Your heart may be working fine now, but how long will it last? If you've never asked yourself that question, now is the time to start thinking about it. After all, coronary heart disease is the number-one killer of adults in the United States. Fortunately, you can defuse much of that danger by understanding the things that put you at risk.
Are you a target for heart disease? You can find out in three easy steps: Look at yourself, consider your lifestyle, and visit your doctor.
Is there a future heart patient in the mirror?
None of us can hide from two of the most important but unalterable risk factors for heart trouble: our age and our gender. Coronary heart disease rarely strikes men younger than 45 or women younger than 55. But after those ages, the risk goes up dramatically.
Now consider your family. If your father, brother, or grandfather had coronary heart disease or a heart attack before 55 years of age or your mother, sister, or grandmother had coronary heart disease or a heart attack before the age of 65, you're at higher risk, too. You may have inherited genes that encourage heart trouble, or you may have picked up some family habits that put you at risk.
And if you haven't tried it recently, step onto a scale. If you're over your ideal weight, your heart may be in danger. To find out your healthy weight range, use our ideal weight calculator. Recent studies have found that extra heft can roughly double your chances of developing coronary heart disease. For more information on weight and the heart, see Heart Disease and Weight.
A look at your lifestyle
A simple survey of your daily habits can say a lot about your risk for heart disease. First of all, do you smoke? A few cigarettes a day can double your odds of having a heart attack in the coming years. Smoke more than a pack each day, and you are up to 15 times as likely as a nonsmoker to have an attack in the near future.
Now take a look at your diet. Do you dine out a lot? Do you eat too much prepared or canned food? Do you frequent fast food joints? The American Heart Association (AHA) recommends getting no more than 35 percent of your calories from fat and less than 7 percent from saturated fat. People who go easy on fatty meats, fried food, fast-food snacks, and products made from whole or 2 percent milk usually have little trouble maintaining those levels. For extra protection, you should also eat five to seven servings of fruits and vegetables every day. If you have to start counting ketchup as a vegetable to get anywhere close to five servings, consider that a wake-up call to change your eating habits. For more information on diet and the heart, see Eating to Ward Off Heart Disease.
Next, have you incorporated a regular exercise program into your weekly routine? Regular exercise is a strong tonic for the heart. In fact, studies show that staying active can cut the risk of a heart attack roughly in half. The AHA recommends 30 minutes of brisk walking or other moderately vigorous exercise every day at least five times each week or 20 minutes of vigorous exercise at least three times a week (consult with a doctor first if you have heart disease). But any activity is better than nothing. You can give your heart a boost simply by working in the garden, doing chores around the house, or taking the stairs instead of the elevator. For more information on exercise and the heart, see Exercise Rx.
Get more answers from your doctor
With a few simple tests, your doctor can tell whether you're on the road to a heart attack or headed in the opposite direction. The American Heart Association's guidelines advise that everyone be evaluated by a doctor starting at age 20. Your doctor should check your blood pressure, body mass index, waist measurement, and pulse at least every two years, and monitor your cholesterol and glucose levels every five years. If you're 40 or over or have multiple risk factors, the AHA recommends that your doctor calculate what the chances are that you'll develop cardiovascular disease in the next 10 years. You can also calculate your own heart attack risk level online using the AHA's risk assessment tool.
The three most important guideposts are your blood pressure, your cholesterol, and your blood glucose (blood sugar). A blood pressure reading above 140/90 can damage your arteries and strain your heart. It's important to have your doctor check it because most people are not even aware of their blood pressure. Also, people with moderately elevated blood pressure rarely feel any specific symptoms at all. If your total cholesterol is over 200 milligrams per deciliter, your arteries are at higher risk of becoming clogged. Just like blood pressure, elevated cholesterol is completely silent. (In rare cases, the cholesterol, if very elevated, can be deposited in the skin and cause cholesterol lumps known as xanthomas or thickened Achilles tendons.) The third guidepost is your blood sugar level. The American Diabetes Association recently revised the glucose (sugar) level for diabetes mellitus to 126 mg/dL. That means that if, on two separate tests, you have a blood glucose level over 126 mg/dL, you fit the criteria for diabetes. At that glucose level, most people will not have any symptoms. A level of 110 to 125, however, portends a higher risk of diabetes and coronary heart disease.
If these numbers point to trouble, your doctor may run other tests to better understand your risks. He or she may check your blood for triglycerides, fats that combine with cholesterol to clog your arteries. If your triglycerides are over 200 mg/dL, heart disease may not be far away. Ideally, your triglyceride level should be below 150 mg/dL.
Some newer blood tests have been helpful in determining one's risk of coronary heart disease. Another simple blood test can measure your levels of homocysteine, an amino acid that builds up in the blood of people who don't get enough B vitamins. Large amounts of homocysteine (more than 12 micromoles per liter) can damage the arteries and encourage blood clots. For some people, rapid CT scans used to detect coronary calcium can be helpful in detecting the presence of heart disease.
A special test to look at inflammation in the body (known as high sensitivity C-reactive protein, or CRP) has also been shown to be an independent marker of heart disease risk. The Centers for Disease Control and Prevention, along with the American Heart Association, recommend that the test be given to people at moderate risk of heart disease, to help their doctors determine a proper course of treatment.
Responding to the risk
You've taken a hard look at yourself, done some detective work on your lifestyle, and visited your doctor. You may have come across a few red flags along the way. But that doesn't mean you're destined to have a heart attack. Every risk factor for heart disease -- except your age, gender, family history, or diabetes -- is under your control. If you adopt a healthy lifestyle and work closely with your doctor, chances are you'll be able to count on your faithful heart for many years to come.
American Academy of Family Physicians. Information from your family doctor. Homocysteine.
American Heart Association updates heart attack, stroke prevention guidelines. http://www.americanheart.org/presenter.jhtml?identifier=3003675
American Heart Association. What Are Healthy Levels of Cholesterol?
American Heart Association. Triglycerides.
American Heart Association. Know Your Fats. http://www.americanheart.org/presenter.jhtml?identifier=532
Haskell WL et al. Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association. Circulation;116:1081-1093. http://www.circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.107.185649v1