What Are Heart Disease Risk Factors?
Heart disease risk factors are conditions or habits
that raise your risk for
coronary
heart disease (CHD; also called coronary artery disease) and
heart
attack. These risk factors also increase the chance that existing heart
disease will worsen.
CHD is a condition in which a fatty material called
plaque (plak) builds up on the inner walls of the coronary arteries. These
arteries carry oxygen-rich blood to your heart muscle.
Plaque narrows the arteries and reduces blood flow
to your heart muscle. This can cause chest pain, especially when you're active.
Eventually, an area of plaque can rupture, causing a blood clot to form on the
plaque's surface.
If the clot becomes large enough, it can mostly or
completely block the flow of oxygen-rich blood to the part of the heart muscle
fed by the artery. This causes a heart attack.
Overview
There are a number of known heart disease risk
factors. You can control some risk factors, and others you can't. Risk factors
you can control include:
The risk factors you can't control are age, gender,
and family history.
Many people have at least one heart disease risk
factor. Your risk for heart disease and heart attack increases with the number
of risk factors you have and their severity. Also, some risk factors, such as
smoking and diabetes, put you at greater risk for heart disease and heart
attack than others.
Many heart disease risk factors start during
childhood. This occurs even more now because many children are overweight and
don't get enough physical activity. Some heart disease risk factors can even
develop within the first 10 years of life.
Researchers continue to study and learn more about
heart disease risk factors.
Outlook
Heart disease is the #1 killer of both women and men
in the United States. Following a healthy lifestyle can help you and your
children prevent or control many heart disease risk factors.
Because many lifestyle habits begin during
childhood, parents and families should encourage their children to make heart
healthy choices. For example, if you maintain a healthy weight, follow a
healthy diet, do physical activity regularly, and don't smoke, you can reduce
your heart disease risk.
On average, people who have a low risk for heart
disease live up to 10 years longer than people at high risk for heart
disease.
If you already have heart disease, lifestyle changes
can help you control your risk factors. This may prevent heart disease from
worsening. Even if you're in your seventies or eighties, a healthy lifestyle
can lower your risk of dying from heart disease by nearly two-thirds.
If lifestyle changes aren't enough, your doctor may
recommend other treatments to help control your risk factors.
Your doctor can help you find out whether you have
heart disease risk factors. He or she also can help you create a plan for
lowering your risk for heart disease, heart attack, and other heart problems.
If you have children, talk to their doctor about their heart health and whether
they have heart disease risk factors.
Heart Disease Risk Factors
High Blood Cholesterol and High Triglyceride
Levels
Cholesterol
High blood cholesterol is a condition in which
there's too much cholesterola waxy, fat-like substancein your
blood. The higher your blood cholesterol level, the greater your risk for
heart
disease and
heart
attack.
Cholesterol travels in the bloodstream in small
packages called lipoproteins (LI-po-pro-teens). Two major kinds of lipoproteins
carry cholesterol throughout your body:
- Low-density lipoproteins (LDL). LDL cholesterol
is sometimes called "bad" cholesterol. This is because it carries cholesterol
to tissues, including your heart arteries. The higher the level of LDL
cholesterol in your blood, the greater your risk for heart disease.
- High-density lipoproteins (HDL). HDL cholesterol
is sometimes called "good" cholesterol. This is because it helps remove
cholesterol from your arteries. A low HDL cholesterol level raises your risk
for heart disease.
A number of factors affect your blood cholesterol
levels. For example, after menopause, women's LDL cholesterol levels tend to
rise and their HDL cholesterol levels tends to fall. Other factors, such as
age, gender, and diet, also affect your cholesterol levels.
Healthy levels of both LDL and HDL cholesterol will
prevent plaque from building up in your arteries. Routine
blood
tests can show whether your blood cholesterol levels are healthy. Talk to
your doctor about having your cholesterol tested and what the results mean.
Children also can have high blood cholesterol,
especially if they're overweight. Talk to your child's doctor about testing
your child' cholesterol levels.
To learn more about high blood cholesterol and how
to manage the condition, see the Diseases and Conditions Index (DCI)
High
Blood Cholesterol article and the National Heart, Lung, and Blood
Institute's (NHLBI's)
"Your
Guide to Lowering Your Cholesterol With TLC."
Triglycerides
Triglycerides are another type of fat found in the
blood. Some studies suggest that a high level of triglycerides in the blood
also may raise the risk for heart disease, particularly in women.
High Blood Pressure
"Blood pressure" is the force of blood pushing
against the walls of your arteries as your heart pumps out blood. If this
pressure rises and stays high over time, it can damage your heart and lead to
plaque buildup.
Often, high blood pressure (HBP) has no signs or
symptoms. However, the condition can be detected using a simple test that
involves placing a blood pressure cuff around your arm.
Most adults should have their blood pressure checked
at least once a year. Talk to your doctor about how often you should have your
blood pressure checked. If you have HBP, you will likely need to have your
blood pressure checked more often.
Children also can develop HBP, especially if they're
overweight. Your child's doctor should check your child's blood pressure at
each routine checkup.
Blood pressure numbers consist of systolic
(sis-TOL-ik) and diastolic (di-a-STOL-ik) pressures. Systolic blood pressure is
the pressure when your heart beats. Diastolic blood pressure is the pressure
when your heart is at rest between beats.
You will most often see blood pressure numbers
written with the systolic number above or before the diastolic number, such as
120/80 mmHg. (The mmHg is millimeters of mercurythe units used to measure
blood pressure.)
All levels above 120/80 mmHg raise your risk for
heart disease. This risk grows as blood pressure levels rise. Only one of the
two blood pressure numbers has to be above normal to put you at greater risk
for heart disease and heart attack.
Blood pressure normally rises with age and body
size. Newborns often have very low blood pressure numbers, while older teens
have numbers similar to adults.
The ranges for normal blood pressure and HBP are
generally lower for youth than for adults. These ranges are based on the
average blood pressure numbers for age, gender, and height.
Your child should have routine blood pressure checks
starting at 3 years of age. To find out whether a child has HBP, a doctor will
compare the child's blood pressure numbers to average numbers for his or her
age, height, and gender.
Both children and adults are more likely to develop
HBP if they're overweight or have diabetes.
For more information about HBP and how to manage the
condition, see the DCI
High
Blood Pressure article and the NHLBI's
"Your
Guide to Lowering Your Blood Pressure With DASH."
Diabetes and Prediabetes
Diabetes is a disease in which the body's blood
sugar level is too high. The two types of diabetes are type 1 and type 2.
In type 1 diabetes, the body's blood sugar level is
high because the body doesn't make enough insulin. Insulin is a hormone that
helps move blood sugar into cells, where it's used for fuel. In type 2
diabetes, the body's blood sugar level is high mainly because the body doesn't
use its insulin properly.
Over time, a high blood sugar level can lead to
increased plaque buildup in your arteries. Having diabetes doubles your risk
for heart disease.
Prediabetes is a condition in which your blood sugar
level is higher than normal, but not as high as it is in diabetes. If you have
prediabetes and don't take steps to manage it, you're likely to develop type 2
diabetes within 10 years. You're also at higher risk for heart disease.
Being overweight or obese raises your risk for type
2 diabetes. With modest weight loss and moderate physical activity, people who
have prediabetes may be able to delay or prevent type 2 diabetes. They also may
be able to lower their risk for heart disease and heart attack. Weight loss and
physical activity also can help control diabetes.
Even children can develop type 2 diabetes. Most
children who have type 2 diabetes are overweight.
Type 2 diabetes develops over time and sometimes has
no symptoms. Go to your doctor or local clinic to have your blood sugar levels
tested regularly to check for diabetes and prediabetes.
For more information on diabetes and prediabetes,
see the National Institute of Diabetes and Digestive and Kidney Diseases'
(NIDDK's)
Introduction to Diabetes.
Overweight and Obesity
The terms "overweight" and "obesity" refer to a
person's overall body weight and whether it's too high. Overweight is having
extra body weight from muscle, bone, fat, and/or water. Obesity is having a
high amount of extra body fat.
The most commonly used measure of overweight and
obesity is body mass index (BMI). BMI is calculated from your height and
weight.
In adults, a BMI of 18.5 to 24.0 is considered
normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or above is
considered obese. Over two-thirds of American adults are overweight, and almost
one-third are obese. You can use the NHLBI's
online BMI calculator to figure
out your BMI, or your doctor can help you.
Overweight is defined differently for children and
teens than it is for adults. Children are still growing, and boys and girls
mature at different rates. Thus, BMIs for children and teens compare their
heights and weights against growth charts that take age and gender into
account. This is called BMI-for-age percentile.
For more information about BMI-for-age growth charts
for children, go to the Centers for Disease Control and Prevention's
BMI-for-age calculator.
Being overweight or obese can raise your risk for
heart disease and heart attack. This is mainly because overweight and obesity
are linked to other heart disease risk factors, such as high blood cholesterol
and triglyceride levels, high blood pressure, and diabetes.
For more information, see the DCI
Overweight
and Obesity article.
Smoking
Smoking tobacco or long-term exposure to secondhand
smoke raises your risk for heart disease and heart attack.
Smoking triggers a buildup of plaque in your
arteries. Smoking also increases the risk of blood clots forming in your
arteries. Blood clots can block plaque-narrowed arteries and cause a heart
attack.
Some research shows that smoking raises your risk
for heart disease in part by lowering HDL cholesterol levels.
The more you smoke, the greater your risk for heart
attack. Studies show that if you quit smoking, you cut your risk for heart
attack in half within a year. The benefits of quitting smoking occur no matter
how long or how much you've smoked.
Most people who smoke start when they're teens.
Parents can help prevent their children from smoking by not smoking themselves.
Talk to your child about the health dangers of smoking and ways to overcome
peer pressure to smoke.
Lack of Physical Activity
Inactive people are nearly twice as likely to
develop heart disease as those who are active. A lack of physical activity can
worsen other heart disease risk factors, such as high blood cholesterol and
high triglyceride levels, high blood pressure, diabetes and prediabetes, and
overweight and obesity.
It's important for children and adults to make
physical activity part of their daily routines. One reason many Americans
aren't active enough is because of hours spent in front of TVs and computers
doing work, schoolwork, and leisure activities.
Some experts advise that children and youth reduce
screen time because it limits time for physical activity. They recommend that
children aged 2 and older should spend no more than 2 hours a day watching
television or using a computer (except for school work).
Being physically active is one of the most important
things you can do to keep your heart healthy. The good news is that even modest
amounts of physical activity are good for your health. The more active you are,
the more you will benefit.
For more information, see the U.S. Department of
Health and Human Services'
"2008 Physical Activity Guidelines for Americans," the
Diseases and Conditions Index Physical Activity and Your Heart article, and the
NHLBI's
"Your
Guide to Physical Activity and Your Heart."
Unhealthy Diet
An unhealthy diet can raise your risk for heart
disease. For example, foods that are high in saturated and trans fats
and cholesterol raise LDL cholesterol. Thus, you should try to limit these
foods.
Saturated fats are found in some meats, dairy
products, chocolate, baked goods, and deep-fried and processed foods.
Trans fats are found in some fried and processed foods. Cholesterol is
found in eggs, many meats, dairy products, commercial baked goods, and certain
types of shellfish.
It's also important to limit foods that are high in
sodium (salt) and added sugars. A high-salt diet can raise your risk for high
blood pressure.
Added sugars will give you extra calories without
nutrients like vitamins and minerals. This can cause you to gain weight, which
raises your risk for heart disease. Added sugars are found in many desserts,
canned fruits packed in syrup, fruit drinks, and nondiet sodas.
You also should try to limit how much alcohol you
drink. Too much alcohol will raise your blood pressure. It also will add
calories, which can cause weight gain.
Stress
Stress and anxiety may contribute to the development
of heart disease. Stress and anxiety also can trigger your arteries to tighten.
This can raise your blood pressure and your risk for heart attack.
The most commonly reported trigger for a heart
attack is an emotionally upsetting event, especially one involving anger.
Stress also may indirectly raise your risk for heart disease if it makes you
more likely to smoke or overeat foods high in fat and sugar.
Age
As you get older, your risk for heart disease and
heart attack rises. This is in part due to the slow buildup of plaque inside
your heart arteries, which can start during childhood.
In men, the risk for heart disease increases after
age 45. In women, the risk increases after age 55.
Most people have some plaque buildup in their heart
arteries by the time they're in their seventies. However, only about 25 percent
of those people have chest pain, heart attacks, or other signs of heart
disease.
Gender
Before age 55, women have a lower risk for heart
disease than men. After age 55, however, the risk for heart disease increases
similarly in both women and men. This is because before menopause, estrogen
provides some protection against heart disease for women.
Some risk factors may affect heart disease risk
differently in women than in men. For example, diabetes raises the risk for
heart disease more in women.
Family History
Family history plays a role in heart disease risk.
Your risk increases if your father or brother was diagnosed with heart disease
before 55 years of age, or if your mother or sister was diagnosed with the
disease before 65 years of age.
However, having a family history of heart disease
doesn't mean that you will have it too. This is especially true if your
affected family member smoked or had other heart disease risk factors that were
not well treated.
Making lifestyle changes and taking medicines to
treat other risk factors often can lessen genetic influences and stop or slow
the progress of heart disease.
How To Prevent and Control Heart Disease Risk
Factors
You can prevent and control many heart disease risk
factors, such as
high
blood cholesterol,
high
blood pressure, and
overweight
and obesity, with lifestyle changes and medicines. Only a few risk factors,
such as age, gender, and family history, can't be controlled.
To reduce your risk for
heart
disease and
heart
attack, try to control each risk factor you can. The good news is that many
lifestyle changes help control several heart disease risk factors at the same
time. For example, physical activity lowers your blood pressure, helps control
diabetes and prediabetes, reduces stress, and helps control
your weight.
A Lifelong Approach
Many lifestyle habits begin during childhood. Thus,
parents and families should encourage their children to make heart healthy
choices, such as following a healthy diet and doing enough physical activity.
Make following a healthy lifestyle a family goal.
To achieve this goal, it's important to learn about
key health measures, such as weight, body mass index (BMI), waist
circumference, and your child's BMI-for-age percentile. For more information
about BMI in adults and children, see "Heart Disease
Risk Factors."
Be aware of you and your family members' blood
pressure, blood cholesterol, and blood sugar levels. Once you know these
numbers, you can work to bring them into, or keep them within, a healthy
range.
Making lifestyle changes can be hard. However,
making lifestyle changes as a family can make it easier for everyone to prevent
or control their heart disease risk factors.
For tips on how to help your children adopt healthy
habits, visit the National Heart, Lung, and Blood Institute's (NHLBI's)
We
Can! Ways to Enhance Children's Activity & Nutrition Web site. For
more information on how to cope with lifestyle changes see "Other Lifestyle
Concerns" below.
Lifestyle Changes
A healthy lifestyle can lower the risk for heart
disease and may prevent current heart disease from worsening. A healthy
lifestyle includes:
- Following a healthy diet
- Maintaining a healthy weight
- Doing physical activity regularly
- Quitting smoking
- Managing stress
Following a Healthy Diet
A healthy diet is an important part of a healthy
lifestyle. To lower your risk for heart disease and heart attack, you and your
family should follow a diet that's:
- Low in saturated and trans fats.
Saturated fats are found in some meats, dairy products, chocolate, baked goods,
and deep-fried and processed foods. Trans fats are found in some fried
and processed foods. Both types of fat raise your LDL, or "bad," cholesterol
level.
- High in the types of fat found in fish and olive
oil. These fats are rich in omega-3 fatty acids. Omega-3 fatty acids lower your
risk for heart attack, in part by helping prevent blood clots.
- High in fiber, whole grains, fruits, and
vegetables. A diet that's rich in these elements not only helps lower your LDL
cholesterol level, but also provides nutrients that may help protect against
heart disease.
- Low in salt and sugar. A low-salt diet can help
you manage your blood pressure. A low-sugar diet can help you prevent weight
gain and control diabetes and prediabetes.
Research suggests that drinking small to moderate
amounts of alcohol regularly also can lower your risk for heart disease. One
drink a day can lower your risk by raising your HDL, or "good," cholesterol
level. One drink is a glass of wine, beer, or a small amount of hard
liquor.
If you don't drink, this isn't a recommendation to
start using alcohol. If you're pregnant, if you're planning to become pregnant,
or if you have another health condition that could make alcohol use harmful,
you shouldn't drink.
Also, too much alcohol can cause you to gain weight
and raise your blood pressure and triglyceride levels. In women, even one drink
a day may raise the risk for certain types of cancer.
Teach your children how to make healthy food
choices. For example, have them help you shop for and make healthy foods. Set a
good example by following the same heart healthy diet that you ask your
children to follow. For more information on following a healthy diet, see
the NHLBI's
Aim for a
Healthy Weight Web site,
"Your
Guide to a Healthy Heart,"
"Your
Guide to Lowering Your Blood Pressure With DASH," and
"Your
Guide to Lowering Your Cholesterol With TLC." All of these resources
provide general information about healthy eating.
Maintaining a Healthy Weight
Following a healthy diet and being physically active
can help you maintain a healthy weight. Controlling your weight helps you
control heart disease risk factors.
If you're overweight or obese, try to lose weight. A
loss of just 5 to 10 percent of your current weight can lower your heart
disease risk. To lose weight, cut back your calorie intake and do more physical
activity.
Eat smaller portions and choose lower calorie foods.
Don't feel that you have to finish the entrees served at restaurants. Many
restaurant portions are oversized and have too many calories for the average
person.
For overweight children or teens, it's important to
slow the rate of weight gain. However, reduced-calorie diets aren't advised
before you talk to a doctor.
If you're obese, or if you haven't been active in
the past, start physical activity slowly and build up the intensity over
time.
Doing Physical Activity Regularly
You don't have to be an athlete to lower your risk
for heart disease. People gain some health benefits from as little as 60
minutes of moderate-intensity aerobic activity per week.
For major health benefits, adults should do at least
150 minutes (2.5 hours) of moderate-intensity aerobic activity or 75 minutes (1
hour and 15 minutes) of vigorous-intensity aerobic activity each week.
Another option is to do a combination of both. A
general rule is that 2 minutes of moderate intensity activity counts the same
as 1 minute of vigorous intensity activity.
The more active you are, the more you will
benefit.
Children and youth should do 60 minutes or more of
physical activity every day. A great way to encourage physical activity is to
do it as a family. You also may want to limit your children's TV, video, and
computer time to encourage them to be more active.
If you have heart disease of symptoms such as chest
pain and dizziness, talk to your doctor before you start a new exercise plan.
Find out how much and what kinds of physical activity are safe for you. Avoid
exercising outdoors when air pollution levels are high or the temperature is
very hot or cold.
For more information on physical activity, see the
U.S. Department of Health and Human Services'
"2008 Physical Activity Guidelines for Americans," the
Diseases and Conditions Index Physical Activity and Your Heart article, and the
NHLBI's
"Your
Guide to Physical Activity and Your Heart."
Quitting Smoking
If you smoke, quit. Smoking can raise your risk for
heart disease and heart attack and worsen other heart disease risk factors.
Talk to your doctor about programs and products that can help you quit smoking.
Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own,
consider joining a support group. Many hospitals, workplaces, and community
groups offer classes to help people quit smoking.
You can help your children avoid smoking or quit
smoking. Talk with them about the health effects of smoking. Teach them how to
handle peer pressure to smoke.
Teens who have parents who smoke are more likely to
smoke themselves. Set a good example by not smoking or quitting smoking. Set
firm rules about no tobacco use in your home.
If you have a child who smokes, help him or her
devise a plan to quit. Offer your child information and resources on how to
quit. Stress the natural rewards that come with quitting, such as freedom from
addiction, better fitness and sports performance, and improved appearance.
Reinforce the decision to quit with praise.
For more information on how to quit smoking, see the
NHLBI's
"Your
Guide to a Healthy Heart." For more information on children and smoking,
see the Department of Health and Human Services'
Smoking & How to Quit and
Kids and Smoking.
Managing Stress
Learning how to manage stress, relax, and cope with
problems can improve your emotional and physical health. Having supportive
people in your life with whom you can share your feelings or concerns can help
relieve stress.
Physical activity, medicine, and relaxation therapy
also can help relieve stress. You may want to consider participating in a
stress management program.
Other Lifestyle Concerns
If making lifestyle changes is hard for you, try
taking things one step at a time. Learn about the benefits of lifestyle
changes. Talk to your doctor, and read some of the resources in "Links to Other Information About Heart Disease Risk
Factors."
Figure out what's stopping you from making or
sticking to your lifestyle changes. Think about how to overcome these issues.
For example, if you're too tired to exercise after work, you may want to try
working out before you go to work.
Make a plan to carry out your lifestyle changes that
includes specific, realistic goals. Act on your plan and work toward your
goals. You may want to do so with the help of a support group or supportive
friends and family.
Reward yourself for the gains you've made. Think
about what you need to do to maintain your lifestyle changes and avoid
unhealthy habits.
Don't give up if you go off your diet or exercise
plan or start smoking again. Instead, find out what you need to do to get back
on track so you can meet your goals. Many people find that it takes more than
one try to make long-term lifestyle changes.
Changing the eating and activity habits of children
takes time. Start with small, easy steps. For example, cut out after-dinner
snacks or go for an after-dinner walk instead of watching TV.
Set a good example, and try to get your children
involved in choosing a new healthy step to take each day. Making lifestyle
changes a group effort will make them easier.
Medicines
Sometimes lifestyle changes aren't enough to reduce
your blood pressure, cholesterol levels, or other risk factors. Your doctor
also may recommend medicines. For example, you may need medicines to:
- Lower your LDL cholesterol
- Lower your blood pressure
- Lower your blood sugar level
- Prevent blood clots and/or inflammation
Take your medicines as prescribed. Don't cut back on
the dosage unless your doctor tells you to. If you have side effects or other
problems related to your medicines, talk to your doctor. He or she may be able
to provide other options.
You should still follow a heart healthy lifestyle,
even if you take medicines to control your risk factors.
Key Points
- Heart disease risk factors are conditions or
habits that raise your risk for
coronary
heart disease (CHD) and
heart
attack.
- CHD is a condition in which a fatty material
called plaque builds up on the inner walls of your coronary (heart) arteries.
Plaque narrows the arteries and reduces blood flow to your heart muscle. It
also makes it more likely that blood clots will form and partly or completely
block blood flow to a section of your heart muscle.
- There are a number of known heart disease risk
factors. You can control some risk factors, and others you cant.
- Risk factors you can control include
high
blood cholesterol and high triglyceride levels,
high
blood pressure,
diabetes and prediabetes,
overweight
and obesity, smoking, lack of physical activity, unhealthy diet, and
stress.
- The risk factors you cant control include
age, gender, and family history. However, even if you have a family history of
heart disease, it doesnt mean that you will have heart disease too.
Making lifestyle changes and taking medicines to treat other risk factors often
can lessen the genetic influences and stop or slow the progress of heart
disease.
- Your risk for heart disease and heart attack
increases with the number of risk factors you have and their severity. Also,
some risk factors, such as smoking and diabetes, put you at greater risk than
others.
- Many heart disease risk factors start during
childhood, and some can even develop within the first 10 years of life. Thus,
parents should encourage children from a young age to make heart healthy
choices.
- Following a healthy lifestyle can help you
prevent or control many heart disease risk factors. A healthy lifestyle
includes following a healthy diet and maintaining a healthy weight, doing
physical activity regularly, quitting smoking, and managing stress.
- If lifestyle changes arent enough to
control your heart disease risk factors, your doctor may recommend medicines.
Medicines can help lower your cholesterol level, blood pressure, and blood
sugar level. Your doctor also may recommend medicines to prevent blood clots
and/or inflammation.
- On average, people who have a low risk for heart
disease live up to 10 years longer than people at high risk for heart disease.
Even if youre in your seventies or eighties, a healthy lifestyle can
reduce your risk of dying from heart disease by nearly two-thirds.
- Your doctor can help you find out whether you
have risk factors for heart disease. He or she also can help you create a plan
for lowering your risk for heart disease, heart attack, and other heart
problems.
- If you have children, talk to their doctor about
their heart health and whether they have heart disease risk factors.
Links to Other Information About Heart Disease Risk
Factors
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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