Takaaki Sugihara writes:

        I should tell Mr. O that he has several risk factors. First, his blood pressure indicates moderate to high hypertension, 165-105 mm Hg. It could be a risk factor because high blood pressure/hypertension was listed on death certificates as the cause of death of 38,130 Americans in 1994 and was listed as a contributing cause on more than 180,000 other death certificates of stroke,heart attack and heart failure victims. And it is known that men are at greater risk for high blood pressure than women until passed age 65 or older.

        Another risk factor is his cholesterol count. His cholesterol tests are not positive. His LDL level is above 160mg/dL = high risk. Higher LDL levels may narrow his vessels. It can be a cause of high blood pressure and hypertension. On the other hand, low HDL cholesterol (less than 35mg/dL) is also a risk factor, because HDL removes cholesterol from the lining of the arteries and help maintain good blood flow.

        According to causal observation, I think that 20 kilos overweight will be a risk factor. Being overweight may increase our blood cholesterol level. Most overweight people with elevated blood cholesterol levels can help lower their levels by losing weight.

        Even if he cuts down his smoking from a pack a day to less than half a pack, smoking must also be a risk factor because about 417,000 Americans died of smoking-related illnesses in 1990. In addition, nearly one-fifth of deaths from cardiovascular diseases are attributable to smoking and about 37,000-40,000 nonsmokers also die each year from cardiovascular diseases as a result of exposure to environmental tobacco smoke.

        And he tells me that he hardly gets out of the office, I think he is a workaholic. But physical inactivity is also said to be a risk factor.The relative risk of coronary heart disease( heart attack) associated with physical inactivity ranges from 1.5 to 2.4, an increase in risk comparable with that observed for high cholesterol, high blood pressure or cigarette smoking.

        These risk factors may bring on another myocardial infarction. Data shows that sudden death occurs at from four to six times the rate of the general population among people who've had a heart attack.

        I want to think about what he can do if he had a heart attack. Even though the symptoms are hard to recognize,l et's try to learn about the signals of heart disease and your own risk factors. This is the first step if he wants to live longer. If he experiences one or more symptoms of a heart attack, he has to act quickly and take the following steps. Sit down or lie down. And if symptoms persist for 2 minutes, call the local emergency telephone number and say you may be having a heart attack. If you can go to the hospital faster than by ambulance, have someone drive you. You should never drive your car. If you have nitroglycerin tablets, take up pills, one at a time every 5 minutes. The point is not to delay getting medical treatment, even if you are not sure you are having a heart attack.

        Next, I will take four measures for his risk factors.

        First, about his high blood pressure: There are several medicines known as antihypertensives. Some, called diuretics, rid the body of excess fluids and salt (sodium). Others called beta blockers reduce the heart rate and the heart's output of blood. Other class of antihypertensives are called sympathetic nerve inhibitors, vasodilators, A.C.E. or angiotensin converting enzyme inhibitors and the calcium antagonists. If he uses these drugs following the doctor's instructions, and one of his risk factors will be removed.

        Second, about his cholesterol count: He should reduce LDL levels and gain more HDL. Quitting smoking, losing weight, and becoming physically active may help raise his HDL-cholesterol level. Saturated fat raises our blood cholesterol level more than anything we eat. Foods high in cholesterol or saturated fat are: egg yolks, sausage, kidneys, liver, and whole milk products such as butter, cheese, yogurt and ice cream. Red meats are also higher in cholesterol. And vegetable oils, such as palm, palm kernel, and coconut oil, contain no cholesterol but are high in saturated fat. So avoiding these foods as much as he can (for example, only three times a week) may help to bringhis cholesterol level to near normal.

        Third, about his being overweight combined with physically inactivity: To keep his weight down, he should participate in routine physical exercise and control his calorie intake. In this case he should do it carefully, because his heart attack occurred on a hiking trip before.

        Fourth, about his smoking: Just stop smoking! I propose that he make it his first step to lead a healthy life.

        The first three suggestions are what Mr.O should do in the long term to help prevent the occurrence of another heart attack. And the fourth is what he should do within the next few weeks to improve his health outlook.

         

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