For more information, visit http://www.nhlbi.nih.gov/health/health-topics/topics/hd/

Coronary Heart Disease Risk Factors

High Blood Cholesterol and Triglyceride Levels

Cholesterol

High blood cholesterol is a condition in which your blood has too much cholesterol—a waxy, fat-like substance. The higher your blood cholesterol level, the greater your risk of coronary heart disease (CHD) and heart attack.

Cholesterol travels through the bloodstream in small packages called lipoproteins (LI-po-pro-teens). Two major kinds of lipoproteins carry cholesterol throughout your body:

• Low-density lipoproteins (LDL). LDL cholesterol sometimes is called "bad" cholesterol. This is because it carries cholesterol to tissues, including your heart arteries. A high LDL cholesterol level raises your risk of CHD.
• High-density lipoproteins (HDL). HDL cholesterol sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk of CHD.

Many factors affect your cholesterol levels. For example, after menopause, women's LDL cholesterol levels tend to rise, and their HDL cholesterol levels tend to fall. Other factors—such as age, gender, diet, and physical activity—also affect your cholesterol levels.

Healthy levels of both LDL and HDL cholesterol will prevent plaque from building up in your arteries. Routine blood tests can show whether your blood cholesterol levels are healthy. Talk with your doctor about having your cholesterol tested and what the results mean.

Children also can have unhealthy cholesterol levels, especially if they're overweight or their parents have high blood cholesterol. Talk with your child's doctor about testing your child' cholesterol levels.

To learn more about high blood cholesterol and how to manage the condition, go to the Health Topics High Blood Cholesterol article.

Triglycerides

Triglycerides are a type of fat found in the blood. Some studies suggest that a high level of triglycerides in the blood may raise the risk of CHD, especially in women.

High Blood Pressure

"Blood pressure" is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.

Blood pressure is measured as systolic (sis-TOL-ik) and diastolic (di-a-STOL-ik) pressures. "Systolic" refers to blood pressure when the heart beats while pumping blood. "Diastolic" refers to blood pressure when the heart is at rest between beats.

You most often will see blood pressure numbers written with the systolic number above or before the diastolic number, such as 120/80 mmHg. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)

All levels above 120/80 mmHg raise your risk of CHD. This risk grows as blood pressure levels rise. Only one of the two blood pressure numbers has to be above normal to put you at greater risk of CHD and heart attack.

Often, high blood pressure has no signs or symptoms. However, the condition can be detected using a simple test that involves placing a blood pressure cuff around your arm.

Most adults should have their blood pressure checked at least once a year. If you have high blood pressure, you'll likely need to be checked more often. Talk with your doctor about how often you should have your blood pressure checked.

Children also can develop high blood pressure, especially if they're overweight. Your child's doctor should check your child's blood pressure at each routine checkup.

In children, blood pressure normally rises with age and body size. Newborns often have very low blood pressure numbers, while older teens have numbers similar to adults. The ranges for normal blood pressure and high blood pressure generally are lower for youth than for adults.

Your child should have routine blood pressure checks starting at 3 years of age. To find out whether a child has high blood pressure, a doctor will compare the child's blood pressure numbers to average numbers for his or her age, gender, and height.

Both children and adults are more likely to develop high blood pressure if they're overweight or have diabetes.

For more information about high blood pressure and how to manage the condition, go to the Health Topics High Blood Pressure article.

Diabetes and Prediabetes

Diabetes is a disease in which the body's blood sugar level is too high. The two types of diabetes are type 1 and type 2.

In type 1 diabetes, the body's blood sugar level is high because the body doesn't make enough insulin. Insulin is a hormone that helps move blood sugar into cells, where it's used for energy. In type 2 diabetes, the body's blood sugar level is high mainly because the body doesn't use its insulin properly.

Over time, a high blood sugar level can lead to increased plaque buildup in your arteries. Having diabetes doubles your risk of CHD.

Prediabetes is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. If you have prediabetes and don't take steps to manage it, you'll likely develop type 2 diabetes within 10 years. You're also at higher risk of CHD.

Being overweight or obese raises your risk of type 2 diabetes. With modest weight loss and moderate physical activity, people who have prediabetes may be able to delay or prevent type 2 diabetes. They also may be able to lower their risk of CHD and heart attack. Weight loss and physical activity also can help control diabetes.

Even children can develop type 2 diabetes. Most children who have type 2 diabetes are overweight.

Type 2 diabetes develops over time and sometimes has no symptoms. Go to your doctor or local clinic to have your blood sugar levels tested regularly to check for diabetes and prediabetes.

For more information about diabetes and heart disease, go to the Health Topics Diabetic Heart Disease article. For more information about diabetes and prediabetes, go to the National Institute of Diabetes and Digestive and Kidney Diseases' (NIDDK's) Introduction to Diabetes.

Overweight and Obesity

The terms "overweight" and "obesity" refer to body weight that's greater than what is considered healthy for a certain height. More than two-thirds of American adults are overweight, and almost one-third of these adults are obese.

The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.

You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your doctor can help you.

Overweight is defined differently for children and teens than it is for adults. Children are still growing, and boys and girls mature at different rates. Thus, BMIs for children and teens compare their heights and weights against growth charts that take age and gender into account. This is called BMI-for-age percentile.

For more information about BMI-for-age percentile, go to the Centers for Disease Control and Prevention's (CDC's) BMI-for-age calculator.

Being overweight or obese can raise your risk of CHD and heart attack. This is mainly because overweight and obesity are linked to other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, and diabetes.

For more information, go to the Health Topics Overweight and Obesity article.

Smoking

Smoking tobacco or long-term exposure to secondhand smoke raises your risk of CHD and heart attack.

Smoking triggers a buildup of plaque in your arteries. Smoking also increases the risk of blood clots forming in your arteries. Blood clots can block plaque-narrowed arteries and cause a heart attack.

Some research shows that smoking raises your risk of CHD in part by lowering HDL cholesterol levels.

The more you smoke, the greater your risk of heart attack. Studies show that if you quit smoking, you cut your risk of heart attack in half within a year. The benefits of quitting smoking occur no matter how long or how much you've smoked.

Most people who smoke start when they're teens. Parents can help prevent their children from smoking by not smoking themselves. Talk with your child about the health dangers of smoking and ways to overcome peer pressure to smoke.

For more information, including tips on how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's "Your Guide to a Healthy Heart."

For more information about children and smoking, go to the U.S. Department of Health and Human Services' (HHS') Kids and Smoking Web page and the CDC's Smoking and Tobacco Use Web page.

Lack of Physical Activity

Inactive people are nearly twice as likely to develop CHD as those who are active. A lack of physical activity can worsen other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.

It's important for children and adults to make physical activity part of their daily routines. One reason many Americans aren't active enough is because of hours spent in front of TVs and computers doing work, schoolwork, and leisure activities.

Some experts advise that children and teens should reduce screen time because it limits time for physical activity. They recommend that children aged 2 and older should spend no more than 2 hours a day watching TV or using a computer (except for school work).

Being physically active is one of the most important things you can do to keep your heart healthy. The good news is that even modest amounts of physical activity are good for your health. The more active you are, the more you will benefit.

For more information, go to HHS' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Unhealthy Diet

An unhealthy diet can raise your risk of CHD. For example, foods that are high in saturated and trans fats and cholesterol raise LDL cholesterol. Thus, you should try to limit these foods.

Saturated fats are found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. Trans fats are found in some fried and processed foods. Cholesterol is found in eggs, many meats, dairy products, commercial baked goods, and certain types of shellfish.

It's also important to limit foods that are high in sodium (salt) and added sugars. A high-salt diet can raise your risk of high blood pressure.

Added sugars will give you extra calories without nutrients like vitamins and minerals. This can cause you to gain weight, which raises your risk of CHD. Added sugars are found in many desserts, canned fruits packed in syrup, fruit drinks, and nondiet sodas.

You also should try to limit how much alcohol you drink. Too much alcohol will raise your blood pressure. It also will add calories, which can cause weight gain.

Stress

Stress and anxiety may play a role in causing CHD. Stress and anxiety also can trigger your arteries to tighten. This can raise your blood pressure and your risk of heart attack.

The most commonly reported trigger for a heart attack is an emotionally upsetting event, especially one involving anger. Stress also may indirectly raise your risk of CHD if it makes you more likely to smoke or overeat foods high in fat and sugar.

Age

As you get older, your risk of CHD and heart attack rises. This is in part due to the slow buildup of plaque inside your heart arteries, which can start during childhood.

In men, the risk of CHD increases faster after age 45. In women, the risk of CHD increases faster after age 55.

Most people have some plaque buildup in their heart arteries by the time they're in their seventies. However, only about 25 percent of those people have chest pain, heart attacks, or other signs of CHD.

Gender

Before age 55, women have a lower risk of CHD than men. This is because before menopause, estrogen provides women some protection against CHD. After age 55, however, the risk of CHD increases similarly in both women and men.

Some risk factors may affect CHD risk differently in women than in men. For example, diabetes raises the risk of CHD more in women.

Also, some risk factors for heart disease only affect women, such as preeclampsia (pre-e-KLAMP-se-ah). Preeclampsia is a condition that can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine.

Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases your risk of preeclampsia.)

Family History

Family history plays a role in CHD risk. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age.

However, having a family history of CHD doesn't mean that you will have it too. This is especially true if your affected family member smoked or had other CHD risk factors that were not well treated.

Making lifestyle changes and taking medicines to treat other risk factors often cen lessen genetic influences and stop or slow the progress of CHD. 

How To Prevent and Control Coronary Heart Disease Risk Factors

You can prevent and control many coronary heart disease (CHD) risk factors with lifestyle changes and medicines. Examples of these controllable risk factors include high blood cholesterol, high blood pressure, and overweight and obesity. Only a few risk factors—such as age, gender, and family history—can't be controlled.

To reduce your risk of CHD and heart attack, try to control each risk factor you can. The good news is that many lifestyle changes help control several CHD risk factors at the same time. For example, physical activity may lower your blood pressure, help control diabetes and prediabetes, reduce stress, and help control your weight.

A Lifelong Approach

Many lifestyle habits begin during childhood. Thus, parents and families should encourage their children to make heart healthy choices, such as following a healthy diet and being physically active. Make following a healthy lifestyle a family goal.

To achieve this goal, you should learn about key health measures, such as weight, body mass index (BMI), waist circumference, and your child's BMI-for-age percentile. For more information about BMI in adults and children, go to "Coronary Heart Disease Risk Factors."

Be aware of your and your family members' blood pressure, blood cholesterol, and blood sugar levels. Once you know these numbers, you can work to bring them into, or keep them within, a healthy range.

Making lifestyle changes can be hard. But if you make these changes as a family, it may be easier for everyone to prevent or control their CHD risk factors.

For tips on how to help your children adopt healthy habits, visit the National Heart, Lung, and Blood Institute's (NHLBI's) We Can!^® Ways to Enhance Children's Activity & Nutrition Web site.

Lifestyle Changes

A healthy lifestyle can lower the risk of CHD. If you already have CHD, a healthy lifestyle may prevent it from getting worse. A healthy lifestyle includes:

• Following a healthy diet
• Being physically active
• Maintaining a healthy weight
• Quitting smoking
• Managing stress

Following a Healthy Diet

A healthy diet is an important part of a healthy lifestyle. To lower your risk of CHD and heart attack, you and your family should follow a diet that is:

• Low in saturated and trans fats. Saturated fats are found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. Trans fats are found in some fried and processed foods. Both types of fat raise your low-density lipoprotein (LDL), or "bad," cholesterol level.
• High in the types of fat found in fish and olive oil. These fats are rich in omega-3 fatty acids. Omega-3 fatty acids lower your risk of heart attack, in part by helping prevent blood clots.
• High in fiber. Fiber is found in whole grains, fruits, and vegetables. A fiber-rich diet not only helps lower your LDL cholesterol level, but also provides nutrients that may help protect against CHD.
• Low in salt and sugar. A low-salt diet can help you manage your blood pressure. A low-sugar diet can help you prevent weight gain and control diabetes and prediabetes.

Research suggests that drinking small to moderate amounts of alcohol regularly also can lower your risk of CHD. One drink a day can lower your risk by raising your high-density lipoprotein (HDL), or "good," cholesterol level. One drink is a glass of wine, beer, or a small amount of hard liquor.

If you don't drink, this isn't a recommendation to start using alcohol. If you're pregnant, if you're planning to become pregnant, or if you have another health condition that could make alcohol use harmful, you shouldn't drink.

Also, too much alcohol can cause you to gain weight and raise your blood pressure and triglyceride level. In women, even one drink a day may raise the risk of certain types of cancer.

Teach your children how to make healthy food choices. For example, have them help you shop for and make healthy foods. Set a good example by following the same heart healthy diet that you ask your children to follow.

For more information about following a healthy diet, go to the NHLBI's Aim for a Healthy Weight Web site, "Your Guide to a Healthy Heart," "Your Guide to Lowering Your Blood Pressure With DASH," and "Your Guide to Lowering Your Cholesterol With TLC." All of these resources provide general information about healthy eating.

Being Physically Active

You don't have to be an athlete to lower your risk of CHD. You can benefit from as little as 60 minutes of moderate-intensity aerobic activity per week.

For major health benefits, adults should do at least 150 minutes (2.5 hours) of moderate-intensity aerobic activity or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity each week.

Another option is to do a combination of both. A general rule is that 2 minutes of moderate-intensity activity counts the same as 1 minute of vigorous-intensity activity.

The more active you are, the more you'll benefit. If you're obese, or if you haven't been active in the past, start physical activity slowly and build up the intensity over time.

Children and youth should do 60 minutes or more of physical activity every day. A great way to encourage physical activity is to do it as a family. You also may want to limit your children's TV, video, and computer time to encourage them to be more active.

If you have CHD or symptoms such as chest pain and dizziness, talk with your doctor before you start a new exercise plan. Find out how much and what kinds of physical activity are safe for you. Avoid exercising outdoors when air pollution levels are high or the temperature is very hot or cold.

For more information about physical activity, go to the U.S. Department of Health and Human Services' (HHS') "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Maintaining a Healthy Weight

Following a healthy diet and being physically active can help you maintain a healthy weight. Controlling your weight helps you control CHD risk factors.

If you're overweight or obese, try to lose weight. A loss of just 5 to 10 percent of your current weight can lower your risk of CHD.

To lose weight, cut back your calorie intake and do more physical activity. Eat smaller portions and choose lower calorie foods. Don't feel that you have to finish the entrees served at restaurants. Many restaurant portions are oversized and have too many calories for the average person.

For overweight children and teens, slowing the rate of weight gain is important. However, reduced-calorie diets aren't advised, unless approved by a doctor.

Quitting Smoking

If you smoke, quit. Smoking can raise your risk of CHD and heart attack and worsen other CHD risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

You can help your children avoid smoking or quit smoking. Talk with them about the health effects of smoking. Teach them how to handle peer pressure to smoke.

Teens who have parents who smoke are more likely to smoke themselves. Set a good example by not smoking or quitting smoking. Set firm rules about no tobacco use in your home.

If you have a child who smokes, help him or her create a plan to quit. Offer your child information and resources on how to quit. Stress the natural rewards that come with quitting, such as freedom from addiction, better fitness and sports performance, and improved appearance. Reinforce the decision to quit with praise.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's "Your Guide to a Healthy Heart."

For more information about children and smoking, go to HHS' Kids and Smoking Web page and the Centers for Disease Control and Prevention's Smoking and Tobacco Use Web page.

Managing Stress

Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress.

Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program.

Other Lifestyle Concerns

If making lifestyle changes is hard for you, try taking things one step at a time. Learn about the benefits of lifestyle changes. Talk with your doctor, and read some of the resources in "Links to Other Information About Coronary Heart Disease Risk Factors."

Figure out what's stopping you from making or sticking to your lifestyle changes. Try to find ways to overcome these issues. For example, if you're too tired to exercise after work, you may want to try working out before you go to work.

Make a plan to carry out your lifestyle changes that includes specific, realistic goals. Act on your plan and work toward your goals. You may want to do so with the help of a support group or supportive friends and family.

Reward yourself for the gains you've made. Think about what you need to do to maintain your lifestyle changes and avoid unhealthy habits.

Don't give up if you go off your diet or exercise plan or start smoking again. Instead, find out what you need to do to get back on track so you can meet your goals. Many people find that it takes more than one try to make long-term lifestyle changes.

Changing the eating and activity habits of children takes time. Start with small, easy steps. For example, cut out after-dinner snacks or go for an after-dinner walk instead of watching TV.

Set a good example, and try to get your children involved in choosing a new healthy step to take each day. If you make lifestyle changes a group effort, it will make them easier.

Medicines

Sometimes lifestyle changes aren't enough to control your blood pressure, cholesterol levels, or other CHD risk factors. Your doctor also may prescribe medicines. For example, you may need medicines to:

• Lower your LDL cholesterol
• Lower your blood pressure
• Lower your blood sugar level
• Prevent blood clots and/or inflammation

Take your medicines as prescribed. Don't cut back on the dosage unless your doctor tells you to. If you have side effects or other problems related to your medicines, talk with your doctor. He or she may be able to provide other options.

You should still follow a heart healthy lifestyle, even if you take medicines to control your CHD risk factors.

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^® We Can! is a registered trademark of HHS.

Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has helped doctors learn more about coronary heart disease (CHD) risk factors, as well as ways to prevent or treat them.

The NHLBI continues to support research aimed at learning more about CHD risk factors. For example, NHLBI-supported research includes studies that explore:

• How risk factors for CHD affect people's health as they age
• Whether omega-3 fatty acids reduce early signs of heart disease risk
• How nutritional and behavioral therapies can help treat CHD risk factors

Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.

For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to CHD risk factors, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

• http://clinicalresearch.nih.gov
• www.clinicaltrials.gov
• www.nhlbi.nih.gov/studies/index.htm
• www.researchmatch.org

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.

Links to Other Information About Coronary Heart Disease Risk Factors

NHLBI Resources

• Act in Time to Heart Attack Signs
• Aim for a Healthy Weight
• "Aim for a Healthy Weight" Patient Booklet
• Cardiovascular Information for the Public
• Coronary Artery Disease/Coronary Heart Disease (Health Topics)
• DASH Eating Plan (Health Topics)
• Diabetic Heart Disease (Health Topics)
• Heart Attack (Health Topics)
• High Blood Cholesterol (Health Topics)
• High Blood Pressure (Health Topics)
• Keep the Beat™ Deliciously Healthy Eating
• Overweight and Obesity (Health Topics)
• Physical Activity and Your Heart (Health Topics)
• Smoking and Your Heart (Health Topics)
• Story of Success: Conquering Cardiovascular Disease
• The 10-Year Heart Attack Risk Assessment Tool
• The Heart Truth^® for Women Campaign
• "The Healthy Heart Handbook for Women"
• "Your Guide to a Healthy Heart"
• "Your Guide to Living Well With Heart Disease"
• "Your Guide to Lowering Your Blood Pressure"
• "Your Guide to Lowering Your Blood Pressure With DASH"
• "Your Guide to Lowering Your Cholesterol With TLC"
• "Your Guide to Physical Activity and Your Heart"
• We Can! Ways to Enhance Children's Activity & Nutrition

Non-NHLBI Resources

• "2008 Physical Activity Guidelines for Americans" (U.S. Department of Health and Human Services (HHS))
• Diabetes and Prediabetes (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK))
• Diabetes, Heart Disease, and Stroke (NIDDK)
• Heart Diseases (MedlinePlus)
• Kids and Smoking (HHS)
• Smoking and Tobacco Use (Centers for Disease Control and Prevention)

Clinical Trials

• Children and Clinical Studies
• Clinical Trials (Health Topics)
• Current Research (ClinicalTrials.gov)
• NHLBI Clinical Trials
• NIH Clinical Research Trials and You (National Institutes of Health)
• ResearchMatch (funded by the National Institutes of Health)

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^™ Keep the Beat is a trademark of HHS.
^® The Heart Truth is a registered trademark of HHS.