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Healthy Heart

Know Your Risks

ABCs of Knowing Your Heart Risk

Understanding the risk factors for heart disease can help you decide to take charge of your health, according to Johns Hopkins research. By working with your doctor, you can make important changes to protect your heart.

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Research Shows
For Best Heart Risk Assessments, Talk to Your Doctor

Four out of five commonly used heart risk calculators— including those used by the American Heart Association and the American College of Cardiology—overestimate a person’s odds of having a heart attack, according to a 2015 report by Johns Hopkins researchers. The result: Some people may be unnecessarily prescribed medication when they have a risk level that can be controlled through lifestyle changes.

“Guidelines are just a starting point for a conversation between the patient and the physician about the risks and benefits of different treatments or preventive strategies,” says Johns Hopkins cardiologist Michael Blaha, M.D., the report’s senior investigator. To get a clearer picture of risk, additional testing beyond the traditional calculator—which relies on data such as cholesterol and blood pressure readings, family history, whether you smoke or have diabetes—may be needed. For instance, a coronary calcium scan can look at the actual state of damage in the arteries. 

Will you suffer a heart attack or stroke? Doctors can look at many known risk factors to estimate, with fairly good accuracy, your odds of a future heart event. The more risk factors you have, and the more severe they are, the higher your risk of heart disease.

People who have a low risk of coronary artery disease live an average of 10 years longer than those with a high risk. And the best news is that once you understand your risk, you can do a lot to lower it. “We prefer preventing heart attacks in the first place,” says Johns Hopkins cardiologist Seth Martin, M.D., M.H.S. “And to do that, we want to identify and manage risks as early as possible.”

That’s why it’s useful to understand these ABCs of risks to your heart:

A. Age and other factors you can’t change

“Age alone doesn’t cause coronary artery disease, but the older you get and the longer you’ve been exposed to the effects of risks such as high blood pressure or an unhealthy lifestyle, the greater your overall risk,” Martin says. In other words, damage adds up. Men older than age 45 and women past menopause have the highest risk of a heart event.

A family history of heart disease is a risk factor that you can’t directly control but that you should be aware of. It’s especially important to check with your doctor for an assessment if you have a father or brother who had heart disease before age 55, or a mother or sister who was diagnosed before age 65.

B. Blood pressure

Blood pressure is the force blood exerts on artery walls. When your reading is consistently above 140/90, you have a condition called hypertension, or high blood pressure. The stress that higher blood pressure places on one’s arteries and heart makes a heart attack or stroke more likely.

C. Cholesterol levels

High blood cholesterol is defined as having too much cholesterol—a waxy, fatty substance—in the blood. Having either high LDL cholesterol (“bad” cholesterol) or low HDL cholesterol (“good” cholesterol)—or both—is one of the best predictors of your risk of heart disease. A blood lipid profile measures both your cholesterol numbers and your triglycerides, another type of fat in the blood that is a risk factor.

Increasingly, doctors look at what’s referred to as “non-HDL cholesterol” as an even better alert for certain high-risk people.

D. Diabetes

High blood sugar increases plaque buildup, which causes artery damage that leads to heart disease. Diabetics have double the risk of coronary heart disease. In fact, most people with type 2 diabetes eventually develop heart disease. If you’re prediabetic or have diabetes, you should work with your doctor to develop a plan for diet, exercise and (if needed) medication to help bring blood glucose to healthier levels.

E. Excess weight, smoking and other lifestyle factors you can change

Sitting a lot and not exercising can nearly double the risk of poor heart health. Diet matters too: Following a low-carb, healthy-fat, lean protein diet (such as the Mediterranean diet) can improve heart-health while also helping you maintain a healthy weight. Being overweight or obese is linked to other risks for coronary artery disease.

Smoking is one of the strongest risk factors for heart disease that’s within your control. Even light or occasional smoking can increase the formation of plaque. Cigarette smoke also reduces the available oxygen to your heart and lungs, and can add to chest pain if you already have a heart condition. Women over age 35 who smoke and take birth control pills have an additional risk. 

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