Heart Health and Diabetes

What are the risk factors for heart disease?

Heart disease is the most common cause of death in the United States (1) and the second leading cause of death in Canada (2). Approximately 18.2 million adults in the United States have coronary artery disease (the most common type of heart disease), and every year about 655,000 Americans die from heart disease (1).

There are several different factors that can increase the risk of heart disease (3). Some of these factors cannot be changed (e.g. genetic risk), while lifestyle changes can mitigate the risk associated with some of the other risk factors (e.g. abstaining from smoking).

In this article, we will discuss what can increase your risk of heart disease, and how you can try to minimize that risk.

Risk factors for heart disease include:

  • High blood pressure
  • High blood cholesterol
  • Overweight or obese
  • Prediabetes or diabetes
  • Smoking
  • Sedentary lifestyle
  • Family history
  • Unhealthy diet
  • Older than 55 for females or older than 45 for males

High blood pressure
High blood pressure can also be called hypertension. It is when blood flows through the arteries at higher-than-normal pressure. Normal blood pressure in adults is less than 120/80 mm Hg, while high blood pressure is when the systolic reading is at least 130 mm Hg or the diastolic reading is at least 80 mm Hg (4).

Most affected people are not even aware that they have high blood pressure until it causes a serious health problem, in particular heart disease. This is why health recommendations state that everyone aged 3 years or older should have their blood pressure checked at least once a year (4). Blood pressure checks are simple, painless, and very quick.

Following a heart-healthy lifestyle is often all that is required to lower high blood pressure. This should include a healthy diet, limited alcohol, regular physical exercise, maintenance of a healthy weight, abstaining from smoking, getting quality sleep, and managing stress. If these lifestyle changes do not adequately control blood pressure, medications may be prescribed (4). See our “How to keep a healthy heart” article for more information.

High blood cholesterol
Cholesterol is a waxy type of fat (lipid), which travels around the body in the blood. It is produced in adequate quantities in the liver, but can also be obtained from foods from animals. Cholesterol is an essential molecule, but only in moderation. Excess cholesterol can cause health complications and is particularly damaging to blood vessels. Total cholesterol levels below 200 mg/dL are considered desirable for adults (5).

Cholesterol is carried around the body by lipoproteins, particularly low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL-cholesterol is considered the “bad” cholesterol, as when in excess, it can get deposited in the blood vessels. In contrast, HDL-cholesterol is “good” cholesterol, as this gets scavenged from around the body and returned to the liver for recycling or excretion (6).

The National Cholesterol Education Program (NCEP) recommends that all adults 20 years of age and over should have a fasting lipoprotein profile (total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride) once every five years to screen for coronary heart disease risk (5). A blood test can measure your cholesterol levels. This can be through your doctor or simply use one of our at-home heart health tests for an accurate analysis.

The same heart-healthy lifestyle recommended to lower high blood pressure is also beneficial for reducing high cholesterol, and more information about specific foods to avoid is available here. Medications may also be required, with the most common being statins (7).

Overweight or obese
Overweight and obesity are becoming more and more common in the United States. Carrying excess body weight puts additional strain on your whole body, significantly increasing the risk of heart disease, as well as diabetes, cancers, sleep disorders, and metabolic syndrome.

Starting with a heart-healthy lifestyle is the best approach to losing excess weight and keeping it off. In particular, to be able to lose weight, energy output (through physical activity) needs to be more than energy input (through diet) (8). Medications and surgical procedures are other options, but physical activity is the first step. If you are physically inactive, start small and work from there. Any exercise is better than nothing!

Prediabetes or diabetes
Diabetes is a metabolic disorder that occurs when the pancreas is no longer able to make sufficient insulin, or when the body cannot make good use of the insulin it produces. This inhibits the control of blood glucose (sugar) levels and leads to raised blood glucose (hyperglycemia), which causes damage to various tissues and organs in the body. Hyperglycaemia can weaken blood vessels and increase the likelihood of cholesterol buildup and plaque formation, the very factors that contribute to heart disease (9). In fact, in the United States, at least 68% of people over 65 years with diabetes die from heart disease (10).

Type 2 diabetes is by far the most common form of diabetes, but can usually be prevented with healthy food choices and adequate physical activity. Pre-diabetes (also known as impaired glucose tolerance) is when blood glucose is higher than normal, but not high enough to be considered diabetes. Pre-diabetes is associated with an increased risk of type 2 diabetes, but diet and lifestyle changes can prevent the disease progression (9).

Monitoring and effectively controlling your blood sugar levels is very important for diabetic people to reduce the risk of heart complications as well as other diabetic complications. Measurements of HbA1c levels are a beneficial way to monitor blood sugar levels.

Smoking
Smoking contributes to a multitude of health problems, including as a major contributor to heart disease.

The chemicals in cigarettes can cause the cells lining the blood vessels to swell and become inflamed, narrowing the blood vessels. This contributes to the formation of atherosclerotic plaques, which occur when fat and cholesterol build-up. These cigarette chemicals also cause the blood to thicken and increase the risk of blood clots forming (11).

The more you smoke and the longer you continue to smoke, the higher your risk of heart disease. Quitting smoking reduces your risk of heart disease. Consider joining a support group if you are having trouble quitting smoking on your own.

Sedentary lifestyle
A sedentary lifestyle (lack of physical activity) is a significant risk factor for heart disease, as well as a risk factor for diabetes, high blood pressure, high cholesterol, and obesity – which are all other risk factors for heart disease! According to WHO, 60-85% of people around the world have sedentary lifestyles and nearly 2/3 of children also don’t get enough exercise (12). Being physically inactive increases your risk of heart disease just as much as smoking, high blood pressure, and high cholesterol (13).

So how much exercise do you need to improve your heart health? The American Heart Association recommends 30-60 minutes of aerobic exercise 3-4 times per week (13). This doesn’t need to be a workout at the gym or a 10 km run, just something as simple as an evening walk, dancing, or yard work will provide you with significant benefits for your heart and your lungs too.

Family history
A family history of heart disease may be indicative of an underlying genetic factor that increases the risk of heart problems. Common genetic variants that are linked to an increased risk of heart disease (particularly high cholesterol) include variants in the APOE, LDLR, APOB, and PCSK9 genes (14).

Although genetic testing is available to detect these risk variants, there is nothing that you can do to change your genetic risk of heart disease. However, knowing that you are genetically predisposed to heart disease may be just the push you need to improve your health and reduce your other risk factors.

It is also important to note that family history alone does not definitely mean you have inherited genetic risk factors. Unfortunately, poor diet and lifestyle are often “inherited” from your parents too. Don’t make the same poor choices that will lead you down the same path to heart disease.

Unhealthy diet
Good nutrition is essential for not just heart health, but also to lower the risk of obesity, diabetes, and certain cancers. However, according to the CDC, most Americans do not have a healthy diet. Less than 10% of adults eat enough fruits and vegetables, 90% consume too much sodium, and more than 50% have a sugary drink most days (15).

Although the easy food option might be a prepackaged and highly processed snack, it is the worst option for your heart health! Do your heart a favor and grab a fruit or vegetable snack, instead of that bag of chips.

Focus on consuming lots of nutrient-rich foods to obtain plenty of vitamins, fiber, and other nutrients. Include lots of vegetables, fruits, and whole grains, choose fat-free or low-fat dairy products over full-fat, obtain your protein from healthy sources (e.g. fish, lean meats, eggs, nuts, seeds, legumes) instead of fatty meats, and consume oils and foods high in monounsaturated and polyunsaturated fats (e.g. olive oil, nuts, salmon, avocados, tofu) in place of foods high in saturated and trans fats (3).

Older than 55 for females or older than 45 for males
Increasing age is obviously one of the risk factors that no one can change! But it is even more important when you’re older to get regular checkups and adequately monitor your health, so if anything is untoward, you can make changes before it is too late.

Annual measurements of blood pressure should continue. Lipid (cholesterol) analyses should increase from once every five years to an annual analysis, even in the absence of other risk factors (other than age) (16).

References:
1. Heart Disease Facts. Heart Disease. (Reviewed Sept 2020) CDC
2. Heart Disease in Canada. Government of Canada. (Modified Feb 2017)
3. Heart-Healthy Living. National Heart, Lung, and Blood Institute. NIH
4. High Blood Pressure. National Heart, Lung, and Blood Institute. NIH.
5. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. (2002). Circulation. 106 (25), 3143-421.
6. HDL (Good), LDL (Bad) Cholesterol and Triglycerides. American Heart Association. (2020).
7. Blood Cholesterol. National Heart, Lung, and Blood Institute. NIH.
8. Overweight and Obesity. National Heart, Lung, and Blood Institute. NIH.
9. What is Diabetes? National Institute of Diabetes and Digestive and Kidney Diseases. NIH
10. Lifestyle Changes for Heart Attack Prevention. Heart Attack. (Reviewed July 2015). American Heart Association.
11. Smoking and Cardiovascular Disease. CDC Fact Sheet.
12. Physical inactivity a leading cause of disease and disability, warns WHO. (April 2002). World Health Organization.
13. Physical Inactivity and Cardiovascular Disease. Department of Health, New York States.
14. Song Y, Stampfer MJ, Liu S (2004). Meta-Analysis: Apolipoprotein E Genotypes and Risk for Coronary Heart Disease. Ann Intern Med. 141(2): 137-147.
15. Poor Nutrition. National Center for Chronic Disease Prevention and Health Promotion. (Reviewed Jan 2021). CDC
16. Sazlina SG (2015) Health screening for older people – what are the current recommendations? Malays Fam Physician. 10(1), 2-10.