Practising cardiologist, author and media commentator, Dr. Ross Walker considers important health concerns for those in their 50s, urging patients, if they are not sure, to simply take the test.
Although I believe every visit to your doctor should be an opportunity for health screening, it’s important to have relatively simple checks starting in your 40s. But the big league, serious assessments should start during this decade. Let me make an important point that can’t be emphasised enough. All your common diseases have their origins in your childhood, teens and early adulthood, but typically become manifest after age 50. Our biggest killer, atherosclerosis, can often start in utero. At this point I’d like to introduce the concept of early vascular priming.
Hertfordshire Heart Study
Hertfordshire is the county immediately to the north of London. The Hertfordshire Heart Study followed the health patterns of around 5600 men born in the county between 1911 and 1930. They found three very interesting factors that influenced the risk of these men for coronary artery disease. Number one, low birth weight; number two, an inability to double their birth weight by one year old; number three, breastfeeding beyond 12 months.
All three factors, but especially low birth weight, were associated with a marked increase in heart disease risk. The theory is that malnourishment during pregnancy and for the first 12 months leads to immaturity in the blood vessels and a degree of mal-development. This commonly occurs in lower socioeconomic groups, who often have poorer eating habits.
Once these young children were exposed to (often) excess calories with energy-dense but nutrient-poor foods, their immature, poorly developed blood vessels weren’t strong enough to withstand this assault, and thus it was very easy for the fat to accumulate in the walls of their arteries at a very young age.
So, using the example of our most common disease process, atherosclerosis occurs very early on in your life and builds up over decades to eventually rupture into the channel of the blood vessels, blocking the arteries, leading to heart attack, stroke and sudden death.
However, it does usually take decades for this to occur. So if you don’t have a rampant family history of heart disease (typically occurring before age 60 in first-degree relatives, i.e. parents, grandparents or siblings), or none of the other major risk factors for heart disease, age 50 is a good time to start screening. Pre-conception, though, is a good time for your parents to start thinking about your health. Unfortunately, poor decisions and lifestyle behaviour on the part of your parents may impact on your health for decades to come. So, age 50 is also a very good time to be screened for the following common illnesses:
1. Cardiovascular assessment, including diabetic screening and Alzheimer’s disease for those with a family history;
2. Common cancers – prostate, bowel, breast, melanoma, lung for current and former smokers;
Although I’m a great advocate and believer in screening, it’s important to make the point strongly that there is no test in medicine that is 100 per cent accurate. I introduced coronary calcium scoring using CT technology into Australia in the late-90s, but while this is the most accurate screening test for heart-attack risk, as I’ve said, like all tests it isn’t 100 per cent accurate. I occasionally see people who have heart attacks with zero scores, but there is no doubt that from the hundreds of thousands of people who’ve been screened and benefited from this technology, the higher the score, the higher your risk. Screening for any condition is purely an indication of disease potential. Mammography is not always right – it sometimes over-diagnoses a cancer and sometimes misses a cancer. This is the nature of the disease and the nature of the test.
Now, this is a major point: symptoms always override test results. If you have a symptom, it always needs to be checked. If your calcium score was zero but six months later you start to experience chest pain, especially with exertion or stress, it is angina until proven otherwise. These symptoms do necessitate a rather urgent stress echo cardiogram. A breast lump needs careful evaluation. Any gastrointestinal bleeding or change in bowel habits need a thorough gastrointestinal work-up. In a simple sentence: don’t ignore symptoms!
This is an edited extract from 5 Stages of Health by Dr Ross Walker
Copyright © Dr Ross Walker 2012
Reprinted by Permission of Random House Australia
All Rights Reserved
$34.95 Bantam Australia available now from all bookshops.