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Heart Disease - Risk Factors for Coronary Artery Disease (CAD)

The lifetime risk of developing coronary artery disease (CAD) after age 40 is 49% for males, 32% for women. Efforts to reduce controllable risk factors, including diet and physical activity, should be taken to decrease CAD risk.

Controllable risk factors for CAD:

High blood cholesterol:

  • Low-density lipoproteins (LDL cholesterol): an overabundance of LDL cholesterol causes atherosclerosis, a narrowing of coronary arteries due to plaque build up on artery walls. Blood clots can form on plaque surfaces, further blocking the blood supply to the myocardium (heart muscle) and resulting in myocardial infarction (heart attack).
  • High-density lipoproteins (HDL cholesterol): HDL carries cholesterol away from the heart back to the liver where it is eventually removed from the body. High HDL cholesterol removes excess LDL cholesterol from artery walls, reducing atherosclerosis (a narrowing of the arteries).
Total cholesterol (mg/dL) LDL cholesterol (mg/dL) HDL cholesterol (mg/dL)
Ideal: Less than 200 Borderline high risk: 200-239
High risk: 240 and over
Ideal: less than 130 Borderline high risk: 130-159
High risk: 160 or higher
Ideal: 60 or higher
High risk: lower than 40

LDL cholesterol levels can be reduced by limiting consumption of saturated fats (whole-fat dairy products, cheeses, red meats), increasing physical activity, and weight reduction when appropriate. Increased consumption of monounsaturated fats (olive oil, nuts, fatty fish) has been shown to reduce LDL cholesterol and increase HDL cholesterol, lowering CAD risk. Drug therapy for cholesterol reduction includes statins, bile acid resins, nicotinic acid and fibrates.

The U.S. government recently recommended treating high cholesterol more aggressively in people with diabetes. Click here to read more.

Hypertension: Hypertension (high blood pressure) results from arterial narrowing, which causes blood to be pumped with greater force against the artery walls. Hypertension can be corrected by dietary changes (i.e., avoiding salt, increasing consumption of fruits, vegetables, and low-fat dairy products). Drug therapy includes beta-blockers, ACE inhibitors, and calcium channel blockers.

Blood Pressure Category Systolic(mm Hg)   Diastolic(mm Hg)
Normal less than 120 and less than 80
Prehypertension 120-139 or 80-89
Stage 1 140-159 or 90-99
Stage 2 160 or higher or 100 or higher

Source: American Heart Association

Smoking: Smoking significantly increases heart disease and stroke risk. Specifically, smoking causes atherosclerosis (narrowing of arteries), thrombosis (blood clots), coronary artery spasm (abnormal constriction of the muscle fibers of the coronary artery) cardiac arrhythmia (abnormal heartbeat) and other disorders which increase the risk of myocardial infarction (heart attack). Further, research shows smoking to reduce HDL ("good") cholesterol levels.