The intrusion of fat into the artery walls can begin very early in life, and often builds up as we age. However, certain characteristics, or risk factors, increase the likelihood that fatty streaks in the artery wall will develop into atherosclerosis and coronary artery disease. Some of these heart disease risk factors are simply part of who we are, and cannot be changed. But many risk factors can be improved by following the treatment prescribed by your doctor and by making healthy lifestyle choices. That means you have the power to reduce your risk of heart disease.
Stages of development of blockage in heart arteries (coronary plaque). The left-most artery is a healthy normal artery. As atherosclerosis develops, the artery gradually narrows, as shown from left to right in this diagram. Over time, extensive plaque can build up but still allow blood to pass through as in the the vessels. Finally, the blockage becomes so severe that it restricts blood from passing through, as shown in the far right illustration.
Heart disease risk factors include the following:
Age. The risk of cardiovascular disease increases as you age. For men, the risk starts to climb at about age 45, when 10 out of every 1,000 men develop signs of heart disease. By age 55, the risk has doubled to about 21 out every 1,000 men. It continues to rise until, by age 85, about 74 out of every 1,000 men have cardiovascular disease. For women, the risk of cardiovascular disease also climbs with age, but the trend begins about 10 years later than in men and especially with the onset of menopause.
Gender. Men are more likely to develop heart disease than women, but that difference begins to disappear after women go through menopause.
Family history of heart disease. Your risk of heart disease is approximately doubled if a parent or a brother or sister developed heart disease early in life (before age 55 for men, and age 65 for women).
Smoking. When you smoke, you expose your heart and blood vessels to nicotine, carbon monoxide and other harmful substances contained in smoke. This causes blood vessels to constrict, blood pressure to go up and cholesterol levels to climb. In addition, smoking deprives the body's tissues of oxygen, damages the inner lining of blood vessels, allows plaques to grow inside your arteries, and makes it more likely that dangerous blood clots will form.
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Some risk factors are genetic. But as Dr. Kimberly A. Skelding, Geisinger Medical Center, explains in this video, families can reduce the risks.
High cholesterol levels. High levels of LDL cholesterol - the so-called bad cholesterol - can increase the build-up of plaque in the arteries of the heart. It's also unhealthy to have low levels of HDL, or "good" cholesterol. The ideal blood cholesterol level for you depends on your age, gender, and history of heart disease, but for most people with coronary artery disease, the target LDL cholesterol level is 100 mg/dL or below, and the target HDL cholesterol level is above 40 mg/dL for men, and above 50 mg/dL for women.
High blood pressure. If your blood pressure is above 140/90 mmHg for long periods of time, it can damage the blood vessels. This not only makes it more likely that cholesterol plaques will form, it also causes the artery walls to become thicker, stiffer, and less able to expand and contract with changes in activity and other physical demands.
Diabetes. High blood sugar levels can damage the blood vessels throughout the body, making it more likely that atherosclerotic plaques will develop. In fact, about 1 out of 3 people with diabetes also have coronary artery disease.
Being overweight or obese. Carrying around too much body weight not only puts a strain on your heart, it also makes it more difficult to control high blood pressure, high cholesterol levels, and diabetes. Men and women who are overweight are about 20 percent more likely to develop cardiovascular disease. Being obese - more than 20 percent above ideal body weight - is even more dangerous. Obesity increases the risk of cardiovascular disease by 46 percent in men and 64 percent in women.
Physical inactivity. A lack of exercise weakens your muscles and makes it harder to control several other heart disease risk factors, including blood pressure, cholesterol levels, diabetes, obesity, and stress.
Metabolic syndrome. The term metabolic syndrome is used to describe a cluster of traits that, together, increase the risk for developing heart disease. These traits include high blood sugar, high blood pressure, low levels of "good" HDL cholesterol, high blood levels of fats known as triglycerides, and excess body weight, particularly in the belly area.
Stress. High levels of stress in your life, or a tendency to often feel angry, have also been linked to an increased risk for heart disease.
High levels of C-reactive protein. CRP is produced by the body in response to infection or inflammation. Your doctor may use a special high-sensitivity CRP test to look for signs that you have inflammation in the arteries of your heart. If your CRP levels are high, your risk of having a heart attack is increased.
Learn from Other Patients’ Stories
All of a sudden, Jack Blatherwick couldn’t take 50 steps into his four-mile daily walk without extreme chest pain. With a Ph.D. in physiology and a career overseeing the conditioning of professional and Olympic ice hockey players, Jack, 65, recognized his symptoms as angina – the chest pain that occurs when arteries to the heart are blocked and the heart is starved for oxygen. Though he was active and maintained a heart-healthy diet, there was one risk factor for heart disease that Jack couldn’t control: His genetic heritage. Both his father and uncle had died from heart attack in their 50s. Read more about how Jack got treated and got back to his active lifestyle.