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Coronary Heart Disease Risk Factors

High Blood Cholesterol and Triglyceride Levels

Cholesterol

High blood cholesterol is a condition in which your blood has too much cholesterol—a waxy, fat-like substance. The higher your blood cholesterol level, the greater your risk of coronary heart disease (CHD) and heart attack.

Cholesterol travels through the bloodstream in small packages called lipoproteins (LI-po-pro-teens). Two major kinds of lipoproteins carry cholesterol throughout your body:

  • Low-density lipoproteins (LDL). LDL cholesterol sometimes is called "bad" cholesterol. This is because it carries cholesterol to tissues, including your heart arteries. A high LDL cholesterol level raises your risk of CHD.
  • High-density lipoproteins (HDL). HDL cholesterol sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk of CHD.

Many factors affect your cholesterol levels. For example, after menopause, women's LDL cholesterol levels tend to rise, and their HDL cholesterol levels tend to fall. Other factors—such as age, gender, diet, and physical activity—also affect your cholesterol levels.

Healthy levels of both LDL and HDL cholesterol will prevent plaque from building up in your arteries. Routine blood tests can show whether your blood cholesterol levels are healthy. Talk with your doctor about having your cholesterol tested and what the results mean.

Children also can have unhealthy cholesterol levels, especially if they're overweight or their parents have high blood cholesterol. Talk with your child's doctor about testing your child' cholesterol levels.

To learn more about high blood cholesterol and how to manage the condition, go to the Health Topics High Blood Cholesterol article.

Triglycerides

Triglycerides are a type of fat found in the blood. Some studies suggest that a high level of triglycerides in the blood may raise the risk of CHD, especially in women.

High Blood Pressure

"Blood pressure" is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.

Blood pressure is measured as systolic (sis-TOL-ik) and diastolic (di-a-STOL-ik) pressures. "Systolic" refers to blood pressure when the heart beats while pumping blood. "Diastolic" refers to blood pressure when the heart is at rest between beats.

You most often will see blood pressure numbers written with the systolic number above or before the diastolic number, such as 120/80 mmHg. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)

All levels above 120/80 mmHg raise your risk of CHD. This risk grows as blood pressure levels rise. Only one of the two blood pressure numbers has to be above normal to put you at greater risk of CHD and heart attack.

Often, high blood pressure has no signs or symptoms. However, the condition can be detected using a simple test that involves placing a blood pressure cuff around your arm.

Most adults should have their blood pressure checked at least once a year. If you have high blood pressure, you'll likely need to be checked more often. Talk with your doctor about how often you should have your blood pressure checked.

Children also can develop high blood pressure, especially if they're overweight. Your child's doctor should check your child's blood pressure at each routine checkup.

In children, blood pressure normally rises with age and body size. Newborns often have very low blood pressure numbers, while older teens have numbers similar to adults. The ranges for normal blood pressure and high blood pressure generally are lower for youth than for adults.

Your child should have routine blood pressure checks starting at 3 years of age. To find out whether a child has high blood pressure, a doctor will compare the child's blood pressure numbers to average numbers for his or her age, gender, and height.

Both children and adults are more likely to develop high blood pressure if they're overweight or have diabetes.

For more information about high blood pressure and how to manage the condition, go to the Health Topics High Blood Pressure article.

Diabetes and Prediabetes

Diabetes is a disease in which the body's blood sugar level is too high. The two types of diabetes are type 1 and type 2.

In type 1 diabetes, the body's blood sugar level is high because the body doesn't make enough insulin. Insulin is a hormone that helps move blood sugar into cells, where it's used for energy. In type 2 diabetes, the body's blood sugar level is high mainly because the body doesn't use its insulin properly.

Over time, a high blood sugar level can lead to increased plaque buildup in your arteries. Having diabetes doubles your risk of CHD.

Prediabetes is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. If you have prediabetes and don't take steps to manage it, you'll likely develop type 2 diabetes within 10 years. You're also at higher risk of CHD.

Being overweight or obese raises your risk of type 2 diabetes. With modest weight loss and moderate physical activity, people who have prediabetes may be able to delay or prevent type 2 diabetes. They also may be able to lower their risk of CHD and heart attack. Weight loss and physical activity also can help control diabetes.

Even children can develop type 2 diabetes. Most children who have type 2 diabetes are overweight.

Type 2 diabetes develops over time and sometimes has no symptoms. Go to your doctor or local clinic to have your blood sugar levels tested regularly to check for diabetes and prediabetes.

For more information about diabetes and heart disease, go to the Health Topics Diabetic Heart Disease article. For more information about diabetes and prediabetes, go to the National Institute of Diabetes and Digestive and Kidney Diseases' (NIDDK's) Introduction to Diabetes.

Overweight and Obesity

The terms "overweight" and "obesity" refer to body weight that's greater than what is considered healthy for a certain height. More than two-thirds of American adults are overweight, and almost one-third of these adults are obese.

The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.

You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your doctor can help you.

Overweight is defined differently for children and teens than it is for adults. Children are still growing, and boys and girls mature at different rates. Thus, BMIs for children and teens compare their heights and weights against growth charts that take age and gender into account. This is called BMI-for-age percentile.

For more information about BMI-for-age percentile, go to the Centers for Disease Control and Prevention's (CDC's) BMI-for-age calculator.

Being overweight or obese can raise your risk of CHD and heart attack. This is mainly because overweight and obesity are linked to other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, and diabetes.

For more information, go to the Health Topics Overweight and Obesity article.

Smoking

Smoking tobacco or long-term exposure to secondhand smoke raises your risk of CHD and heart attack.

Smoking triggers a buildup of plaque in your arteries. Smoking also increases the risk of blood clots forming in your arteries. Blood clots can block plaque-narrowed arteries and cause a heart attack.

Some research shows that smoking raises your risk of CHD in part by lowering HDL cholesterol levels.

The more you smoke, the greater your risk of heart attack. Studies show that if you quit smoking, you cut your risk of heart attack in half within a year. The benefits of quitting smoking occur no matter how long or how much you've smoked.

Most people who smoke start when they're teens. Parents can help prevent their children from smoking by not smoking themselves. Talk with your child about the health dangers of smoking and ways to overcome peer pressure to smoke.

For more information, including tips on how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's "Your Guide to a Healthy Heart."

For more information about children and smoking, go to the U.S. Department of Health and Human Services' (HHS') Kids and Smoking Web page and the CDC's Smoking and Tobacco Use Web page.

Lack of Physical Activity

Inactive people are nearly twice as likely to develop CHD as those who are active. A lack of physical activity can worsen other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.

It's important for children and adults to make physical activity part of their daily routines. One reason many Americans aren't active enough is because of hours spent in front of TVs and computers doing work, schoolwork, and leisure activities.

Some experts advise that children and teens should reduce screen time because it limits time for physical activity. They recommend that children aged 2 and older should spend no more than 2 hours a day watching TV or using a computer (except for school work).

Being physically active is one of the most important things you can do to keep your heart healthy. The good news is that even modest amounts of physical activity are good for your health. The more active you are, the more you will benefit.

For more information, go to HHS' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Unhealthy Diet

An unhealthy diet can raise your risk of CHD. For example, foods that are high in saturated and trans fats and cholesterol raise LDL cholesterol. Thus, you should try to limit these foods.

Saturated fats are found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. Trans fats are found in some fried and processed foods. Cholesterol is found in eggs, many meats, dairy products, commercial baked goods, and certain types of shellfish.

It's also important to limit foods that are high in sodium (salt) and added sugars. A high-salt diet can raise your risk of high blood pressure.

Added sugars will give you extra calories without nutrients like vitamins and minerals. This can cause you to gain weight, which raises your risk of CHD. Added sugars are found in many desserts, canned fruits packed in syrup, fruit drinks, and nondiet sodas.

You also should try to limit how much alcohol you drink. Too much alcohol will raise your blood pressure. It also will add calories, which can cause weight gain.

Stress

Stress and anxiety may play a role in causing CHD. Stress and anxiety also can trigger your arteries to tighten. This can raise your blood pressure and your risk of heart attack.

The most commonly reported trigger for a heart attack is an emotionally upsetting event, especially one involving anger. Stress also may indirectly raise your risk of CHD if it makes you more likely to smoke or overeat foods high in fat and sugar.

Age

As you get older, your risk of CHD and heart attack rises. This is in part due to the slow buildup of plaque inside your heart arteries, which can start during childhood.

In men, the risk of CHD increases faster after age 45. In women, the risk of CHD increases faster after age 55.

Most people have some plaque buildup in their heart arteries by the time they're in their seventies. However, only about 25 percent of those people have chest pain, heart attacks, or other signs of CHD.

Gender

Before age 55, women have a lower risk of CHD than men. This is because before menopause, estrogen provides women some protection against CHD. After age 55, however, the risk of CHD increases similarly in both women and men.

Some risk factors may affect CHD risk differently in women than in men. For example, diabetes raises the risk of CHD more in women.

Also, some risk factors for heart disease only affect women, such as preeclampsia (pre-e-KLAMP-se-ah). Preeclampsia is a condition that can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine.

Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases your risk of preeclampsia.)

Family History

Family history plays a role in CHD risk. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age.

However, having a family history of CHD doesn't mean that you will have it too. This is especially true if your affected family member smoked or had other CHD risk factors that were not well treated.

Making lifestyle changes and taking medicines to treat other risk factors often cen lessen genetic influences and stop or slow the progress of CHD. 

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Coronary Heart Disease Risk Factors Clinical Trials

Clinical trials are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. To find clinical trials that are currently underway for Coronary Heart Disease Risk Factors, visit www.clinicaltrials.gov.


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Know the Facts and Act Fast!

Collage image of new heart attack materials

When a heart attack happens, any delays in treatment can be deadly. 

Knowing the warning symptoms of a heart attack and how to take action can save your life or someone else’s.

The NHLBI has created a new series of informative, easy-to-read heart attack materials to help the public better understand the facts about heart attacks and how to act fast to save a life.

Click the links to download or order the NHLBI's new heart attack materials:

“Don’t Take a Chance With a Heart Attack: Know the Facts and Act Fast” (also available in Spanish)

“Heart Attack: Know the Symptoms. Take Action.”

“Learn What a Heart Attack Feels Like—It Could Save Your Life”

 
February 01, 2011 Last Updated Icon

The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.

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