Nine factors that affect your heart's health

By Steve Sternberg, USA TODAY Mon Jan 9, 7:23 AM ET

If you think heart disease is inevitable, Salim Yusuf has news for you.

Nine risk factors account for 90% of the heart disease in every population on earth, says Yusuf, a global heart specialist at McMaster University in Toronto.

Change your lifestyle and that percentage will shrink dramatically. So will the $400 billion annual cost of heart treatment and lost productivity; the 900,000 heart attacks and strokes; the 1.2 million angioplasties; the 500,000 bypass operations and a million hospitalizations for heart failure, according to the American Heart Association.

The risk factors aren't new. You've heard them before: smoking, high blood pressure, diabetes, obesity, stress, a desk-bound job and a diet that is rich in processed foods, low in fruit and fiber and missing a daily thimbleful of alcohol.

What's new is the powerful evidence of the toll they take. The evidence lies in Yusuf's Interheart study, a worldwide examination of heart-disease risk factors involving more than 26,000 volunteers in 52 countries. Slightly more than half of the volunteers had heart disease. Based on the study, Yusuf says, "we know virtually all of the risk factors in every population."

Clogged arteries are a "societal disease," Yusuf says, brought on by cities built for automobiles and ease, featuring urban sprawl, high-pressure sedentary work, passive entertainment and lots of cheap, tasty processed food. Surprisingly, family history - believed by many to be the biggest heart risk of all - accounts for just a fraction of the 10% of remaining risk, the study shows.

"I'm a fan of the study," says Richard Milani, director of preventive cardiology at the Ochsner Institute in New Orleans. "It reflects risk factors for all of us, and heart disease is a leading killer no matter where we live."

Interheart, Milani says, focuses on things we can do something about. "We're all dying from a disease that's primarily a disease of choice, of lifestyle," he says.

"We're not saying your Dad had a heart attack, you're doomed. All these things can be changed. If you can focus your attention on these nine things, there's not much else you have to worry about."

NINE FACTORS

Abdominal obesity

Abdominal obesity more than doubles heart attack risk in both men and women. "It's not a big butt that will get you in trouble, it's a big belly," Milani says. Abdominal fat is hormonally active, "begetting diabetes, high blood pressure and high cholesterol."

Alcohol

Another platelet blocker. Modest amounts of alcohol reduce a man's heart attack risk by 12% and a woman's by 60%. All forms of alcohol help in small amounts. Too much beer or hard liquor, more than a drink a day, can promote heart disease, cancer and alcoholism.

Bad cholesterol/good cholesterol

High cholesterol roughly quadruples heart attack risk. It works this way: Bad cholesterol (LDL) carries fats into the artery wall; good cholesterol (HDL) carts it away. A sedentary lifestyle and fatty diet increase LDL and lower HDL. Exercise and a healthy diet switch that ratio and keep arteries clear.

Diabetes

Diabetes is especially deadly for women, quadrupling their risk of having a heart attack. Men aren't much better off; diabetes doubles their risk. Like smoking, diabetes causes platelets to stick together, resulting in scores of tiny clots. These clots clog the microscopic blood vessels that feed nerves and arteries, which is a key reason diabetes destroys circulation. Diabetes also raises the level of harmful fats in the blood.

Eating fruits and vegetables

Eating fruits and vegetables daily cuts heart risk by 30% to 40%. They lower bad cholesterol, improve blood sugar and replace foods that might not be as healthy.

Exercise

Moderate exercise reduces a man's heart risk by 23% and a woman's by twice that amount. "We're not talking about marathons," Milani says. "Even just a nice walk in the park." Exercise improves cholesterol, staves off diabetes by improving blood sugar and promotes blood vessel growth.

High blood pressure

High blood pressure nearly triples a man's risk of having a heart attack and more than doubles a woman's. Narrowed blood vessels force the heart to work harder, slowly wearing it out. The blood's friction against artery walls also can promote the rupture of plaques, which can lead to heart attacks.

Psychosocial stress

Stressful life events, behavioral disorders and depression nearly triple heart attack risk. Depressed people with heart disease are four times more likely to have a heart attack or die, and depression is prevalent among 20% of people with heart disease in the USA.

Smoking