Heart Disease: 8 Factors That Raise Your Risk

Heart disease is the leading killer of men and women in America — and it has been for more than 100 years, despite major gains in public health.

For years, doctors have known that high blood pressure, high cholesterol, diabetes and smoking raise the risk of cardiovascular disease. They typically use these factors to calculate patients’ individual risk — and to guide treatment recommendations. But in recent years, experts have started thinking more broadly about what drives cardiovascular disease risk.

With smoking on the decline, and with better cholesterol and blood pressure treatments now available, death rates from heart attack and stroke have fallen in the last half-century, said Dr. Sadiya Khan, a preventive cardiologist at the Feinberg School of Medicine at Northwestern University. But several factors now threaten to slow — or even undo — that progress, including the rise of metabolic conditions like obesity and diabetes and increasing rates of heart failure.

In recognition of these changes, the American Heart Association last year released a new risk calculator, called PREVENT, that includes measures of metabolic and kidney health and makes it possible for doctors to predict the risk of heart failure in addition to that of heart attack and stroke.

“I don’t think the main risk factors for cardiovascular disease have necessarily changed,” said Dr. Michael Nanna, an interventional cardiologist at Yale School of Medicine. “But I think there’s an increased recognition of a broader set of risk factors than we as cardiologists thought about traditionally.”

The big risk factors remain.

Conditions that lead to plaque buildup on the inside walls of blood vessels are a big concern. As plaques grow, they narrow the space available for blood to flow, which can cause symptoms like chest pain. Eventually the plaques can break off and block an artery that carries blood to the heart or brain, causing a heart attack or stroke, explained Dr. Jeremy Sussman, an associate professor of internal medicine at University of Michigan Medical School.