• AgriLife.org
• Texas AgriLife Extension Service

Heart Disease –
Risk factors, screenings, changes

February 2010 – Vol. 14, No. 2

Editor: Janet M. Pollard, MPH

“Heart disease is the No. 1 worldwide killer of men and women…. [It] is responsible for 40 percent of all deaths in the United States, more than all forms of cancer combined.”¹ Heart disease is a broad term used to describe a range of diseases that affect your heart and blood vessels, such as coronary heart disease [CHD], heart rhythm problems (arrhythmias), heart defects you are born with (congenital heart defects), as well as infections of the heart muscle and valves.¹

The term heart disease is often used interchangeably with cardiovascular disease, which generally refers to conditions that involve narrowed or blocked blood vessels that can lead to heart attack (PDF), angina (chest pain) (PDF), stroke (PDF), congestive heart failure (PDF), aneurysm (PDF), peripheral artery disease (PDF), and sudden cardiac arrest (PDF).¹

Coronary artery disease (CAD) (also called coronary heart disease), in which the coronary arteries supplying blood to the heart muscle are narrowed or blocked by the buildup of plaque (cholesterol and other materials), is the most common type of heart disease and the leading cause of death in both men and women in the United States.^2,3,4

Don’t Assume…You have no signs; you’re not at risk; it can be cured

Often, we don’t worry about heart disease because we think we aren’t at risk. Maybe it’s because we feel generally healthy, we don’t have any symptoms, we’re not overweight, a woman assumes a man is much more likely to die of heart disease, or we think it can be cured with medicines, surgeries, or other procedures – so why be concerned? The truth is:

• Sometimes there are no symptoms until it is too late and you have a heart attack – that’s why it is important to be screened early and regularly for heart disease risk factors. “Heart disease is easier to treat when it is detected early,”¹ and some of the problems, such as plaque build-up or tendencies toward overweight, can begin early in life, even in childhood.⁵ So it is important to find out if you are at risk now.
• Having multiple risk factors for heart disease is serious because they tend to “gang up” and worsen each other’s effects, but even one risk factor greatly increases your chance of developing heart disease.⁶
• People who are at a normal body weight may think they are protected and can eat any diet they choose.⁷ However, even people of a normal body weight can have blocked arteries and need to eat a healthy diet and participate in regular physical activity. People of a normal body weight can also have high blood pressure and cholesterol, as well as diabetes. While individuals of an ideal weight are less likely to have these health issues, your genetic makeup can predispose you to abnormalities, such as high cholesterol or other heart-related issues.⁷ Heredity can play a part (having a father or brother diagnosed with heart disease before age 55 or a mother or sister before age 65 puts you at greater risk).⁸
• While women tend to develop heart disease 7–10 years later than men,^9,10 women are less likely to seek treatment for heart disease or to recognize the symptoms of heart attack.¹⁰ Although more males have heart attacks, heart disease is the leading cause of death for American women¹¹ as well and also a leading cause of disability among women.¹²
• “Heart disease is a lifelong condition.”¹³ Medications, procedures, and surgeries do not cure coronary heart disease.¹⁴ “Even if you’ve had surgery or other procedures to help with blood flow in your heart, your arteries remain damaged, [and] their condition will worsen unless you make changes in your daily habits.”¹³

The good news is, heart disease can be prevented. And if you already have heart disease, you can manage your condition and keep it from worsening by changing your daily habits, as well as following therapies prescribed by your doctor. Learn the risk factors for heart disease; if you have risk factors, make appropriate changes. Ask your doctor to perform regular screenings for heart disease such as checking your blood pressure, cholesterol and other lipid levels, and your blood glucose. Knowing these factors can help put you in control of your heart and health.

Know Your Risk Factors: What’s in your control?

“Risk factors are behaviors or conditions that increase the chance of disease.”⁸ While there are some risk factors that you cannot control, it is important to control those that can be modified.

Factors you cannot control:

• Age (PDF). “Simply getting older increases your risk for damaged and narrowed arteries and weakened or thickened heart muscle, which contributes to heart disease.”¹ Coronary artery disease is more likely to occur as you get older, especially after 65.
• Gender (PDF). For men, the risk for heart attack increases after 45. For women, the risk increases after age 55.⁸
• Race (PDF). African Americans, Mexican Americans, American Indians, native Hawaiians, and some Asian Americans have a higher risk of heart disease.¹⁵
• Family history (PDF). Family history of early heart disease – a father or brother diagnosed before age 55 or a mother or sister diagnosed before 65 – puts you at greater risk.⁸

Factors you can control (modifiable):

• Tobacco (PDF). “Smoking and long-term exposure to secondhand smoke damage the interior walls of arteries…allowing deposits of cholesterol and other substances to collect and slow blood flow,…and increases the risk of deadly blood clots forming and causing a heart attack.”¹⁶
• Diabetes (PDF). “Diabetes can occur in childhood, but it appears more often in middle age and among overweight people. Diabetes greatly increases your risk of a heart attack.”¹⁶
• High blood pressure (PDF). “Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the vessels through which blood can flow,”¹ and thus, greatly increases your risk for heart disease.
• High blood cholesterol or triglycerides (i.e., abnormal blood lipid levels) (PDF). “Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol in your blood increases your risk of a heart attack…. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable.”¹⁶
• Physical inactivity (PDF). “An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure.”¹⁶
• Overweight and obesity (PDF). “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.”¹⁷
• Poor diet (PDF). A poor diet, primarily one high in saturated fat and cholesterol, can contribute to heart disease risk.¹⁵
• Uncontrolled stress or anger (PDF). Some scientists have noted a relationship between coronary heart disease risk and stress in a person’s life and their health behaviors.¹⁷
• Alcohol (PDF). “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.”¹⁷
• Poor hygiene (PDF). Keeping hands and teeth clean and getting enough sleep can help prevent viral or bacterial infections that can put you at risk of heart infections, especially if you already have an underlying heart condition.^1,14

Get Screened: Know your numbers

So how do you know if you’re at risk for heart disease? Some risks are obvious – you know your age, gender, race. You know if you are a smoker or if you’re physically inactive. You might know your family history of heart disease; if you don’t – ask. But, do you know if you have high blood pressure, high cholesterol, or normal blood glucose levels? There are some risk factors you must be screened for at your doctor’s office. The following are screening recommendations from the National Heart, Lung, and Blood Institute.¹⁸ Ask your doctor to give you the following tests. Each one will give you valuable information about your heart disease risk.

Lipoprotein Profile¹⁸

What: A blood test that measures total cholesterol, HDL or “good” cholesterol, LDL or “bad” cholesterol, and triglycerides, another form of fat in the blood. The test is given after a 9- to 12-hour fast.

Why: To find out if you have any of the following: high blood cholesterol (high total and LDL cholesterol), low HDL cholesterol, or high triglyceride levels. These levels affect your risk for heart disease.¹⁸

• Total cholesterol level – Lower is better when it comes to total cholesterol level. Less than 200 mg/dL is best (“desirable”); 200–239 mg/dL is considered “borderline high;” 240 mg/dL and above is “high.”¹⁹
• LDL (bad) cholesterol – Lower is better. Less than 100 mg/dL is best (“optimal”); 100–129 mg/dL is “near optimal;” 130–159 mg/ dL is “borderline high;” 160–189 mg/dL is “high;” 190 mg/dL and above is “very high.”¹⁹
• HDL (good) cholesterol – Higher is better. More than 60 mg/dL is best.¹⁹
• Triglyceride levels – Lower is better. Less than 150mg/dL is best.¹⁹

When: All healthy adults should have their blood cholesterol levels checked at least once every five years. Depending on the results, your doctor may want to repeat the test more frequently.¹⁸

Blood Pressure¹⁸

What: A simple, painless test using an inflatable cuff on the arm.

Why: To find out if you have high blood pressure (also called hypertension) or prehypertension. Both are risk factors for heart disease.¹⁸

• High blood pressure – High blood pressure is a blood pressure reading of 140/90 or higher.¹⁹
• Prehypertension – A blood pressure reading of 120/80 to 139/89 is considered prehypertension, which means that you don’t have high blood pressure now, but you are likely to develop it in the future.¹⁹
• Normal blood pressure – A blood pressure reading below 120/80 is usually considered normal.¹⁹
• Very low blood pressure – A very low blood pressure reading (lower than 90/60) can sometimes be a cause of concern and should be checked out by a doctor.¹⁹

When: At least every two years, or more often if you have high blood pressure or prehypertension.¹⁸

Fasting Plasma Glucose¹⁸

What: The preferred test for diagnosing diabetes. After you have fasted overnight, you will get a blood test the following morning.

Why: To find out if you have diabetes or are likely to develop the disease.

• Diabetes – Fasting plasma glucose levels of more than 126 mg/dL on two tests on different days mean that you have diabetes.
• Prediabetes – Levels between 100–125 mg/dL mean you have an increased risk for diabetes and may have prediabetes.¹⁸
• Normal blood glucose – A healthy fasting blood glucose number is under 100 mg/dL.²⁰

When: At least every three years, beginning at age 45. If you have risk factors for diabetes, you should be tested at a younger age and more often.¹⁸

Body Mass Index (BMI) and Waist Circumference¹⁸

What: BMI is a measure of your weight in relation to your height. Waist circumference is a measure of the fat around your middle.

Why: To find out whether your body type raises your risk of heart disease.

• Overweight – A BMI of 25 or higher means you are overweight.
• Obese – A BMI of 30 or higher means you are obese. Both overweight and obesity are risk factors for heart disease.
• Women – For women, a waist measurement of more than 35 inches increases the risk of heart disease and other serious health conditions.¹⁸
• Men – For men, a waist measurement of more than 40 inches increases the risk of heart disease and other serious health conditions.²¹

When: Every two years, or more often if your doctor recommends it.¹⁸

Note: The American Heart Association recommends blood pressure, lipid levels, and BMI and weight circumference tests beginning at age 20 for healthy adults and blood glucose tests beginning at age 45.²² If you have a family history of these risks, you may need to have these measures checked at an earlier age and/or more often than recommended for those without these risks.

Once you know your numbers, you can see where your risks lie and work with your doctor to set goals and achieve them by making healthy changes, along with any medication or other therapies recommended by your doctor. If you know your cholesterol and blood pressure numbers and are over 20 years old without known heart disease or diabetes, you can use this risk assessment tool²³ to estimate your 10-year risk of having a heart attack. You can also see the American Heart Association’s Numbers that Count for a Healthy Heart chart for an overview of test result numbers and goals.

Make Changes

“Taking action to control risk factors can help prevent or delay heart disease…. The good news is that many lifestyle changes help control multiple risk factors. For example, physical activity lowers your blood pressure, helps control diabetes, reduces stress, and helps control your weight.”²⁴ Losing weight with a healthy diet can help you control or reduce your risk for high blood pressure, high cholesterol, and diabetes.⁹

Concentrate on the “Big Four”:¹⁸

1. Eat a nutritious diet. (PDF)
2. Engage in regular physical activity. (PDF)
3. Maintain a healthy weight. (PDF)
4. Stop smoking. (PDF)

“Currently only 3 percent of U.S. adults practice these “Big Four” heart healthy habits. But it’s never too late to start. No matter what heart disease risk factors you have – or how many – you will greatly benefit from taking action in these four areas. If you already have heart disease, you can lessen its severity…. True, you may need to take other steps to prevent or control heart disease. For example, if you have diabetes, you also will need to keep your blood sugar levels under control. But following a heart healthy eating plan, controlling your weight, and engaging in more physical activity will help you keep your blood sugar at healthy levels. These steps will also help reduce your chances of developing high blood pressure or high blood cholesterol.”¹⁸

---

Women & Hormone Replacement Therapy

“Menopausal hormone therapy was once thought to lower the risk of heart attack and stroke for women with heart disease. But research now shows that women with heart disease should not take it. Menopausal hormone therapy can involve the use of estrogen alone or estrogen plus progestin. For women with heart disease, estrogen alone will not prevent heart attacks, and estrogen plus progestin increases the risk for heart attack during the first few years of use. Estrogen plus progestin also increases the risk for blood clots, stroke, and breast cancer.”²⁵ If you are considering hormone therapy to prevent menopausal symptoms, such as hot flashes, mood swings, vaginal dryness, or bone loss, talk with your doctor about the benefits versus the risks of hormone therapy as well as what other alternatives are available to you.²⁵ “If you decide to use hormones, use them at the lowest dose that helps for the shortest time needed.”¹⁹

---

This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

---

References:

1. Mayo Clinic (2009). Heart disease [online]. Retrieved December 18, 2009. From http://mayoclinic.com/health/heart-disease/DS01120.
2. U.S. National Library of Medicine (2009). Coronary artery disease [online]. Retrieved January 5, 2010. From http://www.nlm.nih.gov/medlineplus/coronaryarterydisease.html.
3. U.S. National Library of Medicine (2009). Heart disease [online]. Retrieved January 6, 2010. From http://www.nlm.nih.gov/medlineplus/ency/article/000147.htm.
4. National Heart, Lung, and Blood Institute (2009). What is coronary artery disease? [online]. Retrieved December 17, 2009. From http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html.
5. National Heart, Lung, and Blood Institute (2009). What is heart attack? [online]. Retrieved December 18, 2009. From http://www.nhlbi.nih.gov/actintime/aha/what.htm.
6. National Heart, Lung, and Blood Institute (2009). The heart truth – lower heart disease risk: What are the risk factors for heart disease? [online]. Retrieved December 17, 2009. From http://www.nhlbi.nih.gov/educational/hearttruth/lower-risk/risk-factors.htm.
7. Cleveland Clinic (2010). Myth versus reality [online]. Retrieved February 5, 2010. From http://my.clevelandclinic.org/heart/askdoctor/heart_myth_reality.aspx.
8. National Heart, Lung, and Blood Institute (2009). Who’s at risk? [online]. Retrieved December 18, 2009. From http://www.nhlbi.nih.gov/actintime/aha/who.htm.
9. American Academy of Family Physicians (2009). Heart Disease and Heart Attacks: What Women Need to Know [online]. Retrieved January 29, 2010. From http://familydoctor.org/online/famdocen/home/common/heartdisease/risk/287.printerview.html.
10. Cleveland Clinic (2010). Coronary artery disease – symptoms [online]. Retrieved January 5, 2010. From http://my.clevelandclinic.org/heart/disorders/cad/cadsymptoms.aspx
11. American Academy of Family Physicians (2009). Warning signs and tips on prevention [online]. Retrieved December 17, 2009.From http://familydoctor.org/online/famdocen/home/common/heartdisease/basics/291.printerview.html.
12. U.S. National Library of Medicine (2010). Heart disease and women [online]. Retrieved January 5, 2010. From http://www.nlm.nih.gov/medlineplus/heartdiseaseinwomen.html.
13. National Heart, Lung, and Blood Institute (2006). In brief: Your guide to living well with heart disease [online]. Retrieved January 5, 2010. From http://www.nhlbi.nhi.gov/health/public/heart/other/your_guide/living_hd_fs.pdf.
14. U.S. National Library of Medicine (2006). X-plain heart attack reference summary [online]. Retrieved January 5, 2010. From http://www.nlm.nih.gov/medlineplus/tutorials/heartattack/ct139103.pdf.
15. Cleveland Clinic (2009). Coronary artery disease treatment guide [online]. Retrieved January 5, 2010. From http://my.clevelandclinic.org/documents/heart/coronary_artery_disease_treatment_guide.pdf.
16. Mayo Clinic (2009). Heart attack [online]. Retrieved December 17, 2009. From http://mayoclinic.com/health/heart-attack/DS00094.
17. American Heart Association (2009). Risk factors you can change [online]. Retrieved January 26, 2010. From http://www.americanheart.org/presenter.jhtml?identifier=494#obesity.
18. National Heart, Lung, and Blood Institute (2007). The heart healthy handbook for women [online]. Retrieved January 5, 2010. From http://www.nhlbi.nih.gov/health/public/heart/other/hhw/hdbk_wmn.pdf.
19. United States Department of Health and Human Services (2009). Heart disease: Frequently asked questions [online]. Retrieved December 18, 2009. From http://womenshealth.gov/faq/heart-disease.cfm#e.
20. American Diabetes Association (2010). High blood glucose [online]. Retrieved February 4, 2010. From http://www.diabetes.org/diabetes-basics/prevention/checkup-america/highbg.html.
21. National Heart, Lung, and Blood Institute (2000). The practical guide: Identification, evaluation, and treatment of overweight and obesity in adults [online]. Retrieved January 27, 2010. From http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf.
22. American Heart Association (2010). Recommended schedule for screening tests [online]. Retrieved January 26, 2010. From http://www.americanheart.org/presenter.jhtml?identifier=3046593.
23. Cleveland Clinic (2010). Risk assessment tool for estimating your 10-year risk of having a heart attack [online]. Retrieved February 4, 2010. From http://my.clevelandclinic.org/ccform/Heart_Center_Risk_Tool.aspx.
24. National Heart, Lung, and Blood Institute (2009). Diabetic heart disease [online]. Retrieved December 17, 2009. From http://www.nhlbi.nih.gov/health/dci/Diseases/dhd/dhd_summary.html.
25. National Heart, Lung, and Blood Institute (2009) The heart truth - lower heart disease risk: Menopausal hormone therapy and heart disease [online]. Retrieved December 17, 2009. From http://www.nhlbi.nih.gov/educational/hearttruth/lower-risk/hormone-therapy.htm

[back to top]

---

Last updated: 26 July, 2010

Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin.