by Brian P. Randall, MD and Marjorie Montemayor-Quellenberg, MA
Heart disease is the leading cause of death in the US. Although there are different types of heart disease, coronary artery disease (CAD) is the most common. CAD occurs when vessels that supply blood to the heart muscle become narrow. This narrowing happens when fats, cholesterol, and calcium build up on the vessel walls. As the build-up thickens, the vessels become narrower, making it difficult for blood to flow to the heart muscle. This can lead to a heart attack, heart failure, or even death.
Cholesterol receives a lot of attention for being a risk factor for CAD. You may think that if you lower your cholesterol numbers, you will reduce your overall heart disease risk. But focusing on your cholesterol numbers is only a small part of achieving the real goal—lowering your risk of CAD. Beyond the numbers, there are other risk factors that you need to be aware of.
There are 2 main types of risk factors for heart disease. There are those that you can change (modifiable) and those that you cannot change (non-modifiable). For example, age is a non-modifiable risk factor. Being older puts you at greater risk for developing CAD, but you cannot prevent aging. Smoking also puts you at higher risk for developing heart disease. But this risk factor is modifiable because you can quit smoking and lower your risk. Here are more examples of the types:
Since it is not always possible to see heart disease developing, measuring cholesterol levels is a way for you and your doctor to get an idea of whether heart disease is more likely. But keep in mind that maintaining or achieving ideal cholesterol levels does not mean that you no longer have to worry about a heart attack, stroke, or heart disease. For instance, a 65-year-old man who is overweight, smokes, and has a family history of heart disease is still at risk of having a heart attack, even if his cholesterol levels are ideal.
The great thing about working on all of your modifiable risk factors is that many are connected. For example, if you are physically active, not only does the activity lower your risk for heart disease, but it can also lower your weight, cholesterol, and blood pressure.
Here are some things you can do to lower your risk of heart disease:
Aim for at least 2 hours and 30 minutes of moderate aerobic exercise each week. Some good choices include walking, cycling, jogging, and swimming. Add in some strength training for your major muscle groups at least 2 days a week.
Try to include plenty of fruits and vegetables, nuts, and whole grains in your diet. A healthy diet should include foods that are low in saturated fat, cholesterol, trans fat, sugar, and salt. Also, limiting your total calories to a reasonable amount is important.
Everyone’s body is different. A healthy weight for one person may not be healthy for another person. One thing is certain: too much weight can increase your risk of heart disease. Eating healthy and exercising can remove obesity as a risk factor.
Do not smoke. If you do smoke, talk to your doctor about ways to quit. Smoking is one of the biggest risk factors for heart disease. Quitting smoking has immediate and long-term benefits.
Non-smokers should also avoid second-hand smoke.
Limit your alcohol intake to a moderate level. This means two or fewer drinks per day for men and one or fewer drinks for women. One drink equals a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5 ounces of liquor.
If you have high cholesterol, do not just try to lower the number. Instead, focus on lowering your risk for heart disease. Exercise raises your HDL (good) cholesterol level. Decreasing your intake of saturated fat lowers your LDL (bad) cholesterol. Changes in both numbers helps make you healthier overall.
Medication may be needed for some people. Statins are one type of drug that not only lower cholesterol, but also lower heart disease risk in some people. Statins should be used along with healthy lifestyle habits. If you are prescribed a statin and your cholesterol numbers improve, this does not mean that you should be sedentary and eat whatever you want. You will still need to focus on other modifiable risk factors.
If you have high blood pressure, work to get it under control. Eating a healthful diet, exercising, and not drinking alcohol are just some ways to help control your blood pressure. Some people will also need to take medication.
If you have diabetes, it is important to keep it under control. Eating well, exercising, and taking medication can help with this. If you do not have diabetes, maintaining a healthy weight will help lower your chance of developing diabetes.
Decreasing your risk for heart disease means more than just achieving normal cholesterol levels—it means addressing all modifiable risk factors. Practicing a healthy lifestyle is key to reducing many of the risk factors for heart disease. Work with your doctor or registered dietitian to develop a plan that is right for you. This will ensure that you are doing all you can to keep your heart healthy.
American Heart Association
National Heart, Lung, and Blood Institute
Canadian Cardiovascular Society
Heart & Stroke Foundation of Canada
Cardiovascular disease prevention overview. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116873/Cardiovascular-disease-prevention-overview. Updated January 21, 2018. Accessed May 2, 2018.
Coronary artery disease (CAD). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116156/Coronary-artery-disease-CAD. Updated January 21, 2018. Accessed May 2, 2018.
Coronary artery disease major risk factors. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T474255/Coronary-artery-disease-major-risk-factors. Updated January 21, 2018. Accessed May 2, 2018.
Dietary guidelines for Americans 2015-2020. Office of Disease Prevention and Health Promotion website. Available at: https://health.gov/dietaryguidelines/2015/guidelines. Accessed May 2, 2018.
Explore high blood cholesterol. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/hbc. Accessed May 2, 2018.
Heart disease. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/heartdisease. Accessed May 2, 2018.
How does smoking affect the heart and blood vessels? National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/smo. Accessed May 2, 2018.
Physical activity basics. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/physicalactivity/basics/index.htm. Accessed May 2, 2018.
Last reviewed April 2018 by Michael Woods, MD, FAAP
Last Updated: 5/2/2018