Coronary Artery Disease - Risk factors

Are you at risk?

Facts about cardiovascular disease

Cardiovascular disease includes a number of conditions affecting the structures or function of the heart, including coronary artery disease and vascular (blood vessel) disease. Cardiovascular disease is by far the leading cause of death in the United States.

Coronary artery disease (narrowing of the arteries supplying blood to the heart) causes about one million heart attacks each year. Even more worrisome, 220,000 people with heart attacks will die before even reaching the hospital.

Research about cardiovascular disease risk factors suggests that making even small lifestyle changes can reduce the risk of coronary artery disease, heart attack, stroke and other serious cardiovascular conditions.

Are you at risk?

Risk factors are certain conditions that increase a person’s risk for cardiovascular disease. It is important to know:

• Some risk factors, called "nonmodifiable risk factors," cannot be changed.
• Some risk factors, called "modifiable risk factors," can be modified, controlled or treated.
• The more risk factors you have, the greater your chance of developing cardiovascular disease.
• Higher levels of each risk factor correlate with a higher risk for cardiovascular disease.

Nonmodifiable risk factors - note which ones apply to you

• Increasing age. Cardiovascular disease is more likely to occur as you get older. About 85 percent of people who die of coronary artery disease are age 65 or older.
• Male gender. Men have a greater risk of heart attack then women.
• Menopause. After menopause, a woman's risk of cardiovascular disease increases, but does not reach the level of a man's.
• Family history. Your risk of cardiovascular disease increases if your parents, brothers, sisters, or children have the disease.
• Race. The risk of cardiovascular disease is higher in African Americans, Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This increased risk is partly due to higher rates of high blood pressure, obesity and diabetes in these populations.

Since you can't change any of these risk factors, it is important to focus on the risk factors you CAN change.

Risk Factor Goals

You, along with support from your family and friends, can work to achieve the following goals to change or treat your modifiable risk factors and reduce your risk of cardiovascular disease. If you already have cardiovascular disease, you can follow these guidelines to help prevent its progression. (note which ones apply to you)

Stop smoking

• Smoking is the most preventable risk factor for cardiovascular disease and stroke.
• Smokers (including cigarette, pipe and cigar smokers) have more than twice the risk of a heart attack than nonsmokers.
• Smoking is also the biggest risk factor for sudden cardiac death. Even one to two cigarettes a day greatly increases the risk of heart attack, stroke and other cardiovascular conditions.
• Nonsmokers who are exposed to constant smoke also have an increased risk.

Goal: Eliminate the use of all tobacco products. Stay away from other's smoke.

More information: Smoking and Heart Disease

Lower your total cholesterol, LDL (bad) cholesterol and triglyceride levels.

Excessive lipids (fatty substances including cholesterol and triglycerides), especially in the form of LDL cholesterol, cause the build-up of fatty deposits within your arteries, reducing or blocking the flow of blood and oxygen to your heart.

• There’s a sharp increase in the risk for cardiovascular disease when total cholesterol levels are 240 mg/dl and above.

Goals: Total cholesterol less than 200 mg/dl

LDL cholesterol should be less than 70 mg/dl for those with heart or blood vessel disease and other patients at very high risk of cardiovascular disease, such as those with metabolic syndrome. LDL cholesterol should be less than 100 mg/dl for those who have a high risk of cardiovascular disease, such as some patients with diabetes or those who have multiple heart disease risk factors. For all others, LDL cholesterol should be less than 130 mg/dl.

Triglycerides less than 150 mg/dl.

It is recommended to have your cholesterol level checked as early as age 20 or earlier if you have a family history of high cholesterol. The cholesterol profile includes an evaluation of total cholesterol, HDL, LDL and triglyceride levels. Your health care provider can tell you how often to have your cholesterol tested.

Raise your HDL (good cholesterol).

HDL cholesterol takes the LDL (bad) cholesterol away from the arteries and back to the liver where it can be passed out of the body. High levels of HDL seem to protect against cardiovascular disease.

Goal: HDL greater than 40 mg/dl; the higher the HDL level, the better.

More information: Cholesterol Guidelines

Lower high blood pressure

Blood pressure is a measurement of the pressure or force inside your arteries with each heartbeat.

• High blood pressure increases the workload of the heart and kidneys, increasing the risk of heart attack, heart failure, stroke and kidney disease.
• High blood pressure is the biggest risk factor for stroke.

Goal: 120/80 mmHg or lower (high blood pressure is 140/90 or higher)

Control blood pressure through diet, exercise, weight management, and if needed, medications. Also limit alcohol, as it can increase your blood pressure.

More information:

    * Your Blood Pressure
    * Strategies to Control Blood Pressure

Control Diabetes

Diabetes occurs when the body is unable to produce insulin or use the insulin it has. This results in elevated blood sugar levels.

• People with diabetes (especially women) have a higher risk of cardiovascular disease because diabetes increases other risk factors, such as high cholesterol, LDL and triglycerides; lower HDL; and high blood pressure.
• Keeping diabetes under control is essential in reducing your risk.

Goal: Hemoglobin A1c test less than 7.0% if you have diabetes, and less than 6.0% if you do not have diabetes. Follow-up with your doctor on a regular basis.

More information: Cleveland Clinic Health Information Center

Maintain a healthy body weight

The more you weigh, the harder your heart has to work to give your body nutrients.

• Research has shown that being overweight contributes to the onset of cardiovascular disease.
• Excess weight also raises blood cholesterol, triglycerides and blood pressure, lowers HDL cholesterol and increases the risk of diabetes.
• How a person’s weight is distributed also is important. People who carry their weight in the middle have a greater risk of developing cardiovascular disease, compared to people who carry their weight in their arms and legs. Waist measurements are one way to determine fat distribution.
• Weight is best determined by calculating Body Mass Index (BMI). BMI is a figure calculated from your height and weight. Doctors often use BMI as an objective indicator of whether a person is overweight, underweight, or at a healthy weight, and it is recommended by the National Institutes of Health for this purpose.

To calculate your BMI, divide weight in kilograms (kg) by height in meters squared (m2).

Metric conversions are: pounds divided by 2.2 = kg; inches multiplied by 0.0254 = meters.

For example, a woman who weighs 140 pounds and is 5 feet, 6 inches tall has a BMI of 23.
140 lbs divided by 2.2 = 64 kg
5’6” = 65” x 0.0254 = 1.65
1.652 = 2.72
64 divided by 2.72 = 23

Your health care provider can help you calculate your BMI.

Goals: A normal BMI ranges from 18.5 to 24.9 kg/m2. Overweight is defined as having a BMI higher than 25 kg/m2. A BMI higher than 30 kg/m2 is considered obese.

Waist measurements for women should be less than 35 inches. Men should aim for a waist less than 40 inches.

Achieve and maintain a desirable weight. A diet and exercise program will help you reach your goal.

More information: Overweight and Heart Disease (includes BMI calculator)

Exercise

The heart is like any other muscle -- it needs a workout to stay strong and healthy. Exercising helps improve how well the heart pumps blood through your body.

• Activity and exercise also help reduce so many other risk factors: You can lower blood pressure, lower high cholesterol, reduce stress, achieve and maintain a healthy body weight, help yourself quit smoking and improve your blood sugar levels.

Goals: Moderate exercise 30 minutes a day, on most days. More vigorous activities are associated with more benefits.

Exercise should be aerobic, involving the large muscle groups. Aerobic activities include brisk walking, cycling, swimming, jumping rope and jogging. If walking is your exercise of choice, use the pedometer goal of 10,000 steps a day.

Consult your doctor before starting any exercise program.

More information: Exercise for your health

Follow a heart-healthy diet

The old saying, “You are what you eat,” may be truer than ever - especially when it comes to cardiovascular disease. Four risk factors are related to diet: high blood pressure, high blood cholesterol, diabetes and obesity.

Goals: Eat foods low in sodium, saturated fat, cholesterol, trans fat (partially hydrogenated fats) and refined sugar.

Omega-3 fatty acids are good fats and come from tuna, salmon, flaxseed, almonds, and walnuts. Mono- unsaturated fats also are preferred and are found in olive and peanut oils.

Also eat plant-based foods such as fruit and vegetables, nuts and whole grains.

More information: Nutrition Strategies

Contributing Risk Factors (note which ones apply to you)

Some risk factors are not considered traditional risk factors, but are still thought to contribute to overall risk for heart disease. These include:

Individual response to stress: Although stress is not considered a traditional risk factor, some researchers have noted a relationship between cardiovascular disease risk and stress in a person’s life, their health behaviors and socioeconomic status. Stress may affect established risk factors.

Learn to manage stress by practicing relaxation techniques, learning how to manage your time, setting realistic goals, and trying some new techniques such as guided imagery, massage, Tai Chi or yoga.

Drinking too much alcohol Intake of too much alcohol can lead to increased blood pressure, heart failure and stroke. It is also linked to high triglycerides, irregular heart beats, obesity, and cancer. Research has shown that those who drink one drink per day (4 oz. of wine, 12 oz. of beer, or 1-1/2 oz. of 80-proof spirits) may have less risk. However, the American Heart Association does not recommend that non-drinkers start using alcohol or that drinkers increase the amount they drink.

Know your risk factors

If you have a family history of cardiovascular disease or high cholesterol, it is even more important to decrease your other risk factors. Get your cholesterol levels tested every year. Make sure you follow-up with your health care provider every year for a checkup.

Ask your doctor about the ultra-sensitive C-reactive protein (us-CRP) blood test. High us-CRP levels are related to an increased risk of heart attack, stroke, peripheral vascular disease and restenosis (reclosing) of the arteries after angioplasty procedures.

Homocysteine is a protein in the blood. High levels of homocysteine -- above 10 -- are associated with an increased risk of cardiovascular disease. There have been conflicting studies about the benefits and risks related to treatment of elevated homocysteine levels with folic acid and B vitamins. Therefore, ask your doctor before taking these supplements.

Click here to learn more about these laboratory tests

Here’s to your heart-health!

The Preventive Cardiology and Rehabilitation Program at The Cleveland Clinic comprises a multi-disciplinary team of physicians, nurses, dietitians, exercise physiologists, and behaviorists. This team cares for people who either have heart disease or who are at risk. The program includes assessment, education, treatment and follow-up. A referral is required for an evaluation. Preventive Cardiology provides reports to your referring doctor on your treatment and progress.If you would like to be evaluated at the Cleveland Clinic for risk factors and current prevention strategies for cardiovascular disease, please use the Contact Us Form or contact the Preventive Cardiology and Rehabilitation Program at 216.444-9353 (or toll-free at 800/223-2273, extension 49353).

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