How Can I Reduce My Risk for Heart Disease?

Heart disease is the biggest killer in the United States. 

There are many known risk factors for heart disease. Some of these you may be able to control, such as smoking or your diet. Others you may not be able to control, like your family history or age. 

Regardless of your age, there are steps you can start taking now to reduce your risk of heart disease. 

How common is heart disease?

It’s likely that you or someone close to you has heart disease. In fact, almost half of adult Americans have some type of heart disease. 

Heart disease often starts with a problem called atherosclerosis. This is when fatty collections called plaques stick to the walls of arteries. This narrows the arteries and can decrease oxygen flow to areas of the body. Pieces of the plaques can also break and form a clot, leading to a heart attack or stroke.

Heart disease can take many different forms:

• Coronary artery disease: This is when the arteries to the heart build up with plaque and become narrowed. This can make it hard for your heart muscle to get enough oxygen. 

• Heart attack: This is when blood flow to your heart is blocked. The heart muscle does not get enough oxygen, and it begins to die.

• Heart failure: This is when your heart does not pump blood very well, and your body can’t get the oxygen it needs. 

• Arrhythmia: This is when the heart has an irregular heartbeat. 

• High blood pressure: This is when there is increased pressure against the walls of your blood vessels.

• Valvular heart disease: This is when a heart valve is damaged or not working properly.

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What are the biggest risk factors for heart disease?

There are many risk factors for heart disease. Some you may be able to control, while others you cannot.

The biggest risk factors for heart disease that you may be able to control include:

• Smoking

• High blood pressure

• High cholesterol

• Overweight or obesity

• Diabetes 

• A diet high in saturated or trans fats

• Lack of exercise 

• Heavy alcohol use

There are also risk factors that you can’t control. These include:

• Family history of heart disease: This includes having a first-degree male relative (such as father or brother) with heart disease under the age of 55, or a first-degree female relative (such as a mother or sister) under age 65.

• Age: Heart disease risk increases with age.

• Ethnicity: Certain ethnicities have higher risk of heart disease, including African Americans, American Indians, Alaska natives, and white people.

Is heart disease genetic?

Yes. Heart disease has a strong genetic component. There are many genes that can increase risk of heart disease. It also means that heart disease can run in families. 

Sometimes, a change in one gene can cause a heart condition — like very high cholesterol, or an enlarged heart. More often, though, there are many genes that contribute to an increased heart disease risk. 

The best way to determine your genetic risk is to know your family history. If a parent or sibling has heart disease, your risk increases by 40% to 75%.

If you do have genetic risks, you can reduce your risk of heart disease by almost 50% by doing the following:

• Not smoking 

• Having a healthy weight

• Following a heart-healthy diet

• Doing regular exercise

Can heart disease be prevented at any age?

It’s never too early to start preventing heart disease. The sooner you develop healthy habits, the more benefit they will have. Plaque buildup can begin in your 40s, yet it may not cause symptoms for decades. 

Even if you already have been diagnosed with heart disease and you might think it’s too late — there is evidence that you can actually reverse heart disease with lifestyle changes.

How can you prepare today for heart health in your senior years?

There are steps you can take now to prevent heart disease later. Here are some specific actions you can take in your diet and lifestyle to reduce your risk of heart disease:

Increase your physical activity

This means getting the following amount of exercise: 

• 150 minutes per week (20 to 30 minutes per day) of moderate-intensity exercise like walking or gardening

OR 

• 75 minutes per week (10 to 20 minutes per day) of vigorous-intensity exercise like running or swimming laps

Improve your diet 

This means having a diet that is high in:

• Fruits

• Vegetables

• Fiber

• Whole grains

• Healthy fats (more below)

Find a healthy weight

Work on weight loss if you have overweight or obesity. 

Don’t smoke or take cannabis

Avoid smoking tobacco or using cannabis. 

Avoid excessive alcohol

More than one to two drinks per day may increase your risk for heart problems. 

Improve sleep

Try to get at least 7 hours of sleep per night. Sleeping less than 7 hours can increase your risk of heart disease. 

Control your risk factors

If you have high blood pressure, diabetes, or high cholesterol, it’s important to make sure these are well-controlled. 

Talk to your doctor

You should also plan to talk with your healthcare provider about your specific heart risk, and if a daily medication like aspirin or a statin might be recommended.

Review your supplements and vitamins

You may also want to review any supplements or vitamins you are taking to make sure they don’t increase your risk of heart disease. For example, some studies suggest that calcium supplements could cause plaque buildup.

Why is physical activity so important in preventing heart disease?

Physical activity is crucial for heart health. A recent study showed that exercising in midlife reduces heart problems in older age. 

Here’s how exercise helps your heart:

• Reduces blood pressure

• Helps with weight loss

• Reduces bad (LDL) cholesterol 

• Increases good (HDL) cholesterol

• Increases your body’s absorption of blood sugar (insulin sensitivity)

What are the best and worst foods for a heart-healthy diet?

The food you eat has a big impact on your heart health. 

Best foods

The best foods for heart health include:

• Nuts

• Legumes, like beans and lentils

• Whole grains, like brown rice, quinoa, and oats

• Fruits and vegetables

• Fatty fish, like salmon or trout

• Soy products, like edamame, tempeh, and tofu

• Healthy fats, like olive oil, canola oil, and flaxseed oil

Worst foods

The worst foods for heart health include:

• Red meat and processed meats

• Fried foods

• Trans fats, like margarine or shortening (often found in packaged foods)

• Sugary foods with high fructose corn syrup or other added sugars

What are the best ways to monitor your heart health?

There are many tests you can do to monitor your heart health. The best tests for you will depend on your age and risk factors. 

Blood tests (lab tests) for heart health may include the following:

• Cholesterol testing: Cholesterol tests measure the different types of fats (lipids) in your blood. There are several types of cholesterol, including HDL (good) and LDL (bad) cholesterol. High amounts of some types of cholesterol can cause heart problems. 

• High sensitivity C-reactive protein (hs-CRP) test: This test measures the amount of hs-CRP in your blood. A high level is a sign of inflammation. If the inflammation is in your heart, you could be more likely to have a heart attack. 

• Homocysteine test: This test measures the amount of homocysteine in your blood. Homocysteine can damage your blood vessels and cause blood clots. People with high levels of homocysteine are more likely to have heart problems. 

• Trimethylamine N-oxide (TMAO) testing: This test measures the TMAO in your blood. TMAO is determined by the bacteria in your gut. High levels are linked to an increased risk of heart disease.

Your healthcare provider will also monitor other tests that can impact heart health such as: 

• Hemoglobin A1c (blood sugar)

• Liver and kidney function

• Thyroid function

• Vitamin D levels 

In addition to blood tests, there are tests that look directly at your heart function. These tests can determine if you already have signs of heart disease. These include:

• Electrocardiogram (EKG): An EKG looks at the electrical activity of your heart, and it shows if you have an abnormal heart rhythm or heart damage. It can also detect whether you’ve had a heart attack in the past.

• Echocardiogram: An “echo” uses ultrasound (special sound waves) to look at the function of your heart muscles and valves.

• Stress test: A stress test uses exercise or medication to make your heart pump harder. This can evaluate how well your heart and blood vessels work under pressure. 

• Coronary CT Scan: A CT scan can show blockages in your coronary (heart muscle) arteries. It can also check for plaques in your heart. This information can give a coronary calcium score, which can help you understand your heart attack risk.

• Cardiac MRI: An MRI is used to look at heart structure, function, and scarring.

• Holter monitor: This is a wearable monitor that tracks your heart rhythm for an extended period of time — usually for at least 24 hours. It can pick up abnormal rhythms (arrhythmias). 

• Cardiac catheterization (or coronary angiogram): This is a more invasive test, where a catheter is inserted into your artery. Dye is injected to evaluate your heart blood vessels and heart function. 

There are also some ways you can monitor your heart health at home. These may include:

• Heart rate monitor: This can tell you your resting heart rate and your heart rate with exercise.

• Blood pressure monitor: This can help you keep an eye on your blood pressure more regularly.

• Heart health apps: There are many apps that can help you track your diet, weight, cholesterol, or medication.

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Written by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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