HOMA-IR, which is essentially a measurement of insulin resistance. Usually I’ll check a basic lipid panel as well since I care about triglycerides and HDL. The other cholesterol stuff….like LDL….go back up to the chart and see how much it matters. Not a whole lot.
The cost of these tests isn’t much. Members at Citadel Health Center can get the labs I mentioned above done for $13.
And usually, the best treatment is lifestyle changes. Eat healthy. By eating healthy I mean eating whole real foods that aren’t high in carbohydrates. Foods that don’t need a nutrition label. Try to do some exercise. Enjoy interacting with family and community. Get enough sleep. Sometimes medications/supplements are appropriate. And sometimes I suggest using a continuous glucose monitor to track how foods affect your blood sugar.
But in summary, I think a lifestyle that decreases your risk of diabetes is the most important strategy to avoid heart disease.
Dugani SB, Moorthy MV, Li C, et al. Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women. JAMA Cardiol. 2021;6(4):437–447. doi:10.1001/jamacardio.2020.7073