As a physician assistant in cardiology, I have talked to many patients about their heart disease risk. Many patients worry about family history of heart problems or wonder how lifestyle factors might affect their heart health. These are important conversations to have. While some risk factors can’t be changed, understanding and managing personal risks can make a big difference in heart health outcomes.

Understanding heart disease risk

Emerging risk factors for heart disease are continuously being researched. While traditional factors like high blood pressure, smoking, and high cholesterol still play a central role, new evidence has highlighted additional factors that could contribute to heart disease risk. These risk factors include chronic inflammation, mental health issues like anxiety and depression, excessive alcohol use, air pollution, and things like E-cigarettes and vaping.

Heart disease remains the leading cause of death nationwide. Identifying risk factors early allows for better prevention and management. Risk factors fall into two categories—those we can’t control (non-modifiable) and those we can influence through lifestyle changes (modifiable).

Many of the more common risk factors for heart disease can interact, amplifying the effect on cardiovascular health. High blood pressure accelerates the damage caused by high cholesterol. Conversely, high cholesterol can worsen high blood pressure by contributing to plaque buildup, which limits blood flow and increases resistance in the arteries. 

Smoking damages the blood vessels and increases inflammation in the body. It also contributes to high blood pressure and high cholesterol. The chemicals in cigarette smoke reduce the amount of oxygen in the blood, leading to lower oxygen levels in the heart, which can contribute to ischemia (reduced blood flow to the heart).

Other chronic conditions, such as diabetes and high blood pressure, can speed up the development of cardiovascular diseases. The combination leads to endothelial dysfunction (problems with the inner lining of blood vessels), which is a significant contributor to heart disease.

Non-modifiable risk factors

By understanding non-modifiable risk factors, we can focus on those we can control.

Family history: Having immediate family members with heart disease increases risk. Having close relatives with heart disease doesn’t guarantee you’ll develop it—it just means we need to be more proactive about prevention. Documenting family heart disease history helps healthcare teams develop appropriate prevention strategies.

Age and gender: Risk increases with age, and men generally develop heart disease earlier than women. However, after menopause, women’s risk increases significantly.

Genetic factors: Some inherited conditions can affect heart health. This includes how the body processes cholesterol and regulates blood pressure.

When evaluating patients for cardiac risk assessment, we regularly use several tests and screening tools. Routine blood pressure measurements are likely one of the most common. Checking routine labs such as cholesterol and lipids, blood glucose, and A1C are recommended for most patients.

If you have known risk factors, family history, or symptoms concerning heart disease, we may order more cardiac-specific tests like EKGs, stress testing, or echocardiograms. Screening tests are essential to help identify patients at higher risk and allow for early intervention and prevention.

Modifiable risk factors

Many heart disease risk factors can be altered with lifestyle changes.

Blood pressure: High blood pressure often shows no symptoms but significantly increases the risk of heart disease. Regular monitoring and management through medication, diet, and lifestyle changes can help maintain healthy levels.

Cholesterol: High cholesterol contributes to artery blockages. Regular screening and management through diet, exercise, and sometimes medication help reduce this risk.

Weight management: Excess weight strains the heart and often accompanies other risk factors like high blood pressure and diabetes. Even modest weight loss can improve heart health.

Additional modifiable risk factors include:

• Smoking status
• Physical activity level
• Diet choices
• Stress management
• Sleep habits

Taking control of your heart health

Patients with multiple cardiac risk factors need to adopt a comprehensive and proactive approach to their heart health. Working closely with providers and scheduling routine follow-ups will ensure you are regularly monitored on the recommended medications and educated on proper lifestyle modifications.

Following a heart-healthy diet and maintaining an appropriate exercise plan will also help reduce your modifiable risk factors. The key is to have a broad approach and include medical management with lifestyle changes to improve your overall cardiovascular health.

Prevention strategies

Knowing what to focus on can feel overwhelming. Your provider can help you set goals and order the appropriate diagnostic tests to monitor your health. The following tools and strategies will help you reduce your heart disease risk:

• Regular health screenings
• Blood pressure monitoring
• Cholesterol checks
• Diabetes screening
• Weight management
• Physical activity
• Heart-healthy diet
• Stress reduction techniques

Lifestyle modifications

Regular physical activity strengthens your heart muscle, improves circulation, and helps manage risk factors like high blood pressure and cholesterol. The recommendation is 150 minutes of moderate-intensity activity weekly. Walking provides a great starting point for increasing physical activity.

Diet guidelines

Choosing heart-healthy foods is important in reducing your heart disease risk.

• Choose plenty of fruits and vegetables
• Choose whole grains
• Opt for lean proteins over red meat
• Limit processed foods
• Reduce sodium intake
• Consume alcohol in moderation

Monitoring your health

Regular check-ups can help you stay on top of your heart health. Your provider will be able to track your risk through:

• Physical examinations
• Blood pressure monitoring
• Cholesterol screening
• Blood sugar testing
• Heart rhythm assessment
• Weight tracking

Cardiac risk factor management has evolved significantly in recent years, reflecting advancements in medical research, technology, and our understanding of heart disease prevention. Strategies have become more personalized, preventive, and data-driven as we gain more insights into the complex relationships between various risk factors and heart disease.

Early screening tools, advances in medication development, and more precise imaging techniques have allowed us to provide more effective treatments. New tools such as smartwatches and fitness trackers can empower patients to be more involved in their heart health.

Schedule an appointment with our board-certified cardiologists and heart care specialists, who are experts in diagnosing, treating, and managing a full spectrum of heart conditions. We provide comprehensive risk assessment and personalized care to monitor your heart health.