Cardiovascular disease includes a number of conditions affecting the structures or function of the heart, including coronary artery disease and vascular (blood vessel) disease. Cardiovascular disease is by far the leading cause of death in the United States.
Coronary artery disease (narrowing of the arteries supplying blood to the heart) causes about one million heart attacks each year. Even more worrisome, 220,000 people with heart attacks will die before even reaching the hospital.
Research about cardiovascular disease risk factors suggests that making even small lifestyle changes can reduce the risk of coronary artery disease, heart attack, stroke and other serious cardiovascular conditions.
Are You at Risk?
Risk factors are certain conditions that increase a person’s risk for cardiovascular disease. Nonmodifiable risk factors are risk factors that cannot be changed, while modifiable risk factors CAN be modified, controlled, or treated.
The more risk factors you have, the greater your chance of developing cardiovascular disease. In addition, higher levels of each risk factor mean there is a higher risk for developing cardiovascular disease.
Nonmodifiable risk factors
- Increasing age. Cardiovascular disease is more likely to occur as you get older. About 85 percent of people who die of coronary artery disease are age 65 or older.
- Male gender. Men have a greater risk of heart attack than women.
- Menopause. After menopause, a woman’s risk of cardiovascular disease increases.
- Family history. Your risk of cardiovascular disease increases if your parents, brothers, sisters, or children have the disease, especially if male relatives were less than age 55 when diagnosed, or female relatives were less than age 65 when diagnosed.
- Race. The risk of cardiovascular disease is higher in African Americans, Mexican Americans, American Indians, native Hawaiians, and some Asian Americans. This increased risk is partly due to higher rates of high blood pressure, obesity, and diabetes in these populations.
Since you can’t change any of these risk factors, it is important to focus on the risk factors you CAN change.
Risk Factor Goals
You, along with support from your family and friends, can work to achieve the following goals to reduce your risk of cardiovascular disease. If you already have cardiovascular disease, you can follow these guidelines to help prevent its progression.
Smoking is the most preventable risk factor for cardiovascular disease and stroke. Smokers (including cigarette, pipe, and cigar smokers) have more than twice the risk of a heart attack than nonsmokers. Smoking is also the biggest risk factor for sudden cardiac death. Even one to two cigarettes a day greatly increases the risk of heart attack, stroke, and other cardio-vascular conditions. Nonsmokers who are exposed to constant smoke also have an increased risk.
- Eliminate the use of all tobacco products. Stay away from others’ smoke.
Lower your total cholesterol, LDL (bad) cholesterol, and triglyceride levels
Excessive lipids (fatty substances including cholesterol and triglycerides), especially in the form of LDL cholesterol, cause the build-up of fatty deposits within your arteries, reducing or blocking the flow of blood and oxygen to your heart. There’s a sharp increase in the risk for cardiovascular disease when total cholesterol levels are 240 mg/dl and above.
- Total cholesterol less than 200 mg/dl.
- LDL cholesterol should be less than 70 mg/dl for those with heart or blood vessel disease.
- LDL should be less than 100 mg/dl for those who have a high risk of cardiovascular disease, such as some patients with diabetes or those who have multiple heart disease risk factors.
- For all others, LDL cholesterol should be less than 130 mg/dl.
- Triglycerides less than 150 mg/dl.
For most patients, it is recommended to have your cholesterol level checked as early as age 20. The cholesterol profile includes an evaluation of fasting total cholesterol, HDL, LDL, and triglyceride levels. Your health care provider can tell you how often to have your cholesterol tested.
Raise your HDL (good) cholesterol
HDL cholesterol takes the LDL (bad) cholesterol away from the arteries and back to the liver where it can be passed out of the body. High levels of HDL seem to protect against cardiovascular disease.
Low HDL: less than 40 mg/dl
- Greater than 55 mg/dl for women, greater than 45 mg/dl for men; the higher the HDL level, the better.
Lower high blood pressure
Blood pressure is a measurement of the pressure or force inside the arteries with each heartbeat. High blood pressure increases the workload of the heart and kidneys, increasing the risk of heart attack, heart failure, stroke, and kidney disease. High blood pressure is the biggest risk factor for stroke.
- Ideal blood pressure is less than 120/80. For patients with diabetes and established cardiovascular disease, blood pressure should be less than 130/85.
- Control blood pressure through diet (low-salt diet), exercise, weight management, and if needed, medications.
- Also limit alcohol, as it can increase blood pressure.
Diabetes occurs when the body is unable to produce insulin or use the insulin it has. This results in elevated blood sugar levels. People with diabetes (especially women) have a higher risk of cardiovascular disease because diabetes increases other risk factors, such as high cholesterol, LDL, and triglycerides; lower HDL; and high blood pressure. Keeping diabetes under control is essential in reducing your risk.
- Hemoglobin A1c test less than 6.5 if you have diabetes.
- Hemoglobin A1c less than 5.7 if you do not have diabetes.
- Follow up with your doctor on a regular basis.
Maintain a healthy body weight
The more you weigh, the harder your heart has to work to give your body nutrients. Research has shown that being overweight contributes to the onset of diabetes and cardiovascular disease. Excess weight also raises blood cholesterol, triglycerides, and blood pressure, lowers HDL cholesterol, and increases the risk of diabetes.
How a person’s weight is distributed also is important. People who carry their weight in the middle have a greater risk of developing cardiovascular disease, compared to people who carry their weight in their arms and legs. Waist measurements are one way to determine fat distribution. For men, waist circumference should be less than 40 inches. For women, waist circumference should be less than 35 inches.
Weight is best determined by calculating Body Mass Index (BMI). BMI is a figure calculated from your height and weight. Doctors often use BMI as an objective indicator of whether a person is overweight, underweight, or at a healthy weight, and it is recommended by the National Institutes of Health for this purpose.
To calculate your BMI, use this BMI calculator or divide weight in kilograms (kg) by height in meters squared (m<sup>2</sup>). Metric conversions are: pounds divided by 2.2 = kg; inches multiplied by 0.0254 = meters.
For example, a woman who weighs 140 pounds and is 5 feet, 6 inches tall has a BMI of 23.
140 lbs divided by 2.2 = 64 kg
5’6" = 66" x 0.0254 = 1.68
1.682 = 2.82
64 divided by 2.82 = 22.69
Your health care provider can help you calculate your BMI.
- A normal BMI ranges from 18.5 to 24.9 kg/m<sup>2</sup>. Overweight is defined as having a BMI higher than 25. A BMI higher than 30 is considered obese.
- For men, waist measurement should be less than 40 inches.
- For women, waist measurement should be less than 35 inches.
- Achieve and maintain a healthy weight. A diet and exercise program will help you reach your goal weight.
The heart is like any other muscle -- it needs a workout to stay strong and healthy. Exercising helps improve how well the heart pumps blood through your body. Activity and exercise also help reduce so many other risk factors: You can lower blood pressure, lower high cholesterol, reduce stress, achieve and maintain a healthy body weight, help yourself quit smoking, and improve your blood sugar levels.
- Moderate exercise 30 minutes a day, on most days. More vigorous activities are associated with more benefits. Exercise should be aerobic, involving the large muscle groups. Aerobic activities include brisk walking, cycling, swimming, jumping rope, and jogging.
- If walking is your exercise of choice, use the pedometer goal of 10,000 steps a day.
- Consult your doctor before starting any exercise program.
Follow a heart-healthy diet
The old saying "You are what you eat," may be truer than ever - especially when it comes to cardiovascular disease. Four risk factors are related to diet: high blood pressure, high blood cholesterol, diabetes, and obesity.
- Eat foods low in sodium, saturated fat, cholesterol, trans fat (partially hydrogenated fats), and refined sugar.
- Omega-3 fatty acids are good fats and come from tuna, salmon, flaxseed, almonds, and walnuts.
- Mono-unsaturated fats also are preferred and are found in olive, canola and peanut oils.
- Also eat plant-based foods such as fruit and vegetables, nuts, and whole grains.
Contributing Risk Factors
Individual response to stress:
Although stress is not considered a traditional risk factor, some researchers have noted a relationship between cardiovascular disease risk and stress in a person’s life, their health behaviors, and socioeconomic status. Stress may affect established risk factors.
Learn to manage stress by practicing relaxation techniques, learning how to manage your time, setting realistic goals, and trying some new relaxation techniques such as guided imagery, massage, Tai Chi, meditation, or yoga.
Drinking too much alcohol:
Drinking too much alcohol can lead to increased blood pressure, heart failure, and stroke. It is also linked to high triglycerides, irregular heartbeats, obesity, and cancer. Research has shown that those who drink one drink per day (4 oz. of wine, 12 oz. of beer, or 1-1/2 oz. of 80-proof spirits) may have less risk. However, the American Heart Association does not recommend that non-drinkers start using alcohol or that drinkers increase the amount they drink.
If you have a family history of cardiovascular disease or high cholesterol, it is even more important to decrease your other risk factors. Get your cholesterol levels tested every year. Know your numbers, including blood pressure, BMI, waist circumference, and hemoglobin A1c. Make sure you follow up with your health care provider every year for a checkup.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.