RISK FACTORS
THINGS YOU CAN CHANGE
Cholesterol
How can cholesterol affect your health?
Cholesterol is a waxy, fat-like substance in your blood.
You get cholesterol from two sources:
• Your liver produces cholesterol, since your body needs
a certain amount to function properly. In fact, your
body typically makes all of the cholesterol you need.
• You get cholesterol through foods such as red meats,
egg yolks, and whole-milk dairy products.
There are two types of cholesterol:
• LDL or low-density lipoprotein (bad cholesterol)
• HDL or high-density lipoprotein (good cholesterol)
Most people consume much more cholesterol than they need. So some of the
excess cholesterol in the blood can build up in your blood vessels and form
plaque. Enough plaque can lead to atherosclerosis which can, over time, clog
your arteries. It can also lead to a higher risk of:
• Coronary artery disease (CAD)
• Chest pain (angina)
• Heart attack
• Stroke
What you can do
To some degree your cholesterol level may be hereditary. But even if you might
have inherited a risk for high cholesterol, it's possible to make a significant impact
on your cholesterol if you:
• Lower the amount of fatty and processed food you eat—at home, in
restaurants, and at fast-food chains
• Exercise regularly—this lowers LDL and raises HDL
• Maintain a healthy weight—losing weight improves both LDL and HDL
• Quit smoking—quitting can raise levels of HDL (good cholesterol)
Please check with your doctor or nurse before starting a diet or exercise
program.
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Diet
How can diet affect your health?
The foods you eat have a huge impact on your health. When you improve your
eating habits, you improve your overall health. Consider these examples:
• Fiber improves your cholesterol and blood sugar levels. Controlling blood
sugar levels is important for people with pre-diabetes or diabetes.
• Too much alcohol can increase your blood pressure, cause heart failure, and
lead to stroke.
• Saturated fat or cholesterol can cause plaque buildup in your arteries, which
increases your risk for stroke and heart attack.
• Salt or sodium—found in many canned foods, frozen dinners, and fast
foods—can raise blood pressure for many people. If you have heart failure,
salt can also make your symptoms worse.
What you can do
The following are typical guidelines for a heart-healthy diet:
• Eat more fiber—fresh vegetables, whole grain breads and cereals, dried
beans, and oats.
• Limit the amount of fat you eat—especially saturated fat, or fat from animals.
• Drink alcohol in moderation—one drink per day for women, two for men.
• Eat plenty of fruits and vegetables—instead of chips or other snacks high in
cholesterol and sodium.
• Buy foods with the American Heart Association heart-check mark.
American Heart Association and logo are trademarks of the American Heart
Association.
• Limit salt intake—and check out the sodium content on the foods you eat.
Find out from your doctor or nurse if you should follow any special food
guidelines.
Don't discount the impact that lifestyle changes can have on your health.
According to the National Institutes of Health, a healthy lifestyle can help lower
heart disease risk by 82%. In most cases, this means you should follow a hearthealthy eating plan, get regular physical activity, maintain a healthy weight, and
quit smoking.
Please check with your doctor or nurse before starting a diet or exercise
program.
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Exercise
How can exercise affect your health?
According to the American Heart Association, 44% of American adults get some
exercise. But it is not regular or intense enough to help their hearts and overall
health. Another 28% of Americans aren't active at all.
Once you get in the habit, exercise becomes more than a healthy activity. It
becomes a part of your life. In fact many people don't feel as good when they
miss their workouts. In addition, exercise can help decrease the following:
• Risk of heart disease
• High blood pressure
• High cholesterol
Exercise can help improve:
• Blood flow throughout your body
• Muscle strength, increasing your ability to do other physical activities
• Lung function
In addition, exercise can:
• Help you lose weight
• Boost your energy level
• Relieve tension
• Help you manage stress
• Improve your self-image
• Ease some anxiety and depression
• Prevent bone loss
• Help you sleep better
What you can do
As the first step, you should always check with your doctor about the types of
exercise that are right for you. Then if you aren't used to exercise, you might
want to start out slowly. Begin with 10 minutes a day. Then increase your time by
5 minutes per week until you are up to 30-60 minutes most days of the week.
Exercise can of course include brisk walking, jogging, rollerblading, or tennis. But
here are other ideas to work exercise into your daily routine:
• Do garden work that gets you moving—and avoid using a riding mower.
• Walk instead of taking the cart when golfing.
• Take the stairs instead of the elevator.
• Do leg lifts while talking on the phone.
• Park your car or get off the bus a few blocks early, and walk the rest of the
way.
• Find a distant parking spot at the mall and walk to the entrance.
• Get into dancing.
• Use motivators when you exercise—watch a DVD, listen to a book on tape or
CD, or listen to your favorite music.
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Don't discount the impact that lifestyle changes can have on your health.
According to the National Institutes of Health, a healthy lifestyle can help lower
heart disease risk by 82%. In most cases, that means you should get regular
physical activity, follow a heart-healthy eating plan, maintain a healthy weight,
and quit smoking.
Please check with your doctor or nurse before starting a diet or exercise
program.
Smoking
How can smoking affect your health?
Many people link smoking to cancer. But in fact, among smokers worldwide it's
heart and blood vessel disease—not cancer—that's the number 1 cause of
death. That's because smoking damages the lining of your arteries and promotes
plaque buildup. Plaque is made of fatty deposits like cholesterol that collect at
certain places in your arteries. Plaque can eventually block the arteries and cut
off the blood and oxygen supply.
Plaque buildup, also called atherosclerosis, can lead to:
Heart attack—inside the coronary arteries (on the surface of your heart), plaque
or a clot can block blood flow and cause a heart attack.
Stroke—inside the carotid arteries (in your neck), plaque or a clot can block
blood flow to the brain and cause a stroke.
Smoking actually does more than promote plaque buildup. It also affects
substances in your blood, such as proteins, which make your blood sticky and
more likely to clot.
Smoking has also been linked to:
• High blood pressure—smoking narrows the blood vessels, which increases
blood pressure. Smoking also increases your heart rate, making your heart
work harder.
• High cholesterol—smoking lowers HDL or high-density lipoprotein (good
cholesterol) in your blood. And it increases LDL or low-density lipoprotein
(bad cholesterol). The tobacco smoke also contains chemicals called free
radicals that make the LDL even more harmful to your arteries.
• Obesity—since smoking can affect your lung function, it can limit your
exercise. This can also lead to weight gain.
• Diabetes—smoking increases your body’s resistance to insulin, a hormone
you need to convert blood sugar into energy.
• Irregular heartbeats—called arrhythmias.
• Sudden cardiac death (SCD)—caused by dangerously fast arrhythmias.
• Heart failure—the weakened pumping of the heart.
Most people know that smoking contributes to cancer—cancers of the lung,
larynx (voice box), oral cavity, pharynx (throat), esophagus, bladder, liver, colon,
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rectum, cervix, kidney, stomach, and pancreas. In addition, smoking can cause
or contribute to cataracts, osteoporosis, and some leukemias.
What you can do
You can take action—because it's never too late to quit. In 2004 the US Surgeon
General noted that even if you don't kick the habit until age 65 or older, you can
still cut your risk of dying from a smoking-related disease by nearly 50%. The
table shows you how.
Time Since Quitting
20 minutes
12 hours
2 weeks – 3 months
1 – 9 months
1 year
5 – 15 years
10 years
15 years
Health Benefit
Your heart rate drops.
The carbon monoxide level in your blood drops to
normal.
Circulation improves and lung function increases.
Coughing and shortness of breath decrease.
The excess risk of heart disease is half that of a
smoker's.
The risk of stroke is as low as a nonsmoker's.
The lung cancer death rate is about half that of a
smoker's.
The risk of heart and blood vessel disease is as low as a
nonsmoker's.
Don't discount the impact that lifestyle changes can have on your health.
According to the National Institutes of Health, a healthy lifestyle can help lower
heart disease risk by 82%. In most cases, this means you should follow a hearthealthy eating plan, get regular physical activity, maintain a healthy weight, and
quit smoking.
Talk to your nurse about methods that can help you kick the habit. Today there
are patches, self-help classes, toll-free telephone hotlines, and nicotine
replacement therapy. You can see which works best for you.
Stress
How can stress affect your health?
Stress is a part of life for many people. You might feel stressed by traffic jams,
problems at work, or disagreements at home. For some people, a health
condition can also be a source of stress. Finding a healthy way to deal with
stress is important. Unchecked, stress can take a toll on your health.
Stress or anxiety has a biological impact on your body and mind. Your pituitary
gland (at the base of your brain) and your adrenal glands (near your kidneys)
release certain hormones. The hormones can affect your body in the following
ways:
Heart and blood vessels—your heart rate increases, your blood pressure rises,
and your cholesterol levels go up. All can increase your risk of heart attack or
stroke.
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Digestive system—stress affects your stomach and intestines, so you can get a
stomachache or diarrhea.
Immune system—your immune system might become weaker. This can result in
more colds or infections.
Other effects—skin conditions like eczema, acne, or hives can get worse. Stress
can also lead to an asthma attack.
What you can do
If the stress in your life isn't likely to disappear, you need to think about how to
manage that stress. The first step is to become aware of the sources of your
stress. Then find the best ways for you to relieve some of the stress:
• Get exercise—it’s a natural stress reducer.
• Care for your body—eat right and get enough sleep.
• Have fun—make time to get together with friends or enjoy a favorite activity.
Specific techniques might also help you relax in a healthy way. Ask your nurse to
give you information about:
• Breathing exercises
• Meditation
• Yoga
• Muscle relaxation
• Positive thinking
Avoid trying to relieve stress with alcohol, drugs, and cigarettes. And if you feel
like stress is getting the best of you, talk to your doctor. You might benefit from a
referral to another health professional.
Please check with your doctor or nurse before starting a diet or exercise
program.
Weight
How can weight affect your health?
People who maintain a normal weight are helping their own health. But they are
also in the minority. Among US adults, 35% are overweight. And an additional
34% are obese. The problem isn't limited to adults. About 19% of children and
teenagers in the United States are overweight. That’s 2-3 times what the rate
was in 1980.
Excess weight does more than add inches to your waistline. It seriously affects
your health. Excess weight or obesity:
• Raises LDL or low-density lipoprotein (bad cholesterol)
• Lowers HDL or high-density lipoprotein (good cholesterol)
• Raises blood pressure
• Can lead to diabetes
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All of the factors listed above increase your risk of heart and blood vessel
conditions. In addition, excess weight can contribute to coronary artery disease
(CAD), heart attack, and stroke.
Aside from heart and blood vessel conditions, excess weight can also lead to the
following:
• Arthritis—the added weight is hard on your joints
• Diabetes
• Gallbladder disease
• High blood pressure
• Sleep apnea and respiratory problems
• Some cancers—endometrial, breast, uterine, esophagus, kidney, and colon
What you can do
First, become aware of your eating patterns. Loading up on calories is easier
today than it was decades ago for the following reasons:
Meal size—portions are bigger, both at home and especially in restaurants.
Fat content—restaurant and ready-to-eat meals are often high in fat.
Sodas—we drink a lot more sugary beverages.
Snacking—we eat more high-fat snacks.
In addition, check whether you get enough exercise to burn up the calories you
eat. Both children and adults are less physically active than they used to be.
They sit more now—to use the computer, play video games, or watch TV.
Think about how lifestyle choices are tied to habit, or behavior. If you get used to
not exercising, or eating large portions, it can take time to change those
behaviors. But it can be done. Here are some tips that may help you set goals
and change your old habits:
• Get into exercise. Do at least 30 minutes of strenuous exercise most days of
the week, and preferably daily.
• Find a way to stick with your exercise plan. Often it helps to exercise with a
friend.
• Avoid fad diets.
• Eat slowly, and notice when your hunger is satisfied. Then stop.
• Talk to a dietician or nurse about foods to choose and foods to avoid. Also ask
how to prepare healthier meals.
• Eat small servings, and don't go back for seconds.
• When you eat out, make low-fat choices. Then take doggy bags home from
restaurants—where portions are often very large—and save them for the next
meal.
• Tell your family and friends about your plans, and ask them to help you reach
your goal. Let them know how they can help.
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Don't discount the impact that weight loss can have on your health. According to
the National Institutes of Health, a healthy lifestyle can help lower heart disease
risk by 82%. In most cases, that means you should maintain a healthy weight,
follow a heart-healthy eating plan, get regular physical activity, and quit smoking.
Please check with your doctor or nurse before starting a diet or exercise
program.
THINGS YOU CANNOT CHANGE
Age
How can age affect your health?
With age comes wisdom. But sometimes age can also bring physical limitations
and health conditions. As you age, your muscles and bones change, which may
limit your flexibility. In a sense, the same thing happens with your heart and blood
vessels.
As you age, your:
• Heart pumps less efficiently, so it has to work harder to pump the same
amount of blood to the body. This can raise your risk of heart failure.
• Blood vessels become more rigid and less elastic. This can lead to high blood
pressure.
• Arteries can become blocked by plaque. This can put you at higher risk of a
heart attack and stroke.
The risk of heart and blood vessel disease generally increases with age. That is
especially true for women. At menopause, the risk of heart disease and stroke
begins to rise. And it keeps rising. In part, that's because a woman's body stops
making the hormone estrogen. If menopause is caused by surgery to remove the
uterus and ovaries, the risk of heart disease and stroke rises more sharply. The
risk rises more slowly when menopause occurs naturally.
Some women consider hormone replacement therapy (HRT) during or after
menopause. Your doctor can explain the benefits of HRT—as well as the
potential risks for heart and blood vessel disease.
What you can do
You can help take control of your health by knowing what risk factors you can
change. You can't change your age, gender, or genetic makeup. But you can
modify the following:
• Your cholesterol level
• What you eat
• How often you exercise
• Whether you smoke
• How you deal with stress
• How much you weigh
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Exercise even if you have limited mobility. Low-impact exercises are easier on
your joints. So think about:
• Taking a daily walk with a friend
• Riding a stationary bike
• Swimming or doing water aerobics, which are especially good for people with
arthritis
Any activity that works for you will also help your heart work better too.
Don't discount the impact that lifestyle factors can have on your health. According
to the National Institutes of Health, a healthy lifestyle can help lower your heart
disease risk by 82%. The Risk Factors section has more information about these
lifestyle factors—look under Things You Can Change.
Gender
How can gender affect your health?
All other things being equal, men and women have similar chances of developing
heart or blood vessel disease. But men and women are likely to develop heart or
blood vessel disease at different ages. And there are also differences in survival
rates.
Stroke—although stroke is more common in men, more women die from strokes.
Both women and men need to pay close attention to sudden body changes that
could be symptoms of stroke. And if you notice symptoms, don't delay in getting
help.
High blood pressure—men younger than age 55 have a greater risk of high
blood pressure than women of the same age. At age 55, men's and women's
risks are similar. At age 75 and older, women are more likely to develop high
blood pressure than men are.
Heart attack—more men have heart attacks at a younger age. Generally women
are about 10 years older than men when they have heart attacks. But heart
disease is the number 1 cause of death for both women and men. Researchers
used to think that men were at much higher risk of heart disease. Now we know
that both men and women are at equal risk for heart and blood vessel disease.
Heart and blood vessel disease—when looking at heart and blood vessels
conditions, more women than men die each year. It's critical for both men and
women to know the symptoms of heart attack (listed below) and stroke.
To find out more about stroke and its symptoms, high blood pressure, or heart
attack, go to the Health Conditions section. You can select and read about one or
all three of these conditions.
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Differences in women and men
Blood vessels—one large study recently found that women more often develop
plaque in smaller arteries, while men develop plaque in larger arteries. Smaller
artery blockages do not show up on an angiogram as well as larger arteries. The
angiogram (the standard test for artery blockages) was developed to find
blockages in larger arteries. That’s because for many years doctors thought that
men were at much greater risk for heart disease than women.
Heart attack—researchers recently found that women notice symptoms earlier than
men do. Men usually have symptoms right before or during a heart attack. But
women can have symptoms for weeks before the attack. Here are the five most
common symptoms that women notice a month or more before the heart attack:
1. Unusual fatigue
2. Sleep disturbances
3. Shortness of breath
4. Indigestion
5. Anxiety
Just before or during a heart attack, men and women also have different
symptoms. The common "traditional" warning signs of a heart attack are from
research done mostly on men. Now researchers have outlined some of the most
common symptoms for women too.
"Traditional" Symptoms During a Heart
Attack
1. Pain or discomfort in the center of the chest
2. Discomfort in arms, back, neck, jaw, or
stomach
3. Shortness of breath
4. A cold sweat
5. Nausea or lightheadedness
Women's Symptoms During a Heart
Attack
1. Shortness of breath
2. Weakness
3. Unusual fatigue
4. A cold sweat
5. Nausea or dizziness
It's good to know all the common heart attack symptoms. This knowledge might
someday help you identify symptoms in yourself, your partner, your family, or
your friends.
What you can do
You can help take control of your health by knowing what risk factors you can
change. You can't change your age, gender, or genetic makeup. But you can
modify the following:
• Your cholesterol level
• What you eat
• How often you exercise
• Whether you smoke
• How you deal with stress
• How much you weigh
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Don't discount the impact that lifestyle factors can have on your health. According
to the National Institutes of Health, a healthy lifestyle can help lower heart
disease risk by 82%. The Risk Factors section has more information about these
lifestyle factors—look under Things You Can Change.
Heredity
How can heredity affect your health?
Maybe you inherited your eyes, your hair color, or your smile from your parents.
It's possible you also inherited the risk of heart and blood vessel disease.
Heredity can affect the following conditions:
High cholesterol—some families have a genetic condition that raises blood
cholesterol or triglyceride levels. A cholesterol test measures the amount of
cholesterol, triglycerides, and other fatty substances in your blood. High
cholesterol and triglyceride levels can increase your chances of heart attack or
stroke.
High blood pressure or diabetes—high blood pressure and diabetes can also
run in families. Both conditions increase your chances of developing heart or
blood vessel disease.
Heart attack—if your brother, father, or grandfather had a heart attack before
age 55—or your sister, mother, or grandmother had one before age 65—you
may be at risk, too.
Stroke—your risk of stroke is higher if a parent, grandparent, sister, or brother
had a stroke.
What you can do
First of all, ask your older relatives about the health history of your immediate
family. For example, ask about your grandparents, parents, aunts, and uncles.
It's important to have the right information. Share your family medical history with
your doctor, who can then decide the best treatment for you.
Most people with a family history of heart and blood vessel disease have at least
one other risk factor. Often it's a risk factor they can change. You can't change
your age, gender, or genetic makeup. But you can modify the following:
• Your cholesterol level
• What you eat
• How often you exercise
• Whether you smoke
• How you deal with stress
• How much you weigh
Don't discount the impact that lifestyle factors can have on your health. According
to the National Institutes of Health, a healthy lifestyle can help lower your heart
disease risk by 82%. The Risk Factors section has more information about these
lifestyle factors—look under Things You Can Change.
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Important Safety Information
HEARTISTRY is provided for informational purposes only. It is not meant to replace any doctor’s
advice. Always talk to your doctor before staring any new treatment or program.
Boston Scientific is a trademark and HEARTISTRY is a service mark of Boston Scientific Corporation.
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