Heart disease risk factors: what you can and cannot change

Why risk factors matter

The National Heart, Lung, and Blood Institute (NHLBI) says your risk of coronary heart disease goes up with the number of risk factors you have and how serious they are. Some, such as high blood pressure and unhealthy cholesterol levels, can be changed through heart-healthy lifestyle changes. Others, such as age, family history, and race and ethnicity, cannot (NHLBI CHD risk factors).

The NHLBI says almost half of adults in the United States have at least one of three key risk factors: high blood pressure, high cholesterol or smoking (NHLBI CHD risk factors). MedlinePlus, from the National Library of Medicine, calls heart disease the leading cause of death in the United States and says the first step to preventing it is understanding your risk (MedlinePlus).

Risk factors and the tool that checks each one

This table lists the main risk factors named by the NHLBI and MedlinePlus (NHLBI CHD risk factors) (MedlinePlus), with the calculator or check on this site that looks at each one.

To put several of these together into one number, the heart risk calculator uses age, sex, cholesterol, blood pressure, diabetes, smoking and kidney function. For how it differs from the older pooled cohort equations, see PREVENT vs ASCVD.

Risk factors you cannot change

• Age. Heart disease can happen at any age, but the risk goes up as you get older. The NHLBI says men's risk starts to increase significantly around age 45, and women's risk rises more quickly around age 55. Before menopause, women have a lower risk than men (NHLBI CHD risk factors). MedlinePlus puts the higher risk at men age 45 and older and women age 55 and older (MedlinePlus).
• Family history. A family history of early heart disease raises your risk, especially if your father or brother was diagnosed before age 55, or your mother or sister before age 65 (NHLBI CHD risk factors) (MedlinePlus). Some genes are linked to a higher risk (NHLBI CHD risk factors).
• Sex. Coronary heart disease affects both men and women. The NHLBI notes that coronary microvascular disease is more common in women, and that some pregnancy-related conditions may raise women's risk (NHLBI CHD risk factors). MedlinePlus notes that diabetes raises the risk of heart disease more in women than in men (MedlinePlus).
• Race or ethnicity. The NHLBI reports that Black adults in the United States have a death rate from heart and blood vessel disease twice that of White adults, and American Indian and Alaska Native people a rate 1.5 times that of White people. It links this to higher rates of risk factors and social and economic disadvantage. People of South Asian ancestry have a higher risk and tend to develop coronary heart disease younger (NHLBI CHD risk factors).

Risk factors you can change

MedlinePlus says you can make changes gradually, one at a time, and that what matters most is making them (MedlinePlus).

• Blood pressure. High blood pressure is a major risk factor. MedlinePlus advises a blood pressure check at least once a year for most adults, and more often if you have high blood pressure (MedlinePlus). See blood pressure ranges.
• Cholesterol and triglycerides. High cholesterol can clog your arteries and raise the risk of coronary artery disease and heart attack. High triglycerides may also raise the risk, especially in women (MedlinePlus).
• Smoking. Smoking or long-term exposure to secondhand smoke can damage your blood vessels (NHLBI CHD risk factors). If you smoke, quitting lowers your risk of heart disease (MedlinePlus).
• Diabetes. MedlinePlus says having diabetes doubles your risk of diabetic heart disease, because over time high blood sugar can damage blood vessels and the nerves that control the heart and blood vessels. It advises getting tested and keeping diabetes under control (MedlinePlus).
• Weight. Overweight and obesity raise heart disease risk, mostly because they are linked to high cholesterol and triglycerides, high blood pressure and diabetes (MedlinePlus).
• Physical activity. Being inactive can worsen other risk factors, such as high cholesterol and triglycerides, high blood pressure, diabetes and prediabetes, and overweight (NHLBI CHD risk factors).
• Eating pattern. Eating a lot of saturated fat and refined carbohydrates, such as white bread, pasta and white rice, can lead to obesity, high cholesterol and plaque buildup in the heart's arteries (NHLBI CHD risk factors). MedlinePlus suggests limiting saturated fat, sodium and added sugars, and eating plenty of fruit, vegetables and whole grains (MedlinePlus).
• Alcohol. The NHLBI says more than two drinks a day for men or one a day for women can raise cholesterol and triglycerides, and names binge drinking (four or more drinks for a woman, five or more for a man, within about 2 hours) as a key risk factor (NHLBI CHD risk factors). MedlinePlus says it is best not to drink (MedlinePlus).
• Sleep. Not getting enough quality sleep may raise the risk of coronary heart disease (NHLBI CHD risk factors). MedlinePlus suggests 7 to 9 hours a night for adults and asks people who think they may have sleep apnea to talk to their provider about a sleep study (MedlinePlus).
• Stress and mental health. Stress, depression, anxiety and post-traumatic stress disorder can raise the risk of coronary heart disease (NHLBI CHD risk factors). Stress can raise blood pressure, and coping by overeating, heavy drinking or smoking is bad for the heart (MedlinePlus).

Other conditions and surroundings

The NHLBI also lists medical conditions that can raise the risk of coronary heart disease, including autoimmune and inflammatory diseases such as rheumatoid arthritis, lupus and psoriasis, chronic kidney disease, COVID-19, HIV, metabolic syndrome and sleep disorders. Air pollution, wildfire smoke, very hot or cold weather, and some work conditions (such as working more than 55 hours a week, long or night shifts, a lot of stress at work, or sitting for long periods) can add to risk as well (NHLBI CHD risk factors).

Common questions

Does having one risk factor mean I will get heart disease?

No. A risk factor raises your chance; it does not decide the outcome. The NHLBI says that whatever risk factors you have, you can take steps to protect your heart with a heart-healthy lifestyle and other treatments (NHLBI CHD risk factors).

Which risk factors are the most important?

The NHLBI names high blood pressure, high cholesterol and smoking as three key risk factors (NHLBI CHD risk factors). Your provider looks at all of yours together, which is what tools like the heart risk calculator do with the numbers they use.

What numbers should I know?

Your blood pressure, your cholesterol panel and whether you have diabetes are a good start. See what numbers do I need for where to find each one.