Heart Disease Risk Factors

What is cholesterol?

Cholesterol is a lipid, or fatlike substance, that travels through your blood and helps to form cell membranes and some hormones. The cholesterol that you need is produced naturally by your body. The problem starts when there is too much cholesterol in your body. This may come from food you eat, like meat or dairy products, that is rich in cholesterol. Or it is also possible that your body produces excess amounts of cholesterol or is unable to control cholesterol naturally. If you have too much cholesterol, it can stick to the walls of your arteries, keeping your blood from flowing freely. When this happens, the buildup is called plaque, and it can be a dangerous problem.

All cholesterol isn’t created equal!

Your total cholesterol is made up of three types of cholesterol – some good and some bad.

• High-density lipoprotein (HDL) is good cholesterol. It helps prevent cholesterol from building up in your arteries.
• Low–density lipoprotein (LDL) is bad cholesterol. Too much of it leads to a buildup of cholesterol in your arteries.
• Triglycerides are a type of fat that circulates in your blood but is stored as body fat.

You can find out your cholesterol levels with a simple blood test. You should aim for a low total cholesterol number, a high LDL, a low LDL, and low triglycerides; our Know Your Numbers chart provides specific guidelines.

High blood pressure raises your risk of a heart attack or a stroke. High blood pressure creates space on the blood vessel walls where cholesterol deposits can build up, eventually blocking the blood flow. Fortunately, you can control your blood pressure and improve your heart health by making smart choices about food, exercise, and medication.

Lowering your levels

Once your cholesterol has been tested and you know your numbers, you’ll know how cholesterol is affecting your personal heart health. If cholesterol is negatively affecting your heart, don’t panic. These common-sense strategies can help:

• Get screened. There are no signs or symptoms of high cholesterol, but you can find out your numbers with a simple blood test.
• Build your support system. It’s easier to make healthy changes when you can count on the support of the people in your life. Ask your friends and family for help as you work toward the goal of heart health.
• Choose heart healthy foods. Making better food choices, like cutting back on your saturated and trans-fats, is the best step you can take to lower your cholesterol.
• Lighten up. Extra weight increases your LDL (bad) cholesterol level. Losing even small amounts of weight loss can make a big difference to your cholesterol.
• Get moving. An inactive lifestyle tends to raise your cholesterol. Engaging in some type of physical activity on most days can lower your cholesterol levels.
• Relax. Many habits that are associated with stress, such as eating too much and not exercising enough, can raise your cholesterol. Reducing your stress can also reduce your cholesterol levels.
• Manage your medications. If you take medications, including over-the-counter drugs, be sure to take them as directed.

Remember, you don’t have to take all these steps at once! Adopting even a few can make a big difference.

What is blood pressure?

Blood pressure is the push made as your heart pumps blood through your body. It’s recorded as two numbers: your systolic pressure (the pressure as your heart contracts to push blood out) "over" your diastolic pressure (the pressure as your heart fills with blood). Both numbers are important, and as we grow older, systolic pressure becomes especially important.

High blood pressure, also called hypertension, happens when the pressure in your heart rises and stays high over time. 140/90 mmHg is considered the threshold for high blood pressure, which is dangerous because it:

• Makes your heart work too hard.
• Can lead to hardening of your arteries (atherosclerosis).
• Can cause other conditions, such as congestive heart failure, kidney disease, and blindness.

If your blood pressure is above normal (120/80 mmHg), but not considered high, then you may have prehypertension. This means that although you don't have high blood pressure now, you need to take action to prevent yourself from developing it later.

What can you do?

We often think of high blood pressure as a stress disease -- the result of overwork, lack of activity, and poor eating habits. The truth is, in most cases, experts don’t know what causes high blood pressure.

What they do know is that there is a lot you can do to keep your blood pressure under control and reduce your risk of heart disease. Taking these steps will also lower your risk of heart disease and lead you on the path to a healthier life. Remember, you don’t have to do them all at once. We will walk you through each step and break them down into smaller steps that are manageable for you.

• Get screened. If you don’t know if you have high blood pressure, it’s time to find out. High blood pressure is sometimes called the silent killer because most people don’t know that they have it, and it rarely causes symptoms. A quick, simple test can tell you for sure whether you’re at risk.
• Build your support system. It’s easier to make healthy changes when you can count on the support of the people in your life. Ask your friends and family for help as you work toward the goal of heart health.
• Choose heart healthy foods. The foods you choose affect your blood pressure, so making healthy meal and snack choices is a great way to start lowering your numbers.
• Lighten up. Losing even small amounts of weight loss can make a big difference to your heart.
• Get moving. Daily activity can help you keep your blood pressure under control. There are plenty of easy ways to incorporate physical activity into your day – and even making small changes can help lower your blood pressure.
• Manage your medications. If you take medications, including over-the-counter drugs, be sure to take them as directed.

A special note for women: If you are pregnant, or are taking oral contraceptives or hormone replacement therapy, you may experience a rise in your blood pressure so be sure to have it checked regularly. Pregnant women who have high blood pressure may be particularly at risk for certain problems.

People with diabetes are twice as likely as those without it to have a heart attack or stroke. In fact, heart disease is the leading cause of death for people with diabetes. Fortunately, by eating a healthy diet low in fat and sugar and staying active, you can control, delay, or even prevent diabetes.

What is diabetes?

Diabetes is a disease that prevents the body from properly using glucose, the sugar that gives our bodies their main source of energy. As we eat, most of our food is broken down into glucose. After we digest our food, this glucose enters our bloodstreams, and a hormone called insulin helps our bodies to put it to good use for growth and energy. However, the bodies of people with diabetes don’t have enough insulin or don’t use insulin properly. As a result, they have too much sugar in their blood and can develop serious health problems.

What’s the link between diabetes and heart disease?

Over time, high glucose levels, or high blood sugar, can cause a buildup of fatty materials on the blood vessel walls. This buildup may affect blood flow, leading to clogging, the hardening of blood vessels (atherosclerosis), and a greater possibility of a heart attack or stroke.

If you have diabetes, these problems in your blood vessel walls increase your chances of developing heart disease. A diagnosis of diabetes as an adult carries the same risk as already having one heart attack.

What types of diabetes are there?

There are three main types of diabetes:

• Type 1 diabetes is usually diagnosed in children and young adults. The onset, which happens when the body doesn’t produce insulin, is sudden. People with Type 1 diabetes must take insulin daily.
• Type 2 diabetes is the most common form of diabetes. In many cases, it can be prevented or delayed. Type 2 diabetes occurs when the body doesn’t properly use insulin, which is sometimes called insulin resistance.
• Gestational diabetes, which is similar to type 2 diabetes, usually occurs during late pregnancy. Although this form of diabetes often disappears after the birth of the baby, women who have had gestational diabetes are more likely to develop type 2 diabetes later in life.

When a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes, they have prediabetes. If you’ve been diagnosed with prediabetes, you’ve been warned: it’s time to make safe choices to protect your health.

What are the signs and symptoms?

A blood glucose test can determine if you have, or are at risk, for diabetes. (Our Know Your Numbers chart provides specific guidelines.) People often don’t realize they have Type 2 diabetes because many of its symptoms can seem harmless. Recognizing the symptoms and getting early treatment can reduce complications down the road.

Some diabetes symptoms include:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision
• Sores that do not heal

If you have any of these symptoms, see your doctor right away.

What can you do?

You can do a lot to lower your chances of getting diabetes or to control it if you already have it. Taking these steps will also lower your risk of heart disease and give you a longer, healthier life!

• Get screened. The first step to protecting yourself against diabetes is finding out whether your blood glucose level is high. If the test is high, talk with your doctor about getting a fasting glucose test. A simple screening could save your life!
• Build your support system. It’s easier to make healthy changes when you can count on the support of the people in your life. Ask your friends and family for help as you work toward the goal of heart health.
• Choose heart healthy foods. Paying attention to what you eat can help you lower your blood sugar levels. Limiting sugary drinks and starchy snacks is a great place to start.
• Lighten up. Losing weight can help you control, delay, or prevent diabetes.
• Get moving. An active lifestyle can help your body use insulin efficiently.
• Manage your medications. If you take medications, including over-the-counter drugs, be sure to take them as directed.

Remember, you don’t have to take all these steps at once! Adopting even a few can make a big difference.

Getting active doesn’t mean you have to take up running or join a gym. It starts with simply moving more during the day – by taking the stairs instead of the elevator, choosing a faraway parking spot, or walking to a coworker’s cubicle instead of picking up the phone to talk. Even small increases in activity can lower your risk of heart disease enormously and help you feel better physically, emotionally, and mentally. You may experience less stress, be less likely to overeat, and feel calmer and happier. If that isn’t enough, think of the good example you’ll be setting for your family and friends!

How does physical activity help your heart?

Physical activity helps to control many of the risk factors for heart disease: cholesterol, diabetes, obesity, blood pressure and stress. So it isn’t surprising to find that 35 percent of deaths from heart disease could be avoided through increased activity. In fact, the cardiac risk of being inactive is comparable to the risk from smoking cigarettes.

How much is enough?

Ideally, everyone should engage in some physical activity for 30 minutes on most days of the week. Since that’s not always practical, it’s important to recognize that every incremental increase in physical activity yields some health benefit. Plus, small steps can easily lead to bigger ones!

What can you do to increase your level of physical activity?

• Get moving. Find an activity that you enjoy and make it convenient to your lifestyle.
• Build your support system. Finding an exercise partner is a wonderful way to get moving, have fun, and spend quality time with a friend. Ask your friends and family to join you as you work toward the goal of heart health.
• Eat heart healthy foods. Foods that fuel your body make it easier to move.

What do overweight and obesity mean?

Your healthy weight is based on your height, age, and other factors. Excess weight may come from muscle, bone, fat, or body water. Overweight means you weigh more than you should to be healthy. Obesity refers specifically to having too much body fat.

A higher weight or too much body fat increases your chances of developing high blood pressure, diabetes, and high cholesterol—all of which are risk factors for heart disease. In addition, excess body fat—especially abdominal fat—may produce substances that cause inflammation, which may raise heart disease risk. Obesity can also lead to congestive heart failure, a condition in which the heart can’t pump enough blood to meet your body’s needs.

What causes overweight and obesity?

Many factors can affect your weight, including:

• Eating more than your body needs to function healthfully.
• Lack of physical activity.
• Environment, including a stressful work schedule, lack of access to healthy foods, and lack of access to appropriate spaces for physical activity
• Family history and genetics.
• Health conditions, such as an underactive thyroid, and certain medicines.
• Advancing age.
• Lack of sleep.
• Emotional factors, such as eating when you are bored, happy, depressed, or upset.

How healthy is your weight?

The most commonly used method of determining if your weight is considered healthy is the body mass index (BMI), which is an index of weight adjusted for your height.

A BMI of 25.0 to 29.9 is considered overweight. A BMI of 30.0 or greater is considered obese. If your BMI is above 25, follow up with your doctor to evaluate your weight status and associated health risks.

Another factor in determining a healthy weight is your waist circumference. Fat deposits, especially around the abdomen, are an important independent risk factor for developing coronary artery disease. The ideal waist circumference is less than 40 inches for men, and less than 35 inches for women.

You can measure your waist easily by wrapping a non-elastic measuring tape around your waist (above your belly button). Make sure that the tape is snug, does not squeeze your skin, and is parallel to the floor.

How can weight be controlled?

Many factors can cause you to be overweight or obese. Fortunately, you can do a lot to get your weight under control. Taking these steps will also lower your risk of heart disease and lead you on the path to a healthier life.

Remember, you don’t have to do everything at once! Even small changes can make a big difference to your heart.

• Know your numbers. Comparing your Body Mass Index and waist circumference to a healthy range will help you discover whether you need to lose weight or don’t want to gain any more.
• Eat heart healthy foods. Your food choices influence your weight. Eating lots of fruits and vegetables and paying attention to portions can have a big impact, so
• Get moving. Physical activity can help keep your weight under control and your heart strong.
• Manage your medications. If you take medications, including over-the-counter drugs, they can affect your weight. Be sure to take them as directed.
• Relax. Controlling your stress supports healthy eating and exercise habits.
• Build a support system. Losing weight is easier when you do it with a partner. Find a family member or friend who also wants to reach a healthier weight and tackle it together. If you prefer to lose weight alone, it’s still important to engage your family and friends in supporting your changes.

Smoking is one of the biggest risk factors for a heart attack. It also puts you at risk for lung cancer, increases your chance of a stroke, and leads to coughing and shortness of breath. Furthermore, smoking affects the health of those around you – including your family.

The good news is that it’s never too late to quit. If you stop smoking, you’ll improve your health and reduce your long-term risks – and you’ll see immediate benefits, some within just a few hours!

Quitworks is a great resource for quitting smoking, which is a free, evidence-based stop-smoking service developed by the Massachusetts Department of Public Health in collaboration with all major health plans in Massachusetts. For more information on Quitworks, please visit their website by clicking here.

How does smoking affect your heart?

The more cigarettes you smoke, the higher your risk of a heart attack. When you smoke:

• Your heart beats faster.
• Your blood pressure rises.
• Your blood flow is reduced.
• More carbon monoxide is carried in your blood.
• Your vital organs and tissues receive less oxygen.

Smoking can also aggravate other heart disease risk factors by:

• raising your blood pressure
• reducing your HDL (good) cholesterol
• lessening your ability to exercise
• increasing blood clotting

Special note for women: Smoking can have additional negative effects on women who use oral contraceptives, giving them a higher risk of heart disease and strokes.

What about secondhand smoke?

Smoking isn’t just bad for you; it’s bad for the people around you. There is a clear link between secondhand smoke and heart disease. Smoking around your children can have especially severe health consequences. Children of smokers tend to have more lung illnesses, including pneumonia and bronchitis; may develop asthma; and are more likely to develop chest illnesses.

Could it be too late to stop smoking?

It’s never too late to stop smoking! Your health risks start decreasing quickly after you stop smoking, and they continue dropping over time. You’ll see big benefits after you quit, no matter how long you’ve been smoking – even if you’ve already developed some smoking-related problems.

Need more reasons to be a quitter?

Look at the health improvements you can expect within the first year:

• 20 minutes after quitting: Your blood pressure and heart rate will drop.
• 12 hours after quitting: The carbon monoxide level in your blood will return to normal.
• 2 weeks to 3 months after quitting: Your circulation and lung function will improve.
• 1 to 9 months after quitting: You’ll cough less and you’ll have less shortness of breath. Your lungs will be more able to handle mucus, clean themselves, and reduce your risk of infection.
• 1 year after quitting: Your excess risk of heart disease will be half that of a smoker.

And the benefits don’t stop there! Within several years your stroke and heart disease risk can equal that of a non-smoker’s and your risk of cancer will be dramatically reduced as well.

You’ll also see immediate benefits in your everyday life:

• Your breath will smell better.
• Your teeth will get whiter.
• Your clothes and hair will stop smelling of cigarette smoke.
• Your yellow fingers and fingernails will disappear.
• Your senses of smell and taste will improve.
• Everyday activities – like climbing stairs or doing light housework – won’t leave you out of breath.

There’s one more important benefit to stopping smoking: You’ll save money! Smoking is expensive. When you stop buying cigarettes, the payoff is big.

What is stress?

Stress is the mental tension and physical condition caused by the way we react to physical, chemical, emotional or environmental factors. Everyone feels stress, but in different ways and in different amounts.

Stress can lead to overeating, becoming inactive, drinking alcohol, or smoking. All these behaviors are directly related to risk factors for heart disease.

What are the benefits of managing stress?

You will find that as you manage your stress, you will:

• Sleep better
• Control your weight.
• Lessen neck and back pain.
• Get along better with family and friends.
• Concentrate better.
• Feel happier.

How can you tell if you’re under stress?

This checklist of stress symptoms can help you determine whether you’re under stress.

• Feeling of being overwhelmed.
• Difficulty concentrating.
• Feeling short-tempered.
• Exhaustion.
• Loss of appetite or increased appetite.
• Headaches.
• Sleep problems.
• Depression and anxiety.

How can you recognize what causes your stress?

If you know what situations make you feel stressed, it may be possible for you to make changes to reduce that stress – for example, by avoiding situations or people that put too much pressure on you. Below is a list of common stress sources. How many apply to you?

• Money, personal financial problems.
• Relationships.
• Family responsibilities.
• Health problems affecting you.
• Health problems affecting a member of your family.
• Work pressures or job security.

What else can you do to reduce stress?

As you work on reducing your stress, be sure to stay in tune with the rest of your body and stay heart healthy!

• Get screened. Find out what heart disease risk factors you may have and learn how you can control them.
• Build your support system. Being connected to other people helps to manage stress. Surround yourself with people who help to lift your spirits and keep you positively focused.
• Eat heart healthy foods. Knowing that stress can lead to poor eating habits can motivate you to stay on top of your diet by planning healthy meals and snacks. This won’t just help reduce your physical reaction to stress – it will also help your heart!
• Get moving. Activity is a wonderful way to get rid of some of your physical tension. Find something that makes you smile and have some fun!
• Stop smoking. Smoking may seem like a way to relieve stress, but in reality, you’re only adding more stress to your body, especially your heart.

It's no secret that heart disease can run in families. In fact, your family’s health history may be one of the strongest influences on your risk of developing heart disease.

You have a higher risk of heart disease if you have a family history of “early heart disease.” That is, a father or brother who had heart disease before age 55 or a mother or sister who had heart disease before age 65.

While you can’t change your genes, you can change many behaviors that affect them. Therefore, you need to understand the risk factors that impacted your family. Did your father have high cholesterol? Did you mother have high blood pressure? Knowing this information can help you take action to protect your body against its genetic tendencies.

That’s why it’s important to record your family’s health history. To make sure you’re fully aware of any health risks that run in your family, it’s wise to gather a written family health history.

Start by interviewing your parents and siblings. The health histories of other close blood relatives can also hold important clues, so be sure to include your children, aunts, uncles, and grandparents, too. Just follow these simple steps:

• Make a list of all blood relatives you wish to include in your family history.
• Pick a time and place to talk, one on one. If it’s not possible to talk to your relatives in person, you can also talk with them over the telephone, or send them questions by mail or e-mail. Ask other relatives to fill in the gaps about family members you cannot contact or who are deceased.
• Ask if they've had or currently have any of the following health conditions and write down the answers:
  • heart disease
  • high cholesterol
  • high blood pressure
  • diabetes
  • smoker
  • overweight
• Record important dates, too. Date like when a heart attack occurred, how long a person was a smoker, or when diabetes was diagnosed.
• Ask about your ancestry. Some heart disease risk factors are higher for certain ethnicities.
• Review your findings with your doctor. Your doctor can assess your health risks and recommend lifestyle changes.
• Keep your family history up to date. The information will not only help you, but your children will want access to it at some point, too.

What else can you do to keep history from repeating itself?

Having a family history of heart disease doesn’t mean you will get it. Your lifestyle and health habits give you a lot of control. These are smart steps to follow:

• Reduce other risk factors. You can’t change your family history, but you can do things to keep your overall heart disease risk as low as possible.
• Get regular screening tests for conditions such as blood pressure, cholesterol, and diabetes. By getting screened, you can monitor your health and detect any other risk factors you may have.
• Make heart-healthy lifestyle changes, one step at a time!

As men and women get older, their risk for heart disease increases. However, while you cannot control your age, you can control other factors that put you at increased risk for heart disease.