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Heart Disease - Risk Factors for Coronary Artery Disease (CAD)

The lifetime risk of developing coronary artery disease (CAD) after age 40 is 49% for males, 32% for women. Efforts to reduce controllable risk factors, including diet and physical activity, should be taken to decrease CAD risk.

Controllable risk factors for CAD:

High blood cholesterol:

  • Low-density lipoproteins (LDL cholesterol): an overabundance of LDL cholesterol causes atherosclerosis, a narrowing of coronary arteries due to plaque build up on artery walls. Blood clots can form on plaque surfaces, further blocking the blood supply to the myocardium (heart muscle) and resulting in myocardial infarction (heart attack).
  • High-density lipoproteins (HDL cholesterol): HDL carries cholesterol away from the heart back to the liver where it is eventually removed from the body. High HDL cholesterol removes excess LDL cholesterol from artery walls, reducing atherosclerosis (a narrowing of the arteries).
Total cholesterol (mg/dL) LDL cholesterol (mg/dL) HDL cholesterol (mg/dL)
Ideal: Less than 200 Borderline high risk: 200-239
High risk: 240 and over		 Ideal: less than 130 Borderline high risk: 130-159
High risk: 160 or higher 		Ideal: 60 or higher
High risk: lower than 40

LDL cholesterol levels can be reduced by limiting consumption of saturated fats (whole-fat dairy products, cheeses, red meats), increasing physical activity, and weight reduction when appropriate. Increased consumption of monounsaturated fats (olive oil, nuts, fatty fish) has been shown to reduce LDL cholesterol and increase HDL cholesterol, lowering CAD risk. Drug therapy for cholesterol reduction includes statins, bile acid resins, nicotinic acid and fibrates.

The U.S. government recently recommended treating high cholesterol more aggressively in people with diabetes. Click here to read more.

Hypertension:

Hypertension (high blood pressure) results from arterial narrowing, which causes blood to be pumped with greater force against the artery walls. Hypertension can be corrected by dietary changes (i.e., avoiding salt, increasing consumption of fruits, vegetables, and low-fat dairy products). Drug therapy includes beta-blockers, ACE inhibitors, and calcium channel blockers.
Blood Pressure Category Systolic(mm Hg)   Diastolic(mm Hg)
Normal less than 120 and less than 80
Prehypertension 120-139 or 80-89
High      
Stage 1 140-159 or 90-99
Stage 2 160 or higher or 100 or higher

* Source: American Heart Association

Smoking: Smoking significantly increases heart disease and stroke risk. Specifically, smoking causes atherosclerosis (narrowing of arteries), thrombosis (blood clots), coronary artery spasm (abnormal constriction of the muscle fibers of the coronary artery) cardiac arrhythmia (abnormal heartbeat) and other disorders which increase the risk of myocardial infarction (heart attack). Further, research shows smoking to reduce HDL ("good") cholesterol levels.

Diabetes: Diabetes increases the risk of heart disease, stroke, blindness, hypertension, kidney disease, and amputations. Type II diabetes, formerly called adult onset diabetes, can often be prevented by increasing physical activity and reducing weight. For patients who already have diabetes, the focus should be placed on reducing controllable CAD risk factors such as cholesterol levels, blood pressures levels, not smoking, etc. Diabetics with high cholesterol should be treated aggressively to decrease the risk of heart disease.

Obesity: Obesity increases CAD and stroke risk. Obesity increases strain on the heart, raises blood pressure and cholesterol, and increases diabetes risk. Weight reduction can be achieved with modifications to diet and increased physical activity.

Body mass index (BMI) measures a person’s total body fat based on weight and height. BMI is derived by multiplying a person's weight in pounds by 703 and then dividing it twice by the person’s height in inches. According to federal guidelines:

  • BMI of 24 or under = not overweight
  • BMI of 25 to 29.9 = overweight
  • BMI of 30 or greater = obese

The following chart provides calculations for BMI based on weight and height:

Height (feet and inches)

Weight
(pounds)		 5'0" 5'2" 5'4" 5'6" 5'8" 5'10" 6'0" 6'2" 6'4" 6'6" 6'8"
100 20 18 17 16 15 14 14 13 12 12 11
105 21 19 18 17 16 15 14 14 13 12 12
110 22 20 19 18 17 16 15 14 13 13 12
115 23 21 20 18 18 17 16 15 14 13 13
120 23 22 21 19 18 17 16 15 14 14 13
125 24 23 22 20 19 18 17 16 15 14 14
130 25 24 22 21 20 19 18 17 16 15 14
135 26 25 23 22 21 19 18 17 16 16 15
140 27 26 24 23 21 20 19 18 17 16 15
145 28 27 25 23 22 21 20 19 18 17 16
150 29 27 26 24 23 22 20 19 18 17 17
155 30 28 27 25 24 22 21 20 19 18 17
160 31 29 28 26 24 23 22 21 20 19 18
165 32 30 28 27 25 24 22 21 20 19 18
170 33 31 29 27 26 24 23 22 21 20 19
175 34 32 30 28 27 25 24 23 21 20 19
180 35 33 31 29 27 26 24 23 22 21 20
185 36 34 32 30 28 27 25 24 23 21 20
190 37 35 33 31 29 27 26 24 23 22 21
195 38 36 34 32 30 28 27 25 24 23 21
200 39 37 34 32 30 29 27 26 24 23 22
205 40 38 35 33 31 29 28 26 25 24 23
210 41 38 36 34 32 30 29 27 26 24 23
215 42 39 37 35 33 31 29 28 26 25 24
220 43 40 38 36 34 32 30 28 27 25 24
225 44 41 39 36 34 32 30 29 27 26 25
230 45 42 40 37 35 33 31 30 28 27 25
235 46 43 40 38 36 34 32 30 29 27 26
240 47 44 41 39 37 35 33 31 29 28 26
245 48 45 42 40 37 35 33 32 30 28 27
250 49 46 43 40 38 36 34 32 30 29 28
255 50 47 44 41 39 37 35 33 31 30 28
260 51 48 45 42 40 37 35 33 32 30 29
265 52 49 46 43 40 38 36 34 32 31 29
270 53 49 46 44 41 39 37 35 33 31 30
275 54 50 47 44 42 40 37 35 34 32 30
280 55 51 48 45 43 40 38 36 34 32 31
285 56 52 49 46 43 41 39 37 35 33 31
290 57 53 50 47 44 42 39 37 35 34 32
295 58 54 51 48 45 42 40 38 36 34 32
300 59 55 52 49 46 43 41 39 37 35 33

Lack of physical activity: Regular exercise reduces CAD risk by controlling blood cholesterol levels, decreasing the risk of obesity or diabetes, and lowering blood pressure levels in some patients.

Stress: Research indicates a possible relationship between stress and CAD. Hypertension and high cholesterol are associated with stress, as are an increased tendency to smoke, gain weight, and/or decrease physical activity.

Uncontrollable risk factors for CAD:

Gender: Males are at higher risk of CAD than females, and males are also more likely to suffer myocardial infarction (heart attack) earlier in life. However, heart disease kills more females each year than any other disease, including breast cancer. An alarming survey reported by the American Heart Association found that only 8% of women perceive heart disease as the greatest threat to their health despite the fact that heart disease is the leading cause of death among both women and men. Over 500,000 American women die from cardiovascular disease each year--twice the number of deaths from all cancers combined. Also, women are more likely to die within the first year of a heart attack than men.

Advancing Age: Four out of five patients who suffer myocardial infarction (heart attack) are 65 years of age or older. For example, post-menopausal women are much more likely to have a heart attack than pre-menopausal women.

Family History: A family history of heart disease increases the risk for CAD and other heart problems.

Race: In the United States, African Americans tend to have more severe high blood pressure (hypertension) than Caucasians, increasing CAD risk. The incidence of heart disease is also higher among certain population groups such as Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This may be due to the fact that obesity and/or diabetes may be higher among some of these population groups.

Genetics: Patients may have congenital heart defects or other diseases that increase CAD risk.

Updated: March 16, 2008