Risk factors for heart disease: Frequently asked questions

What are the warning signs of heart disease?

Heart disease can manifest as chest pain, tightness, or discomfort. Sometimes even shortness of breath can be a symptom of a heart attack. Any unusual restriction in your activity could be a warning sign of heart disease. Dizziness or a fast or irregular heartbeat are other possible symptoms.

Is heart disease an irreversible condition?

Heart disease is potentially reversible by attending to risk factors like cholesterol, blood pressure, and smoking. Several studies have shown, for example, that aggressive lowering of blood cholesterol with LDL levels below 100 can open up blocked coronary arteries at least partially. LDL cholesterol is the “bad” cholesterol component.

Is heart disease hereditary?

There is an increase in the risk of heart attack if a first-degree relative (parent or sibling) has had a heart attack or stroke. That is mainly seen when the relative has had a heart attack before the age of 45 if they are male, 55 if they are female. Obviously, you cannot change your family history, but a positive history should suggest the need to improve all the other risk factors like stopping smoking and decreasing cholesterol.

If you have a family history of heart disease, it is wise to have your blood cholesterol checked after the age of 18 and regularly thereafter. The patient should also have their blood pressure checked annually as well as tests for diabetes. Perhaps more importantly, one should maintain a healthy lifestyle at any age. That includes no cigarettes, a heart-healthy diet, and regular exercise.

Does smoking increase your risk of heart disease?

Smoking is a major risk for several diseases including heart disease, stroke, and several cancers. Even low-tar cigarettes and light smoking can increase the risk of heart disease substantially. There are now several alternative approaches to helping people stop smoking. These include nicotine-replacement patches and gum as well as oral medication.

If you are able to stop smoking, your risk of a heart attack or stroke decreases within a few weeks. The risk goes down to that of a nonsmoker within about two years. In addition, a lot of patients comment that they feel healthier and have more energy after they’ve stopped smoking.

Is hypothyroidism a risk factor?

Hypothyroidism can increase blood cholesterol levels and that contributes to heart disease; however, if the hypothyroidism is being treated with a thyroid hormone, then the cholesterol returns to normal.

Are birth control pills a contributor to heart disease?

Birth control pills can cause a small increase in the risk of thrombosis and heart attack. That occurs mainly in people who have been on the pill for more than 10 years and who smoke cigarettes.

Does being overweight increase the risk of heart disease?

Being overweight can increase the risk of heart disease in several ways. There can be a ten-fold increase in risks of high blood pressure and diabetes. In addition, being overweight will decrease the HDL or “good” cholesterol, which is now recognized as a major risk factor. If you are overweight, it is important to diet and exercise in order to lose weight and reduce these risk factors.

Consider a diet that is balanced among all the main food groups, with fat content making up no more than 30 percent of calories and most of that fat being unsaturated. Avoid a diet that restricts carbohydrates or fruits and vegetables, because this may adversely affect vitamin intake and blood cholesterol.

Red meat contains a lot of saturated fat. If you eat red meat every day, it is likely that your cholesterol is about 10-20 percent higher than it should be. Alternatives to red meat include chicken, fish, and turkey, as well as nonmeat protein sources like nuts and beans.

It usually takes two to four weeks for a change in diet to start to influence cholesterol levels. However, the full effect of a change in diet may not be seen for up to three months.

Is salt bad for your heart?

Salt in the diet can cause an increase in blood pressure in some patients. For that reason doctors usually recommend that salt intake be restricted to moderate levels. It is particularly important to watch salt intake if a patient has high blood pressure that is not controlled with usual therapy. Many foods, such as potato chips, peanuts, and ready-made meals, have very high salt content.

How important is diabetes as a risk factor?

The importance of diabetes is often underestimated. Studies have shown that if a patient has diabetes, their risk of a heart attack is increased five-fold above a patient who does not have diabetes. In addition, treating blood pressure and cholesterol in diabetic patients can dramatically reduce the risk of heart disease. For that reason it is very important that patients with diabetes have their blood pressure and cholesterol values checked frequently and are treated appropriately.

Can stress cause heart disease?

Stress can increase the risk of heart disease, although we still do not know how this happens. A sudden physical or emotional stress can certainly lead to an episode of angina or even a heart attack.

How is heart disease related to strokes?

Heart disease is commonly caused by atherosclerosis (hardening and blockage of the arteries), and this process can also cause strokes. Most strokes are due to a blood clot that forms either in the brain or travels from a narrowed artery in the neck. We know that treating risk factors for atherosclerosis can reduce both heart attacks and stroke. For example, cholesterol lowering can reduce the risk of a stroke by about 25 percent.

What happens if heart disease is left untreated? 

If heart disease is not treated, it can cause severe angina, heart failure with shortness of breath on even mild activities. The risk of death is increased. Most physicians are now very familiar with treating heart disease, so it does not often go untreated.

Will taking an aspirin a day reduce the risk of heart disease?

Aspirin may be helpful for patients who have already had a heart attack, stroke, atherosclerosis in other blood vessels, or who have diabetes or well-controlled hypertension. Aspirin has been shown to reduce the risk of heart attack and stroke by about 25 percent when taken in a dose of 325 mg or less a day. However, even low doses of aspirin can cause a slight increase in the risk of bleeding into the brain. For that reason, it is usually not recommended for low-risk patients who have not yet had a heart attack or stroke.

Is it true that a glass of red wine is good for your heart?

There is information that having one or two drinks per day can reduce the risk of heart attack. This may be because wine drinking or alcohol in general increases the level of good cholesterol, or HDL. However, this applies only to moderate intake of alcohol. The benefit is lost at higher levels of drinking. The benefit is not restricted to red wine; the data would suggest any kind of alcohol-containing drink might have some cardiac benefit.

Can exercise really make your heart stronger?

Exercise has huge benefits. It reduces blood pressure and increases HDL, or good cholesterol. It improves the number of blood vessels in the heart and in the rest of the body. So exercise makes it less likely that you will have a heart attack and if you do have a heart attack, it's likely that it will be less severe. In addition, exercise is a very important component of any weight-loss program.