Heart disease: Risks you can help control

Tobacco use

Tobacco use is the most preventable cause of death in the United States.

• Cigarette smokers are two to four times more likely to develop heart disease than nonsmokers, and 10 times as likely to develop peripheral artery disease (PAD).
• People who smoke are at an increased risk for heart attack, stroke and circulatory problems, as well as cancer, lung disorders and reproductive health issues.

Quit altogether or at least reduce your use of tobacco.

• Talk with your doctor about your best treatment options.
• You can also check with your insurance provider about quitting programs that may be available to you.
• For more information, see Smoking: A heart disease risk factor you can control.

High blood pressure

Blood pressure is the amount of pressure within the walls of your arteries. Blood pressure is measured by two numbers:

• The first (top) number is the systolic blood pressure. It measures the amount of pressure within the walls of your blood vessels during heartbeats. (When your heart is pumping.)
• The second (bottom) number is the diastolic blood pressure. It measures the amount of pressure within the walls of your blood vessels between heartbeats (when your heart is resting).

Your blood pressure is written with the systolic number above the diastolic number (such as 120/80). A reading of 140/90 or greater is considered high blood pressure (hypertension).

High blood pressure can have a few different causes, any of which cause increased pressure against artery walls:

• a narrowing of the arteries (artherosclerosis or temporary constriction)
• a greater than normal volume of blood
• the heart beating faster or more forcefully than it should
• heredity (your family history)
• kidney disorders
• eating too much salt
• certain medicines
• rare tumors and other diseases.

If not found and treated, high blood pressure can cause:

• heart failure
• heart attack
• kidney failure (chronic kidney disease)
• aneurysms (small bulges) in blood vessels
• vision changes and blindness
• stroke

Have your blood pressure checked regularly. Ask your health care team what your target blood pressure should be.

High blood cholesterol (high total cholesterol and high LDL cholesterol)

Blood cholesterol naturally occurs in your body. It is a white, waxy substance that is found in your cell walls,hormones and bile acids. How much cholesterol you have in your body is determined by your: genetics (family history),food choices, weight and activity level.

There are two kinds of cholesterol, sometimes called "good" and "bad."

• Good cholesterol is called high density lipoprotein, or HDL. HDLs are believed to help remove "bad" cholesterol from your body, so the more you have — the higher your HDL levels — the better. HDL levels under 40 mg/dL are considered a risk factor for heart disease. You can increase your HDL level by exercising aerobically, losing weight and not smoking. Don’t be too disappointed if your HDL levels don’t go up much. Your low HDL may be caused by your family history.
• Bad cholesterol is low density lipoprotein, or LDL. LDL carries cholesterol from your liver to other tissues in your body, and forms deposits on blood vessel walls. Too much cholesterol can build up in your blood vessels and "clog the pipes." LDL levels under 100 mg/dL are desirable in a person with heart disease.

Sometimes, you'll hear triglycerides discussed along with cholesterol. Triglycerides are a normal part of your blood. High levels can be caused by alcohol use or high sugar and fat intake. High triglycerides with low HDL are associated with increased risk of heart disease. Check the following chart for good levels.

To keep your heart its healthiest, your cholesterol levels should fall within the recommended range.

Desirable cholesterol levels for people with coronary artery disease

Total cholesterol	LDL "bad" cholesterol	HDL "good" cholesterol	Triglycerides
Less than 200 mg/dL	Less than 70 mg/dL	More than 60 mg/dL	Less than 150 mg/dL

Stress

Strong emotions can cause your body to make more adrenaline, a hormone that increases your heart rate and blood pressure. Tension causes small arteries in your body to contract (get smaller) and may temporarily raise your blood cholesterol levels.

Stress can be big, such as: death, divorce, marriage, job loss or change, financial problems, family illness, moving or having a baby. Stress can be smaller, such as: standing in a long line at the grocery store with a fussy child, getting stuck in traffic or being bogged down at work while facing a deadline.

How you handle stress will have an affect on your body and emotional well-being. You can help manage stress by trying to reduce the causes. When you are under stress, you must take good care of yourself.

• Eat well-balanced meals and healthful snacks. Drink plenty of water each day.
• Do not smoke or chew smokeless tobacco.
• Get plenty of rest each night. In the morning, you should feel relaxed and fresh.
• Exercise three to five times each week. Go for a walk, bike ride, swim, join a dance class or do stretching exercises.
• Focus your attention on something relaxing, not stressful.
• Ask for help if you can't handle your work load or home duties. There’s no shame in admitting you need help.
• Don't worry about things you can't change.
• Write down what causes you stress and how you handle each situation.
• Avoid as much stress as you can. Try not to drive in rush hour traffic and avoid situations that make you feel anxious or emotionally drained.
• Schedule things you enjoy.
• Take a break. Sit back and take a few deep breaths.
• Develop a positive attitude.
• Do relaxation exercises.

Lack of exercise

Regular exercise is important to:

• maintain your ideal body weight
• manage your cholesterol levels, stress level and blood pressure
• improve your muscle tone
• improve how well your heart and circulation work
• increase your resistance to fatigue
• help prevent blood clots from forming in your arteries
• improve your mental and emotional well-being
• decrease your blood fats
• suppress your appetite.

Help manage this risk by beginning and maintaining an exercise program. Start small, but keep at it. Ask your health care provider for some suggestions.

Weight

Being overweight makes your heart work harder. Help manage this risk by working to maintain the
body weight that is right for you:

• Eat a well-balanced diet.
• Limit fats and sweets.
• Do activities and exercise as you are able and as recommended by a cardiac rehabilitation therapist or doctor.
• Eat only when you are hungry, not when you are bored, tired or feeling stressed.

Eating habits

What you eat directly affects the health of your heart. Eating a well-balanced, low-fat diet with a variety of healthful foods is a great way to help your heart. Choosing healthful foods — even if you are in a time crunch — and eating only when you are hungry is important.

• A diet high in cholesterol, saturated fats and trans fats puts you at an increased risk for heart disease.
• A diet high in sodium makes your body retain fluid and can raise your blood pressure.
• A diet too high or too low in potassium can make your heart rhythm irregular.

Help manage this risk by following a diet created by your health care team.

Diabetes

Having diabetes puts you at an increased risk for heart problems because of the disease's effect on your blood vessels. When diabetes is not under control, a build-up of glucose in your blood leads to an increase in triglycerides, which hardens your blood vessels.

Adults who have diabetes are two to four times more likely to have heart disease or suffer a stroke than people who do not have diabetes. About 65 percent of people who have diabetes die from heart disease or stroke, according to the National Diabetes Education Program.

Diabetes is a stronger heart disease risk factor for women than it is for men.

Diabetes is a lifelong disease that cannot be cured, but it can be managed. To reduce your risk for heart disease and stroke, control your glucose and lipid levels, manage your blood pressure, get regular exercise, control your weight, watch your diet and do not smoke. Work with your health care team to keep your fasting blood glucose below 120 mg/dL and your hemoglobin A1c below 7 percent.

Alcohol

Studies show a link between heavy alcohol use and heart disease. Heart enlargement or heart failure can occur after
long-term moderate or heavy alcohol use.

Heavy use of alcohol can increase your blood pressure, raise your triglyceride levels and add more calories to your diet.

Light alcohol use is not linked with increased heart risk and it may even have benefits. Talk with your health care team about your alcohol use.

Related Links

Heart disease: Risks you cannot control

Heart attack or brain attack (stroke): Are you at risk?

Cardiovascular disease specialists

First published: 10/04/2002
Last updated: 06/01/2007

Reviewed by: Allina Patient Education experts