Modifiable Risk Factors
Modifiable risk factors are things that you can control, change, or modify by changing your lifestyle or taking medications to reduce your cardiovascular risk. These can be divided into biological factors and psychosocial factors:
Biological Factors
- Cigarette smoke – For the individual who smokes, their risk of a heart attack is more than double that of a non-smoker. Smokers who have a heart attack also are more likely to die and die suddenly (within an hour). Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. Being exposed to other people's smoke increases the risk of heart disease even for non-smokers. If you are a smoker and you stop smoking, you promptly decrease your risk for heart disease. For more information, visit the Health Canada website.
- High blood cholesterol – A person's cholesterol level is also affected by their age, gender, heredity and lifestyle. Lowering blood cholesterol levels through lifestyle and if required, medication will reduce your risk for heart attack. Increased levels of cholesterol in the blood, particularly low-density lipoprotein cholesterol (LDL-C) contributes to the development of atherosclerosis (“hardening of the arteries”). The process of atherosclerosis causes blockages to form in arteries. If these blockages occur in the arteries of the heart, a heart attack may result; if the blockages occur in the arteries supplying the brain, a stroke may result. Blockages may also form in the arteries of the legs that can result in lack of blood flow to the lower extremities.
- High blood pressure – High blood pressure makes your heart have to work harder, and over time, this may cause the heart to thicken and become stiff. High blood pressure increases your risk of stroke, heart attack, kidney failure and congestive heart failure. Even a “little bit” of high blood pressure can significantly increase your risk for cardiovascular disease. According to Canadian guidelines, optimal blood pressure 120/80 – 129/84 mmHg). For more information, visit the College of Family Physicians of Canada website.
- Physical inactivity – Lack of physical exercise or an inactive lifestyle is a risk factor for heart disease. Regular, moderate-to-vigorous physical activity helps prevent heart and blood vessel diseases. Even moderate-intensity activities help if done regularly and long term. Exercise can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure in some individuals. The benefits of exercise all add up to increase your daily activity level. The benefits of physical activity include lowering the risk for developing heart and blood vessel disease, help to lose weight or maintain weight loss and reduce body fat, lower blood pressure, lower and control blood cholesterol, keep bones, muscles and joints healthy, and help manage any feelings of sadness, anxiety or stress. For more information, visit our listing of resources and links.
- Obesity and overweight – According to Statistics Canada (1998), 47.9% of Canadians were overweight. Genes and heredity may increase an individual’s susceptibility to being overweight, however most people consume too many calories, or have low activity levels. People who have excess body weight are more likely to develop heart disease and stroke, even if they have no other risk factors. Excess weight increases the heart's work and also contributes to high blood pressure, increased triglycerides, and lowers HDL ("good") cholesterol levels. It can also make diabetes more likely to develop. Many obese and overweight people may have difficulty losing weight, but even reducing your weight by as few as 10 to 20 pounds, you can lower your heart disease risk.
How body weight is distributed is also important: Individuals who carry their extra body weight around their waist are at particular risk. According to Canadian Guidelines, waist circumference is a useful estimate of abdominal obesity and indicator of cardiovascular risk. For men, their risk increases with a waist circumference of 102 cm or greater, for women, their risk increases with a waist circumference of 88cm or greater. For more information, visit the National Institutes of Health website.
- Diabetes mellitus – Diabetes seriously increases your risk of developing cardiovascular disease – most individuals with diabetes die from some form of heart or blood vessel disease. In addition, diabetes is the leading cause of renal failure requiring dialysis. Individuals with diabetes can reduce their risk by having good control of their blood glucose levels. If you have diabetes, it's extremely important to work with your healthcare provider to manage it and control any other risk factors you can. For more information, visit the Canadian Diabetes Association website.
Psychosocial Factors
- Depression – Sadness is characterized by a momentary sense of loss, hurt, or feeling touched by a goodbye or ending. It can come with a surrender, or the giving up of a struggle and acceptance of the inevitable. Healthy sadness is free of blame, but typically passes in a short period of time, especially if there is an improvement in the situation that started it. Depression, on the other hand, is a low mood or lack of interest in life that occurs almost every day and goes on for weeks. Research has demonstrated that depression contributes to the development, progression, morbidity and mortality of coronary artery disease. More severe depression is related to greater likelihood of adverse cardiac events. For information about depression feel free to download the Antidepressant Skills Workbook, which is available on the Mental Health Evaluation and Consultation Unit web site.
- Anxiety – Anxiety is a response to a “threat” sensed in the mind, rather than an immediately present physical danger (Greenberg, 2002). Anxiety is adaptive when it helps us prepare for something we are anticipating, like an exam. However, anxiety can also be maladaptive, as in the case of fear of losing control or fear of abandonment in a relationship. Anxiety is a well-established risk factor for the development and progression of coronary artery disease. Similar to depression, a dose-dependent relationship exists between anxiety and cardiac death. Two recommended books on anxiety are: 1) Master of your Anxiety and Worry, by M.G. Craske, D.H. Barlow, and T.A. O’Leary, 2) The Anxiety and Phobia Workbook, by E.J. Bourne
- Stress – Stress, or what most people refer to as “distress”, reflects an experience of challenge or overload. Distress raises the level of adrenaline and corticosterone in the body, which in turn increases the heart rate, respiration, and blood pressure and puts more physical stress on bodily organs. Long-term stress can be a contributing factor in heart disease, high blood pressure, stroke, enlarged adrenal glands, and other illnesses. In fact, research has shown that individuals who have heart attacks report significantly more work, home and financial stress.
There are maladaptive and adaptive ways to cope with stress. Maladaptive ways include avoidance (e.g., by overeating, drinking alcohol, smoking etc) or over-control (e.g., aggression, obsessionality, manipulation). Adaptive ways include problem solving and managing emotions. There are many books available to help people develop healthy ways of coping, and most provide information about relaxation techniques, healthy lifestyle practices, time management, and assertiveness.
- Anger – Anger is an emotional state that varies in intensity from mild irritation to intense fury. It is accompanied by physiological and biological changes; when you get angry, your heart rate and blood pressure go up, as do the levels of your energy hormones, adrenaline, and noradrenaline. Anger, hostility, and cynical mistrust have been shown to be associated with an increased risk for cardiac events for both healthy subjects and patients with known coronary artery disease. The goal of anger management is to reduce both your emotional feelings and the physiological arousal that anger causes. Relaxation, changing the way you think, problem solving, and improving communication are techniques that may help. If you feel that your anger is out control, and is having an impact on your relationships and on important parts of your life, you might consider counseling to learn how to handle it better.
- Low Social Support - Low social support has been related to increase risk for cardiac death for patients with identified coronary artery disease. Likewise, a small social network to rely on has been related to an increase risk in the development of coronary artery disease over time.
Please visit the Heart and Stroke Foundation website for detailed information on Heart Disease and Stroke.