By Jasmin Roohi, MD
Who’s at Risk
There are two kinds of risk factors for coronary artery disease – those you can modify and those you can’t. One non-modifiable risk factor is heart disease in your family. Family history doesn’t mean you will definitely get heart disease, but it increases your chances substantially, especially if it affected your parents or siblings.
Tell your doctor if anyone in your family, especially parents, siblings, grandparents, or children, had a heart attack or stroke, particularly at a young age (under 55 for men, under 65 for women). Also make sure to disclose if anyone have a heart rhythm problem, a heart murmur, or bypass surgery.
Other non-modifiable risk factors include age and gender. Though you can have a stroke or heart attack at any age, men are most at risk after age 45 and women after 55. Estrogen offers women a certain amount of protection before menopause. However, women who undergo early menopause – after a hysterectomy, for instance – are twice as likely to develop heart disease as other women their age. But most people who die of heart attacks – men and women – are over 65.
The good news is that no matter your age, gender, or family history, there are many risk factors you can change. The CDC estimates that nearly half of Americans have one of three key modifiable risk factors: high blood pressure, high cholesterol and/or triglycerides, or smoking. Other modifiable risk factors include poor diet, lack of exercise, being overweight or obese, and having uncontrolled diabetes or prediabetes.
The American Heart Association recommends that you be screened for the following risk factors, especially if you have a family history of heart disease:
High blood pressure. You should have your blood pressure checked yearly with your annual physical exam. If it is higher than 120/80, your doctor may want to check it more often. High blood pressure can be controlled through medication and/or lifestyle changes like losing weight, reducing salt intake, and exercising.
Cholesterol. A lipid panel measures total cholesterol and triglycerides as well as LDL (bad) cholesterol and HDL (good) cholesterol. Your doctor will decide how often to screen you based on your results and risk profile. Cholesterol can be controlled through lifestyle changes and/or medication.
Untreated diabetes. If you’re overweight and have at least one additional risk factor, your doctor may recommend testing for diabetes and prediabetes. The American Diabetes Association recommends screening at least every three years, beginning at age 45.
Obesity. Being overweight is a major risk factor, and managing your weight can help mitigate other risk factors – including diabetes and high blood pressure. Your doctor will weigh you and may check your waist circumference or use your body weight to calculate your body mass index (BMI) during your regular checkup.
Smoking, Diet, and Exercise. If you smoke, your doctor will likely suggest that you quit, and refer you to programs to help. He or she will also likely talk to you about avoiding trans and saturated fats, avoiding high-salt packaged and fast foods, and eating more whole foods, especially grains, fruits, and vegetables. And he or she will recommend regular exercise – for instance, walking 30 minutes a day – if you are not physically active.
A single risk factor can double your risk of coronary artery disease, but having three or more risk factors can actually increase your risk tenfold, according to the National Institutes of Health. And some risk factors – smoking and diabetes, for instance – increase your jeopardy more than others. But it isn’t easy, or even necessary, to tackle all of your risk factors at once.
Most doctors will suggest that you approach lifestyle changes gradually, perhaps beginning a new medication and making time for that 30-minute walk every day. The important thing is to set realistic goals and to get started.
For more information about coronary artery disease risk factors, screening, and prevention, visit MAPMG’s Staying Healthy pages.