TowsonUniversitySt.

JosephMedicalCenter WellnessCenter

RiskFactorsforCoronaryHeartDisease
AHAScientificPosition Extensiveclinicalandstatisticalstudieshaveidentifiedseveralfactorsthatincreasetheriskofcoronaryheart diseaseandheartattack.Majorriskfactorsarethosethatresearchhasshownsignificantlyincreasetheriskof heartandbloodvessel(cardiovascular)disease.Otherfactorsareassociatedwithincreasedriskof cardiovasculardisease,buttheirsignificanceandprevalencehaven'tyetbeenpreciselydetermined.They're calledcontributingriskfactors. TheAmericanHeartAssociationhasidentifiedseveralriskfactors.Someofthemcanbemodified,treatedor controlled,andsomecan't.Themoreriskfactorsyouhave,thegreateryourchanceofdevelopingcoronary heartdisease.Also,thegreaterthelevelofeachriskfactor,thegreatertherisk.Forexample,apersonwitha totalcholesterolof300mg/dLhasagreaterriskthansomeonewithatotalcholesterolof245mg/dL,even thougheveryonewithatotalcholesterolgreaterthan240isconsideredhighrisk. Whatarethemajorriskfactorsthatcan'tbechanged?

IncreasingageOver83percentofpeoplewhodieofcoronaryheartdiseaseare65orolder.At olderages,womenwhohaveheartattacksaremorelikelythanmenaretodiefromthemwithinafew weeks. Malesex(gender)Menhaveagreaterriskofheartattackthanwomendo,andtheyhaveattacks earlierinlife.Evenaftermenopause,whenwomen'sdeathratefromheartdiseaseincreases,it'snotas greatasmen's. Heredity(includingRace)Childrenofparentswithheartdiseasearemorelikelytodevelopit themselves.AfricanAmericanshavemoreseverehighbloodpressurethanCaucasiansandahigher riskofheartdisease.HeartdiseaseriskisalsohigheramongMexicanAmericans,AmericanIndians, nativeHawaiiansandsomeAsianAmericans.Thisispartlyduetohigherratesofobesityanddiabetes. Mostpeoplewithastrongfamilyhistoryofheartdiseasehaveoneormoreotherriskfactors.Justas youcan'tcontrolyourage,sexandrace,youcan'tcontrolyourfamilyhistory.Therefore,it'sevenmore importanttotreatandcontrolanyotherriskfactorsyouhave.

Whatarethemajorriskfactorsyoucanmodify,treatorcontrolbychangingyourlifestyleortaking medicine?

TobaccosmokeSmokers'riskofdevelopingcoronaryheartdiseaseis24timesthatof nonsmokers.Cigarettesmokingisapowerfulindependentriskfactorforsuddencardiacdeathin patientswithcoronaryheartdiseasesmokershaveabouttwicetheriskofnonsmokers.Cigarette smokingalsoactswithotherriskfactorstogreatlyincreasetheriskforcoronaryheartdisease.People whosmokecigarsorpipesseemtohaveahigherriskofdeathfromcoronaryheartdisease(and

possiblystroke)buttheirriskisn'tasgreatascigarettesmokers'.Exposuretootherpeople'ssmoke increasestheriskofheartdiseaseevenfornonsmokers.

HighbloodcholesterolAsbloodcholesterolrises,sodoesriskofcoronaryheartdisease.When otherriskfactors(suchashighbloodpressureandtobaccosmoke)arepresent,thisriskincreases evenmore.Aperson'scholesterollevelisalsoaffectedbyage,sex,heredityanddiet. HighbloodpressureHighbloodpressureincreasestheheart'sworkload,causingtheheartto thickenandbecomestiffer.Italsoincreasesyourriskofstroke,heartattack,kidneyfailureand congestiveheartfailure.Whenhighbloodpressureexistswithobesity,smoking,highbloodcholesterol levelsordiabetes,theriskofheartattackorstrokeincreasesseveraltimes. PhysicalinactivityAninactivelifestyleisariskfactorforcoronaryheartdisease.Regular, moderatetovigorousphysicalactivityhelpspreventheartandbloodvesseldisease.Themore vigoroustheactivity,thegreateryourbenefits.However,evenmoderateintensityactivitieshelpifdone regularlyandlongterm.Exercisecanhelpcontrolbloodcholesterol,diabetesandobesity,aswellas helplowerbloodpressureinsomepeople. ObesityandoverweightPeoplewhohaveexcessbodyfatespeciallyifalotofitisatthewaist aremorelikelytodevelopheartdiseaseandstrokeeveniftheyhavenootherriskfactors.Excess weightincreasestheheart'swork.Italsoraisesbloodpressureandbloodcholesterolandtriglyceride evels,andlowersHDL("good")cholesterollevels.Itcanalsomakediabetesmorelikelytodevelop. Manyobeseandoverweightpeoplemayhavedifficultylosingweight.Butbylosingevenasfewas 10pounds,youcanloweryourheartdiseaserisk. DiabetesmellitusDiabetesseriouslyincreasesyourriskofdevelopingcardiovasculardisease. Evenwhenglucose(bloodsugar)levelsareundercontrol,diabetesincreasestheriskofheartdisease andstroke,buttherisksareevengreaterifbloodsugarisnotwellcontrolled.Aboutthreequartersof peoplewithdiabetesdieofsomeformofheartorbloodvesseldisease.Ifyouhavediabetes,it's extremelyimportanttoworkwithyourhealthcareprovidertomanageitandcontrolanyotherrisk factorsyoucan.

Whatotherfactorscontributetoheartdiseaserisk?

Individualresponsetostressmaybeacontributingfactor.Somescientistshavenotedarelationship betweencoronaryheartdiseaseriskandstressinaperson'slife,theirhealthbehaviorsand socioeconomicstatus.Thesefactorsmayaffectestablishedriskfactors.Forexample,peopleunder stressmayovereat,startsmokingorsmokemorethantheyotherwisewould.

Drinkingtoomuchalcoholcanraisebloodpressure,causeheartfailureandleadtostroke.Itcancontribute tohightriglycerides,cancerandotherdiseases,andproduceirregularheartbeats.Itcontributestoobesity, alcoholism,suicideandaccidents. Theriskofheartdiseaseinpeoplewhodrinkmoderateamountsofalcohol(anaverageofonedrinkfor womenortwodrinksformenperday)islowerthaninnondrinkers.Onedrinkisdefinedas11/2fluidounces (floz)of80proofspirits(suchasbourbon,Scotch,vodka,gin,etc.),1flozof100proofspirits,4flozofwine or12flozofbeer.It'snotrecommendedthatnondrinkersstartusingalcoholorthatdrinkersincreasethe amounttheydrink.