Are All Heart Health Risk Factors Equal?

If giving up cigarettes causes you to gain 50 pounds, is the extra weight worse for you than smoking? Or did you simply trade one heart health risk factor for another?

It’s a good question. Many people have more than one risk factor, and the thought of addressing them all at the same time may be overwhelming. So does it matter which one you tackle first? Are all heart health risk factors equally important?

“Some cardiovascular risk factors are worse than others,” says preventive cardiologist Luke J. Laffin, MD. “Everyone is different, though, so each patient’s plan requires a personalized approach.”

What are the biggest risks?

The number one risk factor for heart disease is smoking. “Smoking is at or near the top of the list of risks, no matter how much weight you’ve gained,” says Dr. Laffin. “No one argues with the idea that smoking is bad for the heart. It also increases blood pressure and the risk of lung cancer.”

That being said, the number of people in the United States who smoke has dropped dramatically in recent years, meaning other risk factors have become more prominent.

Dr. Laffin says the main concerns are obesity and an inactive lifestyle. Excess body weight, particularly when it is found in the abdomen (“apple shape”), leads to high blood pressure, high “bad” LDL cholesterol, low “good” HDL cholesterol and lower insulin sensitivity, which can evolve into diabetes.

“Obesity is similar to smoking, in that there is nothing good about it,” he says. “Nor does a lot of good come from sitting around.”

The risk of developing coronary artery disease from not being as physically active as you should is comparable to the risk from high blood pressure, high cholesterol levels and smoking. People who don’t exercise have nearly twice the risk of heart attack as those who do.

Assessing your risks

It should be clear that if you smoke, are overweight or live an inactive lifestyle, changing those habits are essential for improving your overall health. Quitting smoking, losing excess weight and exercising will do your heart a world of good.

But this might not be enough to prevent a future heart attack. Other risk factors have to be considered, too, including:

• Diabetes.
• Abnormal blood lipid levels.
• High blood pressure.

The good news is that all of these risks can be improved or eliminated with lifestyle changes and/or medications.

Just how much they will affect you depends on risk factors that you have no control over. These include older age, gender, race and genetics. “These factors increase your risk of heart disease, no matter which modifiable risk factors you have,” Dr. Laffin explains.

There are also additional conditions that can raise a patient’s risk. That list includes:

• Inflammatory conditions, such as rheumatoid arthritis and psoriasis.
• Certain types of chemotherapy.
• Radiation to the chest.
• Depression.
• Human immunodeficiency virus (HIV).
• South Asian ancestry.
• Several conditions that are specific to women, including premature menopause and preeclampsia.

“We don’t account for these when conducting a basic risk assessment, but they will raise an individual’s risk to a certain degree and are so-called risk-enhancing features,” Dr. Laffin explains.

Lowering your risk

Even if you have one of those additional conditions, the priority is on tackling any modifiable risk factors you have so you can lower your chances of having a future heart attack or other cardiovascular issues.

“We call this ‘addressing the root cause of disease,’” says Dr. Laffin. It’s tempting to think that medications can do the job for you. If you need to lower your blood pressure, blood sugar or cholesterol levels, medications may be required. But you may need to make specific lifestyle changes, as well.

Keep in mind that lowering heart health risks shouldn’t be a short-term goal. “It’s about preventing a heart attack over the coming years and decades,” says Dr. Laffin. “Maintaining these healthy lifestyle changes — quit smoking, lose weight and get regular exercise — is the best way to reduce risk long term.”

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