The presence of a risk factor increases your likelihood of developing heart disease. Some risk factors, such as age and gender, cannot be changed while others may be modified.

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The National Heart Centre Singapore (NHCS), a member of the SingHealth group, explains the risk factors for coronary heart disease (also known as ischaemic heart disease) that are within your control and those that aren't. 

Plus, what you can do to keep your heart healthy well into your senior years.

8 modifiable risk factors for coronary heart disease (risk factors within your control)

1. Keep your blood cholesterol in check

As high blood cholesterol itself does not cause symptoms, many people may not be aware that their cholesterol level is high.

Therefore, it is important to check your cholesterol level regularly. If the level is high, it should be lowered to reduce your susceptibility to coronary heart disease. The desirable level of cholesterol depends on your pre-existing risk for coronary heart disease.

2. Manage your blood pressure

"High blood pressure (hypertension) is one of the major risk factors for coronary heart disease and cerebrovascular disease, such as stroke," say doctors from National Heart Centre Singapore (NHCS), a member of the SingHealth group. ​

Hypertension usually occurs without any symptoms. ​​Hypertension, left untreated over the long term, can lead to damage of the heart and blood vessels leading to stroke or heart attack.

When your blood pressure is e​xtremely high, headaches, dizziness or alterations in vision may be experienced. Marginally elevated blood pressure may normalise when you lose weight, exercise more and reduce salt intake. 

If these measures are not successful, then drug treatment may be needed. Once medication has started, it is essential to continue with the treatment, complemented by a healthy lifestyle.

Treatment of hypertension for most people is lifelong. You should have your blood pressure checked at least once a year.

It is recommended that adults over 40 years should have their blood pressure checked annually, and their blood cholesterol checked once every three years; more frequently if results are abnormal or if there are other risk factors.

3. (Avoid diabetes) Keep your blood sugar levels under control

Type 2 diabetes (diabetes mellitus) is a chronic illness. It is often associated with other cardiovascular risk factors, such as high blood pressure, increased total cholesterol and triglyceride levels, decreased HDL-cholesterol levels (“good” cholesterol) and obesity.

The basic treatment strategy is to maintain good control over the amount of glucose in your blood. Maintaining a healthy weight, a balanced diet and a regular exercise routine can prevent the onset of diabetes mellitus.

People with diabetes are 2 to 4 times more likely to develop coronary artery disease and stroke.

4. Menopause raises coronary heart disease risk

Many women before menopause seem to be partly protected from coronary heart disease, heart attack and stroke by natural oestrogen.

A woman’s oestrogen level is highest during her childbearing years and declines during menopause. If menopause is caused by surgery to remove the uterus and ovaries, the risk rises sharply.

As a woman ages, the loss of natural oestrogen may contribute to a higher risk of heart disease and stroke.

If menopause occurs naturally, the risk rises gradually. However, routine hormone replacement for women who have undergone natural menopause does not prevent heart disease.

5. Maintain a healthy weight

People with excess body fat – especially around the waist – are more prone to developing heart disease and stroke even if they have no other risk factors. 

Excess weight increases the strain on the heart, raises blood pressure, blood cholesterol and triglyceride levels, and lowers HDL. It is also associated with the development of diabetes mellitus.

Family history and environment play a part in determining obesity. Physical inactivity and a high fat diet also contribute to obesity.

As body fat increases when more food calories than required are consumed over a long period of time, weight control (fat loss) is possible by decreasing food intake together with increasing physical activity.

If you burn more calories because of increased physical activity, a gradual decrease in body weight will take place. Diet alone can also cause weight loss, which leads to a decrease in blood pressure, blood glucose and blood cholesterol levels.

6. Be physically active

An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate physical activity helps prevent heart and blood vessel disease if done over a period of time.

Regular exercise may also lead to an improvement in other cardiovascular risk factors, such as weight loss, lower blood pressure, decreased stress and improved cholesterol levels.

Exercise is beneficial especially since the risks involved are minimal. Exercise programmes should start at a slow pace initially to avoid injury to muscles and ligaments.

People with known coronary artery disease or those above 40 years of age who have been inactive should seek medical advice before starting a regular exercise programme.

7. Quit smoking (if you haven't)

Smokers account for 40 per cent of deaths caused by heart disease in patients younger than 65 years.

Smoking also leads to heart attack, stroke, high blood pressure, blood vessel disease, cancer and lung disease. Smoking causes a decrease in HDL-cholesterol.

Smokers have 2 to 3 times the risk of non-smokers for sudden cardiac death.

8. Manage your stress well

Your blood pressure goes up momentarily when you get angry, excited, frightened or when you are under stress.

If you experience constant stress over a prolonged period, you may be at a higher risk of developing high blood pressure, leading to a heart attack.

3 non-modifiable risk factors for heart disease (risk factors beyond your control)

1. Age increase

Age increases a person’s susceptibility to heart disease. "For women, the effects of menopause, including the loss of the hormone oestrogen, appear to increase the risk of coronary heart disease and stroke," say doctors from National Heart Centre Singapore​ (NHCS), a member of the SingHealth group.

2. Your gender

'Men are 3 to 5 times more likely to have coronary heart disease than women. However, the risk for women increases after menopause. By about 5 to 10 years following menopause, the risk of coronary heart disease for women increases to the same rate as men.

3. Your ethnicity

Risk for coronary heart disease varies with different ethnic groups. The likelihood of coronary heart disease is high​est amongst South Asians in Singapore. Compared with the Chinese, South Asians are three times, and Malays are two times more likely to suffer from coronary heart disease.

4. Your family history

You can be at a higher risk of having heart disease if your immediate family members (parents, children, brothers and sisters) have a history of premature heart disease. Certain risk factors tend to run in some families. If there is a history of heart disease in the family, you should try very hard to control your other risk factors too.

Ref: I23 (ed)

Check out other articles on heart disease:

Heart Disease: Early Warning Signs Not To Be Ignored

Chronic Conditions that Raise Risk of Heart Disease

How to Reduce Your Risk of Heart Disease