Risk Factors

The American Heart Association (AHA) identifies risk factors or lifestyle habits that are most commonly found in people who have coronary artery disease (CAD). These factors can be divided into controllable and uncontrollable risk factors.

Controllable   Uncontrollable  
Tobacco Use  Age
High Blood Pressure  Gender
High Levels of Blood Cholesterol  Family History
Lack of Exercise  

We know that the presence of these factors makes some people “coronary-prone” or increases their chances of having CAD. A few people have CAD without possessing any of these risk factors. Still other factors may affect your risk of heart attack and stroke, too. They include unhealthy responses to stress, hormonal factors, excessive alcohol and some illegal drugs.

Tobacco Use (Cigarettes, pipe, cigar and smokeless tobacco)
Tobacco use is the number one preventable cause of death and disease in the U.S. Tobacco use is more likely to be the reason a person has heart disease than having high cholesterol, high blood pressure or stress. Studies have shown that using tobacco makes the heart beat faster, may elevate blood pressure, and cause the coronary arteries to narrow. Tobacco use also increases the chances of blood clots forming in arteries. These responses of the body to smoking are caused by a powerful chemical, nicotine, found in tobacco. All of these reactions significantly increase the work load of the heart. Tobacco use also increases the bad cholesterol (LDL) and decreases the good cholesterol (HDL) in the blood system, increasing the risk for plaque formation.

Carbon monoxide is also a dangerous by-product of smoking. It prevents the red blood cell from carrying as much oxygen as needed by the heart and body. This lack of oxygen to the heart could bring on chest pain and/or cause damage to the heart muscle itself.

Other harmful effects of tobacco use are the possibility of developing peptic ulcer disease, lung cancer and serious lung diseases such as emphysema, bronchitis and asthma.

What this all adds up to is increased work for the heart, added danger of damage to the heart, and impaired  function of other body organs. Smoking dramatically increases the occurrence of sudden death from coronary artery disease (CAD). Smokers are four times as likely to have a heart attack as nonsmokers.

Smoking has no known beneficial effects. It is a risk you cannot afford. It is worth the effort to stop smoking, regardless of the number of years you have smoked. It is never too late to add extra years and/or quality to your life.

If you need help quitting, Gundersen Health System offers a tobacco cessation clinic called Journey to Freedom. This program is offered three times per year and is a comprehensive 24-week journey toward your destination-freedom from nicotine. Learn more about tobacco cessation.

High Blood Pressure (Hyper tension)
Many Americans have high blood pressure and don’t even know it. Often, there are no obvious symptoms related to high blood pressure. That is why medical checkups are so important to help detect this “silent disease” that greatly increases one’s risk of heart disease. When a person with high blood pressure has other conditions such as obesity, elevated cholesterol or diabetes, the risk of heart disease greatly increases. Hypertension, once detected, must be treated and controlled for the rest of one’s life in order to prevent damage to the heart, brain, kidneys and other organs. A goal to strive for with blood pressure is 130/80 at rest.

When the heart pumps blood through the arteries, pressure is created against the artery walls, which we can measure. This is called blood pressure and is measured with a blood pressure cuff. When the blood pressure increases significantly and remains high, it causes constant extra work for the heart and speeds the narrowing of the coronary arteries. Although we still do not know exactly what causes high blood pressure, treatment may include:

  •  Decreased salt (sodium) intake.
  •  Medication.
  •  Coping with and/or reducing stressors in one’s life.
  •  Weight reduction.
  •  Exercise.
  •  Smoking termination.
  •  Regular checkups.

High Cholesterol and Intake of Animal Fat
Cholesterol is a fatty substance produced by your body and also found in many of the foods we eat. Cholesterol is needed for normal body functions, such as, cell wall protection, nerve impulse transmission and hormone production. High levels of blood cholesterol are associated with a greater risk of developing atherosclerosis (narrowed arteries). The more fat we eat the higher our cholesterol will be.

We are able to measure several forms of cholesterol. The total cholesterol in people with one or more other risk factors should be 200 or less.

The HDL (high density lipoproteins) are the “good guys” of the cholesterol family. High levels of HDL help remove LDL (low density lipoprotein) from the body. People with HDL values of 50-70 mg/dl have a significantly lower chance of developing heart disease. Watching your diet, exercising, maintaining a normal weight and not smoking can help increase the “good cholesterol”.

LDL (low density lipoproteins) are the “bad guys” of the cholesterol family. The level of LDL recommended for persons with coronary artery disease is ideally 100 or less. It can be treated to 70 mg/dl. LDL’s can be lowered by decreasing the saturated fat and cholesterol in your diet.

Triglycerides are another type of fat found in our blood. Triglycerides tend to be elevated in people who have diabetes, are overweight or drink too much alcohol. Some people over manufacture triglycerides as well. An acceptable level of triglycerides is 150 or less.

Tension and Stress
Some authorities consider the tension and stressors in one’s life to be major factors in the development of CAD. Although we are all faced with many decisions, responsibilities and potential stressful situations each day, the key is how one handles these encounters.

How then does one “slow down” and reduce stress and tension in daily living? Staff is available to help you evaluate your current stress level and to offer some practical suggestions for behavior change. There are also counselors here who specialize in this area and are able to work with people on a more individual basis over a longer period of time.

Learning to handle stress and tension in your life is part of a change in lifestyle that will be beneficial to you in your efforts to delay or prevent further heart disease.

Lack of Exercise
Studies have shown that people who lead inactive lives have a greater risk of having CAD than do those who exercise regularly. People who get regular exercise have better control over all cardiovascular risk factors like hypertension, obesity, high cholesterol and diabetes.

Exercise causes conditioning of the heart and skeletal muscle. Heart muscle in a well-conditioned person does not have to work as hard to circulate blood and nourish the body. We cannot say for certain that regular exercise will prevent the progression of atherosclerosis, but it may decrease its rate of progression. Current evidence regarding exercise after a heart attack seems to suggest that although another heart attack may not be prevented, survival after another heart attack is improved.

People who exercise regularly feel better. People who are well conditioned get through their daily activities with less strain on their heart than those who are deconditioned.

Overweight (Obesity)
If a person is overweight, the heart must work harder to nourish the extra tissue with blood. Extra pounds mean extra work for the heart! Your healthcare providers may suggest a reducing diet if you are overweight.

You should never “crash diet” but select a weight-reducing program that works for you. Develop sensible eating habits and you will lose weight and keep it off.

Exercise in combination with a diet plan will help you in your weight reduction program. If you’re not overweight now, keep it that way!

Diabetes, or sugar in the blood, occurs when the body is unable to produce enough of a chemical or hormone called insulin or is unable to use the available insulin effectively. When the body lacks insulin, sugar and starches cannot be used properly for energy, causing excess sugar to build up in the blood. This can cause impaired circulation by acceleration of atherosclerosis. Uncontrolled diabetes may also have harmful long-range effects on the kidneys, eyes, brain, heart and the nervous system.

Diabetes often appears in men and women in their middle years, especially if they are overweight. If you become aware of any of the early warning signs of possibly elevated blood sugar (excessive thirst, excessive hunger, excess urination, weight loss and/or chronic fatigue) seek medical attention in order to receive a thorough examination and means of diabetic management.

One can inherit the tendency towards having CAD. If you have close relatives who have had coronary disease, especially if it was before the age of 50, your chances of having CAD are also increased. Even though you may inherit the tendency toward heart disease, you may help prevent or delay it by reducing the controllable risk factors in your life. It is especially important that your children are taught to control risk factors too!

Atherosclerosis is a normal aging process. The older you become, the more likely you are to develop coronary artery disease. A man’s risk for CAD begins to increase at age 45. A woman’s risk increases after menopause.

Women have less CAD than men until they experience menopause. The decrease in hormones in menopause increases the occurrence of atherosclerosis. Heart and vascular disease claim more American women’s lives each year than do all forms of cancer combined.

PROPER MEDICATIONS for cardiovascular disease almost always include Aspirin in any form such as a baby aspirin or enteric-coated adult aspirin or inexpensive generic aspirin on a daily basis. If you had a heart attack, the beta blockers are often recommended. There should be a reason for not using them if that is the case. Talk to your doctor. Other drugs such as ACE Inhibitors and statins may be indicated for you, especially if you are diabetic. Again, talk to your doctor.

Have you met all of these goals? If so, you are doing everything you can to decrease your risk for future heart disease. If not, talk to your doctor and make a plan to get this important job done.

* <130/80 if diabetic and renal patient.

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