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Causes of Heart Disease
Disease Risk Factors
From Texas Heart Institute
Cardiovascular disease can take many forms: high blood pressure, coronary
artery disease, valvular heart disease, stroke, or rheumatic fever/rheumatic
heart disease. According to the World Health Organization, cardiovascular
disease causes 12 million deaths in the world each year. Cardiovascular disease
is responsible for half of all deaths in the United States and other developed
countries, and it is a main cause of death in many developing countries as well.
Overall, it is the leading cause of death in adults.
In the United States, more than 60 million Americans have some form of
cardiovascular disease. About 2600 people die every day of cardiovascular
disease. Cancer, the second largest killer, accounts for only half as many
Coronary artery disease, the most common form of cardiovascular disease, is the
leading cause of death in America today. But thanks to many studies involving
thousands of patients, researchers have found certain factors that play an
important role in a person's chances of developing heart disease. These are
called risk factors.
Risk factors are divided into two categories: major and contributing. Major risk
factors are those that have been proven to increase your risk of heart disease.
Contributing risk factors are those that doctors think can lead to an increased
risk of heart disease, but their exact role has not been defined.
The more risk factors you have, the more likely you are to develop heart
disease. Some risk factors can be changed, treated, or modified, and some
cannot. But by controlling as many risk factors as possible, through lifestyle
changes and/or medicines, you can reduce your risk of heart disease.
Major Risk Factors
High Blood Pressure (Hypertension). High blood pressure increases your
risk of heart disease, heart attack, and stroke. Though other risk factors can
lead to high blood pressure, you can have it without having other risk factors.
If you are obese, you smoke, or you have high blood cholesterol levels along
with high blood pressure, your risk of heart disease or stroke greatly
Blood pressure can vary with activity and with age, but a healthy adult who is
resting generally has a systolic pressure reading between 120 and 130 and a
diastolic pressure reading between 80 and 90 (or below).
High Blood Cholesterol. One of the major risk factors for heart disease
is high blood cholesterol. Cholesterol, a fat-like substance carried in your
blood, is found in all of your body's cells. Your liver produces all of the
cholesterol your body needs to form cell membranes and to make certain hormones.
Extra cholesterol enters your body when you eat foods that come from animals
(meats, eggs, and dairy products).
Although we often blame the cholesterol found in foods that we eat for raising
blood cholesterol, the main culprit is the saturated fat in food. (Be sure to
read nutrition labels carefully, because even though a food does not contain
cholesterol it may still have large amounts of saturated fat.) Foods rich in
saturated fat include butter fat in milk products, fat from red meat, and
tropical oils such as coconut oil.
Too much low-density lipoprotein (LDL or "bad cholesterol") in the blood causes
plaque to form on artery walls, which starts a disease process called
atherosclerosis. When plaque builds up in the coronary arteries that supply
blood to the heart, you are at greater risk of having a heart attack.
Diabetes. Heart problems are the leading cause of death among people with
diabetes, especially in the case of adult-onset or Type II diabetes (also known
as non-insulin-dependent diabetes). Certain racial and ethnic groups (African
Americans, Hispanics, Asian and Pacific Islanders, and Native Americans) have a
greater risk of developing diabetes. The American Heart Association estimates
that 65% of patients with diabetes die of some form of cardiovascular disease.
If you know that you have diabetes, you should already be under a doctor's care,
because good control of blood sugar levels can reduce your risk. If you think
you may have diabetes but are not sure, see your doctor for tests.
Obesity and Overweight. Extra weight is thought to lead to increased
total cholesterol levels, high blood pressure, and an increased risk of coronary
artery disease. Obesity increases your chances of developing other risk factors
for heart disease, especially high blood pressure, high blood cholesterol, and
Many doctors now measure obesity in terms of body mass index (BMI), which is a
formula of kilograms divided by height in meters squared (BMI =W [kg]/H [m2]).
According to the National Heart, Lung, and Blood Institute (NHLBI), being
overweight is defined as having a BMI over 25. Those with a number over 30 are
Smoking. Most people know that cigarette and tabacco smoking increases
your risk of lung cancer, but fewer realize that it also greatly increases your
risk of heart disease and peripheral vascular disease (disease in the vessels
that supply blood to the arms and legs). According to the American Heart
Association, more than 400,000 Americans die each year of smoking-related
illnesses. Many of these deaths are because of the effects of smoking on the
heart and blood vessels.
Research has shown that smoking increases heart rate, tightens major arteries,
and can create irregularities in the timing of heartbeats, all of which make
your heart work harder. Smoking also raises blood pressure, which increases the
risk of stroke in people who already have high blood pressure. Although nicotine
is the main active agent in cigarette smoke, other chemicals and compounds like
tar and carbon monoxide are also harmful to your heart in a variety of ways.
These chemicals lead to the buildup of fatty plaque in the arteries, possibly by
injuring the vessel walls. And they also affect cholesterol and levels of
fibrinogen, which is a blood-clotting material. This increases the risk of a
blood clot that can lead to a heart attack.
Physical Inactivity. People who are not active have a greater risk of
heart attack than do people who exercise regularly. Exercise burns calories,
helps to control cholesterol levels and diabetes, and may lower blood pressure.
Exercise also strengthens the heart muscle and makes the arteries more flexible.
Those who actively burn 500 to 3500 calories per week, either at work or through
exercise, can expect to live longer than people who do not exercise. Even
moderate-intensity exercise is helpful if done regularly.
Gender. Overall, men have a higher risk of heart attack than women. But
the difference narrows after women reach menopause. After the age of 65, the
risk of heart disease is about the same between the sexes when other risk
factors are similar.
Heredity. Heart disease tends to run in families. For example, if your
parents or siblings had a heart or circulatory problem before age 55, then you
are at greater risk for heart disease than someone who does not have that family
history. Risk factors (including high blood pressure, diabetes, and obesity) may
also be passed from one generation to another.
Also, researchers have found that some forms of cardiovascular disease are more
common among certain racial and ethnic groups. For example, studies have shown
that African Americans have more severe high blood pressure and a greater risk
of heart disease than whites. The bulk of cardiovascular research for minorities
has focused on African Americans and Hispanics, with the white population used
as a comparison. Risk factors for cardiovascular disease in other minority
groups are still being studied.
Age. Older age is a risk factor for heart disease. In fact, about 4 of
every 5 deaths due to heart disease occur in people older than 65.
As we age, our hearts tend to not work as well. The heart's walls may thicken,
arteries may stiffen and harden, and the heart is less able to pump blood to the
muscles of the body. Because of these changes, the risk of developing
cardiovascular disease increases with age. Because of their sex hormones, women
are usually protected from heart disease until menopause, and then their risk
increases. Women 65 and older have about the same risk of cardiovascular disease
as men of the same age.
Contributing Risk Factors
Stress. Stress is considered a contributing risk factor for heart disease
because little is known about its effects. The effects of emotional stress,
behavior habits, and socioeconomic status on the risk of heart disease and heart
attack have not been proven. That is because we all deal with stress
differently: how much and in what way stress affects us can vary from person to
Researchers have identified several reasons why stress may affect the heart.
Stressful situations raise your heart rate and blood pressure, increasing the
your heart's need for oxygen. This need for oxygen can bring on angina pectoris,
or chest pain, in people who already have heart disease.
During times of stress, the nervous system releases extra hormones (most often
adrenaline). These hormones raise blood pressure, which can injure the lining of
the arteries. When the arteries heal, the walls may harden or thicken, making is
easier for plaque to build up.
Stress also increases the amount of blood clotting factors that circulate in
your blood, and makes it more likely that a clot will form. Clots may then block
an artery narrowed by plaque and cause a heart attack.
Stress may also contribute to other risk factors. For example, people who are
stressed may overeat for comfort, start smoking, or smoke more than they
Sex hormones. Sex hormones appear to play a role in heart disease. Among
women younger than 40, heart disease is rare. But between the ages 40 and 65,
around the time when most women go through menopause, the chances that a woman
will have a heart attack greatly increase. From 65 onward, women make up about
half of all heart attack victims.
Birth control pills. Early types of birth control pills contained high
levels of estrogen and progestin, and taking these pills increased the chances
of heart disease and stroke, especially in women older than 35 who smoked. But
birth control pills today contain much lower doses of hormones. Birth control
pills are considered safe for women younger than 35, who do not smoke or have
high blood pressure.
But if you smoke or have other risk factors, birth control pills will increase
your risk of heart disease and blood clots, especially if you are older than 35.
According to the American Heart Association, women who take birth control pills
should have yearly check-ups that test blood pressure, triglyceride, and glucose
Alcohol. Studies have shown that the risk of heart disease in people who
drink moderate amounts of alcohol is lower than in nondrinkers. Experts say that
moderate intake is an average of one to two drinks per day for men and one drink
per day for women. One drink is defined as 1?fluid ounces (fl oz) of 80-proof
spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-proof
spirits, 4 fl oz of wine, or 12 fl oz of beer. But drinking more than a moderate
amount of alcohol can cause heart-related problems such as high blood pressure,
stroke, irregular heartbeats, and cardiomyopathy (disease of the heart muscle).
And the average drink has between 100 and 200 calories. Calories from alcohol
often add fat to the body, which may increase the risk of heart disease. It is
not recommended that nondrinkers start using alcohol or that drinkers increase
the amount that they drink.
It is never too late梠r too early梩o begin improving heart health. Some risk
factors can be controlled, while others cannot. But, by eliminating risk factors
that you can change and by properly managing those that you cannot control, you
may greatly reduce your risk of heart disease.
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