Coronary Heart Disease - Risk Factors - Risk Factors

Genetic or lifestyle factors cause plaque to build up in your arteries as you age. In men, the risk for coronary heart disease starts to increase around age 45. Before menopause, women have a lower risk of coronary heart disease than men. After around age 55, women’s risk goes up. This is likely because women make less estrogen (a female hormone) after menopause. Also, changes in the small blood vessels of the heart as you age raise the risk for coronary microvascular disease.

Air pollution in the environment can put you at higher risk of coronary heart disease. The increase in risk may be higher in older adults, women, and people who have diabetes or obesity. Air pollution may cause or worsen other conditions, such as atherosclerosis and high blood pressure, which are known to increase your risk for coronary heart disease.

Your work life can also raise your risk if you:

• Come into contact with toxins, radiation, or other hazards
• Have a lot of stress at work
• Sit for long periods
• Work more than 55 hours a week, or work long, irregular, or night shifts that affect your sleep

A family history of early heart disease is a risk factor for coronary heart disease. This is especially true if your father or brother was diagnosed before age 55, or if your mother or sister was diagnosed before age 65. Research shows that some genes are linked with a higher risk for coronary heart disease.

Over time, unhealthy lifestyle habits increase your risk of coronary heart disease because they can lead to plaque buildup in the heart’s blood vessels. Unhealthy lifestyle habits that are risk factors include the following:

• Being physically inactive, which can worsen other heart disease risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.
• Not getting enough good quality sleep, including waking up often throughout the night, which may raise your risk of coronary heart disease. While you sleep, your blood pressure and heart rate fall. Your heart does not work as hard as it does when you are awake. As you begin to wake up, your blood pressure and heart rate increase to the usual levels when you are awake and relaxed. Waking up suddenly can cause a sharp increase in blood pressure and heart rate, which has been linked to angina and heart attacks. Learn more in our How Sleep Works topic.
• Smoking tobacco or long-term exposure to secondhand smoke, which can damage the blood vessels.
• Stress, which can trigger the tightening of your arteries, which increases your risk of coronary heart disease, especially coronary microvascular disease. Stress may also indirectly raise your risk of coronary heart disease if it makes you more likely to smoke or overeat foods high in fat and added sugars.
• Unhealthy eating patterns, such as consuming high amounts of saturated fats or trans fats and refined carbohydrates (white bread, pasta, and white rice). This can lead to overweight and obesity, high blood cholesterol, atherosclerosis, and plaque buildup in the heart’s arteries.

Learn about steps you can take to improve your heart health in our Heart-Healthy Living topic.

Other medical conditions that can raise your risk of developing coronary heart disease include:

• Atherosclerosis
• autoimmune and inflammatory diseases such as Crohns disease, ulcerative colitis, psoriasis, lichen planus, pemphigus, histiocytosis, lupus erythematosus, and rheumatoid arthritis
• Chronic kidney disease
• Congenital coronary artery defects
• Diabetes
• High blood LDL cholesterol (sometimes called “bad cholesterol”)
• High blood pressure
• High blood triglycerides
• HIV/AIDS, especially among older adults. Part of the risk might be due to side effects of HIV treatments.
• Mental health conditions, including anxiety, depression, and posttraumatic stress disorder (PTSD)
• Metabolic syndrome
• Overweight and obesity
• Sleep disorders, such as sleep apnea or sleep deprivation and deficiency

Coronary heart disease is the leading cause of death for people of most racial and ethnic groups in the United States, including African Americans, Hispanics, and whites.

For Asian Americans or Pacific Islanders and American Indians or Alaska Natives, heart disease is second only to cancer. People of South Asian ancestry are at higher risk of developing coronary heart disease and serious complications than other Asian Americans.

Coronary heart disease affects men and women. Obstructive coronary artery disease is more common in men. However, nonobstructive coronary artery disease is more common in women. Since the nonobstructive type is harder to diagnose, women may not be diagnosed and treated as quickly as men.

If you are a woman having chest discomfort or shortness of breath during physical activity, ask your doctor about tests to check for nonobstructive coronary artery disease or coronary microvascular disease.

Women may have a higher than normal risk for developing coronary heart disease if they have one of the following conditions.

• Endometriosis, which raises the risk for heart disease in younger women
• Gestational diabetes, which can raise the risk for diabetes and metabolic syndrome even after pregnancy and the risk of developing coronary heart disease
• Polycystic ovary syndrome
• Preeclampsia, a condition that can happen during pregnancy and is linked to an increased lifetime risk for coronary heart disease
• Early menopause (before age 40)