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Heart disease (including coronary heart disease, high blood pressure, and stroke) is the number one cause of death in the United States (AHA-a, 2019). This year, about 735,000 Americans will have a heart attack—that’s one every 40 seconds (CDC-a, 2019). And 121 million Americans have some form of cardiovascular disease, which is largely caused by narrowed or blocked blood vessels that can lead to a heart attack or stroke (AHA-b, 2019).
But your ticker doesn’t have to be a time bomb. Knowing what causes heart disease, and the ways you can improve your heart health can lower your risk of heart attack and heart disease.
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What causes heart disease?
Heart disease includes several conditions, many of which are related to atherosclerosis, a process when plaque builds upon the walls of the arteries and blood vessels that feed into the heart. Plaque consists of cholesterol deposits from the blood. Over time they can grow or even become calcified. Eventually, that buildup narrows the arteries, lessening blood flow. If the flow is blocked completely and/or a blood clot forms, that can cause a heart attack or stroke.
Heart disease risk factors
High blood pressure, high LDL (low-density lipoprotein) cholesterol, and smoking are the major risk factors for heart disease. According to the Centers for Disease Control and Prevention, almost half of Americans (47%) have at least one of those three risk factors. But there are several other factors that can raise your risk of heart disease.
1. Personal attributes
Male sex: Heart disease is the leading cause of death for men in the United States, causing almost ¼ of all male deaths, the CDC says (CDC-a, 2020). Men face a greater risk of heart disease earlier in life. After the age of 65, the risk of heart disease is about equal for both sexes. The average age for a heart attack is 72 in women and 65 in men.
Age: The risk of heart disease increases with age, starting with about age 45 for men and 55 for women. By age 55, a man’s risk of heart disease has doubled (SCAI, 2014). About four out of five people who die of heart disease are older than 65 (NIHR, 2017).
Race: Heart disease is the leading cause of death in the United States for non-Hispanic whites, non-Hispanic blacks, and Native Americans, the CDC says (CDC-a, 2019).
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2. Existing conditions
High blood pressure: High blood pressure is when the pressure of blood inside your arteries and other blood vessels is too high. Over time, that can damage the linings of the blood vessels, encouraging the development of plaque.
High blood cholesterol: A high LDL (“bad”) cholesterol level contributes to heart disease because it can increase the production of plaque, narrowing arteries. High triglycerides (a type of fat in the blood) can also contribute to heart disease. And recent research suggests that “remnant cholesterol,” which is a type of cholesterol present in the blood with triglycerides, is also associated with the development of heart disease.
Diabetes: Diabetes is a condition in which a person’s blood sugar is too high. That happens when the body can’t manufacture (or respond properly to) insulin, a hormone that moves sugar out of the blood and into cells. That’s dangerous because high sugar levels can damage the walls of arteries, potentially leading to complications such as blindness and heart disease. In fact, diabetes can be so damaging to blood vessels that it is often considered a coronary artery disease risk equivalent.
Obesity: According to the CDC, obesity is related to a number of conditions that can lead to heart disease, including high LDL cholesterol levels, high blood pressure, and diabetes. People who are obese have a 28% higher risk of heart disease than people of normal weight (NIHR, 2017).
Clinical depression: People with depression develop heart disease at a higher rate than people who aren’t depressed (Day, 2016). According to Harvard Medical School, depression has been linked to low-grade inflammation, which contributes to the clogging of arteries (Harvard Health Publishing, 2016). Depression ramps up the body’s production of stress hormones, which dull the response of the heart and arteries to demands for increased blood flow. It also activates blood cells known as platelets, making them more likely to form clots in blood vessels.
Unhealthy eating habits: A diet high in fat and processed foods and low in fruits and vegetables can increase blood cholesterol and triglyceride levels and deprive the body of protective vitamins and nutrients, raising the risk of heart disease.
Lack of exercise: Physical inactivity increases your risk of being overweight and having high blood pressure, which, in turn, increases your heart disease risk.
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Abuse of alcohol: Overindulging in alcohol can raise triglyceride levels and lead to high blood pressure, poor eating habits, and being overweight. Alcohol abuse also can weaken, thin, and enlarge the heart muscle, making it more difficult for the heart to pump blood throughout the body.
Tobacco use: Tobacco smoke contains thousands of toxins that can harm blood cells and damage artery walls and blood vessels. It can also lower HDL (“good”) cholesterol, raise triglycerides, cause blood vessels to narrow, and make blood more sticky and susceptible to clotting. All of this increases your risk of atherosclerosis and heart disease.
Secondhand smoke: Secondhand smoke also risks the heart health of those around you: It lowers “good” cholesterol, raises blood pressure and damages heart tissue, according to the National Institutes of Health (NHLBDI, n.d.). In fact, nonsmokers who breathe secondhand smoke have a 25–30% higher risk of developing heart disease than people who aren’t around secondhand smoke (CDC, 2018).
4. Family history
Know your family history of heart disease or heart problems. Some cases of heart disease or high blood pressure may at least partially result from a genetic predisposition. Or you might be at increased risk not because of genetics, but because of unhealthy learned lifestyle habits, such as poor diet or tobacco use.
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How to lower the risk of heart disease
There are several easy things you can do to lower your heart disease risk and increase your chances of having a healthy heart for life.
- Eat a healthy diet. Eat a diet low in saturated fat and salt. Incorporate healthy monounsaturated and polyunsaturated fats such as olive oil and avocados; healthy fats seem to have a cholesterol-lowering effect. Consume plenty of fruits, vegetables, and whole grains and avoid processed foods. The American Heart Association recommends eating two servings of fatty fish, such as salmon, per week; it’s rich in omega-3 fatty acids, which lower blood pressure and triglycerides.
- Get regular exercise. Frequent physical activity is key to heart health. The American Heart Association recommends that all adults get 150 minutes of moderate aerobic exercise (such as brisk walking) or 75 minutes of vigorous exercise (such as running, swimming or rowing) every week.
- Maintain a healthy weight.
- Quit smoking or don’t start. There is no “safe” amount of tobacco use; even one cigarette a day can compromise your heart health.
- Keep diabetes, high blood pressure, and high cholesterol under control. Follow your doctor’s advice about diet and lifestyle changes, and comply with any medications you’re prescribed. If you don’t have diabetes or high blood pressure, make healthy lifestyle choices to avoid developing these medical conditions.
- Drink alcohol in moderation. The AHA recommends moderate drinking, defined as no more than two drinks a day for men and one a day for women. (One drink is defined as one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits.)
- Prioritize mental health. Be alert to signs of stress or depression. Maintain social connections—loneliness seems to increase the risk of heart disease because it increases stress. If you suspect you might have depression, talk with your healthcare provider; you don’t have to live with it.
- Know your family history of heart disease. Be aware if any of your family members have had a heart attack, stroke, or heart disease. If so, ask your healthcare provider if any additional testing is warranted.
- See your healthcare provider regularly. Have an annual physical. Experts recommend that all adults get their blood pressure checked once a year. Your healthcare provider can also perform a simple blood test to check your cholesterol and triglyceride levels, and an EKG or stress test to assess heart function.
- American Heart Association (AHA-a). (2019). Cardiovascular diseases affect nearly half of American adults, statistics show. Retrieved from https://www.heart.org/en/news/2019/01/31/cardiovascular-diseases-affect-nearly-half-of-american-adults-statistics-show
- American Heart Association (AHA-b). (2019). Heart Disease and Stroke Statistics—2019 at a Glance. Retrieved from https://healthmetrics.heart.org/wp-content/uploads/2019/02/At-A-Glance-Heart-Disease-and-Stroke-Statistics-%E2%80%93-2019.pdf
- Centers for Disease Control and Prevention (CDC). (2018, February 8). Heart Disease and Stroke. Retrieved from https://www.cdc.gov/tobacco/basic_information/health_effects/heart_disease/index.htm
- Centers for Disease Control and Prevention (CDC-a). (2019, December 2). Heart Disease Facts. Retrieved from https://www.cdc.gov/heartdisease/facts.htm
- Centers for Disease Control and Prevention (CDC-b). (2019, December 9). Know Your Risk for Heart Disease. Retrieved from https://www.cdc.gov/heartdisease/risk_factors.htm
- Centers for Disease Control and Prevention (CDC). (2020, January 31). Men and Heart Disease. Retrieved from https://www.cdc.gov/heartdisease/men.htm
- Cleveland Clinic. (2019, December 24). Women or Men – Who Has a Higher Risk of Heart Attack? Retrieved from https://health.clevelandclinic.org/women-men-higher-risk-heart-attack/
- Day, J. A. (2016, April 14). Depression and Heart Disease. Retrieved from https://www.hopkinsmedicine.org/heart_vascular_institute/centers_excellence/womens_cardiovascular_health_center/patient_information/health_topics/depression_heart_disease.html
- Harvard Health Publishing. (2016). Depression and heart disease: A two-way street. Retrieved from https://www.health.harvard.edu/heart-health/depression-and-heart-disease-a-two-way-street
- National Heart, Lung, and Blood Institute (NHLBI). (n.d.). Smoking and Your Heart. Retrieved from https://www.nhlbi.nih.gov/health-topics/smoking-and-your-heart
- National Institute for Health Research (NIHR). (2017, November 7). Being overweight or obese is linked with heart disease even without other metabolic risk factors. doi: 10.3310/signal-000501. Retrieved from https://discover.dc.nihr.ac.uk/content/signal-000501/being-overweight-or-obese-is-linked-with-heart-disease-even-without-other-metabolic-risk-factors
- Seconds Count (SCAI). (2014, November 4). Who Is Affected by Cardiovascular Disease? Retrieved from http://www.secondscount.org/treatments/treatments-detail-2/who-is-affected-by-cardiovascular-disease