Extensive clinical and statistical studies have identified several factors that increase the risk of heart attack and stroke. These risk factors can be grouped into two classifications:

1) major risk factors and

2) contributing risk factors.


Major risk factors are those that medical research has shown to be definitely associated with a significant increase in the risk of heart and blood vessel (cardiovascular) disease.

Contributing risk factors are those associated with increased risk of cardiovascular disease, but their significance and prevalence haven’t yet been precisely determined.


Some risk factors can be changed, treated or modified, and some cannot. But the more risk factors a person has, the greater the chance that he or she will develop heart disease.

What are the major risk factors you can’t change?


  • Increasing age: About four out of five people who die of coronary heart disease are age 65 or older. At older ages, women who have heart attacks are twice as likely as men are to die from them within a few weeks.


  • Gender: Men have a greater risk of heart attack than women, and they have attacks earlier in life. Even after menopause, when women’s death rate from heart disease increases, it’s not as great as men’s.


  • Heredity (including race): Children of parents with heart disease are more likely to develop it themselves. African Americans have among the highest rates of hypertension in the world. Consequently, their risk of heart disease is greater.


What are the major risk factors you can change, treat or modify?

  • Cigarette and tobacco use: Cigarette smoking and tobacco use is the single most preventable cause of premature death in the United States. It worsens atherosclerosis and speeds its growth in blood vessels throughout the body. Smokers’ risk of heart attack is 2-4 times that of nonsmokers. Cigarette smoking is the biggest risk factor for sudden cardiac death: smokers have twice the risk of nonsmokers. Second-hand smoke increases the risk of heart disease even in nonsmokers. The health benefits of quitting smoking start almost immediately. Within a few years, a former smokers’ risk of heart disease and stroke is similar to that of a nonsmoker.


  • High blood cholesterol levels: Cholesterol is a soft, waxy, fat-like substance found in the blood and cells of the body. It is used to make cell membranes and some hormones. It is also used in other bodily processes. Cholesterol does not dissolve in the blood. It travels through the blood attached to substances called lipoproteins. Low Density Lipoprotein, LDL, is known as “bad” cholesterol. LDL carries most of the cholesterol in the blood. Too much LDL causes most of the buildup of cholesterol in the arteries creating blockages over time. High Density Lipoprotein, HDL, is known as “good” cholesterol. HDL carries cholesterol to the liver where it can be removed from the body. Triglycerides are the most common form of fat in the body that is mainly stored in fat tissue. They are also a major source of energy that is both made by the body and is found in food.



Too much cholesterol in your blood can lead to heart disease and stroke. The risk of coronary heart disease rises as blood cholesterol levels increase. When other risk factors (such as high blood pressure and cigarette smoke) are present, this risk increases even more. 75% of the blood’s cholesterol is made in the liver each day. A person’s cholesterol level is also affected by age, sex, heredity and diet. There are no symptoms associated with high cholesterol. The only way to know your cholesterol levels is to get it checked!


Cholesterol Goals

Total cholesterol: Under 200 mg/dL                            LDL: Less than 100 mg/dL

HDL: Above 40 mg/dL (men) 50 mg/dL (women)       Triglycerides: Less than 150 mg/dL


  • High blood pressure: This means that the pressure within your blood vessels is elevated. Blood pressure is the pressure blood exerts against blood vessel walls. Systolic pressure, the top number, is the force of blood pushing against the vessel walls when your heart contracts to push blood out to the rest of your body. Diastolic pressure, the bottom number, is the force of blood pushing against the vessel walls when your heart is relaxing between heart beats.


High blood pressure is diagnosed when the pressure stays above 140/90 over time. High blood pressure increases the heart’s workload, causing the heart to enlarge and weaken over time. It also increases the risk of stroke, heart attack, kidney failure and congestive heart failure. The cause of high blood pressure is unknown 90-95% of the time. It is known as the “silent killer” because there are no symptoms. When high blood pressure exists with obesity, smoking, high cholesterol or diabetes, the risk of heart attack or stroke increases several times.


Pre-Hypertension is considered 120-139/80-89 mm Hg. Optimal blood pressure is below 120/80 mm Hg.


  • Physical inactivity: Lack of physical activity is a risk factor for coronary heart disease. Regular, moderate-to-vigorous exercise plays a significant role in preventing heart and blood vessel disease. Even moderate-intensity physical activity is beneficial if done regularly and long term. Exercise can help control blood cholesterol, diabetes and obesity as well as help to lower blood pressure in some people. It is important to exercise for a minimum of 30 minutes a day, 5 or more days a week at a moderate intensity.


  • Obesity and overweight: People who have excess body fat, especially around the waist, are more likely to develop heart disease and stroke even if they have no other risk factors. Obesity is unhealthy because excess weight increases the strain on the heart. It’s directly linked with coronary heart disease because it influences blood pressure, blood cholesterol and triglyceride levels, and makes diabetes more likely to develop.


Waist circumference is one way to estimate body fat. A high risk waistline is 35 inches or greater for women and 40 inches or greater for men.


Many obese and overweight people may have difficulty losing weight. A weight loss of even 10 to 20 pounds can help lower the risk of heart disease.


  • Diabetes mellitus: People who are diabetic either do not produce enough insulin or their bodies do not use insulin properly or both. This causes glucose, or sugar, to build up in the body. Insulin is a hormone that changes sugar and other food into glucose that is used for energy and delivers it to cells in the body.


Diabetes seriously increases the risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes seriously increases the risk of heart disease and stroke. 2/3 of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it is critically important for you to monitor and control any other risk factors you can.

What other factors contribute to heart disease risk?

Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and a person’s life stress, behavior habits and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.


Drinking too much alcohol can raise blood pressure, cause heart failure and lead to stroke. It can contribute to high triglycerides, cancer and other diseases, and produce irregular heartbeats. It contributes to obesity, alcoholism, suicide and accidents. The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women or two drinks for men per day) is lower than in nondrinkers. One drink is defined as 1-1/2 fluid ounces (fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-proof spirits, 4 fl oz of wine or 12 fl oz of beer. It’s not recommended that nondrinkers start using alcohol or that drinkers increase the amount they drink.


What can I do to reduce my risk of further heart problems?


  • Stop using tobacco products if you currently smoke or dip.
  • Take your medications as prescribed by your doctor.
  • Follow a low fat, low cholesterol and low salt diet.
  • Exercise for a minimum of 30 minutes most days of the week at a moderate intensity.
  • If you are overweight, a weight loss of even 10-20 pounds can reduce your risk of further heart problems.
  • If you are diabetic, keep your blood sugar under control by following a diabetic diet, taking any medications as prescribed by your doctor and exercise regularly.
  • Follow up with your doctor at regular intervals.
  • Limit your alcohol intake to 1 drink a day or less.
  • Practice relaxation techniques to reduce stress.