Understanding the terms of risk
Extensive clinical and statistical studies have identified several factors that increase the risk of coronary heart disease and heart attack. View an animation of a heart attack.
- Major risk factors are those that research has shown significantly increase the risk of heart and blood vessel (cardiovascular) disease.
- Contributing risk factors
Other factors are associated with increased risk of cardiovascular disease, but their significance and prevalence haven't yet been precisely determined. - Modifiable risk factors
The American Heart Association has identified several risk factors. Some of them can be modified, treated or controlled, and some can't. - Risk calculations
The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the greater the risk. For example, a person with a total cholesterol of 300 mg/dL has a greater risk than someone with a total cholesterol of 245 mg/dL, even though everyone with a total cholesterol greater than 240 is considered high-risk.
Assess your risk of having a heart attack or dying from coronary heart disease in the next 10 years with the Heart Attack Risk Calculator.
Risk Factors and Coronary Heart Disease
Extensive clinical and statistical studies have identified several factors
| Extensive clinical and statistical studies have identified several factors that increase the risk of coronary heart disease and heart attack. Major risk factors are those that research has shown significantly increase the risk of heart and blood vessel (cardiovascular) disease. Contributing risk factors are associated with increased risk of cardiovascular disease, but their significance and prevalence haven't yet been precisely determined. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the more that factor affects your overall risk. |
| Extensive clinical and statistical studies have identified several factors that increase the risk of coronary heart disease and heart attack. Major risk factors are those that research has shown significantly increase the risk of heart and blood vessel (cardiovascular) disease. Contributing risk factors are associated with increased risk of cardiovascular disease, but their significance and prevalence haven't yet been precisely determined. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the more that factor affects your overall risk. |
Major risk factors that can't be changed
Increasing Age
About 82 percent of people who die of coronary heart disease are 65 or older. At older ages, women who have heart attacks are more likely than men are to die from them within a few weeks.
Male Sex (Gender)
Men have a greater risk of heart attack than women do, 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 more severe high blood pressure than Caucasians and a higher risk of heart disease. Heart disease risk is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes. Most people with a strong family history of heart disease have one or more other risk factors. Just as you can't control your age, sex and race, you can't control your family history. Therefore, it's even more important to treat and control any other risk factors you have.
Major risk factors you can modify, treat or control by changing your lifestyle or taking medicine
Smokers' risk of developing coronary heart disease is 2-4 times that of nonsmokers. People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than people who’ve never smoked. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke) but their risk isn't as great as cigarette smokers'. Exposure to other people's smoke increases the risk of heart disease even for nonsmokers.
Learn about smoking and cardiovascular disease
Visit our Quitting Smoking area for plans, tips and tools to help you quit
High blood cholesterol
As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet. Here's the lowdown on where those numbers need to be:
- Total Cholesterol: Less than 180 mg/dL
- Low-density-lipotrotein (LDL) cholesterol = "bad" cholesterol
A low LDL cholesterol level is considered good for your heart health. However, your LDL number should no longer be the main factor in guiding treatment to prevent heart attack and stroke, according to the latest guidelines from the American Heart Association. For patients taking statins, the guidelines say they no longer need to get LDL cholesterol levels down to a specific target number. A diet high in saturated and trans fats raises LDL cholesterol. - High-density-lipoprotein (HDL) cholesterol = "good" cholesterol
With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol puts you at higher risk for heart disease. People with high blood triglycerides usually also have lower HDL cholesterol. Genetic factors, type 2 diabetes, and certain drugs, such as beta-blockers and anabolic steroids, also lower HDL cholesterol levels. Smoking, being overweight and being sedentary can all result in lower HDL cholesterol. - Triglycerides
Triglyceride is the most common type of fat in the body. Normal triglyceride levels vary by age and sex. A high triglyceride level combined with low HDL cholesterol or high LDL cholesterol is associated with atherosclerosis, the buildup of fatty deposits in artery walls that increases the risk for heart attack and stroke.
High blood pressure
High blood pressure increases the heart's workload, causing the heart muscle to thicken and become stiffer. This stiffening of the heart muscle is not normal, and causes the heart not to work properly. It also increases your risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times.
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Take our Blood Pressure Risk Assessment
Physical inactivity
An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate-to-vigorous physical activity helps prevent heart and blood vessel disease. The more vigorous the activity, the greater your benefits. However, even moderate-intensity activities help if done regularly and long term. Physical activity can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure in some people.
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Start! a walking program
Obesity and overweight
People who have excess body fat — especially if a lot of it is at the waist — are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart's work because often the blood pressure is higher. It also raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL ("good") cholesterol levels. It can also make diabetes more likely to develop. Many obese and overweight people may have difficulty losing weight. But by losing even 10% from your current weight, you can lower your heart disease risk.
Visit our Weight Management website
Diabetes mellitus
Diabetes seriously increases your risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes increases the risk of heart disease and stroke, but the risks are even greater if blood sugar is not well controlled. At least 65% of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it's extremely important to work with your healthcare provider to manage it and control any other risk factors you can. Persons who are obese or overweight should lose weight to keep blood sugar in control.
Other factors that contribute to heart disease risk
Stress
Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and stress in a person's life, their health behaviors 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.
Get stress management tips and tools
Alcohol
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 is lower than in nondrinkers. If you drink, limit your alcohol consumption to no more than two drinks per day for men and no more than one drink per day for women. 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.
Read our recommendation on alcohol, wine and cardiovascular disease
Diet and Nutrition
A healthy diet is one of the best weapons you have to fight cardiovascular disease. The food you eat (and the amount) can affect other controllable risk factors: cholesterol, blood pressure, diabetes and overweight. Choose nutrient-rich foods — which have vitamins, minerals, fiber and other nutrients but are lower in calories — over nutrient-poor foods. A diet rich in vegetables, fruits, whole-grain and high-fiber foods, fish, lean protein and fat-free or low-fat dairy products is the key. And to maintain a healthy weight, coordinate your diet with your physical activity level so you're using up as many calories as you take in.
Smoking and Cardiovascular Disease
Learn the Risks
Cigarette smoking is the most important preventable cause of premature death in the United States. It accounts for more than 440,000 of the more than 2.4 million annual deaths. Cigarette smokers have a higher risk of developing several chronic disorders. These include fatty buildups in arteries, several types of cancer and chronic obstructive pulmonary disease (lung problems). Atherosclerosis (buildup of fatty substances in the arteries) is a chief contributor to the high number of deaths from smoking. Many studies detail the evidence that cigarette smoking is a major cause of coronary heart disease, which leads to heart attack.
Cigarette smoking is the most important preventable cause of premature death in the United States. It accounts for more than 440,000 of the more than 2.4 million annual deaths. Cigarette smokers have a higher risk of developing several chronic disorders. These include fatty buildups in arteries, several types of cancer and chronic obstructive pulmonary disease (lung problems). Atherosclerosis (buildup of fatty substances in the arteries) is a chief contributor to the high number of deaths from smoking. Many studies detail the evidence that cigarette smoking is a major cause of coronary heart disease, which leads to heart attack.
How does smoking affect coronary heart disease risk?
Cigarette and tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and diabetes are the six major independent risk factors for coronary heart disease that you can modify or control.
Cigarette smoking is so widespread and significant as a risk factor that the Surgeon General has called it "the leading preventable cause of disease and deaths in the United States."
Cigarette smoking increases the risk of coronary heart disease by itself. When it acts with other factors, it greatly increases risk. Smoking increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot. Smoking also increases the risk of recurrent coronary heart disease after bypass surgery.
Cigarette smoking is the most important risk factor for young men and women. It produces a greater relative risk in persons under age 50 than in those over 50.
Women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease and stroke compared with nonsmoking women who use oral contraceptives.
Smoking decreases HDL (good) cholesterol. Cigarette smoking combined with a family history of heart disease also seems to greatly increase the risk
What about cigarette smoking and stroke and peripheral arterial disease?
Studies show that cigarette smoking is an important risk factor for stroke. Inhaling cigarette smoke produces several effects that damage the cerebrovascular system. Women who take oral contraceptives and smoke increase their risk of stroke many times. Smoking also creates a higher risk for peripheral arterial disease and aortic aneurysm.
What about cigar and pipe smoking?
People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke), but their risk isn't as great as that of cigarette smokers. This is probably because they're less likely to inhale the smoke. Currently there's very little scientific information on cigar and pipe smoking and cardiovascular disease, especially among young men, who represent the vast majority of cigar users.
What about passive or secondhand smoke?
The link between seconhand smoke (also called environmental tobacco smoke) and disease is well known, and the connection to cardiovascular-related disability and death is also clear. About 22,700 to 69,600 premature deaths from heart and blood vessel disease are caused by other people's smoke each year.
Fighting Tobacco Deaths through Advocacy
For decades the American Heart Association has been working to reduce the number of deaths that result from tobacco use. Thanks in part to the work of the American Heart Association, there is no smoking on airline flights, there are lifesaving automated external defibrillators in many public places, and many of us enjoy smokefree communities.
The American Heart Association is active in communities around the nation advocating for healthful policies that reduce tobacco use, especially among youth, and non-smokers’ exposure to secondhand smoke. Read more about how we are Reducing Tobacco-Related Deaths Through Advocacy.
Discover more about what the association is doing on the federal, state and local levels to curb tobacco use.
Stop Smoking: Resources and Tools for Quitting
Your heart will thank you for quitting smoking, so don’t waste any time. The health benefits start almost immediately, and within a few years of quitting your risk of stroke and coronary artery disease are similar to non-smokers. We can help with resources and tools for the healthiest decision you will make – quitting smoking.
Take Action! Join You’re the Cure
Don’t just stand on the sidelines – speak up and let your elected officials know you want to fight tobacco use! Join You’re the Cure, our advocacy network of people committed to reducing death and disability from heart disease and stroke, and a group passionate about tobacco control.
This content was last reviewed on 10/20/2012.
