Risk Factors

Non-modifiable Risk Factors

Risk factors are conditions that increase your risk of developing cardiovascular disease. Some risk factors are called “non-modifiable’ because you cannot change them.

Non-modifiable cardiovascular disease risk factors include:

According to American Heart Association computations, about 80 percent of people who die from cardiovascular disease are 65 years and older. Age itself increases your risk of developing heart disease

Heart disease has long been considered to be primarily men’s disease. Although women tend to develop cardiovascular disease about 10 years later in life than men, the outcome for women is often worse.

  • 2/3 of US women have at least 1 risk factor
  • More than 60% are overweight or obese
  • 25% have almost NO physical activity
  • More than 50% of women over 45 years old have hypertension
  • 40% of women over 55 years old have elevated cholesterol
  • Low HDL (Less than 40mg) is a stronger risk factor for older women than older men
  • Diabetes increases relative risk 3-7 fold for women

Family history of heart disease
Your risk for developing heart disease increases if you have a relative who developed heart disease at an early age (before 55 years old). If your parents developed heart disease later in life, it may be age-related rather than genetic. While you can not change your genes, it is important to know your family medical history and share it with your doctor.

African Americans are at a greater risk of developing cardiovascular disease.

Modifiable Risk Factors

Other risk factors are called ”modifiable” because they can be changed or treated.

The modifiable risk factors include:

High blood pressure
Blood pressure is recorded as two numbers, with a ratio like this: 120/80 mmHg. The top number, called systolic blood pressure, measures the pressure in the arteries when the heart beats. The lower number, called diastolic blood pressure, measures the pressure in the arteries between the heartbeats. High blood pressure is defined as over 140/90 on at least two separate occasions on separate days. Blood pressure should be measured at each doctor’s office visit starting at 18 years, but at least every 2 years. Target blood pressure is 120/80 mmHg regardless of age. Many people have high blood pressure for years. If left untreated, it can lead to coronary heart disease, heart attack or stroke. A higher percentage of men than women have HBP until age 45. From ages 45–64, the percentage of men and women is similar. After that, a much higher percentage of women have HBP than men.

BP Classification Systolic BP mmHg   Diastolic BP mmHg
Normal More than 120 and Less than 80
Prehypertension 120–139 or 80–89
Stage 1 HBP 140–159 or 90–99
Stage 2 HBP More than 160 or More than 100

For persons over age 50, systolic blood pressure is more important than diastolic blood pressure as a cardiovascular disease risk factor. Starting at 115/75 mmHg, cardiovascular disease risk doubles with each increment of 20/10 mmHg throughout the BP range. Those with systolic BP of 120–139 mmHg or diastolic BP of 80–89 mmHg should be considered prehypertensive and require health-promoting lifestyle modifications to prevent cardiovascular disease.

Smoking is the most preventable risk factor. Smokers have more than twice the risk of developing cardiovascular disease. On average, smoking costs 13 years to a male smoker and 14 years to a female smoker. Exposure to smoke (second hand smoking) increases the risk even for non smokers. Among adults over 18 years old in the US, about 20% are current smokers. Don’t’ smoke!

The cholesterol profile includes LDL (bad) cholesterol, HDL (good) cholesterol, triglycerides and total cholesterol.

LDL cholesterol (low density lipoprotein) contributes to the artery blockages (plaques). Most people should aim at an LDL cholesterol level of 100 mg/dL or lower. If you are a very high risk of developing cardiovascular disease, or if you have already had a heart attack, you may need to aim at an LDL level below 70 md/dL.

HDL cholesterol (high density lipoprotein) is a reverse-transport protein: it removes cholesterol from the arteries and takes it to the liver where it can be passed out of the body. High levels of HDL cholesterol lower your risk of developing cardiovascular disease. An HDL level of 60 mg/dL and over is considered excellent, providing you optimal protection.

Triglyceride is the most common type of fat in the body. Many people who have heart disease or diabetes have high triglyceride levels. Normal triglyceride level is less than 150 mg/dL.

Total cholesterol is a measure of LDL cholesterol, HDL cholesterol and other lipids. The desirable level of total cholesterol is less than 200mg/dL.

Diabetes mellitus is defined as a fasting blood glucose of greater than 125 mg/dL. Diabetes (elevated blood sugar) increases your risk for developing cardiovascular disease. There are two main types of diabetes. Type 1 diabetes is usually first diagnosed in children and young adults. Type 2 diabetes is the most common form and can develop at any age. If you have diabetes, no matter which type, it means that you have too much glucose in your blood, and it can lead to serious health issues. Diabetes and heart disease share similar risk factors (high cholesterol level, high blood pressure, obesity).

People with a fasting blood glucose level between 100 mg/dL and 125 mg/dL have an increased risk for developing Type 2 diabetes. If they do not make lifestyle modifications, they will likely develop diabetes within the next 10 years. Pre-diabetes is reversible. If the affected person loses weight, maintains a healthy diet and increases his or her physical activity, he or she may be able to prevent progression to diabetes.

Metabolic Syndrome

Metabolic syndrome is a cluster of abnormalities that occur together, increasing your risk of developing heart disease, stroke, and diabetes. The group of metabolic risk factors includes the following syndromes:

• Abdominal obesity (excessive fat tissue in and around the abdomen), waist circumference
  of greater than 40 inches for men and 35 inches for women

• Fasting blood triglycerides greater than 150 mg/dL

• Blood HDL cholesterol less than 40 mg/dL for men and less than 50 mg/dL for women

• Fasting blood glucose ( blood sugar) greater than 100 mg/dL

• Elevated blood pressure (130/85 mmHg or higher)

Metabolic syndrome is identified if you have three or more of these factors present.

Learn Your Risk

Did you know that:

  • You can measure your risk of heart disease?
  • You can change the modifiable risk factors to reduce your risk?

The risk assessment tool will help you estimate the risk of dying of a heart disease in the next 10 years. It will also show if you may have metabolic syndrome, which increases your chances of developing cardiovascular disease. The assessment tool uses the scoring system from the Framingham Heart Study to assess the risk of heart disease and national ATP III guidelines to assess the metabolic syndrome.

Who can use the risk assessment tool?

The tool is designed for adults aged 20 and older, who do not have heart or blood vessel disease.

What information do you need in order to use the risk assessment tool?

You will need the following information:

  1. Blood pressure.
    If you do not know your diastolic and systolic blood pressure you can have it measured by your provider during a routine office visit.
  2. Height
  3. Weight
  4. Waist circumference
  5. Blood test results with :
  • Total cholesterol
  • HDL cholesterol
  • LDL cholesterol
  • Blood sugar level (Fasting glucose)
  • Triglycerides

Here is an example to help you understand the blood test report.

Name of the test Abbreviation used Your result Unit of measurement Normal range

If you are unable to obtain the blood test results, the system will assess your risk based on other factors. However, your results will be more accurate if you answer all questions.