Why doctors seek these ‘silent’ health risks

Doctors use various tests to have an insight into our health, and of particular interest are ‘silent’ health risks. These risks can sit quietly in the background but the collective effects of these conditions over time may create health issues. Revealing them early and then determining a proactive way of making improvements to reduce those health risks can offer long term benefits.

‘Silent’ health risks

The old saying goes ‘what you don’t know cannot hurt you’, yet in the case of disease and chronic conditions, knowing these health risks exist is the first step in reducing their potential effect upon the body.

High blood pressure, referred to as ‘hypertension’ by doctors, is often referred to as the ’silent killer’. This is for good reason as there are no obvious signs or symptoms of this condition. To make things worse many people are unaware of how crucial blood pressure is to their health. Not only is it the biggest risk factor for heart disease and strokes, its potential to cause serious long-term damage can be linked to chronic kidney disease.

Blood sugar sounds far less dramatic but too much glucose in the blood can, over time, damage the body’s organs. One of the possible side effects is damage to blood vessels that in turn can lead to kidney, eye, feet and nerve problems as well as the risk of heart attack and stroke. When blood glucose levels are higher than normal, the results may be classified as pre-diabetes. This means that there is an increased risk of developing type 2 diabetes unless positive changes to lifestyles are made such as weight loss and increased physical activity.

Unfortunately, those who are diagnosed with diabetes are more prone to have unhealthy high levels of the next health risk, cholesterol. Normal levels of triglycerides and cholesterol serve their own functions within the body, but when they are out of balance, like most things that’s where the problems begin. Once again high cholesterol does not show any symptoms but an accumulation of cholesterol on the walls of arteries can reduce blood flow and contribute to cardiovascular disease and the risk of stroke and heart attack.

Cholesterol hitches a ride with proteins when being carried through our blood. This duo is called lipoprotein, and so the different types of cholesterol describe what the lipoprotein is carrying. The ‘good’ cholesterol is called high-density lipoprotein (or HDL) as this picks up and delivers excess cholesterol back to the liver where it is eliminated from the body. The ‘bad’ cholesterol is called low-density lipoprotein ( or LDL) as it carries cholesterol particles throughout the body, where it can build up inside the walls of arteries. Another contributor to this build up is Triglycerides which like cholesterol are a type of lipid, or in simple terms, fat. They must be tracked as well since they contribute to the development of atherosclerosis, that being the narrowing and hardening and of the arteries.

But there is good news in that the complications that arise from chronic diseases such as diabetes, can be reduced by keeping the silent risks of blood pressure, blood glucose and cholesterol levels within the recommended range. So regardless of feeling perfectly well and having no symptoms, checking if cholesterol or glucose levels are too high with a blood test or having your doctor take your blood pressure, can help gauge the level of risk of future health conditions.

So now we know some of the things that doctors are looking for in these tests, it would be good to know what parameters we would need to be within to have good results.

Results that are ideal

The goal blood glucose level will differ depending on whether a person does or does not have diabetes. The Diabetes Australia Website describes glucose levels here for fasting and non-fasting.

To work out someone’s ideal blood pressure a doctor will look at their individual circumstances, but as a general guide, a reading under 120/80 mmHg is optimal. Readings from 120/80 mmHg up to 139/89mmHg are in the normal to high range. When blood pressure is over 140/90mmHg it is generally considered to be high. Of course, blood pressure will fluctuate throughout the day and will be influenced by things such as the time of day, what a person is doing, medicines being taken and how hydrated they are. Sleep, exercise, and emotions all play a part and a rise in blood pressure is natural, especially if you are visiting the doctor. Blood pressure generally returns to normal when resting, so a doctor may ask you to sit quietly for a moment before taking a reading.

For cholesterol, a lipid profile will look at the various levels of high-density lipoproteins (HDL cholesterol), low-density lipoproteins (LDL cholesterol) and triglycerides via a blood test. The results of these three factors can help assess the risk of coronary artery disease. Each of the three lipids will be presented as a number in the blood test results. Depending on an individuals health assessment a doctor will be able to advise if those levels are ideal or could be improved, all the while balancing both the risks and benefits of changes to that individual’s lifestyle. For example, those who need to be treated for high cholesterol should be aiming for LDL (‘bad’) cholesterol levels lower than 2.0 mmol/L. However, those that have had a heart attack or have a chronic disease such as diabetes should aim for an even lower level.

No matter what the results of the tests above, generally there is room for improvement. Luckily we have the ability to monitor other areas that may improve not just those results but our health in general.

Risk factors we can change

There are some simple lifestyle changes that can make great improvements in not only these areas of concern but health in general. Increasing our intake of vegetables and fruit would be a logical start. Aiming for the recommended minimum of five vegetable and two fruit serves per day is good, with dark, green leafy vegetables being particularly healthy. Fibre-rich foods, specifically those that contain soluble fibre like oats and legumes are worth adding to the pantry. Two to three serving of fish per week and a daily dose of healthy unsaturated fat from things like avocado, nuts, seeds, and olive oil, will add variety to meals. On the other hand cutting back on foods that are low in nutrients but high in sugar, salt, and fat such as pastries, cakes or flavoured drinks, will make other efforts worthwhile.

Further to changes in what is consumed, the amount we consume will help as well. More of the whole, healthy foods and less of optional, processed treats will make headway in another area, the waistline. Often body mass index or BMI is the major focus of a healthy weight as it provides an estimate of total body fat and from that the risk of developing weight-related diseases. Yet it does not provide an accurate measurement of fat versus muscle mass and is less accurate for certain groups such as the elderly, pregnant women or certain ethnic groups.

A waist measurement provides a better indication of fat distribution, as long as it is measured correctly. This is best done by finding the halfway point between the top of the hipbone and the lowest rib, so roughly in-line with the belly button. Wrap a tape measure around the waist on the skin, snugly but without compressing the skin and measure after breathing out normally. Men are aiming for a waist measurement less than 94cm and for women under 80cm as recommended by the heart foundation. Above that increases the risk of many serious health problems including the ones above as well as cancer. Over a 102cm waistline measurement for men, or 88cm for women and there is even greater risk.

As much as we may try our best to aspire to these ideal parameters, there will generally be a mix of factors, some outside our control, that could still place us at risk.

Risk factors beyond our control

One of the first things a doctor may do in an initial consultation is to take your family medical history. This will take into account whether people in your family have had long term health problems like diabetes or heart disease and if there are any health issues such as high cholesterol or high blood pressure. Other serious illnesses such as cancer will be included to formulate a picture that helps your doctor choose the screening tests that are most applicable to the history described.

The success of identifying an above average chance of having common disorders like heart disease, high blood pressure, stroke, certain cancers, and diabetes will be dependant on the information provided to the doctor. Often this can be achieved by asking family and relatives about the family medical history. Knowing how and what age several generations of family have passed and what other conditions they had can provide some surprising information.

Of course, having a strong history of a certain health concern does not mean that someone will definitely develop the same condition. Conversely, just because someone’s grandparents lived to ripe old age, won’t guarantee the same for them. However knowing our family history can make it easier to work with a doctor and implement steps that reduce the risks of disease, such as more frequent screening at an earlier age. A concise and in-depth history can also be shared to benefit the health plans of other family members.

The environment we live in also contributes to our health. It is true that how we were raised has a big impact on our health yet it’s never too late to make changes to our lifestyle. So a GP may also ask about our social history that would encompass employment, the use of drugs and alcohol as well as sexual history. Past medical, surgical and psychiatric history may also be queried along with immunisations, medications, and allergies. The more information the better, as your doctor will be able to build a broader picture of current health and possible risk factors that tests may not cover.

So although we have no influence on our age, gender, genes, and medical history, we can work with a doctor and implement steps to help reduce the risks that can be controlled. To complement these efforts and for those health risks out of our control, general health can be reviewed and adjusted.

Contributions to risk reduction

Awareness of our health risk factors is a start and once they are identified, changes can be made for the better. For example, one in eleven Australians has not had their blood pressure checked in the last two year. If high blood pressure is detected then changes to weight, eating habits, alcohol intake, and the level of physical activity can have a positive influence on blood pressure.

The big issue is that the further back those habits go the harder the changes are to make. Thankfully change is about choice. So a good strategy when making changes is to have something there to replace what is going to be taken away. For something like chocolate, the body will be craving sugar. Replacing half the amount of chocolate with fruit will help ease the transition. For others abruptly stopping sugar and never going back may be the strategy that suits best.

Whatever the choices that are made, being aware of the risks and making changes that matter is a better way to protect your future health. In fact, knowing that you have a health risk may provide some much-needed incentive when tempted to slip back into old ways.

Where to from here?

Most of us have likely been tested for these risk factors already. Having had our blood pressure, weight or waist measurement taken in a GP consultation or being sent off for a blood or urine samples are examples. Although we may feel in good health and those tests have revealed nothing in the past, they enable a doctor to see if our health is on track or if something needs to be addressed.

Either way, a doctor can provide an explanation of anything of concern and from there, suggestions can be made as to where lifestyle changes can be made. For some of us, this will be enough. Others may prefer to understand more about those results such as the terminology used and what results we should be aspiring to achieve and maintain.

Ideally, it would be good if these tests came back with an A, B or C like school ‘tests’. Yet the results doctors provide are generally made up of a range of figures which doctors would prefer for us to stay within. As results will vary with age and lifestyle changes, its good to know the ideal ranges of these ‘silent’ health risks and how falling outside the ideal healthy range can be addressed.