From our collaborators at Johns Hopkins Medicine International | Why going beyond routine screening makes sense

The path to a long and healthy life starts with addressing risk factors you can influence

Posted February 27, 2017By Charles Locke, MD, Senior Physician Adviser, Assistant Professor of Medicine, Johns Hopkins University School of Medicine

In this article and video exclusive to Medcan, Dr. Charles Locke explains the importance of early screening and preventive health choices to offset chronic disease

Most people are familiar with the many axioms of the great American statesman, scientist and philosopher Benjamin Franklin. One of the most famous is “an ounce of prevention is worth a pound of cure.” Franklin, when he wrote this, was trying to convince Philadelphians that an organized group was needed to prevent a catastrophic fire that could destroy the city. Philadelphia, due in large part to Franklin’s efforts, formed its first volunteer fire department in 1736. In addition to municipal fire prevention strategy, Franklin’s adage can apply to personal health.

The most effective medicine starts with early screening and life changes

Today’s news is filled with constant advances in modern medicine, including new immunotherapies for cancer, heart valves that can be replaced through a small catheter, robotic surgery and sophisticated genetic screening profiles. While these advances are critical to some, for most of us, our best path to a long and healthy life is to pursue an “ounce of prevention,” including maintaining a healthy lifestyle and having routine screenings done by a health professional for common conditions, including high blood pressure, diabetes and high cholesterol.

The above three conditions are linked to cardiovascular disease and stroke, the leading cause of death and disability in Canada, respectively. Canadians will suffer an estimated 60,000 heart attacks and 50,000 strokes in 2017. Fortunately, these conditions are treatable and, in some cases, preventable or reversible, meaning they are “modifiable risk factors”. High blood pressure, high cholesterol and diabetes are often asymptomatic (do not show any symptoms). Appropriate screening for these conditions by a health care professional is critical so they can be detected and treated early.

High blood pressure is typically not felt but easy to screen for

High blood pressure, also called hypertension, affects nearly a quarter of all adult Canadians. A middle-aged person with normal blood pressure has a 90 percent lifetime risk of developing hypertension. This condition is associated with increased risk for cardiovascular disease, kidney disease and death.

Patients with hypertension are often asymptomatic until they suffer a stroke or heart attack. Screening for hypertension is easy and can be done in any doctor’s office. Your blood pressure is reported in two numbers — systolic (higher number) and diastolic (lower number). Elevation of either number is associated with increased cardiovascular risk. The Canadian Task Force on Preventive Health Care (CTFPHC) recommends blood pressure measurements be taken at all adult primary care visits.

A physician can review your blood pressure. If it is elevated, he or she can decide, based on your individual risk profile and the degree of elevation, if your blood pressure should be addressed by changes in exercise, weight and diet, and if you need to be treated with blood pressure medication. Even with our vast knowledge of high blood pressure and how best to treat it, a recent study found that over 30 percent of Canadians with high blood pressure do not have their blood pressure under control.

How to defend against diabetes

Diabetes is the commonly used term for diabetes mellitus, which comes from the Greek word “diabetes,” meaning “siphon” or “pass through,” and the Latin word “mellitus,” for “sweet” or “honeyed.” Like hypertension, diabetes is associated with an increased risk of cardiovascular disease, kidney disease, eye damage (retinopathy) and death. It can also cause neuropathy (nerve damage), a painful and potentially debilitating condition. It is estimated that 3.4 million Canadians have diabetes and another 5.7 million have prediabetes.

There are two main types of diabetes mellitus: type 1 and type 2. Type 1 is an autoimmune disease in which the body produces antibodies that destroy the cells in the pancreas that produce insulin, a hormone necessary for the metabolism of glucose. Type 2 diabetes is when the body can’t respond to insulin appropriately.

Most Canadians who have diabetes have type 2 diabetes. Being overweight and living a sedentary lifestyle are associated with an increased risk of type 2 diabetes. Most people are asymptomatic when they develop type 2 diabetes, so the CTFPHC recommends screening for diabetes in all people at increased risk. With a simple blood test, your physician can tell you if you have diabetes or if you are at increased risk for developing diabetes, meaning you have prediabetes. Your doctor will be able to tell you if your blood glucose level should be addressed by changes in exercise, weight and diet alone, and if you need to take diabetes medication.

Early screening of elevated cholesterol levels gives you time to offset disease

Elevated cholesterol is also associated with an increased risk of cardiovascular disease. High cholesterol is almost always asymptomatic, so screening is the only way to detect it early, before a stroke or a heart attack. The CTFPHC recommends “individual clinical judgment” when deciding who should have their cholesterol checked. Given that nine out of 10 Canadians have at least one risk factor for cardiovascular disease, screening adults for high cholesterol has become a routine part of any comprehensive health evaluation in Canada. Your doctor will most likely check a lipid panel, which includes HDL (high-density lipoprotein), LDL (low-density lipoprotein), triglycerides and total cholesterol. A physician should consider the individual risk profile and goals of the patient when determining how best to treat high cholesterol.

For the busy professional who feels fine, taking the time to see a physician for a comprehensive health evaluation, including screening for high blood pressure, diabetes and high cholesterol, may not seem like a priority. But who would consider living in a modern city without a fire department? Not only will a physician screen you for these common diseases, but he or she will also take the time to discuss the results with you and recommend the appropriate course of action based on your individual risk profile. “An ounce of prevention is worth a pound of cure” is as true today as it was when it was first penned almost 300 years ago, both for city fire policy and personal health.