Heart’s Health and Blood Pressure

Today’s Pop Quiz: Larry in Boise, Nils in Copenhagen, Guido in Milan, and Yashihito in Yokahama are all 48 years old. Rank the men in order of their risk for death from heart attack.

Crib Note: You don’t need more information to render an educated prediction, concludes researcher Peggy van den Hoogen of The Netherlands’ National Institute of Public Health and the Environment.

Her team analyzed 25 years of data on 12,031 middle-aged men from six world geographic regions. (The men were 40 to 59 years when they enrolled in the study. We don’t want to hurt your feelings, but apparently the Dutch think 40 is middle-aged.)

The most important variable, the researchers found, is where a man lives. After that, there’s only one other variable that matters measurably – blood pressure. Larry, Nils, Guido, and Yashihito all are 140 over 90, which is just across the threshold of high.

Answer and Analysis: Larry and Nils are at greatest risk to succumb to heart disease. Guido is less likely, and Yashihito is least.blood_pressure
“Americans and Northern European men with high blood pressure are three times more likely to die of a heart attack than Japanese and Mediterranean men with the same BP,” reports the van de Hoogen study in the January 10, 2015, issue of the New England Journal of Medicine.

Throughout the world, the average risk of death rises 28 percent for each 10-point increase in the systolic blood pressure reading (the first number) or for each 5-point increase in diastolic (second number) reading.

But apparently the average means nothing – North American and northern European men with systolics of 140 had about 70 heart attack deaths per 10,000 person-years (total years lived by all participants during the study). Mediterraneans and Japanese had only 20.

By the same token, one improves his chances of longevity by lowering blood pressure that is not high. Dr. Richard Pasternak: “Taking someone from 135 (systolic) to 125 would lower their risk by 25 or 30 percent.”

“Risk” really distills down to “lifestyle,” says Dr. Pasternak

Dr. Pasternak, who is Director of Preventive Cardiology at Massachusetts General Hospital as well as an American Heart Association spokesman. “If you eliminate the factors that we know about, which are largely lifestyle issues — smoking, high blood pressure, high cholesterol, lack of exercise, and diabetes — you can eliminate somewhere between 70 and 90 percent of disease in our population.”

What the doctor means is that disease-inducing “lifestyles” are not sentences conveyed by geography; they are choices influenced by local culture.

The reason heart disease correlates with where you live is because the typical man does what everyone else does in his region. Larry golfs and is overweight, for example, and Yashihito occupies an office cubicle and smokes a lot.

Yashihito also exemplifies how some of those lifestyle elements can counteract others. Despite their being among the world’s heaviest smokers, men who live in Japan rank among the lowest in rates of cancer and heart disease.

Previous studies concluded that this is because the homeland diet includes so little fat and red meat and so much green tea and soy products — a diet that trumps smoking. Further, those studies and others suggest it isn’t primarily a matter of genetics: Japanese men raised in northern Europe and the United States have cancer and heart disease at about the same rates as their Caucasian countrymen.

stroke1The other recent finding about death from heart attacks has nothing to do with an individual’s lifestyle but could rightly be a factor of location:

Heart attack survival rates are far higher at larger hospitals having the most experience in treating coronary incidents.
While Larry in Idaho doesn’t have a great prognosis compared to his peers in other lands, he stands a better chance than Mike in Alabama.

According to Newswise Service, Jan. 10, the January, 2000 issue of the medical journal Stroke reports a study which found that “high blood pressure is more prevalent among Southerners than their non-southern counterparts of the same age and gender.” Maybe fewer BBQ ribs and more blackeyed peas for you, Mikey. And lower your blood pressure.

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