“There are two kinds of risk factors for heart disease: those you cannot change, and those you can,” says Dr. David Dannenbaum, a Cree Public Health physician specializing in diabetes and other chronic diseases. Into the first group fall genetic risks: if you are born to a family that has a history of cardiovascular diseases, then you run a higher risk of having heart disease at a younger age. In addition, men are more likely to suffer from heart disease than women, and older people are more at risk than the young. And you cannot change how old you are, your gender or the family you are born into.
Historically, the Cree have also enjoyed lower levels of heart disease than the general North American population, thanks to genetic make-up, actives lifestyles, and a diet low in unhealthy fats. But these factors have changed, and, even as heart disease rates are dropping across the rest of the continent, they are rising in Cree communities. Unfortunately, this trend seems likely to get worse, especially with increased rates of diabetes – another important risk factor in the development of heart disease. “For people with diabetes, cardiovascular diseases take about 10 to 20 years to develop,” says Dannenbaum. “But most cases of diabetes in the Cree communities have been diagnosed in the last ten years, so we’re at the tip of the iceberg. As people with diabetes get older, the ones who are not taking care of themselves – which includes paying attention to blood pressure, cholesterol, and sugar levels – are at high risk of having heart problems.”
The bright news is that many risk factors can be controlled, including smoking habits, cholesterol intake, and levels of physical activity. In fact, many of the behaviors that help protect people from getting diabetes – or which help keep it under control, if they already have it – will also reduce the chance of developing heart disease. And small changes in behavior can make a big difference. “Risk factors for heart disease are more than additive – one plus one is always more than two,” Dannenbaum points out. “If you smoke and come from a family with a history of heart disease, your risk is more than these two risk factors added together. It’s more like one plus one equals three. In fact, smoking increases risk of heart disease by two to four times, so quitting smoking is the most important thing you can do.” On the other hand, even little changes can pay off. So going from an inactive lifestyle to doing a small amount of activity, smoking five cigarettes a day instead of a pack, or losing just five pounds, can make a significant difference in reducing risk. “The ‘biggest loser’ weight challenges are unhealthy and unnecessary,” he says. “But small changes in risk factors have a huge benefit.”
Making a difference
A change in diet could also make a big difference. “Eating saturated and trans fats leads to high cholesterol,” says Dr. Elizabeth Robinson, Cree Public Health physician and community health specialist. “The animals that are part of the traditional Cree diet – like fish, geese, or caribou – tend to have less of these types of fat, and their fat is healthier than the fat found in commercial pork and beef. And much healthier than the fat you fry chips in.” Cree Public Health’s recent environmental health study measured trans fats in people, finding that younger people have more than older people – thanks to a diet heavy in processed foods, including baked goods and foods like poutine, fries and chips. These foods increase the risk of high cholesterol, which can lead to heart disease and strokes as well as diabetes. However, eating fewer unhealthy foods that contain saturated and trans fats will reduce this danger.
The message is clear: focus on risk factors you can change, such as the food you eat, quitting smoking, and physical activity. This is especially important for people with family histories of heart disease, and those with diabetes, as they have the highest risk. “Any change, however small, is a good change. Often people make changes without even realizing it – they just give up eating a chocolate bar at lunch, or walking a bit more,” says Dannenbaum. “And people who have made significant changes to their lifestyles tell me, ‘Boy, do I feel better. Why didn’t I do this years earlier?’ It can be hard to start, but people can learn from other people’s successes.” The goal is to not give up, but to make a change for life.