There is no doubt in any doctor’s mind that stress plays a crucial role in many of today’s illnesses, both physical and mental, though just how big a role stress plays in any particular disease is difficult to assess. Undoubtedly the link between ‘type A’ behaviour (competitive and aggressive) and heart attacks is real enough and the links between stress and high blood pressure, certain bowel disease, asthma, eczema, migraine and many other conditions are all too obvious to many people.
Each of these eight headings points to what the preventive medical world calls ‘risk factors’. If you want to reduce your chances of getting a particular disease, or indeed of being unwell at all, you have to be aware of what you personally are at risk from. Only by knowing what your risk factors are can you understand the causes and set about possible risk-reducing activities.
Risk appraisal generally depends on the study of probability tables. The Robbins-Hall method of risk-factor analysis (probably the best devised so far) looks at the top twelve to fifteen causes of death, because between them they account for about two-thirds of all deaths. By comparing treated and untreated groups of people in any specific disease category a doctor can find out which intervention produces results, and can work out a ‘health appraisal’ age to compare with the patient’s actual chronological age. Let’s look at an example.
Take a 41-year-old man with a blood pressure of 180/94 mmHg and a cholesterol level of 220 mm/dl who is overweight by 15 per cent and is a non-diabetic. He also smokes twenty cigarettes a day, has eighteen drinks a week, drives 15,000 miles a year, wearing a seat-belt 75 per cent of the time, and exercises moderately each week. He has no family history of heart disease and his parents are both over 60 years old. Using the Robbins-Hall method this man’s total personal risk is 9,680. This means his chances of dying during the next 10 years are 9,680 in 100,000.
If he stops smoking, has his mild blood pressure treated and cuts his drinks to six per week, he can reduce his risk from 9,680 to 4,992. This large reduction is possible because by changing his behaviour in this way he can reduce his risk of heart attack considerably. It would also reduce his risk of cirrhosis, lung cancer, stroke and car accidents.
This man’s total personal risk before he starts his personal preventive programme translates to a risk age of 46.5 years compared with his actual age of 41 years. By using personal preventive measures he can reduce his personal risk age to 40. The Robbins-Hall printout would show that this man’s level of high blood pressure elevates his risk of heart attack by 150 per cent, and that his smoking plus his raised blood Pressure increase his stroke risk. His drinking increases his chances of both liver cirrhosis and of having a car accident.
*19/72/5*
