The bad news is that there are several risk factors for CAD, and most of them are common in Western societies. The good news is that most of these risk factors are things we have the ability to control. So we ourselves have a lot to say about how likely we are to have a heart attack.
The risk factors for heart attack can be divided into two general groups - those which we have no control over, and those which we can control.
Non-controllable Risk FactorsNon-controllable risk factors are risk factors we cannot do anything about. Generally, these risk factors are related to age, sex and genes.
- A family history of premature CAD (generally, CAD that has occurred in male relatives before the age of 50, or in female relatives before the age of 60.)
- Age 55 or older (men), or 65 or older (women)
- For women, being post-menopausal, or having your ovaries removed.
- Chronic kidney disease.
Controllable Risk RactorsControllable risk factors are risk factors under our control. Even though you can't do much about your age, sex, or genes, you can greatly diminish your risk of heart attack by paying careful attention to the following risk factors:
- Smoking. While smoking is the chief cause of heart attacks in people under the age of 40, it is a strong risk factor at any age.
- High cholesterol. High LDL cholesterol and total cholesterol, and low HDL cholesterol levels are associated with a significantly increased risk of heart attack.
In-depth information on cholesterol, and how to control it.
- Obesity. Being overweight, and especially having a big belly, has been associated with an increased risk of heart attack.
More information on obesity and heart disease.
- Lack of exercise. People who exercise regularly have a reduced risk of heart attack.
How much exercise do you really need to begin to reduce that risk?.
- Hypertension. High blood pressure is a major risk factor for heart attack, and especially stroke. Hypertension is very common in Americans over the age of 55, but is commonly inadequately treated.
Current recommendations for treating hypertension.
- Diabetes. Diabetes is becoming much more frequent in the U.S., as the population becomes more overweight. Diabetes - specifically, the elevated blood sugars and the other metabolic abnormalities that accompany this disease - greatly accelerates the development of atherosclerosis.
You can read all about diabetes at the About.com Diabetes Site.
- Metabolic syndrome. Metabolic syndrome is closely related to diabetes, and in fact can be thought of as a sort of pre-diabetes. It, too, is strongly associated with the development of atherosclerosis.
More on metabolic syndrome.
- Increased c-reactive protein (CRP). CRP is a relatively "new" risk factor. Increased levels of CRP indicate active inflammation somewhere in the body, and unless some obvious source of inflammation is seen elsewhere (such as active arthritis), elevated CRP is thought to reflect inflammation in the blood vessels - which goes along with atherosclerosis.
You can read about CRP here.
- Lack of moderate alcohol intake. Several studies suggest that moderate alcohol intake (one to two drinks per day, or in some studies, one to two drinks per week) is associated with a reduced risk of heart attack. The reason doctors are reluctant to recommend alcohol for cardiac risk reduction is that, when people drink more than about two drinks per day, their overall risk of death (from liver disease, heart disease, breast cancer, trauma, and other causes) rises very quickly. And as we all know, for many people it's hard to stop with one or two.
Learn about the complex relationship between alcohol and the heart.
- Psychological stress. Stress has been linked to heart attacks for many years. But some stress in life is unavoidable - and is even a good thing in many cases.
What "kinds" of stress to avoid?
Additional Risk Factors in WomenHere are two more risk factors that are specific to women:
- Taking birth control pills, especially among smokers. Birth control pills have been associated with a small increase in the risk of early heart attack in women. But when birth control pills are combined with smoking, there is a very large increase in risk. In fact, doctors should recommend that women who smoke should not take birth control pills.
- Complicated pregnancy. Women who develop certain complications during pregnancy - specifically, women who develop high blood pressure (a condition called preeclampsia) or diabetes during pregnancy, or who deliver low-birth-weight babies - have an increased risk of early heart attack. Because complicated pregnancies identify women who are at increased risk, these women should manage all their controllable risk factors very aggressively.
Lloyd-Jones, DM, Larson, MG, Beiser, A, et al. Lifetime risk of developing coronary heart disease. Lancet 1999; 353:89.
Wilson, PW, D'Agostino, RB, Levy, D, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97:1837.
Yusuf, S, Hawken, S, Ounpuu, S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364:937.